What is the association between student well‐being and high‐stakes examination scores?

Abstract

Introduction As educators seek to improve medical student well‐being, it is essential to understand the interplay between distress and important outcomes. Performance on Step 1 of the United States Medical Licensing Examination has played a significant role in selection for postgraduate residency positions in the United States and consequently has been a source of great stress for medical students. The purpose of this study was to examine whether student well‐being correlates with performance on a high stakes licensing examination. Methods Between 2014 and 2016, three sequential cohorts of medical students at the University of Michigan Medical School completed the Medical Student Well‐Being Index (MSWBI) at the end of their 2nd‐year curriculum, shortly before taking Step 1. Associations between well‐being and Step 1 scores were investigated while adjusting for MCAT scores and cumulative second‐year course scores. Results In total, 354 students were included in the analysis (68.1% of potential responders). On bivariate analysis, poor student well‐being (0 = low distress [high well‐being], 7 = high distress [poor well‐being]) was associated with lower Step 1 examination scores (slope = −2.10, P < .01), and well‐being accounted for 5% of overall Step 1 score variability (R2 = .05). However, after adjustment for MCAT scores and cumulative GPA (full model R2 = .51), the relationship between well‐being and Step 1 score was no longer significant (slope = −0.70, P‐value = .06). Conclusions When controlling for metrics of academic performance, student well‐being prior to taking Step 1 was not associated with how well students performed on Step 1 for the study sample.

Medical student wellness assessment beyond anxiety and depression: A scoping review

“…Scores greater than or equal to four are indicative of a higher risk of severe distress, fatigue, burnout and potentially student dropout and suicide ideation [ 22 ]. Six of the articles identified to use the MSWBI [ 2 , 21 – 25 ].…”

“…The MSWBI has been described as a powerful risk stratification tool [ 21 ] and a robust measure of medical student wellbeing [ 2 ]. Although the instrument is validated as a screening tool, it is not a diagnostic measure for the domains it assesses.…”

“…Others studied the effect variables such as time [ 23 ] and interventions like peer support [ 22 ] on mental health. Interestingly, one study evaluated the correlation between well-being before Step 1, which is a significant exam that American second-year students must complete, to the subsequent performance on the test [ 2 ].…”

“…Approximately 50% of medical students demonstrate psychological helplessness, detachment and burnout [ 2 ]. At the start of their training, medical students have similar mental health to others of the same age and level of education.…”

Perceptions and emotions about learning and assessment: Why should we care?

“…Much discussion and research about assessment centres around the potential positive relationship between assessment and learning: promoting learning, evaluating what learning has occurred, communicating the goals of learning and promoting accountability for learning. But how emotion mediates the relationship between assessment and learning in the various phases and contexts of medical education and whether emotions impact performance on assessments that have high stakes outcomes associated with them are important areas for further study 5,6 . Fortunately, the field has increasingly acknowledged that assessment is never just about test content or format but rather a complex interaction of people, social structures, tasks and technologies (exemplified in MPCs) 7 .…”