A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study

Abstract

Objective: To assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers.

Design: Prospective cohort study with follow up after 20 years by postal questionnaire.

Setting: A UK medical school in London.

Participants: 511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002.

Main outcome measures: Time taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up.

Results: 47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.

Conclusions: Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

Fig 1

Careers of doctors in hospital medicine and general practice (career grade above and acquisition of memberships, diplomas, and academic degrees below)

Fig 2

Kaplan-Meier plots for percentage of doctors obtaining membership in relation to A level grade, after taking hospital/general practice differences into account

Fig 3

Path model of causal associations between different educational achievements of doctors. Coefficients represent standardised path coefficients (β coefficients) with their associated significance levels