uk medical careers research group

Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

• Accessibility
• Our Research

Medical Careers Research Group

welcome to the ukmcrg website

The UK Medical Careers Research Group (UKMCRG) undertakes longitudinal cohort studies of the careers of all doctors who graduated in particular years from UK medical schools.

These cohort studies comprise postal and web-based surveys in which we ask structured questions about career intentions and progression, and the factors that influence them. In addition, we invite respondents to write free text comments about any aspect of their training, career or work.

To date, we have collected data from over 60,000 doctors from fifteen cohorts of medical graduates. Each cohort is defined by year of graduation.

We have surveyed the graduates of 1974, 1977, 1980, 1983, 1988, 1993, 1996, 1999, 2000, 2002, 2005, 2008, 2009, 2011, 2012 and 2015. 

We estimate that over one in three practising NHS doctors who qualified since 1974 has completed one or more of our questionnaires. Results from our studies have been published in leading international journals - see the publications pages on this site for links to many of them.

These cohort studies have been funded by the Department of Health since the 1970s and were first established by Dr James Parkhouse. We work to a research protocol written by us and agreed with the Department. We maintain links with the Department of Health, Medical School Deans, the General Medical Council, and others. 

  THE  MEDICAL CAREERS RESEARCH GROUP STOPPED CONDUCTING SURVEYS IN MARCH 2018.

Trevor Lambert

Project Director, MCRG

Michael Goldacre

Emeritus Professor of Public Health

Shelly Lachish

Research Officer

Geraldine Surman

Selected publications.

Journal article

Smith F. et al, (2017), BMJ Open, 7

Lambert TW. et al, (2018), J R Soc Med, 111, 18 - 30

Smith F. et al, (2016), JRSM Open, 7

Lambert TW. et al, (2016), JRSM Open, 7

Surman G. et al, (2016), Postgrad Med J, 92, 194 - 200

Research - Introduction

Objectives of the uk mcrg cohort studies, data collected in each survey, the cohorts, current issues, publications, all publications to 2018, standard reports of our surveys, other methods of dissemination.

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• Retention in the...

Retention in the British National Health Service of medical graduates trained in Britain: cohort studies

• Related content
• Peer review
• Michael J Goldacre , professor of public health ,
• Jean M Davidson , research officer ,
• Trevor W Lambert , statistician
• 1 UK Medical Careers Research Group, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF
• Correspondence to: M J Goldacre, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX7 3LF michael.goldacre{at}dphp.ox.ac.uk
• Accepted 11 May 2009

Objective To report the percentage of graduates from British medical schools who eventually practise medicine in the British NHS.

Design Cohort studies using postal questionnaires, employment data, and capture-recapture analysis.

Setting Great Britain.

Subjects 32 430 graduates from all British medical schools in nine graduation cohorts from 1974 to 2002, subdivided into home based medical students (those whose homes were in Great Britain when they entered medical school) and those from overseas (whose homes were outside Great Britain when they entered medical school).

Main outcome measures Working in the NHS at seven census points from two to 27 years after qualification.

Results Of home based doctors, 88% of men (6807 of 7754) and 88% of women (7909 of 8985) worked as doctors in the NHS two years after qualification. The corresponding values were 87% of men (7483 of 8646) and 86% of women (7364 of 8594) at five years; 86% (6803 of 7872) and 86% (5407 of 6321) at 10 years; 85% (5404 of 6331) and 84% (3206 of 3820) at 15 years; and 82% (2534 of 3089) and 81% (1132 of 1395) at 20 years. Attrition from the NHS had not increased in recent cohorts compared with older ones at similar times after graduation. Of overseas students, 76% (776 of 1020) were in the NHS at two years, 72% (700 of 972) at five years, 63% (448 of 717) at ten years, and 52% (128 of 248) at 20 years.

Conclusions The majority of British medical graduates from British medical schools practise in the NHS in both the short and long term. Differences between men and women in this respect are negligible. A majority of doctors from overseas homes remain in Britain for their years as junior doctors, but eventually about half leave the NHS.

Introduction

Training adequate numbers of physicians and retaining a high proportion of them in the medical workforce are global concerns. Policy makers need to know the extent to which medical school graduates contribute not just to long term medical practice but specifically to the national medical workforce in their country of training. 1 Furthermore, as the number of women in medical training rapidly expands in many countries, it is important to investigate how the participation of women in the medical workforce compares with that of men. 2 We report participation rates in the British NHS of graduates from British medical schools.

We used data from longitudinal surveys of doctors undertaken by our Medical Careers Research Group (MCRG) using postal questionnaires, supplemented by data from NHS employment records. Survey data and NHS data were analysed with capture-recapture methods, originally developed in animal ecology to estimate the total size of animal populations, 3 to provide very accurate information about NHS participation. NHS posts included those held by doctors in academic posts with honorary contracts to practise medicine in the NHS.

Data from UK MCRG surveys

The study population comprised all medical graduates from all medical schools in Great Britain (England, Wales, and Scotland) who qualified in 1974, 1977, 1983, 1988, 1993, 1996, 1999, 2000, and 2002. Our methods, used in ongoing surveys, have been described elsewhere. 4 In the year of qualification of each cohort, we obtained addresses from doctors’ registration with the General Medical Council. We used postal questionnaires to seek information, including job histories, current employment, dates of jobs, job location, employer, specialty, and basic demographic information. Questionnaires were mailed to all graduates one year after qualification, at subsequent intervals of two years up to seven years, at 10 years, and at approximately 15 and 25 years. Reminder mailings were sent to non-respondents.

We used location of family home (Great Britain or overseas), as reported to us by the doctors, to classify each doctor as a “home” student or “overseas” student at the time of entry to medical school.

Data from the Department of Health

From employment records the English Department of Health produces an annual census of all doctors working in the NHS on 30 September each year. Department of Health staff specified whether each doctor was in the NHS on the census date using the doctor’s General Medical Council registration number.

Capture-recapture calculations

For capture-recapture analysis, NHS employment status was classified at each census point as (a) known to both MCRG and Department of Health to be working in the NHS, (b) known to MCRG, but not to Department of Health, to be working in the NHS, and (c) known to Department of Health, but not to MCRG, to be working in the NHS. These three categories were used to calculate the size of a fourth group (d), working in the NHS, but not known as such to either the MCRG or the Department of Health, using the formula d=bc/(a+1). An estimated total number (e) in the NHS can then be calculated as a+b+c+d. 5 6 7 This value can be compared with the total of all doctors in each cohort (f), excluding the small numbers known to be deceased or who asked to be non-participants, to give the percentage of the cohort estimated to be in the NHS at each census time (e/f). The 95% confidence interval for each percentage was estimated using the standard formula for calculating the standard error of a capture-recapture estimate. 5

We present results for particular landmark years: at two years, five years, 10 years, 15 years, 20 years, 25 years, and 27 years after graduation.

Study population and response rate

The initial study population comprised the 32 430 doctors who graduated from British medical schools in the relevant years. After excluding 160 doctors known to be deceased at the time of the most recent survey of each cohort, and 257 who declined to participate, 32 013 doctors from these cohorts (98.7%) were included in questionnaire mailings. Responses were received from 28 439 of 32 013 doctors (88.8%) on at least one occasion. Appendix 1 shows the details for individual cohorts.

Over all cohorts, we knew the family home location of 25 833 of 32 013 doctors (80.7%). Of the 25 833, 94% (24 361) were from family homes in Great Britain and 6% (1472 doctors) were from family homes overseas. The contribution of individual cohorts of home based and overseas based doctors to the analysis for landmark years is shown in appendix 2. For the early years of the 1974, 1977 and 1983 cohorts, Department of Health data, needed for capture-recapture analysis, were not available.

Participation in the NHS in Great Britain: home based graduates

Of graduates with family homes in Great Britain, 88% were working in the NHS in Great Britain two years after qualification (table 1 ⇓ ). Subsequent years showed a gradual, small decline: participation was 86% in years five and 10, 85% by year 15, 82% by year 20, and 81% by year 25.

 Percentage (95% CI) of doctors from homes in Great Britain who were working in the NHS after qualification

• View inline

Percentage participation in the NHS by men and women was very similar. 88% of men and 88% of women were in the NHS two years after qualification. The corresponding figures were 87% of men and 86% of women at five years, 86% and 86% at 10 years, 85% and 84% at 15 years, 82% and 81% at 20 years, and 81% and 81% at 25 years. Considering individual cohorts, by five years after qualification percentage participation in the NHS was fractionally higher for men than for women in all but the 2000 cohort. Although differences between men and women were small, the number of doctors in each cohort was large, and some differences were statistically significant.

Comparing cohorts over time, we noted an increasing trend in the more recent cohorts for doctors to be employed in the NHS in the middle years after qualification (five, 10, and 15 years) (table 1) ⇑ , although the overall increase in percentages in the NHS was fairly small. The trend towards retention in the NHS was more evident for women than for men. Importantly, there is no evidence that younger cohorts were more inclined than older cohorts to leave the NHS; and no evidence that there were any periods of time over the past 30 years when there was any sudden loss of doctors from the NHS.

Part time work: home based graduates

Approximately 2% of both male and female home based graduates were working part time two years after qualification (men 1.6%, 86 of 5296; women 2.2%, 145 of 6476; χ 2 =5.4, P=0.02). Among men, part time working settled at about 5% between years five and 15, and then increased to 9% by year 20 and 10% by year 25. The percentages of women working part time at each stage were much higher, with more than 20% working part time at five years, 50% at 10, 54% at 15, and 47% at 25.

Participation in the NHS in Great Britain: doctors with family home outside Britain

Participation in the NHS was significantly lower among overseas based doctors than among their home based contemporaries (table 2 ⇓ ). For example, combining the cohorts, two years after qualification 76% of overseas based doctors were working in the NHS compared with 88% of home based doctors. The values were, respectively, 72% and 86% at five years, 63% and 86% at 10, 58% and 85% at 15, 52% and 82% at 20, and 50% and 81% at 25 years. As with home based doctors, differences between men and women were small.

  Percentage (95% CI) of doctors from overseas homes who were working in the NHS in Great Britain after qualification

Destinations outside the NHS: home based graduates

We subtracted the numbers of doctors in the NHS (known from capture-recapture) from the total number of doctors in the initial cohorts to give the numbers of doctors known not to be in the NHS. We then used the data from the respondents who were not in the NHS, as known to us from each survey of each cohort, and apportioned their responses across the numbers known not to be in the NHS. This assumes that the characteristics of respondents who were not in the NHS are similar to those of the non-respondents who were not in the NHS in respect of sector of employment.

Considering doctors not in the NHS, the largest group were in medicine overseas (for example, 7% of both men and women at year two; 9% of men and 7% of women at year 20). Doctors in medical jobs in Britain, but not in the NHS, comprised 3% of men and 1% of women in year 2; and 7% of men and 6% of women in year 20. Doctors who were not working in medicine at all comprised 2% of men and 4% of women in year 2; and 2% of men and 6% of women at year 20.

Main findings

The great majority of British medical graduates from British medical schools practise in the NHS in both the short and long term. Differences between men and women in whether they worked in the NHS are negligible. Most doctors who were not in the NHS were in medical employment elsewhere. This finding accords with data about what junior doctors say they will do if they leave the NHS: they are much more likely to want to work in medicine elsewhere than to leave medicine. 8

Strengths and weaknesses of the study

Our study provides large scale, long term longitudinal survey data about doctors in Britain. Although response rates were high, we have to consider the possibility of non-responder bias. However, the opportunity to enhance our survey data with workforce statistical records from the Department of Health, and undertake capture-recapture analysis, greatly increased the precision with which we estimated NHS participation in the cohorts. The essence of capture-recapture is to combine the results of two or more independent sources of data to produce much more precise estimates of a population than would be possible from one source alone.

Our calculations of the employment of doctors who were not in the NHS depend on applying the percentages of respondents known to be in non-NHS jobs to the numbers of non-respondents whom we knew were not in the NHS. We have no way of knowing whether the assumption that non-NHS non-respondents have a similar job distribution to non-NHS respondents is justified.

Policy implications and conclusions

A view exists that the increased intake of women to medical school may substantially reduce the percentage of qualified doctors who will eventually work in medicine. 2 9 Our evidence from Britain does not support this view. Percentages of men and of women who eventually work in the NHS are very similar. It is true that, of graduates not employed in the NHS, a slightly higher percentage of women than men are not in medicine; and a slightly higher percentage of men than women are in medicine overseas or in medicine in Britain outside the NHS. It is conceivable that a higher percentage of women who are not in medicine than of men who are not in medicine replied to our questionnaires. If so, some of the apparent difference between women and men not working in medicine might reflect responder bias. Whether or not this is the case, the overall differences between women and men in participation rates in medicine remain small.

As expected, a much higher percentage of women than men work part time. The extent of part-time work by women, rather than whether medically qualified women will work in medicine at all, is the major factor that needs to be considered in workforce planning.

Current British immigration rules allow all doctors who were trained as medical students in Britain to remain in Britain to practise after qualification and to have equal access to jobs and training. 10 11 12 Of doctors whose homes were outside Britain when they became medical students at British universities, the great majority worked in Britain after graduating. Two-thirds were still in the NHS 10 years after qualifying.

From time to time, anecdotal evidence is put forward to suggest that doctors, disenchanted with the NHS, have started to leave it. Our evidence does not suggest that there was any period of time over the past 30 years when there was a sudden and substantial increase in loss of doctors from the NHS. Younger generations of doctors are sometimes viewed as less committed than previous generations to a working career in medical practice, but according to our evidence younger generations are as committed as their predecessors.

What is already known

Very little systematic information is available about the career destinations of medical graduates, including the proportion who eventually practise medicine in the country in which they trained

A common assumption is that a smaller percentage of women than men medical graduates will work in medicine in the long term

It is sometimes considered that there are increases in numbers of doctors quitting the NHS, at times when they become disenchanted with it

What this study adds

The great majority of British-home British-trained medical graduates worked in the NHS, eg 88% at two years after graduation, 86% at 10 years, and 82% at 20 years

The differences between men and women in this respect were negligible

The majority of medical graduates who were not in the NHS were in medicine elsewhere

The majority of doctors who trained in Britain, but who were residents outside it at entry to medical school, subsequently worked in the NHS

We did not identify any times when sharp increases in departure of doctors from the NHS occurred

Cite this as: BMJ 2009;338:b1977

Acknowledgements: We thank the doctors who participated in the surveys, and we thank Emma Ayers, Janet Justice, and Alison Stockford for data preparation and administration.

Contributors: MJG and TWL planned and designed the surveys. MJG and JMD planned the data analysis. JMD undertook the data analysis. TWL provided statistical support. JMD and MJG wrote the first draft of the paper. All authors contributed to further drafts and approved the final version. All had full access to all the data in the study and had final responsibility for the decision to submit for publication, and all are guarantors.

Funding: The UK Medical Careers Research Group is funded by the Policy Research Programme of the English Department of Health. The Unit of Health Care Epidemiology is funded by the English NIHR Coordinating Centre for Research Capacity Development.

Conflict of interest statement: None declared.

Ethical approval: Study approved by Central Office for Research Ethics Committees (COREC), after referral to Brighton Mid Sussex and East Sussex local research ethics committees.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

• ↵ Eckhert NL. The global pipeline: too narrow, too wide or just right? Medical Education 2002 ; 36 : 606 -13. OpenUrl CrossRef PubMed Web of Science
• ↵ Levinson W, Lurie N. When most doctors are women: what lies ahead? Annals of Internal Medicine 2004 ; 141 : 471 -4. OpenUrl PubMed Web of Science
• ↵ Hook EB, Regal RR. Capture-recapture methods in epidemiology: methods and limitations. Epidemiol Rev 1995 ; 17 : 243 -64. OpenUrl FREE Full Text
• ↵ Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1993. BMJ 1996 ; 313 : 19 -24. OpenUrl Abstract / FREE Full Text
• ↵ Lambert TW, Goldacre MJ. Career destinations seven years on among doctors who qualified in the United Kingdom in 1988: postal questionnaire survey. BMJ 1998 ; 317 : 1429 -31. OpenUrl Abstract / FREE Full Text
• ↵ Goldacre MJ, Lambert TW, Davidson JM. Loss of British-trained doctors from the medical workforce in Great Britain. Medical Education 2001 ; 35 : 337 -44. OpenUrl CrossRef PubMed Web of Science
• ↵ Lambert TW, Goldacre MJ, Davidson JM, Parkhouse J. Estimation of numbers of UK medical graduates working in the NHS: comparison of capture-recapture analysis and exhaustive tracing. Journal of Health Services Research and Policy 2004 ; 9 : 234 -6. OpenUrl CrossRef
• ↵ Moss P, Lambert TW, Goldacre MJ, Lee P. Reasons for considering leaving UK medicine: questionnaire study of junior doctors’ comments. BMJ 2004 ; 329 : 1263 -5. OpenUrl Abstract / FREE Full Text
• ↵ Kilminster S, et al. Women in medicine—is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine. Medical Education 2007 ; 41 : 39 -49. OpenUrl CrossRef PubMed Web of Science
• ↵ Byrne E. Should postgraduate training places be reserved for UK graduates? Yes. BMJ 2007 ; 335 : 590 . OpenUrl FREE Full Text
• ↵ Borman E. Should postgraduate training places be reserved for UK graduates? No. BMJ 2007 ; 335 : 591 . OpenUrl FREE Full Text
• ↵ Workforce Directorate of the Department of Health. Modernising Medical Careers (MMC) England. Recruitment to foundation and specialist training: proposals for managing applications from medical graduates outside the European economic area. Equality impact assessment. England: Department of Health, 2008.

• Correspondence
• Open access
• Published: 05 January 2018

The UK medical education database (UKMED) what is it? Why and how might you use it?

• Jon Dowell 1 ,
• Jennifer Cleland 2 ,
• Siobhan Fitzpatrick 3 ,
• Chris McManus 4 ,
• Sandra Nicholson 5 ,
• Thomas Oppé 6 ,
• Katie Petty-Saphon 3 ,
• Olga Sierocinska King 3 ,
• Daniel Smith 6 ,
• Steve Thornton 7 &
• Kirsty White 6  

BMC Medical Education volume  18 , Article number:  6 ( 2018 ) Cite this article

5237 Accesses

33 Citations

5 Altmetric

Metrics details

Educating doctors is expensive and poor performance by future graduates can literally cost lives. Whilst the practice of medicine is highly evidence based, medical education is much less so. Research on medical school selection, undergraduate progression, Fitness to Practise (FtP) and postgraduate careers has been hampered across the globe by the challenges of uniting the data required. This paper describes the creation, structure and access arrangements for the first UK-wide attempt to do so.

A collaborative approach has created a research database commencing with all entrants to UK medical schools in 2007 and 2008 (UKMED Phase 1). Here the content is outlined, governance arrangements considered, system access explained, and the potential implications of this new resource discussed. The data currently include achievements prior to medical school entry, admissions tests, graduation point information and also all subsequent data collected by the General Medical Council, including FtP, career progression, annual National Training Survey (NTS) responses, career choice and postgraduate exam performance data. UKMED has grown since the pilot phase with additional datasets; all subsequent years of students/trainees and stronger governance processes. The inclusion of future cohorts and additional information such as admissions scores or bespoke surveys or assessments is now being piloted. Thus, for instance, new scrutiny can be applied to selection techniques and the effectiveness of educational interventions. Data are available free of charge for approved studies from suitable research groups worldwide.

It is anticipated that UKMED will continue on a rolling basis. This has the potential to radically change the volume and types of research that can be envisaged and, therefore, to improve standards, facilitate workforce planning and support the regulation of medical education and training. This paper aspires to encourage proposals to utilise this exciting resource.

Peer Review reports

Medicine is a cornerstone of higher education globally, with high financial cost and academic resource requirements. Whilst there is no shortage of applicants, there is debate over equity of access, diversity and workforce requirements as well as other issues. In response, the UK Government announced in 2017 an additional 1500 (over 20%) medical school places [ 1 ] with the objective of producing graduates interested in less popular specialities and prepared to work with remote or deprived communities.

In the UK, it is estimated the current 7800 medical school entrants cost the state around £180,000 each (plus personal living expenses) to complete their primary medical qualification. However, this investment of approximately £1.5bn per annum has no organised research and development arm [ 2 ]. Furthermore, the data on which to base selection decisions have never been systematically gathered, which explains why there has been a consistent paucity of robust longitudinal studies within medical education [ 3 , 4 , 5 , 6 , 7 ]. Lack of such UK wide studies was identified as a weakness in the field’s scholarly output by the 2014 UK Research Excellence Framework [ 8 , 9 , 10 ]. Rare events such as leaving medicine or Fitness to Practise (FtP) concerns, require collaboration to collate sufficient numbers for evaluation, and are particularly challenging to perform. The evident success of the multiple UK Birth Cohort Studies is encouraging but also testifies to the challenges of maintaining such as resource [ 11 , 12 , 13 ].

This paper outlines the concept as well as current and planned content of a novel UK national medical education research database (UKMED), and invites researchers and educationists internationally to consider how they might use it. The potential value of a mechanism for tracking the progress of students through medical school and into postgraduate practice, enabling a wide range of original studies to be conducted, has been recognised and is not without precedent. Collating and integrating such a large-scale database could enable high quality longitudinal studies to address significant research questions ranging from selection, through under- and postgraduate training, and eventually into clinical practice and patient outcomes.

Within the UK, the General Medical Council (GMC) has a statutory function under the Medical Act 1983 to co-ordinate the stages and promote high standards of medical education [ 14 ]. A database linking educational outcomes gives the potential to explore the effect of policy changes at each stage of training (medical school, foundation school and postgraduate training programmes) independently. This is key as the GMC’s statutory function justifies using personal data about students and doctors in compliance with the Data Protection Act.

We are not the first to work towards these goals and internationally there have been four related initiatives that we are aware of:

The UK Medical Careers Research Group (MCRG) undertook sequential studies of graduate cohorts from 1973 leading to over 100 publications [ 15 ]

McManus [ 16 ] has led a series of cohort studies, mostly from St Mary’s Hospital Medical School (now part of Imperial College), spanning many years and leading to multiple high impact outputs [ 17 , 18 ]

The Medical Schools Outcomes Database was devised for workforce planning and sought to track graduates in Australia and New Zealand, for example predicting who might wish to work rurally [ 19 , 20 ]

Jefferson Medical School has tracked its own graduates since 1964, leading to a highly effective research programme [ 21 ].

There are also multiple pre-admissions testing organisations that have an interest in evaluating the validity and utility of their assessments and have collaborated with academics in a range of studies. They have provided important insights, especially in USA and Canada, though typically, these organisations have been restricted to a limited range of relatively short-term outcomes (e.g. licensure exam data) or a small number of medical schools [ 22 ]. However, even for non-profit making admissions test providers, funding research could be considered to potentially introduce bias.

Key examples of work to evaluate the validity and utility of pre-admissions testing are available from:

The UK Clinical Aptitude Test (UKCAT) [ 23 ]

Graduate Medical School Admissions Test (GAMSAT) [ 24 ]

The Health Professions Admission Test (HPAT) [ 25 ]

Undergraduate Medicine and Health Sciences Admission Test (UMAT) [ 26 ]

The Medical College Admission Test® (MCAT®) [ 27 ]

The UKCAT consortium commenced in 2005, and since 2006 around 20,000 applicants have sat this aptitude test each year. From its inception, the research potential of data on this scale was apparent but proved hard to realise, primarily because of data protection concerns. It took until 2012 for the first UK wide analyses to emerge [ 28 ] since when over 19 UKCAT related studies have been published [ 23 ]. The consortium has enabled innovative approaches such as the UKCAT-12 study [ 29 , 30 ], and a relevant proof of concept UG-PG matching study [ 31 ].

Hence, in 2011, the Medical Schools Council (MSC) and the GMC were asked to consider extending this database into a comprehensive and ongoing tracking system and research resource, which would link pre-admission metrics (e.g. performance in school level qualifications such as A-levels or Scottish Highers and performance on admissions tests like UKCAT), through graduation and into postgraduate careers. This wider database now also enables new and more detailed areas of research such as:

Recruitment and selection in terms of equity of access and impact on graduate qualities and workforce issues

Assessing the impact of variation or changes in undergraduate education such as comparing graduate and direct entry systems or traditional/integrated/problem-based curricula

Assessing variation in qualities of graduates using a range of outcome measures such as specialist postgraduate exam performance, career choice or FtP events

Equality and diversity in terms of access to and performance within medical careers

Workforce planning and career progression

Patient safety and FtP events

Improving all studies by enabling multivariate analysis to adjust for confounding variables, in particular prior academic attainment.

While no single approach can address all the issues, in this commentary we introduce UKMED as an innovation that offers the opportunity to better understand many of these complex dilemmas. Because patterns of background, performance and capability as a medical student, trainee or doctor often have international relevance and present issues common to all countries, researchers anywhere are invited to utilise UKMED’s unique potential.

Schema and implementation

How was ukmed piloted.

The UK Medical Education Database Phase 1 (2015–2016) was a collaboration that achieved the acquisition, linkage, governance and access to a broad range of routine data on all entrants to every UK medical school ( N  = 15,627) in 2007 and 2008. Extensive data were gathered from the point of application onwards, including graduation, the GMC’s National Training Survey (NTS) and career progression (see Fig.  1 ). Working across agencies enabled three ‘proof of concept’ longitudinal studies to be conducted. The intention was to establish a resource that could be expanded with the addition of successive cohorts and further datasets, ultimately including the planned UK national Medical Licensing Assessment which should provide a common academic outcome measure [ 32 ].

UKMED Phase 1 available data

UKMED Phase 1 established complete coverage of UK medical school entrants and started to support multiple studies. See the UKMED website [ 33 ] for details of all approved studies, data dictionary including online coverage tool, and application forms.

The process has required extensive consultation and legal guidance to address data protection, management and academic governance issues. It was supported by joint leadership from the GMC and MSC, which, due to their roles with all UK medical schools, created a willingness to review and address issues such as data sharing agreements; privacy notices and establishing the GMC as the ‘Data Controller’. (As the Data Controller, the GMC has responsibility for ensuring compliance with the Data Protection Act.) This process took two years but overcame many hurdles, including concerns regarding Freedom of Information (exempt as a research database) and universal coverage as, by using HESA data, UKMED is able to include all UK students in established and emerging medical schools and including UKCAT and GAMSAT selection tests where relevant. Important limitations are acknowledged and discussed below.

Initial database content

In terms of structure based on Phase 1, HESA entry data defined cases for inclusion in UKMED (as not all those who start medical degrees progress to registration) and were linked to test provider data from UKCAT, and GAMSAT using the UCAS person ID [ 34 , 35 ]. Graduates were matched to the GMC register using the medical school code and medical schools’ internal identifying number for each of their students [ 36 ], which the GMC receives as part of the provisional registration process, providing an efficient and reliable approach. There were no selection biases – all cases were included. The GMC number provides links to postgraduate data, including Annual Review of Competence Progression (ARCP) outcomes and royal college exam results; a full list is in the UKMED data dictionary [ 37 ].

Developments since the phase 1 pilot

UKMED is a live project and the UKMED website outlines the current data available, approved research projects and their status [ 33 ]. Key developments since the successful completion of Phase 1 are outlined in Fig.  2 and described below.

Summary of UKMED available data November 2017

The UKMED population is now defined in two ways:

All those who started at a UK medical school since 2002 as defined by the HESA data ( N  = 110,78). The GMC has obtained historical data and now receives updates annually.

Those who have taken part in postgraduate training in the UK since 2012 as captured by the GMC annual census for the National Training Survey [ 38 ]. This includes trainee doctors who obtained their primary medical qualification outside of the UK ( N  = 42,490). Inclusion of all doctors in postgraduate training allows UKMED to be used for studies looking at the predictive validity of selection methods used for postgraduate training programmes. It may also increase the opportunity for international comparisons.

Additional data

Since piloting, UKMED has moved to an annual cycle collating a broader range of undergraduate and test-provider data as well as postgraduate performance and exam data. UKMED now includes:

Data from all medical royal and faculty exams sat from 1 August 2013 by any GMC registered doctor, updated annually

Data since 2014 from the UK Prescribing Safety Assessment (PSA) [ 39 ]

BMAT scores from 2003 [ 40 ]

Data from the Multi-Specialty Recruitment Assessments used for postgraduate training programme selection

Data on practice history. GMC data collected for revalidation purposes originally provided from payroll systems by the four departments of Health: ESR – Electronic Staffing Records. PCIS – Primary Care Information System and SWISS – Scottish Workforce Information Standard System. This allows cases to be tracked through to post-training employment.

Enhancements to the governance processes

It is now possible for researchers to include data generated themselves in a UKMED research extract. This is subject to an information governance review to confirm legality and the presence of suitable identifier for linking purposes. Researchers doing this must make the data available to others via UKMED following completion of their study.

Utility and discussion

UKMED provides access to matched data via a safe haven for studies approved on the basis of their academic rigour and value [ 41 ]. This approach helps address a number of privacy concerns that have hampered research using linked data in other contexts [ 42 ]. It can only be accessed by application to ensure due diligence. Applications are reviewed by an expert panel against the publicly available criteria, including confirmation that only appropriate data are requested. On the basis of this review, a recommendation on each application is made by the UKMED Advisory Board to the GMC as data controller. There are two meetings a year at which applications are reviewed.

The GMC ensures compliance with the Data Protection Act by de-identifying the data: cases are assigned their own unique Study–Id and quasi-identifiers are recoded so unique cases cannot be identified in the extract [ 43 ]. The safe haven further minimises the risk of re-identification; allowing the researchers to run analyses on the extract using the statistical packages of their choice, whilst preventing the export/import of data and re-identification through linkage. Researchers are under contract to use the data only for the purposes of the approved proposal. Analytic outputs are reviewed to ensure compliance with HESA statistical disclosure controls [ 44 ] prior to release to researchers, and all reports are screened prior to publication.

Current guidance from the NHS Health Research Authority [ 45 ] states that Research Ethics Committee (REC) permission is not required, as two exemptions are applicable to UKMED [ 46 ].

“Research limited to secondary use of information previously collected in the course of normal care (without an intention to use it for research at the time of collection) is generally excluded from REC review, provided that the patients or service users are not identifiable to the research team in carrying out the research.”

“Research involving staff: REC review is not normally required for research involving NHS or social care staff recruited as research participants by virtue of their professional role.”

This exemption only applies to data held exclusively in UKMED, so studies that introduce external data may need separate ethical approval and researchers may be required to obtain this from their local committee.

The GMC’s Information Governance Team reviews the privacy statements shown to data subjects; if data collection for a study has not yet commenced, UKMED recommends privacy notices make it clear that:

Identifiable data may be used for future research

Identifiable data may be shared with third parties to undertake the research.

Researchers access data by logging onto the safe haven portal provided by the University of Dundee Health Informatics Centre (HIC) [ 47 ]. Once logged in remotely to the safe haven they are able to work using a Windows desktop and a range of statistical packages. Results are saved onto an output directory which is reviewed before sending to the researcher. Full details are described in the Process for completing UKMED research document [ 41 ].

It is anticipated that access will continue to be provided free of charge. When researchers wish to link additional data to UKMED, they may be asked to cover associated costs, with requests reviewed on a case-by-case basis.

Developments

The creation, use and interpretation of prospective databases is complex. As Pearson [ 11 ] eloquently describes, it is impossible to predict the creative unexpected uses that tend to emerge over time, nor fully address the challenges presented. In particular, the difficulties managing missing data, defining socioeconomic class and equating prior academic attainment of students are challenges within UKMED. A project is underway amongst those conducting the early studies to create some UKMED standard approaches that can be used to simplify these issues. For instance, a syntax for calculating select derived variables using consistent methods is now available and a common approach for multiple imputation of missing values is being considered.

Details of accepted research proposals and their status are available on the UKMED website [ 33 ]. In future, UKMED could enable:

The impact of selection tools to be evaluated in far greater detail and against a wide range of important outcome markers. The comprehensive scale and coverage allows for complex subgroup analysis exploring the impact of background and prior attainment as well as comparing selection tests. Access to retention data, common assessments such as the Situational Judgment Test for selection to the UK Foundation Programme and the PSA introduces new opportunities. Career choices, progression and postgraduate exam performance can be assessed and evaluated in the light of prior attainment and background

Validation studies in the event of the introduction of a UK Medical Licensing Assessment [ 32 ]

Studies into FtP information at the point of graduation, ARCP data and speciality selection information. Thus, an entirely new set of information has been made available for vital key (and relatively rare) performance outcome markers

Studies employing new fields in existing datasets, for instance the GMC’s annual NTS can be amended to include additional questions.

Studies linking external data, for example some centres already have data that merit inclusion (Multiple Mini Interview scores or Conscientiousness Index) and UKMED can be used to both improve and expedite the assessment of these emerging tools. Indeed, entirely new tools can now be designed, and data banked in anticipation that UKMED will provide a follow up mechanism in due course. In particular, this might apply to novel non-academic selection or assessment measures.

Finally, it is possible to conceive of ways in which UKMED might inspire not only new comparisons but generate new interventions. Medical schools could collaborate on testing alternative approaches to complex issues such as improving graduates’ resilience. Even cluster randomised trials might be considered feasible now an efficient follow up system is in place.

The limitations of UKMED.

The data in UKMED are administrative, collected by routine systems. Such data describe what happened but not why or how . There are situations within medical education where qualitative data are very informative. Questions such as unequal access to medical school, the reasons why graduates are reluctant to enter some specialities or work with remote or deprived communities, and doubts about the wider impact of different approaches to selection or education would benefit from qualitative or mixed methods approaches. At the medical school level, there is little data on student aspirations, motivations, interests, personalities and a host of other individual differences which probably underpin much variation. However, UKMED may in future collect some qualitative data in terms of ‘white space boxes’, for instance via the NTS or other independent surveys.

A further limitation concerns examination results. UKMED is collecting data on overall performance in selection tests, medical school examinations (in the form of selection scores for the Foundation Programme) and postgraduate examinations. However, those are total scores of individual applicants. Answers to individual items might be of interest but would produce an extremely complex dataset. Limited data on performance during the undergraduate course are available from some medical schools.

A different sort of limitation is that UKMED only collates data on individuals admitted to medical schools. At present, it does not collect data on individuals who applied but did not enter any UK school, limiting potential for research into selection processes and introducing range restriction issues. For example, if investigating the relationship between UKCAT scores and demographic variables only the better performing cases would be available for analysis within UKMED (such studies would be better conducted using the UKCAT database). Furthermore, even those who apply for medical school are a limited subset of the population as a whole. Recent work suggests that about 10% of 12-year olds put medicine as their first choice for a future career, a figure far removed from the 1% or so of individuals who eventually become doctors [ 48 ]. Finding out about early self-selection is not easy, but might be possible if UKMED can be linked in future to large cohorts such as the Millennium Cohort Study [ 49 ].

Conclusions

The UKMED educational research database presents unique opportunities for multicentre longitudinal studies on ‘big numbers’ covering complex questions. Several studies have been completed and submitted for publication. Although based on UK students, the results have direct relevance for many countries. Research applications for access to datasets are not limited to those in the UK. The challenge is now to ensure that the medical education community takes full advantage of this outstanding new resource.

Abbreviations

Academy of Medical Royal Colleges

Annual Review of Competence Progression

Biomedical Admissions Test

Clinical Knowledge

Foundation Programme Application System

• Fitness to Practise

Graduate Medical School Admissions Test

General Medical Council

Health Education England

Higher Education Statistics Agency

Health Informatics Centre, University of Dundee

The Health Professions Admission Test

Medical College Admission Test

UK Medical Careers Research Group

Medical schools council

National Training Survey

UK wide portal for recruitment to postgraduate medical training programmes.

Prescribing Safety Assessment.

Research Ethics Committee.

Situational Judgement Test.

United Kingdom Foundation Programme Office.

UK Clinical Aptitude Test.

United Kingdom Medical Education Database.

Undergraduate Medicine and Health Sciences Admission Test.

McManus IC (11 October 2016). Hunt promises 25% more medical students in 2018. Br Med J 2016;355: i5480.

Archer J, McManus IC, Woolf K, Monrouxe L, Illing J, Bullock A, Robert T. Without proper research funding, how can medical education be evidence based? Br Med J. 2015;350:h3445.

Article   Google Scholar  

McManus IC, Powis DA, Wakeford R, Ferguson E, James D, Richards P. Intellectual aptitude tests and a levels for selecting UK school leaver entrants for medical school. Br Med J. 2005;331:555–9.

Parry JM, Mathers JM, Stevens A, Parsons A, Lilford R, Spurgeon P, Thomas H. Admissions processes for five year medical courses at English schools: review. Br Med J. 2006;332:1005–9.

Cook DA, Andriole DA, Durning SJ, Roberts NK, Triola MM. Longitudinal research databases in medical education: facilitating the study of educational outcomes over time and across institutions. Acad Med. 2010;85(8):1340–6.

Patterson F, Knight A, Dowell J, Nicholson S, Cousans F, Cleland J. How effective are selection methods in medical education? A systematic review. Med Educ. 2016;50(1):36–60.

Rees EL, Hawarden AW, Dent G, Hays R, Bates J, Hassell AB. Evidence regarding the utility of multiple mini-interview (MMI) for selection to undergraduate health programs: a BEME systematic review: BEME guide no. 37. Med Teach. 2016;38(5):443–55.

Rees C, Francis B, Pollard A. The state of medical education research: what can we learn from the outcomes of the UK research excellence framework? Med Educ. 2015;49(5):446–8.

Butz WP, Torrey BB. Some Frontiers in social science. Science 2006;312(5782):1898-1900. Available at: https://doi.org https://doi.org/10.1126/science.1130121 . Accessed 19 Feb 2017.

MRC Population Health Sciences Group. Maximising the value of UK population cohorts. MRC Strategic Review of the Largest UK Population Cohort Studies. Swindon: 2014 Available at: https://www.mrc.ac.uk/publications/browse/?keywords=maximising&searchSectionID=4BC7DBBA-1972-4E8B-898B31A1B8A6EEB0 . Accessed 19 Feb 2017.

Pearson H. The Life Project: The Extraordinary Story of Our Ordinary Lives. London: Penguin Books; 2016.

Williams C, Birch EE, Emmett PM, Northstone K. Avon longitudinal study of pregnancy and childhood study team. Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study. Am J Clin Nutr. 2001;73(2):316–22.

Google Scholar  

Bath S, Steer C, Golding J, Emmett P, Rayman M. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon longitudinal study of parents and children. Lancet. 2013;382(9889):331–7.

The Medical Act (1983). Available at: http://www.gmc-uk.org/about/legislation/medical_act.asp#5 . Accessed 24 Jan 2017.

University of Oxford Unit of Health-Care Epidemiology. UK Medical Careers Research Group Available at: http://www.uhce.ox.ac.uk/ukmcrg/ . Accessed 18 Nov 2017.

McManus C. University College London Research Department of Clinical, Educational and Health Psychology. Medical Education Studies. 1999. http://www.ucl.ac.uk/medical-education/medical-education-studies . Accessed 28 Dec 2016.

McManus IC, Keeling A, Paice E. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMCMed. 2004;2:29.

McManus IC, Smithers E, Partridge P, Keeling A, Fleming PR. A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study. Br Med J. 2003;327(7407):139–42.

Kaur B, Carberry A, Hogan N, Roberton D, Beilby J. The medical schools outcomes database project: Australian medical student characteristics. BMC Med Educ. 2014;14:180.

Puddey IB, Mercer AA, Playford DE, Pougnault SM, Riley GJ. Medical student selection criteria as predictors of intended rural practice following graduation. BMC Med Educ. 2014;14:218–9.

Gonnella JS, Hojat M, Veloski J. The Jefferson longitudinal study of medical education. Acad Med. 2011;86(3):404. https://doi.org/10.1097/ACM.0b013e31820bb3e7 .

Norcini JJ, Boulet JR, Opalek A & Dauphinee WD. The Relationship Between Licensing Examination Performance and the Outcomes of Care by International Medical School Graduates. Acad Med 2014;89(8):1157-62.

UK Clinical Aptitude Test. Published Research Available at: http://www.ukcat.ac.uk/our-research/published-research/ . Accessed 28 Dec 2016.

Graduate Medical School Admissions Test (GAMSAT) Research Available at: https://gamsat.acer.edu.au/research1 . Accessed 28 Dec 2016.

Health Professions Admission Test–Ireland Research Available at: https://hpat-ireland.acer.edu.au/research . Accessed 28 Dec 2016.

Undergraduate Medicine and Health Sciences Admission Test. Research Available at: https://umat.acer.edu.au/umat-research . Accessed 28 Dec 2016.

Association of American Medical Colleges. 2015. Annotated Bibliography of MCAT ® Research Available at: https://students-residents.aamc.org/content/article/annotated-bibliography-mcat-research/ . Accessed 28 Dec 2016.

Tiffin PA, Dowell JS, McLachlan JC. Widening access to UK medical education for underrepresented socioeconomic groups: modelling the impact of the UKCAT in the 2009 cohort. Br Med J. 2012;344:e1805.

McManus IC, Dewberry C, Nicholson S, Dowell J. The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a collaborative study of twelve UK medical schools. BMC Med. 2013;11:244.

Tiffin P, Mwandigha L, Paton L, Hesselgreaves H, McLachlan J, Finn G, Kasim A. Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study. BMC Med. 2016;14:140.

MacKenzie R, Dowell J, Ayasina D, Cleland J. Do personality attributes assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study. Adv in Health Sci Educ. 2016;22(2)365–385.

General Medical Council (GMC) Press Release 4 June 2015. GMC Council approves development of UK medical licensing assessment Available at: http://www.gmc-uk.org/news/26549.asp . Accessed 28 Dec 2016.

UK Medical Education Database (UKMED) http://www.ukmed.ac.uk . Accessed 5 Nov 2017.

Graduate Medical School Admissions Test (GAMSAT). 2017. Available at: https://gamsat.acer.edu.au /. Accessed 28 Dec 2016.

Higher Education Statistics Agency (HESA). HESA UCAS Personal Identifier Student Record 2016/17 Available at: https://www.hesa.ac.uk/collection/c16051/c/ucasperid/.html/.html/ . Accessed 28 Dec 2016.

Higher Education Statistics Agency (HESA). HESA Unique Student Identifier (HUSID) Student Record 2015/16 Available at: https://www.hesa.ac.uk/collection/c15051/a/husid/ . Accessed 28 Dec 2016.

UK Medical Education Database (UKMED). 2016. UKMED – 2017 v1 Data dictionary Available at: http://www.ukmed.ac.uk/documents/UKMED_data_dictionary.pdf . Accessed 28 Dec 2016.

GMC National Trainee Survey. 2017. Available at: https://www.gmc-uk.org/education/surveys.asp . Accessed 18 Nov 2017.

UK Prescibing Safety Assessment. 2016. Available at: https://prescribingsafetyassessment.ac.uk /. Accessed 18 Nov 2017.

Cambridge Assessment The BioMedical Admissions Test. 2017. http://www.admissionstestingservice.org/for-test-takers/bmat/ . Accessed 18 Nov 2017.

UK Medical Education Database (UKMED). UKMED Process for completing UKMED Research v3 December 2016 Available at: https://www.ukmed.ac.uk/documents/UKMED _research_application_form.pdf [Accessed 14 November 2017].

Hayden JL. The big peek. Nature. 2015;525:440–2.

Sweeney L. Achieving k-anonymity privacy protection using generalization and suppression. Int. J. Uncertainty Fuzziness Knowledge Based Syst. 2002;10(5):571–88.

Higher Education Statistics Agency (HESA). Statistical Confidentiality Policy. Available at: https://www.hesa.ac.uk/about/regulation/official-statistics/confidentiality [Accessed 28 December 2016].

NHS Research Authority. Is NHS REC Review required? 2017. Available at: http://www.hra.nhs.uk/resources/before-you-apply/is-nhs-rec-review-required/ . Accessed 28 Dec 2016.

Queen Mary University of London Ethics of Research Committee. UKMED ethics exemption letter dated 10 December 2015. 2017. http://www.ukmed.ac.uk/documents/UKMED_research_projects_ethics_exemption.pdf . Accessed 19 Feb 2017.

Health Informatics Centre. Safe Haven User Guide October 2015. 2015. Available at: https://medicine.dundee.ac.uk/sites/medicine.dundee.ac.uk/files/Safe%20haven%20User%20Guide.pdf . Accessed 28 Dec 2016.

McManus IC, Ng-Knight T, Riglin L, Frederickson N, Shelton K, Rice F. Doctor, builder, soldier, lawyer, teacher, dancer, shopkeeper. Vet: Exploratory study of which eleven-year olds would like to become a doctor BMC Psychology. 2015;3:38.

Millennium Cohort Study. Centre for Longitudinal Studies Available at: http://www.cls.ioe.ac.uk/page.aspx?sitesectionid=851 . Accessed 14 Nov 2017.

Download references

Acknowledgements

The development of UKMED has been led by the MSC and GMC but would not have been possible without the opportunity to build upon and learn from the work of the UKCAT consortium. In addition, we should like to acknowledge the key contribution of multiple agencies (and their staff) without which this collaboration would not be possible: AoMRC, GAMSAT, HEE, HESA, HIC, UKCAT and UKFPO.

Academy of Medical Royal Colleges (Jane Dacre)

General Medical Council (Peter McNair, Ganesan Gurusamy, Andrew Ledgard)

Graduate Medical School Admissions Test (Veronica Vele and

Marita MacMahon Ball)

Health Education England (Jonathan Howes)

Health Informatics Centre School of Medicine, Dundee University (Mike Ghattas)

Higher Education Statistics Agency (James McLaren, Denise Jones, Claire Morris)

UK Clinical Aptitude Test (Rachel Greatrix)

UK Foundation Programme Office (Charlotte Dainter, Kim Walker and Janet Brown)

HESA Student Record 2007/08 and 2008/09. Copyright. The Higher Education Statistics Agency Limited cannot accept responsibility for any inferences or conclusions derived by third parties from data or other information supplied by it.

The development of UKMED has not been directly funded by but has received support from the General Medical Council and Medical Schools Council as well as staff time from all participating organisations.

Availability of data and materials

Not applicable (see https://www.ukmed.ac.uk ).

Author information

Authors and affiliations.

School of Medicine Deanery, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK

Institute of Education for Medical and Dental Sciences, University of Aberdeen, West Wing, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK

Jennifer Cleland

Medical Schools Council, Woburn House, 20 Tavistock Square, London, WC1H 9HD, UK

Siobhan Fitzpatrick, Katie Petty-Saphon & Olga Sierocinska King

Psychology and Medical Education, University College London, Gower Street, London, WC1E 6BT, UK

Chris McManus

Student Progression & the Centre for Medical Education, Barts and the London School of Medicine and Dentistry, QMUL, Room 2.43 Garrod Building, Turner Street, London, E1 2AD, UK

Sandra Nicholson

General Medical Council, Regents Place, 350 Euston Road, London, NW1 3JN, UK

Thomas Oppé, Daniel Smith & Kirsty White

Health & Obstetrics, Barts and the London School of Medicine and Dentistry, QMUL, VP (Health) Offices, 2nd Floor, Dean Rees House, Charterhouse Square, London, EC1M 6BQ, UK

Steve Thornton

You can also search for this author in PubMed   Google Scholar

Contributions

All authors have participated in the design and development of UKMED, been involved in drafting, accept responsibility for and given approval for publication of the final version.

Corresponding author

Correspondence to Jon Dowell .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

Katie Petty-Saphon, Sandra Nicholson and Jennifer Cleland all currently hold unremunerated roles on the UKCAT executive and have an interest in the success of this charity. Jon Dowell has previously done so. Steve Thornton provides consultancy advice for commercial organisations unrelated to UKMED and is a Trustee of a National charity (Wellbeing of Women).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Dowell, J., Cleland, J., Fitzpatrick, S. et al. The UK medical education database (UKMED) what is it? Why and how might you use it?. BMC Med Educ 18 , 6 (2018). https://doi.org/10.1186/s12909-017-1115-9

Download citation

Received : 15 March 2017

Accepted : 21 December 2017

Published : 05 January 2018

DOI : https://doi.org/10.1186/s12909-017-1115-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Medical schools
• Undergraduate

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Career mobility enriches people and their research and innovation

Director of Talent and Skills, UK Research and Innovation

More people switching between academia, business and government is key to UK’s position as a world-class research and innovation nation.

I had a narrow view of what an academic career looked like when I joined the Economic and Social Research Council (ESRC) 20 years ago. To be fair, I wasn’t alone in thinking that a career in academia was a linear path through the halls of academia.

It reflected my own experience of studying politics at university as an undergraduate and postgraduate and then working with universities in my first years at ESRC.

It was working on a joint ESRC, Biotechnology and Biological Sciences Research Council (BBSRC) and Natural Environment Research Council (NERC) rural economy and land use programme more than 10 years ago that began to open my eyes.

It was innovative for its time in its approach to interdisciplinary working and support for people exchange and mobility. I was seeing for the first time how movement of people between academia, business and government improved the quality and impact of research. I could also see the barriers to that mobility.

Too many conversations I have with students and postdoctorals today continue to reflect a narrow view of what a successful career in research and innovation looks like. The perception remains that you are somehow a second-class citizen if you are not an academic and that what you publish is the key to your success.

Lack of movement hampers our efforts

We want to see more people moving both ways between academia, government and business. I fear lack of movement is reducing opportunities for individuals and hampering our efforts to do world-leading research and innovation to address complex challenges such as reaching net zero and supporting an ageing population.

Yes, we are a world-leading researcher and innovator, but I’ve seen many reviews and studies make the same point that knowledge is siloed, and we must do more to bring research and innovation communities together.

Last year’s independent Nurse review of the research, development and innovation organisational landscape talks about fostering ‘permeability of ideas, technologies and people in both business and academia’.

People and their teams are at the heart of everything we do in research and innovation. They are the ones who have the ideas, and they are the ones who develop the technologies.

Movement spurs creativity and knowledge exchange

It is vital that we have more people moving much more between sectors. It builds connections, joins up thinking, encourages creativity and knowledge exchange and supports adoption of research and innovation.

I represented UK Research and Innovation (UKRI) on the taskforce that produced the recent National Centre for Universities and Business report ‘Pathways to Success’ .

It highlighted the additional benefits of career mobility to individuals, including a broader understanding of applications for their research, wider personal networks and the opportunity to build personal skills and improve salaries.

Switching sectors widens experience

Building on 101 jobs, ‘Switching sectors’ showcases some of the personal and research successes that have grown out of career mobility. I’ve seen lots of impressive stories.

Ashmita Randhawa left India to study biomechanical engineering in the US, moved to Brussels to work on consumer products at Procter and Gamble, then gained an interest in skills development that she decided to pursue at Oxford University.

She is now acting as a bridge between academia and university in her role as director of research and development and lead for Digital Catapult North East Tees Valley at Sunderland Software City .

I’m inspired hearing Ashmita talk about how she learned different things from her respective roles and how she uses that now to build teams and trust in her current job.

Video credit: UK Research and Innovation Video transcript and on-screen captions are available by watching on YouTube.

There are many paths to success

All of us in academia, business and government must continue to promote and value this sort of movement between sectors. We must recognise that there are many ways we can do this and that this should include part-time roles, secondments and placements as well as full-time permanent jobs.

At UKRI, we are promoting career mobility through a range of opportunities that we fund. See the ‘further information’ section for links to our programmes that support cross-sector mobility.

We are increasing the number of students who take industry placements through our doctoral training investments and strengthening expectations on organisations, supervisors and students to explore a broad range of careers.

I was interested to see in a recent evaluation that 60% of BBSRC-funded doctoral students surveyed felt their career ideas had changed due to a placement.

We’re also encouraging greater awareness of career options for postdoctorals through our investments in such programmes as the Prosper initiative and the Centre for Postdoctoral Development in Infrastructure Cities and Energy .

To support flexibility, we are widening eligibility for grants, removing barriers to support for specialist roles and increasing recognition of different roles.

Former army captain examines our future security

I was in Manchester in February for the annual meeting of our 550 future leaders fellows and was amazed at the diversity of careers I encountered among the delegates.

This programme is designed to support talented people whether they are based in universities, businesses or other research and innovation environments. We use Résumé for Research and Innovation (R4RI), which is designed to recognise a wider range of skills and experience than a traditional academic CV.

Dr Patrick Bury is a great example. He is a former British Army captain and North Atlantic Treaty Organization analyst. He is now a reader in security at the University of Bath and was awarded a future leaders fellowship to examine the transformation of transatlantic counter-terrorism in partnership with an international network of experts.

Elements of his earlier work have already helped to develop British defence policy, and it will be no surprise to see his current work helping to improve security for all of us.

We must change our perception of success

It’s clear we must change our perception of what success looks like and move beyond an emphasis on publications.

Of course, the academic outputs of research are important, but we need to expand our definition of research excellence to ensure appropriate recognition and reward is given to the people, culture and environments that are key to a vibrant and sustainable UK research system.

You’ll see that coming through in the REF 28 exercise , which helps to inform decisions on the allocation of around £2 billion of block-grant research funding each year.

We’re also examining our processes for allocating our project-based grants to see how they can better recognise and support the diversity of roles and careers in research. This is building on work we have already done to widen eligibility for our grants.

Great science is a team endeavour

What we are saying is there’s a diversity of people and many routes. People should be able to move across different sectors more easily, move across different disciplines and forge different collaborations.

I see that so much great science and research is a team endeavour. My role is to think about how we support that breadth of people and really understand the contributions they make.

I’m convinced that if we can tap into the talent, wherever they are and whatever their path, our research and our people will be richer for it.

Subscribe for future Voices posts .

Further information

Schemes that support cross-sector mobility, impact acceleration accounts.

Councils involved: UKRI, Arts and Humanities Research Council (AHRC), BBSRC, Engineering and Physical Sciences Research Council (EPSRC), Medical Research Council (MRC) and Science and Technology Facilities Council

Funding type: award via institution

Institutions use Impact Acceleration Accounts funding to rapidly develop research outcomes from our other funding. These activities often involve cross-sectoral working and interaction and can fund placements and secondments.

Future Leaders Fellowships

Councils involved: UKRI

Funding type: fellowship

Future Leaders Fellowships is a flagship UKRI programme that funds fellowships across all sectors, thus enabling the opportunity for long-term, career-changing mobility and the movement of skills.

Innovation scholars secondments

Councils involved: UKRI, AHRC, BBSRC, EPSRC, MRC, Innovate UK

Funding type: grant

The innovation scholars secondments scheme funds flexible, cross-sectoral secondments. Funding opportunities have been offered in biomedical sciences, architecture and design. This scheme directly enables mobility of people and the cross-sectoral element is an eligibility requirement.

Innovation Fellowships

Councils involved: EPSRC

Funded in 2017 by the National Productivity Investment Fund (NPIF), Innovation Fellowships enabled close working between academia and business, resulting in the intersectoral movement of information and skills.

Prosperity Partnerships

Prosperity Partnerships is a flagship EPSRC led programme that funds intersectoral research programmes between business and academia.

These large, long-term grants provide many opportunities for cross-sector mobility and the exchange of skills and ideas.

Local Policy Innovation Partnerships

Councils involved: ESRC

Funding type: centres

ESRC funded four Local Policy Innovation Partnerships to bring together devolved governments, local authorities, local businesses and local communities to harness the power of research and innovation in addressing local challenges.

These centres have driven cross-sectoral working related to policy and social sciences research, moving people, and exchanging skills and knowledge.

Parliamentary Thematic Research Leads

The UK Parliament and the ESRC piloted the Parliamentary Thematic Research Leads roles. Evidence suggests that these prestigious and influential roles are making a positive impact, transferring skills, ideas and people.

As a result, in 2024, parliament will partner with UKRI to expand its network of Thematic Research Leads across a wider range of academic disciplines and policy areas.

UKRI Policy Fellowships

Councils involved: UKRI, AHRC, BBSRC, ESRC

The UKRI Policy Fellowships enhance the relationship between academia, government and research organisations (such as What Works Centres) by improving the flow of evidence, insights and skills by cross sectoral movement of people.

Industrial Strategy Challenge Fund ‘Enabling Research’ call

Councils involved: NERC

Through the Enabling Research call , the funded universities worked closely with partners from across the plastics sector to ensure solutions were responding directly to industry needs. This close working drove cross sector mobility and the exchange of skills and ideas.

Changing the environment awards

Changing the environment awards created new communities to deliver solutions for environmental challenges, taking a whole system approach, drawing across the breadth of appropriate UKRI disciplines.

Cross-sectoral partnerships were required to deliver this, creating many opportunities for cross-sectoral working and the exchange of skills, ideas, and knowledge.

Knowledge exchange fellowships

Funding type: fellowships

NERC knowledge exchange fellowships enable movement of people between sectors to enhance knowledge exchange and drive innovation.

Knowledge Transfer Partnerships

Councils involved: Innovate UK

Knowledge Transfer Partnerships (KTP) is a long-established programme that links innovative businesses with academic skills and knowledge. A partnership is formed between a knowledge exchange organisation and a business or charity with a KTP associate employed to manage the project.

These opportunities provide the possibility of career mobility for the associate and drive the transfer of skills, information and knowledge.

Analysis for Innovators

Councils involved: IUK

The Analysis for Innovators grant enables the UK’s top scientists, using their world-class facilities, to work with companies to address problems in innovative ways. Brokerage meetings foster cross-sectoral working and enable the transfer of skills and knowledge thus boosting a company’s productivity or competitiveness.

Placements and internships for UKRI Doctoral Students

Funding type: placement and internships

Councils provide funding as part of their doctoral training investments to give students the opportunity to undertake placements within other sectors, for example the BBSRC Professional Internships for PhD Students and ESRC Research in Practice placements. They run a cross-UKRI Policy Internships scheme that provides three-month internships for UKRI-funded students at policy organisations.

Academy of Medical Sciences policy internships

Councils involved: MRC

Funding type: internship

Academy of Medical Sciences policy internships allow students on MRC-funded programmes to spend time in medical policy environments, allowing them to gain skills they would not otherwise have and allowing them to work across sectors.

Flexible Talent Mobility Accounts

Councils involved: BBSRC

Funding type: award (via institution)

Flexible Talent Mobility Accounts support placements and exchanges for bioscience research staff from and to universities, BBSRC institutes, businesses, policy, or other settings in the UK and overseas.

Top image:  Credit: UK Research and Innovation

Share this page

• Share this page on Twitter
• Share this page on LinkedIn
• Share this page on Facebook

Frances Burstow

Frances Burstow has worked in a variety of roles since joining the Economic and Social Research Council (ESRC) in 2004, including:

• leading on ESRC investment and policies in researcher development and methodological development and innovation
• strategic lead for skills and methods
• strategic lead for longitudinal studies and head of research grants and policy

This is the website for UKRI: our seven research councils, Research England and Innovate UK. Let us know if you have feedback or would like to help improve our online products and services .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.325(7366); 2002 Sep 28

UK senior doctors' career destinations, job satisfaction, and future intentions: questionnaire survey

Contributors: JP, MJG, and TWL designed the study. Karen Hollick administered the survey, and Janet Justice and Alison Stockford entered the data. JMD analysed the data and wrote the first draft of the paper. All authors contributed to subsequent drafts and approved the final version. JMD, TWL, and MJG will act as guarantors.

Doctors' career choices, destinations, and views about their jobs provide useful insights for workforce planning. We report a survey of all traceable graduates from UK medical schools in 1974.

Participants, methods, and results

We mailed questionnaires in 1998, asking about employment history and current job. In all, 77% (1717/2217) replied (72% (1223) of men and 80% (494) of women). Of respondents, 97% (1673) were in medical employment in the United Kingdom or abroad, and 85% (1460) worked in the UK NHS. The table shows the distribution of their specialties. In NHS general practice, 98% (488) of men and 85% (183) of women were principals; of these, 39% (72) of women and 5% (25) of men worked part time. In NHS hospital practice, 97% (469/485) of men and 76% (114/150) of women whose main paid post was in the NHS (not in a university) were consultants; of these, 26% (30) of women and 11% (50) of men worked part time.

We asked respondents to score five statements about job satisfaction, from “strongly agree” (score 1) to “strongly disagree” (5). The statements were “I find enjoyment in my current post”; “I am doing interesting and challenging work”; “I feel dissatisfied in my current post”; “most days I am enthusiastic about my work”; “I am often bored with my work”). 1 We calculated a job satisfaction score by totalling the scores for all five statements: 20 or more represented a positive response, on average, to all statements, and we suggest that this shows a high level of satisfaction.

Respondents rated their job satisfaction reasonably highly (table), with some significant but small differences between occupational groups. Hospital doctors were more satisfied with their jobs than general practitioners; women general practitioners were more satisfied than men (group median scores 19.7 and 18.8 respectively); and part time general practitioners were more satisfied than those working full time (19.8 and 18.9) (all P<0.001). This last finding was mainly explained by the comparatively lower job satisfaction of male general practitioners working full time.

Respondents practising medicine in the United Kingdom were asked whether they intended to continue doing so for at least another five years. Most respondents definitely intended to do so; more NHS hospital doctors than general practitioners were definite (85.8% (580/676) and 77.9% (553/710); P<0.001). Reasons cited for considering leaving UK medicine included dissatisfaction or disillusionment with their job or with the NHS; ill health; stress or pressure associated with the job; and a desire for change, travel, other interests, or to work in a developing country.

The results provide benchmark findings on the career destinations of doctors who qualified in the 1970s, with which career profiles of more recent generations can be compared. Only a quarter of the 1974 graduates were women. 2 Women from the 1974 cohort were less likely than men to hold consultant or principal posts, and few women were surgeons. Many more women than men worked part time. In the future NHS, many more of the senior posts will be filled by women because more women than men now enter medical school, 3 reversing the former situation in which men substantially outnumbered women. As the government recognises, 4 doctors' working lives need to be balanced with their expectations about raising a family and other interests.

Replies about short term intentions portray a workforce committed to working in the NHS, with stable careers over the next few years. Levels of job satisfaction were generally high. Nevertheless, many respondents commented that they were working close to the limits of what they regarded as a reasonable commitment of their time, and many do not intend to work to the age of 65. 5

Profile of 1673 respondents (graduates from 1974) in medical employment in 1998: specialty and job satisfaction. Values are numbers (percentages of all medical posts) unless stated otherwise

Percentages may not add up exactly owing to rounding. 

Results for individual specialties are based on doctors with NHS contracts in the United Kingdom, including 48 men and 7 women whose main paid post was a university post. 

Acknowledgments

We thank all the doctors who have participated in the study.

Funding: The UK Medical Careers Research Group is funded by the Department of Health. The Unit of Health-Care Epidemiology is funded by the South East regional office of the NHS Executive.

Competing interests: None declared.

• BMJ. 2002 Sep 28; 325(7366): 685–686.

Commentary: Are contented doctors good doctors?

Let's make an assumption—that doctors who are satisfied with their careers, can work as much as they want to (full time or part time), and are not overstretched are happy doctors. But do happy doctors make good doctors, and do unhappy doctors make bad doctors? I am not sure.

It is encouraging to see that most of the doctors in this study (who had been qualified for 24 years at the time they responded) were highly satisfied with their jobs. But what about the younger generation of graduates? They have to negotiate many hurdles that their predecessors escaped, such as the ramifications of Calman training (training at the specialist registrar level—introduced in 1996). Are they also satisfied with their careers, and so are happy and therefore good?

The nearest comparison is the BMA cohort study of 545 doctors who graduated in 1995. The seventh annual report, published this year, is interesting, if somewhat depressing. 1-1 Twenty one per cent of doctors had changed their choice of specialty in the past year. The main reason for this was “hours of work and working conditions,” but in 22% it was because of the tough competition for specialist registrar posts. It is therefore hardly surprising that a quarter stated that their desire to practise medicine was now “lukewarm” and only 13% stated that it was very strong (compared with 44% at graduation). What are we doing wrong?

While Calman training has its good points (standardised and streamlined training in specialty of choice) it is also putting substantial pressure on young doctors. You have to be exceptional rather than competent to gain a “national training number” (entry into the training programme). Even medical students interested in careers in hospital medicine are being advised to do everything they can while they are students so that nothing will be blank on the “desirable criteria” list for specialist training. 1-2

As for the unhappiness with the hours of work and working conditions, this is more proof that the “new deal” (introduced in the United Kingdom in June 1991 to reduce junior doctors' working hours to an average maximum of 56 hours a week) has failed miserably. There are even penalty payments for non-compliance and a contractual obligation to comply by target dates. In some cases the new deal has put more pressure on junior doctors, who are sometimes pressurised by the employing trust to lie about their hours of work. 1-3 It will be interesting to see if the implementation of the European working time directive can do any better. However, some doctors fiercely oppose the implementation of the directive as it will make specialist training even longer—for example, it will now take surgical trainees eight and a half years to accrue the experience currently gained in six years. 1-4

Seven per cent of specialist registrars train flexibly, 1-5 and while this is a good start, it is not enough, and the scheme is vastly oversubscribed. You also have to have a very good reason for wanting to train flexibly—“because I have other interests and want to have a life” is often not good enough.

I don't believe that all this dissatisfaction with careers and working conditions makes today's doctors bad doctors. I think it proves that they have to be very committed to medicine to persist. Surely such dogged commitment is a virtuous and good thing.

On a more positive note, those who regularly read the profiles in Career Focus will know that there are many doctors who still love medicine and are satisfied with their careers. They often have other interests as well, such as writing children's books, being a stand-up comic, and running an art gallery. Could this be the answer to fulfilment, happiness, and therefore “goodness,” I wonder?

Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation

Affiliations.

• 1 Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
• 2 Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom. [email protected].
• PMID: 27737659
• PMCID: PMC5064899
• DOI: 10.1186/s12960-016-0162-3

Background: The greater participation of women in medicine in recent years, and recent trends showing that doctors of both sexes work fewer hours than in the past, present challenges for medical workforce planning. In this study, we provide a detailed analysis of the characteristics of doctors who choose to work less-than-full-time (LTFT). We aimed to determine the influence of these characteristics on the probability of working LTFT.

Methods: We used data on working patterns obtained from long-term surveys of 10,866 UK-trained doctors. We analysed working patterns at 10 years post-graduation for doctors of five graduating cohorts, 1993, 1996, 1999, 2000 and 2002 (i.e. in the years 2003, 2006, 2009, 2010 and 2012, respectively). We used multivariable binary logistic regression models to examine the influence of a number of personal and professional characteristics on the likelihood of working LTFT in male and female doctors.

Results: Across all cohorts, 42 % of women and 7 % of men worked LTFT. For female doctors, having children significantly increased the likelihood of working LTFT, with greater effects observed for greater numbers of children and for female doctors in non-primary care specialties (non-GPs). While >40 % of female GPs with children worked LTFT, only 10 % of female surgeons with children did so. Conversely, the presence of children had no effect on male working patterns. Living with a partner increased the odds of LTFT working in women doctors, but decreased the odds of LTFT working in men (independently of children). Women without children were no more likely to work LTFT than were men (with or without children). For both women and men, the highest rates of LTFT working were observed among GPs (~10 and 6 times greater than non-GPs, respectively), and among those not in training or senior positions.

Conclusions: Family circumstances (children and partner status) affect the working patterns of women and men differently, but both sexes respond similarly to the constraints of their clinical specialty and seniority. Thus, although women doctors comprise the bulk of LTFT workers, gender is just one of several determinants of doctors' working patterns, and wanting to work LTFT is evidently not solely an issue for working mothers.

Keywords: Children; Doctors’ working patterns; Family; Gender differences; Healthcare workforce planning; Less-than-full-time; Part-time; Seniority; Specialty.

Publication types

• Research Support, Non-U.S. Gov't
• Attitude of Health Personnel*
• Career Choice
• Employment*
• General Practitioners
• Logistic Models
• Physicians*
• Physicians, Women
• Specialization
• Surveys and Questionnaires
• United Kingdom
• Work-Life Balance*