Clara A. Callahan

Empathy in medical students as related to academic performance, clinical competence and gender

Context  Empathy is a major component of a satisfactory doctor–patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools.

The predictive validity of three versions of the MCAT in relation to performance in medical school, residency, and licensing examinations: a longitudinal study of 36 classes of Jefferson Medical College.

Purpose The Medical College Admission Test (MCAT) has undergone several revisions for content and validity since its inception. With another comprehensive review pending, this study examines changes in the predictive validity of the MCATs three recent versions. Method Study participants were 7,859 matriculants in 36 classes entering Jefferson Medical College between 1970 and 2005; 1,728 took the pre-1978 version of the MCAT; 3,032 took the 1978–1991 version, and 3,099 took the post-1991 version. MCAT subtest scores were the predictors, and performance in medical school, attrition, scores on the medical licensing examinations, and ratings of clinical competence in the first year of residency were the criterion measures. Results No significant improvement in validity coefficients was observed for performance in medical school or residency. Validity coefficients for all three versions of the MCAT in predicting Part I/Step 1 remained stable (in the mid-0.40s, P < .01). A systematic decline was observed in the validity coefficients of the MCAT versions in predicting Part II/Step 2. It started at 0.47 for the pre-1978 version, decreased to between 0.42 and 0.40 for the 1978–1991 versions, and to 0.37 for the post-1991 version. Validity coefficients for the MCAT versions in predicting Part III/Step 3 remained near 0.30. These were generally larger for women than men. Conclusions Although the findings support the short- and long-term predictive validity of the MCAT, opportunities to strengthen it remain. Subsequent revisions should increase the tests ability to predict performance on United States Medical Licensing Examination Step 2 and must minimize the differential validity for gender.

Prediction of students' performances on licensing examinations using age, race, sex, undergraduate GPAs, and MCAT scores.

The annual selection of new students is one of the most important activities of medical school faculty. They face the challenge of selecting those who can perform well not only in the preclinical years, but also in the clinical arena of medical school, in graduate medical education, and beyond. To make sound, evidence-based decisions, faculty involved in the admission process depend on empirical studies that examine the relationship of an applicant’s academic performance before medical school to that individual’s academic performance during medical school and afterwards. Studies have consistently shown that Medical College Admission Test (MCAT) scores and undergraduate grade-point averages (GPAs) are the most important indicators of students’ future academic performances. Specifically, MCAT science scores and undergraduate science GPAs have been associated with preclinical academic performance. However, verbal scores on the MCAT and non-science GPAs have been more closely associated with performance in the clinical years, such as on the United States Medical Licensing Examination (USMLE) Steps 2 and 3. Correspondingly, the combination of GPAs and MCAT scores has been shown to be the best predictor of preclinical academic performance. The predictive strength of MCAT scores and GPAs is less clear when students’ race and sex have been considered, and when performance has been followed longitudinally beyond the preclinical years. Men on average have outperformed women on the USMLE Step 1. The differences were moderated, but not eliminated, by statistical control for differences in prematriculation measures. Conversely, women have outperformed men on the National Board of Medical Examiners (NBME) Part II, though the differences were not as great as those observed between the scores of men and women on Part I, where men outperformed women. Control for differences in prematriculation measures and Part I performances increased the magnitude of differences between women and men on Part II. This phenomenon had been noted several decades earlier. Finally, the findings related to students’ ages have been equivocal, often because age has been confounded with sex or undergraduate academic performance. Studies among racial groups have revealed substantial differences in performances on Part I. Although white students on average have scored highest, followed by Asian Americans, Hispanics, and African Americans, these gaps become narrower after controlling for MCAT scores and undergraduate GPAs. One might expect Asian Americans, who as a group have had the highest mean MCAT scores, to outperform other racial groups during medical school. However, two major studies across time and across medical schools have reported lower mean performance for Asian Americans than for white students in medical school. In summary, previous admission-prediction studies have looked at the predictive value of MCAT scores and GPAs for USMLE Step 1 performances among racial groups, clerkship performance during medical school, and a combination of Step 1 and clerkship performances. Other studies have ignored either students’ age, race, or sex when examining the correlation between prematriculation measures and students’ performances during medical school, or have studied characteristics such as race without controlling for GPAs and MCAT scores. We designed the present study to evaluate simultaneously the relative importances of MCAT scores, undergraduate GPAs, age, race, and sex in predicting performances on the three-step sequence of preclinical, clinical, and postgraduate licensing examinations.

ECONOMIC DIVERSITY IN MEDICAL EDUCATION The Relationship Between Students' Family Income and Academic Performance, Career Choice, and Student Debt

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

A validity study of the writing sample section of the medical college admission test.

The current version of the Medical College Admission Test (MCAT), introduced in 1991, includes four sections: Biological Sciences, Physical Sciences, Verbal Reasoning, and Writing Sample. The Writing Sample assesses skills in organizing thoughts and presenting ideas in a cohesive manner, and provides evidence of analytic thinking and writing skills. Scoring is based on two 30minute essays about general topics. An example of an essay prompt is ‘‘In a free society, individuals must be allowed to do as they choose.’’ Each essay is holistically scored by two trained reviewers on a six-point scale with regard to specific criteria such as developing the central idea, synthesizing concepts logically, and writing clearly with good grammar, syntax, and punctuation. Essays receiving scores that differ by more than one point are re-evaluated by a third expert reviewer. The scores for the two essays completed by each examinee are summed and converted to an 11-point alphabetical scale ranging from J to T. According to reports by the Association of American Medical Colleges (AAMC), 98% of the essays are given identical scores or scores within one scale point of each other by the independent reviewers. The results of multi-institutional studies, conducted by the MCAT Validity Study Advisory Group, have been published and presented at professional meetings. However, while the need for additional studies of the psychometric properties of the MCAT continues, there is a particular need for study of the predictive power of the Writing Sample. The unique alphabetic scores of the Writing Sample discourage the usual correlational analyses used in validity studies. Although it is possible to convert the alphabetic scores to the integers from 1 to 11 by assuming that the letters constitute an interval scale, such an assumption might not be widely accepted. We designed the present study to examine the validity of the Writing Sample section of the MCAT for students at Jefferson Medical College in Philadelphia, Pennsylvania. We speculated that the ability to organize and express ideas effectively in writing could have relevance to the analytic and problem-solving skills demanded in clinical performance. Furthermore, such skills might also be related to a better presentation of one’s self, and to effective verbal expression of ideas, both of which are critical in promoting interpersonal relationships. Therefore, we hypothesized that scores on the Writing Sample would be associated more closely with indicators of clinical competence than with measures of achievement in basic sciences.

Validity of faculty ratings of students' clinical competence in core clerkships in relation to scores on licensing examinations and Supervisors' ratings in residency.

Connections between assessment measures in medical school, residency, and practice need to be studied in order to ascertain the validity of such assessments in the continuum of medical education and physician training. Assuring the validity of students’ clinical competence ratings is especially important because these assessments are among the major components of the dean’s letter of evaluation and, as such, are used in the ranking of candidates for residency programs. Medical schools expend considerable time and effort in preparing a dean’s letter for each of their graduating students. It is based largely on the faculty’s assessment of the student’s academic and clinical performance. It should be one of the most important attachments to students’ applications for graduate medical education. Despite this, residency directors may not attach much importance to the dean’s letter, in part, perhaps, because they are uncertain that the information contained within it is valid for predicting performance during residency. Previous surveys have indicated that academic criteria such as U.S. Medical Licensing Examinations (USMLE) scores, membership in Alpha Omega Alpha (AOA), the medical honor society, and class rank were rated highly as selection variables by residency directors. More recently, performance during clinical clerkships has been cited as an important factor, particularly in the specialty for which the student is applying, and especially for the most competitive residencies. It is thus increasingly important to confirm the validity of clerkship evaluations to assure the credibility of the dean’s letter as a predictor of postgraduate performance. The dean’s letters of evaluation from Jefferson Medical College include a broad range of information (USMLE Step 1 score, secondand third-year class ranks, histogram of third-year written examination grades, clinical ratings, and excerpts from the narrative evaluations from the third-year clerkships). We have previously documented the validity of a calculated medical school class rank in predicting postgraduate performance. The purpose of this study was to examine the validity of faculty ratings of students’ clinical competences in six core clinical clerkships in relation to the students’ subsequent performances on medical licensing examinations and to program directors’ ratings of clinical performance in the first year of residency.

Components of postgraduate competence : analyses of thirty years of longitudinal data

Context  The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment.

African American and White Physicians: A Comparison of Satisfaction with Medical Education, Professional Careers, and Research Activities

Background: Given the disparity between proportions of minority in the general population and in the physician workforce and the projected increase in the minority population, it is important and timely to examine factors that contribute to satisfaction of minority physicians. Purpose: To examine similarities and differences between African American and White physicians in their satisfaction with medical school, their medical careers, and their professional and research activities and achievements. Methods: A questionnaire was mailed to the 148 active African American graduates of Jefferson Medical College (1960 to 1995). Control group was 148 active White classmates matched as to gender, year of graduation, and scores on Step 2 of the United States Medical Licensing Examination (formerly Part 2 of the National Board). Results: Overall response rate-61% (African Americans-59%, White control group-63%). Both groups were equally satisfied with medical education, careers, and professional and research activities. No differences were noted between the groups in satisfaction with medical school financial support, preparation for a medical career, the educational experience and academic environment, medical careers, and practice incomes. African Americans reported greater dissatisfaction than Whites with interactions with medical school faculty and administrators and with the medical school social environment. African Americans were less likely than Whites to recommend Jefferson to minority applicants and to contribute to annual alumni giving. More African Americans than Whites practiced medicine in economically deprived areas and cared for poor minority patients. Conclusions: African American respondents were comparable with White respondents as to their medical careers, professional activities, and achievements as physicians. Their practice patterns reflected a greater sense of community need and involvement than their White counterparts. The sense of dissatisfaction with the social environment of medical school noted by African American respondents seems to persist during their professional careers.

Pseudotumor cerebri and nutritional rickets

A bulging fontanelle due to benign increased intracranial pressure is not generally recognized as a manifestation of nutritional rickets but should be considered in the appropriate clinical setting. Two children who we saw presented with bulging anterior fontanelles were found to have pseudotumor cerebri in association with nutritional rickets.

EditorialMedical education and health services research: the linkage

The medical community is coming under increased scrutiny. Challenges to the integrity of the healthcare system have been raised due to reports about the prevalence of medical errors. A heightened level of vigilance is required. Equally important is the need to isolate and correct the source of any problem, perceived or real. We are faced with challenging questions. Is the selection of students and residents appropriate? Are their education and evaluation valid? These questions must be answered at least in part by understanding the climate in which the services to the patients are rendered. Otherwise deficiencies noted in practice may be inappropriately attributed to the educational process. This article addresses the importance, implications and impact of the link between medical education and health services research. The goal of medical education is to prepare physicians to meet the challenges of practice by fulfilling their roles of clinician, educator and resource manager. Health services research can be linked to any of these physician roles. An understanding of health services is necessary to assess how well this goal is being met in the context of the changing healthcare system. A partnership between medical education and health services research is essential for academic health centers and health services institutions in assessing issues of health manpower and for the public good. Academic health centers have an important role in this partnership providing an infrastructure and expertise for both education and health services research.