Osama Abu-Tair

The shortage of healthcare professionals is a pressing challenge with which the world is grappling. According to the World Health Organization, there is a staggering shortfall of 4.3 million physicians, nurses, and other health professionals globally – hampering the provision of quality healthcare worldwide. Worse still, this deficit is set to soar to an alarming 10 million by 2030, according to the WHO.

However, where the rest of the developed world faces a challenge, the United Kingdom faces a crisis. A 2022 study published by The BMJ states that one-third of NHS ‘junior’ doctors are planning to leave the country to practice medicine abroad. The situation is exacerbated by industrial disputes that have led to strikes across all seniority levels of physicians, causing longer waiting lists for elective procedures and consultations. The government’s handling of the situation has only raised more concerns.

The Times reports that The UK government plans to double medical school places by 2031 to address physician shortages. This planned increase in medical school places warrants a closer examination of the selection process upon which this expansion relies. All UK medical schools require a clinical admissions test with two options available for undergraduates. This article focuses on the UCAT, which upon closer inspection reveals that there is a lot to be desired.

The UCAT Format

To understand the underlying issues with the UCAT one must first briefly acquaint themselves with its structure.

The UCAT is a five-section test used in a variety of universities across the UK, New Zealand, and Australia. It is designed to measure a variety of clinical and mental skills that could be used to predict the effectiveness of the subject in a medical or dental role provided they are given the education and training. It is broken up into five sections:

The first section is verbal reasoning. Verbal reasoning assesses the candidate’s ability to comprehend passages and answer questions based on them. There are 11 passages, each followed by four questions. The candidate is given roughly one minute and 50 seconds to read the passage which can be up to 300 words long. Decision-making is the second section and assesses the ability to apply logical rules in various formats including text samples, graphs, pie charts, tables, and diagrams.

Quantitative reasoning tests numerical ability at a GCSE pass rate level, assessing candidates’ problem-solving skills. The Abstract Reasoning section assesses shape and pattern recognition with questions grouped in sets of five, and asks candidates to identify the next shape in a series, complete a statement, or determine which shape belongs to a particular Shape Set.

The Situational Judgement Test (SJT) is the final section and presents a series of hypothetical scenarios, often in a clinical setting with up to six questions. Some ask you to rate the importance of statements, while others require you to choose the most and least appropriate action.

The Breakdown

An initial perspective the UCAT already falls short of expectations. Whilst some of the skills covered by each section may seem like a good idea at first, they are assessed in a manner that completely undermines the point.

The first issue lies with the verbal reasoning section. Its aim to test reading comprehension is undermined by its format that encourages applicants to prioritise tactics over understanding. Candidates may ignore context, skim, and answer without comprehension. Additionally, this emphasis on speed may unfairly disadvantage non-native English speakers.

Decision-making processes continue to follow trend with a section that at first glance examines an important skill set, but ultimately fails in execution. The types of questions that can be presented range from tangentially relevant True/False questions to utterly baffling and problem-solving, diagram-based questions that seem to have taken the wrong turn on the way to the ‘crosswords and puzzles’ section of a newspaper.

On the other hand, quantitative reasoning provides a brief breath of fresh air compared to other sections with a well-constructed set of questions to test numerical capability, which can be useful in a clinical setting. However, whilst having good structure and implementation it may not be the most obvious skill to test for identifying future excellent physicians or dentists.

Unfortunately, the break from absurdity ends with quantitative reasoning. If there was any doubt remaining about the UCAT’s irrelevance as a clinical aptitude examination, the Abstract Reasoning section abolishes it all. As the name suggests, the section is incredibly abstract and represents a skill set that many people simply learn to utilise for the test and then proceed to forget. The questions are reminiscent of a sham internet IQ test and have next to no relevance. This section’s only purpose seems to be to throw as many candidates a curveball as possible that perhaps makes it easier for admissions teams to reduce the chances of an applicant earning an interview.

The final section of the UCAT does not contribute to the total UCAT score. Instead, it is displayed alongside the UCAT and allows an admissions team to distinguish applicants who can act appropriately in morally difficult situations. However, anyone who may tend to violate rules or hold little respect for codes of conduct can simply learn how to answer the questions correctly as they all follow a very similar pattern. Memorising a list of basic rules when approaching these hypotheticals can easily ensure you score a good banding in the SJT.

After careful examination, it seems that the UCAT has little relevance to the real medical world. Many of the skills tested are not applicable to medical practice and the testing process itself undermines the exam’s usefulness. A 2021 research article analysed 23 studies and found that the UCAT had no statistically significant predictive validity for over 70% of univariate data points; for the rest, predictive power was weak.

What can be done?

In simple terms, the UCAT needs either overhaul or replacement. We can draw upon inspiration for a solution from other tests. Previously, we mentioned the existence of a second clinical admissions test utilised by medicine schools in the UK, the BMAT. It relies more heavily on scientific knowledge than the UCAT and where it is hardly required. Moreover, the BMAT contains a mathematics section and an essay writing section that allow applicants to demonstrate their communication and reasoning skills.

This lesser used test shows more promise than the UCAT in predicting clinical and academic performance as per the testimony of medical education professionals such as Professor Dr. Jamunarani S Vadivelu of the University of Malaya who said:

“There is a very good correlation to indicate that students with a high score on BMAT do well in the year 1 and year 2 assessments on the MBBS program.”

The BMAT’s assessment of the application of knowledge rather than abstract skills is paralleled elsewhere too. An example can be found in the USA’s MCAT which examines knowledge of various scientific topics as well as reasoning and critical thinking skills for medical school admissions.

For the United Kingdom’s healthcare system to handle upcoming trials, more doctors need to be trained to strengthen the ranks against increasing waiting lists and decreasing care standards. To facilitate this, the outdated and unfair admissions system must be overhauled, starting with the shambolic test it is based on.

Reference list:
– Bala, L., Pedder, S., Sam, A.H. and Brown, C. (2021). Assessing the predictive validity of the UCAT—A systematic review and narrative synthesis. Medical Teacher, pp.1–9. doi: https://doi.org/10.1080/0142159x.2021.1998401 [Accessed 22 Aug. 2023]..
– Editor, K.L., Health Editor | Chris Smyth, Whitehall (2023). NHS workforce to be boosted with doubling of medical school places. www.thetimes.co.uk. [online] 17 Aug. Available at: https://www.thetimes.co.uk/article/nhs-workforece-medical-school-doctors-nurses-v93c887rg#:~:text=NHS%20England%20said%20the%20five [Accessed 22 Aug. 2023].
– Waters, A. (2022). A third of junior doctors plan to leave NHS to work abroad in next 12 months. BMJ, p.o3066. doi: https://doi.org/10.1136/bmj.o3066 [Accessed 19 Aug. 2023].
– World Health Organization (2019). Health Workforce. [online] Who.int. Available at: https://www.who.int/health-topics/health-workforce#tab=tab_1 [Accessed 21 Aug. 2023].

About the Author: Osama Abu-Tair

Periodic content writer and aspiring medical student. I constantly seek out compelling stories, having a particular fascination with the intersections of medicine and social issues in both the UK and the wider global community