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

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

Correlating students' undergraduate science GPAs, their MCAT scores, and the academic caliber of their undergraduate colleges with their first-year academic performances across five classes at Dartmouth Medical School.

Reviewing the predictive validity of admission criteria to improve the selection process is important to a school in maintaining quality in the entering class. For this reason, the authors studied how the academic criteria used to select the 420 students who entered Dartmouth Medical School from 1982 to 1986 compared with the students' first-year academic performances. The criteria used were Medical College Admission Test scores, undergraduate science grade-point averages, and college selectivity (i.e., the academic caliber of the students' undergraduate colleges). Results showed that a combination of these criteria were useful in identifying the students who were successful in their first year. The authors suggest that their findings also demonstrate the ability to an admission committee to subjectively weigh these academic criteria with consistent results in student performance.     

Using a standardized-patient examination to establish the predictive validity of the MCAT and undergraduate GPA as admissions criteria

Performance of senior medical students on an objectively scored examination of clinical competence based on standardized-patient cases was used to assess the predictive validity of the two most commonly used admission measures, the Medical College Admissions Test and the undergraduate grade point average. The students were in the classes of 1986 and 1987 at Southern Illinois University School of Medicine. The correlations of the admissions measures with clinical performances were quite weak, and none of the admissions measures consistently showed a clear advantage as a predictor of clinical performance. Correlations of the admissions measures with scores on National Board of Medical Examiners (NBME) Part I and Part II examinations were small to moderate, although somewhat larger than the correlations with clinical performances. Correlations were corrected for attenuation due to differential unreliabilities of the clinical examination results and the scores on NBME examinations, and for restriction of range due to the stringent medical school selection process. Corrected correlations were small to moderate and showed the same pattern as the uncorrected ones. The study documents that traditional admissions measures are useful for selecting students who will perform effectively in clinical as well as basic science settings.     

The impact of a curriculum renewal project on students' performances on a fourth-year clinical skills assessment.

PURPOSE: To study the performances of three consecutive classes of medical students on a fourth-year clinical skills assessment that remained constant during a curriculum renewal project that involved earlier clinical work, more ambulatory training, and an emphasis on lifelong learning. METHOD: Three classes were involved: 83 baseline students (class of 1997) educated in the old curriculum, 77 transitional students (class of 1998) exposed to some curricular change, and 88 renewal students (class of 1999) in the first year of full curricular change. Each class completed a fourth-year assessment, during which students performed a focused history and physical examination on 14 standardized patients. Scores for these elements were calculated as the percentages of items obtained. Each case also includes a communication skills element rated on the Arizona Clinical Interview Rating scale (ACIR). RESULTS: Small but significant improvements in the means of scores were found in all three elements of the assessment over the study period (history taking scores increased from 74% to 80%, physical exam scores increased from 51% to 58%, and ACIR scores increased from 3.7 to 4.0). More pronounced was the decline in the percentage of students who failed the assessment (from 8% to 0%), and a marked increase in those who passed over 80% of the case elements (from 65% to 89%). CONCLUSION: Renewing the curriculum to expose students to clinical skills earlier, increase the amount of ambulatory training, and promote lifelong learning resulted in small but significant increases in students' performances on a fourth-year clinical skills assessment. The major impact of the new curriculum, however, was to improve the clinical skills assessment performances of marginal and average students.     

The ability of a medical school admission process to predict clinical performance and patients' satisfaction.

PURPOSE: The authors evaluated the ability of a two-step admission process to predict clinical performance and patients' satisfaction on a third-year objective structured clinical examination (OSCE). METHOD: Subjects were three matriculating classes (1993, 1994, 1995) at one medical school. Data for the classes were analyzed separately. Independent variables were the Academic Profile (AP), an initial ranking of applicants based on grade-point ratio and MCAT scores, and the Selection Profile (SeP), an average of three interview scores. Interviews were offered based on AP rank, and admission was offered based on SeP rank. Dependent variables were total score on the faculty-graded portion of the OSCE and patients' satisfaction scores completed by the OSCE standardized patients. The authors evaluated the correlations between AP and OSCE performance and between SeP and OSCE performance. The authors also compared the OSCE performances of students whose ranks changed after interviews (SeP rank < AP rank or SeP rank > AP rank). The level of significance was adjusted for the number of comparisons (Bonferroni method). RESULTS: Complete data were available for 91% of eligible students (n = 222). No class showed a significant correlation between either AP or SeP rankings and OSCE performance (p > .01). Likewise, there was no difference in OSCE performance for students whose ranks changed after the interview. CONCLUSIONS: The admission ranking and interview process at this medical school did not predict clinical performance or patients' satisfaction on this OSCE.     

How interruptions in students' medical education affect their clinical performance evaluations

The enrollment records of 380 medical students from the graduating class of 1983-1988 at a four-year medical school were compared with the students' performances on two measures, third-year clinical rotation grades and National Board of Medical Examiners Part II examination (NBME-II) scores. Thirty-seven students (9.7%) interrupted their progress through medical school for negative (school-initiated, academic) reasons or neutral (student-initiated, nonacademic, or personal) reasons. On both performance measures, the students in the neutral group performed similarly to regular-progress students and significantly better than students who interrupted their attendance in medical school for negative reasons.     

Participation in a premedical summer program for underrepresented-minority students as a predictor of academic performance in the first three years of medical school: two studies.

PURPOSE: To determine whether the performances of underrepresented minority students in the Medical Education and Development Program (MEDP) at the University of North Carolina Chapel Hill (UNC-CH) School of Medicine (a structured, nine-week summer premedical program that simulates the medical school's first year curriculum) predicted their academic performances in the first three years of medical school. METHOD: These two studies looked separately at the predictive value of students' rankings (top quarter or top half) within their MEDP cohorts. The first study involved 165 students who had participated in the MEDP from 1981 to 1990 and who then matriculated at UNC-CH. Using backward elimination logistic regression models, the author determined whether those rankings and other, more traditional academic performance predictors predicted three types of academic difficulty during the first two years of medical school: (1) required participation in summer review; (2) deceleration; and (3) dismissal. The predictive validity of each regression model was assessed by calculating the sensitivity and the positive predictive value. The second study involved 135 students who had participated in the MEDP from 1981 to 1990 and who had finished their third-year clinical clerkships at UNC-CH. Forty-four of those students had taken the National Board of Medical Examiners (NBME) Part II examination. Using Spearman correlations, the Student t test, and the chi-square test, the author determined the simple relationships among MEDP ranking, traditional premedical academic predictors, and third-year clinical performance (as measured by clerkship grades and NBME scores). The author determined the best predictors of third-year clinical performance using stepwise backward-elimination linear regression models. RESULTS: In both studies, a student's ranking within his or her MEDP cohort was the strongest, if not the only, predictor of medical school academic performance. CONCLUSION: These studies suggest that structured summer premedical programs such as UNC-CH's MEDP are quite good at determining whether participants will be able to handle the academic rigors of medical school.     

Testing for validity and bias in the use of GPA and the MCAT in the selection of medical school students

In the 1988 study reported here, Medical College Admissions test (MCAT) scores and grade point averages for undergraduate science courses (S-GPAs) were examined for predictive validity and differential prediction of National Board of Medical Examiners Part I scores. Data from 579 medical students from the classes of 1979-80 through 1983-84 attending a midwestern medical college were analyzed via moderated multiple regression. The findings indicated that using the S-GPA and a composite MCAT score based on the Biology Knowledge, Chemistry Knowledge, Physics Knowledge, Science Problems, and Reading subtests was valid and equally predictive for the minority and majority groups studied. These results are discussed in terms of past findings on cognitive tests in general, and the MCAT and the S-GPA specifically.     

Assessing the acquisition of core clinical skills through the use of serial standardized patient assessments.

PURPOSE: Students in many medical schools now undergo multiple standardized-patient-based assessments. In this study, the authors examine the ability of such serial assessments to detect interval learning. METHOD: Twenty-one students from the University of California, Irvine, College of Medicine, class of 1999, underwent a clinical skills appraisal after three months of their third-year instruction. After nine months, all 89 members of that class completed an OSCE. Subsequently, all 87 students in the class of 2000 also completed clinical skills assessments after their third and ninth months of third-year instruction. All of these exercises included identical or similar stations measuring history, physical examination, and communication skills. Communication skills were measured somewhat differently during some of the exercises, using checklists that were either "content-" or "process-"oriented. The authors compared the performances for all groups. RESULTS: Both classes demonstrated significant improvement in physical examination performance, while their history performances remained unchanged. According to the assessments, their communication skills deteriorated over the course of their third-year instruction. Repeated exposures to similar or identical cases on the serial assessments did not impact the students' performances. Both content- and process-oriented measures of communication skills yielded highly similar results. CONCLUSIONS: Serial assessments using standardized patients can detect interval changes in performance that are independent of repeated exposures to similar or identical cases. Changes detected using this approach may have important curricular implications.     

Medical gross anatomy as a predictor of performance on the USMLE Step 1

Traditional predictors of medical school performance, such as Medical College Admission Test (MCAT) scores and grade point averages, are often used during the admissions process to help identify the prospective students who are most likely to complete the basic science portion of the curriculum successfully. Here we analyzed the admissions files and student records of 285 first-year medical students who matriculated at the University of California at Davis School of Medicine between 1999 and 2001 to determine if performance in medical gross anatomy is a similar, if not better, predictor of performance on the United States Medical Licensing Examination (USMLE) Step 1 than traditional predictors used by medical school admissions committees. Though MCAT scores and grade point averages were correlated with scores on the USMLE Step 1, only the score on the biological science section of the MCAT was significantly correlated with passing the licensing examination. In contrast, class rank in medical gross anatomy and the score on a gross anatomy comprehensive final examination were correlated both with scores on the USMLE Step 1 and passing the examination. Our results indicate that medical schools should consider performance in medical gross anatomy just as much, if not more, than traditional predictors of medical school performance when trying to identify students who may need more time or tutoring to pass the licensing examination.     

When are students most at risk of encountering academic difficulty? A study of the 1992 matriculants to U.S. medical schools.

The authors carried out the study reported here to assess which variables are most predictive of the risk of medical students' experiencing academic difficulties and to assess when these students are most susceptible to encountering those difficulties. The entering class of 1992 was chosen as the study population because it was the first matriculating class in which the majority of students (88%) applied to medical school with scores from the revised Medical College Admission Test (MCAT), first implemented in 1991. The primary event of interest in this study was the first occurrence of one of the following events because of academic difficulty: withdrawal, leave of absence, dismissal, or delay of graduation date. The variables examined were MCAT scores undergraduate science GPA, undergraduate institutional selectivity, undergraduate major, racial-ethnic background, sex, and age upon entering medical school. Survival analysis was used to assess which variables were most predictive of the risk of academic difficulty and when students with different characteristics were most at risk. The results of the survival analysis indicated that (1) while the risk and timing of academic difficulty varied across the groups studied, a majority of the students who experienced academic difficulty eventually graduated from medical school and (2) students with non-science undergraduate majors did not have a greater risk of academic difficulty. The results confirm previous findings that increased risk of academic difficulty is associated with low MCAT scores, low science GPA, low undergraduate institutional selectivity, being a woman, being a member of a racial-ethnic underrepresented minority, or being older. The study findings can be generalized to help in early identification of students who are more likely to be at risk of experiencing academic difficulty. Knowing when these students are more likely to be at risk can help medical schools develop targeted remedial and enrichment programs. Further studies are needed to investigate school-related factors associated with risk.     

USMLE performances in a predominantly Asian and Pacific Islander population of medical students in a problem-based learning curriculum.

PURPOSE: To compare the USMLE performances of students of various ethnicities, predominantly Pacific Islander and Asian, at one medical school and to examine the predictive validity of MCAT scores for USMLE performance. METHOD: A total of 258 students in the graduating classes of 1996-2000 at the University of Hawai'i School of Medicine were classified by ethnicity. Demographic and performance characteristics of the groups were examined, and MCAT scores with and without undergraduate science GPA were used to predict USMLE performance. Under- and over-prediction rates were computed for each ethnic group. RESULTS: Ethnic groups did not differ significantly by gender or undergraduate GPA. Chinese, Caucasian, and Other Asian students tended to have higher MCAT scores than Hawaiian/other Pacific Islander, and Filipino students. Ethnic groups did not differ significantly in prediction of USMLE Step 1 performance. For Step 2, MCAT scores significantly over-predicted performance of Filipino students and tended to under-predict performance of Caucasian students. CONCLUSION: Although MCAT scores and science GPA were good predictors of USMLE performance, ethnic differences were found in the degrees of their predictive validity. These findings both replicate and extend results of earlier studies, and again point to the importance of exploring additional predictor variables. The authors encourage future research on the effects of the following factors on success in medical school: reading and test-taking skills, socio-cultural and environmental influences on learning, communication styles, primary language use, family support, and family responsibilities.     

The association between students' research involvement in medical school and their postgraduate medical activities

The authors examined the impact of students' research involvement during medical school on their postresidency medical activities. The three medical schools involved--The Pennsylvania State University College of Medicine (PSU), The University of Connecticut School of Medicine (UCONN), and The University of Massachusetts Medical School (UMASS)--have nearly indistinguishable applicant, matriculant, and curriculum profiles. However, at PSU a research project is a curriculum requirement for students who did not do medical research prior to entering medical school. Questionnaires were sent to all graduates from the classes of 1980, 1981, and 1982. A total of 567 graduates completed the questionnaires, an overall response rate of approximately 76%. Medical school research experience was reported by 83% (183) of the PSU graduates, 34% (52) of the UCONN graduates, and 28% (54) of the UMASS graduates. When compared on a school-by-school basis, the graduates from the three schools did not differ with respect to residency specialty training, fellowship training, academic appointments, career practice choices, or postgraduate research involvement. However, when all the graduates studied were examined as a single group, medical school research experience was found to be strongly associated with postgraduate research involvement.     

The effect on grades of the timing and site of third-year internal medicine clerkships

Two important factors affecting the performances of third-year medical students on their basic internal medicine clerkships were investigated: (1) the effect on their grades of when in the academic year they took the internal medicine clerkship, and (2) the effect on their grades of the site of the clerkship. During the academic years 1983-84, 1984-85, and 1985-86, the Department of Internal Medicine of the University of Illinois College of Medicine at Chicago conducted 12-week junior clerkships at six hospital sites. The study analyzed the 535 students' subjective grades, clerkship examination scores, final grades, and National Board of Medical Examiners Part I (NBME-I) scores. Although students' performances as characterized by subjective evaluations did not improve as the academic year progressed, mean scores on clerkship examinations improved steadily during the same period. The site of the clerkship, whether a community-affiliated hospital or a medical center hospital, affected neither subjective nor objective grades.     

Evaluation of an early medical school selection program for underrepresented minority students.

PURPOSE: To evaluate the academic performance in the first two years of medical school of underrepresented minority students (URMS) who participated in an early identification and admission program. METHOD: The study involved 39 early-selection URM students who entered one medical school from 1992 through 1999. Successful completion of the first two years of medical school and passing the United States Medical Licensure Examination (USMLE) Step 1 were correlated with Scholastic Aptitude Test I (SAT I) scores and Medical College Admission Test (MCAT) scores. The students were required to maintain an overall grade-point average of at least 3.0 on a 4.0 scale to remain in the program. RESULTS: Students who had combined scores of at least 900 on the SAT I and total scores of at least 18 on the three multiple-choice sections of the MCAT had more success completing the first two years of medical school and passed USMLE Step 1 with greater frequency than did those students who scored at lower levels on these tests. CONCLUSION: An early-selection program for URM students can identify early in their academic careers students who can complete the first two years of medical school and pass the USMLE Step 1.     

Health science learning academy: a successful "pipeline" educational program for high school students.

OBJECTIVE: The objective of the Health Professions Partnership Initiative is to increase the number of underrepresented minority Georgia residents who become health care professionals by (1) creating a pipeline of well-qualified high school and college students interested in health care careers, (2) increasing the number of well-qualified applicants to medical and other health professions schools, and (3) increasing the number of underrepresented minority students at the Medical College of Georgia (MCG). DESCRIPTION: The Health Professions Partnership Initiative at MCG was created in 1996 by collaboration among the MCG Schools of Medicine and Nursing, two Augusta high schools attended primarily by underrepresented minority students, three historically black colleges and universities, the Fort Discovery National Science Center of Augusta, community service organizations, and MCG student organizations. The project was funded by the Association of American Medical Colleges and The Robert Wood Johnson Foundation. The high school component, the Health Science Learning Academy (HSLA), was designed to strengthen the students' educational backgrounds and interest in professional careers as evidenced by increased standardized test scores and numbers of students entering college and health professions schools. Additional goals included a system to track students' progress throughout the pipeline as well as professional development sessions to enrich faculty members' knowledge and enhance their teaching expertise. The HSLA began with ninth-grade students from the two high schools. During its second year, funding from the Health 1st Foundation allowed inclusion of another high school and expansion to ninth grade through twelfth grade. The HSLA's enrichment classes meet for three hours on 18 Saturday mornings during the academic year and include computer-interactive SAT preparation and English composition (tenth grade); biology, algebra, calculus, and English composition (eleventh grade); and advanced mathematics and biology (twelfth grade). DISCUSSION: The ultimate solution to the paucity of underrepresented minority physicians resides largely in successful pipeline programs that expand the pool of well-qualified applicants, matriculants, and graduates from medical schools. Intermediate results of the HSLA support the success of the program. Since its creation in the 1996-1997 academic year, 203 students have participated in the HSLA and all 38 (from the original two schools) who completed the four-year program have enrolled in college. The mean SAT score for students who completed the HSLA program was 1,066, compared with a mean of 923 for all college-bound students in the participating schools. The mean increases in SAT scores for students who completed the four-year program were.5% (1,100 to 1,105) for students attending a magnet high school and 18% (929 to 1,130) for students attending the comprehensive high school. The mean overall increases in SAT scores for students in the two high schools were 1% (1,044 to 1,048) and 9.1% (765 to 834), respectively. The HSLA is accomplishing its goals and, while it is too early to know if these students will participate in MCAT preparatory programs and apply to medical and other health professions schools, their sustained commitment and enthusiasm bode well for continued success.     

The educational value of community preceptorships in surgery

Increasing class size provided the impetus to send students on the core surgery course at the Medical University of South Carolina College of Medicine into the community hospitals with members of the clinical faculty. Each student was assigned to a surgeon and accompanied this preceptor on rounds, in the operating room, and in the office. To determine whether the students' learning was affected by being outside the university, the authors looked at the experience from 1977 to 1986 with 683 surgery students who took community preceptorships and 696 surgery students who took only university-based rotations. The two groups were compared in regard to age, sex, basic science grade-point average, class rank at the end of the first two years in medical school, ward evaluations, grades on departmental final examinations, and National Board of Medical Examiners "mini-examination" scores and Part II surgery scores. No differences were found. Choices of specialty for the first postgraduate year and evaluations of program directors were reviewed for 1982, 1985, and 1986, and were similar for all three years. The preceptorship program has been popular with students, who stated that they valued the one-to-one relationship with surgeons who liked to teach. The program has relieved pressure on the university hospital system and provided a good learning experience for students.     

Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry.

PURPOSE: Medical school is a critical time for physicians in training to learn the professional norms of interacting with the pharmaceutical industry, yet little is known about how students' attitudes vary during the course of training. This study sought to determine students' opinions about pharmaceutical industry interactions with medical students and whether these opinions differ between preclinical and clinical students. METHOD: The authors surveyed medical students at Harvard Medical School (HMS) from November 2003 through January 2004 using a six-question survey. The authors then analyzed how responses differed among the classes. RESULTS: Out of 723 questionnaires, 418 were returned--an overall response rate of 58%. A total of 107 (26%) students believed that it is appropriate for medical students to accept gifts from pharmaceutical companies, and 76 (18%) agreed that the medical school curriculum should include events sponsored by the pharmaceutical industry. Many students--253 (61%)--reported that they do not feel adequately educated about pharmaceutical industry-medical professionals' interactions. Preclinical and clinical students had similar opinions for the majority of their responses. Finally, students who reported feeling better educated about pharmaceutical industry interactions tended to be less skeptical of the industry and more likely to view interactions with the industry as appropriate. CONCLUSIONS: Students' opinions about interactions with the pharmaceutical industry were similar between preclinical and clinical students, suggesting that the current medical school experience may have limited impact on students' views about interactions with the pharmaceutical industry.     

适应心理辅导在高三学生中的应用

目的 验证适应心理辅导在教学中的作用和效果。方法 队列研究方法,选择2000级的雅安市雨城区第一中学的两个高中班,入学成绩两个班基本相同（没有显著性差异）。将其中一个班进行适应心理辅导另一个班没有应用。结果 应用适应心理辅导班的高考成绩明显优于对照班。适应学习的能力明显提高。结论 适应心理辅导能够提高学生的适应能力,提高学生的学习成绩。     

The strategic impact of a changing curriculum and learning environment on medical students' academic performance

In recent years, the administration of Meharry Medical College, School of Medicine (SOM), Nashville, Tennessee, recognized the need to modify the curriculum to help improve student academic performance especially on the National Board of Medical Examiners (NBME) US Medical Licensing Examination (USMLE) steps 1 and 2. Thus, a number of changes occurred with respect to the traditional curriculum in the SOM, resulting in an integrated organ system-based curriculum design. The change in the learning environment was studied to determine the impact on performance after the introduction of the integrated organ system-based curriculum as compared to that of the traditional curriculum. With the utilization of a cadre of variables, it was believed that the strategic impact anticipated would provide a predictive validity profile to assist in the identification of students "at risk" of failure so that proactive intervention methodology could be made available to facilitate the students' successful progression during matriculation in the SOM. The purpose of this study was to analyze whether students trained with the integrated organ systems curriculum perform better than students trained with the traditional medical school curriculum on the medical education preclinical subject board examinations, and the NBME USMLE steps 1 and 2 examinations. From the 584 students studied in the control group (graduation classes for years 2005, 2006, and 2007) and the intervention group (graduation classes for years 2008, 2009, and 2010), significant improvement in performance on the NBME USMLE steps 1 and 2 examinations was noted following the introduction of the integrated organ system-based curriculum particularly among "at-risk" students. Data access availability from the School of Medicine of Meharry Medical College automatically gave reason for a preferential comparative relationship and study of the resulting strategic impact on cohorts graduating in years 2005-2010. Thus, this longitudinal retrospective review was to determine whether or not students' academic performance profiles might provide some valid predictive information to help identify "at-risk" students early in their pursuit of a health professions career.