Predicting the "strugglers": a case-control study of students at Nottingham University Medical School

doi:10.1136/bmj.38730.678310.63

BMJ 2006;332:1009-1013 (29 April), doi:10.1136/bmj.38730.678310.63 (published 16 March 2006)

Research

Predicting the "strugglers": a case-control study of students at Nottingham University Medical School

Janet Yates, research fellow¹, David James, director of medical education¹

¹ Medical Education Unit, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH

Correspondence to: D James David.James{at}nottingham.ac.uk

Abstract

Objective To identify potential predictors of undergraduatestudents who struggle during their medical training.

Design Case-control study. Cases were students who had experiencedacademic or personal difficulties that affected their progressionon the course ("strugglers"). Controls were selected at randomfrom the corresponding year cohorts, using a ratio of four controlsfor each struggler.

Setting University of Nottingham Medical School.

Participants Students who entered the course over five consecutiveyears.

Main outcome measures Likelihood ratios for independent riskfactors for struggling on the course

Results 10-15% of each year's student intake were identifiedas strugglers. Significant independent predictors of studentsbeing in this category were negative comments in the academicreference (likelihood ratio 2.25, 95% confidence intervals 1.44to 3.50), lower mean examination grade at A level (2.19, 1.37to 3.51), and the late offer of a place (1.98, 1.19 to 3.30).Male sex was a less significant risk factor (1.70, 1.09 to 2.65)as was a lower grade at GCSE science (2.13, 1.12 to 4.05). InUK students whose ethnicity was known, not being white was asignificant predictor of struggling (2.77, 1.52 to 5.05) butthe presence of negative comments was not. Age at entry to thecourse and the possession of a previous degree were not predictive.

Conclusions Our results support retention of existing selectionpractices relating to academic achievement and critical reviewof students' references. We plan to undertake further investigationof the reasons why some students, including men, those withlate offers and those from ethnic minority backgrounds, maydo less well on the Nottingham course.

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