WHAT PREDICTS GOOD CLINICAL PERFORMANCE?
Investigators looking for early predictors of what makes a good clinician generally use reports from clinical clerkships and from the house officer or intern year. However, we should note that drop-out will mean that some unsatisfactory students will have left before the house officer year.
Clinical performance is not generally predicted by pre-entry academic scores1,
35,
53,
54,
55,
56,
57: the one report of correlation between matriculation scores and clinical performance noted that matriculation scores included 50% contribution from school teacher assessment
58.
Neither age nor gender predicts clinical performance, nor does previous study of physical sciences, but
there is evidence that previous study of English and humanities correlates with better clinical performance5,
34,
59. There are some reports of association between clinical performance and admission interviews
55,
56,
60,
61, although others reveal no correlation
54,
58. In a school that carefully evaluates applicants, empathy and motivation to be a doctor were found particularly important in predicting both clinical and academic success
62.
WHAT FACTORS PREDICT ACADEMIC FAILURE IN MEDICINE?
The first thing that strikes anyone exploring the work on predictors in medicine is that we are obsessed with exam results: by far the largest number of papers examines predictors of passing exams. This may be justified because of the economic and personal waste of losing students who begin a medical degree but fail to complete, with loss from schools that select at entry, both in the UK and elsewhere, generally reported between 8% and 10%
24,
25,
26,
27. However, most studies assess ‘failure' in broad terms to include all students who re-take an examination, as well as those who are excluded from the course, so predictors should be treated with caution. Although virtually all students are high academic achievers at school, from the top 0.4%
8 to the top 10%
29, school and medical exam scores do correlate, with contribution to variability reported between 16%
29 and 58%
30. Some UK studies show that certain science A levels predict exam success, variously putting biology, chemistry or physics in prime place
31,
32,
33, and research from outside the UK reports associations between performance in physical sciences and in medical exams
34,
35,
36. Generally this association falls later in the course, with no difference to longer term success or failure
37,
38,
39,
40.
Non-academic factors also predict exam success or failure. Some researchers report that older students are more likely to fail exams
36,
38,
41, but others have not found this
42. Several US studies found higher failure rates among women and ethnic minority students, although most eventually graduate
36,
38,
41, and one school reported that students admitted through affirmative action were as likely to graduate as those admitted by use of traditional criteria
43. Proficiency in English is important for students for whom English is not their first language
44,
45, and in the US, reading skills of disadvantaged minority students have been shown to predict academic success
46. Non-cognitive factors are stronger predictors for women and ethnic minority students than for white men in the US. For women, interview ratings and previous relevant experience were more predictive than previous exam scores
47, while for ethnic minority students, locus of control and ability to self-evaluate were predictors
48,
49. One US study showed that different cognitive and non-cognitive factors correlate with academic success in different schools, so different cultures and teaching styles influence outcome
50.
It has been argued that we cannot reduce loss further
51, because some failure is inevitable and we cannot avoid a few students' wanting to change career. However, two medical schools have shown that careful selection and good support can have a positive impact. In Newcastle, New South Wales, for five years 50% of students were selected on academic marks alone but underwent a lengthy structured interview which was not used for selection. As a result, some students were admitted with very low interview scores. The remaining 50% were selected from a wider band of academic performance but scored high in interview. Analysis after ten years showed a significant correlation between low interview score and later drop-out but no correlation between academic score at entry and drop-out. Reasons for dropping out were academic failure or a variety of personal reasons, including lack of motivation for study or for medicine
28. Another example of low drop-out comes from McMaster University in Ontario, which also invests heavily in selection and in addition offers ‘remediation' for students having academic difficulty. In one five-year period in a class of 100 students, only one student was excluded because of academic failure, 3 changed careers, while 8% had remedial help
52.
The Royal Society of Medicine, 2002
... you're in luck! You can scratch #s 1-3 from the above list 
