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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.
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.
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).
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.
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.
PMCID: PMC3974177  PMID: 24695362
admissions; underperformance; selection; at-risk students
2.  Preadmission Criteria as Predictors of Academic Success in Entry-Level Athletic Training and Other Allied Health Educational Programs 
Journal of Athletic Training  2001;36(2):141-144.
To investigate preadmission criteria, Scholastic Aptitude Test (SAT) scores, and high school grade point average (HSGPA) and to determine the ability of those criteria to predict the college grade point average (CGPA) of graduates from programs in athletic training and 5 other allied health disciplines.
Design and Setting:
Descriptive data, including age, sex, year of graduation, HSGPA, CGPA, and SAT scores (SAT mathematics [SATM], SAT verbal [SATV], and SAT total) were gathered from the files of graduates (1992 to 1997) of allied health education programs.
The complete records of 373 graduates (244 women and 129 men) of 6 allied health education programs in athletic training, health management systems, occupational therapy, perfusion technology, physician assistant, and physical therapy were used in this study. Subjects with incomplete files were excluded from this study.
We collected data from official college transcripts, official high school transcripts, and SAT scores reported to the university. Descriptive statistics, analysis of variance, Pearson correlation, and stepwise forward regression analyses were used to determine the ability of SATV score, SATM score, and HSGPA to predict CGPA.
Both SATV score and HSGPA were found to predict 14% of the variance in student success (CGPA) in all allied health programs; however, only HSGPA was predictive of student success in athletic training (P = .00). Both SATV score and HSGPA were predictive of CGPA in both physical (P = .02 and .03, respectively) and occupational (P = .02 and .00, respectively) therapy graduates; however, they predicted only 12% and 21%, respectively, of the variance in CGPA. The SATM score was predictive of CGPA in both perfusion technology (P = .05) and physician assistant (P = .00) graduates, accounting for 7% and 18% of the variance in outcomes.
Overall, HSGPA and SATV score were predictive of student success (CGPA) in the allied health group as a whole and should continue to be used as part of the process of admission in higher education until such time that more predictive criteria are determined. The HSGPA was predictive of CGPA (r 2 = 0.38) in athletic training graduates, predicting more than one third of the professional program success. Athletic training educators should continue to use HSGPA as a predictor of success; however, they may wish to establish similar baseline comparisons between athletic training and other disciplines at their schools before determining the importance of standardized preadmission criteria for future students. This work should be considered a pilot study for the profession of athletic training and should be repeated at individual schools to determine the findings' applicability to other athletic training education programs.
PMCID: PMC155524  PMID: 12937454
predictors of academic success; admission criteria; grade point average; Scholastic Aptitude Test
3.  Predictors of first-year GPA of medical students: a longitudinal study of 1285 matriculates in China 
BMC Medical Education  2014;14:87.
Although medical education has developed rapidly in the last decade, and the National College Entrance Examination (NCEE) is used as the "gold standard" for admission to medical college in mainland China, there is a lack of literature regarding the influence of NCEE score and other factors on the academic performance of medical students. This study aimed to examine potential predictors of first-year grade point average (GPA) for medical students.
This study included 1,285 students who matriculated at a first-tier medical university in mainland China in 2011. The precollege motivational attitudes for each matriculate were investigated via questionnaire. A hierarchical linear model was fitted to regress first-year GPA on a 100-point scale on NCEE score and other student-level and major-level characteristics.
NCEE score was a significant predictor of both within-major and between-major variation of first-year GPA for medical students. Majors with higher mean NCEE scores had higher mean GPAs, and higher GPAs were observed among those individuals with higher NCEE scores after controlling for major-level characteristics. First-year GPA differed by certain individual socio-demographic variables. Female students had a 2.44-higher GPA on average than did male students. NCEE repeaters had a 1.55-lower GPA than non-repeaters. First-year GPA was associated negatively with parental income but positively with academic self-concept.
NCEE score is an important predictor of the first-year GPA of medical students, but it is not the sole determinant. Individual socio-demographic characteristics and major-level characteristics should be taken into account to understand better and improve the first-year GPA of medical students.
PMCID: PMC4004455  PMID: 24755355
National College Entrance Examination; First-year GPA; Medical students; China; Hierarchical linear model
4.  Predicting academic outcomes in an Australian graduate entry medical programme 
BMC Medical Education  2014;14:31.
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.
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.
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.
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.
PMCID: PMC3931285  PMID: 24528509
5.  USSTRIDE program is associated with competitive Black and Latino student applicants to medical school 
Medical Education Online  2014;19:10.3402/meo.v19.24200.
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.
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.
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).
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.
PMCID: PMC4033323  PMID: 24861543
minority health; medical education; pipeline; healthcare workforce; minorities in medicine; medical school admission
6.  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.
PMCID: PMC4027806  PMID: 24872856
Medical studies; admission; GPA; school leaving grades
7.  Predictors of Attrition and Academic Success of Medical Students: A 30-Year Retrospective Study 
PLoS ONE  2012;7(6):e39144.
To determine attrition and predictors of academic success among medical students at University of Split, Croatia.
We analysed academic records of 2054 students enrolled during 1979–2008 period.
We found that 26% (533/2054) of enrolled students did not graduate. The most common reasons for attrition were ‘personal’ (36.4%), transfer to another medical school (35.6%), and dismissal due to unsatisfactory academic record (21.2%). Grade point average (GPA) and study duration of attrition students were significantly associated with parental education. There were 1126 graduates, 395 men and 731 women. Their average graduation GPA was 3.67±0.53 and study duration 7.6±2.44 years. During 5-year curriculum only 6.4% (42/654) of students graduated in time, and 55% (240/472) of students graduated in time after curriculum was extended to 6 years. Variables predicting whether a student will graduate or not were high school grades, entrance exam score and year of enrollment. Significant predictors of graduation grades were high school grades and entrance exam score. Entrance exam score predicted length of studying.
Preadmission academic qualifications and year of enrollment predict academic success in medical school. More attention should be devoted to high attrition.
PMCID: PMC3377595  PMID: 22737228
8.  Association of the pre-internship objective structured clinical examination in final year medical students with comprehensive written examinations 
Medical Education Online  2012;17:10.3402/meo.v17i0.15958.
The purpose of this study is to evaluate the association of the pre-internship Objective Structured Clinical Examination (OSCE) in final year medical students with comprehensive written examinations.
Subjects and material
All medical students of October 2004 admission who took part in the October 2010 National Comprehensive Pre-internship Examination (NCPE) and pre-internship OSCE were included in the study (n=130). OSCE and NCPE scores and medical grade point average (GPA) were collected.
GPA was highly correlated with NCPE (r=0.76 and P<0.001) and moderately with OSCE (r=0.68 and P<0.001). Similarly a moderate correlation was observed between NCPE and OSCE scores(r=0.6 and P<0.001).Linear stepwise regression shows r 2 of a model applying GPA as predictor of OSCE score is 0.46 (β=0.68 and P<0.001), while addition of gender to the model increases r 2 to 0.59 (β=0.61 and 0.36, for GPA and male gender, respectively and P<0.001). Logistic forward regression models shows male gender and GPA are the only dependent predictors of high score in OSCE. OR of GPA and male gender for high OSCE score are 4.89 (95% CI=2.37–10.06) and 6.95 (95% CI=2.00–24.21), respectively (P<0.001).
Our findings indicate OSCE and examination which mainly evaluate knowledge, judged by GPA and NCPE are moderately to highly correlated. Our results illustrate the interwoven nature of knowledge and clinical skills. In other words, certain level of knowledge is crucial for appropriate clinical performance. Our findings suggest neither OSCE nor written forms of assessments can replace each other. They are complimentary and should also be combined by other evaluations to cover all attributes of clinical competence efficiently.
PMCID: PMC3338186  PMID: 22547924
OSCE; clinical skills; written examination; reliability; validity
9.  Evaluating Distance Learning in Health Informatics Education 
The purpose of this study was to compare academic performance between distance-learning and on-campus health informatics students. A quantitative causal-comparative research design was utilized, and academic performance was measured by final GPA scores and Registered Health Information Administrator certification exam scores. Differences in previous academic performance between the two groups were also determined by comparing overall admission GPA and math/science admission GPA. The researchers found no difference in academic performance between the two groups when final GPA scores and total certification scores were compared. However, there were statistically significant differences between the two groups in 4 of the 17 sub-domains of the certification examination, with the on-campus students scoring slightly higher than the distance students. Correlation studies were also performed, and the researchers found significant correlations between overall admission GPA, math/science admission GPA, final GPA, and certification scores.
PMCID: PMC2366082  PMID: 18458788
Health informatics; distance learning; distance education; academic performance; comparative studies; allied health
10.  Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools 
BMC Medical Education  2013;13:173.
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.
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.
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.
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.
PMCID: PMC3880586  PMID: 24373207
Selection; Predictive validity; Admissions policy
11.  Predictors of Academic Success in a Doctor of Pharmacy Program 
To evaluate the correlation between specific prepharmacy college variables and academic success in the Texas Tech doctor of pharmacy degree program.
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.
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).
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
12.  Identifying Medical Students Likely to Exhibit Poor Professionalism and Knowledge During Internship 
Journal of General Internal Medicine  2007;22(12):1711-1717.
Identifying medical students who will perform poorly during residency is difficult.
Determine whether commonly available data predicts low performance ratings during internship by residency program directors.
Prospective cohort involving medical school data from graduates of the Uniformed Services University (USU), surveys about experiences at USU, and ratings of their performance during internship by their program directors.
Uniformed Services University.
One thousand sixty-nine graduates between 1993 and 2002.
Residency program directors completed an 18-item survey assessing intern performance. Factor analysis of these items collapsed to 2 domains: knowledge and professionalism. These domains were scored and performance dichotomized at the 10th percentile.
Many variables showed a univariate relationship with ratings in the bottom 10% of both domains. Multivariable logistic regression modeling revealed that grades earned during the third year predicted low ratings in both knowledge (odds ratio [OR] = 4.9; 95%CI = 2.7–9.2) and professionalism (OR = 7.3; 95%CI = 4.1–13.0). USMLE step 1 scores (OR = 1.03; 95%CI = 1.01–1.05) predicted knowledge but not professionalism. The remaining variables were not independently predictive of performance ratings. The predictive ability for the knowledge and professionalism models was modest (respective area under ROC curves = 0.735 and 0.725).
A strong association exists between the third year GPA and internship ratings by program directors in professionalism and knowledge. In combination with third year grades, either the USMLE step 1 or step 2 scores predict poor knowledge ratings. Despite a wealth of available markers and a large data set, predicting poor performance during internship remains difficult.
PMCID: PMC2219838  PMID: 17952512
predicting; intern; professionalism; knowledge; medical education
13.  Requirements for admission to medical school: how many years of university study are necessary? 
OBJECTIVE: To assess whether students admitted to medical school after completing 2 years of undergraduate study performed as well as those admitted after longer periods of undergraduate study in terms of broad patient-care skills measured at the time of graduation. DESIGN: Retrospective study. SETTING: University of Alberta, Edmonton. PARTICIPANTS: Graduates of the classes of 1990 and 1991, of the 226 graduates 133 had entered medical school after 2 years of undergraduate training, 39 after 3 years and 54 after 4 or more years. Eight students had been excluded because they were either transfer students or international students. OUTCOME MEASURES: Objective and subjective assessments of the main clinical rotations (internal medicine, obstetrics and gynecology, pediatrics, psychiatry, radiology and surgery), results of the faculty's final comprehensive examination and of the Medical Council of Canada's Qualifying Examination. RESULTS: The students who had completed 2 years of undergraduate study before medical school were significantly younger than those who had completed 3 years and those who had completed 4 or more years (mean age [and standard deviation (SD)] 20.5 [2.1], 21.5 [2.4] and 25.1 [4.4] years respectively, p < 0.001). They also had a significantly higher mean grade point average (GPA) for the prerequisite courses for admission to medical school than those with 3 years and those with 4 or more years of undergraduate study (8.26 [SD 0.3], 7.95 [SD 0.3] and 7.80 [SD 0.5] respectively, p < 0.001). The overall mean GPA for the best 2 years of undergraduate study did not differ significantly between the three groups. The students with 2 years of undergraduate study had a significantly lower mean score for the pre-entry interview than those who had 4 or more years of undergraduate study (32.1 [SD 7.6] v. 38.3 [SD 8.5], p < 0.001). There were no significant differences between the three groups in the results of any of the subjective or objective outcome measures. CONCLUSION: Students who completed 2 years of undergraduate study before admission to medical school were able to achieve a satisfactory level of competency and maturity by the end of medical school. The 2-year option for entrance into medical school should be reconsidered.
PMCID: PMC1488032  PMID: 7489552
14.  A Predictive Validity Study of the Pharmacy College Admission Test 
To examine the validity of Pharmacy College Admission Test (PCAT) scores for predicting grade point averages (GPAs) of students in years 1-4 of pharmacy programs.
Data were collected from 11 colleges and schools of pharmacy: entering cumulative and math/science GPAs, PCAT scaled scores, pharmacy program GPAs for years 1-4, student status after 4 years. Correlation, regression, discriminant, and diagnostic accuracy analyses were used to determine the validity of the PCAT for predicting subsequent GPAs.
PCAT scaled scores and entering GPAs were positively correlated with subsequent GPAs. Regression analyses showed the predictive value of the PCAT scores, especially in combination with entering GPAs. Discriminant and diagnostic accuracy analyses supported these findings and provided practical suggestions regarding optimal PCAT scores for identifying students most likely to succeed.
Both PCAT scaled scores and entering cumulative GPAs showed moderate to strong predictive validity as indicators of candidates likely to succeed in pharmacy school.
PMCID: PMC1636944  PMID: 17136174
Pharmacy College Admission Test (PCAT); predictive validity
15.  Assessment of scientific thinking in basic science in the Iranian second national Olympiad 
BMC Research Notes  2012;5:61.
To evaluate the scientific reasoning in basic science among undergraduate medical students, we established the National Medical Science Olympiad in Iran. In this Olympiad, the drawing of a concept map was used to evaluate a student's knowledge framework; students' ability in hypothesis generation and testing were also evaluated in four different steps. All medical students were invited to participate in this program. Finally, 133 undergraduate medical students with average grades ≥ 16/20 from 45 different medical schools in Iran were selected. The program took the form of four exams: drawing a concept map (Exam I), hypothesis generation (Exam II), choosing variables based on the hypothesis (Exam III), measuring scientific thought (Exam IV). The examinees were asked to complete all examination items in their own time without using textbooks, websites, or personal consultations. Data were presented as mean ± SE of each parameter. The correlation coefficient between students' scores in each exam with the total final score and average grade was calculated using the Spearman test.
Out of a possible score of 200, the mean ± SE of each exam were as follows: 183.88 ± 5.590 for Exam I; 78.68 ± 9.168 for Exam II; 92.04 ± 2.503 for exam III; 106.13 ± 2.345 for Exam IV. The correlation of each exam score with the total final score was calculated, and there was a significant correlation between them (p < 0.001). The scatter plot of the data showed a linear correlation between the score for each exam and the total final score. This meant that students with a higher final score were able to perform better in each exam through having drawn up a meaningful concept map.
The average grade was significantly correlated with the total final score (R = 0.770), (p < 0.001). There was also a significant correlation between each exam score and the average grade (p < 0.001). The highest correlation was observed between Exam I (R = 0.7708) and the average grade. This means students with higher average grades had better grades in each exam, especially in drawing the concept map.
We hope that this competition will encourage medical schools to integrate theory and practice, analyze data, and read research articles. Our findings relate to a selected population, and our data may not be applicable to all medical students. Therefore, further studies are required to validate our results.
PMCID: PMC3292993  PMID: 22270104
16.  Weight, socio-demographics, and health behaviour related correlates of academic performance in first year university students 
Nutrition Journal  2013;12:162.
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.
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.
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.
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.
PMCID: PMC3878497  PMID: 24344995
Weight; Health behaviour; Correlates; Academic performance; First year university students
17.  Admission Variables Predictive of Academic Struggle in a PharmD Program 
Objective. To characterize and describe admission variables predictive of poor grade attainment by students in 2 pathways to a doctor of pharmacy (PharmD) program.
Methods. A retrospective analysis of course grades of PharmD students admitted from 2000 to 2009 (N= 1,019) in the traditional degree pathway (“1 plus 5” degree program) and the provisional pathway (admitted directly from high school) was performed.
Results. Four hundred three grades of D or less were earned by 183 (18%) students. There were more grades of D or less in the first pharmacy year. Receipt of an unsatisfactory grade was associated with all Pharmacy College Admission Test (PCAT) subcategory scores, PCAT composite score, cumulative prepharmacy coursework hours, prepharmacy grade point average (GPA), prepharmacy science and math GPA, and interview score for accepted students in the traditional pathway. For students in the provisional pathway, PCAT-quantitative analysis, PCAT composite score, prepharmacy cumulative GPA, prepharmacy science and math GPA, English American College Testing (ACT) score, and composite ACT score predicted poor grades.
Conclusion. Admissions committees should heed PCAT scores and GPAs, regardless of program pathway, while progression committees should focus on early program coursework when designing strategies to optimize retention.
PMCID: PMC3578340  PMID: 23459593
admission; pharmacy students; grades; academic performance; retention
18.  Comparison of communication skills between medical students admitted after interviews or on academic merits 
BMC Medical Education  2012;12:46.
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.
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).
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.
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.
PMCID: PMC3503650  PMID: 22726308
19.  Preadmission Predictors of PharmD Graduates' Performance on the NAPLEX 
To identify prepharmacy variables that predicted graduate performance on the North American Pharmacist Licensure Examination (NAPLEX) test.
Undergraduate and pharmacy school transcripts for 424 students admitted to the Texas Tech University Health Sciences Center (TTUHSC) Doctor of Pharmacy program from the fall of 1996 to the fall of 2001 were reviewed. NAPLEX scores were provided by the Texas State Board of Pharmacy (TSBP). Statistical analyses were performed using SPSS, 11.5.
Grade point average, composite Pharmacy College Admission Test (PCAT) score, and California Critical Thinking Skills Test (CCTST) score were each positively correlated with NAPLEX score (p < 0.001 for each). Type of school where organic chemistry was completed; age; advanced courses taken in chemistry, biology, and math; and attainment of a BS, BA, or MS degree were not significantly correlated with NAPLEX score (p > 0.05). When comparing students who successfully graduated and passed the NAPLEX with students who were academically suspended or who failed the NAPLEX, there were significant differences in mean PCAT scores, CCTST score, and age (p < 0.05 for all). Stepwise regression analysis applying all admission variables except PCAT subscores revealed a correlation between predictors (composite PCAT, prepharmacy GPA, and age) and NAPLEX score (p < 0.001).
Composite PCAT score was the strongest predictor of success and failure on the NAPLEX. However, the combined predictive ability of PCAT and CCTST scores, prepharmacy GPA, and age was relatively low. Thus, a full review of each candidate's application is justified.
PMCID: PMC1847544  PMID: 17429505
North American Pharmacist Licensure Examination (NAPLEX); admissions; PCAT; grade point average; performance; CCTST
20.  Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying 
Addictive behaviors  2012;38(3):1643-1650.
This study tested the hypothesis that college students’ substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories with NPS for studying was then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.
PMCID: PMC3558594  PMID: 23254212
academic performance; alcohol; cannabis; college students; nonmedical use of prescription stimulants
21.  Who gets into medical school? 
Canadian Family Physician  2005;51(9):1241.
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.
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.
Province of Ontario, its six medical schools, and its 1 500 000 rural citizens (13% of the total population).
All 4948 applicants to Ontario medical schools in 2002 and 2003 who had gone to high school in Ontario.
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.
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).
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
Student admission into the College of Medicine at King Saud University (KSU) is dependent on the achievement of a grade point average (GPA) of ≥3.5 /5 by the end of the premedical year. This study was undertaken to ascertain whether pre-selected medical students who achieve a relatively low GPA (≤3.75/5) in the premedical year are at risk of having academic difficulties in subsequent years.
A cross-sectional study of all students admitted to the College of Medicine at KSU during 5 academic years (1994 to 1998) was conducted in 2004. The likelihood of completing the program by 2004 and the dropout frequency were compared in the two groups based on their GPA in the premedical year: High GPA (>3.75) and Low GPA (≤3.75).
During the study period, 739 students were admitted to the college. Of these, 619 (84%) were in High GPA group, and 120 (16%) in the Low GPA group. Of the students with High GPA, 545 (88%) out of 619 graduated compared with 79 (66%) of 120 in the Low GPA group (OR 3.822 [95% CI: 2.44, 5.99]: P<0.0001). Overall, 28 students (3.8%) dropped out, but there was a significantly greater frequency of dropping out in the Low GPA group (10/120; 8.3%) compared with the High GPA group (18/619; 2.9%: OR 3.035 [95% CI: 1.37, 6.75], P=0.01).
Our results support the prerequisite of a minimum GPA in the premedical year before proceeding to the higher levels. The GPA of premedical year is a useful predictor of students who need close monitoring and academic support. The use of GPA in the premedical year for admission into medical colleges should help optimize the use of resources and reduce student wastage.
PMCID: PMC3377026  PMID: 23012172
Medical student selection; GPA; Pre-medical year; drop-out; academic performance
23.  Are study strategies related to medical licensing exam performance? 
To examine the relationship between study strategies and performance on a high stakes medical licensing exam entitled the United States Medical Licensing Examination Step 1.
The action research project included seventy nine student participants at the Texas A&M Health Science Center College of Medicine during their pre-clinical education. Data collection included pre-matriculation and matriculation academic performance data, standardized exam data, and the Learning and Study Strategies Instrument. Multiple regression analyses were conducted. For both models, the dependent variable was the Step 1 score, and the independent variables included Medical College Admission Test, Undergraduate Grade Point Average, Year 1 Average, Year 2 Average, Customized National Board of Medical Examiners Average, Comprehensive Basic Science Exam score, and Learning and Study Strategy Instrument sub-scores. Model 2 added Comprehensive Basic Science Self-Assessment average.
Concentration (Model 1 - β = .264; Model 2 - β = .254) was the only study strategy correlated with Step 1 performance. The other statistically significant predictors were Customized National Board of Medical Examiners Average (β = .315) and Year 2 Average (β = .280) in Model 1 and Comprehensive Basic Science Self-Assessment Average (β = .338) in Model 2.
There does appear to be a relationship between the study strategy concentration and Step 1 licensing exam performance. Teaching students to practice and utilize certain techniques to improve concentration skills when preparing for and taking exams may help improve licensing exam scores.
PMCID: PMC4224045  PMID: 25362627
Study strategies; medical licensing exams; academic performance
24.  Predicting Performance in the First-Year of Pharmacy School 
Objectives. To determine the predictive validity of the Pharmacy College Admission Test (PCAT) scores and other variables for students’ success in the first year of doctor of pharmacy (PharmD) programs.
Methods. PCAT scores, entering grade-point averages (GPAs), demographic characteristics, and GPAs for the first year of pharmacy curriculum were collected from the Pharmacy College Application Service (PharmCAS) and from 22 pharmacy programs.
Results. PCAT scores and entering GPAs were positively correlated with subsequent GPAs after the first year. Regression analyses showed the contribution of PCAT scores and entering GPAs in predicting first-year pharmacy GPAs.
Conclusions. PCAT scores and prepharmacy GPAs both showed moderate predictive validity in indicating candidates likely to succeed in the first year of the pharmacy program. These findings are consistent with those of previous similar studies.
PMCID: PMC3142965  PMID: 21829255
Pharmacy College Admission Test; predictive validity; grade point average; assessment; student performance
25.  Predictors of Student Success in Graduate Biomedical Informatics Training: Introductory Course and Program Success 
To predict student performance in an introductory graduate-level biomedical informatics course from application data.
A predictive model built through retrospective review of student records using hierarchical binary logistic regression with half of the sample held back for cross-validation. The model was also validated against student data from a similar course at a second institution.
Earning an A grade (Mastery) or a C grade (Failure) in an introductory informatics course.
The authors analyzed 129 student records at the University of Texas School of Health Information Sciences at Houston (SHIS) and 106 at Oregon Health and Science University Department of Medical Informatics and Clinical Epidemiology (DMICE). In the SHIS cross-validation sample, the Graduate Record Exam verbal score (GRE-V) correctly predicted Mastery in 69.4%. Undergraduate grade point average (UGPA) and underrepresented minority status (URMS) predicted 81.6% of Failures. At DMICE, GRE-V, UGPA, and prior graduate degree significantly correlated with Mastery. Only GRE-V was a significant independent predictor of Mastery at both institutions. There were too few URMS students and Failures at DMICE to analyze. Course Mastery strongly predicted program performance defined as final cumulative GPA at SHIS (n = 19, r = 0.634, r 2 = 0.40, p = 0.0036) and DMICE (n = 106, r = 0.603, r 2 = 0.36, p < 0.001).
The authors identified predictors of performance in an introductory informatics course including GRE-V, UGPA and URMS. Course performance was a very strong predictor of overall program performance. Findings may be useful for selecting students for admission and identifying students at risk for Failure as early as possible.
PMCID: PMC3002135  PMID: 19717804

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