|Year : 2012 | Volume
| Issue : 2 | Page : 124-127
The Influence of Pre-Admission Tracks on Students' Academic Performance in a Medical Programme: Universiti Sains Malaysia
H Arzuman, R Ja'afar, NMRM Fakri
Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
|Date of Submission||08-Nov-2010|
|Date of Decision||06-Sep-2012|
|Date of Acceptance||19-Sep-2012|
|Date of Web Publication||14-Nov-2012|
Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan
Source of Support: None, Conflict of Interest: None
Context: An aim of medical schools is to select the most suitable candidates who are more likely to become good doctors, fulfilling societal expectations. It is imperative to better understand the influence of 'selection' variables on students' academic performance. We conducted a retrospective record review (3R) to examine the predictive power of pre-admission tracks on academic performance in the medical programme at the Universiti Sains Malaysia. Methods: Data were collected on medical graduates' of the university for the years 2003 through 2007. This represented 805 graduates after exclusion of 42 for incomplete and inconsistent data related to the analysis. Results: A total of 95% of the graduates were included in this analysis; 67% were female. Of the 805 graduates, 75% were from the Matriculation course track, 22% from the High School Certificate (HSC) course and 1% from other pre-admission tracks. There was 2% missing information. The majority (79%) were Biology majors and 13% were Physics majors. Graduates from the HSC course and with a Biology background demonstrated a strong correlation with positive academic performance (P < 0.05) compared with other groups. Conclusion: The HSC track and Biology background may be helpful for the medical school in selecting future students.
Keywords: Academic performance, biology, high school certificate, Malaysia, matriculation, predictive, physics
|How to cite this article:|
Arzuman H, Ja'afar R, Fakri N. The Influence of Pre-Admission Tracks on Students' Academic Performance in a Medical Programme: Universiti Sains Malaysia. Educ Health 2012;25:124-7
| Introduction|| |
The study of medicine is highly demanding, well-respected and valued by the community. Enrolment in medical programmes is exceedingly selective, competitive and difficult. Competition for admission to medical school is intense and selection is getting more difficult, as reported by Yates et al. Student selection is important for medical training as selection variables can predict performance in medical school and the type of doctors the programme will produce.
The validity of using pre-admission academic variables to predict student performance has been studied in many circumstances. [2-4] Medical colleges are using different measures in the attempt to predict student performance, since it has been established that pre-admission variables can predict performance in medical school. , A strong correlation was reported between grades in A-level Biology with examination success in medical courses. ,,, The global picture shows that students are entering medical schools from different courses and tracks, for example directly from high school, through Matriculation or graduate level entry. 
In Malaysia, the medical degree programme in the public sector provides two distinct tracks for entering medical school, that is, Matriculation and the High School Certificate (HSC) course, with different subjects and study backgrounds. The Matriculation is a one-year pre-university programme meant for Malaysian 'Bumiputera' students to qualify for entering degree programmes in the science and technology fields. The HSC is a two-year pre-university course with a different curriculum and assessment format taken mostly by students of other ethnic backgrounds. The requirement for entering into public medical schools is performance in Matriculation with a cumulative grade point average of 3.8-4.0 in science subjects or a grade of at least B in the HSC course. 
As a public medical school, the Universiti Sains Malaysia (USM) has the same two main tracks of students with different study backgrounds. An unpublished local study found that the HSC students performed better than Matriculation students, and concluded that the HSC students had a 12.2 times chance of performing better in the pre-clinical years and 16.1 times chance to achieve good grades in the clinical years.  The purpose of the present study was to explore the influence of pre-admission academic tracks and subjects on students' subsequent academic performance in medical schools.
| Methods|| |
We conducted a retrospective record review (3R) study at the School of Medical Sciences of USM. We analysed data from five classes of graduates (for the years 2003-2007). After ethical clearance from the University Research and Ethics Committee (Human), and approval from the Dean, School of Medical Sciences, a data extraction form was developed to access graduates' folders in the academic office. We looked at pre-admission, academic course or track (HSC and Matriculation) and subjects (Biology and Physics) as independent variables. The dependent variables were Professional I, II and III examination results. A total of 805 folders were included in our study, after exclusion of 42 due to inconsistencies in the data. A research assistant was employed to collect the information under the supervision of researchers.
Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0 Chicago: SPSS Inc). Data were entered into an SPSS file, coded and cleaned. Statistical assumptions were checked prior to data analysis. Standard descriptive statistics involving frequency distributions and computation of percentages were used for pre-admission academic qualification and subjects studied by the graduates. Repeated measure analysis of variance (ANOVA) was applied to determine the relationship between the independent and dependent variables. Post hoc tests by the Bonferroni method were done to determine the significance of differences of mean scores in each of the professional examinations with the variables under consideration.
| Results|| |
A total of 805 (95%) of the graduates' folders from the years 2003 to 2007 were examined; 540 (67%) represented female students. The majority of the graduates (605; 75%) were from the Matriculation track, followed by HSC (178; 22%) and from other courses or tracks (9; 1%). There was 2% missing information (n=13). Nearly 79% (632) of graduates had Biology as a pre-admission subject, whereas 107 (13%) had a major in Physics.
The HSC graduates' mean scores in professional examinations ranged from 63.3% to 64.2%; Matriculation graduates ranged from 56.7% to 58.6% and other course graduates from 62.5% to 63.8%. The graduates from the HSC course had higher mean scores throughout the study period compared with Matriculation and other tracks [Table 1]. Repeated measure ANOVA was applied to determine the relationship between the pre-admission academic courses with the mean scores in professional examinations. The graduates' pre-admission courses were significantly associated with their academic performance in medical school (P<0.05). Post hoc tests by the Bonferroni measure showed a significant higher positive association of HSC course graduates with their academic performance throughout the study period (P<0.05).
|Table 1: Relationship between graduates' mean marks on professional examinations with pre-admission tracks|
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There was a significant association between taking Biology with good performance in medical school (P<0.05). Post hoc tests by the Bonferroni measure showed that Biology background graduates had significantly higher scores compared with Physics background graduates in medical school performance throughout the study period (P<0.05).
| Discussion|| |
Selecting tomorrow's doctors is a huge and challenging task for medical schools. The unique nature of the medical profession requires certain capabilities to produce future doctors who will be competent in knowledge, skills and abilities. Methods of measuring desired characteristics need to be addressed in the admission process. Having been established in 1979 as the third public medical school in Malaysia, the medical school of USM needs to be on par with the rest of the medical schools in the country to maintain its graduates' credibility. To do this, it is important for the USM medical school to identify factors that are good predictors of academic performance, to address these in student selection, and enhance the success of students. Our study identified some interesting facts about the pre-entry tracks and subjects that can be useful to consider for future student selection into the medical programme.
The most notable finding was the significant higher performance by HSC graduates compared with Matriculation and other entry track graduates. The Matriculation graduates had significantly lower scores throughout the study period compared with HSC and the others groups. From the study findings, we believe that a cumulative grade point average of 3.8 and above in Matriculation might not be equivalent to a grade of B in HSC subjects. The differences between the course structure, curriculum and assessment formats of the two pre-entry courses may be the confounding factor for the observed performance differences.  Moreover, age and maturity might be another confounding factor for good performance by HSC graduates as HSC is a two-year course and Matriculation is a one-year course, and as such the admission criteria are not equivalent.
It appears that the HSC course has a positive influence on academic performance in medical school, which is consistent with study findings of the National University of Malaysia.  However, we cannot draw a firm conclusion about this since we did not explore the relationship between clinical performance and entry courses. Still, it may be time to review and revise the Matriculation course curriculum and extend it to two years, similar to the standard of the HSC programme. Results seem to point to the importance of considering a common track for medical school admission.
Another option may be to implement a common entrance examination, similar to other countries. Our study also demonstrated that having Biology in the pre-admission track has a positive influence on subsequent academic performance in medical school. ,,, However, more studies are required before we can draw this conclusion.
The current system of student selection in most public medical schools is centrally controlled and an individual medical school is not allowed to select its own students. The minimum requirements for the medical course is more or less the same for all public medical schools with the exception of the School of Medical Sciences of USM, which introduced an interview process in 2009 for final selection from the initial list of academically qualified applicants. Medical schools need to take into consideration respective philosophy, course objectives and curriculum models in selecting their students.
Overall, results confirmed our general observation that HSC students do better academically than Matriculation students in medical schools. Based on our findings, we recommend a standardised course for the potential and interested candidates for the medical programme. Their level of education and age should also be seriously considered. In this study, factors that were strongly and positively associated with students' subsequent performance should be considered as important criteria for student selection in the future. The present findings cannot be generalised to other public and private medical schools in the country and other countries, as it was conducted only at the medical school of USM. We need more extensive, in-depth and multi-centre research to build a strong evidence base. Nevertheless, our study points to the importance of considering performance variables in the selection of students for the future medical workforce.
| Acknowledgements|| |
The authors would like to express their gratitude to the USM research committee for approving the project. The authors thank Professor Sayed Hatim Noor from the Biostatistics and Research Methodology unit and Dr. Muhamad Saiful Bahari Yusoff from the Department of Medical Education of USM who were of great help with statistical analysis. This project was funded by the Research Committee of the School of Medical Sciences under the Short-Term Grant Programme, USM.
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