Predicting academic performance at a predominantly black medical school

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

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

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

Use of MCAT data in selecting students for admission to medical school

In the spring of 1986, medical school admissions personnel were surveyed on their institutions' admissions practices and the use of Medical College Admission Test (MCAT) data in student selection. The admissions officers listed sources of information considered in processing applications. The variables accorded high importance were: overall and science undergraduate grade-point averages, quality of degree-granting institutions, letters of evaluation, interview ratings, MCAT scores, extracurricular activities, work in areas related to health care, breadth and/or difficulty of course work, and state of legal residence. Variables judged of medium importance were: nonscience grade-point average, graduate study, narratives supplied through the American Medical College Application Service or supplemental narratives, demographic factors, and undergraduate research. The respondents divided the 15-point MCAT scale into exemplary, acceptable, and unacceptable ranges of performance. These responses varied widely among institutions. The mean response for the bottom of the acceptable range was a score of seven, and the mean for the beginning of the exemplary range was 11. In considering individual MCAT subtest scores, 34 percent of the admissions officers regarded the six scores individually and equally, 51 percent weighted the areas in ways related to their curricula, and 43 percent summed or averaged scores with equal weights at some point. Thirty-one percent used MCAT scores to adjust grade-point averages across undergraduate institutions.     

Relationship between past academic performance and results of specialty in-training examinations

In this study, the authors review the records of 63 graduates of Northwestern University Medical School who were residents in its graduate medical education programs of anesthesia and orthopedic surgery. They examine the relationship among college grades, medical school performance, and the results of assessment by annual, nationwide, medical specialty in-training examinations. For the anesthesia group, the best predictors of in-training examination performance were the Medical College Admission Test (MCAT) Verbal Ability score, the college grade-point average for nonscience subjects, and the MCAT Science, General Information, and Quantitative Ability scores. For the orthopedic group, the best predictors were the MCAT Verbal Ability score, the college grade-point average in nonscience subjects, the MCAT Science score, and the National Board of Medical Examiners Part I and Part II examination scores. The previous academic records for the 63 residents contained little to presage results in the in-training examination. The correlation obtained between nonscience college subjects and the in-training examination results was negative.     

Changes in the qualifications of medical school applicants, 1981 to 1985

The decline in the number of medical school applicants has prompted concerns among medical educators regarding the effects of this decrease on the qualifications of the applicant pool. Changes in the qualifications of medical school applicants were analyzed in terms of age, sex, and ethnicity or racial group using two measures of quality: Medical College Admission Test (MCAT) scores and grade-point averages. The distributions of these measures for 1981 and 1985 applicants were compared. The results showed that there were significant but modest gains over the years in the percentage of men and women applicants who scored from 10 to 15 on the MCAT biology, chemistry, physics, and science problems subtests. There were also significant percentage gains for applicants in all age categories, except applicants over age 32, and for all ethnic or racial groups except blacks. The authors conclude that a variety of sociodemographic, educational, and selection factors may account for these changes.     

The quality of deans' letters from medical schools

Residency training directors have noted considerable variability in the quality of deans' letters sent by medical schools on behalf of graduating students. A total of 212 deans' letters from 103 U.S. medical schools received by a large psychiatric residency program were rated by two of the authors. Of these, 26.9 percent were judged excellent, 49.5 percent average, and 23.6 percent poor. Excellent letters were characterized by detailed personal and academic comments; verbatim statements for each clinical clerkship; tactful , yet explicit, remarks about problems; and internal consistency. Poor letters were generally short regardless of content, offered global impressions about clerkship performance by fusing remarks from several different clerkships without identifying sources, or omitted important information that was quickly evident to the discriminating interviewer. Recommendations are offered for authors and readers of deans' letters and to medical students.     

Teacher-student interaction in a medical clerkship.

Seventeen randomly selected clinical teaching sessions in a medical school clerkship were videotaped during a one-month period, including teaching rounds, working rounds, morning report sessions, lectures, patient management conferences, grand rounds, and journal clubs. Using a verbal behavior classification schedule, the investigators analyzed the videotapes in terms of the proportion of talking done by clerkship instructors, medical students, residents, and others. The nature of the verbal interaction was examined by assessing the proportion of time devoted to giving information versus asking questions. The proportions on these dimensions were further analyzed according to the cognitive level of the verbal interaction. The data suggest that the teaching observed was not optimal for promoting problem-solving ability, since students were placed in a very passive role in which they received a preponderance of low-level, factual information.     

Undergraduate medical education

The number of applicants to US medical schools, which declined steadily between 1985 and 1988, increased slightly for the class entering in 1989. The profile of entering students showed a small decline from last year in the percentage of students with grade point averages categorized as "A" (3.5 or above on a 4-point scale) and slight declines in four of the six MCAT subtest scores. The percentage of both women and minority students in the entering class increased from the previous year. An interesting observation is the large percentage increase this year in students transferring to LCME medical schools from graduate and professional degree programs and from osteopathic medical schools. While the number of full-time faculty members in medical schools continues to increase, significant vacancy rates exist in some departments. More than 5% of full-time faculty positions are vacant in genetics, pathology, dermatology, family medicine, neurology, obstetrics-gynecology, orthopedics, otolaryngology, pediatrics, and surgery departments. Along with faculty vacancies, there has been a considerable turnover of medical school deans. The curriculum in most medical schools includes some innovative instructional formats, such as problem-based learning and computer-assisted instruction. However, current data do not allow a generalization about the extent to which these are being utilized. It seems that, at least in some institutions, multiple methods are being used to assess the clinical competence of medical students (observation by faculty members and residents, written and oral examinations, and multiple station examinations), including the use of standardized patients. About half of the medical schools require students to pass the NBME Part I examination and about one third require passage of Part II. The subject examinations provided by the NBME seem to be used widely, at least in the clinical disciplines. Within the past year, about 14% of medical schools have reported the presence of students or residents who have been diagnosed with human immunodeficiency virus infection, and 12% have had students or residents diagnosed with hepatitis B virus infection. It is critical that medical schools teach students how to prevent occupational exposure to these infections, as well as ensuring that adequate health insurance coverage be provided for these conditions.     

Longitudinal study of medical students selected for admission to medical school by actuarial and committee methods.

This study evaluates a "mid period" follow-up evaluation of the outcomes of selection of medical students by customary committee review procedures versus actuarial selection. One-third of a freshman class was selected solely on the basis of a predictor index which was a previously validated, optimally weighted combination of scores on the Medical College Aptitude Test and the premedical grade-point average. The remaining two-thirds were selected by committee decision based on review of the total application file which, in addition to the aptitude test scores and academic record, included basic demographic data, information on extracurricular activities, avocational interests, work experience, letters of recommendation, personality test profiles, and interview impressions. In a previous study, it was reported that the two groups of students were undifferentiated with respect to their academic standing at the close of their sophomore year. In the present study, the actuarially selected and committee selected students were compared on class rank at the end of the junior year, total and subtest scores on part II of the National Board Examinations administered toward the close of their senior year, and type and location of internship, and practice or training status one year after graduation. The two groups were not reliably differentiated on any of these variables. Implications of the findings are discussed with respect to reliability, efficiency, and economy in the selection process and the function of the admissions committees with respect to borderline cases and issues of school policy and philosophy.     

Relationships between performance in medical school and first postgraduate year

Data from a longitudinal study of Jefferson Medical College graduates were analyzed to determine levels of clinical competence in the first postgraduate year and relationships between postgraduate ratings and performance during medical school. Ratings were obtained on knowledge, data-gathering skills, clinical judgement, and professional attitudes from the hospitals in which the graduates received their training. Significant relationships were found among three levels of performance in medical school and postgraduate ratings and in all four competence areas. Relationships were strongest at the highest and lowest performance levels. It is concluded that in a substantial number of cases good and poor performance in the first postgraduate year can be predicted on the basis of information already available to the medical school faculty.     

运用循证医学理念指导临床医学专业本科生临床见习教学

循证医学即遵循科学证据的医学,其实质是一种新式高效的终身学习的临床教育理念。本研究应用循证医学理念指导我校2003级临床医学专业本科生的临床见习教学,通过理论考试、临床技能考核及问卷调查进行教学效果的评价。结果显示,实验组学生理论考试和临床技能考核成绩均明显高于对照组(P<0.05),实验组中91.4%的学生赞成此种教学方法。本研究结果提示,将循证医学理念引入医学生的临床见习教学中,有利于教学质量的提高和学生综合素质的培养。     

The new MCAT and medical student performance

The "old" Medical College Admission Test (MCAT) has been replaced by the "new" MCAT. For many years the University of California, Irvine, has included the old MCAT in a prediction index as part of its admissions procedure. The use of the New MCAT has required this index to be recalculated. Since the predictive power of the new MCAT is unknown, it has been necessary to wait until the first class admitted completed its freshman year. This paper is an analysis of the new MCAT and its relationship to the criterion of class standing achieved in the school year ending in the spring of 1979.     

Evaluation of a preentrance enrichment program for minority students admitted to medical school

The authors report on an enrichment program for minority students and its effect on those students' performance in the first year of medical school. The six-week preentrance enrichment program (PEP) offers a curriculum of basic science courses, study skills training, and a seminar on special topics, typically on sociomedical issues. From 1973 through 1984, 115 students who had been admitted to Boston University School of Medicine participated in the PEP prior to matriculation. The PEP participants had lower scores on the Medical College Admission Test than minority nonparticipants admitted to the medical school. Analysis of the first-year performance of PEP participants, however, indicated that the participants had significantly higher proportions of pass and honors grades than minority nonparticipants in two courses and slightly higher (though not significant) proportions of pass and honors grades in six other courses of the nine courses in the first-year curriculum. In a related study, preliminary analysis showed that participation in the PEP was one of the consistent predictors of overall academic performance during the first year. Questionnaires completed by participants before and after the program and their responses to a survey at the end of their first year of medical school indicated the participants felt they had gained benefits from the program that enhanced their academic adjustment.     

Study of required clerkships in internal medicine in U.S. and Canadian medical schools

The authors studied teaching of clinical skills and the supervision of clinical education of undergraduate medical students by reviewing students' patient-related experiences in required internal medicine clerkships in the United States and Canada during the 1979-1982 accreditation cycle of the Liaison Committee on Medical Education. The reported patient-related experiences of 180 medical students from 42 medical schools who took histories and performed physical examinations on 2,891 patients formed the basis of this paper. Variability in clerkship length, time worked, supervision, and patient mix suggests that additional quantitative data should be sought on medical students' experiences during the clerkship.     

The role of the student ward in the medical clerkships

The authors describe the structure and the development of an internal medicine clerkship designed to promote proficiency in the process of clinical reasoning. The clerkship is centered around a "student ward" in which the student assumes the role of primary physician. The environment provides not only close supervision and counsel but also allows a great deal of autonomy as students embark on their first clinical medicine rotation. The student ward offers a structured environment where the emphasis is on in-depth clinical exposure and the acquisition of clinical knowledge in a manner consistent with the principles of problem-based learning. Breadth of clinical exposure is accomplished through a variety of educational approaches.     

A model for predicting performance on the NBME Part I examination

Multiple regression analyses were employed to determine the relationships between achievement variables as predictors of the performance on Part I of the National Board of Medical Examiners examinations (NBME-I) of 366 medical students. The students' examination score averages in first- and second-year basic science courses were sequentially added to a composite Medical College Admission Test (MCAT) score to investigate the increases in prediction accuracy. Four prediction equations were cross validated on two subsequent medical school classes. While the multiple correlation between the predicted NBME-I score and the actual score significantly increased as first- and second-year course examination scores were added to the equations, the overall accuracy in predicting passing or failing did not substantially increase. The most useful equation employed a combination of the MCAT score and the first semester anatomy course examination score. The NBME-I predictions were given by letter to the 1984 and 1985 students approximately a year before they were to take the NBME-I examination so that students at risk of failure could undertake remedial study.     

Evaluating medical school graduates of a reduced course program: a preliminary report

The performance of 32 medical school graduates who had pursued a reduced course load ("extended program") for one or more years during medical school was examined during the first postgraduate year (PGY-1) of training. Those with academic problems as undergraduates performed at only a slightly lower than average level, while those who had extended their curricula to pursue personal or extracurricular interests tended to perform at a better than average level in the PGY-1 residency. Graduates with significant emotional disorders in medical school who pursued a reduced course load had a high (35 percent) dropout rate during the residency that occurred despite expert psychiatric care and substantial support during medical school and the residency. The authors suggest that extended programs may be useful for students seeking personal enrichment and for some with academic problems but that they do not seem particularly helpful to students with major emotional disturbances.     

Correlations between SAT scores and MCAT scores of black students in a summer program

The purpose of the study reported here was to determine the relationship between Scholastic Aptitude Test (SAT) scores and Medical College Admission Test (MCAT) scores of black students who had participated in a summer program for minority students interested in health careers held at the Medical College of Georgia. A significant correlation was established between these students' SAT and MCAT scores. These findings suggest that students who are likely to perform well in medical school can be selected for medical school while they are still underclassmen, accepted conditionally, and admitted after completing a prescribed curriculum. Early selection has implications for increasing the number of minority students in medicine and for permitting more liberal arts in the premedical education than the present selection process.     

Student peer review of diagnostic tests at the Medical College of Ohio.

Students in their clinical clerkship performed retrospective reviews of their peers' laboratory usage patterns. Data covering the patient's history and physical examination, problem list, and treatment plan had been completed by students during internal medicine and pediatrics rotations. This information, along with the first day's diagnostic orders, was provided to community medicine clerkship students who then evaluated the cost and medical necessity of diagnostic tests ordered in light of the problem information. Application of such cost control programs, before students form definitive conceptions of treatment, may contribute to more cost-conscious behavior in their future medical practice.     

Responses of fourth-year medical students to a required clerkship in geriatrics

Fourth-year medical students at the Mount Sinai School of Medicine of the City University of New York taking a required four-week clinical clerkship in geriatrics were surveyed before and after the clerkship on their knowledge of geriatrics, attitudes toward the elderly, and evaluation of the rotation. The students showed a significant improvement in their knowledge of geriatrics and gave a mildly favorable evaluation of geriatrics as a required clerkship. Their attitudes toward the elderly did not change, however. This latter finding may be related to favorable attitudes before the clerkship, some factor inherent to the clerkship, or the previously demonstrated lack of correlation between measured attitudes and behavior. The present authors suggest that educators, in establishing clinical clerkships in geriatrics, should focus on imparting knowledge in geriatrics, should assess students' acceptance of the clerkship carefully, and should not use changes in attitudes toward the elderly as the sole measure of the effectiveness of such a clerkship.