Situational judgement test performance and subsequent misconduct in medical students

Abstract

Introduction: Situational judgement tests (SJTs) have been widely adopted, internationally, into medical selection. It was hoped that such assessments could identify candidates likely to exhibit future professional behaviours. Understanding how performance on such tests may predict the risk of disciplinary action during medical school would provide evidence for the validity of such SJTs within student selection. It would also inform the implementation of such tests within student recruitment. Methods: This cohort study used data for 6910 medical students from 36 UK medical schools who sat the University Clinical Aptitude Test (UCAT) SJT in 2013. The relationship between SJT scores at application and the risk of subsequent disciplinary action during their studies was modelled. The incremental ability of the SJT scores to predict the risk of disciplinary action, above that already provided by UCAT cognitive test scores and secondary (high) school achievement, was also evaluated in 5535 of the students with information available on this latter metric. Results: Two hundred and ten (3.05%) of the students in the cohort experienced disciplinary action. The risk of disciplinary action reduced with increasing performance on the admissions SJT (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.69 to 0.92, p = 0.002). This effect remained similar after adjusting for cognitive performance and prior academic attainment (OR 0.77, 95% CI 0.65 to 0.92, p = 0.004). The overall estimated effect-size was small (Cohen's d = 0.08) and no evidence of ‘threshold’ effects were observed for the SJT scores and risk of disciplinary action. Conclusions: Performance on admissions SJTs can, at least modestly, incrementally predict the risk of subsequent disciplinary action, supporting their use in this context. However, for this SJT and outcome, there did not seem a distinct threshold score above which the risk of disciplinary action disproportionately increased. This should be considered when using the scores within medical selection.