Do study strategies predict academic performance in medical school?

CONTEXT: Study strategies, such as time and study management techniques, seem to be consistently related to achievement even when aptitude is controlled for, but the picture is not entirely clear. As there is limited research in this area, we explored the relative strengths of academic aptitude, as measured by the Medical College Admission Test (MCAT), undergraduate grade point average (UGPA) and study strategies, as measured by the Learning and Study Strategies Inventory (LASSI), in predicting academic performance in 106 students in the first semester of an integrated curriculum. OBJECTIVES: Our purpose was to determine whether relationships could be identified between academic aptitude, study strategies and academic performance which would enable us to provide students with feedback in certain skill areas in order to maximise achievement. METHODS: Data analysis consisted of four multiple regression analyses. The criterion variables were: semester overall final average, semester written examination average, semester practical examination average, and percentage correct on a customised National Board of Medical Examiners (NBME) examination. The predictor variables in each regression were: MCAT score; UGPA; and subscores on the 10 LASSI subscales for Anxiety, Attitude, Motivation, Concentration, Information Processing, Self-Testing, Selecting Main Idea, Study Aids, Time Management and Test-Taking Strategies. RESULTS: The results of three regressions indicated that two study skills, time management and self-testing, were generally stronger predictors of first-semester academic performance than aptitude. CONCLUSIONS: Improving the prioritisation and organisation of study time and teaching students to predict, compose and answer their own questions when studying may help to advance student performance regardless of student aptitude, especially on course-specific examinations.

The Texas A&M experience with class size and campus expansion: evaluation of first year using distance learning and on-site curriculum delivery.

BACKGROUND: The Texas A&M College of Medicine was traditionally a small 2+2 institution where students spent 2 years on one campus for basic science study and 2 years on another campus for clinical study. PURPOSE: To answer calls for an increased physician workforce, we more than doubled our class size and our number of fully matriculating branch campuses. This article describes the 1st full year's experience with expansion. Distance learning was a key part of the experience. METHODS: After extensive planning and pilot study, 1st-year students were fully matriculated at 1 of 2 campuses. Year-end comparisons were made on students' achievement and a satisfaction questionnaire. RESULTS: No statistically significant differences were found on any achievement measures and only several questionnaire items. CONCLUSIONS: Expansion from the 2+2 system to 2 fully-matriculating campuses with a larger student body was successful during its 1st year. Some persistent problems and planned solutions are reported.

Learning basic surgical skills with mental imagery: using the simulation centre in the mind.

CONTEXT: Although surgeons and athletes frequently use mental imagery in preparing to perform, mental imagery has not been extensively researched as a learning technique in medical education. OBJECTIVE: A mental imagery rehearsal technique was experimentally compared with textbook study to determine the effects of each on the learning of basic surgical skills. METHODS: Sixty-four Year 2 medical students were randomly assigned to 2 treatment groups in which they undertook either mental imagery or textbook study. Both groups received the usual skills course of didactic lectures, demonstrations, physical practice with pigs' feet and a live animal laboratory. One group received additional training in mental imagery and the other group was given textbook study. Performance was assessed at 3 different time-points using a reliable rating scale. RESULTS: Analysis of variance on student performance in live rabbit surgery revealed a significant interaction favouring the imagery group over the textbook study group. CONCLUSIONS: The mental imagery technique appeared to transfer learning from practice to actual surgery better than textbook study.

Attitudes of veterinary medical students and medical students toward collaborative learning: an experiment.

This study measured the attitudes of 55 medical students and 30 veterinary medical students as they participated in an experiment of collaborative teaching and learning about basic surgical skills. Two parallel forms of an attitude questionnaire were developed, with three subscales: confidence in one's own surgical skill; collaboration with the other type of student; and inter-professional collaboration in general. These attitude scales were administered before and after an experiment involving the veterinary medical students teaching the medical students incision and exploratory laparoscopy in a laboratory setting using live rabbits. After the experiment, measures of the medical students' attitudes had increased significantly on all three subscales. Measures of the veterinary students' attitudes increased significantly on two subscales but declined on the subscale of inter-professional collaboration.

Is the evaluation of the personal statement a reliable component of the general surgery residency application?

BACKGROUND: Each year, fourth-year medical students spend considerable time writing and rewriting their personal statements. However, there is little evidence of what role the personal statement plays in deciding which applicants will be invited for an interview. OBJECTIVE: To evaluate the inter-rater reliability of a surgical selection committee's ratings for both the personal statement and the application summary parts of the residency application. DESIGN: We completed a retrospective analysis of the 2007-2008 Scott & White surgical residency application pool. From a total pool of 174 residency applications, we selected 8 (5%) applications randomly to be evaluated by 4 experienced members of the selection committee. The 4 committee members rated each personal statement on a 7-point scale, from "negative-would not invite for an interview" to "positive-will invite for an interview." They rated respective application summaries separately on a similar 7-point scale. Committee members also listed their top three reasons for assigning their scores. METHODS: Rating scores for the personal statements and the applications were analyzed for inter-rater correlation. The qualitative data (ie, reasons for the scores) were reviewed to help the investigators profile the reasons given for very positive and very negative scores. RESULTS: For the application summaries, the correlations between each pair of raters ranged from 0.79 to 0.94 with an overall average of 0.88. For the personal statements, inter-rater correlations ranged from -0.83 to 0.63 with an overall average of -0.09. CONCLUSION: These results demonstrate that the personal statements lacked objective criteria for evaluation.

Lexicons, contexts, events, and images: commentary on Elman (2009) from the perspective of dual coding theory.

Elman (2009) proposed that the traditional role of the mental lexicon in language processing can largely be replaced by a theoretical model of schematic event knowledge founded on dynamic context-dependent variables. We evaluate Elman's approach and propose an alternative view, based on dual coding theory and evidence that modality-specific cognitive representations contribute strongly to word meaning and language performance across diverse contexts which also have effects predictable from dual coding theory.

Enhancing competency in professionalism: targeting resident advance directive education.

BACKGROUND: Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. METHODS: In 2009, 59 internal medicine and family medicine residents (postgraduate year 2-3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. RESULTS: While 53% of residents agreed/strongly agreed they had "sufficient knowledge of advance directives, given my years of training," 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that "didactic sessions on advance directives should be offered by my hospital, residency program, or medical school." A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: "Advance directives should only be discussed with patients over 60," "I have sufficient knowledge of advance directives, given my years of training," and "I believe my experience with advance directives is adequate for the situations I routinely encounter." CONCLUSION: Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

Student Course Evaluations: Common Themes across Courses and Years.

Student course evaluations were analyzed for common themes across five different basic science, clinical, and innovative courses from the first and third years of medical school. Each course had both unique and common numerically scaled items including an overall quality rating item. A principal components analysis was conducted for each course to determine the items that loaded most heavily on the same component as the overall quality item. Across courses and years, the items that consistently loaded on the same component as the overall quality item were (1) administrative aspects including course organization, (2) clearly communicated goals and objectives, and (3) instructional staff responsiveness. These results concur with recent medical education literature in this area. Faculty interested in increasing student ratings of the overall quality of their courses might best attend primarily to carefully organizing course goals and objectives and clearly communicating them. The limitations of these conclusions are discussed.

A reliable and valid instrument to assess competency in basic surgical skills in second-year medical students.

BACKGROUND: Despite calls for competency based education, a dearth of validated instruments for measuring basic skills currently exists. We developed an instrument to assess competency in basic surgical skills in second-year medical students and tested it for psychometric reliability and validity. METHODS: From a review of the literature, an instrument comprised of numerically scaled items was constructed. After initial tests, several items were divided to produce a final instrument more specific and more appropriate for providing feedback to students. The final instrument was empirically tested for reliability and validity. RESULTS: The final 10-item instrument is presented here along with all of the empirical evidence including internal consistency reliability and interrater reliability, and content, criterion-related, and construct validity. Overall alpha reliability was 0.84 and interrater reliability was r = 0.83, P < 0.01 for the total scores. Factor analysis provided evidence of construct validity. CONCLUSIONS: The instrument has psychometric properties adequate for use as one criterion for summative evaluation and is educationally practical enough to provide focused and detailed feedback for student improvement.

Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students.

OBJECTIVE: The purpose of this study was to test the effects of varying the amount of physical practice and mental imagery rehearsal on learning basic surgical procedures. STUDY DESIGN: Using a sample of 65 second-year medical students, 3 randomized groups received either: (1) 3 sessions of physical practice on suturing a pig's foot; (2) 2 sessions of physical practice and 1 session of mental imagery rehearsal; or (3) 1 session of physical practice and 2 sessions of imagery rehearsal. All participants then performed a surgery on a live rabbit in the operating theater of a veterinary college under approved conditions. Analysis of variance was applied to pre- and post-treatment ratings of surgical performance. RESULTS: Physical practice followed by mental imagery rehearsal was statistically equal to additional physical practice. CONCLUSION: Initial physical practice followed by mental imagery rehearsal may be a cost-effective method of training medical students in learning basic surgical skills.