What is the association between student well-being and high-stakes examination scores?

Abstract

As educators seek to improve medical student well-being, it is essential to understand the interplay between distress and important outcomes. Performance on Step 1 of the United States Medical Licensing Examination has played a significant role in selection for postgraduate residency positions in the United States and consequently has been a source of great stress for medical students. The purpose of this study was to examine whether student well-being correlates with performance on a high stakes licensing examination. Between 2014 and 2016, three sequential cohorts of medical students at the University of Michigan Medical School completed the Medical Student Well-Being Index (MSWBI) at the end of their 2nd-year curriculum, shortly before taking Step 1. Associations between well-being and Step 1 scores were investigated while adjusting for MCAT scores and cumulative second-year course scores. In total, 354 students were included in the analysis (68.1% of potential responders). On bivariate analysis, poor student well-being (0=low distress [high well-being], 7=high distress [poor well-being]) was associated with lower Step 1 examination scores (slope=-2.10, P<.01), and well-being accounted for 5% of overall Step 1 score variability (R2 =.05). However, after adjustment for MCAT scores and cumulative GPA (full model R2 =.51), the relationship between well-being and Step 1 score was no longer significant (slope=-0.70, P-value=.06). When controlling for metrics of academic performance, student well-being prior to taking Step 1 was not associated with how well students performed on Step 1 for the study sample.