title: Predicting performance: relative importance of students' background and past performance.
abstract: BACKGROUND
  Despite evidence for the predictive value of both pre-admission characteristics and past performance at medical school, their relative contribution to predicting medical school performance has not been thoroughly investigated.
  
  
  OBJECTIVE
  This study was designed to determine the relative importance of pre-admission characteristics and past performance in medical school in predicting student performance in pre-clinical and clinical training.
  
  
  METHODS
  This longitudinal prospective study followed six cohorts of students admitted to a Dutch, 6-year, undergraduate medical course during 2002-2007 (n = 2357). Four prediction models were developed using multivariate logistic regression analysis. Main outcome measures were 'Year 1 course completion within 1 year' (models 1a, 1b), 'Pre-clinical course completion within 4 years' (model 2) and 'Achievement of at least three of five clerkship grades of ≥ 8.0' (model 3). Pre-admission characteristics (models 1a, 1b, 2, 3) and past performance at medical school (models 1b, 2, 3) were included as predictor variables.
  
  
  RESULTS
  In model 1a - including pre-admission characteristics only - the strongest predictor for Year 1 course completion was pre-university grade point average (GPA). Success factors were 'selected by admission testing' and 'age > 21 years'; risk factors were 'Surinamese/Antillean background', 'foreign pre-university degree', 'doctor parent' and male gender. In model 1b, number of attempts and GPA at 4 months were the strongest predictors for Year 1 course completion, and male gender remained a risk factor. Year 1 GPA was the strongest predictor for pre-clinical course completion, whereas being male or aged 19-21 years were risk factors. Pre-clinical course GPA positively predicted clinical performance, whereas being non-Dutch or a first-generation university student were important risk factors for lower clinical grades. Nagelkerke's R(2) ranged from 0.16 to 0.62.
  
  
  CONCLUSIONS
  This study not only confirms the importance of past performance as a predictor of future performance in pre-clinical training, but also reveals the importance of a student's background as a predictor in clinical training. These findings have important practical implications for selection and support during medical school.
authors: Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors: Karen M
authors: KM
authors: Stegers-Jager
authors: Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.|Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors: Axel P N
authors: AP
authors: Themmen
authors: Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors: Janke
authors: J
authors: Cohen-Schotanus
authors: Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
mesh_terms: D000124:Achievement; D000293:Adolescent; D000367:Age Factors; D003099:College Admission Test; D004521:Educational Measurement / Q000379:methods*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D012570:School Admission Criteria; D012737:Sex Factors; D013337:Students, Medical; D055815:Young Adult