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1.  A holistic review of the medical school admission process: examining correlates of academic underperformance 
Medical Education Online  2014;19:10.3402/meo.v19.22919.
Background
Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum.
Methods
The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB).
Results
Of the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance.
Conclusions
Our review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.
doi:10.3402/meo.v19.22919
PMCID: PMC3974177  PMID: 24695362
admissions; underperformance; selection; at-risk students
2.  To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study 
BMC Medical Education  2013;13:68.
Background
Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.
A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills.
Method
Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models.
Results
Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.
In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest.
Conclusion
We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.
doi:10.1186/1472-6920-13-68
PMCID: PMC3667098  PMID: 23663266
Selection; Medical; Student; Validity; Predictive; HPAT-Ireland; Assessment; Cognitive; Ability
3.  The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors 
BMC Medicine  2013;11:242.
Background
Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.
Methods
Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.
Results
Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.
Conclusions
The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.
doi:10.1186/1741-7015-11-242
PMCID: PMC3827330  PMID: 24229333
Academic Backbone; Secondary school attainment; Undergraduate medical education; Post-graduate medical education; Longitudinal analyses; Continuities; Medical student selection; Cognitive capital; Medical capital; Aptitude tests
4.  Predictors of Academic Success in a Doctor of Pharmacy Program 
Objectives
To evaluate the correlation between specific prepharmacy college variables and academic success in the Texas Tech doctor of pharmacy degree program.
Methods
Undergraduate and pharmacy school transcripts for 424 students admitted to the Texas Tech doctor of pharmacy degree program between May 1996 and May 2001 were reviewed in August of 2005. Statistical analyses were performed using SPSS Release 11.5. The undergraduate college variables included prepharmacy grade point-average (GPA), organic chemistry school type (2- or 4-year institution), chemistry, biology, and math courses beyond required prerequisites, and attainment of a bachelor of science (BS), bachelor of arts (BA), or master of science (MS) degree. Measurements of academic success in pharmacy school included cumulative first-professional year (P1) GPA, cumulative GPA (grade point average of all coursework finished to date), and graduation without academic delay or suspension.
Results
Completing advanced biology courses and obtaining a BS degree prior to pharmacy school were each significantly correlated with a higher mean P1 GPA. Furthermore, the mean cumulative GPA of students with a BS degree was 86.4 versus cumulative GPAs of those without a BS degree which were 84.9, respectively (p = 0.039). Matriculates with advanced prerequisite biology coursework or a BS degree prior to pharmacy school were significantly more likely to graduate from the doctor of pharmacy program without academic delay or suspension (p = 0.021 and p = 0.027, respectively). Furthermore, advanced biology coursework was significantly and independently associated with graduating on time (p = 0.044).
Conclusions
Advanced biology coursework and a science baccalaureate degree were significantly associated with academic success in pharmacy school. On multivariate analysis, only advanced biology coursework remained a significant predictor of success.
PMCID: PMC1637008  PMID: 17149435
academic success; pharmacy students; grade point average; graduation; prerequisites; performance
5.  Exploring the divergent academic outcomes of U.S.-origin and immigrant-origin Black undergraduates 
Journal of diversity in higher education  2012;5(4):10.1037/a0030181.
To explore the divergent academic experiences and outcomes of U.S.-origin and immigrant-origin Black Americans, we drew on Tinto’s model of persistence (1993) to test a three-wave longitudinal model of college persistence using path analysis. Our sample was comprised of 101 ethnically-diverse Black students who were randomly selected from nine public high schools in the metropolitan Boston area and went on to matriculate at 32 different, predominantly White colleges and universities. Specifically, we compared U.S.-origin and immigrant-origin Black undergraduates’ reported college social support/social integration and academic integration; and measured the influence of these factors (as well as high school grades and socioeconomic status) on college persistence two years later. As predicted, and consistent with previous studies, immigrant-origin Black students academically outperformed their U.S.-origin Black counterparts, earning significantly higher high school grades and demonstrating greater persistence in college. However, when the effects of high school grades and SES on college persistence were included in a multivariate path model together with immigration status and college social and academic integration, immigration status no longer predicted college persistence. Neither social nor academic integration predicted college persistence, within the path model, as hypothesized, but social integration did predict academic integration as expected. In separate correlational analyses, academic integration and SES were associated with college persistence for U.S.-origin Black students, but this was not the case for immigrant-origin Black students. We discuss the implications of these findings for fostering greater success among diverse Black undergraduates.
doi:10.1037/a0030181
PMCID: PMC3816006  PMID: 24198895
African Americans; immigrant Black Americans; college persistence; academic integration; social integration
6.  Experienced stressors and coping strategies among Iranian nursing students 
BMC Nursing  2007;6:11.
Background
College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to affect students' health and academic functions. If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result. Effective coping strategies facilitate the return to a balanced state, reducing the negative effects of stress.
Methods
This descriptive cross-sectional study was performed to determine sources of stress and coping strategies in nursing students studying at the Iran Faculty of Nursing & Midwifery. All undergraduate nursing students enrolled in years 1-4 during academic year 2004-2005 were included in this study, with a total of 366 questionnaires fully completed by the students. The Student Stress Survey and the Adolescent Coping Orientation for Problem Experiences Inventory (ACOPE) were used for data collection.
Results
Most students reported "finding new friends" (76.2%), "working with people they did not know" (63.4%) as interpersonal sources of stress, "new responsibilities" (72.1%), "started college" (65.8%) as intrapersonal sources of stress more than others. The most frequent academic source of stress was "increased class workload" (66.9%) and the most frequent environmental sources of stress were being "placed in unfamiliar situations" (64.2%) and "waiting in long lines" (60.4%). Interpersonal and environmental sources of stress were reported more frequently than intrapersonal and academic sources. Mean interpersonal (P=0.04) and environmental (P=0.04) sources of stress were significantly greater in first year than in fourth year students. Among coping strategies in 12 areas, the family problem solving strategies, "trying to reason with parents and compromise" (73%) and "going along with family rules" (68%) were used "often or always" by most students. To cope with engaging in demanding activity, students often or always used "trying to figure out how to deal with problems" (66.4%) and "trying to improve themselves" (64.5%). The self-reliance strategy, "trying to make their own decisions" (62%); the social support strategies, "apologizing to people" (59.6%), "trying to help other people solve their problems" (56.3%), and "trying to keep up friendships or make new friends" (54.4%); the spiritual strategy, "praying" (65.8%); the seeking diversions strategy, "listening to music" (57.7%), the relaxing strategy "day dreaming" (52.5%), and the effort to "be close with someone cares about you" (50.5%) were each used "often or always" by a majority of students. Most students reported that the avoiding strategies "smoking" (93.7%) and "drinking beer or wine" (92.9%), the ventilating strategies "saying mean things to people" and "swearing" (85.8%), the professional support strategies "getting professional counseling" (74.6%) and "talking to a teacher or counselor" (67.2%) and the humorous strategy "joking and keeping a sense of humor" (51.9%) were used "seldom or never".
Conclusion
First year nursing students are exposed to a variety of stressors. Establishing a student support system during the first year and improving it throughout nursing school is necessary to equip nursing students with effective coping skills. Efforts should include counseling helpers and their teachers, strategies that can be called upon in these students' future nursing careers.
doi:10.1186/1472-6955-6-11
PMCID: PMC2203983  PMID: 17999772
7.  A survey and analysis of student academic support programs in medical schools focus: underrepresented minority students. 
This article describes an investigation that compiled information regarding academic support for medical students at 120 US medical schools. Specifically, the purpose of the study was to identify programs for underrepresented minority medical students and to review prospective applicant materials for photographic evidence that underrepresented minorities are involved in medical education. Eighty-three responses were returned and analyzed. Academic support services described most frequently were prematriculation, tutoring, and counseling and advising. Forty-one of the 83 schools indicated they offer prematriculation programs, 28 of which were required of under-represented minority freshmen entrants. Fifteen described offerings for undergraduate students and six for both undergraduate and secondary school students. Materials from the University of Iowa, the University of Medicine and Dentistry of New Jersey, and Stanford University revealed a variety of services and the largest numbers of photographs of under-represented minorities. These institutions are also among the leaders in underrepresented minority enrollment. Effective communication of academic support and minority presence appear to be contributory factors in enhancing diversity in medical education. Further investigation of academic support, evaluation of support services by participants, and dialogue about effective components of quality academic support are logical next steps to achieve the Association of American Medical College's goal of 3000 by 2000.
PMCID: PMC2607663  PMID: 8046766
8.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Background
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
Conclusions
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001743.
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
doi:10.1371/journal.pmed.1001743
PMCID: PMC4196737  PMID: 25314155
9.  Factors related to medical school application and acceptance in minority summer enrichment program students. 
Baylor College of Medicine has conducted a summer enrichment program for minority/disadvantaged premedical students since 1969. Follow-up data on medical school application and acceptance for participants from 1980 through 1984 were analyzed in relation to selected preprogram variables--cumulative college grade point average, total Scholastic Aptitude Test score, competitiveness of undergraduate college, sex, and ethnicity. Results of univariate and multivariate analyses indicated that: 1) females were significantly less likely to apply to medical school than males, 2) females had significantly lower mean MCAT scores (5.9 vs 7.2) even though their preprogram academic performance was comparable to that of the males, and 3) after controlling for MCAT scores, none of the preprogram variables were significant in predicting medical school acceptance. These findings suggest the need for research to explain the discrepancy between male and female MCAT performance and frequency of medical school application in summer program participants. The findings also have implications for the type of counseling provided to female participants in summer enrichment programs.
PMCID: PMC2627148  PMID: 1920520
10.  Improving Underrepresented Minority Medical Student Recruitment with Health Disparities Curriculum 
Journal of General Internal Medicine  2010;25(Suppl 2):82-85.
ABSTRACT
BACKGROUND
Diversity improves all students’ academic experiences and their abilities to work with patients from differing backgrounds. Little is known about what makes minority students select one medical school over another.
PURPOSE
To measure the impact of the existence of a health disparities course in the medical school curriculum on recruitment of underrepresented minority (URM) college students to the University of Chicago Pritzker School of Medicine.
METHODS
All medical school applicants interviewed in academic years 2007 and 2008 at the University of Chicago Pritzker School of Medicine (PSOM) attended an orientation that detailed a required health care disparities curriculum introduced in 2006. Matriculants completed a precourse survey measuring the impact of the existence of the course on their decision to attend PSOM. URM was defined by the American Association of Medical Colleges as Black, American Indian/Alaskan Native, Native Hawaiian, Mexican American, and Mainland Puerto Rican.
RESULTS
Precourse survey responses were 100% and 96% for entering classes of 2007 and 2008, respectively. Among those students reporting knowledge of the course (128/210, 61%), URM students (27/37, 73%) were more likely than non-URM students (38/91, 42%) to report that knowledge of the existence of the course influenced their decision to attend PSOM (p = 0.002). Analysis of qualitative responses revealed that students felt that the curriculum gave the school a reputation for placing importance on health disparities and social justice issues. URM student enrollment at PSOM, which had remained stable from years 2005 and 2006 at 12% and 11% of the total incoming classes, respectively, increased to 22% of the total class size in 2007 (p = 0.03) and 19 percent in 2008.
CONCLUSION
The required health disparities course may have contributed to the increased enrollment of URM students at PSOM in 2007 and 2008.
doi:10.1007/s11606-010-1270-8
PMCID: PMC2847120  PMID: 20352498
health disparities; curriculum; education; medical students; underserved
11.  The impact of nonacademic variables on performance at two medical schools. 
Recent research shows that nonacademic variables must be taken into account when analyzing the indicators of medical student success. However, most previous studies have been limited to a single institution or population. This study investigated the relationship between nonacademic variables and performance at two very different medical schools. The Noncognitive Questionnaire was administered to 104 students at School A (predominantly white and historically oriented toward women) and 102 at School B (predominantly black). Correlation and multiple regression analyses were conducted to determine the relationship among nonacademic variables, undergraduate academic variables (Medical College Admission Test, undergraduate grade point average, and college quality), basic science grades, and US Medical Licensure Exam Step I (USMLE 1) scores. At School A, leadership/decisiveness, expected difficulty, and motivation predicted higher USMLE I scores and higher basic science grades each semester. At School B, expected difficulty was correlated with higher first semester grades only. For School A women, initiative/commitment was positively associated with both higher grades and higher USMLE scores. For black students of School B, expected difficulty was positively associated with higher grades. Identifying school-specific nonacademic variables of performance is critical to developing improved student support services.
PMCID: PMC2608243  PMID: 9094842
12.  Perceptions of the educational environment of a new medical school, Saudi Arabia 
Background
Educational environment hugely impacts the learning process. An assessment of perceptions of students about the educational environment at Qassim University College of Medicine (QUCOM) would assist educators and college administration in gauging the quality of the learning in this venue. The aim of this study is to see the educational environment of an innovative undergraduate medical program through the eyes of students.
Methods
During the academic year 2011/2012, a survey was performed at QUCOM using the Dundee Ready Education Environment Measure (DREEM) questionnaire. All undergraduate students participated in the survey. Comparisons between, students’ responses according to their study years in the college and gender were taken into consideration. Data were entered and analyzed using SPSS version 17.0. The scores assigned by the students to questionnaire items were converted into and continuous variables and summarized as means.
Results
Out of 467 students enrolled at QUCOM 454 students (61% males and 39% females)participated in the study (response rate of 97%). The mean age of the participants was 21.4 (standard deviation: 2.2). The mean total score was 112, out of a possible maximum of 200. The mean total score for Perception of Learning was 26/48; for Perceptions of Teaching 25/44; for Academic Self perceptions 20/32; for Perceptions of Atmosphere 26/48 and for Social Self Perceptions 15/28. The mean score of 1.13 for Item 3 “There is a good support system for students who get stressed” was the lowest and is indicative of the pressures felt by the students. While the mean score of 3.24 for Item 15 “I have good friends in this school” was the highest showing good relationship between students. There were no significant differences of perceptions between genders and between basic sciences and clinical phases.
Conclusion
Students perceive the educational environment at QUCOM as having more positives than negatives. Certain areas need further exploration and improvements, which should serve as a decision support mechanism for educationists at QUCOM in rationalizing their priorities for reforms.
PMCID: PMC3883605  PMID: 24421744
Educational climate; Educational environment; Medical culture; Medical education
13.  Predictors of performance of students in biochemistry in a doctor of chiropractic curriculum 
Objective
This study investigated the effect of completion of course prerequisites, undergraduate grade point average (GPA), undergraduate degree, and study habits on the performance of students in the biochemistry course at Palmer College of Chiropractic Florida.
Methods
Students self-reported information regarding academic preparation at the beginning of the semester using a questionnaire. Final exam grade and final course grade were noted and used as measures of performance. Multivariate analysis of variance was used to determine if number of prerequisites completed, undergraduate GPA, undergraduate degree, hours spent studying in undergraduate study, and hours spent studying in the first quarter of the chiropractic program were associated significantly with the biochemistry final exam grade or the final grade for the biochemistry course.
Results
The number of prerequisites completed, undergraduate degree, hours spent studying in undergraduate study, and hours spent studying in the first quarter of the chiropractic program did not significantly affect the biochemistry final exam grade or the final grade for the biochemistry course, but undergraduate GPA did. Subsequent univariate analysis and Tukey's post hoc comparisons revealed that students with an undergraduate GPA in the 3.5 to 3.99 range earned significantly higher final course grades than students with an undergraduate GPA in the 2.5 to 2.99 range.
Conclusion
No single variable was determined to be a factor that determines student success in biochemistry. The interrelationship between the factors examined warrants further investigation to understand fully how to predict the success of a student in the biochemistry course.
doi:10.7899/JCE-12-32
PMCID: PMC3967647  PMID: 24295362
Biochemistry; Chiropractic; Education; School Admission Criteria
14.  Predicting academic outcomes in an Australian graduate entry medical programme 
BMC Medical Education  2014;14:31.
Background
Predictive validity studies for selection criteria into graduate entry courses in Australia have been inconsistent in their outcomes. One of the reasons for this inconsistency may have been failure to have adequately considered background disciplines of the graduates as well as other potential confounding socio-demographic variables that may influence academic performance.
Methods
Graduate entrants into the MBBS at The University of Western Australia between 2005 and 2012 were studied (N = 421). They undertook a 6-month bridging course, before joining the undergraduate-entry students for Years 3 through 6 of the medical course. Students were selected using their undergraduate Grade Point Average (GPA), Graduate Australian Medical School Admissions Test scores (GAMSAT) and a score from a standardised interview. Students could apply from any background discipline and could also be selected through an alternative rural entry pathway again utilising these 3 entry scores. Entry scores, together with age, gender, discipline background, rural entry status and a socioeconomic indicator were entered into linear regression models to determine the relative influence of each predictor on subsequent academic performance in the course.
Results
Background discipline, age, gender and selection through the rural pathway were variously related to each of the 3 entry criteria. Their subsequent inclusion in linear regression models identified GPA at entry, being from a health/allied health background and total GAMSAT score as consistent independent predictors of stronger academic performance as measured by the weighted average mark for the core units completed throughout the course. The Interview score only weakly predicted performance later in the course and mainly in clinically-based units. The association of total GAMSAT score with academic performance was predominantly dictated by the score in GAMSAT Section 3 (Reasoning in the biological and physical sciences) with Section 1 (Reasoning in the humanities and social sciences) and Section 2 (Written communication) also contributing either later or early in the course respectively. Being from a more disadvantaged socioeconomic background predicted weaker academic performance early in the course. Being an older student at entry or from a humanities background also predicted weaker academic performance.
Conclusions
This study confirms that both GPA at entry and the GAMSAT score together predict outcomes not only in the early stages of a graduate-entry medical programme but throughout the course. It also indicates that a comprehensive evaluation of the predictive validity of GAMSAT scores, interview scores and undergraduate academic performance as valid selection processes for graduate entry into medical school needs to simultaneously consider the potential confounding influence of graduate discipline background and other socio-demographic factors on both the initial selection parameters themselves as well as subsequent academic performance.
doi:10.1186/1472-6920-14-31
PMCID: PMC3931285  PMID: 24528509
15.  Predictive Value of the School-leaving Grade and Prognosis of Different Admission Groups for Academic Performance and Continuity in the Medical Course – a Longitudinal Study 
Background: The school-leaving GPA and the time since completion of secondary education are the major criteria for admission to German medical schools. However, the predictive value of the school-leaving grade and the admission delay have not been thoroughly examined since the amendment of the Medical Licensing Regulations and the introduction of reformed curricula in 2002. Detailed information on the prognosis of the different admission groups is also missing.
Aim: To examine the predictive values of the school-leaving grade and the age at enrolment for academic performance and continuity throughout the reformed medical course.
Methods: The study includes the central admission groups “GPA-best” and “delayed admission” as well as the primary and secondary local admission groups of three consecutive cohorts. The relationship between the criteria academic performance and continuity and the predictors school-leaving GPA, enrolment age, and admission group affiliation were examined up to the beginning of the final clerkship year.
Results: The academic performance and the prolongation of the pre-clinical part of undergraduate training were significantly related to the school-leaving GPA. Conversely, the dropout rate was related to age at enrolment. The students of the GPA-best group and the primary local admission group performed best and had the lowest dropout rates. The students of the delayed admission group and secondary local admission group performed significantly worse. More than 20% of these students dropped out within the pre-clinical course, half of them due to poor academic performance. However, the academic performance of all of the admission groups was highly variable and only about 35% of the students of each group reached the final clerkship year within the regular time.
Discussion: The school-leaving grade and age appear to have different prognostic implications for academic performance and continuity. Both factors have consequences for the delayed admission group. The academic prognosis of the secondary local admission group is as problematic as that of the delayed admission group. Additional admission instruments would be necessary, in order to recognise potentially able applicants independently of their school-leaving grade and to avoid the secondary admission procedure.
doi:10.3205/zma000913
PMCID: PMC4027806  PMID: 24872856
Medical studies; admission; GPA; school leaving grades
16.  Cognitive Enhancement Drug Use Among Future Physicians: Findings from a Multi-Institutional Census of Medical Students 
Journal of General Internal Medicine  2013;28(8):1028-1034.
ABSTRACT
BACKGROUND
Nonmedical use of prescription psychostimulants such as methylphenidate and amphetamine salts for the purpose of cognitive enhancement is a growing trend, particularly in educational environments. To our knowledge, no recent studies have evaluated the use of these psychostimulants in a medical academic setting.
OBJECTIVE
To conduct an online census of psychostimulant use among medical students.
DESIGN
In 2011, we conducted a multi-institutional census using a 31–48 item online survey regarding use of prescription psychostimulants.
PARTICIPANTS
2,732 actively enrolled medical students at four private and public medical schools in the greater Chicago area.
MAIN MEASURES
Prevalence and correlates of psychostimulant use
KEY RESULTS
1,115 (41 %) of students responded to the web-based questionnaire (range 26–47 % among schools). On average, students were 25.1 years of age (SD = 2.7, range 20–49), and single (70 %). Overall, 18 % (198/1,115) of this medical student sample had used prescription psychostimulants at least once in their lifetime, with first use most often in college. Of these, 11 % (117/1,115) of students reported use during medical school (range 7–16 % among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson’s correlation r > 0.5, Student’s t-test p < 0.01); male gender (21 % male versus 15 % female, Chi squared p = 0.007); and training at a medical school which by student self-report determined class rank (68 % versus 51 %, Chi-squared p = 0.018). Non-users were more likely to be first year students (Chi-squared p = 0.048) or to have grown up outside of the United States (Chi-squared p = 0.013).
CONCLUSIONS
Use of psychostimulants, including use without a prescription, is common among medical students. Further study of the side effects, medical implications, and use during post-graduate medical training and medical practice is needed to inform evidence-based policy.
doi:10.1007/s11606-012-2249-4
PMCID: PMC3710394  PMID: 23595918
cognitive enhancement; nootropics; amphetamine salts; methylphenidate; medical students; drug use
17.  Debiasing the hidden curriculum 
Canadian Family Physician  2011;57(1):e26-e30.
Abstract
Objective
To compare the academic performance of students who entered family medicine residency programs with that of students who entered other disciplines and discern whether or not family physicians are as academically talented as their colleagues in other specialties.
Design
Retrospective quantitative study.
Setting
University of Calgary in Alberta.
Participants
Three graduating classes of students (2004 to 2006) from the University of Calgary medical school.
Main outcome measures
Student performance on various undergraduate certifying examinations in years 1, 2, and 3, along with third-year in-training evaluation reports and total score on the Medical Council of Canada Qualifying Examination Part I.
Results
Complete data were available for 99% of graduates (N = 295). In the analysis, residency program (family medicine [n = 96] versus non–family medicine [n = 199]) served as the independent variable. Using a 1-way multivariate ANOVA (analysis of variance), no significant difference among any of the mean performance scores was observed (F5289 = 1.73, P > .05). Students who entered family medicine were also well represented within the top 10 rankings of the various performance measures.
Conclusion
The academic performance of students who pursued careers in family medicine did not differ from that of students who chose other specialties. Unfounded negativity toward family medicine has important societal implications, especially at a time when the gap between the number of family physicians and patients seeking primary care services appears to be widening.
PMCID: PMC3024184  PMID: 21252122
18.  Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries 
BMC Medical Ethics  2004;5:4.
Background
Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program.
Methods
The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed.
Results
All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2–9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2–7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified.
Conclusions
This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum.
doi:10.1186/1472-6939-5-4
PMCID: PMC509252  PMID: 15283868
19.  Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study 
BMC Medical Education  2012;12:69.
Background
Over two-thirds of UK medical schools are augmenting their selection procedures for medical students by using the United Kingdom Clinical Aptitude Test (UKCAT), which employs tests of cognitive and non-cognitive personal qualities, but clear evidence of the tests’ predictive validity is lacking. This study explores whether academic performance and professional behaviours that are important in a health professional context can be predicted by these measures, when taken before or very early in the medical course.
Methods
This prospective cohort study follows the progress of the entire student cohort who entered Hull York Medical School in September 2007, having taken the UKCAT cognitive tests in 2006 and the non-cognitive tests a year later. This paper reports on the students’ first and second academic years of study. The main outcome measures were regular, repeated tutor assessment of individual students’ interpersonal skills and professional behaviour, and annual examination performance in the three domains of recall and application of knowledge, evaluation of data, and communication and practical clinical skills. The relationships between non-cognitive test scores, cognitive test scores, tutor assessments and examination results were explored using the Pearson product–moment correlations for each group of data; the data for students obtaining the top and bottom 20% of the summative examination results were compared using Analysis of Variance.
Results
Personal qualities measured by non-cognitive tests showed a number of statistically significant relationships with ratings of behaviour made by tutors, with performance in each year’s objective structured clinical examinations (OSCEs), and with themed written summative examination marks in each year. Cognitive ability scores were also significantly related to each year’s examination results, but seldom to professional behaviours. The top 20% of examination achievers could be differentiated from the bottom 20% on both non-cognitive and cognitive measures.
Conclusions
This study shows numerous significant relationships between both cognitive and non-cognitive test scores, academic examination scores and indicators of professional behaviours in medical students. This suggests that measurement of non-cognitive personal qualities in applicants to medical school could make a useful contribution to selection and admission decisions. Further research is required in larger representative groups, and with more refined predictor measures and behavioural assessment methods, to establish beyond doubt the incremental validity of such measures over conventional cognitive assessments.
doi:10.1186/1472-6920-12-69
PMCID: PMC3473297  PMID: 22873571
20.  Predictors of Success on the NATABOC Certification Examination 
Journal of Athletic Training  1997;32(4):323-327.
Objective:
To determine the degree to which a selected number of variables could predict success on the first attempt at the National Athletic Trainers' Association Board of Certification Examination.
Design and Setting:
Data were obtained from the student records of subjects who were enrolled in the same undergraduate athletic training education program for a minimum of two years, maintained a minimum GPA of 2.5 on a 4.0 scale, and had taken the National Athletic Trainers' Association Board of Certification Examination. A telephone survey of the subjects was used to supplement these records.
Subjects:
Fifty-two subjects (38 male, 14 female) who had been enrolled for a mean of seven semesters (±2.57) participated in this study. Subjects maintained a mean overall GPA of 3.27 (± 0.39), with an athletic training mean GPA of 3.34 (±0.43) and an academic minor mean GPA of 2.91 (±0.46). The mean ACT composite score was 18 (±4.02).
Measurements:
Subjects sat for the National Athletic Trainers' Association Board of Certification Examination. Examination passing status, rather than subjects' scores on individual sections, was used in the analysis.
Results:
Analysis using forward multiple linear regression indicated that no single independent variable predicted examination success. However, a strong interrelationship was present between several of the independent variables. Multiple discriminant analysis was used to determine the nature and strength of these interrelationships. A composite set of variables was formed to include overall academic GPA, athletic training GPA, academic minor GPA, ACT composite score, and number of semesters of university enrollment. This composite set explained 42% of the variance in predicting successful completion of the entire examination on the first attempt. The predictive power of the composite set greatly decreased after the first examination attempt.
Conclusions:
Academic variables are the strongest predictors of first-time success on the overall National Athletic Trainers' Association Board of Certification Examination and its component sections.
PMCID: PMC1320349  PMID: 16558467
education; achievement; athletic training; undergraduate
21.  USSTRIDE program is associated with competitive Black and Latino student applicants to medical school 
Medical Education Online  2014;19:10.3402/meo.v19.24200.
Purpose
We compared MCAT scores, grade point averages (GPAs), and medical school acceptance rates of Black and Latino students in an outreach program called Undergraduate Science Students Together Reaching Instructional Diversity and Excellence (USSTRIDE) to non-USSTRIDE students. We hypothesized that Black and Latino participants in USSTRIDE had higher acceptance rates to medical school, higher MCAT scores, and college GPAs when compared to other Black and Latino medical school applicants from our institution.
Methods
The academic performance (GPAs and MCAT scores) and acceptance and matriculation rate data on all Black and Latino Florida State University applicants to any medical school from 2008 to 2012 were collected from the AIS/AMCAS database and separated into two comparison groups (USSTRIDE vs. Non-USSTRIDE). Independent sample T-tests and chi-square analysis, Cohen's D test, and odds ratios were determined.
Results
Average science GPA was 3.47 for USSTRIDE students (n=55) and 3.45 for non-USSTRIDE students (n=137, p=0.68, d=0.0652). Average cumulative GPA was 3.57 for USSTRIDE students and 3.54 for non-USSTRIDE students (p=0.45, d=0.121). Average MCAT score was 23 for USSTRIDE students and 25 for non-USSTRIDE students (p=0.02, d=0.378). Twenty-three percent of accepted USSTRIDE students and 29% of accepted non-USSTRIDE students had multiple acceptances (p=0.483, OR 1.38, 95% CI 0.52–3.88). Forty-nine percent of non-USSTRIDE students and 75% of USSTRIDE students matriculated in medical school (p=0.001, OR 3.13 95% CI 1.51–6.74). About 78.6% of USSTRIDE students matriculated at FSU's medical school compared to 36.2% of non-USSTRIDE students (p<0.01).
Conclusions
USSTRIDE and non-USSTRIDE students had similar science and cumulative GPAs. USSTRIDE students' MCAT scores were lower but acceptance rates to medical school were higher. Participation in USSTRIDE is associated with increased acceptance rates for Black and Latino students to our medical school. This finding is true for other medical schools as USSTRIDE students are as likely as non-USSTRIDE students to have multiple acceptances.
doi:10.3402/meo.v19.24200
PMCID: PMC4033323  PMID: 24861543
minority health; medical education; pipeline; healthcare workforce; minorities in medicine; medical school admission
22.  Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal 
Background
In recent years there has been a growing appreciation of the issues of quality of life and stresses involved medical training as this may affect their learning and academic performance. However, such studies are lacking in medical schools of Nepal. Therefore, we carried out this study to assess the prevalence of psychological morbidity, sources and severity of stress and coping strategies among medical students in our integrated problem-stimulated undergraduate medical curriculum.
Methods
A cross-sectional, questionnaire-based survey was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal during the time period August, 2005 to December, 2006. The psychological morbidity was assessed using General Health Questionnaire. A 24-item questionnaire was used to assess sources of stress and their severity. Coping strategies adopted was assessed using brief COPE inventory.
Results
The overall response rate was 75.8% (407 out of 525 students). The overall prevalence of psychological morbidity was 20.9% and was higher among students of basic sciences, Indian nationality and whose parents were medical doctors. By logistic regression analysis, GHQ-caseness was associated with occurrence of academic and health-related stressors. The most common sources of stress were related to academic and psychosocial concerns. The most important and severe sources of stress were staying in hostel, high parental expectations, vastness of syllabus, tests/exams, lack of time and facilities for entertainment. The students generally used active coping strategies and alcohol/drug was a least used coping strategy. The coping strategies commonly used by students in our institution were positive reframing, planning, acceptance, active coping, self-distraction and emotional support. The coping strategies showed variation by GHQ-caseness, year of study, gender and parents' occupation.
Conclusion
The higher level of psychological morbidity warrants need for interventions like social and psychological support to improve the quality of life for these medical students. Student advisors and counselors may train students about stress management. There is also need to bring about academic changes in quality of teaching and evaluation system. A prospective study is necessary to study the association of psychological morbidity with demographic variables, sources of stress and coping strategies.
doi:10.1186/1472-6920-7-26
PMCID: PMC1951961  PMID: 17678553
23.  Weight, socio-demographics, and health behaviour related correlates of academic performance in first year university students 
Nutrition Journal  2013;12:162.
Background
This study aimed to examine differences in socio-demographics and health behaviour between Belgian first year university students who attended all final course exams and those who did not. Secondly, this study aimed to identify weight and health behaviour related correlates of academic performance in those students who attended all course exams.
Methods
Anthropometrics of 101 first year university students were measured at both the beginning of the first (T1) and second (T2) semester of the academic year. An on-line health behaviour questionnaire was filled out at T2. As a measure of academic performance student end-of-year Grade Point Averages (GPA) were obtained from the university’s registration office. Independent samples t-tests and chi 2 -tests were executed to compare students who attended all course exams during the first year of university and students who did not carry through. Uni- and multivariate linear regression analyses were conducted to identify correlates of academic performance in students who attended all course exams during the first year of university.
Results
Students who did not attend all course exams were predominantly male, showed higher increases in waist circumference during the first semester and consumed more French fries than those who attended all final course exams. Being male, lower secondary school grades, increases in weight, Body Mass Index and waist circumference over the first semester, more gaming on weekdays, being on a diet, eating at the student restaurant more frequently, higher soda and French fries consumption, and higher frequency of alcohol use predicted lower GPA’s in first year university students. When controlled for each other, being on a diet and higher frequency of alcohol use remained significant in the multivariate regression model, with frequency of alcohol use being the strongest correlate of GPA.
Conclusions
This study, conducted in Belgian first year university students, showed that academic performance is associated with a wide range of weight and health related behaviours. Future studies should investigate whether interventions aiming at promoting healthy behaviours among students could also have a positive impact on academic performance.
doi:10.1186/1475-2891-12-162
PMCID: PMC3878497  PMID: 24344995
Weight; Health behaviour; Correlates; Academic performance; First year university students
24.  Addition by Subtraction: The Relation Between Dropout Rates and School-Level Academic Achievement 
Teachers College record (1970)  2012;114(8):1-26.
Background/Context
Efforts to improve student achievement should increase graduation rates. However, work investigating the effects of student-level accountability has consistently demonstrated that increases in the standards for high school graduation are correlated with increases in dropout rates. The most favored explanation for this finding is that high-stakes testing policies that mandate grade repetition and high school exit exams may be the tipping point for students who are already struggling academically. These extra demands may, in fact, push students out of school.
Purpose/Objective/Focus
This article examines two hypotheses regarding the relation between school-level accountability and dropout rates. The first posits that improvements in school performance lead to improved success for everyone. If school-level accountability systems improve a school for all students, then the proportion of students performing at grade level increases, and the dropout rate decreases. The second hypothesis posits that schools facing pressure to improve their overall accountability score may pursue this increase at the cost of other student outcomes, including dropout rate.
Research Design
Our approach focuses on the dynamic relation between school-level academic achievement and dropout rates over time—that is, between one year’s achievement and the subsequent year’s dropout rate, and vice versa. This article employs longitudinal data of records on all students in North Carolina public schools over an 8-year period. Analyses employ fixed-effects models clustering schools and districts within years and controls each year for school size, percentage of students who were free/reduced-price lunch eligible, percentage of students who are ethnic minorities, and locale.
Findings/Results
This study finds partial evidence that improvements in school-level academic performance will lead to improvements (i.e., decreases) in school-level dropout rates. Schools with improved performance saw decreased dropout rates following these successes. However, we find more evidence of a negative side of the quest for improved academic performance. When dropout rates increase, the performance composites in subsequent years increase.
Conclusions/recommendations
Accountability systems need to remove any indirect benefit a school may receive from increasing its dropout rate. Schools should be held accountable for those who drop out of school. Given the personal and social costs of dropping out, accountability systems need to place more emphasis on dropout prevention. Such an emphasis could encompass increasing the dropout age and having the school’s performance composite include scores of zero on end-of-grade tests for those who leave school.
PMCID: PMC3763746  PMID: 24013958
25.  Race and Academic Achievement in Racially Diverse High Schools: Opportunity and Stratification 
Teachers College record (1970)  2010;112(4):1038-1063.
Background/Context
Brown v Board of Education fundamentally changed our nation's schools, yet we know surprisingly little about how and whether they provide equality of educational opportunity. Although substantial evidence suggests that African American and Latino students who attend these schools face fewer learning opportunities than their White counterparts, until now, it has been impossible to examine this using a representative sample because of lack of data.
Purpose/Objective/Research Question/Focus of Study
This study uses newly available data to investigate whether racially diverse high schools offer equality of educational opportunity to students from different racial and ethnic groups. This is examined by measuring the relative representation of minority students in advanced math classes at the beginning of high school and estimating whether and how this opportunity structure limits the level of achievement attained by African American and Latino students by the end of high school.
Setting
This study uses data from the Adolescent Health and Academic Achievement Study (AHAA) and its partner study, the National Longitudinal Study of Adolescent Health (Add Health), a stratified, nationally representative study of students in U.S. high schools first surveyed in 1994–1995.
Population/Participants/Subjects
Two samples of racially diverse high schools were used in the analysis: one with African Americans, Whites, and Asians (26 schools with 3,149 students), and the other with Latinos, Whites, and Asians (22 schools with 2,775 students).
Research Design
Quantitative analyses first assess how high schools vary in the extent to which minority students are underrepresented in advanced sophomore math classes. Hierarchical multilevel modeling is then used to estimate whether racial-ethnic differences in representation in advanced math have an impact on African American and Latino students’ achievement by the end of high school, relative to the Whites and Asians in the school. Specifically, we estimate the effects of Whites’ and Asians’ overrepresentation in sophomore-year math (or Latino or African American underrepresentation) within the school on students’ senior-year grades and their postsecondary enrollment.
Findings/Results
Findings show that schools vary in the extent to which African American and Latino students are underrepresented in advanced sophomore math classes. This pattern of racial inequality in schools is associated with lower minority senior-year grades and enrollment in 4-year postsecondary institutions, net of students’ own background.
Conclusions/Recommendations
Evidence consistently suggests that schools can play an active role in the provision of opportunities for social mobility or in the exacerbation of social inequality, depending on how they are structured. It is important to consider racial stratification within schools as a mechanism of inequality of educational opportunity.
PMCID: PMC2893342  PMID: 20593006

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