By Upasana Tayal BMJ

A level results can predict long term career success in medicine, according to a paper recently published in the BMJ by researchers at University College London (2003;327:00-00).

Professor I C McManus and colleagues followed up over 500 doctors who had studied at Westminster medical school, London, between 1975 and 1982 and measured how successful their careers had been. They looked at dropout rates, how long it took students to get to different career grades, the number of research publications they had, and at measures of their stress and burnout levels. The students had all taken A level exams and were also all given an AH5 intelligence test when they entered clinical school.

When they compared whether A level results or intelligence were better predictors for long term success, the researchers found that it was the A level results that came out on top. Past achievement seems to predict future achievement. Doctors who dropped out of medical training, therefore no longer on the medical register, had lower grades than the doctors still on the register. On the contrary, intelligence did not predict dropping off the register or career outcome.

Students' A levels results are an important selection criterion for medical school entry, and this report implies that they accurately predict subsequent success in a student's career. The study comes at a time when many medical schools are thinking of lowering their entry grades for students from low performing state schools, to try to close the class divide in medical schools. Bristol University's history department has previously awarded places to people with lower A level qualifications than expected if they were performing better at their schools than previous students had done.

According to McManus, what distinguishes intelligence tests from A level grades is that they "assess cognitive ability independently of cultural content and educational experience." He continues, 'Because [A levels] can be biased or inaccurate, due to poor schooling, absent role models, low expectations, or inappropriate motivation, there is a case for replacing A levels with measures of aptitude or ability." However, he does not think that intelligence tests should replace A levels as selection criteria: "We have shown that A level results can predict time taken to gain membership qualifications, choosing to become a general practitioner, and leaving the register. In contrast, the AH5 cannot independently predict membership qualifications or dropout."

The authors stop short though of recommending that A levels be the only basis for selection. A level results did not predict the number of research publications or stress and burnout: "The causes of stress and burnout in doctors are complex, but our data suggest that excess intellectual ability is not one of them." The authors suggest that personality measures may be more useful indicators for these.