Preclinical progress in relation to personality and academic profiles

Summary. One hundred and forty-six (93%) of the University of Wales College of Medicine intake of new students completed a personality questionnaire (Cattell 16PF) on registration in October 1988. The students were divided into four groups depending on their academic progress up to and including 2nd MB BCh. Whereas the majority (73%) encountered no major examination problems, 40 (27%) did experience such difficulties, nine of them serious enough to delay graduation. Fourteen students had left the course, nine of them voluntarily. Academic progress was not significantly related to any of Cattell's personality factors, either primary or second order. Further analyses of established clusters of factors which have previously been associated with problems among students were also shown to be unrelated to the medical students' progress. A profile at entry involving previous degrees, points obtained and number of attempts at A-levels proved to be a much better predictor of success during the preclinical period.     

Personality and performance of preclinical medical students

This study deals with personality variables of medical students in relation to their academic success in the preclinical stage. One hundred and one students completed the 16PF Questionnaire at the beginning of their medical course and the scores were analysed in relation to their marks obtained at the end of the 2–year preclinical stage. This study shows that the 16PF Questionnaire can be a useful instrument for identifying personality variables in candidates who are likely to have academic problems and those who are likely to do well in the preclinical stage of a medical course. Students of urban origin and the eldest in the family performed better in their preclinical years. Performance was not related to sex, ethnic group, family size or entrance qualification into medicine. Personality variables of being enthusiastic, venturesome, self-opinionated, imaginative, experimenting, resourceful and driven correlate positively with performance, whereas being self-assured has negative correlation. Problem students were more reserved, emotionally less stable and more apprehensive than non-problem students.     

Medical school selection: impact of dysfunctional tendencies on academic performance

PURPOSE: Dysfunctional personality characteristics have a negative impact on the learning process, academic motivation, academic grades and course attendance. They are associated with higher levels of anxiety and negative mood before examinations, a lack of self-confidence and fear of failure, social skills deficits, and personal and social relationship problems. Dysfunctional personality characteristics inhibit interpersonal working relationships and are detrimental to team effectiveness. Previous research revealed that the majority of students selected into an Australian undergraduate medical programme via the process of academic merit, application and interview reported elevated levels of dysfunctional personality characteristics. Our research now identifies those patterns of dysfunctional behaviour that impacted on academic grades over the first 3 years of the medical programme. METHODS: Dysfunctional personality characteristics in a sample of Australian undergraduate medical students were assessed with the Hogan Development Survey (HDS). The scores of 139 students were then correlated with their end-of-year examination marks for each of the first 3 years of medical training, and their average grade. RESULTS: Pearson's bivariate correlation analysis revealed that there were a number of significant negative relationships between academic grades and the HDS syndromes of Away and Against. There were significant positive relationships between academic grades and the HDS syndrome of Diligent. CONCLUSIONS: To enrol and teach students who fail to graduate, need to repeat, choose not to pursue a career in medicine upon graduation, or become inefficient practitioners is costly. A measure of dysfunctional behaviour has the potential to predict academic performance and improve the cost-effectiveness of medical education.     

Parental problems influencing the academic achievement of medical students: a prospective study

The 227 students offered places in the 1988 medical student intake at the University of Queensland were surveyed regarding their demographic characteristics. This was correlated with the students' subsequent performance and persistence during the first year of the medical course. Coming from a lower socioeconomic background and having family problems were both associated with either a decreased academic performance or an increased attrition rate. The results are discussed, relevant literature is reviewed and suggestions for further research are made.     

Academic performance of students admitted after repeating entrance examinations to medical school

Summary The academic performance of matched groups of students who did, or did not, repeat a year at school so as to achieve the entrance qualifications necessary for admission to medical school was assessed. Repeating students were asked to provide possible reasons for their failure to enter on their first attempt. Better performance was predicted, to a small extent, in those who offered internal atrributions as an explanation for their initial failure. It was not predicted by actual entrance examination grades, either at first or second attempt. Repeating students as a group were clearly academically weaker throughout the medical course. The implications for medical school admission policy are examined.     

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.     

Medical students' personality characteristics and academic performance: a five-factor model perspective

OBJECTIVES: This study investigates: (1) which personality traits are typical of medical students as compared to other students, and (2) which personality traits predict medical student performance in pre-clinical years. DESIGN: This paper reports a cross-sectional inventory study of students in nine academic majors and a prospective longitudinal study of one cohort of medical students assessed by inventory during their first preclinical year and by university examination at the end of each pre-clinical year. SUBJECTS AND METHODS: In 1997, a combined total of 785 students entered medical studies courses in five Flemish universities. Of these, 631 (80.4%) completed the NEO-PI-R (i.e. a measure of the Five-Factor Model of Personality). This was also completed by 914 Year 1 students of seven other academic majors at Ghent University. Year end scores for medical students were obtained for 607 students in Year 1, for 413 in Year 2, and for 341 in Year 3. RESULTS: Medical studies falls into the group of majors where students score highest on extraversion and agreeableness. Conscientiousness (i.e. self-achievement and self-discipline) significantly predicts final scores in each pre-clinical year. Medical students who score low on conscientiousness and high on gregariousness and excitement-seeking are significantly less likely to sit examinations successfully. CONCLUSIONS: The higher scores for extraversion and agreeableness, two dimensions defining the interpersonal dynamic, may be beneficial for doctors' collaboration and communication skills in future professional practice. Because conscientiousness affects examination results and can be reliably assessed at the start of a medical study career, personality assessment may be a useful tool in student counselling and guidance.     

Does studying for an objective structured clinical examination make a difference?

PURPOSE: This study examines the extent to which second-year medical students studied for an objective structured clinical examination (OSCE), how they studied, and the impact of self-reported studying on OSCE performance. METHOD: One class of 113 medical students completed an end-of-second-year OSCE, held on two consecutive evenings. The OSCE was comprised of eight stations, each of which was of 20 minutes' duration. The OSCE was formative: students received performance feedback but were not graded. Prior to the OSCE, students completed a brief survey regarding their preparation for the OSCE and their perceptions of confidence, anxiety and preparedness. Only 78 students returned surveys with names, comprising the data for these analyses. RESULTS: Mean studying time was 3.3 h, ranging from 0 to 19 h. Studying time was positively associated with age and negatively associated with basic science examination scores. The most study time was dedicated to reviewing the physical examination textbook, class notes and supplemental course readings. The breadth of study strategies increased as more time was spent in OSCE preparation. OSCE performance was related to study time and to achievement on pre-clinical basic science examinations. DISCUSSION: The students whose performance was above average seemed to be the talented students whose records indicated a history of academic success. The amount of time they reported for OSCE preparation was comparable to that reported by students with below average performance. It appears that prior academic performance rather than preparatory studying time is a better predictor of OSCE outcomes.     

Support for students with academic difficulties

CONTEXT: The human and financial costs of academic failure amongst medical students are extremely high. Often, remedial support is infrequently available or is available only for students failing their final examinations. We describe the design, implementation and preliminary evaluation of a remedial programme (RP) for students who experience academic difficulties. METHODS : A total of 24 students were identified from Years 4 and 5 of the undergraduate medical course at our medical school. Students invited to participate were identified following failure in summative and/or continuous assessment processes. Students underwent an individual educational diagnosis by means of free discussion and a semi-structured interview. Each negotiated a problem list, action plan and learning contract with course tutors. Of the 24 students, 16 received academic support and tutorials. Tutorial content was determined by individual students and took place over a 6-12-month period, initially individually and subsequently in pairs. Regular feedback and appraisal occurred. Information was delivered to the medical school academic progress review system. Student satisfaction was investigated and subsequent examination scores reviewed. RESULTS : The causes of academic failure were widespread and ranged from deficient study skills to financial, domestic and emotional problems. In contrast, the subjects in which students had difficulty were remarkably similar, in that they all related to core clinical skills and frequently involved communication skills. Students enjoyed the programme, reported improved motivation both for study and for their chosen career and demonstrated a greatly improved pass rate in subsequent examinations. CONCLUSIONS : The causes of academic failure in undergraduate medical students are diverse and are often not academic in origin. Students can benefit from an individually tailored remedial programme and go on to success in subsequent parts of the curriculum. Provision of individually tailored remedial teaching is labour-intensive and requires full faculty support.     

Students, tutors and relationships: the ingredients of a successful student support scheme

BACKGROUND: Medical students suffer from stress and psychological morbidity. Much of this stress is related to uncertainty about course work and workload. Although several student support systems are on offer at various medical schools, few have been shown to meet the needs of students. OBJECTIVE: To evaluate one student support scheme and determine the factors which are essential for success. METHOD: A total of 144 second- and third-year medical students were randomly selected at the University of Dundee. They were asked to complete questionnaires regarding contact with their personal tutors, frequency of meetings, activities during meetings, opinions on how to improve the system and how satisfied they were with the present system. In addition 28 tutors were also asked to complete a questionnaire which matched as far as possible that for students. Qualitative data was collected from semi-structured interviews, free-text responses from questionnaires, email communications with student group representatives and telephone interviews. RESULTS: The scheme was rated as successful or very successful by 25 (18.4%) students and five (29.4%) tutors. A high success rating was associated with regular and frequent meetings, with tutors actively seeking their students and taking part in social as well as academic activities. CONCLUSIONS: The relationship that is formed between students and tutors is the most important factor contributing to the success of the scheme. Taking part in social activities encourages the relationship to develop, whilst addressing academic problems helps to meet the needs of students. Those students who fail exams appear to have the same needs as those who pass.     

Library use and academic achievement among medical students

Many factors play a part in determining the performance of students in examinations, but the extent to which students use library facilities does not appear to have been recently considered as a factor, in medicine or in any other academic subject. In this study, the number of books borrowed from the library by undergraduate medical students was used as a simple measure of library use, and significant differences in book-borrowing levels were found between students in different years of the medical course, students from different regions of the world, and men and women students. In the first year of the course, students who borrowed most also performed best in their end-of-year examinations, and this association was only partly explained by regional differences. No such association was found among final-year students, suggesting different study habits and different assessment criteria in the clinical years of the course.     

Medical student attrition: a 10-year survey in one medical school

Medical student wastage leads to adverse emotional and social consequences for individual students and financial difficulties and morale problems for medical schools. This study retrospectively assessed the records of all students at Leeds School of Medicine who left the course prematurely between 1983 and 1992. The demographic data of the leavers were compared with those of all students entering the school during the 10 years studied. A-level examination choices and results of the leavers were compared with those of a control group of all students who entered the school in 1990. The attrition rate over the 10 years was 14% (283 students), with more males than females leaving. Fewer mature students than expected left the course. More leavers had A-level physics and lacked A-level biology compared with the control group. The leavers were academically less able than the controls. Fifty-three per cent of leavers were asked to withdraw from the course for academic reasons; the rest left voluntarily. Thirty per cent had personal problems, 9% had a combination of academic and personal problems and 8% had health problems (psychological difficulties were the commonest). Seventy-one per cent of leavers entered another degree course; science degrees were the most popular. Reasons for medical student wastage and possible solutions are discussed.     

The influence of admissions variables on first year medical school performance: a study from Newcastle University, Australia

AIMS: This study examined the relationship between the performance of first year medical students at the University of Newcastle, Australia, and admission variables: previous educational experience, and entry classification (standard -- academic or composite, Aboriginal and Torres Strait Islander, or overseas), age and gender. METHODS: Admission and demographic information was obtained for students who entered first year medicine at Newcastle between the years 1994 and 1997 inclusive. Academic performance was measured according to results of first assessment ('satisfactory' vs. 'not satisfactory') and the final assessment of the first year ('satisfactory' vs. 'not satisfactory'). Logistic regression was used to examine the relationship between predictor variables and outcomes. RESULTS: Assessment and admissions information was obtained for 278 students, 98% of all students who entered the medical course between 1994 and 1997. Regression analysis of first assessment indicated that Aboriginal and Torres Strait Islander and overseas students were significantly more likely to be 'not satisfactory' than all other students (RR=3.1,95% CI: 1.4. - 6 7 and RR=1.5, 95% CI: 1.2-1.8, respectively). Analysis of final assessment indicated these two student groups were also significantly more likely to be 'not satisfactory' than all other students (RR=4.5, 95% CI: 1.4-13.5 and RR=3.5, 95% CI: 1.2-10.8, respectively). At first assessment, students entering via the standard academic pathway and older students were less likely to be 'not satisfactory' (RR=0.6, 95% CI: 0.5-0.7 and RR=0.8, 95% CI: 0.7-0.9, respectively). However both these differences were not evident at final assessment. There were no significant relationships between performance in first year and the remaining variables. CONCLUSIONS: Aboriginal and Torres Strait Islander, and overseas medical students had academic difficulties in the first year of the course, suggesting the need for extra course support. The result may reflect the educational and other obstacles these students must overcome in order to enter and progress through their medical degree. More research is warranted to explore the extent to which these differences persist throughout the medical degree.     

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

Summary. 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.     

Towards the identification of student learning problems: the development of a diagnostic inventory

An understanding of how students approach their learning has important implications for medical education. Of particular interest is the fact that the approach students use in their study has a significant impact on both the quality of the learning and their academic success. It would clearly be of value to identify students whose approach to learning was predictive of unsatisfactory performance. This paper describes the initial development of two versions of an inventory (questionnaire) which was designed to aid in the diagnosis of student learning problems. Preliminary information is given on the reliability and validity of these instruments. Factor analyses support the underlying design. Correlation of subscales with academic performance has provided encouraging evidence of the potential of these inventories in identifying students with specific learning or study problems.     

Portfolios as a learning tool in obstetrics and gynaecology undergraduate training

CONTEXT: We developed a structured portfolio for medical students to use during their obstetrics and gynaecology undergraduate training. The main objective was to support the learning process of the students. We also wanted feedback information to enhance teaching. METHODS: The study population consisted of 91 medical students who completed the portfolio during their training course. The portfolio consisted of a 28-page A5-size booklet. The students entered all the clinical procedures they had performed and all the deliveries they had attended. After each group session, they answered questions about what they had learned and evaluated the performance of the teacher. They also indicated their general evaluation of the course and the portfolio itself. The teachers listed the 13 most important skills to be learned during the course. The students were asked to evaluate their own development on a scale of 0-5 before and after the course. A content analysis was performed on all the texts the students produced, and all quantitative variables were coded. RESULTS: The amount of text written in the portfolio correlated (P < 0.001, F-value 4.2) with success in the final exam. In addition to acting as a logbook, use of the portfolio enhanced the learning process during the course. Students' attitudes towards the portfolio were mainly positive. Students appreciated the departmental interest in their learning process. CONCLUSION: Portfolios support the personal and professional development of medical students. A portfolio clarifies the learning goals and helps students to monitor how these goals are achieved. A portfolio encourages constant self-reflection.     

A prospective analysis of stress and academic performance in the first two years of medical school

AIM: This study provides prospective, longitudinal data on the relationship between stress-related measures and academic performance during the first two years of medical school. METHODS: First year medical students (n = 121) were surveyed prior to beginning classes (wave 1), and again 8 months later (wave 2). Personality variables predisposing to distress (optimism and trait anxiety), stress response (depression and state anxiety), and stress management strategies were assessed at wave 1 and wave 2. Pre-medical academic scores, and grades at the end of five assessment periods over the course of the first 2 years of medical school were also obtained. RESULTS AND CONCLUSIONS: As expected, pre-medical-school academic performance strongly predicted performance in medical school. Academic performance before and during medical school was negatively related to reported stress levels. On bivariate correlations, there were numerous significant relationships between stress reported at waves 1 and 2, and medical school academic performance assessed after these measures. In addition there were modest negative correlations between self-reported coping strategies of 'humour' and 'wishful thinking', and consequent academic performance. However, the predictive value of stress and its management on prospective academic performance was much decreased once pre-medical-school performance was statistically controlled.     

Gender differences in the results of the final medical examination at University College Dublin

OBJECTIVES: In 1984 females made up 45% of medical undergraduates in Ireland. By 1996 this proportion had increased to 57%. This study examines gender differences in performance at final medical examinations, with a view to ascertaining the impact of the change in proportion of females attending medical school. DESIGN: Final year examination results of medical students over a 5-year period (1992-96) were obtained from the broadsheets of University College Dublin (UCD) examinations office. The results of 557 students (females n=277; males=280) were analysed for all final year examinations (n=5). SETTING: University College Dublin. SUBJECTS: Final year medical students. RESULTS: Overall females were found to have performed better than their male counterparts. They were more likely to achieve an honours grade and had a similar or lower likelihood of passing or failing. Gender differences in performance were most marked in paediatrics (P < 0.01), psychiatry (P < 0.01) and obstetrics and gynaecology (P=0.01), females being more successful in each case. CONCLUSIONS: The success of females and their increased numbers at undergraduate level are not reflected at senior registrar and consultant level. As medical manpower becomes more of an issue the lack of women, particularly in certain specialties, and the possible reasons for this need to be addressed.     

Attitudes toward mental illness in medical students: does personal and professional experience with mental illness make a difference?

PURPOSE: Medical students may be susceptible to emotional difficulties because of the high levels of both academic and interpersonal stress associated with their training. This study examined attitudes toward mental illness in medical students. It was expected that people who had experience of mental illness, either in their personal lives or through their professional experience, would have more positive attitudes toward students with mental health problems than would people who had not had such experience. METHOD: Faculty and staff employed by a large American university medical centre completed a questionnaire package including several measures designed to assess specific attitudes toward medical students with emotional problems. Data were also collected on the degree to which specific mental disorders were thought to interfere with the performance of medical students. RESULTS: In general, prior experience with mental illness, either through personal or professional activities, was associated with more positive attitudes about students with mental illness. However, the pattern of findings was complex. CONCLUSION: Future research should examine the extent to which specific mental illnesses actually affect the performance of medical students.     

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.