• I C McManus, Eleni Smithers, Philippa Partridge, A Keeling, and Peter R Fleming.
• Department of Psychology, University College London, London WC1E 6BT. i.mcmanus@ucl.ac.uk
• BMJ. 2003 Jul 19; 327 (7407): 139-42.

ObjectiveTo assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers.DesignProspective cohort study with follow up after 20 years by postal questionnaire.SettingA UK medical school in London.Participants511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002.Main Outcome MeasuresTime taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up.Results47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.ConclusionsResults of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

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