Abstract
Dropping out from undergraduate medical education is costly for students, medical schools, and society in general. Therefore, the early identification of potential dropout students is important. The contribution of personal features to dropout rates has merited exploration. However, there is a paucity of research on aspects of student experience that may lead to dropping out. In this study, underpinned by theoretical models of student commitment, involvement, and engagement, we explored the hypothesis of using inferior participation as an indicator of a higher probability of dropping out in year 1. Class participation was calculated as an aggregate score based on teachers’ daily observations in class. The study used a longitudinal dataset of six cohorts of high-school entry students (N = 709, 67% females) in one medical school with an annual intake of 120 students. The findings confirmed the initial hypothesis and showed that lower scores of class participation in year 1 added predictive ability to pre-entry characteristics (Pseudo-R2 raised from 0.22 to 0.28). Even though the inclusion of course failure in year 1 resulted in higher explanatory power than participation in class (Pseudo-R2 raised from 0.28 to 0.63), ratings of class participation may be advantageous to anticipate dropout identification, as those can be collected prior to course failure. The implications for practice are that teachers’ ratings of class participation can play a role in indicating medical students who may eventually drop out. We conclude that the scores of class participation can contribute to flagging systems for the early detection of student dropouts.
Similar content being viewed by others
References
Adam, J., Bore, M., McKendree, J., Munro, D., & Powis, D. (2012). Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study. BMC Medical Education, 12, 69. https://doi.org/10.1186/1472-6920-12-69.
Arulampalam, W., Naylor, R., & Smith, J. (2004). Factors affecting the probability of first year medical student dropout in the UK: A logistic analysis for the intake cohorts of 1980-92. Medical Education, 38(5), 492–503. https://doi.org/10.1046/j.1365-2929.2004.01815.x.
Arulampalam, W., Naylor, R. A., & Smith, J. P. (2007). Dropping out of medical school in the UK: Explaining the changes over ten years. Medical Education, 41(4), 385–394. https://doi.org/10.1111/j.1365-2929.2007.02710.x.
Astin, A. W. (1984). Student involvement: A developmental theory for higher education. Journal of College Student Personnel, 25(4), 297–308.
Astin, A. W. (1993). What matters in college: Four critical years revisited. San Francisco, CA: Jossey-Bass.
Bösner, S., Pickert, J., & Stibane, T. (2015). Teaching differential diagnosis in primary care using an inverted classroom approach: Student satisfaction and gain in skills and knowledge. BMC Medical Education, 15, 63. https://doi.org/10.1186/s12909-015-0346-x.
Carini, R. M., Kuh, G. D., & Klein, S. P. (2006). Student engagement and student learning: Testing the linkages. Research in Higher Education, 47(1), 1–32. https://doi.org/10.1007/s11162-005-8150-9.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: LEA.
Compton, M. T., Carrera, J., & Frank, E. (2008). Stress and depressive symptoms/dysphoria among US medical students: Results from a large, nationally representative survey. Journal of Nervous and Mental Disease, 196(12), 891–897. https://doi.org/10.1097/nmd.0b013e3181924d03.
Duffy, R. D., Manuel, R. S., Borges, N. J., & Bott, E. M. (2011). Calling, vocational development, and well-being: A longitudinal study of medical students. Journal of Vocational Behavior, 79(2), 361–366. https://doi.org/10.1016/j.jvb.2011.03.023.
Dyrbye, L. N., Thomas, M. R., Power, D. V., Durning, S., Moutier, C., Massie, F. S., Jr., et al. (2010). Burnout and serious thoughts of dropping out of medical school: A multi-institutional study. Academic Medicine, 85(1), 94–102. https://doi.org/10.1097/acm.0b013e3181c46aad.
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U. S. and Canadian medical students. Academic Medicine, 81(4), 354–373.
Fonseca, M., Dias, D., Sá, C., & Amaral, A. (2014). Waves of (dis)satisfaction: Effects of the numerus clausus system in Portugal. European Journal of Education, 49(1), 144–158. https://doi.org/10.1111/ejed.12042.
Frellsen, S., Baker, E. A., Papp, K. K., & Durning, S. J. (2008). Medical school policies regarding struggling students during the internal medicine clerkships: Results of a national survey. Academic Medicine, 83(9), 876–881. https://doi.org/10.1097/acm.0b013e318181da98.
Garrud, P., & Yates, J. (2012). Profiling strugglers in a graduate-entry medicine course at Nottingham: A retrospective case study. BMC Medical Education, 12, 124. https://doi.org/10.1186/1472-6920-12-124.
Goldberg, L. R., Bell, E., King, C., O’Mara, C., McInerney, F., Robinson, A., et al. (2015). Relationship between participants’ level of education and engagement in their completion of the Understanding Dementia Massive Open Online Course. BMC Medical Education, 15, 60. https://doi.org/10.1186/s12909-015-0344-z.
Hojat, M., Gonnella, J. S., Erdmann, J. B., & Veloski, J. J. (1997). The fate of medical students with different levels of knowledge: Are basic medical sciences relevant to physician competence? Advances in Health Sciences Education, 1(3), 179–196.
Hu, S., & Kuh, G. D. (2002). Being (dis)engaged in educationally purposeful activities: The influences of student and institutional characteristics. Research in Higher Education, 43(5), 555–575.
Jones, R. F., & Korn, D. (1997). On the cost of educating a medical student. Academic Medicine, 72(3), 200–210.
Kahu, E. R. (2013). Framing student engagement in higher education. Studies in Higher Education, 38(5), 758–773. https://doi.org/10.1080/03075079.2011.598505.
Kaufman, D. M., & Hansell, M. M. (1997). Can non-expert PBL tutors predict their students’achievement? An exploratory study. Academic Medicine, 72(Suppl. 1), S16–S18.
Krause, K.-L., & Coates, H. (2008). Students’ engagement in first-year university. Assessment and Evaluation in Higher Education, 33(5), 493–505. https://doi.org/10.1080/02602930701698892.
Kuh, G. D. (2003). What we’re learning about student engagement from NSSE. Change, 35(2), 24–32. https://doi.org/10.1080/00091380309604090.
Kuh, G. D., Cruce, T. M., Shoup, R., Kinzie, J., & Gonyea, R. M. (2008). Unmasking the effects of student engagement on first-year college grades and persistence. Journal of Higher Education, 79(5), 540–563. https://doi.org/10.1353/jhe.0.0019.
Lameris, A. L., Hoenderop, J. G. J., Bindels, R. J. M., & Eijsvogels, T. M. H. (2015). The impact of formative testing on study behavior and study performance of (bio)medical students: A smartphone application intervention study. BMC Medical Education, 15, 72. https://doi.org/10.1186/s12909-015-0351-0.
Liu, R., Carrese, J., Colbert-Getz, J., Geller, G., & Shochet, R. (2015). “Am I cut for this?” Understanding the experience of doubt among first-year medical students. Medical Teacher, 37(12), 1083–1089. https://doi.org/10.3109/0142159x.2014.970987.
Maher, B. M., Hynes, H., Sweeney, C., Khashan, A. S., O’Rourke, M., Doran, K., et al. (2013). Medical school attrition—Beyond the statistics. A ten year retrospective study. BMC Medical Education, 13, 13. https://doi.org/10.1186/1472-6920-13-13.
Mørcke, A. M., O’Neill, L., Kjeldsen, I. T., & Eika, B. E. (2012). Selected determinants may account for dropout risks among medical students. Danish Medical Journal, 59(9), A4493.
O’Brien, B., Cooke, M., & Irby, D. M. (2007). Perceptions and attributions of third-year student struggles in clerkships: Do students and clerkship directors agree? Academic Medicine, 82(10), 970–978. https://doi.org/10.1097/acm.0b013e31814a4fd5.
O’Neill, L. D., Mørcke, A. M., & Eika, B. (2016). The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study. Advances in Health Sciences Education, 21(5), 1061–1079. https://doi.org/10.1007/s10459-016-9677-6.
OʼNeill, L. D., Wallstedt, B., Eika, B., & Hartvigsen., J. (2011). Factors associated with dropout in medical education: A literature review. Medical Education, 45(5), 440–454. https://doi.org/10.1111/j.1365-2923.2010.03898.x.
Papadakis, M. A., Hodgson, C. S., Theherani, A., & Kohatsu, N. D. (2004). Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Academic Medicine, 79(3), 244–249.
Robbins, S. B., Lauver, K., Le, H., David, D., Langley, R., & Carlstom, A. (2004). Do psychosocial and study skills factors predict college outcomes? A meta-analysis. Psychological Bulletin, 130(2), 261–288. https://doi.org/10.1037/0033-2909.130.2.261.
Rocca, K. A. (2010). Student participation in the college classroom: An extended multidisciplinary literature review. Communication Education, 59(2), 185–213. https://doi.org/10.1080/03634520903505936.
Sandars, J., Patel, R., Steele, H., & McAreavey, M. (2014). Developmental student support in undergraduate medical education: AMEE Guide No. 92. Medical Teacher, 36(12), 1015–1026. https://doi.org/10.3109/0142159x.2014.917166.
Simpson, K. H., & Budd, K. (1996). Medical student attrition: A 10-year survey in one medical school. Medical Education, 30(3), 172–178. https://doi.org/10.1111/j.1365-2923.1996.tb00739.x.
Svanum, S., & Bigatti, S. M. (2009). Academic course engagement during one semester forecasts college success: Engaged students are more likely to earn a degree, do it faster, and do it better. Journal of College Student Development, 50(1), 120–132.
Tinto, V. (1993). Leaving college: Rethinking the causes and cures of student attrition (2nd ed.). Chicago: University of Chicago Press.
Tinto, V. (2012). Enhancing student success: Taking the classroom success seriously. The International Journal of the First Year in Higher Education, 3(1), 1–8. https://doi.org/10.5204/intjfyhe.v3i1.119.
Tyssen, R., Dolatowski, F. C., Røvik, J. O., Thorkildsen, R. F., Ekeberg, O., Hem, E., et al. (2007). Personality traits and types predict medical school stress: A six-year longitudinal and nationwide study. Medical Education, 41(8), 781–787. https://doi.org/10.1111/j.1365-2923.2007.02802.x.
Urlings-Strop, L. C., Stijnen, T., Themmen, A. P., & Splinter, T. A. (2009). Selection of medical students: A controlled experiment. Medical Education, 43(2), 175–183. https://doi.org/10.1111/j.1365-2923.2008.03267.x.
Ward, A. M., Kamien, M., & Lopez, D. G. (2004). Medical career choice and practice location: Early factors predicting course completion, career choice and practice location. Medical Education, 38(3), 239–248. https://doi.org/10.1046/j.1365-2923.2004.01762.x.
Weaver, R. R., & Qi, J. (2005). Classroom organization and participation: College students’ perceptions. The Journal of Higher Education, 76(5), 570–601.
Whitfield, C. F., & Xie, S. X. (2002). Correlation of problem-based learning facilitators’ scores with student performance on written exams. Advances in Health Sciences Education, 7(1), 41–51.
Wijnia, L., Loyens, S. M. M., Derous, E., Koendjie, N. S., & Schmidt, H. G. (2014). Predicting educational success and attrition in problem-based learning: Do first impressions count? Studies in Higher Education, 39(6), 967–982. https://doi.org/10.1080/03075079.2012.754856.
Wijnia, L., Loyens, S. M. M., Derous, E., & Schmidt, H. G. (2016). University teacher judgments in problem-based learning: Their accuracy and reasoning. Teaching and Teacher Education, 59, 203–212. https://doi.org/10.1016/j.tate.2016.06.005.
Yates, J. (2011). Development of a “toolkit” to identify medical students at risk of failure to thrive on the course: An explorative retrospective case study. BMC Medical Education, 11, 95. https://doi.org/10.1186/1472-6920-11-95.
Yates, J. (2012). When did they leave, and why? A restrospective case study of attrition on the Nottingham undergraduate medical course. BMC Medical Education, 12, 43. https://doi.org/10.1186/1472-6920-12-43.
Yates, J., & James, D. (2006). Predicting the ‘‘strugglers’’: A case-control study of students at Nottingham University Medical School. British Medical Journal, 332(7548), 1009–1013. https://doi.org/10.1136/bmj.38730.678310.63.
Yates, J., & James, D. (2007). Risk factors for poor performance on the undergraduate medical course: Cohort study at Nottingham University. Medical Education, 41(1), 65–73. https://doi.org/10.1111/j.1365-2929.2006.02648.x.
Yates, J., & James, D. (2010). Risk factors at medical school for subsequent professional misconducts: Multicentre retrospective case-control study. BMJ, 340, c2040. https://doi.org/10.1136/bmj.c2040.
Acknowledgements
The authors would like to express their gratitude to all faculty members of the School of Medicine for their permanent commitment to the process of assessment of student participation. The authors also thank the medical school deanery and all students for their support and commitment to the ongoing Minho Longitudinal Education Study (MILES Study) that originated the data for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Araújo, A.M., Leite, C., Costa, P. et al. Early identification of first-year students at risk of dropping out of high-school entry medical school: the usefulness of teachers’ ratings of class participation. Adv in Health Sci Educ 24, 251–268 (2019). https://doi.org/10.1007/s10459-018-9863-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-018-9863-9