We are always worrying about medical student performance.
Measures of performance, including grades and standardized test scores, are
monitored and discussed regularly. After sitting on an academic performance
committee for several years, I have noticed that some students that struggle
are a surprise to the faculty. Oh sure, there are some students who have lower
pre-matriculant variables (undergraduate science GPA, MCAT, performance in
upper level science courses) prior to starting medical school. In those
students we might expect a lower performance in medical school. But there are
regularly, students who did well during undergraduate studies, they have MCAT
scores that are fine, and they are coming before the academic committee because
of poor performance-usually failing a course or multiple courses. Why does this happen?
Educational researchers in the Netherlands (ErasmusUniversity Medical Centre) and the Centre for Research and Innovation in Medical Education) have tried to
tackle this question. (1) Their research question was: what is the relationship
between motivation, learning strategies, participation, and performance in
medical school. They are interested in the concept of self-regulated learning
(SRL) which can be thought of as a learner that uses meta-cognition,
motivation, and behavioral proactivity to improve their own learning. Several
things that can be seen in self-regulated learners (and I would say in
high-performing medical students): they monitor their progress towards their
own goals; they are interested in learning for the sake of learning; and they
develop and utilize effective learning behaviors.
This study was done in a medical school in Rotterdam,
the Netherlands which has a six-year medical curriculum. First year students in
2008 and 2009 were included in the study. There were 303 students in 2008 (32%
male) and 369 students in 2009 (37% male). Students were given a questionnaire
that was about their study techniques and were given immediate feedback and
recommendations for ways to improve. An 81 item survey with six motivation
subscales and nine strategies subscales was given to measure their
Self-regulated Learning. The survey used a Likert scale (1=not at all true of
me to 7=very true of me). The questions were things like “understanding the
subject matter of this course is very important to me” and “I ask myself
questions to make sure I understand the material I have been studying for this
course” and “I make sure I keep up with the weekly readings and assignments for
this course.” Students also rated their attendance in lecture, clinical skills
training, and assignments
The authors found that Participation (lecture attendance,
completing study assignments, and skill training attendance) was positively
associated with Year 1 Performance and improvements in the mean GPA. Deep
learning strategies were negatively associated with Year 1 performance. So
students who utilized deep learning strategies more frequently as their study
method, had more difficulty in the preclinical (Year 1) curriculum.
So why does participation affect performance? Is it just
because people that go to lecture are able to learn things and get explanations
that are not in the available written information? Or is it because of the
repetition of the material? They have heard it more times- a concept known as
distributed practice (study effort is distributed over several study sessions).
Or is it differential repetition? Material is presented in lecture, on-line modules,
tutorials, small groups, skills training, and independent study which gives
more opportunity to absorb and integrate the information into a structured
knowledge base.
Is it just because people that go to lecture are more in
tune with the material covered and how it will be tested? Since they go to
lecture, they know what is going to be on the test based on the cues and clues
from the faculty. This is an area that needs more research. We want students to
utilize deep learning strategies because information that is learned this way
are more likely to retain that information. We don’t want students that do
better on the test just because they show up, unless showing up leads to deeper
learning and retention of information.
(1) Stegers-Jager KM, Cohen-Schotanus J, Themmen APN. Motivation,
learning strategies, participation and medical school performance. Medical Education 2012: 46: 678–688.
