Understanding Excellence: a Qualitative Analysis of High-Performing Learner Study Strategies

High- and low-achieving international medical students' perceptions of the factors influencing their academic performance at Chinese universities

China has become an attractive destination for international medical students, particularly those from developing countries in Asia and Africa. These students are known to face difficulties in adapting to Chinese medical universities and they tend to score poorly on subsequent examinations to enter the medical profession in their home or in a third country. To date, limited research concerning the factors that affect the academic performance of this group of students in China has been conducted. In particular, there have been very few comparisons between high and low achievers to identify the factors that high- and low-achieving international medical students in all years of study perceive as affecting their academic performance. A qualitative research approach was implemented at two medical universities. Semi-structured interviews were conducted with 18 high achievers and 22 low achievers in their second, third, fourth, fifth, sixth, and post-graduation years. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach.A few key overlapping factors were identified: social support, learning motivation and interest, exam preparation and strategies, time management, and coping. The high achievers manipulated these strategies successfully while the low achievers did not. The high achievers demonstrated efficient learning methods (efficient use of class time, good note-taking habits, preview and review strategies, expanded learning, self-study and group learning, deep learning, choosing an appropriate study location, and focusing on basics and concepts). They also achieved a good balance between studying and leisure. The low achievers mentioned learning challenges, health issues, English language barriers, and problems with online classes. This study allowed us to identify important factors that international medical students at Chinese institutions perceive to influence their performance. The findings contribute to the literature on the topic and provide a solid basis for practice and policy development.

Digital flashcards and medical physiology performance: a dose-dependent effect

Use of digital flashcards promotes active recall, spaced repetition, and self-assessment academic principles. This work explores the association and dose-dependent effect of this study method and locomotor (LP) and cardiovascular physiology (CP) grades. A single-faculty cohort study of medical LP and CP students was conducted, and 155 and 676 flashcards, respectively, were created through Moodle. An exploratory analysis examined three exam results (2019), and a confirmatory study used a fourth exam (2021) in another CP cohort. Of 685 students enrolled, 558 participated in the exploratory analysis: 319 (69%) for LP and 311 (84%) for CP, of which 203 LP and 267 CP students were flashcard users. Median grades were higher among flashcard users, and the number of cards reviewed was positively correlated with grades (r = 0.275 to 0.388 for LP and r = 0.239 to 0.432 for CP, P < 0.001). Multiple linear regression models confirmed a positive dose-dependent association between results and the number of flashcards studied: for every 100 LP cards reviewed, exam grades increased 0.44-0.75 on a 0-20 scale range (P < 0.001), and for every 1,000 CP flashcards, results raised 0.81-1.08 values (P < 0.05). These findings were confirmed in the 2021 CP cohort of 269 participants, of whom 67% were flashcard users. Digital flashcard revision has a consistent positive dose-dependent association on LP and CP grades.NEW & NOTEWORTHY Implementing flashcard-based strategies is a feasible way to promote active recall, spaced repetition, and self-assessment, and students are highly adherent to these initiatives. There is a positive dose-dependent association between the number of flashcards reviewed and physiology grades. These results are consistent across different physiology subjects, under different cohorts, over short and medium terms.

Implementation of Spaced Repetition by First-Year Medical Students: a Retrospective Comparison Based on Summative Exam Performance

Many medical students use spaced repetition as a study strategy to improve knowledge retention, and there has been growing interest from medical students in using flashcard software, such as Anki, to implement spaced repetition. Previous studies have provided insights into the relationship between medical students' use of spaced repetition and exam performance, but most of these studies have relied on self-reports. Novel insights about how medical students use spaced repetition can be gleaned from research that takes advantage of the ability of digital interfaces to log detailed data about how students use software. This study is unique in its use of data extracted from students' digital Anki data files, and those data are used to compare study patterns over the first year of medical school. Implementation of spaced repetition was compared between two groups of students who were retrospectively grouped based on average performance on three exams throughout the first year of medical school. Results indicate that students in the higher scoring group studied more total flashcards and implemented spaced repetition via Anki earlier in the year compared to the lower scoring group. These findings raise the possibility that implementing spaced repetition as a study strategy early in medical school may be related to improved knowledge retention and exam performance. Additional research should be performed at more sites to further examine the relationship between spaced repetition implementation and exam performance.

Envisioning the Future of Student Success: Report of the 2022-2023 AACP Student Affairs Standing Committee

Over the past several years, traditional metrics have indicated declining student success within colleges and schools of pharmacy. Though students may be less well-prepared for professional school than in years past, once candidates are admitted to our institutions, we have a responsibility to effectively support their progression through the program. The 2022-2023 Student Affairs Committee was convened to evaluate and advance the construct of student success within Doctor of Pharmacy programs. The Student Affairs Committee was charged with identifying environmental factors affecting the ability of pharmacy students to be successful; determining how colleges and schools of pharmacy are currently meeting needs related to student progress; conducting a literature review to determine what academic support measures minimize attrition; and developing innovative suggestions and recommendations that better support student success. To accomplish this work, we conducted an extensive literature review and synthesis of evidence, engaged in professional networking across the Academy, and administered a wide-ranging student success survey to all colleges and schools of pharmacy. In this report, we explore the complex and interacting systems that affect learning behavior and academic success and offer a novel, comprehensive description of how the Academy is currently responding to challenges of academic and student success. Additionally, we envision the future of student success, offering 7 recommendations to the American Association of Colleges of Pharmacy and 5 suggestions to members of the Academy to advance this vision.

Well-being at a Military Medical School and Implications for Military Retention

INTRODUCTION

Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine.

METHODS

In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions.

RESULTS

Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item.

CONCLUSION

The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.

Educational Videos Versus Question Banks: Maximizing Medical Student Performance on the United States Medical Licensing Examination Step 1 Exam

Objective The aim of this research was to determine if medical students' use of the active study strategy of working practice questions is associated with improved performance on the United States Medical Licensing Examination (USMLE) Step 1 exam when compared to students who used the passive study strategy of watching educational videos. Methods The study used a correlational design. Participants were students from two cohorts in a United States medical school (N=164 and N=163) who completed their first two years and took the USMLE Step 1 exam. Data collected retrospectively included the number of practice questions completed, educational videos watched, Step 1 exam scores, average scores on in-class exams, and scores on the Medical College Admission Test (MCAT). Results The number of videos watched was negatively and significantly correlated with the Step 1 score for cohort 2022 (r= -0.294, α=0.01) and cohort 2023 (r= -0.175, α=0.05). The number of practice questions worked was positively and significantly correlated with the Step 1 score for cohort 2022 (r=0.176, α=0.05) and cohort 2023 (r=0.143 though not significant). The number of practice questions was a significant positive predictor of Step 1 score for cohort 2022 (β=0.141, p=0.017) and cohort 2023 (β=0.133, p=0.015). Videos were significant negative predictors for cohort 2023 (β= -0.118, p=0.034). Conclusions Answering practice questions appears to be a more effective study method than passively watching videos. Though other studies have supported the use of active learning methods, this study is unique in finding a negative correlation between test scores and the number of educational videos watched. Medical students should be urged to make the most effective use of study time by incorporating working practice questions and limiting watching educational videos.

Attendance of Near-Peer Tutoring Sessions Improves Academic Performance of First-Year Medical Students

Introduction

Many medical schools have implemented near-peer tutoring (NPT) programs based on the substantial benefits of these programs to both tutors and tutees. This study correlated the frequency of attending weekly NPT sessions to students' academic performance, and also compared performance of high and low attending students.

Methods

Twenty-one weekly NPT sessions were delivered by fourth-year (M4) students to first-year (M1) students. Attendance was recorded, and accordingly students were divided into three groups, high (15-21 sessions), moderate (7-14 sessions), and low (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to assess the relationship between students' frequency of attendance and their overall performance on overall basic medical sciences at the end of M1 year and M2 mid-year NBME® CBSE. Students' performance was also analyzed using ANCOVA and Bonferroni post hoc test to compare differences between the three attendance groups.

Results

An increase in number of attended NPT weekly sessions corresponds with an increase in students' performance on overall M1 basic sciences weighted average (r(196) = .240, p ≤ 0.001) and the M2 mid-year NBME® CBSE (r(196) = .325, p ≤ 0.001). High attending students performed significantly higher than low attending students on overall M1 weighted average of basic science courses (F(2, 192) = 8.518, p < .001) and M2 mid-year NBME® CBSE (F(2, 192) = 15.494, p < .001).

Conclusion

Attending NPT weekly sessions is a valuable experience that is associated with an improvement in M1 medical students' academic performance. However, low performing students tend to miss attending NPT weekly sessions.

Weekly near-peer tutoring sessions improve students' performance on basic medical sciences and USMLE Step1 examinations

PURPOSE

This study examined the relationship between attendance at weekly near-peer tutoring (NPT) sessions offered in the second year of medical school and academic performance on basic science and USMLE Step 1 examinations.

METHODS

Twenty-four weekly NPT sessions were delivered across all modules in the second year of medical school. Attendance of the sessions was recorded and students were divided into three groups: high (16-24 sessions), moderate (7-15 sessions), and low-no (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to determine the relationship between students' frequency of attendance and their performance on overall basic sciences, two NBME CBSEs, and USMLE Step 1 examinations. Students' academic performance was also analyzed using ANOVA and Bonferroni post hoc test (p < 0.05) to compare differences between the three groups.

RESULTS

Pearson correlation analyses revealed that attending peer tutoring sessions was significantly correlated with students' performance in overall basic sciences, CBSE mid-year, CBSE final, and USMLE Step 1 examinations. The high attendance groups significantly outperformed the low-no attendance groups on overall basic sciences (p = 0.007), CBSE mid-year (p < 0.001), CBSE final (p < 0.018), and USMLE Step 1 (p = 0.048) examinations.

CONCLUSIONS

Attending NPT sessions are significantly correlated with students' performance on basic sciences and on USMLE Step1 examinations. Attendance of weekly NPT sessions is a valuable experience for M2 students.