Second-year Course Research Articles

Real Customization or Just Marketing: Are Customized Versions of Generative AI Useful?

Abstract Background Large Language Models (LLMs), as in the case of OpenAITM ChatGPT-4TM Turbo, are revolutionizing several industries, including higher education. In this context, LLMs can be personalised through customization process to meet the student demands on every particular subject, like statistics. Recently, OpenAI launched the possibility of customizing their model with a natural language web interface, enabling the creation of customised GPT versions deliberately conditioned to meet the demands of a specific task. Methods This preliminary research aims to assess the potential of the customised GPTs. After developing a Business Statistics Virtual Professor (BSVP), tailored for students at the Universidad Pontificia Comillas, its behaviour was evaluated and compared with that of ChatGPT-4 Turbo. Firstly, each professor collected 15-30 genuine student questions from “Statistics and Probability” and “Business Statistics” courses across seven degrees, primarily from second-year courses. These questions, often ambiguous and imprecise, were posed to ChatGPT-4 Turbo and BSVP, with their initial responses recorded without follow-ups. In the third stage, professors blindly evaluated the responses on a 0-10 scale, considering quality, depth, and personalization. Finally, a statistical comparison of the systems’ performance was conducted. Results The results lead to several conclusions. Firstly, a substantial modification in the style of communication was observed. Following the instructions it was trained with, BSVP responded in a more relatable and friendly tone, even incorporating a few minor jokes. Secondly, when explicitly asked for something like, “I would like to practice a programming exercise similar to those in R practice 4,” BSVP could provide a far superior response. Lastly, regarding overall performance, quality, depth, and alignment with the specific content of the course, no statistically significant differences were observed in the responses between BSVP and ChatGPT-4 Turbo. Conclusions It appears that customised assistants trained with prompts present advantages as virtual aids for students, yet they do not constitute a substantial improvement over ChatGPT-4 Turbo.

Real Customization or Just Marketing: Are Customized Versions of Generative AI Useful?

Large Language Models (LLMs), as in the case of OpenAI TM ChatGPT-4 TM Turbo, are revolutionizing several industries, including higher education. In this context, LLMs can be personalised through customization process to meet the student demands on every particular subject, like statistics. Recently, OpenAI launched the possibility of customizing their model with a natural language web interface, enabling the creation of customised GPT versions deliberately conditioned to meet the demands of a specific task. This preliminary research aims to assess the potential of the customised GPTs. After developing a Business Statistics Virtual Professor (BSVP), tailored for students at the Universidad Pontificia Comillas, its behaviour was evaluated and compared with that of ChatGPT-4 Turbo. Firstly, each professor collected 15-30 genuine student questions from "Statistics and Probability" and "Business Statistics" courses across seven degrees, primarily from second-year courses. These questions, often ambiguous and imprecise, were posed to ChatGPT-4 Turbo and BSVP, with their initial responses recorded without follow-ups. In the third stage, professors blindly evaluated the responses on a 0-10 scale, considering quality, depth, and personalization. Finally, a statistical comparison of the systems' performance was conducted. The results lead to several conclusions. Firstly, a substantial modification in the style of communication was observed. Following the instructions it was trained with, BSVP responded in a more relatable and friendly tone, even incorporating a few minor jokes. Secondly, when explicitly asked for something like, "I would like to practice a programming exercise similar to those in R practice 4," BSVP could provide a far superior response. Lastly, regarding overall performance, quality, depth, and alignment with the specific content of the course, no statistically significant differences were observed in the responses between BSVP and ChatGPT-4 Turbo. It appears that customised assistants trained with prompts present advantages as virtual aids for students, yet they do not constitute a substantial improvement over ChatGPT-4 Turbo.

Change in Medical Students’ Attitudes Towards Family Planning After Pregnancy Counseling Panel Intervention

Purpose: This study evaluates changes in medical students’ attitudes after a virtual pregnancy counseling panel intervention during pre-clinical medical education at Indiana University School of Medicine. We hypothesized that students would feel more comfortable counseling and treating patients for unplanned pregnancy after attending the virtual panel. Methods: Students participated in a “Pregnancy Options Panel” during their second-year course covering reproductive health. The panel consisted of five health professionals: two complex family planning fellowship-trained physicians, an obstetrician gynecologist that does not perform abortions, a pediatrician with adolescent health training, and a licensed clinical social worker with expertise in adoption. The panelists discussed appropriate care for patients diagnosed with unintended pregnancy. Two identical 19-item surveys consisting of multiple-choice and open-ended questions were electronically disseminated before and after the panel to assess students’ comfort and beliefs about family planning counseling and treatment. A $10 gift card incentive was given to all students who completed both surveys. The survey asked students to rank their comfort on a Likert scale from zero to five with zero being “not comfortable at all” and five being “very comfortable” after considering the following question: “Assuming you have the knowledge and training required, if a patient presents in her first trimester requesting an abortion of a normal pregnancy, indicate how comfortable you would feel a) referring the patient to an abortion provider, b) prescribing an ‘abortion pill,’ and c) performing a surgical abortion?” Students were asked the same question under the circumstance of a fetal anomaly incompatible with life or pregnancy posing a life-threatening risk to the mother. Students were furthermore asked to report how they believe a doctor should behave while counseling patients with unintended pregnancy (i.e., having a neutral status or disclosing their personal beliefs). Statistical analyses were performed using non-parametric statistics (Wilcoxon signed rank and McNemar’s test) to compare before and after responses of participants. Results: The second-year medical school class enrolled in the reproductive health course at Indiana University was composed of 366 students with 189 students (51.6%) identifying as female. Of the 366 students, 207 (60.5%) completed the survey before the panel and 181 (49.5%) completed the survey after the panel. The demographics of the students who completed both surveys before and after the panel (171 students, 46.7%) were as follows: 60.6% female, 37.6% male, 64.9% white, 2.9% black, 84.6% non-Hispanic, and 10.7% Hispanic. After the pregnancy panel, students reported increased comfort when contemplating referral to an abortion provider, prescribing a medication abortion, and performing a surgical abortion compared to prior to the panel (p<0.01, all comparisons). Students felt more comfortable referring a patient to an abortion provider (p<0.01), prescribing an abortion pill (p=0.02), and performing a surgical abortion (p=0.05) knowing the fetus had a condition incompatible with life or the mother’s life was at risk after the educational intervention. In addition, students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% vs 42.3%, p<0.01), felt more capable of approaching the conversation about pregnancy options in a genuinely neutral manner (86.4% vs 71.6%, p<0.01), and had a significant increase in preparedness to counsel on continuing pregnancy, abortion, and adoption (p<0.01). There was no change in students’ beliefs when considering if it is ethical for a physician to advocate their position on abortion when counseling a patient, as 90.0% and 95.3% answered “No” before and after the panel, respectively (p=0.08). Conclusions: Our pregnancy options counseling panel effectively guided students through a common reproductive health scenario counseling a patient who has been diagnosed with unintended pregnancy. Second year preclinical medical students felt more prepared to counsel patients neutrally and without influence of their own beliefs after attending the educational event. Students additionally felt more comfortable referring to an abortion provider, prescribing a medical abortion, and performing a surgical abortion after the panel, emphasizing how exposure to family planning scenarios can influence future physicians’ comfort providing non-judgmental counseling and abortion care. Expert panels comprised of health professionals with diverse clinical and social perspectives on pregnancy options can serve as an instructional model for preparing medical students for their obstetric and gynecological clinical clerkship and improving pre-clinical medical curriculum on the often-neglected topic of abortion.

Gender differences in learning and study strategies impact medical students’ preclinical and USMLE step 1 examination performance

BackgroundEvaluation of students’ learning strategies can enhance academic support. Few studies have investigated differences in learning strategies between male and female students as well as their impact on United States Medical Licensing Examination® (USMLE) Step 1 and preclinical performance.MethodsThe Learning and Study Strategies Inventory (LASSI) was administered to the classes of 2019–2024 (female (n = 350) and male (n = 262)). Students’ performance on preclinical first-year (M1) courses, preclinical second-year (M2) courses, and USMLE Step 1 was recorded. An independent t-test evaluated differences between females and males on each LASSI scale. A Pearson product moment correlation determined which LASSI scales correlated with preclinical performance and USMLE Step 1 examinations.ResultsOf the 10 LASSI scales, Anxiety, Attention, Information Processing, Selecting Main Idea, Test Strategies and Using Academic Resources showed significant differences between genders. Females reported higher levels of Anxiety (p < 0.001), which significantly influenced their performance. While males and females scored similarly in Concentration, Motivation, and Time Management, these scales were significant predictors of performance variation in females. Test Strategies was the largest contributor to performance variation for all students, regardless of gender.ConclusionGender differences in learning influence performance on STEP1. Consideration of this study’s results will allow for targeted interventions for academic success.

Raising the bar: Testing prospective reciprocal relationships between multidimensional trait perfectionism and undergraduate academic achievement

Prospective associations between trait perfectionism and academic achievement among undergraduate students were tested via a random intercept cross-lagged panel model. Undergraduate students (N = 316) who were enrolled in the core first- and second-year courses of a social sciences undergraduate program (Mage = 18.01 years, SD = 0.06; 74.86 % female) completed surveys on multidimensional perfectionism and authorized the use of institution-verified grades for research. At the between-persons level and in line with previous research, self-oriented perfectionism (SOP) was positively linked with academic achievement whereas socially prescribed perfectionism (SPP) was negatively related with academic achievement. At the within-persons level, an increase in academic achievement at the end of students' first year of university, compared to their own personal mean, predicted an increase in SPP at the midterm of their second year of university, demonstrating that academic achievement may encourage undergraduate students to “raise the bar” via amplifying their perfectionistic tendencies.

Effectiveness of distance learning for preclinical periodontal education.

This study aimed to investigate the effectiveness of distance learning (DL) for the second-year periodontics course compared to classroom learning (CL). MATERIALSANDMETHODS: DL for Class A (n1=126) and CL for Class B (n2=133) were implemented. The same instructors recorded or delivered the same lectures in the two learning modules during the second-year periodontics course. Classes A and B took the same final examinations (a total % score of 200). General linear model (GLM) and ordinal logistic regression (OLR) analyses were conducted after considering individual first-year final % scores as a covariate to test if the second-year final % scores and the distributions of letter grades were significantly different between Class A andB. The mean second-year final % score of the DL group (166.4) was significantly higher than that of the CL group (160.8) (independent t-test, p=.019). However, in GLM, the first-year final % scores significantly affected the second-year scores (p=.016); the second-year final % scores between the two groups were not significantly different (p=.268) after considering the individual first-year scores. In OLR, there was no difference in the likelihood of getting lower grades in the second-year course between the two groups (odds ratio=1.6; 95% confidence interval=[0.95, 2.72], p=.078) after considering the first-year final % scores. Within the limitations of the study, the DL for preclinical periodontics resulted in comparable student learning outcomes when compared to the traditional CL.

Technology, the flipped classroom, and exigent paradigm shifts or being forced into the present

Technology, the flipped classroom, and exigent paradigm shifts or being forced into the present

Impact of Simulation-Based Teaching in the Development of Students' Exploration and Learning Skills

Abstract :Students in higher education, learn many courses in their curriculum, especially in various engineering streams. Not all the courses in the curriculum are accompanied by physical laboratories to have practical exposure. Some of the courses are restricted only to theory content. In this context, simulation-based teaching and learning make such courses more interesting and enhance student learning and interaction in classrooms even in online or offline teaching. For the courses that are supported by simulation software, the facilitator or instructor can apply the simulation-based training techniques, tools, and strategies in designing well-defined learning capabilities. As a part of the study, simulation-based teaching and learning was tested in delivering two courses online. One of them is a third-year course “Antennas and Propagation” wherein the “Antenna Designer” application in Matrix Laboratory (MATLAB) environment was used to ensure the students learn the performance of an antenna, based on various design parameters and the other one is a second-year course “Electronic Circuit Analysis” wherein “Multisim Live online simulator” was used for designing and analyzing the circuits. The participation and engagement of around 65 learners each year were examined by the way they performed the complete design and analysis in the respective courses. The student's performance was assessed based on the clear demonstration of design and analysis they performed. This experiment found that about 80% of students benefitted from the experiment in terms of what they learned and how well they could do analysis, in both courses. This method of simulation-based learning embedded with the instructional design helped the students enhance their exploration skills and hence supported learning new concepts. Keywords : Student Engagement, Simulation-Based Le arning, Shor t Demonst ra tions, Student Assessment, MATLAB, Multisim.

#eindakoa (what we have done): A Pedagogical Method of Interior Design Studio

This paper is based on a report of the subject of Interior Projects Design Studio in the second-year course at IDarte. Each exercise of the course is summarized by an image. The image is accompanied by a brief report including the approach, the conceptual support, the historical and philosophical references, as well as the pedagogical orientation and the strategy of the exercise. The originality of this pedagogical method is based on offering the maximum freedom to the student in terms of personal creativity, while always working within a framework and within defined limits. This framework is designed in such a way that, in itself, it offers a complete methodological palette through which students assimilate the content of a subject such as Projects that is so difficult to define and specify. It does so in such a way that each exercise of this framework recreates the constitutive qualities of the architectural project: form, space, function, place, program, etc. In fact, each exercise is singled out based on some of these intrinsic qualities, enhancing the learning of these concepts, which most of the time would remain inaccessible. Thus, we stretch the conditions of each exercise to disparate and opposite extremes, to broaden the creative possibilities of the students (Santa-María, 2019:113; Viaplana, 2016:57). The conclusion represents a tapestry in which each exercise forms a ‘network’ along with the rest. Hence the value of the framework of this paper, since it already constitutes what could be defined as ‘the design of the design’.

Censoring Intersex Science: A Medical School Scandal.

A senior pediatric endocrinologist at a leading medical school in Canada has for years provided the introductory lecture on Disorders of Sex Development/Intersexuality (DSD/I) in the standard second-year course. In 2020/2021, two students complained to medical school administrators about six specific issues of intersex theory and care that were addressed in the lecture (Polychronakos, 2021). Subsequently, the administration replaced the professor with a different lecturer, thus effectively censoring the dissemination of intersex science. An overview of the status of the clinical literature on intersexuality shows that the students' critiques focus on concepts and facts that have been developed in extensive medical and sexological research over the past 50-60years, as is shown for each of their points of critique. By censoring the professor's teaching, the medical school not only violated academic freedom, but also suppressed well-established scientific facts, kept medical students uninformed about the diverse points of view in this area of clinical management, and likely undermined future evidence-based medical and psychosocial care by these students for individuals with this type of medical condition.

Learning-by-Concordance of Perception: A Novel way to Learn to Read Thoracic Images

Learning to interpret thoracic images requires intensive instructor support. Given current cohort sizes at teaching hospitals in North America, instructor availability is rare. A Learning-by-concordance of perception (LbCP) online tool was introduced in a second-year course on lung and oxygenation. The LbCP tool presents thoracic images, students must point or outline abnormal structures directly on the screen and name the lesion. Thereafter, images with correct outline are superimposed on student's work and three key-messages are provided. We aimed to measure student perception of LbCP tool's usefulness and ease of use. The online tool was developed and implemented for second year students for cohorts in 2016, 2017 and 2018 (n=296; 303; and 280; N=879). A survey, comprisingsix questions on a Likert scale was designed to measure perceptions about tool utility and ease of use. An ANOVA analysis was carried out to ensure the normality of the data, and a principal axis factor analysis was used to confirm the presence of the two expected clusters corresponding to our two dimensions. The ANOVA conducted on the combined three year data set revealed an F value of 7.688 (p=0.001), and principal axis factorial analysis revealed a one factor solution. The percentage of variance explained by the factor was 44.5%, with factor loadings leaning heavily in favor of the tool's perceived utility. A second factor was just shy of the eigenvalue threshold of 1.0 and could provide support for the tool's ease of use. The online LbCP tool shows promising impact over three cohorts of students in three consecutive years. Students recognize the pedagogical value of the tool and express their willingness to use more of it in their training.

Implementation of team-based learning (TBL) in a second year medical school course: does prior experience with TBL improve the impact of this pedagogy?

BackgroundWe have shown that use of Team-based learning (TBL) in a first-year Infectious Diseases (ID) course improved final examination and course performance. Therefore, we implemented TBL in the second-year Women’s Health (WH) course to improve acquisition of course content. We hypothesized that prior experience with TBL in the first-year of medical school would lead to a strong correlation between TBL performance in the first and second years.MethodsOur study is a retrospective review of student TBL and final examination performance in the ID and WH courses. The ID course has weekly TBL exercises that cover all course material, while the WH course has one TBL that covers a small portion of the course material. Final examination and TBL individual readiness assurance test (iRAT) scores in the ID and WH courses from three classes (n = 226) were obtained with institutional review board approval. Statistical analyses were performed including comparisons of means and correlation studies.ResultsAverage WH iRAT scores were significantly higher than ID iRAT scores (9.19 vs. 7.40,p < 0.01), and iRAT scores in both courses were highly correlated (r = 0.35,p < 0.01). When stratifying students based on WH course performance, in struggling students, iRAT but not final examination scores were higher in the WH course than the ID course (8.73 vs. 7.00,p < 0.01 and 82.45 vs. 80.51,p > 0.05, respectively).ConclusionsOur results suggest that prior experience with TBL improves TBL iRAT scores, especially in struggling students. Prior TBL experience is also associated with consistent iRAT performance between first- and second-year courses in high performing students.

What Do Peer Evaluations Represent? A Study of Rater Consensus and Target Personality

When professors assign group work, they assume that peer ratings are a valid source of information, but few studies have evaluated rater consensus in such ratings. We analyzed peer ratings from project teams in a second-year university course to examine consensus. Our first goal was to examine whether members of a team generally agreed on the competence of each team member. Our second goal was to test if a target’s personality traits predicted how well they were rated. Our third goal was to evaluate whether the self-rating of each student correlated with their peer rating. Data were analyzed from 130 students distributed across 21 teams (mean team size = 6.2). The sample was diverse in gender and ethnicity. Social relations model analyses showed that on average 32% of variance in peer-ratings was due to “consensus,” meaning some targets consistently received higher skill ratings than other targets did. Another 20% of the variance was due to “assimilation,” meaning some raters consistently gave higher ratings than other raters did. Thus, peer ratings reflected consensus (target effects), but also assimilation (rater effects) and noise. Among the six HEXACO traits that we examined, only conscientiousness predicted higher peer ratings, suggesting it may be beneficial to assign one highly conscientious person to every team. Lastly, there was an average correlation of.35 between target effects and self-ratings, indicating moderate self-other agreement, which suggests that students were only weakly biased in their self-ratings.

Perceived changes of identity construction through digital storytelling:

Study abroad (SA) is considered one of the best ways to learn a foreign (FL) or second language (L2) while developing open-mindedness and intercultural awareness. Yet, less attention has been placed on students’ perception on identity development. Thus, this study explores study abroad (SA) students’ perceptions on identity construction through the incorporation of multiliteracies and multimodal texts (digital stories), by six participants in a second-year foundational Spanish course and an Advanced Spanish Grammar course in a Study Abroad (SA) program. Analyses of surveys, DSs, and final artifacts were grounded in Rogers’ notion of self-concept and Activity Theory (Leontiev, 1978). Results suggest that the digital and multimodal nature of DS creation facilitated greater opportunities for students to document their self-perceived gains in identity.

Improving the student learning experience through the student-led implementation of interactive features in an online open-access textbook

This case study highlights the work of Students as Partners (SaP) as a balanced approach for implementing and evaluating an online open-access textbook in introductory animal physiology at the University of Toronto Mississauga. Started in 2017 with an eCampus Ontario grant, the project involved undergraduate and graduate students developing and improving an open-access e-textbook to support student learning in a second-year undergraduate introductory animal physiology course. This case study focuses on the 2019–2020 academic term and the work of two undergraduate students working alongside faculty and two librarians. As part of their research, the partners consulted the literature and gathered feedback from students taking the course in which the open e-textbook was used. Student partners added updates and new interactive features to create a more engaging educational resource to support student learning. The partners also reflected on their role in the open educational resource development process.

Individualized summative assessments as used during COVID-19

In this classroom note, we outline a system of assessment used by the authors since 2020 to deliver individualized summative assessments to students from first- and second-year mathematics courses. Our system comprises three modular components allowing a mix-and-match of different technological approaches and mathematical question types. First is a question generation module that generates appropriate variables and question syntax, second is a delivery module to send out the individualized assessment to students, and third is a marking module to generate worked solutions and final answers for markers. The key benefits of these assessments are an ability to incorporate individualized authentic elements into assessments, to allow access to technology that would be impractical for an invigilated exam setting, whilst overall reducing the likelihood – but increasing the ease of detection – of academic misconduct and contract cheating, compared with other non-invigilated assessment protocols.

Writing for Wikipedia: An Exercise in Microbiology, Writing, Research, Communication, and Public Service.

The COVID-19 pandemic has had a tremendous impact on how postsecondary education was and is delivered. Educators were forced to rapidly move their instruction online and find new and innovative ways to convey content, stimulate student engagement, and satisfy curricular requirements. The purpose of this article is to describe the use of a Wikipedia writing assignment in Veterinary Bacteriology and Mycology, a second-year course in the Doctor of Veterinary Medicine (DVM) curriculum at the University of Saskatchewan. Students had the opportunity to write and edit incomplete articles on topics related to course content. In addition to deep exploration of a topic, this fostered in students the development of research and communication skills, which have been articulated as core competencies in veterinary programs.

Revisiting the relationship between constructive alignment and learning approaches: A perceived alignment perspective.

The constructive alignment (CA) of university teaching is designed to encourage students to adopt a deep learning approach, which supports meaningful learning. The evidence is mixed, however, with some studies showing that students may adopt a surface approach even when teaching promotes deep learning. To add to the understanding of the relationships between CA and learning approaches, we explored with quantitative measures two potential implications from prior qualitative research. First, we assessed with a novel questionnaire if students’ CA perceptions predicted adaptation towards a deep learning approach. Second, we explored relationships between deep approach adaptation and learning motivation, as well as perceived mental workload. 56 students from two second-year courses in different study programmes completed a learning approach questionnaire in the second (T1), seventh (T2), and the final fourteenth (T3) course week. At T2 and T3, participants also rated the constructive alignment of the course, their learning motivation, and the mental workload. Regression analyses showed that ILO Clarity (i.e. being clear about the intended learning outcomes of the course) and receiving effective feedback were associated with a significant increase in deep approach scores from T2 to T3. That deep approach adaptation was in turn positively related to learning motivation in terms of higher ratings of one’s competence, the importance of high course performance, and course usefulness. Moreover, deep approach adaptation went with higher satisfaction of having accomplished one’s learning goals, but also with stronger feelings of insecurity and stress. Our findings suggest that students’ CA perceptions are meaningful predictors of learning approach adaptation that might eventually be developed into indicators of the effectiveness of CA implementation at the course level.

Generated Themes of E-learning: Exploration of Students’ Challenges During Covid-19

Objective: To explore the perception of undergraduate nursing students of second-year courses regarding e-learning experiences, competencies, interests, and values and obtain suggestions for improving such practices organized during the pandemic crisis of Covid-19. Methodology: The present crosssectional descriptive study design attempted to investigate the undergraduate nursing students’ experiences related to the quality dimensions of e-learning. Data were collected from 121 undergraduate students of a University in Saudi Arabia who completed a set of reflective questions. Findings: Four themes were generated; instructional immediacy, Self-confidence, Innovative navigation, High Versus Low Stakes Assignments, including the advantages, challenges, and recommendations, are also discussed. Novelty: The article demonstrates the domains of challenges that might impact students’ experiences during e-learning amid Covid-19. Keywords: Students experiences; E-learning; Covid-19; quality; generated themes

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

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.