Introduction

Competition for admission to dental schools throughout the United Kingdom is intense with over 11,000 applications to study dentistry made during 2012, far exceeding the number of places available.1 Each applicant will apply to three to four dental schools and as such the number of prospective dental students is in the range of 3,000-3,500. Recruitment of the most appropriate candidates is imperative and a range of 'screening tools' is required for the selection of prospective dental students.2,3 Debate continues as to the best way in which to choose dental students. Previously, much reliance has been placed on pre-admission academic achievement that has demonstrated a relationship with academic performance on a dental degree course.4,5,6 There is, however, the demand for a fairer and more transparent selection process to be developed given that there is a need to select students who have the qualities of a healthcare professional. In addition, there is the desire to widen access to dental schools from individuals from deprived and minority backgrounds and to be able to discriminate between candidates who attain equivalent academic grades at the highest level.7

Within the UK all applications to dental schools are conducted online through the Universities and Colleges Admissions Service (UCAS). Throughout the UK substantial variations remain between and among both non-graduate and graduate-entry dental schools in their admissions processes. Graduate-entry dentistry is a recent innovation in UK dental training and evidence is sparse in relation to student progress and attainment on these programmes. Within the study institution UCAS forms are reviewed for both academic and non-academic achievement. Academically, applicants are expected to hold either a first or upper second class degree in a medical science or health-related degree, although students may be admitted to the course with other degrees where they have demonstrated academic excellence in their programme of study and also, completed an additional science-based university summer school programme. UCAS applications meeting the basic academic requirements are subsequently reviewed by two selectors for non-academic achievements such as evidence of practical skills, team working and work placements within a dental practice or hospital. In addition, a supporting reference is graded and the scores of the assessors are averaged. Grades for academic and non-academic achievement are combined and the highest ranking students are invited for multiple mini-interview (MMI), which consists of a series of stations to assess a variety of domains and assessed by one assessor/station. The UCAS and interview scores are combined and applicants ranked, with offers made to those placed highest.

The current study was designed to determine the relationship between performance at the selection process and subsequent academic performance within a graduate-entry dental school and in addition, to determine the effect of the first degree on achievement within the programme.

Materials and methods

Ethical approval was granted from the College Ethics Research Board to review admission data for 75 students (F: 50; M: 25) for all four years of study admitted to the University of Aberdeen Dental School and Hospital from 2008 to 2011. UCAS forms were reviewed for a pre-admission academic score (PAS) based on academic qualification grades on a scale of 0-25. Grades were awarded according to class of first degree, for example, first, second or third class. Those with masters and PhDs were awarded greater values. All values were assigned by the University Admissions Officer. A minimum value of 19 was required for further admissions consideration. The UCAS forms of those individuals matching the minimum academic tariff, that is 19, were scored (UCAS) on a scale of 0-20 independently by two calibrated admissions selectors, specifically reviewing career aspirations, experience of patient care and interpersonal and practical skills. A supporting reference was given and selectors' scores were averaged. PAS and UCAS scores were combined and the top 60 ranked students were invited for MMI, which was scored from 0-100. MMI consisted of seven minutes with one admissions selector who scored performance according to the following domains:

  1. 1

    Commitment to the University of Aberdeen

  2. 2

    Experience of teamwork

  3. 3

    Exploration of the core qualities of a dental practitioner

  4. 4

    An assessment of communication skills

  5. 5

    Review and assessment of a research article

  6. 6

    Previous work experience within dentistry

  7. 7

    Manual dexterity skills.

Details of the basic demographic data (gender, age) and the first degree were also recorded and the university rank according to the Complete university guide assigned for each degree.8

Assessments consisted of multiple short answer papers (MSAP), objective structured clinical/practical examinations (OSCE). Scores for all end-of-term and end-of-year examinations were converted to the University Common Assessment Scale (CAS) (0-20). The CAS score is not a linear scale and in converting 'raw' marks to a CAS mark there is no requirement that there is the same interval of raw marks for each of the 21 CAS marks. The value of '9' represents the minimum level of performance normally required to be awarded a pass. Examiners decide in a standard-setting meeting the 'raw' mark required to gain a CAS 9 score. Student age, PAS, UCAS, MMI and CAS scores were normalised (Kolmogorov-Smirnov) and data were analysed by multiple linear regression and Pearson correlation and unstacked ANOVA (IBM® SPSS® Statistics 19).

Results

Data were available for 75 students (F: 50; M: 25) with a mean age of 27.7 (SEM = 0.65, range 21.2-54.6) years. Descriptive statistics for PAS, UCAS, MMI and CAS scores are given in Table 1. MMI scores demonstrated a correlation with CAS scores (r = 0.180, p = 0.001, df = 538). Neither PAS nor UCAS scores predicted CAS scores (r = 0.050, p = 0.248 and r = −0.059, p = 0.169, both df = 538, respectively). Associations were noted between MMI stations and CAS scores for previous work experience and manual dexterity and weaker correlations were noted for teamwork and communication skills (Table 2).

Table 1 Descriptive statistics for PAS, UCAS, MMI and CAS scores
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Table 2 Correlation between MMI scores and CAS scores
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Correlations were noted for both university rank and student gender and CAS scores (r2 = 0.201, F = 22.39, p = 0.001 and r2 = 0.156, F = 13.40, p-value = 0.001, both df = 538). Female students attained greater CAS scores than male students (F = 13.40, p = 0.001, df = 538). No association was noted between student age and CAS scores. Correlations were noted between the subject of the first degree and CAS scores (F = 4.08, p = 0.001, df = 9) (Table 3).

Table 3 Correlation between first degree and CAS scores
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Discussion

This small study investigated the association between admissions performance, first degree and subsequent academic achievement within a new accelerated graduate-entry dental school within the UK and forms. This study forms part of an ongoing monitoring of the selection process within the BDS programme at the University of Aberdeen.

Neither PAS nor UCAS scores were predictive of subsequent performance, although MMI demonstrated a small correlation with course achievements. Previous studies have determined that pre-admission academic performance can be a predictor of academic performance4,6 within a degree programme, although the link is less clear for clinical performance.5 Specifically, MMIs that explored teamwork, communication skills, previous work experience and assessed manual dexterity demonstrated a positive association with dental students' performance.

One recent study has identified that the MMI is a useful tool in the selection of dental students.9 Others have developed an evidence-based, objective and structured interview designed to assess the most desirable attributes of a dental professional, which correlated with subsequent formative assessments.10 Another recent review determined that neither academic performance nor interview scores predicted dental students' performance.11 Arguments against MMI related to the expense of running interviews and the potential for assessor bias if a structured system is not enforced.12 MMIs, however, have the ability to assess skills other than academic ability, such as communication skills and manual dexterity, which are important within a clinical discipline.13,14,15

Concerning demographic data, a gender bias was noted with females performing better when compared to their male colleagues. A gender association has been reported previously in dental and medical assessments with one study favouring male students and the other female students.16,17

In relation to first degree, students with medical or anatomy-related degrees and those who had been healthcare professionals previously were better performers. Interestingly, those students with little or no previous science-based experience performed better than the biomedical students among whom there was a wide variation of performance, perhaps given the greater number of students and the range of content of their courses? Data on the academic performance of graduate and non-graduate-entry students are extremely scarce within dentistry. Within medicine, graduate-entry students demonstrated marginally greater academic achievement in the early years of study, which could be explained by an initial science-based degree, although this is not evident during the later years of clinical training.16,17 It is perhaps unsurprising within the current study that those who held a degree in medicine performed better than their cohorts given the overlap in both biosciences knowledge and clinical skills assessment. The latter would be novel to those who held a more theoretical bioscience-type degree.17,18 One other study determined that differences in performance were noted between non-science and science-graduates with science-based prior degrees achieving higher grades in summative assessments, although only at the start of the programme and the effect diminished with time.19 Other studies have demonstrated similar findings between non-science and science-based graduates, although it has been noted that this may be due to age at course entry given a certainty and motivation in relation to career choice. A prior degree, however, in any subject may have some effect on the approach to study in relation to for example prioritisation of learning and time management.20

In relation to the current study, the Admissions Committee will continue to review data obtained from the admissions process and to develop MMI that appear most predictive of performance within the dental course. In addition, the study institution will review the weighting ascribed to the various components of the selection process and where indicated give greater credence to those parts that appear to predict the better performing student.

Conclusions

The current study suggests that there is an association between admission performance at MMI and subsequent achievement on a graduate-entry dental course. In addition, certain prior degrees appear to have an effect on academic attainment. Further data collection and analysis is required to more fully determine the effect of the selection process on student accomplishments.