BMJ 1998;316:345-350 (31 January)

Papers

Clinical experience, performance in final examinations, and learning style in medical students: prospective study

I C McManus, professor of psychology and medical education,a P Richards, medical director,b B C Winder, research coordinator,a K A Sproston, research assistant a

a Academic Department of Psychiatry, Imperial College School of Medicine at St Mary’s, London W2 1PG, b Northwick Park and St Mark’s Trust, Northwick Park Hospital, Harrow HA1 3UJ

Correspondence to: Professor I C McManus Centre for Health Informatics and Multiprofessional Education, University College London Medical School, London N19 5NF i.mcmanus@ucl.ac.uk

Objective: To assess whether the clinical experience of undergraduate medical students relates to their performance in final examinations and whether learning styles relate either to final examination performance or to the extent of clinical experience.
Design: Prospective, longitudinal study of two cohorts of medical students assessed by questionnaire at time of application to medical school and by questionnaire and university examination at the end of their final clinical year.
Subjects: Two cohorts of students who had applied to St Mary’s Hospital Medical School during 1980 (n=1478) and 1985 (n=2399) for admission in 1981 and 1986 respectively. Students in these cohorts who entered any medical school in the United Kingdom were followed up in their final clinical year in 1986-7 and 1991-2.
Main outcome measures: Students’ clinical experience of a range of acute medical conditions, surgical operations, and practical procedures as assessed by questionnaire in the final year, and final examination results for the students taking their examinations at the University of London.
Results: Success in the final examination was not related to a student’s clinical experiences. The amount of knowledge gained from clinical experience was, however, related to strategic and deep learning styles both in the final year and also at the time of application, five or six years earlier. Grades in A level examinations did not relate either to study habits or to clinical experience. Success in the final examination was also related to a strategic or deep learning style in the final year (although not at time of entry to medical school).
Conclusions: The lack of correlation between examination performance and clinical experience calls into question the validity of final examinations. How much knowledge is gained from clinical experience as a student is able to be predicted from measures of study habits made at the time of application to medical school, some six years earlier, although not from results of A level examinations. Medical schools wishing to select students who will gain the most knowledge from clinical experience cannot use the results of A level examinations alone but could assess a student’s learning style.

Key messages

  • Medical students with the most clinical experience do not perform best in final undergraduate examinations, throwing some doubt on the validity of the examinations

  • The amount of knowledge a student gains from clinical experience correlates positively with deep and strategic learning styles as measured not only in the final year but also at the time of selection, five or six years earlier

  • If it is important for students to obtain as much clinical experience as possible then final examinations require restructuring to assess and reward clinical experience, and selection should emphasise deep learning which cannot be assessed from grades at A level

  • The use of deep and strategic learning styles in the final year of medical school predicts better performance in the final examination, but the same measures at the time of selection for admission to medical school do not predict examination performance


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Relevant Article

Clinical experience and performance in final examinations
Wai-Ching Leung, Brian Jolly, Elizabeth Murray, Chris McManus, Belinda Winder, and Peter Richards
BMJ 1998 316: 1984. [Extract] [Full Text]

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