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1.  Socio-economic predictors of performance in the Undergraduate Medicine and Health Sciences Admission Test (UMAT) 
BMC Medical Education  2013;13:155.
Background
Entry from secondary school to Australian and New Zealand undergraduate medical schools has since the late 1990’s increasingly relied on the Undergraduate Medicine and Health Sciences Admission Test (UMAT) as one of the selection factors. The UMAT consists of 3 sections – logical reasoning and problem solving (UMAT-1), understanding people (UMAT-2) and non-verbal reasoning (UMAT-3). One of the goals of using this test has been to enhance equity in the selection of students with the anticipation of an increase in the socioeconomic diversity in student cohorts. However there has been limited assessment as to whether UMAT performance itself might be influenced by socioeconomic background.
Methods
Between 2000 and 2012, 158,909 UMAT assessments were completed. From these, 118,085 cases have been identified where an Australian candidate was sitting for the first time during that period. Predictors of the total UMAT score, UMAT-1, UMAT-2 and UMAT-3 scores were entered into regression models and included gender, age, school type, language used at home, deciles for the Index of Relative Socioeconomic Advantage and Disadvantage score, the Accessibility/Remoteness Index of Australia (ARIA), self-identification as being of Aboriginal or Torres Strait Islander origin (ATSI) and current Australian state or territory of abode.
Results
A lower UMAT score was predicted by living in an area of relatively higher social disadvantage and lower social advantage. Other socioeconomic indicators were consistent with this observation with lower scores in those who self-identified as being of ATSI origin and higher scores evident in those from fee-paying independent school backgrounds compared to government schools. Lower scores were seen with increasing age, female gender and speaking any language other than English at home. Divergent effects of rurality were observed, with increased scores for UMAT-1 and UMAT-2, but decreasing UMAT-3 scores with increasing ARIA score. Significant state-based differences largely reflected substantial socio-demographic differences across Australian states and territories.
Conclusions
Better performance by Australian candidates in the UMAT is linked to an increase in socio-economic advantage and reduced disadvantage.This observation provides a firm foundation for selection processes at medical schools in Australia that have incorporated affirmative action pathways to quarantine places for students from areas of socio-economic disadvantage.
doi:10.1186/1472-6920-13-155
PMCID: PMC4220554  PMID: 24286571
2.  Medical student selection criteria as predictors of intended rural practice following graduation 
BMC Medical Education  2014;14(1):218.
Background
Recruiting medical students from a rural background, together with offering them opportunities for prolonged immersion in rural clinical training environments, both lead to increased participation in the rural workforce after graduation. We have now assessed the extent to which medical students’ intentions to practice rurally may also be predicted by either medical school selection criteria and/or student socio-demographic profiles.
Methods
The study cohort included 538 secondary school-leaver entrants to The University of Western Australia Medical School from 2006 to 2011. On entry they completed a questionnaire indicating intention for either urban or rural practice following graduation. Selection factors (standardised interview score, percentile score from the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance (Australian Tertiary Admissions Rank), together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and an index of rurality) were examined in relation to intended rural or urban destination of practice.
Results
In multivariate logistic regression, students from a rural background had a nearly 8-fold increase in the odds of intention to practice rurally after graduation compared to those from urban backgrounds (OR 7.84, 95% CI 4.10, 14.99, P < 0.001). Those intending to be generalists rather than specialists had a more than 4-fold increase in the odds of intention to practice rurally (OR 4.36, 95% CI 1.69, 11.22, P < 0.001). After controlling for these 2 factors, those with rural intent had significantly lower academic entry scores (P = 0.002) and marginally lower interview scores (P = 0.045). UMAT percentile scores were no different. Those intending to work in a rural location were also more likely to be female (OR 1.93, 95% CI 1.08, 3.48, P = 0.027), to come from the lower eight IRSAD deciles (OR 2.52, 95% CI 1.47, 4.32, P = 0.001) and to come from Government vs independent schools (OR 2.02, 95% CI 1.15, 3.55, P = 0.015).
Conclusions
Very high academic scores generally required for medical school entry may have the unintended consequence of selecting fewer graduates interested in a rural practice destination. Increased efforts to recruit students from lower socioeconomic backgrounds may be beneficial in terms of an ultimate intended rural practice destination.
Electronic supplementary material
The online version of this article (doi:10.1186/1472-6920-14-218) contains supplementary material, which is available to authorized users.
doi:10.1186/1472-6920-14-218
PMCID: PMC4287212  PMID: 25315743
3.  Practice effects in medical school entrance testing with the undergraduate medicine and health sciences admission test (UMAT) 
BMC Medical Education  2014;14:48.
Background
The UMAT is widely used for selection into undergraduate medical and dental courses in Australia and New Zealand (NZ). It tests aptitudes thought to be especially relevant to medical studies and consists of 3 sections – logical reasoning and problem solving (UMAT-1), understanding people (UMAT-2) and non-verbal reasoning (UMAT-3). A substantial proportion of all candidates re-sit the UMAT. Re-sitting raises the issue as to what might be the precise magnitude and determinants of any practice effects on the UMAT and their implications for equity in subsequent selection processes.
Methods
Between 2000 and 2012, 158,909 UMAT assessments were completed. From these, 135,833 cases were identified where a candidate had sat once or more during that period with 117,505 cases (86.5%) having sat once, 14,739 having sat twice (10.9%), 2,752 thrice (2%) and 837, 4 or more times (0.6%). Subsequent analyses determined predictors of multiple re-sits as well as the magnitude and socio-demographic determinants of any practice effects.
Results
Increased likelihood of re-sitting the UMAT twice or more was predicted by being male, of younger age, being from a non-English language speaking background and being from NZ and for Australian candidates, being urban rather than rurally based. For those who sat at least twice, the total UMAT score between a first and second attempt improved by 10.7 ± 0.2 percentiles, UMAT-1 by 8.3 ± 0.2 percentiles, UMAT-2 by 8.3 ± 0.2 percentiles and UMAT-3 by 7.7 ± 0.2 percentiles. An increase in total UMAT percentile score on re-testing was predicted by a lower initial score and being a candidate from NZ rather than from Australia while a decrease was related to increased length of time since initially sitting the test, older age and non-English language background.
Conclusions
Re-sitting the UMAT augments performance in each of its components together with the total UMAT percentile score. Whether this increase represents just an improvement in performance or an improvement in understanding of the variables and therefore competence needs to be further defined. If only the former, then practice effects may be introducing inequity in student selection for medical or dental schools in Australia or NZ.
doi:10.1186/1472-6920-14-48
PMCID: PMC4007585  PMID: 24618021
4.  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
5.  Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools 
BMC Medical Education  2013;13:173.
Background
Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions.
Methods
This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted.
Results
Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables.
Conclusion
The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised.
doi:10.1186/1472-6920-13-173
PMCID: PMC3880586  PMID: 24373207
Selection; Predictive validity; Admissions policy
6.  Admission selection criteria as predictors of outcomes in an undergraduate medical course: A prospective study 
Medical Teacher  2011;33(12):997-1004.
Background
In 1998, a new selection process which utilised an aptitude test and an interview in addition to previous academic achievement was introduced into an Australian undergraduate medical course.
Aims
To test the outcomes of the selection criteria over an 11-year period.
Methods
1174 students who entered the course from secondary school and who enrolled in the MBBS from 1999 through 2009 were studied in relation to specific course outcomes. Regression analyses using entry scores, sex and age as independent variables were tested for their relative value in predicting subsequent academic performance in the 6-year course. The main outcome measures were assessed by weighted average mark for each academic year level; together with results in specific units, defined as either ‘knowledge'-based or ‘clinically’ based.
Results
Previous academic performance and female sex were the major independent positive predictors of performance in the course. The interview score showed positive predictive power during the latter years of the course and in a range of ‘clinically' based units. This relationship was mediated predominantly by the score for communication skills.
Conclusions
Results support combining prior academic achievement with the assessment of communication skills in a structured interview as selection criteria into this undergraduate medical course.
doi:10.3109/0142159X.2011.577123
PMCID: PMC3267525  PMID: 21592024
7.  The impact of preparatory activities on medical school selection outcomes: a cross-sectional survey of applicants to the university of Adelaide medical school in 2007 
BMC Medical Education  2013;13:159.
Background
Selection into medical school is highly competitive with more applicants than places. Little is known about the preparation that applicants undertake for this high stakes process. The study aims to determine what preparatory activities applicants undertake and what difficulties they encounter for each stage of the application process to medical school and in particular what impact these have on the outcome.
Methods
A cross-sectional survey of 1097 applicants who applied for a place in the University of Adelaide Medical School in 2007 and participated in the UMAT (Undergraduate Medicine and Health Sciences Admission Test) and oral assessment components of the selection process. The main outcome measures were an offer of an interview and offer of a place in the medical school and were analysed using logistic regression.
Results
The odds of a successful outcome increased with each additional preparatory activity undertaken for the UMAT (odds ratio 1.22, 95% confidence interval 1.11 to 1.33; P < 0.001) and the oral assessment (1.36, 1.19 to 1.55; P < 0.001) stage of selection. The UMAT preparatory activities associated with the offer of an interview were attendance of a training course by a private organisation (1.75, 1.35 to 2.27: P < 0.001), use of online services of a private organisation (1.58, 1.23 to 2.04; P < 0.001), and familiarising oneself with the process (1.52, 1.15 to 2.00; p = 0.021). The oral assessment activities associated with an offer of a place included refining and learning a personal resume (9.73, 2.97 to 31.88; P < 0.001) and learning about the course structure (2.05, 1.29 to 3.26; P = 0.022).
For the UMAT, applicants who found difficulties with learning for this type of test (0.47, 0.35 to 0.63: P < 0.001), with the timing of UMAT in terms of school exams (0.48, 0.5 to 0.66; P < 0.001) and with the inability to convey personal skills with the UMAT (0.67, 0.52 to 0.86; P = 0.026) were significantly less likely to be offered an interview.
Conclusions
Medical schools make an enormous effort to undertake a selection process that is fair and equitable and which selects students most appropriate for medical school and the course they provide. Our results indicate that performance in the selection processes can be improved by training. However, if these preparatory activities may be limited to those who can access them, the playing field is not even and increasing equity of access to medical schools will not be achieved.
doi:10.1186/1472-6920-13-159
PMCID: PMC4220562  PMID: 24289521
Medical school selection; Admissions; Equity; Preparation
8.  Predictive validity of a new integrated selection process for medical school admission 
BMC Medical Education  2014;14:86.
Background
This paper is an evaluation of an integrated selection process utilising previous academic achievement [Universities Admission Index (UAI)], a skills test [Undergraduate Medicine and Health Sciences Admission Test (UMAT)], and a structured interview, introduced (in its entirety) in 2004 as part of curriculum reform of the undergraduate Medicine Program at the University of New South Wales (UNSW), Australia. Demographic measures of gender, country of birth, educational background and rurality are considered.
Method
Admission scores and program outcomes of 318 students enrolled in 2004 and 2005 were studied. Regression analyses were undertaken to determine whether selection scores predicted overall, knowledge-based and clinical-based learning outcomes after controlling for demographics.
Results
UAI attained the highest values in predicting overall and knowledge-based outcomes. The communication dimension of the interview achieved similar predictive values as UAI for clinical-based outcomes, although predictive values were relatively low. The UMAT did not predict any performance outcome. Female gender, European/European-derived country of birth and non-rurality were significant predictors independent of UAI scores.
Conclusion
Results indicate promising validity for an integrated selection process introduced for the Medicine Program at UNSW, with UAI and interview predictive of learning outcomes. Although not predictive, UMAT may have other useful roles in an integrated selection process. Further longitudinal research is proposed to monitor and improve the validity of the integrated student selection process.
doi:10.1186/1472-6920-14-86
PMCID: PMC3999457  PMID: 24755325
Student selection; Predictive validity; Predicting; Performance; Demographics
9.  Non-cognitive characteristics predicting academic success among medical students in Sri Lanka 
BMC Medical Education  2012;12:66.
Background
To identify non-cognitive and socio-demographic characteristics determining academic success of Sri Lankan medical undergraduates.
Methods
A retrospective study among 90 recently graduated students of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Students were stratified into two equal groups; ‘High-achievers’ (honours degree at the final MBBS examination) and ‘Low-achievers’ (repeated one or more subjects at the same examination). A revised version of the Non-cognitive Questionnaire (NQ) with additional socio-demographic data was the study instrument. Academic performance indicator was performance at the final MBBS examinations. A binary logistic regression analysis was performed using the dichotomous variable ‘Honours degree at final MBBS’ as the dependant factor.
Results
Males were 56.7%. Mean age ± SD was 26.4 ± 0.9 years. ‘High-achievers’ were significantly younger than ‘Low-achievers’. Significant proportion of ‘High-achievers’ were from the Western province and selected to university from Colombo district. A significant majority of ‘High-achievers’ entered medical school from their first attempt at GCE A/L examination and obtained ‘Distinctions’ at the GCE A/L English subject. ‘High-achievers’ demonstrated a significantly higher mean score for the following domains of NQ; Positive self-concept and confidence, realistic self-appraisal, leadership, preference of long range goals and academic familiarity.
The binary logistic regression indicates that age, being selected to university from Colombo district, residency in Western province, entering university from GCE A/L first attempt, obtaining a ‘Distinction’ for GCE A/L English subject, higher number of patient-oriented case discussions, positive self-concept and confidence, leadership qualities, preference of long range goals and academic familiarity all significantly increased the odds of obtaining a Honours degree.
Conclusion
A combined system incorporating both past academic performance and non-cognitive characteristics might help improve the selection process and early recognition of strugglers.
doi:10.1186/1472-6920-12-66
PMCID: PMC3547768  PMID: 22863153
Academic performance; Predictors; Non-cognitive characteristics; Medical students; Sri Lanka
10.  The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools 
BMC Medicine  2013;11:244.
Background
Most UK medical schools use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the United Kingdom Clinical Aptitude Test (UKCAT), and its four sub-scales, along with measures of educational attainment, individual and contextual socio-economic background factors, as predictors of performance in the first year of medical school training.
Methods
A prospective study of 4,811 students in 12 UK medical schools taking the UKCAT from 2006 to 2008 as a part of the medical school application, for whom first year medical school examination results were available in 2008 to 2010.
Results
UKCAT scores and educational attainment measures (General Certificate of Education (GCE): A-levels, and so on; or Scottish Qualifications Authority (SQA): Scottish Highers, and so on) were significant predictors of outcome. UKCAT predicted outcome better in female students than male students, and better in mature than non-mature students. Incremental validity of UKCAT taking educational attainment into account was significant, but small. Medical school performance was also affected by sex (male students performing less well), ethnicity (non-White students performing less well), and a contextual measure of secondary schooling, students from secondary schools with greater average attainment at A-level (irrespective of public or private sector) performing less well. Multilevel modeling showed no differences between medical schools in predictive ability of the various measures. UKCAT sub-scales predicted similarly, except that Verbal Reasoning correlated positively with performance on Theory examinations, but negatively with Skills assessments.
Conclusions
This collaborative study in 12 medical schools shows the power of large-scale studies of medical education for answering previously unanswerable but important questions about medical student selection, education and training. UKCAT has predictive validity as a predictor of medical school outcome, particularly in mature applicants to medical school. UKCAT offers small but significant incremental validity which is operationally valuable where medical schools are making selection decisions based on incomplete measures of educational attainment. The study confirms the validity of using all the existing measures of educational attainment in full at the time of selection decision-making. Contextual measures provide little additional predictive value, except that students from high attaining secondary schools perform less well, an effect previously shown for UK universities in general.
doi:10.1186/1741-7015-11-244
PMCID: PMC3827332  PMID: 24229380
Medical student selection; Educational attainment; Aptitude tests; UKCAT; Socio-economic factors; Contextual measures
11.  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
12.  The role of curriculum in influencing students to select generalist training: A 21-year longitudinal study 
To determine if specific curricula or backgrounds influence selection of generalist careers, the curricular choices of graduates of Mount Sinai School of Medicine between 1970 and 1990 were reviewed based on admission category. Students were divided into three groups: Group 1, those who started their first year of training at the School of Medicine; Group 2, those accepted with advanced standing into their third year of training from the Sophie Davis School of Biomedical Education, a five-year program developed to select and produce students likely to enter primary care fields; and Group 3, those accepted with advanced standing into the third year who spent the first two years at a foreign medical school. All three groups took the identical last two years of clinical training at the School of Medicine. There were no significant differences with respect to initial choice of generalist training programs among all three groups, with 46% of the total cohort selecting generalist training. Of those students who chose generalist programs, 58% in Group 1,51% in Group 2, and 41% in Group 3 remained in these fields rather than progressing to fellowship training. This difference was significant only with respect to Group 3. However, when an analysis was performed among those students providing only primary care as compared to only specialty care, there were no significant differences. Analysis by gender revealed women to be more likely to select generalist fields and remain in these fields without taking specialty training (P<.0001). Differentiating characteristics with respect to choosing generalist fields were not related to either Part I or Part II scores on National Board Examinations or selection to AOA. However, with respect to those specific specialties considered quite competitive (general surgery, obstetrics and gynecology, and ophthalmology), total test scores on Part I and Part II were significantly higher than those of all other students. The analysis indicated that, despite the diverse characteristics of students entering the third year at the School of Medicine, no one group produced a statistically greater proportion of generalists positions than any other, and academic performance while in medical school did not have a significant influence on whether a student entered a generalist field.
doi:10.1007/BF02344466
PMCID: PMC3456709  PMID: 10091195
13.  Cross-sectional study on the relationship between life events and mental health of secondary school students in Shanghai, China 
Shanghai Archives of Psychiatry  2012;24(3):162-171.
Background
The relationship of demographic factors and negative life events to the mental health of mainland Chinese school students has not been fully explored.
Aim
Assess the prevalence of different types of life stressors among secondary school students and identify the demographic characteristics and types of life events that are most closely associated with perceived psychological difficulties in these students.
Methods
This cross-sectional study administered two self-completion questionnaires to a stratified random cluster sample of 1818 students from four secondary schools in two districts of Shanghai: the Strengths and Difficulties Questionnaire (SDQ) and an abbreviated version of the Adolescent Self-rating Life Events Checklist (ASLEC) that assesses 11 negative life events.
Results
Academic stress (74%), criticism from others (66%), family conflict (29%) and peer bullying & discrimination or interpersonal conflict (26%) were the most frequently reported negative life events, but their prevalence varied significantly by gender, type of school and urban versus rural residence. Similarly the level of reported psychological stress associated with life events, the total perceived psychological difficulty, and the level of pro-social behavior in the students varied significantly between different groups of students. Multivariate linear regression analysis identified the following independent predictors of high perceived psychological difficulty in the prior 6 months (in order of importance): high total stress score from negative life events in the prior year, experiencing peer bullying & discrimination or interpersonal conflict, not experiencing the death of a family member, male gender, attending a school in a rural district, and not suffering from a major disease or physical impairment. The independent predictors of a high level of pro-social behavior were high total stress score from negative life events, attending an urban school, female gender, attending a regular-tier school (vs. a high-tier school), experiencing peer bullying & discrimination or interpersonal conflict, not experiencing the death of a family member, and attending a middle school (vs. a high school).
Conclusion
Negative life events are one of many factors associated with perceived stress and level of pro-social behavior in secondary school students. Prospective studies are needed to clarify the causal pathways that connect stress with negative life events in students and to develop and test cohort-specific interventions aimed at decreasing stress and increasing pro-social behaviors.
doi:10.3969/j.issn.1002-0829.2012.03.006
PMCID: PMC4198848  PMID: 25324621
14.  Comparison of communication skills between medical students admitted after interviews or on academic merits 
BMC Medical Education  2012;12:46.
Background
Selection of the best medical students among applicants is debated and many different methods are used. Academic merits predict good academic performance, but students admitted by other pathways need not be less successful. The aim of this study, was to compare communication skills between students admitted to medical school through interviews or on academic merits, respectively.
Methods
A retrospective cohort study. Communication skills at a surgical OSCE in 2008 were assessed independently by two observers using an evaluative rating scale. Correlations, t-tests and multivariate analyses by logistic regressions were employed. Academic merits were defined as upper secondary school grade point average (GPA) or scores from the Swedish Scholastic Assessment Test (SweSAT).
Results
The risk of showing unsatisfactory communicative performance was significantly lower among the students selected by interviews (OR 0.32, CI95 0.12-0.83), compared to those selected on the basis of academic merits. However, there was no significant difference in communication skills scores between the different admission groups; neither did the proportion of high performers differ. No difference in the result of the written examination was seen between groups.
Conclusions
Our results confirm previous experience from many medical schools that students selected in different ways achieve comparable results during the clinical semesters. However, selection through interview seems to reduce the number of students who demonstrate inferior communication skills at 4th year of medical school.
doi:10.1186/1472-6920-12-46
PMCID: PMC3503650  PMID: 22726308
15.  The association of academic tracking to depressive symptoms among adolescents in three Caribbean countries 
Background
Students who are tracked into low performing schools or classrooms that limit their life chances may report increased depressive symptoms. Limited research has been conducted on academic tracking and its association with depressive symptoms among high school students in the Caribbean. This project examines levels of depressive symptoms among tenth grade students tracked within and between high schools in Jamaica, St. Vincent and St. Kitts and Nevis.
Methods
Students enrolled in grade ten of the 2006/2007 academic year in Jamaica, St. Kitts and Nevis and St. Vincent were administered the Beck Depression Inventory II (BDI-II). In Jamaica and St. Vincent, academic tracking was operationalized using data provided by the local Ministries of Education. These Ministries ranked ordered schools according to students' performance on Caribbean school leaving examinations. In St. Kitts and Nevis tracking was operationalized by classroom assignments within schools whereby students were grouped into classrooms according to their levels of academic achievement. Multiple regression analyses were conducted to examine the relationships between academic tracking and BDI-II depression scores.
Results
A wide cross-section of 4th form students in each nation was sampled (n = 1738; 278 from Jamaica, 737 St. Kitts and Nevis, 716 from St. Vincent; 52% females, 46.2% males and 1.8% no gender reported; age 12 to 19 years, mean = 15.4 yrs, sd = .9 yr). Roughly half (53%) of the students reported some symptoms of depression with 19.2% reporting moderate and 10.7% reporting severe symptoms of depression. Students in Jamaica reported significantly higher depression scores than those in either St. Kitts and Nevis or St. Vincent (p < .01). Students assigned to a higher academic track reported significantly lower BDI-II scores than students who were assigned to the lower academic track (p < .01).
Conclusions
There appears to be an association between academic tracking and depressive symptoms that is differentially manifested across the islands of Jamaica, St. Kitts and Nevis and St. Vincent.
doi:10.1186/1753-2000-4-16
PMCID: PMC2898665  PMID: 20509937
16.  Intrinsic component of resilience among entry level medical students in the United Arab Emirates 
The Australasian Medical Journal  2011;4(10):548-554.
Background
Resilience is the capacity to recover and to cope successfully with everyday challenges. Resilience has intrinsic and extrinsic components and an effort has been made to study the intrinsic component and its association with sociodemographic factors, among the entry level students of the Integrated Bachelor of Medicine and Bachelor of Surgery (MBBS) course.
Method
The present study was conducted in Gulf Medical University, using a self-administered questionnaire, comprising of two parts, distributed to all the students who consented to participate. The first part contained questions on socio-demographic details while the second part contained questions on the intrinsic and extrinsic components of resilience of the students. The data collected was analysed using Predictive Analytic Software (PASW) 18.0 using frequency, mean, SD and median.
Results
Among the 58 students who participated 24 (41.4%) were males and 34 (58.6%) females, of which 70.7% were < 20 years and 29.3% ≥ 20years. The mean score for the intrinsic component of resilience was 48.9 (SD, 5 and range 35–60). The median scores showed no significant variation (p<0.05) with age, gender, religion, nationality, family structure, highest education among parents, the person they share their feelings with or the number of friends. However, minimally higher scores were noted in the median scores of students from nuclear families, with Western nationality and those whose parents had a university level education, who shared their feelings with people of their own generation or outside their family and who have 5–9 friends.
Conclusion
The intrinsic component of resilience was found to be almost uniform for the study group and the level is high. A study has to further look into its effect on coping with the stresses encountered during the academic year.
doi:10.4066/AMJ.2011.826
PMCID: PMC3562876  PMID: 23386866
Intrinsic component of resilience; medical students; socio-demographiccharacteristics; number of friends; sharing feelings
17.  BIS-11A -Hindi version: A preliminary study of impulsivity in rural and urban Indian adolescents 
Indian Journal of Psychiatry  2008;50(2):96-99.
Context:
Despite of there being a pressing need to gauge impulsivity scores, there is no behavioral instrument in India to assess the impulsivity in adolescents. No earlier studies have been done in India to access impulsivity in adolescents. Even in western countries, no study has been done in rural setting to access impulsivity, although segment of rural population is small in western nations with major population residing in urban areas.
Aims:
To translate BIS-11A into Hindi from English in a culturally sensitive manner and to do preliminary study in rural and urban areas.
Settings and Design:
First translation of BIS-11 (as it is meant for adults) and cultural substitution resulted in Hindi adult version. Adolescent version was derived from adult version by replacing adult activities with adolescent activities.
Materials and Methods:
BIS-11 English version was translated into Hindi and a back translation was made. As BIS-11 was developed for adults, answering some of the questions poses challenges for adolescents, so to be used with adolescents, questions that do not fit into adolescent age group were substituted keeping in view the activities of adolescents. Besides, questions that were not suitable as per the Indian culture were modified. Initially, these changes were made hypothetically by discussion among the authors and later a group of 48 school students were interviewed about the questions. Based on the interviews of students a final version was prepared. Translation, back translation, cultural substitution -hypothetically, and in school by discussion were carried out. The questionnaire was given to 120 urban high school students (in Jaipur, northern India) and 50 rural students (at Kanota, 25 km from Jaipur, northern India) and the scores were calculated as per the scoring method provided with original BIS-11.
Statistical Analysis:
T-test (two-tailed, two sample unequal variance, i.e., type 3) was used.
Results:
T-test (two-tailed, two sample unequal variance, i.e., type 3) found no significant difference between impulsivity scores of adolescents of urban and rural areas t 0.05(2)1 = 0.57, |t| < t 0.05(2)1, P > 0.05, P = 12.706. There were no gender related differences either.
Conclusions:
As impulsivity can lead to suicide and is implicated for substance abuse in disorders like Schizophrenia, it is important that culturally sensitive impulsivity studies are done in India on a large scale keeping in view the large size of population. Standardization of the BIS11-A Hindi version is being taken up. The work on Hindi version also generates necessity for other tasks if BIS-11(Hindi version) is to be used widely. Work on psychometric properties of Hindi version of BIS-11 A is being taken up. There is a need to devise a quick way to calculate impulsivity scores keeping in view the large population of India (1 billion out of which at least 33% is Hindi speaking, Census Survey of India, 2001). Besides, BIS-11A needs to be developed for other regional languages in India as there is a high-linguistic diversity in India.
doi:10.4103/0019-5545.42395
PMCID: PMC2738344  PMID: 19742223
Adolescent; BIS-11 A; Hindi; rural; urban
18.  Multimedia Educational Program Increases Science Achievement Among Inner-City Non-Asian Minority Middle-School Students 
This study tested the effectiveness of a middle-school, multi-media health-sciences educational program called HEADS UP in non-Asian–minority (Hispanic and African American), inner-city students. The program was designed to increase the number of non-Asian minority students entering the academic health-sciences pipeline. Students of Asian ethnicity were excluded because they are not underrepresented in science professions. The curriculum modules include video role-model stories featuring minority scientists and students, hands-on classroom activities, and teacher resources. The modules (evaluated from 2004-2007) were developed through collaboration among The University of Texas Health Sciences Center, the Spring Branch Independent School District, and the Health Museum, Houston. A quasi-experimental, two-group pre-test/post-test design was used to assess program effects on students' performance, interest, and confidence in their ability to perform well in science; fear of science; and confidence in their ability to pursue science-related careers. An intervention school was matched to a comparison school by test scores, school demographics, and student demographics. Then, pairs of sixth-grade students (428 students) were matched by fifth-grade scores in science and by gender, ethnicity, and poverty status (free or reduced lunch) and followed up for three years. At eighth grade, students from the intervention school scored significantly higher (F=12.38, p<0.001) on the Stanford 10 Achievement Test in science and reported higher interest in science (F=11.08, p<0.001) than their matched pairs from the comparison school. HEADS UP shows potential for improving inner-city minority middle school students' performance and interest in science and is an innovative example of translating health-sciences research to the community.
doi:10.1097/ACM.0b013e3181a425e7
PMCID: PMC3152481  PMID: 19474564
science education; non-Asian minority; Hispanic and African American minority students; multimedia curriculum; educational program
19.  Who gets into medical school? 
Canadian Family Physician  2005;51(9):1241.
OBJECTIVE
Being of rural origin is one of the few predictors of whether medical students choose either family or rural practice as a career. This study investigates what proportion of applicants are of rural origin, what their grades are, and whether they are accepted.
DESIGN
Mailed survey using the postal codes of Ontario medical school applicants’ residences when they attended secondary school to link them to communities. Applicants of rural origin were defined as having attended secondary school while residing in communities with core populations of fewer than 10 000 people.
SETTING
Province of Ontario, its six medical schools, and its 1 500 000 rural citizens (13% of the total population).
PARTICIPANTS
All 4948 applicants to Ontario medical schools in 2002 and 2003 who had gone to high school in Ontario.
MAIN OUTCOME MEASURES
Proportion of rural applicants among all applicants in the given years. Mean grade point averages (GPA) and Medical College Admission Test (MCAT) scores attained by applicants of both urban and rural origin. Proportion of rural students among all students admitted to medical schools.
RESULTS
While 13% of the Ontario population is rural, only 7.3% of Ontario applicants to medical school were of rural origin (P < .001). On average, the GPAs of applicants of rural and urban origin were identical at 3.42 (P = .995 not significant [NS]). The MCAT scores averaged 8.9 for applicants of rural origin and 9.0 for applicants of urban origin (P = .36 NS). Applicants of rural origin were admitted to medical school as frequently as applicants of urban origin (1:5.6 vs 1:4.7, P = .139 NS).
CONCLUSION
Although students of rural origin in Ontario apply to medical school less frequently than students of urban origin do, those that do apply have similar grades to those of urban applicants and are equally likely to be accepted.
PMCID: PMC1479467  PMID: 16926938
20.  Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda 
BMC Medical Education  2010;10:47.
Background
Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training.
Methods
The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas.
Results
Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community.
Conclusion
Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.
doi:10.1186/1472-6920-10-47
PMCID: PMC2904351  PMID: 20573221
21.  The UK clinical aptitude test and clinical course performance at Nottingham: a prospective cohort study 
BMC Medical Education  2013;13:32.
Background
The UK Clinical Aptitude Test (UKCAT) was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Verbal Reasoning, Quantitative Reasoning, Abstract Reasoning, and Decision Analysis), and the results are available to students and admission panels in advance of the selection process. Our first study showed little evidence of any predictive validity for performance in the first two years of the Nottingham undergraduate course.
The study objective was to determine whether the UKCAT scores had any predictive value for the later parts of the course, largely delivered via clinical placements.
Methods
Students entering the course in 2007 and who had taken the UKCAT were asked for permission to use their anonymised data in research. The UKCAT scores were incorporated into a database with routine pre-admission socio-demographics and subsequent course performance data. Correlation analysis was followed by hierarchical multivariate linear regression.
Results
The original study group comprised 204/254 (80%) of the full entry cohort. With attrition over the five years of the course this fell to 185 (73%) by Year 5. The Verbal Reasoning score and the UKCAT Total score both demonstrated some univariate correlations with clinical knowledge marks, and slightly less with clinical skills. No parts of the UKCAT proved to be an independent predictor of clinical course marks, whereas prior attainment was a highly significant predictor (p <0.001).
Conclusions
This study of one cohort of Nottingham medical students showed that UKCAT scores at admission did not independently predict subsequent performance on the course. Whilst the test adds another dimension to the selection process, its fairness and validity in selecting promising students remains unproven, and requires wider investigation and debate by other schools.
doi:10.1186/1472-6920-13-32
PMCID: PMC3621812  PMID: 23442227
22.  Use of UKCAT scores in student selection by UK medical schools, 2006-2010 
BMC Medical Education  2011;11:98.
Background
The United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.
Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.
Methods
Annual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.
Results
Four equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.
Conclusions
There is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.
doi:10.1186/1472-6920-11-98
PMCID: PMC3248371  PMID: 22114935
23.  Graduate entry to medicine in Iran 
Backgrounds
In Iran medical students are selected from high school graduates via a very competitive national university entrance exam. New proposals have been seriously considered for admitting students from those with bachelor degrees. We assessed the opinions of different stakeholders on the current situation of admission into medicine in Iran, and their views on positive and negative aspects of admitting graduates into medicine.
Methods
We conducted five focus group discussions and seven in-depth interviews with stakeholders including medical students, science students, university professors of basic sciences, medical education experts, and policy makers. Main themes were identified from the data and analyzed using content analysis approach.
Results
Medical students believed "graduate admission" may lead to a more informed choice of medicine. They thought it could result in admission of students with lower levels of academic aptitude. The science students were in favor of "graduate admission". The education experts and the professors of basic science all mentioned the shortcomings of the current system of admission and considered "graduate admission" as an appropriate opportunity for correcting some of the shortcomings. The policy makers pointed out the potential positive influences of "graduate admission" on strengthening basic science research. They thought, however, that "graduate admission" may result in lengthening the overall duration of medical education, which is already long in Iran (over 7 years). On the whole, the participants thought that "graduate admission" is a step in the right direction for improving quality of medical education.
Conclusion
"Graduate admission" has the potential to correct some of shortcomings of medical education. Unlike other countries where "graduate admission" is used mainly to admit students who are mentally mature, in Iran the main objective seems to be strengthening basic sciences.
doi:10.1186/1472-6920-8-47
PMCID: PMC2571089  PMID: 18847497
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.  The training and expectations of medical students in Mozambique 
Background
This paper describes the socio-economic profile of medical students in the 1998/99 academic year at the Universidade Eduardo Mondlane (UEM) Medical Faculty in Maputo. It aims to identify their social and geographical origins in addition to their expectations and difficulties regarding their education and professional future.
Methods
The data were collected through a questionnaire administered to all medical students at the faculty.
Results
Although most medical students were from outside Maputo City and Maputo Province, expectations of getting into medical school were already associated with a migration from the periphery to the capital city, even before entering medical education. This lays the basis for the concentration of physicians in the capital city once their term of compulsory rural employment as junior doctors is completed.
The decision to become a doctor was taken at an early age. Close relatives, or family friends seem to have been an especially important variable in encouraging, reinforcing and promoting the desire to be a doctor.
The academic performance of medical students was dismal. This seems to be related to several difficulties such as lack of library facilities, inadequate financial support, as well as poor high school preparation.
Only one fifth of the students reported receiving financial support from the Mozambican government to subsidize their medical studies.
Conclusion
Medical students seem to know that they will be needed in the public sector, and that this represents an opportunity to contribute to the public's welfare. Nevertheless, their expectations are, already as medical students, to combine their public sector practice with private medical work in order to improve their earnings.
doi:10.1186/1478-4491-5-11
PMCID: PMC1877809  PMID: 17445263

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