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Archived Comments for: The effect of an intercalated BSc on subsequent academic performance

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  1. Comment on: BMC Med Educ. 2011 Oct 3;11(1):76. [Epub ahead of print] The effect of an intercalated BSc on subsequent academic performance. Mahesan N, Crichton S, Sewell H, Howell S.

    Martin Ho Yin Wong, Imperial College London

    8 November 2011

    To the editor:

    I read the recent paper by Mahesan et al1 with great interest, and wondered if the authors had considered several possible confounders to their study. Indeed, it is logical that there may be an association between the two variables in the title of this article, but one has to be cautious whether there is causation.

    For example, at King’s College London where this study is based, doing an intercalated BSc (iBSc) is optional for all medical students, and so one may think that those who choose to do one are already more academically-oriented, determined and motivated than those who do not, and so may score higher in subsequent exams and be positioned in a higher academic quartile because of this principle rather than the BSc itself leading to subsequent higher exam performance.

    At Barts and The London School of Medicine and Dentistry, the iBSc is not offered to all medical students; there is a selection criteria based on their prior academic performance at medical school.2 This means that these intercalating students have already been ‘pre-selected’ and may be likely to score higher in subsequent exams and end up in a higher academic quartile.

    At University College London3 and Imperial College School of Medicine4, the iBSc is compulsory for all medical students, and so possibly the next step to this study would be to analyse similar data from these two universities and to compare and contrast the results. This would remove the optional element of the variable and may help to determine whether the iBSc itself does in fact lead to subsequent higher exam performance or not.

    Regarding the exact correlation between having done an iBSc and subsequent overall Foundation School outcome as mentioned in this study, one has to first understand exactly how the Foundation applications are scored.5 Currently for Foundation programmes commencing in August 2012, students will be ranked according to their overall application score and jobs allocated accordingly. The overall score is out of 100 and is divided into 3 main sections: (1) academic quartiles – max 40 points (1st quartile 40, 2nd quartile 38, 3rd quartile 36, 4th quartile 34), (2) other educational achievements other than the primary medical degree – max 10 points, (3) ‘white-space questions’ – max 50 points. In relation to the terms the authors have used in their article relative to the terms above, ‘academic quartile score’ refers to (1) and ‘application form score’ refers to (2) and (3) combined. In this study, the authors did not separately analyse (2) and (3).

    Of particular relevance is section (2), ‘other educational achievements’. This comprises of ‘additional degrees’, where a doctoral degree (PhD, DPhil etc) is allocated 5 points (not relevant here), a 1st class honours is allocated 4 points, 2.1 class allocated 3 points, 2.2 class allocated 2 points and 3rd class allocated 1 point. The fact that a medical student may have an iBSc automatically means that they will be allocated more points in this category compared to a student without an iBSc, and so is more likely to have a higher overall application score and subsequently more likely to secure their first choice Foundation School. One can say that a statistical analysis was not needed to arrive at this conclusion, due to the fact that this is simply how the scoring criteria works. Furthermore, the other 5 points in section (2) relate to PubMed ID publications, national/international presentations and national/international educational first prizes.5 Again, one can state that undertaking an iBSc opens up many opportunities for a student to obtain these additional ‘educational achievements’, which may otherwise not be as easy for a student who had not undertaken an iBSc, and that a statistical analysis was not needed to arrive at this conclusion. Perhaps one way to overcome this ‘confounder’ is to just analyse similar data relating to sections (1) and (3) taken from a university where the iBSc is compulsory, which may give a more accurate answer to the authors’ study aims.

    In conclusion, although I agree that an iBSc and its associated opportunities will increase the likelihood of a student obtaining a higher overall Foundation score and securing their first choice Foundation School, simply due to the way the Foundation Programme scoring system currently works, I believe more research needs to be carried out to conclude exactly whether ‘doing an intercalated BSc leads to an improvement in subsequent exam results’, as stated by the authors. Furthermore, the ‘white-space questions’ could be analysed separately from the ‘educational achievements’ section in order to discover if iBSc students do develop skills that enable them to obtain higher scores in this section of the Foundation application process.


    1. Mahesan N, Crichton S, Sewell H, et al. The effect of an intercalated BSc on subsequent academic performance. BMC Med Educ [Online] 2011; 11(1):76. Available from: [Accessed 8 October 2011].
    2. Barts and The London School of Medicine and Dentistry. Intercalated degrees. [Online]. Available from: [Accessed 8 October 2011]
    3. UCL Medical School. BSc and IBSc. [Online]. Available from: [Accessed 8 October 2011]
    4. Imperial College London Faculty of Medicine. Studying Medicine – 6 year MBBS/BSc. [Online]. Available from: [Accessed 8 October 2011]
    5. The UK Foundation Programme Office. FP 2012 Applicant’s Handbook. [Online]. Available from: Accessed 8 October 2011]

    Competing interests