At-Risk Medical Students: Characteristics and Possible Interventions

Higher education institutions worldwide are faced with large numbers of dropouts and students taking too long to complete their courses. On average almost a third of students in OECD countries withdraw from higher education before obtaining a degree. A substantial proportion of students drop out in their first year. In the UK and Australia an average of 20% of Year 1 students discontinue their enrolment after one year. In the Netherlands, about 10% of Year 1 students drop out from university, while another 25% switch to other courses within or after one year. In general, medical students are a positive exception with respect to success rates and time needed for graduation.However, retrospective data averaged over eight schools and ten generations of Dutch medical students showed that still about 17% fails to complete the six-year curriculum within nine years of study and that the mean study duration of those graduated is 7.31 years. In 2004, the Quality Assurance Netherlands Universities (QANU) reported that for the 1995 to 1999 cohorts of all eight Dutch medical schools on average 64% of the students completed their Year 1 course within one year and 86% within two years. Data from two cohorts of UK medical students revealed an average dropout rate of 10%.9 About half of these dropouts left within the first year of their studies

Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training

Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008–2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations

The relationship between extracurricular activities assessed during selection and during medical school and performance

Several medical schools include candidates’ extracurricular activities in their selection procedure, with promising results regarding their predictive value for achievement during the clinical years of medical school. This study aims to reveal whether the better achievement in clinical training of students selected on the basis of their extracurricular activities could be explained by persistent participation in extracurricular activities during medical school (msECAs). Lottery-admitted and selected student admission groups were compared on their participation in three types of msECAs: (1) research master, (2) important board positions or (3) additional degree programme. Logistic regression was used to measure the effect of admission group on participation in any msECA, adjusted for pre-university GPA. Two-way ANCOVA was used to examine the inter-relationships between admission group, participation in msECAs and clerkship grade, with pre-university GPA as covariate. Significantly more selected students compared to lottery-admitted students participated in any msECA. Participation in msECAs was associated with a higher pre-university GPA for lottery-admitted students only, whereas participation in msECAs was associated with higher clerkship grades for selected students only. These results suggest that persistent participation in extracurricular activities of selected students favours better clinical achievement, supporting the inclusion of ECAs in the selection procedure. More insight in the rationale behind participation in extracurricular activities during medical school may explain differences found between lottery-admitted and selected students

MUM effect in medical education: taking into account the recipient and training setting

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Influence of response instructions and response format on applicant perceptions of a Situational Judgement Test for medical school selection

BACKGROUND: This study examined the influence of two Situational Judgement Test (SJT) design features (response instructions and response format) on applicant perceptions. Additionally, we investigated demographic subgroup differences in applicant perceptions of an SJT. METHODS: Medical school applicants (N = 372) responded to an online survey on applicant perceptions, including a description and two example items of an SJT. Respondents randomly received one of four SJT versions (should do-rating, should do-pick-one, would do-rating, would do-pick-one). They rated overall favourability and items on four procedural justice factors (face validity, applicant differentiation, study relatedness and chance to perform) and ease-of-cheating. Additionally, applicant perceptions were compared for subgroups based on gender, ethnic background and first-generation university status. RESULTS: Applicants rated would-do instructions as easier to cheat than should-do instructions. Rating formats received more favourable judgements than pick-one formats on applicant differentiation, study-relatedness, chance to perform and ease of cheating. No significant main effect for demographic subgroup on applicant perceptions was found, but significant interaction effects showed that certain subgroups might have more pronounced preferences for certain SJT design features. Specifically, ethnic minority applicants - but not ethnic majority applicants - showed greater preference for should-do than would-do instructions. Additionally, first-generation university students - but not non-first-generation university students - were more favourable of rating formats than of pick-one formats. CONCLUSIONS: Findings indicate that changing SJT design features may positively affect applicant perceptions by promoting procedural justice factors and reducing perceived ease of cheating and that response instructions and response format can increase the attractiveness of SJTs for minority applicants

Gender-specific effects of raising Year-1 standards on medical students' academic performance and stress levels

Context: Medical schools are challenged to create academic environments that stimulate students to improve their study progress without compromising their well-being. Objectives: This prospective comparative cohort study investigated the effects of raising Year-1 standards on academic performance and on students' chronic psychological and biological stress levels. Methods: In a Dutch medical school, students within the last Bachelor's degree cohort (n = 410) exposed to the 40/60 (67%) credit Year-1 standard (67%-credit cohort) were compared with students within the first cohort (n = 413) exposed to a 60/60 (100%) credit standard (100%-credit cohort). Main outcome measures were Year-1 pass rate (academic performance), mean score on the Perceived Stress Scale (PSS, psychological stress) and hair cortisol concentration (HCC, biological stress). Results: Year-1 pass rates were significantly higher in the 100%-credit cohort (odds ratio [OR] 4.65). Interestingly, there was a significant interaction effect (OR 0.46), indicating that raising the standard was more effective for male than for female students. PSS scores (n = 234 [response rate [RR]: 57%] and n = 244 [RR: 59%] in the 67%- and 100%-credit cohorts, respectively) were also significantly higher in the 100%-credit cohort (F(1,474) = 15.08, P <.001). This applied specifically to female students in the 100%-credit cohort. Levels of HCC (n = 181 [RR: 44%] and n = 162 [RR: 39%] respectively) did not differ between co

Assessment policies and academic progress: differences in performance and selection for progress

Despite the benefits swift academic progress holds for many stakeholders, there is scarce literature on how academic progress may be improved by changes to assessment policies. Therefore, we investigated academic progress of first-year students after an alteration of characteristics of the assessment policies in three large course programmes: business administration (n = 2048) changed the stakes; medicine (n = 1630) changed the stakes and performance standard; psychology (n = 1076) changed the stakes, performance standard and resit standard. Results indicate that students’ academic progress was sensitive to the characteristics of the assessment policy in all three course programmes. The changes in progress could be explained by differences in performance, as well as by differences in selection for progress by the different policies. Implications are that assessment policies seem effective in shaping student progress, although one size does not fit all

Assessment policies and academic performance within a single course: The role of motivation and self-regulation.

Despite the frequently reported association of characteristics of assessment policies with academic performance, the mechanisms through which these policies affect performance are largely unknown. Therefore, the current research investigated performance, motivation and self-regulation for two groups of students following the same statistics course, but under two assessment policies: education and child studies (ECS) students studied under an assessment policy with relatively higher stakes, a higher performance standard and a lower resit standard, compared with Psychology students. Results show similar initial performance, but more use of resits and higher final performance (post-resit) under the ECS policy compared with the psychology policy. In terms of motivation and self-regulation, under the ECS policy significantly higher minimum grade goals, performance self-efficacy, task value, time and study environment management, and test anxiety were observed, but there were no significant differences in aimed grade goals, academic self-efficacy and effort regulation. The relations of motivational and selfregulatory factors with academic performance were similar between both assessment policies. Thus, educators should be keenly aware of how characteristics of assessment policies are related to students’ motivation, self-regulation and academic performance