Achievement factors and personality in a cohort of medical students

Factor analysis has been used to identify achievement factors in tests attempted by a student cohort during a 6-year medical course.
In the second year of the course students completed a battery of psychometric tests which measured both cognitive and non-cognitive personality traits. Scores derived from these personality tests were used as predictors of the achievement factors.
The cohort completed 28 courses in the 6 years. Analysis of grades reported for these courses demonstrated five independent factors which could be labelled: (a) basic physical science; (b) biological science; (c) paraclinical science; (d) basic clinical science; (e) clinical science.
Over 24% of the variance of the factor scores in 'biological science' could be predicted from psychometric test scores. In contrast no measured personality trait contributed significantly to achievement in 'basic clinical science'. Over 12% of the variance could be predicted for achievement in 'paraclinical' and 'clinical science' while 6% of the variance could be predicted for 'physical science'.
Personality profiles favouring achievement differed significantly between achievement factors. In some cases attributes favouring achievement in one factor operated against achievement in another. In particular, a personality trait associated with extroversion favoured achievement in 'clinical science' but operated against achievement in 'biological science'.
Consideration is given to the use of psychometric tests as a tool for the selection of candidates proposing to enter the medical faculty.     

What ‘makes’ a good doctor?

The relation between gender, personality, school scores, grades at medical school and eventual achievement as a medical practitioner 8 years after qualifying has been explored by path analysis in a cohort of medical students. Factor analysis of data derived from a questionnaire identified a significant factor accounting for 75% of the common variance of the professional achievement scores. Standardized path coefficients were computed to indicate the relative importance of the causal factors to postgraduate achievement. Gender played an important role at many levels. For example it was apparent that many of our women graduates were seriously disadvantaged in their professional careers. Of the school subjects, chemistry was a surprising long-term predictor of postgraduate achievement. Academic achievement during medical school training, particularly in the final year, was a significant predictor, while personality attributes made their contribution to one or other aspect of achievement at earlier stages in training but made little additional direct contribution to postgraduate performance.     

School results as predictors of medical school achievement

In Queensland, scores in the final 2 years of secondary school scaled by an independent aptitude test are used to determine admission to tertiary education. The validity of this procedure for medical school enrollment has been investigated. Data were from four cohorts which entered the medical school to commence the course in each of the years 1975-1978, a total of 943 students. In addition to the school subject scores, overall order of merit scores and results of an independent aptitude test used to scale these scores were included with the predictors. Criteria were derived from the grades obtained in the 33 medical school subjects over the 6-year course, or from a broad pass/fail classification. We demonstrate that the school science subjects were of moderate value for prediction of preclinical achievement, but that school English was the most important predictor of performance in the clinical years, which is perhaps an indication of the value of communication skills.     

Demographic and socio-economic associations with academic attainment (UCAS tariff scores) in applicants to medical school

BACKGROUND: In the United Kingdom medical students are selected predominantly on their academic merit. Their academic achievement marks are equated via the tariff point score structure administered by the Universities and Colleges Admissions Service (UCAS). We studied the applicant databases for 1998-2003 for one English medical school to determine the factors that predict high tariff point scores. METHODS: Complete demographic data and relative socio-economic status, educational institution attended and tariff point score was available for 8997 UK applicants aged 21 years or younger to the 5-year Bachelor of Medicine/Bachelor of Surgery (BM BS) course at Nottingham University medical school (and partially complete data for a further 1891 applicants). The data were subjected to standard univariate and multivariate analyses and to path analysis. RESULTS: In these samples, the independent predictors of a high tariff point score were being younger and male. The effect sizes were small, although significant. Higher tariff point scores were achieved by those from households less materially disadvantaged. Ethnicity was also a predictor with white, Chinese and those of mixed ethnic origin achieving higher tariff point scores than those from other groups. Finally, the type of school attended predicted academic achievement with applicants from further education colleges, independent schools and grant-maintained schools achieving higher tariff point scores. CONCLUSION: Notwithstanding the relatively homogeneous (predominantly young, white, high academic achievers) applicant pool to a single UK medical school we identified consistent significant predictors of high tariff point scores. As high tariff point scores are still the major entry criterion to UK medical schools, our findings will be of value in informing policy decisions concerning 'widening access' schemes being established at government request.     

Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation

OBJECTIVES: The personality of medical students may have an important impact on both their academic performance and emotional adjustment during medical school. There has been little systematic study of the impact of perfectionism on medical students. The present study sought to compare the perfectionism profile of medical students with that of a general arts student group and to examine the relationship among perfectionism, distress symptoms and academic expectations and satisfaction. DESIGN: Medical students (n=96) and arts students (n=289) completed a baseline assessment including two multidimensional perfectionism scales. The medical students also completed measures of distress symptoms, personality (neuroticism, conscientiousness) and questions about their perceptions of their academic performance. Of the medical students, 58 completed a second set of questionnaires 6 months later (time 2). SUBJECTS: First-, second- and third year medical students and first-year arts students. RESULTS: In comparison with arts students, the perfectionism profile of medical students showed higher personal standards, lower doubts about actions and lower maladaptive perfectionism scores. In the medical students adaptive perfectionism (achievement striving) was significantly correlated with baseline academic performance expectations and conscientiousness and was predictive of dissatisfaction with academic performance at time 2. Maladaptive perfectionism (excessive evaluative concerns) was significantly correlated with baseline distress symptoms and neuroticism and was predictive of symptoms of depression and hopelessness at time 2. CONCLUSIONS: Perfectionism in medical students differs systematically from perfectionism in general arts students. Distinguishing adaptive and maladaptive aspects of perfectionism is important in understanding the cross-sectional and longitudinal implications of perfectionism for medical students.     

Selecting candidates for a medical school: an evaluation of a selection model based on cognitive and personality predictors

Two studies were conducted to attempt to evaluate the selection procedures used in Hadassah Medical School. The predictors assessed were the Israeli high school matriculation examinations, a general aptitude test, an interview and a semi-projective test designed to assess personality pathology. In the first study 145 students of the 1975 and 1976 cohorts were assessed, the criteria being a combination of peer evaluations, evaluation of supervisors and academic record. Results showed the matriculation average score to be the only effective predictor for all criteria. In the second study 155 students of the 1979, 1980 and 1981 cohorts were assessed, the criteria being evaluation of supervising doctors, BSc grades and grades during the clinical period. Results again indicated that the matriculation test is the most effective predictor. In this study, however, the other variables added to the prediction of criteria based on clinical evaluations. The results were discussed, raising several possible explanations for the relatively high validity of the matriculation scores. It was suggested the matriculation scores capture personality dimensions, such as motivation and adjustment to the learning environment, which are important factors for success in medical training.     

Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study

CONTEXT: Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful. OBJECTIVES: To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school. SUBJECTS: A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year. METHODS: A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression. RESULTS: Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.     

An assessment of academic performance and personality

This study examines whether personality profiles, using personality factors, or clusters of personality factors, are associated with academic success. One hundred and forty medical students of the University of Wales College of Medicine were invited to complete a personality questionnaire (Cattell 16 PF) as they sat their final examinations in June 1988. A total of 129 usable forms were obtained. The students were divided into four groups dependent on their academic performance, which had been monitored throughout the course. The majority (62%) had no academic problems, but 16 (12%) students had serious difficulties, which entailed delaying qualification by at least 6 months. There was no relationship between the scores obtained for the students' first attempt at A-level and their subsequent medical school academic performance. However, students who obtained a degree either before or during their medical course were significantly less likely to have academic problems. Academic success was not associated with any of Cattell's personality factors. This was true of previously reported groups of factors associated with the poor student performance, and regardless of first or second order factors. We conclude that this personality profile is unlikely to be helpful in selecting future intakes of medical students, although a prospective study would be required for a definite answer to this question.     

Evaluation of the admission procedure and academic performance on the Medical Faculty in Ljubljana, Yugoslavia

The data about the applicants and medical students who matriculated at the Medical Faculty of Ljubljana during the period from 1962–63 to 1969–70 by admission procedure were reviewed.
A higher proportion of women than men was accepted, but men went on from year to year more regularly (  P<0.05  ). Women graduated significantly later (  P<0.05  ). More than half the students came from Ljubljana and its surrounding area.
Academic success was correlated with general success in secondary school and with the raw scores at the admission examinations. Pearson's correlation coefficients were calculated and their values varied greatly between men and women, as well as among single cohorts.
The multiple regression analysis showed that the best predictor for academic performance was the average success in secondary school (gymnasium) and in addition, the raw scores in biology and foreign language obtained at the admission examination.
The results also showed the standardized regression coefficients β and these variables should therefore be retained in the admission procedure in future.
The cumulated coefficient of determination could explain about 11% to 15% of the variability of dependent variables—i.e., average academic success (mean mark of all examinations) and average academic success standardized to the duration of study.
The psychological test was of the least importance and could be omitted in future admission procedures. The mean mark in mathematics in secondary school and the mean mark in somatology (the study of the anatomy and physiology of the body) at the admission examination correlated highly with other admission criteria and could also be omitted in future.     

Medical career choice and practice location: early factors predicting course completion, career choice and practice location

AIMS: The overall aim of the study was to identify the factors that best predict medical career choice and practice location. METHOD: A longitudinal, cohort study was conducted. This followed 2 cohorts of students, numbering a total of 229 students, who commenced medical studies at the University of Western Australia in 1984 and 1989. Data concerning the students' sociodemographic backgrounds, admission scores and personality characteristics were collected in Year 1. Regression analyses were performed to identify the student characteristics that best predicted course completion, a choice of general practice 4 years after graduation and a rural location of practice. OUTCOMES: We found that students who had lower university admission scores and who were less outgoing were less likely to complete the course. Students who were male, had a father in medicine and were more creative and abstract in their thinking and more conscientious and rule-bound were more likely to choose a specialist career. A rural background was found to be the most important predictor of both rural general and specialist practice.     

Personality traits and types predict medical school stress: a six-year longitudinal and nationwide study

OBJECTIVES: Personality types (combinations of traits) that take into account the interplay between traits give a more detailed picture of an individual's character than do single traits. This study examines whether both personality types and traits predict stress during medical school training. METHODS: We surveyed Norwegian medical students (n = 421) 1 month after they began medical school (T1), at the mid-point of undergraduate Year 3 (T2), and at the end of undergraduate Year 6 (T3). A total of 236 medical students (56%) responded at all time-points. They were categorised according to Torgersen's personality typology by their combination of high and low scores on the 'Big Three' personality traits of extroversion, neuroticism and conscientiousness. We studied the effects of both personality types (spectator, insecure, sceptic, brooder, hedonist, impulsive, entrepreneur and complicated) and traits on stress during medical school. RESULTS: There was a higher level of stress among female students. The traits of neuroticism (P = 0.002) and conscientiousness (P = 0.03) were independent predictors of stress, whereas female gender was absorbed by neuroticism in the multivariate model. When controlled for age and gender, 'brooders' (low extroversion, high neuroticism, high conscientiousness) were at risk of experiencing more stress (P = 0.02), whereas 'hedonists' (high extroversion, low neuroticism, low conscientiousness) were more protected against stress (P = 0.001). CONCLUSIONS: This is the first study to show that a specific combination of personality traits can predict medical school stress. The combination of high neuroticism and high conscientiousness is considered to be particularly high risk.     

Facility with the English language and problem-based learning group interaction: findings from an Arabic setting

The Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates (UAE) University is in a unique position to explore issues related to English language proficiency and medical student performance. All students entering the FMHS have English as a second language. This study focused on the issues of students' proficiency in English as measured by the TOEFL test, student background factors and interaction in problem-based learning (PBL) groups. Using a modification of Bales Interaction Process Analysis, four problem-based learning groups were observed over four thematic units, to measure the degree of student interaction within PBL groups and to compare this to individual TOEFL scores and key background variables. The students' contributions correlated highly with TOEFL test results in the giving of information (range r = 0.67-0.74). The female students adhered to interacting in English during group sessions, whereas the male students were more likely to revert to using Arabic in elaborating unclear phenomena (p < 0.01). The educational level of the student's mother was highly predictive of TOEFL scores for the male students, but not for female students. Multivariate analysis was undertaken to analyse the relative contribution of the TOEFL, parental education and years of studying in English. The best predictor of students' contributions in PBL groups was identified as TOEFL scores. The study demonstrates the importance of facilitating a locally acceptable level of English proficiency prior to admission to the FMHS. However, it also highlights the importance of not focusing only on English proficiency but paying attention to additional factors in facilitating medical students in maximizing benefits from interactions in PBL settings.     

Secondary school and admission test grades as predictors of performance of medical students

The performance of three consecutive classes of students admitted to the Colleges of Medicine and Medical Sciences at King Faisal University was studied. All students took the high school graduation examination and sat the college admission test. It was found that performance on the admission test was a better predictor than high school grades in the first two levels of the medical curriculum. However, performance in a combination of certain high school and admission test subjects was a more powerful predictor of students' achievement at all levels. This study indicates that the college admission test is a useful additional tool in the process of medical student selection at this college. Further studies are needed, however, for the formulation of general recommendations.     

Has the UK Clinical Aptitude Test improved medical student selection?

Medical Education 2010: 44 : 1069–1076 Objectives In 2006, the United Kingdom Clinical Aptitude Test (UKCAT) was introduced as a new medical school admissions tool. The aim of this cohort study was to determine whether the UKCAT has made any improvements to the way medical students are selected. Methods Regression analysis was performed in order to study the ability of previous school type and gender to predict UKCAT, personal statement or interview scores in two cohorts of accepted students. The ability of admissions scores and demographic data to predict performance on knowledge and skills examinations was also studied. Results Previous school type was not a significant predictor of either interview or UKCAT scores amongst students who had been accepted onto the programme (n = 307). However, it was a significant predictor of personal statement score, with students from independent and grammar schools performing better than students from state‐maintained schools. Previous school type, personal statements and interviews were not significant predictors of knowledge examination performance. UKCAT scores were significant predictors of knowledge examination performance for all but one examination administered in the first 2 years of medical school. Admissions data explained very little about performance on skills (objective structured clinical examinations [OSCEs]) assessments. Conclusions The use of personal statements as a basis for selection results in a bias towards students from independent and grammar schools. However, no evidence was found to suggest that students accepted from these schools perform any better than students from maintained schools on Year 1 and 2 medical school examinations. Previous school type did not predict interview or UKCAT scores of accepted students. UKCAT scores are predictive of Year 1 and 2 examination performance at this medical school, whereas interview scores are not. The results of this study challenge claims made by other authors that aptitude tests do not have a place in medical school selection in the UK.     

How well do selection tools predict performance later in a medical programme?

The choice of tools with which to select medical students is complex and controversial. This study aimed to identify the extent to which scores on each of three admission tools (Admission GPA, UMAT and structured interview) predicted the outcomes of the first major clinical year (Y4) of a 6?year medical programme. Data from three student cohorts (n?=?324) were analysed using regression analyses. The Admission GPA was the best predictor of academic achievement in years 2 and 3 with regression coefficients (B) of 1.31 and 0.9 respectively (each P?<?0.001). Furthermore, Admission GPA predicted whether or not a student was likely to earn ‘Distinction’ rather than ‘Pass’ in year 4. In comparison, UMAT and interview showed low predictive ability for any outcomes. Interview scores correlated negatively with those on the other tools. None of the tools predicted failure to complete year 4 on time, but only 3% of students fell into this category. Prior academic achievement remains the best measure of subsequent student achievement within a medical programme. Interview scores have little predictive value. Future directions include longer term studies of what UMAT predicts, and of novel ways to combine selection tools to achieve the optimum student cohort.     

The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study

CONTEXT: Previous studies have shown that physicians have an increased risk of mental health problems such as depression, suicide and substance abuse. OBJECTIVES: To study the prevalence of mental health problems during the first postgraduate year, and to investigate whether work-related factors in hospital are linked to these, when we control for gender, previous mental health problems, personality traits, stress in medical school and other possible predictors. DESIGN: Nationwide and prospective postal questionnaire survey. SETTING: University of Oslo. SUBJECTS: Medical students who answered questionnaires in their graduating semester, and 1 year later when they were junior house officers (n=371). RESULTS: Mental health problems (needing treatment) during internship were reported by 11%, with no gender difference. Adjusted predictors of mental health problems were: previous mental health problems, (odds ratio (OR)=5.1, 95% confidence interval (CI) 1.7 to 15.8); being married/cohabitant (OR=0.2, CI 0.1 to 0.7); the personality trait 'vulnerability' (OR=1.5, CI 1.1 to 2.0); negative life events during internship (OR=2.1, CI 1.2 to 3.5), and job stress as house officer (OR=1.05, CI 1.01 to 1.10). The job stress factor of emotional pressure/demands from patients was most important. Perceived study stress and lack of skills at the end of medical school were univariately related to mental health problems in internship, but not when other variables were adjusted. Gender, weekly working hours and lack of sleep were not linked to having problems. CONCLUSION: Job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled for. More support during internship is needed.     

Characteristics of senior medical students at Belfast

This paper analyses and discusses the degree of homogeneity existing in the medical school student population of the Queen's University, Belfast, in relation to certain characteristics: social class, academic attainment, admission standards, intelligence test scores, and personality. Findings are compared with those reported in earlier studies elsewhere. No sex difference in social class distribution of Queen's medical students is noted. There is a much lower proportion of social class I students and a higher social class III proportion, than shown elsewhere in Britain ( Johnson, 1971 ). Women constitute 38% of the medical school student population, a proportion in line with the 40% reported as the overall British percentage ( Brit. Med. J., 1976 ). Females are shown to have a significantly better overall academic record than males, related to intelligence, aptitude for certain subjects and probably to behavioural and attitudinal differences to study and medical care. No significant sex differences are noted in relation to entry qualifications, intelligence, and the personality factors of extraversion and neuroticism. Male A-level scores in the present study are useful predictors of academic success in the medical course, but this is only true for females up to 2nd M.B. stage. General practice is the exception for both sexes, there being no significant correlations with general practice scores. Highly intelligent females and males below their group intelligence mean performed significantly better in learning situations in general practice as reflected in general practice scores, than highly intelligent males. The data may reflect different attitudes to whole person care and varying abilities to integrate knowledge and to define problems in primary care. These findings, including the sex differences in the factors related to academic attainment in the later clinical years of the medical curriculum, may have implications with regard to present selection procedures to most medical schools based solely on A-level grades.     

A preliminary study of empathy, emotional intelligence and examination performance in MBChB students

CONTEXT: There is considerable interest in the attributes other than cognitive ability that medical students need in order to be professionally successful, with a particular focus on empathy and emotional intelligence (EI). Selection considerations have also motivated interest in such attributes as predictors of academic success. There are reports of declines in empathy in US medical students, but no comparative information is available for UK students. OBJECTIVES: This study aimed to compare empathy levels in medical students in Years 2, 3 (pre-clinical) and 5 (clinical), to examine gender differences in empathy and EI, and to investigate whether EI and empathy are related to academic success. METHODS: Questionnaires assessing EI and empathy were completed by students. Previous empathy scores for the Year 2 cohort were also available. Empathy trends were examined using anova; trends for the Year 2 group for whom Year 1 scores were available were examined using repeated-measures anova. Associations of EI and empathy with academic success were examined using Pearson correlation. RESULTS: A significant gender x cohort effect was found, with male empathy scores increasing between Years 1 and 2, whilst female scores declined. Peer ratings in Year 2 problem-based learning (PBL) groups were positively correlated with EI. CONCLUSIONS: Trends in levels of empathy differed by gender. The reasons for this require further investigation, particularly in relation to course content. Associations between academic performance and EI were sparse, and there were none between academic performance and empathy, but the effects of EI (and other characteristics) on PBL group functioning represent a promising area for future study.     

Selection of medical students: a controlled experiment

Objectives  We aimed to discover, through a controlled experiment, whether cognitive and non-cognitive assessment would select higher-achieving applicants to medical school than selection by lottery.
Methods  We carried out a prospective cohort study to compare 389 medical students who had been admitted by selection and 938 students who had been admitted by weighted lottery, between 2001 and 2004. Main outcome measures were dropout rates, study rate (credits per year) and mean grade per first examination attempt per year. Study rates in the 4 pre-clinical years of medical school were used to categorise students' performance as average or optimal.
Results  Pre-admission variables did not differ between the two groups. The main outcome of the selection experiment was that relative risk for dropping out of medical school was 2.6 times lower for selected students than for lottery-admitted controls (95% confidence interval 1.59–4.17). Significant differences between the groups in the percentage of optimally performing students and grade point average for first examination attempts were found only in the 2001 cohort, when results favoured the selected group. The results of the selection process took into account both the assessment procedure involved and the number of students who withdrew voluntarily.
Conclusions  This is the first controlled study to show that assessing applicants' non-cognitive and cognitive abilities makes it possible to select students whose dropout rate will be lower than that of students admitted by lottery. The dropout rate in our overall cohort was 2.6 times lower in the selected group.     

Early identification of future medical students using initial undergraduate grades

This study assessed whether overall academic performance in undergraduate medical coursework can be predicted with reasonable accuracy by using grades from initial college-level courses rather than total premedical grade point averages (GPAs). Initial college grades from four areas, MCAT scores, and NBME I and II scores were recorded for students admitted to the University of Washington Medical School, for students admitted to other medical schools, and for students not admitted to any medical school. The results documented a high relationship between cumulative GPAs and initial grades, with differences found between those students admitted to medical school and those not admitted. The importance of this study is the documentation that little predictive utility is gained by waiting for overall college GPAs from medical school applicants. Initial GPAs are available 2 years earlier than overall GPAs and provide virtually the same information. Exploratory suggestions for medical school admission policies are made.