Medical School Performance Research Articles

Medical education in a multilingual and multicultural world

Medical education in a multilingual and multicultural world

Student selection: are the school-leaving A-level grades in biology and chemistry important?

This study determined the relationships of grades in A-level biology and chemistry with examination success or failure during the medical course. By inspection of medical student records, A-level grades at entry to medical school and examination performance were obtained for 128 (91%) of the students who sat their final MBBCh examination at the University of Wales College of Medicine in June 1988. The majority, 92 (72%), completed their medical school careers with no professional examination failures; 15 failed examinations just in the period up to 2nd MB; 11 failed examinations in the clinical period only and 10 failed examinations in both periods. Whereas grade achieved in A-level chemistry was not associated with undergraduate examination performance, students with a grade A or B in A-level biology were less likely to have problems than the others (21% compared with 47%; the difference of 26% has a 95% confidence interval of 7% to 44%). Specifically, there appears to be a strong relationship between a low grade in biology and difficulties in the preclinical examinations. Moreover, for those who have difficulties at this stage, this association continues later in the course.

Predictors of Achievement in Academic Medicine

To the Editor. —Brancati et al 1 in their article entitled Early Predictors of Career Achievement in Academic Medicine report that scholastic performance and research experience in medical school predict career achievement in academic medicine in a 1948 to 1964 cohort of male graduates of The Johns Hopkins School of Of the cohort of 1337 students, 121 were women. The decision not to study women is not explained. In a one-sentence disclaimer, the authors acknowledge that the results may not reflect contemporary trainees because of the male selection bias and the single medical school. But they dismiss these threats to generalizability as minor, reflecting their insensitivity to well-known gender differences in both opportunity and achievement in academic medicine. The article would be more satisfactory had it been correctly titled Early Predictors of Career Achievement Among Males in Academic Medicine. Indeed, an unexamined and unmentioned hypothesis remains that the most

Early Predictors of Career Achievement in Academic Medicine

To identify early personal and scholastic factors that predict academic career choice and long-term career achievement among academic physicians. A longitudinal cohort study. Nine hundred forty-four male physicians who graduated from The Johns Hopkins University School of Medicine, Baltimore, MD, from 1948 through 1964. Career achievement outcomes included attained faculty rank in 1990 and the number of citations (20 to 24 years after graduation) to published work. Of the 944 physicians, 424 (45%) had chosen academic careers. Scholastic performance and research experience in medical school were independently associated with having chosen an academic career (P less than .001). Among academicians, higher attained rank in 1990 was independently associated with the following: (1) membership in Alpha Omega Alpha (relative risk [RR] = 4.94, P = .0001); (2) rank in the top third of the graduating class (RR = 2.68, P = .01); and (3) research experience in medical school (RR = 3.11, P = .0001). These three factors were also independently associated with more citations to participants' published work (P less than .05). These data suggest that scholastic performance and research experience during medical school predict career achievement in academic medicine over 20 years in the future.

Reexamination of relationships between studentsʼ undergraduate majors, medical school performances, and career plans at Jefferson Medical College

A reexamination of the possible relationships between medical students' undergraduate academic majors and their medical school performances and career plans seems appropriate, given the continuing changes in the characteristics of the medical school applicant pool in the last several years. This study investigated these relationships by comparing cognitive and noncognitive characteristics of medical students who had had different undergraduate majors. The study sample consisted of 812 students who entered Jefferson Medical College between 1985 and 1988. They were classified into six categories based on their undergraduate majors: biological, chemical and physical, social and behavioral, other sciences, humanities and arts, and indeterminate majors. Results indicated that performances in the basic science component of medical education were about the same for students with different undergraduate majors. The groups had similar rates of delayed graduation, but the attrition rate was highest for students who had majored in humanities and arts. The students in undergraduate disciplines traditionally oriented toward medicine (biological, physical, and chemical sciences) were younger and had made the decision to become a physician at earlier ages than had their counterparts with undergraduate majors in social sciences and humanities. Also, the groups differed with regard to their estimates of their future incomes and plans for professional activities after graduation. Similarities concerning the students' preferred professional activities were also noticed among the groups.

Medical school and residency performances of students admitted with and without an admission interview

In 1982 the Brown University Program in Medicine eliminated the personal interview from its process of selecting applicants for admission to medical school. This study compares the 113 M.D.-program students admitted to the first three classes (entering between 1983 and 1985) without an interview with the 67 students in the previous three classes admitted with an interview. The students' characteristics were essentially the same with respect to the preadmission variables, the proportions of women and minority students, course performances, scores on Parts I and II of the National Board of Medical Examiners examinations, and evaluation scores from residency program directors. This study offers additional evidence that the selection interview, as practiced in most U.S. medical schools, does not contribute to the predictive validity of the admission process.

The Resident Selection Process in Otolaryngology--Head and Neck Surgery

This study was undertaken to characterize the objective information available about applicants to otolaryngology-head and neck surgery residency positions, and to determine the influence of these factors on obtaining a residency position. Applicants to the otolaryngology-head and neck surgery programs at University of Utah, Salt Lake City, University of Texas Medical Branch, Galveston, and University of Louisville (Ky) were studied. Thirty-one variables were examined, representing demographic and academic factors. Excellent academic performance in medical school (as represented by medical school grade-point average greater than 3.4, National Board part I score greater than 650, class percentile rank greater than 85th percentile, honors grades in both junior medicine and surgery clinical clerkships, or [5] election to Alpha Omega Alpha) was significantly correlated with success in obtaining an otolaryngology-head and neck surgery residency position.

Postbaccalaureate preparation and performance in medical school

The question whether postbaccalaureate preparation before matriculation in medical school contributes to medical students' performance was addressed by this study. A total of 610 (91%) of the students who entered Jefferson Medical College between 1985 and 1987 were the study sample. Fifty-eight of these students had taken nondegree undergraduate premedical courses and 15 had taken nondegree graduate courses. Fourteen students held graduate degrees and 60 students had some combination of the aforementioned types of postbaccalaureate preparations. The other 463 students had not taken postbaccalaureate courses. Grades received in medical school courses such as anatomy, biochemistry, mechanisms of disease, physiology, microbiology, pathology, and pharmacology, as well as total scores on Part I of the National Board of Medical Examiners examination were selected as performance variables. Statistical analyses showed that the students who had taken nondegree postbaccalaureate courses had lower undergraduate grade-point averages than those without such courses and received lower grades on some measures of performance in medical school. The students with such additional academic backgrounds were also older than the average medical student. When adjustments were made for undergraduate grade-point averages by applying analysis of covariance, the observed differences that favored the group without postbaccalaureate preparation either became nonsignificant or favored those with such preparation. The differences favoring those without postbaccalaureate preparation could be accounted for mostly by these students' higher undergraduate grade-point averages and younger ages. Implications for admission decisions with regard to the changing applicant pool are discussed.

Academic, social and cultural factors influencing medical school grade performance

Studies of medical student performance have focused on various factors, including premedical academics, maturity, familial background and support, and personal experiences with illness. Most studies have been conducted in countries with highly developed educational systems and similar cultural and social systems. It is not clear that these findings can be applied to developing countries, where the educational and cultural experiences may be very different, and where medical instruction is carried out in a non-native language. Information was obtained from a survey of 153 fifth- and sixth-year medical students at King Abdulaziz University in Saudi Arabia. The survey measured premedical educational, social and cultural experiences that might affect medical school performance. Men performed as well as women in the medical school despite heavy familial and social commitments. Women's performance seems to be more influenced by changes in living environment. Achievement in premedical years was correlated positively with grade performance in medical school. Competence in the high-school English courses was related to medical school performance. Interest in the study of medicine prior to medical school was not related to performance. Other motivations, such as social gains, financial benefits or family wish, were related to lower performance. Current interest in clinical medicine correlated negatively with performance. Students motivated by the presence of chronic ill health in their families performed significantly lower. Factors influencing medical school performance in developed countries had similar impact on medical students in a developing country. Social factors, unique to the country, also play a role in medical student performance.

The measurement of outcomes in the assessment of educational program effectiveness

Postsecondary accrediting agencies recognized by the U.S. Secretary of Education and the Council on Postsecondary Accreditation, including the Liaison Committee on Medical Education (LCME), are required to evaluate educational program effectiveness by determining that institutions and programs document the achievement of their students and graduates in verifiable and consistent ways, indicating that institutional and program purposes are met. For the assessment of medical education programs this represents a departure from the traditional method of inferring quality from institutional compliance with standards for program organization and function. In the new assessment calculus, success is measured as the integrated product of the outcomes, the indicators of achievement that medical schools already are collecting from many sources, for instance, data on premedical achievement and attributes, medical school performance, graduate education ratings and test results, specialty certification, licensure, and practice. Although a recent LCME enquiry showed that 80% of U.S. medical schools were collecting outcome data on students and graduates, there was a lack of coherence and system, little integrated analysis, rare longitudinal study, and limited use of the information to evaluate and revise the curriculum or to validate admissions, promotion, and graduation criteria. The longitudinal study of the quantified results of educational programs need not resurrect old controversies about the linkage between learning in medical school and the quality of doctors' later practice. The purpose of examining outcomes is to gain sharper focus on the achievement of distinctive institutional goals, to facilitate program improvement and renewal, and to better assure the competence of graduates within the boundaries of achievement that schools have drawn as their educational objectives.

Traditional predictors of performance in medical school

This paper addresses the predictive value for performance in medical school of undergraduate grades, the Medical College Admission Test (MCAT), information on the selectivity of the undergraduate institution, and selected transcript data. The performance data examined were basic science grades; clinical science grades; scores on National Board of Medical Examiners examinations, Parts I, II, and III; and information on academic difficulty. Methodological sources of differences in validity data, including restriction in range, criterion attenuation, and method specificity, are discussed. Reported validity data affirm the substantial value of traditional academic predictors of performance in medical school. Selection committees should, nevertheless, supplement academic data with nonacademic and interview information. Their inclusion is particularly important for minority and disadvantaged applicants. Medical schools should assess the validity of their selection systems. Additional research on the relations between academic predictors and performance-based indexes of clinical competence and on the role of traditional predictors with regard to the recently declining medical school applicant pool is suggested.

The Learning-Disabled Medical Student

Developmental pediatricians are being consulted by medical school promotion committees with regard to the course of action to be taken with learning-disabled medical students experiencing academic difficulties. Faculty attitude, a difficulty understanding the nature of learning disabilities, appears to be a major contributor to poor medical school performance on the part of learning-disabled adults. Utilizing the sequential-simultaneous information processing model as a simplified introduction to learning disability patterns, the authors argue that recommending intensive remediation of rote spelling and writing skills in students engaged in graduate education represents both a waste of time and a further emotional trauma to these young professionals.

Effects of academic and psychosocial predictors of performance in medical school on coefficients of determination.

This study was designed to answer the following questions: (1) Does a set of selected noncognitive variables predict medical school performance measures? (2) Is there a significant increase in the coefficients of determination when noncognitive measures are added to the conventional cognitive predictors in regression models? Complete data on all measures were available for 88 sophomore medical students. Cognitive (academic) predictors were undergraduate GPA in science and nonscience courses, and scores on science problems, reading and quantitative scales of the Medical College Admission Test. Noncognitive (psychological) predictors were scores on scales of stressful life events, general anxiety, test anxiety, emotionality, external locus of control, intensity and chronicity of loneliness, sociability, self-esteem, perception of early relationships with mother, father and peers, and indices of over- and underconfidence. Criterion measures were freshman and sophomore GPAs in medical school and scores on Part I of the National Board examinations. Results indicate that (1) noncognitive predictors could significantly predict criterion measures and (2) inclusion of noncognitive measures in a model of cognitive predictors could substantially increase the magnitude of the relationships.

A path analysis of medical school and residency performance. Implications for housestaff selection.

The selection and subsequent performance of 212 internal medicine residents was examined by factor analysis and path analysis. A three-factor solution accounted for most of the variance among the nine selection variables. These three factors, labeled Board Scores, Faculty Evaluations, and Academic Distinction, were then combined with in-training residency performance evaluations and composite scores on the ABIM certifying examination to produce a comprehensive path model of house staff selection and performance. The Academic Distinction factor emerged as the strongest predictor of residency performance,; the Faculty Evaluations factor was also a significant component of the model. Standardized test scores correlated poorly with clinical performance. The data suggest that increased attention to the content of letters of reference could substantially improve their predictive validity. Other means of reporting subjective evaluations may also be needed to increase the stature of non-cognitive attributes in house staff selection decisions.

How do supervising doctors construe the medical student in clinical training?

Basing the prediction of student performance in medical school on intellective-cognitive abilities alone has proved to be more pertinent to academic achievement than to clinical practice. A major obstacle to the development of adequate measures has been the elusive nature of requirements for successful clinical performance. The present study aimed at defining the relevant variables through an analysis of the concept of the medical student held by supervising doctors. With the aid of a methodology derived from cognitive-social psychology, the components of how training doctors of a large medical school evaluate their students were first explicated in structured interviews. In a second phase of the research, 18 supervisors in five major clinical departments rated their student-supervisees on 15 obtained traits. Findings of trait correlations with an overall evaluation, as well as Guttman's 'Smallest Space Analysis' (1968), indicated a clear priority of cognitive-motivational traits in supervisors' judgements and reduced relevance of personal and interpersonal variables. Certain inconsistencies between avowed ideology of medical training and actual supervising practice could be detected.

Premedical and medical school performance in predicting first-year residency performance.

In the study reported here the authors examined the relationships among 40 measures of undergraduate college and medical school performance and competence in 18 medical care tasks during the first year of residency. A rating form was developed for the study to assess residents' competency in the medical care tasks and was sent to the directors of the residency programs entered by the graduates of a medical school. Stepwise multiple regression procedures were used to analyze the relationship between these ratings of residency performance and the residents' premedical and medical school performance and to identify the best predictors of residency performance for the 1982 and 1984 classes. A Rasch model analysis of the residency performance ratings indicated the ease or difficulty of each of the 18 tasks. The results provide information that would allow medical educators to use premedical and medical school performance to predict residents' competencies. The task of "clinically evaluates research and clinical data" was the most difficult for the graduates; that is, they were rated lower on it than on any other task. Two groups of measures of undergraduate and medical school performance were significantly related to performance in the residency: the Part II examination of the National Board of Medical Examiners (particularly the scores on the obstetrics-gynecology, medicine, surgery, and pediatrics subtests and the overall score) and the clerkships (particularly the third-year medicine clerkship, the fourth-year medicine clerkship, and the surgery clerkship).

Use of a medical reasoning aptitude test to help predict performance in medical school.

A medical reasoning aptitude test (MRAT) was designed to assess aptitude for clinical problem-solving in medical school applicants. The purpose of the study reported here was to determine whether the information provided by this test, when used in conjunction with college grade-point averages (GPAs) and scores on the Medical College Admission Test (MCAT), would improve the prediction of medical school performance. Specifically, the authors investigated the incremental predictive value of the MRAT relative to students' overall performance in medical school and, more specifically, to their knowledge and clinical reasoning during preclinical years and clinical performance during the clerkship year. Overall, it was found that, with the exception of the first year, the addition of MRAT scores to the GPAs and MCAT scores increased precision in identifying students who performed poorly or exceptionally well in the second year and the clinical clerkship year. This last finding is especially useful, since few other tests have provided that information. On the basis of the preliminary findings, the authors propose further use and validation of the MRAT.

Medical School Performance of Initially Rejected Students

At the University of Texas Medical School at Houston we had a unique opportunity to examine performance through the medical curriculum and one year of postgraduate training of 50 students initially rejected for medical school. Each had been interviewed by the same Admissions Committee, which earlier had selected 150 students through the traditional process. In contrasting the initially accepted and initially rejected groups, academic and demographic variables accounted for only 28% of group difference. The 72% of group difference not accounted for by the variables examined was presumed to relate to Admissions Committee preference. In attrition and in both preclinical and clinical performance through medical school and one year of postgraduate training, there were no meaningful differences between the groups. The observations suggest that the traditional interview process probably does not enhance the ability to predict performance of medical school applicants.

Medical school performance of initially rejected students

Medical school performance of initially rejected students

Predicting academic performance at a predominantly black medical school.

A study was conducted by the authors that examined the validity of the Medical College Admission Test (MCAT), undergraduate grade-point average (GPA), and "competitiveness" of undergraduate college in predicting the performance of students at a predominantly black college of medicine. The performance measures used in the analysis consisted of course grades in all four years of medical school and scores on both Part I and Part II of the National Board of Medical Examiners (NBME) examinations. The predictive validities of the MCAT scores and undergraduate GPAs were found to be similar to those revealed in earlier studies conducted at predominantly white schools. Two exceptions to these similarities were found. First, the MCAT scores at the black school had a somewhat lower validity in predicting NBME examination scores than was the case at the other schools. Second, of the six MCAT subtest scores, Skills Analysis: Reading had the highest correlation with first-year grades, in contrast to results at the other schools. No differences between men and women were found in the validity of MCAT scores and the GPA. The competitiveness of the undergraduate college attended was found to contribute significantly to the prediction of all measures of medical school performance.