Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis

Shona Fielding (Corresponding Author), Paul Alexander Tiffin, Rachel Greatrix, Amanda J Lee, Fiona Patterson, Sandra Nicholson, Jennifer Cleland

Research output: Contribution to journalArticle

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Abstract

Introduction

Medical admissions must balance two potentially-competing missions: to select those who will be successful medical students and clinicians, and increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.

Aim

To examine if changes in medical school selection processes significantly impact on the composition of the student population.

Methods

Design and setting: Observational study of medical students from 18 UK 5-year medical programmes who took the United Kingdom Clinical Aptitude Test (UKCAT) from 2007-2014; detailed analysis on four schools

Primary outcome: Proportion of admissions to medical school for four target groups ( lower socio-economic classes, non-selective schooling, non-white, male).

Data analysis: Interrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were utilised looking at admissions within for the four target groups.

Results

There were no obvious changes in the overall proportion of admissions from each target group over the eight-year period, averaging at 3.3% lower socio-economic group51.5% non-selective school, 30.5% non-white and 43.8% male. Each case study school changed their selection practice in decision making for invite to interview during 2007-2014. Yet this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.

Conclusion

Although our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.
Original languageEnglish
Article number023274
JournalBMJ Open
Volume8
Issue number10
Early online date8 Oct 2018
DOIs
Publication statusPublished - 2018

Fingerprint

Medical Schools
Medical Students
Aptitude Tests
Economics
Interviews
Students
Population
Observational Studies
Interrupted Time Series Analysis
Decision Making
Demography

Keywords

  • medical education and training
  • Admission/selection/minority recruitment
  • continuing medical education

Cite this

Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis. / Fielding, Shona (Corresponding Author); Tiffin, Paul Alexander; Greatrix, Rachel; Lee, Amanda J; Patterson, Fiona; Nicholson, Sandra; Cleland, Jennifer.

In: BMJ Open, Vol. 8, No. 10, 023274, 2018.

Research output: Contribution to journalArticle

Fielding, Shona ; Tiffin, Paul Alexander ; Greatrix, Rachel ; Lee, Amanda J ; Patterson, Fiona ; Nicholson, Sandra ; Cleland, Jennifer. / Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis. In: BMJ Open. 2018 ; Vol. 8, No. 10.
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title = "Do changing medical admissions practices in the UK impact on who is admitted?: An interrupted time series analysis",
abstract = "IntroductionMedical admissions must balance two potentially-competing missions: to select those who will be successful medical students and clinicians, and increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.AimTo examine if changes in medical school selection processes significantly impact on the composition of the student population.MethodsDesign and setting: Observational study of medical students from 18 UK 5-year medical programmes who took the United Kingdom Clinical Aptitude Test (UKCAT) from 2007-2014; detailed analysis on four schoolsPrimary outcome: Proportion of admissions to medical school for four target groups ( lower socio-economic classes, non-selective schooling, non-white, male).Data analysis: Interrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were utilised looking at admissions within for the four target groups.ResultsThere were no obvious changes in the overall proportion of admissions from each target group over the eight-year period, averaging at 3.3{\%} lower socio-economic group51.5{\%} non-selective school, 30.5{\%} non-white and 43.8{\%} male. Each case study school changed their selection practice in decision making for invite to interview during 2007-2014. Yet this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.ConclusionAlthough our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.",
keywords = "medical education and training, Admission/selection/minority recruitment, continuing medical education",
author = "Shona Fielding and Tiffin, {Paul Alexander} and Rachel Greatrix and Lee, {Amanda J} and Fiona Patterson and Sandra Nicholson and Jennifer Cleland",
note = "Our thanks to the Medical Schools Council for funding and to the UKCAT Consortium for access to data. Neither organisation was involved in determining the study design or results reporting. FUNDING STATEMENT This work was supported by Medical Schools Council (MSC) of the UK under the Selecting for Excellence programme.",
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T1 - Do changing medical admissions practices in the UK impact on who is admitted?

T2 - An interrupted time series analysis

AU - Fielding, Shona

AU - Tiffin, Paul Alexander

AU - Greatrix, Rachel

AU - Lee, Amanda J

AU - Patterson, Fiona

AU - Nicholson, Sandra

AU - Cleland, Jennifer

N1 - Our thanks to the Medical Schools Council for funding and to the UKCAT Consortium for access to data. Neither organisation was involved in determining the study design or results reporting. FUNDING STATEMENT This work was supported by Medical Schools Council (MSC) of the UK under the Selecting for Excellence programme.

PY - 2018

Y1 - 2018

N2 - IntroductionMedical admissions must balance two potentially-competing missions: to select those who will be successful medical students and clinicians, and increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.AimTo examine if changes in medical school selection processes significantly impact on the composition of the student population.MethodsDesign and setting: Observational study of medical students from 18 UK 5-year medical programmes who took the United Kingdom Clinical Aptitude Test (UKCAT) from 2007-2014; detailed analysis on four schoolsPrimary outcome: Proportion of admissions to medical school for four target groups ( lower socio-economic classes, non-selective schooling, non-white, male).Data analysis: Interrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were utilised looking at admissions within for the four target groups.ResultsThere were no obvious changes in the overall proportion of admissions from each target group over the eight-year period, averaging at 3.3% lower socio-economic group51.5% non-selective school, 30.5% non-white and 43.8% male. Each case study school changed their selection practice in decision making for invite to interview during 2007-2014. Yet this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.ConclusionAlthough our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.

AB - IntroductionMedical admissions must balance two potentially-competing missions: to select those who will be successful medical students and clinicians, and increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.AimTo examine if changes in medical school selection processes significantly impact on the composition of the student population.MethodsDesign and setting: Observational study of medical students from 18 UK 5-year medical programmes who took the United Kingdom Clinical Aptitude Test (UKCAT) from 2007-2014; detailed analysis on four schoolsPrimary outcome: Proportion of admissions to medical school for four target groups ( lower socio-economic classes, non-selective schooling, non-white, male).Data analysis: Interrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were utilised looking at admissions within for the four target groups.ResultsThere were no obvious changes in the overall proportion of admissions from each target group over the eight-year period, averaging at 3.3% lower socio-economic group51.5% non-selective school, 30.5% non-white and 43.8% male. Each case study school changed their selection practice in decision making for invite to interview during 2007-2014. Yet this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.ConclusionAlthough our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.

KW - medical education and training

KW - Admission/selection/minority recruitment

KW - continuing medical education

U2 - 10.1136/bmjopen-2018-023274

DO - 10.1136/bmjopen-2018-023274

M3 - Article

C2 - 30297349

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 10

M1 - 023274

ER -