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Comparison of A level and UKCAT performance in students applying to UK medical and dental schools in 2006: cohort study

BMJ 2010; 340 doi: (Published 17 February 2010) Cite this as: BMJ 2010;340:c478
  1. David James, foundation director of medical education1,
  2. Janet Yates, research fellow in medical education1,
  3. Sandra Nicholson, reader medical education2
  1. 1University of Nottingham Medical School, Queen’s Medical Centre, Nottingham NG7 2UH
  2. 2Academic Unit of Community-based Medical Education, Institute for Health Science Education, Barts and The London School of Medicine and Dentistry, London E1 2AD
  1. Correspondence to: D James David.james{at}
  • Accepted 14 December 2009


Objectives To determine whether the UK Clinical Aptitude Test (UKCAT) adds value to the selection process for school leaver applicants to medical and dental school, and in particular whether UKCAT can reduce the socioeconomic bias known to affect A levels.

Design Cohort study

Setting Applicants to 23 UK medical and dental schools in 2006.

Participants 9884 applicants who took the UKCAT in the UK and who achieved at least three passes at A level in their school leaving examinations (53% of all applicants).

Main outcome measures Independent predictors of obtaining at least AAB at A level and

UKCAT scores at or above the 30th centile for the cohort, for the subsections and the entire test.

Results Independent predictors of obtaining at least AAB at A level were white ethnicity (odds ratio 1.58, 95% confidence interval 1.41 to 1.77), professional or managerial background (1.39, 1.22 to 1.59), and independent or grammar schooling (2.26, 2.02 to 2.52) (all P<0.001). Independent predictors of achieving UKCAT scores at or above the 30th centile for the whole test were male sex (odd ratio 1.48, 1.32 to 1.66), white ethnicity (2.17, 1.94 to 2.43), professional or managerial background (1.34, 1.17 to 1.54), and independent or grammar schooling (1.91, 1.70 to 2.14) (all P<0.001). One major limitation of the study was that socioeconomic status was not volunteered by approximately 30% of the applicants. Those who withheld socioeconomic status data were significantly different from those who provided that information, which may have caused bias in the analysis.

Conclusions UKCAT was introduced with a high expectation of increasing the diversity and fairness in selection for UK medical and dental schools. This study of a major subgroup of applicants in the first year of operation suggests that it has an inherent favourable bias to men and students from a higher socioeconomic class or independent or grammar schools. However, it does provide a reasonable proxy for A levels in the selection process.


  • We thank David Bennett and Rob Draisey at Pearson VUE for assistance with data extraction and interpretation. We also thank UCAS for permission to include their data and specifically Anna Daws for practical assistance. We acknowledge the contribution of Martin Bland in planning this study.

  • Contributors: All authors contributed to planning the research, analysing and interpreting the results, and drafting the paper, and all approved the final version. JY prepared and manipulated the dataset. DJ is the guarantor.

  • Funding: JY was funded by the UKCAT Board. The UKCAT Board is responsible for an overall research and evaluation programme, but the named authors are responsible for the study design, data analysis and interpretation, and writing of the paper as submitted. UKCAT is responsible for the database and agreed with the decision to submit the article for publication. The authors confirm their independence as researchers from UKCAT acting in this capacity as funders.

  • Competing interests: JY was funded by the UKCAT Board to complete the analysis. SN was elected as chair of the UKCAT Board in December 2008. However, no author has any ongoing financial interests in the publication of these results.

  • Ethical approval: Formal ethical approval was not needed for this analysis of anonymised, routinely collected data. Applicants for the UKCAT test were informed that their anonymised and aggregated data would be used for educational research and evaluation of the UKCAT on registration for the test. UCAS gave consent for UKCAT to use data in research and for this paper to be published. The UKCAT Board commissioned this research and approved the paper.

  • Data sharing: No additional data available.

  • Accepted 14 December 2009

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