Factors affecting students performance on the National Ranking Examination in a French Medical School.

OBJECTIVE: Results on the National Ranking Examination (NRE) taken at the end of 6 years of medical school determine how much choice students have about the medical specialty and geographic area where they will perform their residency. Our objective was to identify academic and non-academic factors predicting performance on the NRE. METHODS: We conducted a database study of all medical students who completed the 6 years of medical studies at Creteil medical school (Paris 12 University) and who took the NRE between 2004 and 2008 (n = 473). Correlations between students' characteristics and the NRE rank were analysed using multivariate linear regression models. The students were also divided into three categories based on whether their NRE rank was in the top quartile, bottom quartile, or middle two quartiles. Those 3 groups were compared using multivariate multinomial logistic regression models. RESULTS: Factors independently associated (p < or = 0.05) with rank on the NRE were repeating the first year of medical school (coefficient: 11.92 [95%IC 8.69-15.15]); rank on the first-, fifth-, and sixth-year examinations (0.14 [0.05-0.22]; 0.19 [0.12-0.26] and 0.32 [0.22-0.42] respectively); number of years with at least one failed examination (3.94 [1.08-6.80]); and failure to attend a practice NRE session (13.0 [12.39-13.61]). Factors associated with the worst NRE performance were similar to those found when the NRE rank was handled as a continuous variable. Socio-economic characteristics of students were strongly associated with medical school performance and, therefore, were not independently associated with rank on the NRE. CONCLUSION: Performance on the NRE was strongly associated with previous performance on medical school examinations, ever since the first year of medical school. Students were informed of these results which will help us to identify high-risk students who require early remedial help.

[Transposition of an American-designed comprehensive medical student examination within the framework of the forthcoming French nationwide comprehensive examination. A preliminary study]. / Intérêt de transposer un examen américain dans le cadre du futur examen national classant validant français. Etude préliminaire.

Medical training is undergoing extensive revision in France. A nationwide comprehensive clinical competency examination will be administered for the first time in 2004, relying exclusively on essay-questions. Unfortunately, these questions have psychometric shortcomings, particularly their typically low reliability. High score reliability is mandatory in a high-stakes context. The National Board of Medical Examiners-designed multiple choice-questions (MCQ) are well adapted to assess clinical competency with a high reliability score. The purpose of this study was to test the hypothesis that French medical students could take an American-designed and French-adapted comprehensive clinical knowledge examination with this MCQ format. Two hundred and eighty five French students, from four Medical Schools across France, took an examination composed of 200 MCQs under standardized conditions. Their scores were compared with those of American students. This examination was found assess French students' clinical knowledge with a high level of reliability. French students' scores were slightly lower than those of American students, mostly due to a lack of familiarity with this particular item format, and a lower motivational level. Another study is being designed, with a larger group, to address some of the shortcomings of the initial study. If these preliminary results are replicated, the MCQ format might be a more defendable and sensible alternative to the proposed essay questions.

Assessing medical students' clinical sciences knowledge in France: a collaboration between the NBME and a consortium of French medical schools.

PURPOSE: The French government, as part of medical education reforms, has affirmed that an examination program for national residency selection will be implemented by 2004. The purpose of this study was to develop a French multiple-choice (MC) examination using the National Board of Medical Examiners' (NBME) expertise and materials. METHOD: The Evaluation Standardisée du Second Cycle (ESSC), a four-hour clinical sciences examination, was administered in January 2002 to 285 medical students at four university test sites in France. The ESSC had 200 translated and adapted MC items selected from the Comprehensive Clinical Sciences Examination (CCSE), an NBME subject test. RESULTS: Less than 10% of the ESSC items were rejected as inappropriate to French practice. Also, the distributions of ESSC item characteristics were similar to those reported with the CCSE. The ESSC also appeared to be very well targeted to examinees' proficiencies and yielded a reliability coefficient of.91. However, because of a higher word count, the ESSC did show evidence of speededness. Regarding overall performance, the mean proficiency estimate for French examinees was about 0.4 SD below that of a CCSE population. CONCLUSIONS: This study provides strong evidence for the usefulness of the model adopted in this first collaborative effort between the NBME and a consortium of French medical schools. Overall, the performance of French students was comparable to that of CCSE students, which was encouraging given the differences in motivation and the speeded nature of the French test. A second phase with the participation of larger numbers of French medical schools and students is being planned.