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EDUCACIÓN MEDICA

Factores predictores favorables en el examen de ingreso a la Facultad de Medicina. ( 2006-2008).
Marcela Lucchese, Julio Enders, María Soledad Burrone, Alicia R Fernández
Revistad de la  Facultad de Ciencias Médicas 2010, 67(1): 51-56

Admission Department, School of Medicine, Universidad Nacional de Córdoba. Córdoba. Argentina
Enrique Barros s/n- Ciudad Universitaria. admision@fcm.unc.edu.ar

INTRODUCTION

Schools for the training of health professionals endeavour to provide their graduates with a high quality education and skills that enable them to meet the healthcare demands of contemporary society. Research has been carried out with the purpose of assessing the incidence of variables such as high-school GPA, demographic characteristics and learning styles on pre-graduate academic performance (1, 2, 3).
Various researchers coincide in pointing to previous performance as one of the best predictors of university academic performance
Within this context and as a complement to the new demands posed by the curricular changes in the School of Medicine (2000), a new admission examination was implemented. This examination has been judged as reliable by faculty and accreditation organizations (5, 6).
As regards the Admission Courses, this assessment provides both instructors and students with relevant data for decision making and improvement of teaching practices. As a component of the educational process, this assessment contributes to students’ awareness and to instructors’ understanding of said process (7).

Thus, the data gathered in the admission courses provided a stimulus for research on the assessment, instruments and implications of students’ performance. This research is of great importance since many studies on the predictive capacity of various entrance examinations have shown a positive correlation of the scores obatined with subsequent academic performance, which makes them very good predictors of future academic performance (8, 9).
It must also be taken into account that the US Medical College Admission Test shows a good correlation with the results obtained by candidates in their professional licensing examinations (10).

The Admission Department worked on a revision of the School of Medicine multiple-choice entrance examination. In the first place, contents and objectives of the test were graded, and a procedure was devised to determine the indexes of difficulty and discrimination of each item and their value in relation to overall examination grades.

Academic performance is the result of a technical-pedagogical process for the assessment of attainment of the aims set out for academic tests (11). Performance may be expressed either quantitatively or qualitatively. Thus, performance is equated to the grades obtained in the tests.
This research project is intended as a feedback between the processes of teaching, learning and evaluation of the Admission Courses for the various curricula of the School of Medicine. The detection of factors that facilitate performance constitutes a valuable contribution to pedagogical decision making tht involve both individuals and groups.

Aims
• To analyze the incidence of socio-demographic characteristics of student population on their performance in the Medical School entrance examination.
• To analyze the incidence of student performance in the various high-school specialization cycles on their performance in the entrance examination to Medical School.
• To analyze the correlation between high-school GPA and entrance examination scores.
• To assess the predictive capacity of socio-demographic and academic indicators of candidates to enter Medical School.

METHODOLOGY
The population surveyed consisted of the students who sat for the entrance examination to the School of Medicine in the years 2006, 2007 and 2008.
Socio-demographic analysis: for this analysis, data gathered from registration forms for Medical School were compiled and classified. The variables under analysis were: gender, age, place of origin, nationality, year of high-school graduation, type of high-school specialization, previous studies, type of high-school attended, job performance of candidate and parents, current job of parents, and educational level of parents.

Analysis of type of high-school specialization: Since distribution characteristics of candidates’ origin indicate that 44.66 % come from the province of Córdoba and 55.34 % come from other provinces, the various specializations were grouped by affinity in order to obtain a schematic representation of the wide variety of options available for high-school students.
 1. Humanities (Humanities and Social Sciences, Belles Lettres, Baccalaureate, Pedagogy, Languages, Art and Design)

 2. Nature Sciences (Nature Sciences, Physics and Mathematics, Health, and Environment)

 3. Economy and Management (Organizational Economy and Management, Production of Goods and Services, Commercial Expert)

 4. Tourism (Tourism, Information Technology, Communications).

 5. Technical Specializations (Agricultural Technology, Industrial and Production Technology)

Analysis of high-school GPA: in order to correlate the performance at the entrance examination with high-school GPA, this variable (ranging between 6 and 10 points) was divided into four equal segments. Statistical analysis was performed in two stages: first, the obtention of confidence intervals between segments; second, a detailed analysis of candidates' GPA distribution. The confidence level was 95 % in all cases; groups of successful and non-successful candidates were compared according to the following class intervals:
Successful candidates with GPA between 6 and 6,99 (G0I); successful candidates with GPA between 7 and 7,99 (G1I); successful candidates with GPA between 8 and 8,99 (G2I); successful candidates with GPA between 9 and 9,99 (G3I); non-successful candidates with GPA between 6 and 6,99 (G0NI); non-successful candidates with GPA between 7 and 7,99 (G1NI); non-successful candidates with GPA between 8 and 8,99 (G2NI); and non-successful candidates with GPA between 9 and 9,99 (G3NI).

Analysis of data: Measurable variables were analysed using ANOVA; attribute variables were analysed using categorical data analysis and multiple correspondence analysis. Means were calculated, and qualitative variables were dichotomized using frequency analysis. Logistic regression analysis was employed in the detection of potential predictive factors of success in the Medical School entrance examination.
 

Socio-demographic variables, which were analyzed using multiple correspondence in the three groups, rendered the following as the variables that best explain success or non-success: Type of High School attended (belonging to a university, private, or public) (p < 0.02) and Educational Level of the Mother (university graduate, and postgraduate studies) (p < 0.02)

High school orientation: the number of candidates with specialization in Nature Sciences prevailed above other specializations (p < 0.001). To analyse performance by high-school specialization, each specialization was compared to the remaining ones, taking into account the numbers of candidates who sat for the entrance examination and of those who passed it. It was found that in all groups those candidates with the specialization in Nature Sciences performed above the rest (p < 0.02).
Correlation between entrance examination performance and high-school GPA: the pertinent correlation analysis showed no association between these variables for any of the cohorts under study.
In order to study the sub-populations of successful and non-successful candidates, the mean of the GPA's was taken into account for each of the intervals of the 6-10 range.
For both groups, the confidence intervals were obtained. For successful candidates, the mean and standard error were 8.47 ± 0.05 points, the lower limit was 8.37, and the upper limit was 8.56. For non-successful candidates, the mean and standard error were 7.95 ± 0.02 points, the lower limit was 7.92, and the upper limit was 7.98. For the total population, the mean and standard error were 8.01 ± 0.02, with a confidence interval between 7.98 and 8.05.
Since the mean for the non-successful candidates does not fall within the confidence intervals of successful candidates, and vice versa, both sub-populations evince a different behaviour as regards high-school GPA.
Later, both successful and non-successful groups were compared by class intervals according to the classification described in Materials and Methods. The groups of successful and non-successful candidates with GPA between 6 and 6.99 were not included, since they were found to have the same behaviour as the corresponding groups with GPA between 7 and 7.99.
When analysing the numbers of successful candidates according to their GPAs, the comparison of group G1I (15.96 %) with group G2I (31.73 %) showed that candidates belonging to G2I outnumbered those of G1I (p < 0.0001). This is reflected in the odds ratio which indicates that G2I students have a probability of success 2.45 times that of G1I students (CI: 1.63 – 2.41).

 

When comparing the numbers of group G1I (15.96 %) with group G3I (46.18 %) it was found that G3I students outnumbered those of G1I (p < 0.0001). The corresponding odds ratio indicates a success probability 4.52 times higher for G3I students (CI: 3.30 – 6.19). Frequency analysis shows that G2I students exhibit better performance than those of group G1I (p < 0.0001).
Frequency analysis of non-successful candidates gives 46.78 % for group G1NI and 33.45 % for group G2NI, which indicates that a higher GPA favours success in the entrance examination (p < 0.0001). This is reflected in the odds ratio, which shows that students belonging to the G1NI have a probability of failing the exam that is 1.75 times higher than the corresponding to G2NI students (CI: 1,50 – 2,04).
This analysis was carried out for the three years under study, with similar results for all of them.

DISCUSSION
The socio-demographic profile of the candidate students indicates that female students prevail in number. The distributions according to age, job status, place of origin and type of high school of graduation show internal coherence, and indicate that candidates are young and without a job. This is coincident with the results of other studies of factors related to academic performance (12, 13, 14, 15, 16).
The positive predictive value of graduation from private and university high schools coincides with the findings of other researchers (17). The educational level of the mother as a positive predictive factor is associated to the direct transmission of the cultural capital of mothers to their children, a characteristic also detected by other educational researchers (18, 19). This idea is also supported by a study of G. Andino (2003) who found that a family environment where parents have a high educational level influences positively the academic performance of students (20).
The analysis of the various high-school specialization types shows that students who graduated in Nature Sciences have a better performance than those of different specializations, which leads to the conclusion that this affinity with medical studies gives students a better chance of success in admission to Medical School.
The results obtained for the degree of association between high-school GPA and the overall score obtained in the entrance examination are coincident with the description of J. Etcheverry (2000), who states that there is a general decay in the indexes of achievement in high-school subjects and a simultaneous tendency to inflate students’ grades (21).
It must be pointed out that, despite previous assessments of the value of high-school GPA as a variable associated to performance in university studies (22, 23), there are indications of a progressive reduction of grade range by an increease of the lower limit, which has deteriorated the predictive value of high-school GPAs (24).
This means that students with grades below 6 have been gradually assimilated to those with GPAs between 6 and 7. This may explain the differences found between the groups of successful and non-successful candidates in the entrance examination.
A study on successful candidates of the Universidad del Nordeste (2004) states that the students with a high-school GPA between 6 and 6.99 have an academic performance of 66 %, which means a difference of 15-20 points when compared to students with a higher GPA. This study also states that for higher GPAs there is a significant increase in academic activity and examinations for which these students sit (25). This study supports the predictive value of high-school GPA, a fact also ascertained by the present study.
There is also a study by Guevara-Guzmán et al (2007) for first-year medical students, who conclude that academic performance during the first year of studies depends essentially on the high-school of graduation, as well as on social status, family relationship and academic background of the parents (26). All these aspects agree with the behaviour of some of the socio-demographic variables analysed in this study. Similarly, a study by Garbanzo Vargas (2007) states that family support is paramount for further academic achievement, and that the higher level of maternal education has a positive influence on academic performance (27).
As a conclusion, we may state that predictive factors for success in the entrance examination to Medical School are associated to socio-cultural factors of the family environment, particularly education of the mother, and to a GPA of 8-9 points.
 

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