Can achievement at medical admission tests predict future performance in postgraduate clinical assessments? A UK-based national cohort study

OBJECTIVE: To determine whether scores on two undergraduate admissions tests (BioMedical Admissions Test (BMAT) and University Clinical Aptitude Test (UCAT)) predict performance on the postgraduate Membership of the Royal Colleges of Physicians (MRCP) examination, including the clinical examination Practical Assessment of Clinical Examination Skills (PACES). DESIGN: National cohort study. SETTING: Doctors who graduated medical school between 2006 and 2018. PARTICIPANTS: 3045 doctors who had sat BMAT, UCAT and the MRCP. PRIMARY OUTCOME MEASURES: Passing each section of the MRCP at the first attempt, including the clinical assessment PACES. RESULTS: Several BMAT and UCAT subtest scores displayed incremental predictive validity for performance on the first two (written) parts of the MRCP. Only aptitude and skills on BMAT (OR 1.34, 1.08 to 1.67, p=0.01) and verbal reasoning on UCAT (OR 1.34, 1.04 to 1.71, p=0.02) incrementally predicted passing PACES at the first attempt. CONCLUSIONS: Our results imply that the abilities assessed by aptitude and skills and verbal reasoning may be the most important cognitive attributes, of those routinely assessed at selection, for predicting future clinical performance. Selectors may wish to consider placing particular weight on scales assessing these attributes if they wish to select applicants likely to become more competent clinicians. These results are potentially relevant in an international context too, since many admission tests used globally, such as the Medical College Admission Test, assess similar abilities.