That medical schools are not identical, and that they vary in many ways, is not news. Over the years both the GMC and NHS England have expressed interest in this variability. Furthermore, there is quite large (20 percentage points) variation in how prepared medical students feel for clinical work when they leave medical school. Some medical schools rely heavily on problem-based learning, while others do not. Some medical schools are heavily primary care orientated, while others are much less so. Of course there are differences in the curriculum and in admission criteria between schools. How do all these factors influence the product?

To find out, McManus, along with more than 100 co-authors, collected data from all 29 medical schools that run five-year courses.[1] Thus Warwick and South Wales were excluded. They collected explanatory data of the above sort and looked at examination performance and complaints.

Of course, they found very large numbers of positive correlations, even after adjusting for the number of statistical tests performed. They tried to carry out causal pathway analysis using structured equations. However, there was so much interaction between variables that it remained difficult to say exactly what was causing what.

Nevertheless, there were some interesting findings. One such feature is that differences between medical schools are stable overtime. Devoting high proportions of medical school teaching time to psychiatry did not result in more specialist trainees in that subject. However, schools that taught a higher proportion of general practice did produce more GP trainees. Interestingly, however, these schools obtained lower marks on the MRCGP examination. The ARC WM Director has never been a fan of problem-based learning as the foundation for medical education.[2] He has always believed that a systematic and structured approach should proceed problem-based methods. The results provide some vindication for this position, since doctors from schools that rely heavily on problembased learning receive lower performance scores on post-graduate examinations. Further, student satisfaction correlates inversely with postgraduate performance. The causal path analysis showed that exam performance at school and medical school was positively associated with post-graduate examination performance. In line with a previous News Blog,[3] self-regulated learning was associated with better subsequent performance. How satisfied a student was with their education and how prepared they felt for clinical work had no influence on postgraduate outcomes. Schools producing higher proportions of male graduates and of GPs had higher numbers of fitness to practice issues.

The authors are careful in the conclusions they draw. The ARC WM Director is less so. He has long argued that, since academic excellence is not negatively correlated with compassion and humanity, medical students should be chosen on academic credentials, rather than nonsense interviews. They should be given a thorough academic foundation at medical school. Their teachers should be role models for patientcentred care, ethical rectitude and academic excellence. Never again should educational psychologists be allowed to dictate the medical curriculum.

Richard Lilford, ARC WM Director

References:

1. McManus IC, Harborne AC, Horsfall HL, et al. Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise. BMC Med. 2020; 18: 136.
2. Lilford RJ. Education Update. NIHR CLAHRC WM News Blog. 2 September 2016.
3. Lilford RJ. A Thoughtful Article on the Radical Changes Pending in Medical Education. NIHR ARC West Midlands News Blog. 27 March 2020; 2(3): 11-12.