'10% of your medical students will cause 90% of your problems': a prospective correlational study

Abstract

• Objectives Our aim was to explore the relationship between medical student Conscientiousness Index scores and indicators of later clinical performance held in the UK Medical Education Database. Objectives were to determine whether conscientiousness in first and second year medical students predicts later performance in medical school and in early practice. Policy implications would permit targeted remediation where necessary or aid in selection. • Design Prospective correlational study • Setting A single UK medical school and early years of practice, 2005-2018. • Participants Data were obtained from the UK Medical Education Database (UKMED) on 858 students. Full outcome data was available for variable numbers of participants, as described in the text. • Main outcome measures Scores on the UK Foundation Programme Office’s Situational Judgement Test (SJT) and Educational Performance Measure (EPM), the Prescribing Safety Assessment (PSA), and Annual Review of Competency Progression (ARCP) outcomes. • Results Linear regression analysis shows Conscientiousness Index scores significantly correlate with pre- and postgraduate performance variables,: SJT scores (R=0.373, R2=0.139, B=0.066, p<0.001, n=539); PSA scores (R=0.249, R2=0.062, B=0.343, p<0.001, n=462); EPM decile scores for the 1st (lowest) decile are significantly lower than the remaining 90% (P=0.003, n=539), as are PSA scores (p<0.001, n=463), and ARCP Year 2 scores (p=0.019, n=517). The Odds Ratio that students in the 1st decile fail to achieve the optimum ARCP outcome is 1.6126 (CI 1.1400 to 2.2809, p=0.0069, n=618).
• Conclusions Conscientiousness Index scores in Year 1 and 2 of medical school have predictive value for later performance in knowledge, skills and clinical practice. This trait could be used either for selection, or for targeted remediation to avoid potential problems in the future.