Risk factors for poor performance on the undergraduate medical course: cohort study at Nottingham University

To determine the risk factors for poor performance at different stages of the undergraduate medical course. Longitudinal retrospective cohort study of progress on a 5-year undergraduate medical course. The University of Nottingham medical school. All students (594) who joined the course in 3 consecutive years were followed throughout their course until graduation, even if this was delayed. Risk factors for poor performance varied at different stages on the course. Students with lower A levels were at increased risk throughout, but primarily in the pre-clinical course. Non-white ethnicity was also a risk factor, independent of domicile, but this was associated more strongly with lower marks on the clinical course. Males and those who received a later offer of a place were at some risk throughout the course. Overall attrition from the course was 5%, and 34/594 students (6%) spent more than the normal 5 years on the course. School performance remains an important indicator of ability to cope with the pre-clinical course. Further research is required to understand why ethnic minority students may be more at risk at all stages, but particularly in the clinical course, and to increase their use of existing support services if necessary.