Impact of an intercalated BSc on medical student performance and careers: A BEME systematic review: BEME Guide No. 28

Figures & data

Table

Practice points

There is evidence that: intercalated BScs may improve subsequent undergraduate performance. iBScs are associated with increased chance of students pursuing academic medical careers. The educational experiences of these courses are often (but not universally) very rich, and students may develop skills in areas that traditional undergraduate courses struggle to provide. These courses are expensive for students, faculty and funding bodies and they delay workforce entry.

Table 1.  Examples of international intercalated iBScs

Country	University	Web address
Australia	University of Sydney	(http://sydney.edu.au/science/fstudent/undergrad/course/com-scimed.shtml) (tinyurl.com/6k3k4aw)
New Zealand	Otago	(http://www.otago.ac.nz/courses/qualifications/bmedschons.html) (tinyurl.com/658m3tm)
Republic of Ireland	University College Cork	http://www.ucc.ie/medstud/YearInt/yearintercalate.html
Jamaica	University of the west Indies	http://sta.uwi.edu/resources/documents/facultybooklets/MedSciUndergrad.pdf
Hong Kong	The Chinese University of Hong Kong	http://www.med.cuhk.edu.hk/v7/Doc/BMedSc%20Information%20Sheet%202008.pdf
South Africa	UCT (Cape Town)	http://www.medicine.uct.ac.za/Clinical%20Scholar/Presentations/11H30%20AKatz.ppt
Canada	University of Manitoba	http://umanitoba.ca/faculties/medicine/education/undergraduate/bsc_med.html

Figure 1. Flow chart of BEME iBSc review.

Table 2.  Examples of intercalated medical and higher degrees

Country	University	Course	Web address/reference
Scotland/UK	St Andrew's	MRes	http://medicine.st-andrews.ac.uk/documents/MRes_Leaflets_Feb11.pdf
UK	Keele	Masters	Creavin et al. (2010)
USA	Various	MD/PhD	Andriole et al. (2008)
UK	UCL	MB/PhD	http://www.ucl.ac.uk/mbphd/
NZ	Auckland	MB PhD others	Park et al. (2010)

Table 3.  Data sources and criteria for both methodological sections of the review

	Meta-analysis	Critical interpretative synthesis
Data source	Studies identified through searches of Medline/National Library of Medicine (NLM), PsychINFO, EMBASE, the student BMJ database, ERIC
Search criteria	medical student AND (outcome OR progres$ OR exam OR succes$ OR fail$), BSc OR bachelor OR degree OR intercalated [Text Word] OR honours [TW] OR honors [TW] OR complementary
Dates	No date range applied, searches undertaken in 2008 and updated in 2012.	Additionally we incorporated research papers, letters, opinion pieces and other articles relating to intercalated degrees within the medical undergraduate course. Date range 1.1.1984–1.6.2009 updated 1.11.12
Quality criteria	(i) observational or trial designs, (ii) controlled for previous academic performance, (iii) a focus on medical students, (iv) outcomes compared to the general under and graduate medical population and (v) availability of an English language abstract (vi) an adequate description of the course.	CIS methodology does not require assessment of quality of primary data sources, just the ability the data have to help generate concepts.

Table 4.  Impact of the iBSc degree on undergraduate medical student performance

Study	Measure	BSc students	Non-BSc students	Odds ratios	95% confidence intervals
Wyllie & Currie (1986)	Finals (getting high score in finals exam) >10/20	32/55 (58.2%)	14/50 (28%)	3.58	1.47–8.83
Cleland et al. (2009)	% achieving highest grade (1–2) in OSCE finals (861 students)	104/154 (67.5%)	421/707 (59.5%)	1.41	0.96–2.09
Howman & Jones (2011)	1st clinical year score – top half	53/136 (38.9%)	37/138 (26.8%)	1.81	1.09–3.01* (*note adjusted score is n/s)
Tait & Marshall (1995)	Data in unusable format – narrative summary
Mahesan et al. (2011)	Finals score	Internal intercalating students scored 1.27 points (95% CI 0.52–2.02) greater than those who did not.

Figure 2. Impact of the iBSc degree on undergraduate medical student performance (diagram does not include data on two studies for which ORs were not calculable).

Figure 3. Impact of iBSc degrees on academic progression (the pursuit of an academic career).

Table 5.  Impact of iBSc degrees on academic advancement – i.e. encouraging students to pursue academic careers

Study	Measure	BSc students	Non-BSc students	Odds ratios	95% Confidence intervals
Gerrard et al. (1988)	Academic career	101/206 (49%)	43/206 (21%)	3.64	2.32–5.77
Wyllie & Currie (1986)	Academic careers	18/42 (43%)	321/2863** (Lambert & Goldacre 1998) (11.2%)	5.94	3.60–11.54

**Expected proportion of academics from Lambert (Lambert & Goldacre 1998).

Figure 4. Impact of iBSc degrees on subsequent careers in general practice.

Table 6.  Impact of iBSc degrees on general practice as a career

Study	Measure	BSc students	Non-BSc students	Odds ratios	95% Confidence intervals
Gerrard et al. (1988)	% family practice	17**/336 (5%)	215/1442 (13%)	0.36	0.20–0.60
Eaton & Thong (1986)	% general practice careers	11/90 (12.2%)	51/112 (45.5%)	0.17	0.07–0.36
MacGowan et al. (1986)	% general practice careers	9/46 (19.5%)	*528/1192 (44.3%)	0.31	0.13–0.65
Nguyen Van Tam et al. (2001)	% general practice careers	86/195 (44%)	*(44.3%)	0.99	0.72–1.36
Williamson (1986)	% general practice careers	3/19 (15.7%)	*(44.3%)	0.24	0.04–0.83
Wyllie & Currie (1986)	% general practice careers	7/42 (17%)	16/39 (41%)	0.29	0.09–0.89
Young & Sefton (1984)	% general practice careers	31/356 (8.7%)	51/112 (45.5%)	0.11	0.07–0.20
Lambert et al. (2001)	% general practice careers	319/2081 (15.3%)	776/2992 (25.9%)	0.52	0.45–0.60

*Expected proportion to follow a GP career (Lambert et al. 1996).

**Estimated from proportions in report, no raw data.

Table A1.  Meta-analysis – data sources

	Author	Outcome measure	Methods/analysis	Commentary	Included	Reason
1	Mahesan et al. (2011)	Finals exam performance and early PG career	Linear regression analysis	School where >50% do iBSc	Yes	High quality study adjusting for prior performance and other baseline factors
2	Howman & Jones (2011)	Summative marks for year 3 (1st clinical year). iBSc taken before or after exam.	Multi-variate analysis of cross-sectional data	School where all non-graduates undertake iBSc reducing risk of selection bias (Author COI)	Yes	High quality study adjusting for prior performance and other baseline factors (NB author COI)
3	Cleland et al. (2009)	Summative MB BS degree assessments taken after intercalating.	Univariate and Multinomial logistic regression	School where 1/3 of student intercalate, selection largely on academic performance	Yes	High quality study adjusting for prior performance and other baseline factors
4	Gerrard et al. (1988)	Career outcome and publication record	Case control iBsc students compared with non-BSc students	Controlled for demographic profile and prior acadmic performance	Yes	High quality study controlling for a range of potential confounders
5	Wyllie & Currie (1986)	Finals performance and career	Case control matched on prior performance	60 Pathology iBSc students matched with non-iBSC	Yes	High quality study adjusting for prior performance and other baseline factors
Studies not included in meta-analysis
6	McManus et al. (1999)	Study habits (surface, deep, and strategic learning style) and interest in different medical careers, including medical research.	Longitudinal questionnaire (prospective) multilevel modelling and multiple regression.	Large multicentre study	Yes	Very high quality study adjusting for prior performance and other baseline factors, but no data relating to review outcomes apart from careers.
7	Tait & Marshall (1995)	Marks in clinical exams subsequent to iBSc.	Case control study compares with gender/academically matched non-IBSc students	Very small numbers n = 14 in iBSc group multiple measures of student performance recorded	Yes	Moderate quality study
	Studies included for data on GP career impact (broader selection criteria)
8	Eaton & Thong (1985, 1986) (2 versions)	Finals performance, careers and academic measures	Retrospective case control study	Australian study following students through to postgraduate training	Yes (for GP career analysis only)	Some matching but not controlled for prior performance
9	Lambert et al. (Med Ed 2001)	GP career by iBSc status	Retrospective survey of UK graduates looking at reported BSc participation	Study will not account for those who do not complete UG course	Yes (for GP career analysis only)	Large nationally representative survey no adjustment for prior academic performance
10	MacGowan et al. (1986)	Academic output (papers) and career destination	Descriptive no data on comparator groups (estimated from national data)	Case series of students completing B Med Biol degree	Yes (for GP career only)	Some source data for careers only
11	Williamson (1986)	Subsequent Career and academic activity	Descriptive series from 1 institution, no comparator group. Comparator data obtained form from national data source	Retrospective survey	Yes (for GP career data only)	Some source data for careers only
12	Nguyen VanTam et al. (2001)	Examine career choice of medical students who completed an honours year in public health & epidemiology	Descriptive analysis	Case series of public health/epidemiology intercalated honours degree	Yes (for GP career data only)	Some source data for careers only
13	Young & Sefton (1984)	Subsequent careers	Case series	No comparator group	Yes (GP career data only)	Some source data for careers only
	Studies not included
14	Elwood et al. (1986) (JECH)	Case series (largely similar data set to BMJ letter & Nguyen data)	Descriptive Case series	No comparator group	No	No comparator group
15	Elwood (2) et al. (BMJ letter) (1986)	Case series (earlier data to1986 study and Nguyen data)	Descriptive	No comparator group	No	Data not usable
16	Wakeford et al. (1985)	UG performance of Profs and reader	Case control study	Not prospective data	No	Will not capture prospective effect of BSc
17	Collins et al. (2010)	Large Australian case series of iBSc students	Case series	No comparator group	No	No comparator group (and cannot reliably use UK comparator groups)
18	Harris (1986)	Series of iBSc students – some data on subsequent academic progression	Case series descriptive	No comparator group	No	Data not usable
19	Nade (1978)	Retrospective survey of higher degree holder	Descriptive no comparator groups	Retrospective	No	Data unusable in this review

Table A2.  Data sources for the critical interpretive synthesis

	Author	Type of data source	Formal qualitative analysis	Commentary	Included	Reason
1	Agha & Howell (2005)	Study aimed at student attitudes to (dis)benefits of doing iBSc	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
2	Agha & Singh (2003)	Letter In journal of record	No	Student letter reflecting on personal development during an iBSc	Yes	Useful student informant data
3	Al-Shaqsi (2010)	Peer reviewed article (NZ) “To intercalate or not to intercalate”	No	Contextual info by student about new iBSc course	Yes	Useful student informant data
4	Asgari-Jihandeh & Haywood (1997)	Short report in peer reviewed journal	No	Useful contextual information about skills acquisition from iBSc	Yes	Useful student informant data
5	Aston (2001)	Student BMJ (sBMJ) letter	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
6	Attwell & Boyd (1996)	Lancet letter	No	External stakeholder opinion on role of iBSc	Yes	Useful external stakeholder informant data
7	Burkitt Wright (2001)	Letter sBMJ	No	Data on career impact and finance	Yes	Useful student informant data
8	Broome et al. (2007)	Peer review paper on students’ views	Yes	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
9	Collier (2001)	sBMJ letter on iBSc research	No	Source of data on student perspective about merits of undertaking research (negative opinion)	Yes	Useful student informant data (and a divergent voice)
10	Dudley (ANZJ Surg) (1989)	Descriptive piece of Australian course	No	Faculty opinion	Yes	Useful faculty informant data
11	Emmel/Goldstein (2002)	sBMJ article on BSc international health/student perspective	No	Some comment on benefits of IBSc	Yes	Useful student informant data
12	Evered et al. (1987)	BMJ peer review article	No	Evidence on provenance of medical researchers including iBSc	Yes	Useful professional (clinician/academic) informant data
13	Fingerote (& Gerrard author reply) (1989)	CMAJ letter	No	Qualified clinician perspective on financial barriers to iBSc	Yes	Useful professional (clinician) informant data
14	Gerrard et al. (1988)	Peer review article (Canada)	No	Some faculty insights in predominantly quantitative study	Yes	Useful faculty informant data
15	Gardner & Olojugba (2008)	sBMJ article on benefits of an iBSc	No	Student and clinician perspective on iBSc	Yes	Useful professional (clinician) and student informant data
16	Gray (1989)	Editorial	No	Faculty perspective on iBSc funding	Yes	Useful faculty informant data
17	Goldie et al. (2004)	Peer reviewed article (Med Ed)	No	Study data on students’ handling ethical issues	Yes	Useful data about (adverse) impact on student skills
18	Greenhalgh & Wong (2003)	Editorial (commentary)	No	Faculty opinion on role of iBSc	Yes	Useful faculty informant data
19	Gutenstein (2000)	sBMJ giving data on medical education costs	No	Source of data on course costs	Yes	Costs data
20	Harris (1986)	BMJ letter	No	Course description/outcome	Yes	Mainly quantitative data
21	Holgate et al. (1999)	(BMJ) Rapid response to McManus	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
22	Holmes (1986)	BMJ letter	No	Qualified clinician perspective on benefits of iBSc	Yes	Useful professional (GP) informant data
23	Iqbal (2001)	Letter sBMJ	No	Useful contextual information about skills acquisition from iBSc	Yes	Useful student informant data
24	Jones et al. (2001)	Peer review article on an IBSc (author COI)	No	Faculty opinion on role of iBSc	Yes	Useful faculty informant data (Author COI)
25	Jones et al. (2005)	Peer review article on an IBSc (author COI)	Yes	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data (Author COI)
26	Jones et al. (2008)	Peer review article on an IBSc (author COI)	Yes	Useful contextual information about student and faculty opinion on iBSc courses/skills acquisition	Yes	Useful student/faculty informant data (Author COI)
27	Kentish & Avkiran (2002)	Response to Krishnan and Krishnan partial retraction	No	Useful contextual information on student and faculty perception of project roles	Yes	Useful student/faculty informant data (and a negative voice/divergent data)
28	Krishnan (2002b)	Letter sBMJ	No	Useful contextual information about skills acquisition from iBSc (rare adverse student comment – subsequently retracted)	Yes	Useful student informant data (and a negative voice/divergent data)
29	Leung (2001)	Article to student about merits doing an iBSc	No	Opinion on merits of IBSc for jobs	Yes	Useful external informant data
30	Leung (1999)	Article aimed at students about strengthening CV	No	Opinion on merits of IBSc for jobs	Yes	Useful external informant data
31	Longmore	BMJ letter	No	Clinician stakeholder opinion(divergent) about role, of iBSc	Yes	Useful clinician stakeholder informant (divergent) data
32	Ludbrook (1989)	Editorial	No	Faculty opinion on role of iBSc	Yes	Useful faculty informant data
33	Morrison (2004)	Editorial Journal of record	No	Faculty opinion on long term impact of iBSc	Yes	Useful faculty informant data
34	Moscrop (2002)	sBMJ letter	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
35	Nicholson et al. (2010)	Peer review article	No	Useful contextual information about student opinion on non-participation in iBSc courses	Yes	Useful (divergent) student informant data
36	Patel (2001)	sBMJ letter	No	Useful contextual information about student opinion on iBSc courses and impact on employment	Yes	Useful student informant data
37	Price (1998)	sBMJ letter	No	Intercalating helps personal development and medical skills	Yes	Useful student informant data
38	Rushforth (2004)	Med ed editorial Academic medicine and intercalated degrees – the myth of student choice”	No	Useful contextual information about student/recent graduate opinion on iBSc courses	Yes	Useful student/stakeholder informant data
39	Smith (1986)	BMJ editorial	No	Clinician/science publisher perspective on iBSc	Yes	Useful professional (BMJ editor) informant data
40	Thiagamoorthy (2001)	sBMJ letter	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
41	White (2006)	sBMJ article Tips on surviving a iBSc	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student informant data
42	Williamson (1986)	BMJ letter	No	Useful contextual information about student/faculty opinion on iBSc courses	Yes	Useful student/faculty informant data
43	Wyllie & Currie (1986)	Peer review article	No	Some faculty insights in predominantly quantitative study	Yes	Useful faculty informant data
44	Yudkin et al. (2003)	Lancet description of new course	No	Contextual info by faculty and student about new iBSc course	Yes	Useful student and faculty informant data
45	Weidmann (2002)	sBMJ	No	Useful contextual information about student opinion on iBSc courses	Yes	Useful student and faculty informant data
46	Park	JNZMA	No	Useful information – survey of intercalated graduates (but some intercalated higher degrees)	yes	Useful student informant data
	Studies not included
	Andriole et al. (2008)	US MD PhD students	No	Characteristics and Career Intentions of the Emerging MD/PhD Workforce	No	Outside scope of review
	Barzansky (2000)	US programme	No	Educational Programs in US Medical Schools	No	Outside scope of review
	Child & Gupta (2009)	sBMJ on pathology	No	Student and faculty view on merits of iBSc in pathology	No	Limited contextual information
	Cursiefen et al. (1995)	Peer reviewed study	No	Research course but not intercalated degree	No	Outside scope of review
	Creavin (2010)	Description of new course	No	Intercalated course but at Masters level	No	Outside scope of review
	Dudley (Br J Med Ed) (1970)	Descriptive piece of Australian course	No	Faculty opinion	No	Little usable data
	Gogalniceanu et al. (2009)	UG anatomy teaching	No	Brief description of iBSc anatomy teaching	No	Limited data
	Griswold et al. (1991)	Peer reviewed paper	No	Summer research school	No	Outside scope of review
	Jacobs & Cross (1995)	Peer reviewed paper	No	Course description – research course	No	Outside scope of review
	Johnstone & Cartwright (2008)	Comparison of med/non-med students doing a BSc	No	Not comparing 2 groups of Medical students	No	Comparison of B.Med Sci (non-medical students) with med students
	Jones et al. (1999)	BMJ (Rapid response to McManus)	No	Faculty opinion (author COI)	No	Limited data
	Kemph et al. (1984)	Peer review paper	No	Summer research school	No	Outside scope of review
	Kolcic et al. (2005)	Peer review journal	No	Research training programme	No	Outside scope of review
	MacGowan et al. (1986)	BMJ letter	No	Course description/outcome	No	Mainly quantitative data
	Peile & Johnson (2008)	sBMJ article on academic medicine	No	Some comment on benefits of IBSc	No	Insufficient contextual information
	Seltzer (1987)	BMJ letter (response to Evered)	No	Comment on results	No	No useable data
	Smith et al. (2001)	Peer review paper	No	Research training programme	No	Outside scope of review
	Smith (1988)	Review on medical research training	No	Some review of data on IBsc	No	Data used in meta-analysis
	Tamber (1986)	News article on MRC withdrawal of funding for BSc	No	Limited data on funders stakeholder opinion	No	Limited data
	Villanueva (2007)	sBMJ article	No	Some contextual information about student opinion on iBSc courses	No	Too brief to be useful
	Wakeford et al. (1985)	Lancet peer reviewed article	No	Evidence on provenance of medical researchers including iBSc	No	Too focused question for this review
	Wakeford (1995)	Med Ed letter (Response to Tait paper)	No	No new data	No	Highlights prev article

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