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Low first year exam scores predict students at risk for poor performance on clerkships

Academic Performance on First-Year Medical School Exams: How well Does it Predict Later Performance on Knowledge-Based and Clinical Assessments? Krupat E, Pelletier S, Dienstag J. Teaching and Learning in Medicine. Jan 18, 2017. DOI:10.1080/104001334.2016.1259109.

Reviewed by Molly Rideout

What was the study question?

Does low academic performance in first year coursework predict academic difficulties later in medical school?

How was the study done?

Three classes of Harvard Medical School students (2008-2010) were followed to compare first year performance with four outcome measures: clerkship grades (translated to GPA), Step 1 score, Step 2CK score, and end of clerkships OSCE score. First year performance was determined by establishing the number of times a student appeared in the lowest quartile based on examination scores, summarized as no appearances, 1-2 appearances, and >= 3 appearances. Investigators also compared 8 traditional predictors (including MCAT score, undergraduate GPA, and undergraduate major), with first year performance to identify additional students at risk for poor performance during clinical years.

What were the results?

There was a high correlation among students (n-321) with >=3 appearances in the lowest quartile during first year with clerkship GPA’s in the lowest tertile. Among the students in the lowest tertile for clerkship GPA, 45% had been in the bottom quartile during first year >=3 times. Of the 19% of students who appeared >=3 times in the lowest quartile during first year, only 8% were in the upper third for clerkship GPA’s.

Investigators found that the strongest predictor of each of the four outcome measures was the number of appearances in the bottom quartile. An additional contrasting finding noted by investigators was that a small number (8%) of students with low first year performance performed extremely well in clerkships, and a small number (9%) who performed well in first year did not perform strongly in clerkships.

What are the implications of these findings?

Performance on first year coursework seems to accurately predict students at risk for poor performance during clinical years and could be used as a marker to identify these students and provide extra support. However, this correlation is not universal, as there are some who performed well in the first year and not during clinical years, and vice versa. It is essential to have continuous monitoring of student progress, with special attention to the students who barely pass.

Editor’s note: I don’t think these results will come as any surprise to medical educators. It would be nice to know what strategies are most effective in providing support for students whose first year performance is concerning. It is also important to note that some of the students who struggle with first year exams can shine in the clinical realm. (RR)

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