When did they leave, and why? A retrospective case study of attrition on the Nottingham undergraduate medical course

BACKGROUND: As part of a wider study into students who experience difficulties, we examined the course files of those who had failed to graduate. This was an exploratory, descriptive study investigating how many students left after academic failure or non-academic problems, or simply changed their minds about reading medicine, and at what stage. The aim of the study was to increase our knowledge about the timings of, and reasons for, attrition. This understanding might help to reduce student loss in the future, by informing selection procedures and improving pastoral support at critical times. It might also assist in long-term workforce planning in the NHS. METHODS: Relevant data on admission and course progress were extracted manually from the archived files of students who had failed to graduate from five recent consecutive cohorts (entry in 2000–2004 inclusive), using a customised Access database. Discrete categories of information were supplemented with free text entries. RESULTS: 1188 students registered over the five-year entry period and 73 (6%) failed to graduate. The highest rates of attrition (46/1188, 4%) occurred during the first two years (largely preclinical studies), with 34 students leaving voluntarily, including 11 within the first semester, and 12 having their courses terminated for academic failure. Seventeen left at the end of the third year (Honours course plus early clinical practice) and the remaining ten during the final two clinical years. The reasons for attrition were not always clear-cut and often involved a mixture of academic, personal, social and health factors, especially mental health problems. CONCLUSIONS: The causes of attrition are complex. A small number of students with clear academic failure might require individual educational interventions for remediation. However, this could have substantial resource implications for the Faculty. Mental health problems predominate in late course attrition and may have been undisclosed for some time. The introduction of a structured exit interview may provide further insight, especially for those students who leave suddenly and unexpectedly early in the course.