Medical School Performance Research Articles

Impact of Scribe Experience on Undergraduate Medical Education.

Medical scribes have become a common fixture in healthcare, but little is known about the impact of a scribe experience on medical school performance. The objective of this study was to determine the frequency of scribe experience for medical students and impact on performance. Thirty-four percent of students were scribes prior to medical school. The majority of scribes felt their scribe experience helped them during their pre-clerkship curriculum. However, there were no significant differences in USMLE Step 1 scores, pre-clerkship class rank, post-encounter note grades, and wellbeing between students with and without scribe experience.

Factors Important in the Selection of a Rhinology/Skull Base Surgery Fellow: A National Survey of Fellowship Directors.

The numbers of Rhinology/Skull Base Surgery fellowship programs and applicants have been increasing in recent years. However, little information is currently available with regards to the most important aspects of the application process. The goal of this study was to determine the factors that Rhinology/Skull Base Surgery fellowship directors consider most important when selecting a fellow. An anonymous, online survey was distributed to current Rhinology/Skull Base Surgery fellowship directors. 28 of 31 fellowship directors (90%) completed the survey. Respondents were asked to provide basic information regarding the program and to rank various selection factors they deem most important. For assessing the quality of an application, fellowship directors placed the highest value on LORs. Research experience and publications were also important considerations. The traditional strength of an applicant's residency program was a factor, while medical school performance, USMLE scores, and OTE score did not play a significant role in the selection process. For subjective assessment of applicants, the most value was placed on faculty assessment of the applicant during their interview. Attention was also given to personality fit with the program and the perceived maturity and initiative of the applicant. Numerous academic achievements and personal characteristics are given consideration in the Rhinology/Skull Base Surgery fellowship selection process, but recommendation from a trusted colleague and performance on interviews were viewed to be the most critical factors for fellowship programs in selecting applicants. This is consistent with studies that have explored the selection process for other otolaryngology fellowship programs.

Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice?

Recognizing that physicians must exhibit high levels of professionalism, researchers have attempted to identify the precursors of clinicians' professionalism difficulties, typically using retrospective designs that trace sanctioned physicians back to medical school. To better establish relative risk for professionalism lapses in practice, however, this relationship must also be studied prospectively. Therefore, this study investigated the sequelae of medical school professionalism lapses by following students with medical school professionalism problems into residency and practice. Beginning in 2014, 108 graduates from Harvard Medical School and Case Western Reserve University School of Medicine who appeared before their schools' review boards between 1993 and 2007 for professionalism-related reasons were identified, as well as 216 controls matched by sex, minority status, and graduation year. Prematriculation information and medical school performance data were collected for both groups. Outcomes for the groups were studied at 2 points in time: ratings by residency directors, and state medical board sanctions and malpractice suits during clinical practice. Compared with controls, students who appeared before their schools' review boards were over 5 times more likely to undergo disciplinary review during residency (16% vs 3%, respectively) and almost 4 times more likely to require remediation or counseling (35% vs 9%, respectively). During clinical practice, 10% of those who had made review board appearances were sued or sanctioned vs 5% of controls. Logistic regression for these outcomes indicated, however, that professional lapses in medical school were not the only, or even the most important, predictor of problems in practice. Students with professionalism lapses in medical school are significantly more likely to experience professionalism-related problems during residency and practice, although other factors may also play an important predictive role.

Implications of COVID-19 on the General Surgery Match.

Implications of COVID-19 on the General Surgery Match.

A Descriptive Study on the Sleeping Habits and Correlation of Sleepiness with Academic Performance in a State University-run Medical School in the Philippines

Background and Significance. Sleep is a vital facet of human existence that is vital to learning and memory; lack of sleep is associated with significant impairment in learning. Medical students are a special population because of the demands of medical school. They are very prone to sleep deprivation and poor quality of sleep, hence academic performance might be affected.Objectives. We determined the different sleeping habits of medical students using a descriptive tool, with variables chosen specifically for this study. The level of sleepiness was then correlated with the academic performance (using the general weighted average) among students in a state university run-medical school in the Philippines. Methods. The study is a prospective cross-sectional survey among medical students in a state university-run medical school enrolled for the academic year 2016-2017. The questionnaires used were the Epworth Sleepiness Score and specific questions about sleeping habits. The General Weighted Average (GWA) of those who participated were obtained from the student records section of the college. Descriptive statistics were used to describe the results on different sleeping habits, while the chi-squared test was used to determine any significant differences in the GWA versus level of sleepiness across all year levels. Results. A total of 426 medical students (or 60% of the total student population of the college) participated. However, of the 426, only 326 had complete GWAs and were therefore included in the final analysis for correlation. The average medical student is “sleep-deprived”, sleeping two hours less (six hours) than the recommended daily minimum duration of sleep (eight to 10 hours). For the correlation of sleepiness and academic performance, we found out that there is no significant difference in academic performance among those who are excessively sleepy (ESS greater than 10) versus those who are not, p-value = 0.892. Conclusion. Increased level of sleepiness does not correlate with poorer academic performance among these medical students, despite them sleeping less than the general recommendation for adults. The study is limited however by the use of the GWA as the sole tool to measure academic performance, which is affected by many other factors. We recommend the performance of this study in a broader population and use more validated tools to measure sleepiness and academic performance.

Medical student volunteerism and interest in working with underserved and vulnerable populations

BackgroundThe desire of medical students to eventually work with underserved and vulnerable populations (hereafter ‘service interest’), has been shown to be shaped by individual factors including job satisfaction and financial considerations. School-level factors such as required longitudinal primary care experiences and the availability of extracurricular opportunities to work with underserved patients also affect service interest, but little is known about the impact of student volunteer activities.MethodsThis cross-sectional study gathered data from preclinical medical students via an online questionnaire. The data were linked to academic records, deidentified, and analysed using an ordinal logistic regression model with interest in caring ‘primarily for underserved or vulnerable populations’ as the outcome variable.ResultsOf 121 respondents (33% response rate), 24.8% expressed a definite interest, 55.3% expressed possible interest, and 19.9% expressed no service interest. Intent to work with the underserved was not related to age, sex, race/ethnicity, being from a rural hometown, academic qualifications prior to medical school, or anticipated debt at medical school graduation. Students with no service interest had a higher average academic performance in medical school and plans of subspecialising. When considering volunteerism prior to medical school, students in the highest and middle volunteerism tertiles had 5.68 (95% CI: 1.63, 19.81) and 4.34 (1.32, 14.32) times the odds, respectively, of having definite or possible service interest relative to those who were in the lowest volunteerism tertile, after adjusting for potential confounders. Volunteerism in a student-run clinic for the underserved during medical school was not correlated with service interest.ConclusionsMedical schools looking to enroll more students interested in working with underserved or vulnerable populations may choose to emphasise applicant premedical volunteerism record in their admissions decisions.

Peer Assisted Learning Experience as an Extracurricular Activity during a Gross Anatomy course.

Multiple medical schools have modified classical teaching methods introducing new tools to improve learning processes 1. Amongst these, extra academic activities defined as out of the curriculum, of voluntary participation 2, and without grading, have been described as activities requiring auto discipline, teamwork, commitment and knowledge 3 as these are mostly carried out by an academic peer. These and other group activities in and out of campus should not be overlooked, as they also influence student performance in medical school. Additionally, peer assisted learning has many benefits, which include preparing students as future educators, improving their communication skills and reducing staff workload.The aim of this study is to describe the effect of a peer assisted learning based extracurricular activity on student performance during a Gross Anatomy course in an integrated curriculum medical school and the students’ perception on their own learning process.Quantitative and qualitative data acquisition tools were used to determine the existence or not of an association between the activity and students summative performance. Grades from two groups without the activities n=162 and two with these n=127 were considered with a total of 22 interventions. Additionally, quantitative data was triangulated with qualitative data obtained from a focal group with the student’s perception on their own learning process.No positive association (p > 0.05) between the grades of each group were found. However, as each exam is composed by a theoretical and a practical component, a decrease in the difference between theoretical and practical grades when peer assisted extracurricular activities were applied was evident. When qualitative data was analyzed, there was a general perception by students that they had less stress levels during the practical component after the activity.Peer‐assisted extracurricular activities show to be beneficial for both: those who attend and peers. Students consider this activity as helpful in reducing other factors such as stress and anxiety that may also be influencing their performance on the exam. However, not finding an association may occur because the students who are more academically able tend to seek out teaching and/or research opportunities and participated at these activities 2. This and other factors need to be addressed and evaluated in order to restructure this tool, so it can be improved in a way it can be implemented and fully analyzed in the future.Support or Funding InformationAnatomy Laboratory, Universidad de los Andes School of Medicine

Relationship of Clinical Skills Performance in Medical School With COMLEX-USA Level 2-Performance Evaluation.

Osteopathic medical students are required to pass the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1- and 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation (PE) to graduate. Predictors of COMLEX-USA cognitive exam performance are well established, but relatively few studies have explored factors associated with performance on the Level 2-PE. To evaluate the relationship between school-based clinical competency assessments (written, simulation, and workplace evaluations) and Level 2-PE performance to ensure that these assessment efforts are effective and grounded in evidence to support student readiness. School-based performance measures for 451 first-time takers of COMLEX-USA Level 2-PE were analyzed. A series of Mann-Whitney analyses were applied to compare 3 types of clinical performance assessments against COMLEX-USA Level 2-PE pass-fail performance: (1) internal objective structured clinical examinations (OSCE; average discipline-specific OSCE score and a comprehensive OSCE); (2) national examination performance (average clinical subject Comprehensive Osteopathic Medical Achievement Test, or COMAT, scores and Comprehensive Osteopathic Medical Self-Assessment Examination, or COMSAE, Phase 2 scores); and (3) a workplace-based clinical evaluation by preceptors. Students who passed the Level 2-PE had a significantly higher average discipline-specific OSCE score, COMSAE Phase 2 performance score, average COMAT score, and individual subject COMAT scores in all subjects except Psychiatry. Students who passed the Level 2-PE humanistic domain also had significantly higher scores in the communication skill component of the school's comprehensive OSCE. Similarly, students who passed the Level 2-PE biomedical domain had significantly higher scores in the data gathering and subjective, objective, assessment, and plan documentation scores on the internal OSCE. The size of these differences (η2) was relatively small. Student performance on the competency-based preceptor evaluation showed no significant relationship with pass-fail performance on the Level 2-PE. High-stakes OSCEs aligned with the level 2-PE blueprint are effective predictors of performance and are an important way to support student readiness for the Level 2-PE. Other assessments, such as subject-based COMATs and COMSAE Phase 2, add value to school-based assessments over workplace-based assessments.

Summer Enrichment Program: A Novel Pre‐Matriculation Anatomy Curriculum for Medical Students

Study ObjectivesMedical schools increasingly accept students from Alternative Academic Pathways (“Alt Path”), such as through early assurance programs or after gaps of time in education. These students may have difficulty with the rigors of medical school and need further preparation to succeed. Exposure to first‐year content, including anatomy coursework, prior to starting medical school has been shown to improve students’ academic performance. Through a novel pre‐matriculation Summer Enrichment Program (“SEP”), we sought to prepare Alt Path medical students for their transition to medical school and first‐year courses. Over the years, varying curricula have been implemented.Our objectives include: (1) evaluating the impact of including anatomy in the SEP on the performance of Icahn School of Medicine at Mount Sinai (“ISMMS”) medical students in their first‐year anatomy course, (2) comparing anatomy performance between the SEP participants and traditional path peers, and (3) understanding Alt Path students’ perceptions of preparedness and confidence in starting medical school.MethodsStudents completed a 5‐week intensive SEP the summer before starting medical school with a curriculum utilizing didactics, laboratories, review sessions, and assessments. Anatomy has been included in the SEP for the Classes of 2019 and 2021–2023 cohorts. Anatomy was not included for the Class of 2020 cohort. This provides a natural experiment for comparison of first‐year anatomy course performance between two subsequent cohorts of Alt Path students (Classes of 2019 and 2020). SEP anatomy was taught by the same faculty teaching the first‐year anatomy course. Future data analysis will include comparisons of coursework performance between Alt Path and traditional students among the Classes of 2019–2023 cohorts. For the Class of 2023 cohort, the perceived impact of the SEP on academic performance and adjustment to medical school will be evaluated using surveys and focus groups to holistically triangulate students’ experiences with the SEP.ResultsIn the Class of 2020 cohort (SEP did not include anatomy), 5 of the 8 students who marginally passed/failed the first‐year anatomy course participated in the SEP. In the Class of 2019 cohort (SEP included anatomy), only 1 of the 8 students who marginally passed/failed the anatomy course participated in the SEP. This suggests that anatomy education immediately prior to medical school in the SEP may positively impact students’ course performance. Qualitatively, Alt Path students positively reviewed the SEP and expressed sentiments of preparedness and confidence with first‐year coursework.Despite the small sample size, all SEP iterations since have included anatomy as a primary component of the curriculum. Future analysis of five Class cohorts (Classes of 2019–2023; n=700) may reveal additional insights.ConclusionMedical educators should consider pre‐matriculation programs in order to enhance medical school preparedness and performance of Alt Path students. Providing these students with educational opportunities focused on foundations prior to first‐year coursework may academically and professionally benefit such students.Support or Funding InformationThe authors received no funding for this work.

The Relationships among Self-Designated Disadvantage, Socioeconomic Disadvantage, and Academic Performance in Medical School: A Multi-Institutional Study.

As medical schools seek to address the growing disparity between the socioeconomic makeup of their students and the general population, it is important to understand the academic trajectory of disadvantaged students. We used a locally-developed multicomponent socioeconomic disadvantage (SED) measure and the self-designated disadvantaged (SDA) question ["yes" (+) or "no" (-)] from the American Medical College Application Service application to examine academic performance of students from three disadvantaged categories (high SED/SDA+, high SED/SDA-, and low SED/SDA+); with low SED/SDA-as the reference group across five California schools. Compared with reference, the DA+ subgroups scored lower on USMLE Step 1 and Step 2 Clinical Knowledge examinations and received fewer clerkship Honors. After adjustment for academic metrics and sociodemographic variables, high SED subgroups performed similarly to reference, but performance gaps for low SED/SDA+ students persisted. Medical schools must better understand the institutional and other drivers of academic success in disadvantaged students.

The WRITE Stuff: A Rural Longitudinal Integrated Clerkship Addresses Workforce Needs

Introduction:
 The University of Washington School of Medicine has six campuses in the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. The WRITE (WWAMI Rural Integrated Training Experience) program is a 22 to 24 week long rural longitudinal integrated clerkship experience offered to medical students in their clinical phase (third year) of training. This program seeks to meet the rural workforce needs of the WWAMI region by increasing the number of medical students going into primary care. Critics of LIC’s have expressed concern about overall quality control of the more remote educational experience and the lack of specialty specific teaching. The aim of this study was to compare medical school and PGY-1 performance of WRITE and Non-WRITE students while determining how well each cohort is meeting the regional workforce needs.
 Methods:
 The study group was all UWSOM students who matriculated from 2009 to 2013, advanced to graduation, and subsequently matched to a residency through the National Residency Match Program. WRITE and non-WRITE cohorts were compared for USMLE step 1 and 2 scores, MSPE (Medical Student Performance Evaluation) key word, and self and program director assessments in the first year of residency. The match results of the two cohorts were also compared to determine the proportions entering primary care residencies. Finally, for both cohorts the specialty choice at matriculation was compared with the match results. Descriptive statistics were used to test the comparisons.
 Results:
 The medical school performance of the WRITE and Non-WRITE cohorts was equivalent in all metrics (USMLE Step 1 and 2, MSPE key word, self and program director assessment of performance in the first year of residency). WRITE students were significantly more likely to match into primary care (67.6% vs 48.3%, p<0.001) overall and, in particular, Family Medicine as their specialty (40% vs 14.3%, p<0.001). WRITE students were also more likely to match into the same specialty that they indicated on the UWSOM matriculation survey. For Family Medicine the loss of fidelity between matriculation and match among WRITE students was 3% (43.4 - 40.4) and among Non-WRITE students, it was 6.3% (20.6 - 14.3).
 Conclusions:
 Performance outcomes of the WRITE program are equivalent to a traditional block curriculum. However, the WRITE cohort is significantly more likely to go into primary care fields, especially family medicine and is more likely to stay with the declared specialty at matriculation. Medical schools that seek to increase the number of students going into primary care may benefit from adopting a similar model.

Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study

ObjectivesThe UK Clinical Aptitude Test (UKCAT) previously piloted an assessment of ‘online confidence’, where candidates were asked to indicate how confident they were with their answers. This study examines the...

Prematriculation Healthcare Employment Predicts Success in Clerkship Environment.

The average age of the matriculating medical student is increasing as more students take time between college and medical school. Increasing numbers of students are employed in the healthcare field during these gap years. Studies have explored the relationship between matriculation age and medical school performance with conflicting findings. The impact of prior healthcare employment (PHE) on future clerkship performance has not been explored. We hypothesize that medical school performance metrics would be higher for students with PHE than their peers. A retrospective review of four medical school classes at a single institution was conducted. Each student's admission application was examined to identify students with at least 6months paid employment in a clinical healthcare position (i.e., pre-matriculation direct patient interaction, PHE cohort). Multiple medical school performance metrics were obtained for each student. Of the 434 included students, 49 were PHE (11.29%) and percent of students with PHE trended up over time. MCAT scores, USMLE Step 1, and Step 2 CK scores were not different for PHE and non-PHE medical students. PHE students had significantly higher NBME subject exams, clinical clerkship scores, and cumulative year 3 performance. Students who matriculate to medical school with prior healthcare employment outperform their peers in the clinical environment, possibly due to acquisition of knowledge or skills from their prior employment. These findings support students seeking paid healthcare experiences prior to medical school and have implications for pre-medicine advising, admissions, and medical school curricula.

Are there differences between those doctors who apply for a training post in Foundation Year 2 and those who take time out of the training pathway? A UK multicohort study

IntroductionKnowledge about the career decisions of doctors in relation to specialty (residency) training is essential in terms of UK workforce planning. However, little is known about which doctors elect to...

Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive?

To evaluate for appearance-based discrimination in the selection of radiology residents. A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models. Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]). Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

Determinants of academic performance in medical students: evidence from a medical school in south-east Nigeria.

BackgroundMedical education is considered one of the toughest college degrees to acquire. Exploring the factors that determine good academic performance in medical school will help in the planning of curriculum and assist students to navigate through medical school more effectively.MethodsThis cross-sectional and descriptive study enrolled 145 second year clinical students (500 level) of the Enugu State University of Science and Technology in south-east Nigeria using purposive and convenient sampling method. It assessed factors that predicted good academic performances in surveyed students.ResultsMedical students without membership in any campus group, those that receive(s) less than ten thousand naira (≈US$27) every month as upkeep allowance, those admitted through the University Matriculation Examination, and students who visit their families on a weekly basis were more likely to have better academic performances than those in corresponding categories. Of these significant predictors of good academic performance, mode of admission into medical school (Rs=−0.310 P=0.001) and monthly allowance students got for upkeep (Rs=−0.281 P=0.001) had the strongest correlation with good academic performances.ConclusionOur study identified factors that correlate with academic performances among medical students. We propose frequent appraisal of these factors and support system that will help improve performance in these students.

Anatomy education in Ethiopia - the effect of school background on medical school performance

Objectives: In Ethiopia, western modern education has been introduced in 1908, though there has been traditional education starting from the entrance of Christianity in Ethiopia in the sixth century. Currently, there are thousands of government and private schools in the country. The objective of this study is to identify who scores well in anatomy in the university; students coming from government or private schools? Methods: A cross-sectional study design was used to assess the effect of high school background on medical students’ performance in anatomy among 120 randomly selected students at Bahir Dar University College of Medicine and Health Sciences. Results: Anatomy is given for medical students as separate course in regional approach for ten months after they complete premed courses as five hours lecture and one hour practical session per week. Students than take an exam with theoretical and practical parts, after completion of each region. Out of 120 randomly selected students about 64% joined the university from government schools and the rest were from private schools. From the government school group, only 17% of the students scored low. However, out of the total private school students 40% were low scorers. There was a statistically significant correlation between school background and medical student performance in anatomy (p=0.007). The odds of private school students performance in anatomy was 3.22 times lower than those of government school students (p=0.007) Conclusion: Students graduated from government high schools perform better in academics than students graduated from private schools.

The Revised Medical School Performance Evaluation: Does It Meet the Needs of Its Readers?

The Medical School Performance Evaluation (MSPE) is an important factor for application to residency programs. Many medical schools are incorporating recent recommendations from the Association of American Medical Colleges MSPE Task Force into their letters. To date, there has been no feedback from the graduate medical education community on the impact of this effort. We surveyed individuals involved in residency candidate selection for internal medicine programs to understand their perceptions on the new MSPE format. A survey was distributed in March and April 2018 using the Association of Program Directors in Internal Medicine listserv, which comprises 4220 individuals from 439 residency programs. Responses were analyzed, and themes were extracted from open-ended questions. A total of 140 individuals, predominantly program directors and associate program directors, from across the United States completed the survey. Most were aware of the existence of the MSPE Task Force. Respondents read a median of 200 to 299 letters each recruitment season. The majority reported observing evidence of adoption of the new format in more than one quarter of all medical schools. Among respondents, nearly half reported the new format made the MSPE more important in decision-making about a candidate. Within the MSPE, respondents recognized the following areas as most influential: academic progress, summary paragraph, graphic representation of class performance, academic history, and overall adjective of performance indicator (rank). The internal medicine graduate medical education community finds value in many components of the new MSPE format, while recognizing there are further opportunities for improvement.

Writing the Curriculum Vitae and Personal Statement.

Two of the most important components of the medical student's application for the National Resident Matching Program are the curriculum vitae (CV) and personal statement (PS). The aim of the CV is to give an itemized account of the applicant's accomplishments since the beginning of their undergraduate studies, with the main emphasis on their activities and performance in medical school. The PS, on the other hand, is the applicant's chance to give program directors (PDs) a sense of who they are. The purpose of the PS is to complement but not rehash the CV. It is an opportunity to convey what makes them fit for a residency in emergency medicine (EM). A well-written statement should guide the reader through the heartbreaks, triumphs, and inspirations that drive the applicant. Applicants should remember that the CV and PS are the first impression they brand. Both the CV and PS should be brief; easy to read; professional; honest; consistent; and free of clichés, spelling mistakes, and grammatical errors.

The Match: Magic Versus Machines.

The Match: Magic Versus Machines.