Influence of study approaches on academic outcomes during pre-clinical medical education

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Table

Practice points

During their pre-clinical years, medical students preferentially adopt deep learning approaches, followed by strategic and surface approaches. Students adopting strategic approaches generally had greater success than peers in coursework and on board examinations. Students adopting surface approaches generally struggled in comparison to peers.

Table 1.  Statements in the ASSIST inventory grouped according to approach (Entwistle 1997)

Deep approach
Seeking meaning	4. I usually set out to understand for myself the meaning of what we have to learn.
	17. When I’m reading an article or book, I try to find out for myself exactly what the author means.
	30. When I am reading I stop from time to time to reflect on what I am trying to learn from it.
	43. Before tackling a problem or assignment, I first try to work out what lies behind it.
Relating ideas	11. I try to relate ideas I come across to those in other topics or other courses whenever possible.
	21. When I’m working on a new topic, I try to see in my own mind how all the ideas fit together.
	33. Ideas in course books or articles often set me off on long chains of thought on my own.
	46. I like to play around with ideas of my own even if they don’t get me very far.
Use of evidence	9. I look at the evidence carefully and try to reach my own conclusions about what I’m studying.
	23. Often I find myself questioning things I hear in lectures or read in books.
	36. When I read, I examine the details carefully to see how they fit in with what's being said.
	49. It's important for me to be able to follow the argument, or to see the reason behind things.
Interest in ideas	13. Regularly I find myself thinking about ideas from lectures when I’m doing other things.
	26. I find that studying academic topics can be quite exciting at times.
	39. Some of the ideas I come across in the course I find really gripping.
	52. I sometimes get “hooked” on academic topics and feel I would like to keep studying them.
Strategic approach
Organized studying	1. I manage to find conditions for studying which allow me to get on with my work easily.
	14. I think I’m quite systematic and organized when it comes to revising for exams.
	27. I’m good at following up some of the reading suggested by lecturers or tutors.
	40. I usually plan out my week's work in advance, either on paper or in my head.
Time management	5. I organize my study time carefully to make the best use of it.
	18. I’m pretty good at getting down to work whenever I need to.
	31. I work steadily through the term or semester, rather than leave it all until the last minute.
	44. I generally make good use of my time during the day.
Alertness to assessment demands	2. When working on an assignment, I’m keeping in mind how best to impress the marker.
	15. I look carefully at tutors’ comments on course work to see how to get higher marks next time.
	28. I keep in mind who is going to mark an assignment and what they’re likely to be looking for.
	41. I keep an eye open for what lecturers seem to think is important and concentrate on that.
Achieving	10. It's important to me to feel that I’m doing as well as I really can on the courses here.
	24. I feel that I’m getting on well, and this helps me put more effort into the work.
	37. I put a lot of effort into studying because I’m determined to do well.
	50. I don’t find it at all difficult to motivate myself.
Monitoring effectiveness	7. I go over the work I’ve done carefully to check the reasoning and that it makes sense.
	20. I think about what I want to get out of this course to keep my studying well focused.
	34. Before starting work on an assignment or exam question, I think first how best to tackle it.
	47. When I have finished a piece of work, I check it through to see if it really meets requirements.
Surface approach
Lack of purpose	3. Often I find myself wondering whether the work I am doing here is really worthwhile.
	16. There's not much of the work here that I find interesting or relevant.
	29. When I look back, I sometimes wonder why I ever decided to come here.
	42. I’m not really interested in this course, but I have to take it for other reasons.
Unrelated memorizing	6. I find I have to concentrate on just memorizing a good deal of what I have to learn.
	19. Much of what I’m studying makes little sense.
	32. I’m not really sure what's important in lectures, so I try to get down all I can.
	45. I often have trouble in making sense of the things I have to remember.
Syllabus-boundedness	12. I tend to read very little beyond what is actually required to pass.
	25. I concentrate on learning just those bits of information I have to know to pass.
	38. I gear my studying closely to just what seems to be required for assignments and exams.
	51. I like to be told precisely what to do in essays or other assignments.
Fear of failure	8. Often I feel I’m drowning in the sheer amount of material we’re having to cope with.
	22. I often worry about whether I’ll ever be able to cope with the work properly.
	35. I often seem to panic if I get behind with my work.
	48. Often I lie awake worrying about work I think I won’t be able to do.

Figure 1. First-year GPA and ASSIST results from beginning and end of first year.

Figure 2. First-year GPA and changes in ASSIST results during first year.

Figure 3. Second-year GPA and ASSIST results from beginning of first year to end of second year.

Figure 4. Second-year GPA and changes in ASSIST results during first year.

Figure 5. Second-year GPA and changes in ASSIST results during second year.

Figure 6. Board exam performance and ASSIST results from beginning of first year to end of second year.

Figure 7. Board exam performance and changes in ASSIST results during the first year.

Figure 8. Board exam performance and changes in ASSIST results during the second year.

Table 2.  Significant differences between specific approaches to study and mean first-year GPA (shown in Figures 1 and 2)

Groups with 95% confidence interval entirely above second-year mean GPA	First-year mean GPA	Groups with 95% confidence interval entirely below second-year mean GPA
Strategic at end of first year 85.3 (84.51, 86.0)	84.5%	Surface at end of first year 82.4 (81.1, 83.7)
Consistently strategic throughout first year 85.8 (84.8, 86.7)		Change to surface during in first year 82.2 (80.6, 83.8)

Table 3.  Significant differences between specific approaches to study and mean second-year GPA (shown in Figures 3–5)

Groups with 95% confidence interval entirely above second-year mean GPA	Second-year mean GPA	Groups with 95% confidence interval entirely below second-year mean GPA
Strategic at end of first year 85.3 (85.9, 87.2)	85.7%	Surface at end of first year 82.6% (82.3, 84.8)
Strategic at end of second year 87.0 (86.2, 87.8)		Change to surface during first year 83.4 (81.9, 85.0)
Consistently strategic throughout first year 87.0 (86.2, 87.9)		Change to deep during second year 83.7 (81.7, 85.6)
Consistently strategic throughout second year 87.6 (86.3, 88.8)

Table 4.  Significant differences between specific approaches to study and mean COMLEX step 1 score (shown in Figures 6–8)

Groups with 95% confidence interval entirely above second-year mean GPA	Mean COMLEX score	Groups with 95% confidence interval entirely below second-year mean GPA
Strategic at end of first year 498.3 (484.4, 512.2)	482.1	Surface at end of first year 448.3 (419.6, 477.2)
Strategic at end of second year 524.0 (507.0, 541.0)		Change to surface during first year 445.8 (407.9, 483.6)
Consistently strategic throughout first year 505.7 (488.1, 523.3)		Change to deep during second year 435.9 (402.6, 469.1)
Consistently strategic throughout second year 529.2 (504.8, 553.6)
Change to strategic during second year 524.3 (492.1, 556.4)

Table 5.  Specific approaches to study that lead to failure on medical board exams (shown in Figures 7 and 8)

Minimum passing COMLEX score	Groups with 95% confidence interval that includes failing scores on COMLEX
400	Consistently surface throughout first year 455.6 (380.9, 530.4)
	Consistently surface throughout second year 498.8 (376.2, 603.4)
	Change to surface during second year 445.9 (385.4, 506.3)

Entwistle NJ. The approaches and study skills inventory for students (ASSIST). Centre for Research on Learning and Instruction, University of Edinburgh, Edinburgh 1997

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