Predicting the "strugglers": a case-control study of students at Nottingham University Medical School.
OBJECTIVE
To identify potential predictors of undergraduate students who struggle during their medical training.


METHODS
Case-control study. Cases were students who had experienced academic or personal difficulties that affected their progression on the course ("strugglers"). Controls were selected at random from the corresponding year cohorts, using a ratio of four controls for each struggler.


METHODS
University of Nottingham Medical School.


METHODS
Students who entered the course over five consecutive years.


METHODS
Likelihood ratios for independent risk factors for struggling on the course


RESULTS
10-15% of each year's student intake were identified as strugglers. Significant independent predictors of students being in this category were negative comments in the academic reference (likelihood ratio 2.25, 95% confidence intervals 1.44 to 3.50), lower mean examination grade at A level (2.19, 1.37 to 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). In UK students whose ethnicity was known, not being white was a significant predictor of struggling (2.77, 1.52 to 5.05) but the presence of negative comments was not. Age at entry to the course and the possession of a previous degree were not predictive.


CONCLUSIONS
Our results support retention of existing selection practices relating to academic achievement and critical review of students' references. We plan to undertake further investigation of the reasons why some students, including men, those with late offers and those from ethnic minority backgrounds, may do less well on the Nottingham course.
Medical Education Unit, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH.
Janet
J
Yates
David
D
James
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004516:Education, Premedical / Q000592:standards; D004522:Educational Status; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D013337:Students, Medical / Q000523:psychology*