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

Effects of the alternative medical curriculum at the Hannover Medical School on length of study and academic success

Objective

The model curriculum HannibaL (Hannoversche integrierter berufsorientierter und adaptiver Lehrplan) differs significantly from other medical study programs in Germany in terms of its structure with which, among other factors, the Hannover Medical School (MHH) saw an opportunity to positively influence the length of study. We investigate how the length of medical study is influenced by the curriculum's structure and whether this has any impact on academic success.

Methods

We use data from over 2,500 students who studied medicine at MHH between 2011 and 2021. We measure study time as the number of years which pass until completion of the respective study phases and academic success as the grades achieved on final exams.

Results

Since they more often fail or postpone exams, students admitted based on special quotas (VQ) or a waiting list (WQ) need significantly more time to complete the first study phase (M1) compared to students who were admitted based on a selection process (AdH) or who belong to the "best school graduates" quota (AQ) because they earned the highest scores on the final secondary school exam. Yet, students from all admission groups reach the written state exam (M2) almost simultaneously. In HannibaL, WQ and VQ manage to catch up on delays from M1 with no negative impact on success in M2. In general, however, VQ and WQ achieve lower grades and drop out more often than students from AQ and AdH.

Discussion

In the regular curriculum, students can only proceed with their studies once M1 has been entirely completed. HannibaL, on the other hand, allows for the catching up of delays from the first two years of study by integrating both study phases. The curricular structure thus accommodates students with lower academic performance who accumulate delays early on in their studies. By contrast, delays in the AQ and AdH groups arise during the second phase of study (M2).

Considering vocational training as selection criterion for medical students: evidence for predictive validity

Prior work experience in a relevant medical profession is an important admission criterion currently used at many German medical schools in addition to cognitive criteria. In other countries, work experience is often considered in later admission stages (e.g., interviews with pre-selected subgroups of applicants). However, evidence for its predictive validity for study success in addition to cognitive admission criteria is currently lacking. We therefore assessed whether completed vocational training in a relevant medical profession can predict study performance in the first two years of study in addition to cognitive admission criteria. Admission and study performance data of all currently enrolled medical students at two German medical schools (Göttingen and Heidelberg) beginning with the 2013/14 cohort were retrospectively analyzed. Cognitive admission criteria in our sample were GPA grades and a cognitive test ("Test für Medizinische Studiengänge", TMS). We defined the study outcome parameter as the mean percentile rank over all performance data points over the first two years of study for each location, respectively. A multi-level model with varying intercepts by location, GPA, TMS, vocational training, and sex as predictors accounted for 14.5% of the variance in study outcome. A positive predictive association with study outcome was found for vocational training (ß = 0.33, p = .008) beyond GPA (ß = 0.38, p < .001) and TMS (ß = 0.26, p < .001). Our results support the use of prior vocational training as a selection criterion for medical studies potentially adding predictive validity to cognitive criteria.

Using longitudinal progress test data to determine the effect size of learning in undergraduate medical education - a retrospective, single-center, mixed model analysis of progress testing results

Medical education research focuses on the development of efficient learning methods promoting the acquisition of student's knowledge and competencies. Evaluation of any modification of educational approaches needs to be evaluated accordingly and a reliable effect size needs to be reached. Our aim is to provide a methodological basis to calculate effect sizes from longitudinal progress test data that can be used as reference values in further research. We used longitudinally collected progress test data and evaluated the increasing knowledge of medical students from the first to the fifth academic year. Students were asked to participate in the progress test, which consists of 200 multiple-choice questions in single best answer format with an additional 'don't know' option. All available individual test scores of all progress tests (n = 10) administered between April 2012 and October 2017 were analyzed. Due to the large amount of missing test results, e.g., from students at the beginning of their studies, a linear mixed model was fitted to include all collected data. In total, we analyzed 6324 test scores provided by 2587 medical students. Mean score for medical knowledge (% correct answers) increases from 16.6% (SD: 10.8%) to 51.0% (SD: 15.7%, overall effects size using linear mixed models d = 1.55). Medical students showed a learning effect of d = 0.54 (total gain: 6.9%) between the 1^st and 2^nd, d = 0.88 (total gain: 12.0%) between the 2^nd and 3^rd, d = 0.60 (total gain: 7.9%) between the 3^rd and 4^th and d = 0.58 (total gain: 7.9%) between the 4^th and 5^th study year. We demonstrated that incomplete data from longitudinally collected progress tests can be used to acquire reliable effect size estimates. The demonstrated effects size between d = 0.53-0.9 by study year may help researchers to design studies in medical education.

Association of professional pre-qualifications, study success in medical school and the eligibility for becoming a physician: A scoping review

BACKGROUND

Literature, individual experiences and common considerations suggest that prior professional qualification can be an advantage for later career development. For instance, in Germany, professional pre-qualification has been honored by medical faculties in selection procedures for several years. However, a systematic evaluation of this relationship lacks. This scoping review summarizes existing literature and addresses the role of prior professional pre-qualifications on objective or subjective study success and the choice of a specialization.

METHODS

The scoping review was performed oriented on the PRISMA guidelines. PsycINFO and PubMed databases were searched for relevant studies that included data of medical students with and without professional pre-qualifications. To answer the underlying research questions, this scoping review also includes studies that examine professional pre-qualifications in association with non-cognitive "soft" criteria.

RESULTS AND FURTHER DIRECTIONS

1055 items were identified and reviewed by two independent reviewers with final 11 studies were included for this scoping review. The results of identified studies that report possible effects of prior pre-professional qualifications are inconclusive but suggest that prior professional qualifications tend not to have rather an advantage on study success. Medical school success for students with prior professional qualifications tended to be below average in the preclinical setting, and there were no differences in the clinical setting compared with students without prior professional qualifications. The influence of professional pre-qualifications has not yet been adequately studied without the moderator variable "waiting time" and "A-levels grade". The scoping review indicates insufficient number of articles stating a co-relation of prior pre-qualifications and subjective data. Again, the results found are not sufficient to state a clear relationship between professional pre-qualifications and the choice of a specific speciality preference. However, professional pre-qualifications, both in medicine and as "practical experience in rural areas", tend to be beneficial for the choice of becoming a rural physician. Large-scale cross-sectional and longitudinal studies are needed to investigate the influence of professional pre-qualifications on different study trajectory parameters.

The prognostic validity of the formative for the summative MEQ (Modified Essay Questions)

Objective: The purpose of formative examinations is that students and lecturers receive an early feedback regarding the success of learning behavior and teaching methods. These also serve as practice for later summative exams. The aim of this paper is to investigate to what extent the result of the formative MEQ* at the end of the first semester at Witten/Herdecke University (UW/H) in the study program human medicine can be used as a predictor for the summative MEQ-1 at the end of the second semester which is part of the equivalence examination replacing the state examination. Methodology: The predictive value of the score achieved in the MEQ* on the MEQ-1 score, as well as the potential influence of the variables gender, age, high school graduation grade (German Abiturnote), professional background, and self-efficacy expectancy, was determined for students of human medicine. Results: Data from two cohorts of UW/H with a total of 88 students were included. Scores on the formative MEQ* correlate with those on the summative MEQ-1 in both cohorts. In regression analyses, only the score on the MEQ* proves to be a significant predictor of performance on the MEQ-1 (40.5% variance explanation). Particularly significant predictors are the scores in the subjects anatomy and clinical reasoning. Vocational training or pre-study only appear to contribute to higher scores in the MEQ* after the first semester, but have no further significance in predicting scores in the MEQ-1. Conclusion: The MEQ* was confirmed to be a good predictor of the MEQ-1. Thus, it serves as a formative exam to inform students about their current state of knowledge with regard to the summative exam MEQ-1, so that they can adequately adapt their learning strategies in the course of the second semester.

Are different medical school admission tests associated with the outcomes of a simulation-based OSCE?

BACKGROUND

Medical school admission procedures have the common goal to select applicants with the greatest potential of becoming successful physicians. Hamburg Medical Faculty selects medical students by grade point average (GPA) and employs a two-step selection process of a natural sciences test (HAM-Nat), in some cases followed by multiple mini-interviews (HAM-Int). Multiple mini-interviews can predict non-cognitive outcomes, while GPA has predictive validity for cognitive outcomes. The aim of our study was to explore communication skills and clinical knowledge of advanced medical students according to their respective admission procedure.

METHODS

In July 2019, 146 students grouped according to their admission procedure into GPA-only (19.2 %), HAM-Nat (33.6 %), HAM-Int (30.8 %), and Waiting List (16.4 %) participated in four OSCE stations which equally assessed students' communication skills (OSCE part 1) and clinical knowledge (OSCE part 2) in simulated patient encounters, rated by physicians with checklists. Additionally, psychosocial assessors ranked communication skills with a global rating scale (GR). The students also participated in a multiple choice (MC) exam testing clinical knowledge. Kruskal-Wallis analyses of variance of test performance and Spearman correlation of instruments were calculated.

RESULTS

Students from the Waiting List group performed significantly worse on the MC exam compared to GPA-only and HAM-Int (adjusted p = .029 and 0.018, respectively). No significant differences were found between the admission groups with respect to communication skills. Global Rating and OSCE part 1 (communication) correlated significantly (ρ = 0.228, p = .006) as did OSCE part 2 (clinical knowledge) and MC exam (ρ = 0.242, p = .003), indicating criterion validity. Constructs did not overlap, indicating divergent validity.

CONCLUSIONS

Advanced medical students selected for undergraduate studies by multiple mini-interviews assessing psychosocial skills showed similar communication skills compared to students admitted to medical school by other entryways. It is unclear whether these similarities are due to an effective undergraduate longitudinal communication curriculum. Assessing baseline communication skills of all medical students at entry-level may aid with this question.

Semantic fluency including task switching predicts academic success in medical school

Objectives

The future state treaty on the admission of students to German medical schools calls for a variety of selection criteria among which at least two are required to be independent of school leaving grades. Against this background, the present study investigated achievement motivation and executive functions as predictors of academic success in medical school.

Material and methods

Second year medical students were assessed for executive functioning by using the Tower of London Test (ToL), a German version of the Controlled Oral Word Association Test (COWAT), the Trail Making Test (TMT-A) and for motivation by using the Achievement Motivation Inventory (AMI). Academic success was evaluated twofold, i) whether the first state exam (M1) was passed at the earliest possible, after completion of the second year and ii) via the grades obtained.

Results

81 out of 226 students enrolled participated in our study. Passing the M1 was best explained by semantic fluency including task switching. Moreover, academically successful students achieved significantly higher levels in the AMI-facets "compensatory effort" and "engagement". All students scored above average in the TMT-A and average in the ToL.

Conclusion

Alternating semantic fluency—requiring simultaneously inhibition, updating and task shifting—turned out highly predictive of academic success in medical school. Moreover, higher levels in "compensatory effort" and “engagement” suggested that both, increased energy expenditure as response to fear of failure and elevated readiness to exert effort also impacted positively on success.

Exam performance of different admission quotas in the first part of the state examination in medicine: a cross-sectional study

BACKGROUND

Most medical students in Germany are admitted via selection procedures, which are adjusted to the demands of the universities. At Lübeck medical school, scores from interviews that measure non-academic skills and pre-university GPAs are summed to arrive at an admission decision. This article seeks to illuminate the effectiveness of this selection procedure in comparison to other non-selected student groups.

METHODS

Quota information and exam results from the first federal exam were linked for students admitted to Lübeck medical school between 2012 and 2015 (N = 655). Five different student groups (university-specific selection quota, pre-university GPA quota, waiting time quota, ex-ante quota and foreign students) were compared regarding exam attempts, written and oral grades, temporal continuity and examination success in the standard study period.

RESULTS

While the pre-university GPA quota outperformed all other quotas regarding written and oral grades, it did not differ from the selection quota regarding exam attempts, temporal continuity and examination success in the standard study period. Students in the waiting time and ex-ante quotas performed inferior by comparison. The results of foreign students were the most problematic.

CONCLUSION

Students selected by the university show high temporal continuity and examination success. These results, and possible advantages in physician eligibility, argue for the utilisation of non-academic skills for admission.

Longitudinal development of different dimensions of perfectionism in undergraduate medical students with respect to their medical school admission procedure

Objective: The concept of perfectionism comprises high standards of performance as needed in medicine, but also concerns about making mistakes and dealing with social reactions about not being perfect. Perfectionism is associated with motivation and deep learning strategies but high expression of perfectionism has been found to be associated with symptoms of stress and anxiety in students. We aim to gain insights into the longitudinal development of different dimensions of perfectionism in medical students with respect to their way of medical school admission. Methods: At the Medical Faculty of Hamburg University, 167 undergraduate medical students completed validated questionnaires (MPS-H and MPS-F) of different dimensions of perfectionism and sociodemographic data including medical school admission procedures, personality traits (BSI-10 and GSE), and symptoms of depression and anxiety (PHQ-9 and GAD-7) at the start of their first year and at half term of their second year. Results: On average, after controlling for baseline and age, a significant decrease (p≤0.05) in Self-Oriented Perfectionism was found during the first two years in students who were admitted after a waiting period (M: -12.57; 95% CI: [-21.94 - -3.35]), by other ways of medical school entrance (M: -6.36; 95% CI: [-12.71 - -0.02]), by multiple mini-interviews (HAM-Int) (M: -5.52; 95% CI: [-9.90 - -1.14]), and by a natural science test (HAM-Nat) (M: -3.41; 95% CI: [-6.71 - -0.11]. Waiting period students also showed a significant longitudinal decline in the scale Personal Standards (M: -4.62; 95% CI: [-8.04 - -1.21]. Conclusions: Since medical students from all admission groups except from the high school degree group showed a significant longitudinal decrease in Self-Oriented Perfectionism, high levels of aspects of perfectionism associated with intrinsic motivation or deep learning strategies could be included medical school admission processes. Additionally, particular attention needs to be paid not to induce a loss of intrinsic motivation or deep learning strategies during undergraduate medical education.

Motivation as an important criterion for graduation among medical students admitted from the waiting list

Aim: Graduation rates among medical students who have been admitted to medical school from the waiting list quota are significantly lower than those for medical students who are directly admitted on the basis of their competitive secondary school academic record or through the universities' selection process. The aim of this study was to identify risk factors that can predict a longer length of study or dropping out and potential resilience factors predictive of timely and successful graduation. Method: First, students admitted from the waiting list were asked in qualitative interviews at the beginning of their studies about risk factors connected with dropping out. These students were then followed until completion of the first state medical exam, or at least until the end of their fourth semester. In parallel, personality traits were measured using the NEO Five-Factor Inventory according to Costa and McCrae (NEO-FFI). Successful study was defined as a length of study time lasting four semesters before taking the first section of the state medical exam (Physikum). Serving as indicators for students at risk were a prolonged period of study and dropping out before taking the first state medical examination. Finally, the factors associated with successful study were identified. Results: Students from the waiting list who displayed a stronger than average conscientiousness in their personality and stated being underchallenged in their prior (medicine-related) occupation as the motivation for studying medicine were significantly more often successful than students from the waiting list who displayed a less pronounced conscientious personality and named dissatisfaction with their previous occupation as their motivation to pursue medical study. In addition, successful students were often distinguished by ambition and reported placing high academic demands on themselves. Early failures on exams were found to be predictive of an uncertain course of study at Rostock Medical School. Conclusions: The reason for studying medicine and an ambitious personality appear to be basic predictors of study success and could therefore be considered not only as a selection criterion for admission, but also monitored during the course of study as a predictive marker for prolonged study or drop-out. Regardless how students are selected for admission, medical schools should take a closer look at the academic performance of the enrolled students to identify at-risk students who are failing exams early in the course of study and to adequately advise them on course scheduling, motivation and exam preparation.

From HAM-Nat to the "Physikum" - Analysis of the study success parameters before and after the introduction of a science test in the approval procedure

Background/Objectives: For the winter semester 2012/13, the Medical School of Otto-von-Guericke University Magdeburg introduced the HAM-Nat test (Hamburg Assessment Test for Medical Degrees - Natural Sciences Section) for the selection of its study applicants with the aim of improving the academic success of their students in the pre-clinical part which has a heavy emphasis on natural sciences. The study examines the extent to which the new University Selection Procedure (AdH) influences two criteria for measuring students' success, compliance with the standard period of study up until the first part of the medical state exam (M1) and its result. Methodology: A comparison of above-mentioned parameters for measuring student success for the matriculation years 2008-2011 (no HAM-Nat test, Pre-Matriculation) and those of the matriculation years 2012-2014 (Nat-Matriculation), whose students have passed the HAM-Nat test in the selection process of the university. In addition, it was taken into account the number of course certificates gained within the standard time period. In the Nat-Matriculation, the HAM-Nat results were merged with the associated M1 exam results. Results: The proportion of AdH students who were admitted to the Physikum (first part of the medical state exam (M1)) within the standard period of study only increased slightly in the period studied. Within the AdH group, 70% of the Pre-Matriculation group gained entry to the second phase of studies without delay, rising to 78% in the AdH-group of the Nat-Matriculation. For all admission groups taken together, the overall grades for the first section of the medical state exam 2010-2016 show a positive trend, regardless of the selection procedure. The proportion of correctly answered questions in the nationwide M1 increased accordingly in the period studied. The better those matriculating had performed in the HAM-Nat test, the better their results were in the written and oral parts of the first part of the medical state exam. Conclusion: Although a significant proportion of students in the AdH group had obtained their place of study only on the basis of their test result and the score in the HAM-Nat test only weakly correlated with the school leaving grade (Abitur), the quantifiable study success parameters to date - in an albeit short observation period before and after introduction of the test - improved slightly. The number of Nat-Matriculations is too low to be able to assess the effect of the HAM-Nat test bearing in mind natural fluctuations. Nevertheless, the HAM-Nat test as an instrument of selection also made it possible for candidates with originally insufficient Abitur grades to gain admission without negative effects on the study success of the AdH cohort.

Research into finding a stable prognosis parameter for the detection of students in need of guidance - Realization of equal opportunities through a diversity-oriented study guidance

Objective: The internationalization of teaching and studying as well as increasing numbers of students with increasingly heterogeneous educational biographies and lifestyles require universities to develop awareness of this diversity and the need for adequate diversity management. For some diversity criteria at least it has been proven that they can influence the individual study success of students. The Dean's Office of the Medical Faculty of the University of Cologne has empirically determined a stable prognosis parameter for study progression on the basis of selected criteria in order to enable early detection of students in need of guidance. This will then be used for targeted, diversity-oriented study guidance. On the one hand a correspondingly adapted guidance offer should take into account individual study progressions. On the other hand, measures to improve the equal opportunities of students with regard to their academic success can be discussed. Methodology: With the help of study progression analyses, study progress of cohorts can be recorded longitudinally. The study progression analysis implemented in the control of faculty teaching serves as a central forecasting and steering tool for the forthcoming concept of diversity-oriented study guidance. The significance measurement of the various features is determined using binary logistic regression analyses. Results: As part of the study progression analyses, the study success rate after the first semester has the strongest influence on the concordance with the minimum duration of study in the pre-clinical phase, followed by the characteristics age at commencement of studies and place of university entrance qualification. The school leaving grade only just misses the required significance level of p <0.05. As a predictor gender provides no explanatory contribution in the considered model. Conclusion: In order to do justice to the heterogeneity among the students, university administrators and lecturers should understand the recognition of diversity as a cross-cutting task and keep an eye on diversity-related aspects and discrimination-critical topics for different target groups as well as individual guidance services in the context of individual study guidance. Within the scope of this study, we were able to empirically prove the stable prognosis parameter study success rate after the first semester allows reliable detection of students in need of guidance. The explanatory contribution is larger than any of the individual criteria examined in this study. The specific causes that led to a delay in studying will be analyzed in the context of downstream and diversity-oriented study guidance. A follow-up study will deal with the question of whether the success of students requiring study guidance can be significantly improved by subsequent study guidance.

The impact of the program structure at Hannover Medical School on academic success in medical studies

Aim: The classical course structure for medicine in Germany is separated by three sections of the medical state examination. This structure is generally regarded as sensible and unchangeable. Because the special program structure at Hannover Medical School (MHH) has one integrated, rather than two separate study blocks, it is possible to examine the influence of structural modifications on the study success of different admission groups. Methods: The data was obtained from students admitted to the MHH between 2006 and 2008 in different admission quotas. Study success was defined as the successful completion of the entire program, but completion of the first section of the state examination was also analysed. Results: More students from the best "Abitur" (school leaving examinations) quota successfully completed their studies than those accepted via the selection process of the universities. The latter were more successful than students from the waiting list quota. However the successful graduates of this last group completed their studies more often within the prescribed period of study, although they needed more time for completing all parts of the first section of the state examination. Conclusion: The data shows that an integrated course structure can offer, in particular, students from the waiting list quota, the opportunity to compensate for delays in the first years of study. However, they do not provide any evidence which applicants are best suited to meet the social and professional requirements of trained doctors. Due to the complex structure of such longitudinal studies, our results allow more than one plausible interpretation.

Student characteristics, professional preferences, and admission to medical school

Objectives: A potential new avenue to address the shortage of country doctors is to change the rules for admission to medical school. We therefore study the link between high-school grade point average and prospective physicians' choice to work in rural areas. To further inform the discussion about rules for admission, we also study the effects of other predictors: a measure of students' attitudes towards risk; whether they waited for their place of study (Wartesemester); whether their parents worked as medical doctors; and whether they have some practical experience in the medical sector. Methods: We conducted two internet surveys in 2012 and 2014. In the first survey, the sample comprised 701 students and in the second, 474 students. In both surveys, we asked students for their regional preferences; in the 2014 survey, we additionally asked students for their first, second, and third preferences among a comprehensive set of specializations, including becoming a general practitioner. In both surveys, we asked students for basic demographic information (age and gender), their parents' occupation, a measure of subjective income expectations, a measure of risk attitudes, and their high-school grade point average (Abiturnote), and First National Boards Examination grade (Physikum). In 2014, we additionally asked for waiting periods (Wartesemester) as well as for prior professional experience in the health-care sector. Results: We find that three factors increase the probability of having a preference for working in a rural area significantly, holding constant all other influences: having a medical doctor among the parents, having worse grades in the high-school grade point average, and being more risk averse. Moreover, we find that those willing to work in the countryside have significantly more experience in the medical sector before admission to medical school. Discussion: Our results suggest that a change in the selection process for medical school may increase the supply of country doctors. Instead of focusing on the high-school grade point average, universities could even more intensely screen for study motivation through interviews or by taking into account students' background, extracurricular activities, or waiting periods.

Test anxiety in medical school is unrelated to academic performance but correlates with an effort/reward imbalance

PURPOSE

During their early years at medical school, students repeatedly criticize their workload, time constraints and test associated stress. At the same time, depressiveness and anxiety among first and second year medical students are on the rise. We therefore hypothesized that test anxiety may be related to depressiveness and considered cognitive and academic performances as confounders for the former and psychosocial distress for the latter.

METHODS

A whole class of 200 second year students was invited to participate in the study. Anxiety as a trait, depressiveness, crystallized intelligence, verbal fluency and psychosocial distress were assessed using validated tests and questionnaires. Acute state anxiety and sympathetic stress parameters were measured in real life situations immediately before an oral and a written exam and paired tests were used to compare the individual anxieties at the various time points. Previous academic performances were self-reported, the results of the impending exams were monitored. Finally, correlations were performed to test for interrelatedness between academic performances and the various personal, cognitive and psychosocial factors.

RESULTS

Acute test anxiety did not correlate with depressiveness nor did it correlate with previous nor impending academic performances nor any of the expected confounders on academic performance. However both, depressiveness and test anxiety strongly correlated with the perceived imbalance between efforts spent and rewards received. Moreover, anxiety as a trait not only correlated with acute state anxiety before an exam but was also significantly correlated to the feeling of over-commitment.

CONCLUSION

Depressiveness during the early years of medical school seems unrelated to test anxiety and academic performance. Instead, it strongly correlated with the psychosocial distress emanating from attending medical school and points at a perceived imbalance between efforts spent and rewards received.

Academic Performance of Students with the Highest and Mediocre School-leaving Grades: Does the Aptitude Test for Medical Studies (TMS) Balance Their Prognoses?

BACKGROUND

Admission to undergraduate medical training in Germany occurs by central and local pathways. Central admission includes two distinct groups: Students with top school-leaving grades (best-SLG group) and students with inferior school-leaving grades who are admitted with a delay of up to seven years (delayed admission group). Students with academic difficulties and early dropouts are present in both groups. Local admission at our university involves the German Test for Medical Studies (TMS) and allows the admission by merit of students with a wide range of school-leaving grades.

AIMS

To examine the justification of a TMS-based strategy to reduce the admission of potentially weak best school-leavers and enhance the admission of potentially able candidates with mediocre school-leaving grades.

METHOD

The prognostic contribution of the school-leaving (SL) GPA and the TMS to academic performance and to continuity in the pre-clinical part of the undergraduate medical program was examined in two study groups: best school leavers (SL grade 1.0, SL-GPA 823-900 points) and mediocre school leavers (SL grades 2.0-2.3, SL-GPA 689-660 points). The outcomes in both groups were compared in relation to their TMS results. The prospective study included four consecutive cohorts.

RESULTS

In each study group the TMS predicted the academic performance (β=0.442-0.446) and the continuity of studies (OR=0.890-0.853) better than the SL-GPA (β=0.238-0.047; OR=1.009-0.998). Attrition was most strongly associated with failing to take the TMS (OR=0.230-0.380). Mediocre school leavers with TMS scores ≥125 performed as well as the best school leavers. Mediocre school leavers with TMS scores between 110-124 performed on average less well but within the required standards. Best school leavers with mediocre TMS scores and 30% of the best school leavers who hadn't taken the TMS performed less well than most mediocre school leavers with high TMS scores.

DISCUSSION

The TMS appears to differentiate between potentially successful and less successful students in both GPA categories. Mediocre school leavers (SLG 2.0-2.3) with exceptionally high TMS results reach better pre-clinical examination results than best school leavers (SLG 1.0) with mediocre TMS results. Thus, the present data justify the use of the TMS to facilitate the participation of mediocre school leavers in the competition for admission slots.