ORIGINAL ARTICLE

Correlation Between MCAT Aggregate Marks, Grit and Academic Performance of Students in Khawaja Muhammad Safdar Medical College Sialkot

AMINA TAHIR1, ESHA MUKARRAM2, SAMAN JAMAL3

ABSTACT

Background: Medical College Admission Test (MCAT) is among the controversial criterion for selection for medical colleges as it does not take account of aptitude. Available studies suggest that the predictive accuracy of MCAT ranged from small to medium for medical academic performance. But scanty work is done to evaluate the predictive accuracy of non-cognitive abilities like GRIT score. Aim: To determine the predictive validity of MCAT and its correlation with GRIT and academic performance in medical college as non-cognitive abilities score may fulfil the deficiency of MCAT. Methods: In a cross sectional surveywas done on 158 gender proportionate randomized sampling of students of 2nd, 3rd and 4th year medical students at Khawaja Muhammad Safdar Medical College Sialkot after. Students completedstandardized 12 item GRIT scale “questionnaire. 1st professional results and MCAT score was obtained from records. The correlation between the MCAT Score and score of 12-item GRIT scale with the academic performance was determined by Pearson’s correlation. Using SPSS 21, GRIT scoring, MCAT and first professional marks were presented as mean and standard deviations. Pearson product moment correlation was calculated between the three scores with p < .01 was taken as statistical Results: Significant correlation was observed between mean GRIT score and MCAT score. Correlation between professional part one score and GRIT score came out significant (p < 0.05).However, no significant correlation was found between MCAT score and average scores of both parts of first professional. Conclusion: It was concluded that the students who were grittier performed better in MCAT and Professional exam in medical college. Keywords: GRIT Scale Score, Medical College Admission Test, Aptitude tests, academic performance

INTRODUCTION over-coming of hindrances or tasks which are Medical college admission test which is renowned as present inside a persistent individual’s path to MCAT in Pakistan is a seeminglyunsurpassable accomplish & serves as dynamic force in obstacle which must be successfully passed by achievement awareness. Candidates having high every candidate who wants to join the medical grit, are talented to preserve their purpose and colleges of Pakistan. of Health Sciences, enthusiasm for prolonged time no matters, failure & in Punjab conducted this exam. Eligibility criteria to difficulty comes across. appear in MCAT is 60% marks in FSc. or any The primary scientific discoveries on grit come equivalent examination. MCAT assesses knowledge from Duckworth et al., who evaluated grit as and cognition alone by employing objective test candidate difference trait talented to predict methods. prolonged success.1 It was suggested that persons Grit is defined as “perseverance & passion for who own energy to diligently work through long-term goals”. Psychologically, Grit is a challenges, failures & difficulties to accomplish the constructive, non-cognitive characteristic depending targets and exclusively stood to touch higher on candidate’s craving for specific prolongedgoal, in successes than others who lack similar energy. addition to strong enthusiasm to accomplish their It is axiomatic that enrollment in a medical goals. This persistence of determination indorses the college isextremely selective filtration point in the ------higher qualification. Immense resources are 1Demonstrator, Department of Physiology, Amna Inayat Medical exploited by government and university, to improve College, Lahore an appropriate selection criteria which aims to isolate 2 WMO, Ammar Complex, Jail Road, Lahore the most suitable candidates with the intellectual 3WMO, THQ Khariyan Correspondence to Dr. Amina Tahir ability to handle the academic inclemency and Email: [email protected] Cell: 03054558931

516 P J M H S Vol. 12, NO. 1, JAN – MAR 2018 Amina Tahir, Esha Mukarram, Saman Jamal potentials to withstand inter-relational, ethical, & METHODOLOGY motivational tasks in the school. Diverse range of tools are utilized for selection in This cross sectional analytical study was carried out medical colleges.Mostly, it includes previous at Kh. Muhammad Safdar Medical College, Sialkot. academic performance, interviews, orientations, The representative sample for medical students in personal declarations & MCAT performance7. this study were taken and 400 students are enrolled. MCAT is conducted to select and screen Only students of 2nd, 3rd and 4th year were included candidates for medical in many countries including as the result of 1st year Mbbs was not declared at the Pakistan3. Predictive validity of MCAT is variously time of commencement of this study. studied. Several studies at international level indicate The three basic sciences (Bio-chemistry, that the predictive accuracy of MCAT for presentation &Physiology) are being taught in 1st & 2nd in medical school both in pre-medical and medical year of MBBS. Study subjects are the medical years ranges from small to medium.4,5 On the other students of 2nd, 3rd and 4th year in Khawaja hand, literature showed high positive predictive value Muhammad Safdar Medical College, Sialkot. Sample of written tests.8,9 Koenig et al.,found that MCAT is size was calculated to be 158 considering confidence not a reliable tool and other predictors like level at 95% and confidence interval at 5% using conscientiousness, enthusiasm & communication Stratified random sampling. The MCAT aggregate skills requiremoreresearcher6. score was extracted from college record and Grit While there is substantial research work was measured by distributing a self-administered 12- available about the predictive validity of MCAT in item grit scale questionnaire after taking informed assessing the outcome in medical college, scanty consent. Complete anonymity was ensured. work is done to evaluate the importance of non- Limitations cognitive skills in determining academic success. But  As the study was done on a small proportion of presentation in pre-clinical years is projected by medical students, its results cannot be grade-point average & MCAT marks, no correlation generalized. found for successes inclinical years, during post-  It employs a single self graduation or as physicians as it does not provide any administered questionnaire extent of non-cognitive capabilities10. to measure the grit-score of Correlation of academic performance and a few students. non cognitive skills like motivation, conscientious-  A single cross sectional study alone cannot ness, vulnerability to stress, self confidence , realistic establish exact correlationbetween MCAT Grit self appraisal and self esteem is scrutinized in and academic performance. different studies11,12,13. Among them, motivation was  Although we examined academic performance seen to be positively correlate with academic recently it is unknownwhether this performance is performance12,13. related to professional exam scoretranslates into One such non-cognitive variable is Grit defined improved clinical practice and enhanced patient as ‘passion and perseverance for long term goals’. outcomes. Duckworth in an attempt to find out the answer why few candidates achieved more than others with equal RESULTS aptitude, developed a grit-scale andfind out that Gritty candidatesoutclassedless gritty peers: Grit In a cross-sectional survey, a representative, gender- scores were more linked to higher GPAs (r=0.25, proportionate sample of 158 students was taken p<0.01), a relationship become more strong when using stratified random sampling, considering 95% SAT scores were done constant (r=0.34, p<0.001). confidence level and 5% confidence interval. Thus SAT scores were also related to GPA (r=0.30, A self-administered standardized 12-item grit p<0.001)14.Unlike the previous studies, we scale questionnaire was given after taking informed measured the grit score of students and correlational consent.The MCAT score was taken from the analysis was done with MCAT score and record.All of the participants filled the form so the performance in the professional exam score. response rate was 100%.Among the participants, The objective of the study was to determine 27% were females and 72% were males which predictive validity of MCAT and evaluate correlation accurately corresponds to the male:female ratio in of MCAT and grit with academic performance of the college performance both in 1st professional part students in medical college 1 (p value :0.07) and first professional part 2(p value: 0.03, significant at p<0.1). There was insignificant correlation between MCAT and Grit i.e. r=0.291, p=0.119

P J M H S Vol. 12, NO. 1, JAN – MAR 2018 517 Correlation Between MCAT Aggregate Marks, Grit and Academic Performance of Students

Fig. 1: Gender distribution of participants MCAT score was only moderately correlated with academic performance only in 1st professional part- 1.(p value 0.021).Grit was found to be positively correlated with MCAT (p value :0.039 ) and academic

72.62% DISCUSSION 80.00% MCAT is being used as selection criteria for 70.00% admission into medical colleges for decades. The 60.00% MCAT was first developed in 1929 and was first 50.00% called asScholastic Aptitude Test for medical admission. Association of American Medical 40.00% 27.38% Colleges framed the MCAT that is applied to screen 30.00% candidates for admission in medical institutes in 20.00% USA. Likewise, in Pakistan according to “Admission 10.00% in MBBS & BDS Course & House job/ Internship/ 0.00% Foundation Year, Regulations – 2013”, entry test is Male Female “compulsory for admission in MBBS/BDS”. The revised criteria has integrated the fsc maeks and matric marks as well in the final aggregate marks of MCAT:” The admission authority would determine the Fig 2: Linear correlation between Grit and professional mandate of merit, though allocating the following score part one weightage to following marks: Matric/equivalent: 10% F.Sc (pre-medical)/HSSC: 40% MCAT: 50% Several researchers have meticulously explored the predictive validity of MCAT both at national and international level4-7,11,15. Our current study indicates no significant correlation between professional scores and MCAT scores. Similarly, a meta-analysis showed that predictive accuracy of MCATis small to medium both for medical school performance and medical board licensing exam4. Contrary to this, few studies that are conducted in Pakistan suggest that MCAT and pre- Fig. 3: linear correlation between MCAT and grit score admission grades are good predictors of academic performance in medical college11,15,16. The cross- sectional analysis of Kott Khawaja Saeed Medical College, Ameer-ud-Din Medical college, Gujranwala Medical college and , showed that out of 3 predictors (F.Sc. marks, merit score & MCAT score), F.Sc marks were strongly correlated with academic performance.15The study conducted in Ayub medical college also signifies correlation between professional part 1 score and mcat results in the cohort of 208-200916.The difference in results from our study can be explained by the fact that all the abobe mentioned studies in Pakistan were done when the MCAT aggregate consist of fsc marks70% and entry test weight age Table 1: Distribution of participants according to class. just 30% while in our study the new revised Frequency Percent 2nd year 55 32.7 weightage was used in which the mcat ratio was 3rd Year 56 33.3 augmented to 50% of the aggregate and 10% of 4th year 57 39.9 aggregate marks consist of matric marks.so probably Total 168 100 due to this re-arrangement of weightage the

518 P J M H S Vol. 12, NO. 1, JAN – MAR 2018 Amina Tahir, Esha Mukarram, Saman Jamal predictive validity of MCAT aggregate marks has Published Research. Academic . January reduced. Though we cannot generalize facts by 2007;8(1):105 results of the study population as small as ours but 6. RE. Evaluating the predictive validity of MCAT scores further elaborative prospective long term cohort and across diverse applicant groups. Acad Med.1998; 73(10):1015 case-control studies are highly advisable to get a 7. Koenig J, Sireci S, Wiley A. Evaluating the predictive clearer picture. validity of MCAT scores across diverse applicant Furthermore , studies have also shown theneed groups. Acad Med 1998;73:109 for inculcation of assessment tools to judge the con- 8. Ferguson E, James D, Madeley L. Factors associated cognitive abilities of candidates ,required to flourish in with success in medical school: systematic review of the tremulous waters of medical profession17,18.One the literature. BMJ. 2002;13:952–957. such non-cognitive attribute is Grit-passion and doi:10.1136/bmj.324.7343.9525-106 perseverance for long term goals.in our current study 9. Kreiter C, Kreiter Y. A validity generalization grit is shown to be significantly correlate with MCAT perspective on the ability of undergraduate GPA and the medical school admission test to predict important score and professional part 1 scores as well hence outcomes. Teach and Learn in Med 2007; 14:95-108. inferred that the gritty students can perform 10. McManus IC, Powis DA, Wakeford R, Ferguson E, considerably well in diverse examination settings. James D, Richards P. Intellectual aptitude tests and A Our findings are consistent with another research levels for selecting UK school leaver entrants for which inferred that Grit howeververified incremental medical schools. BMJ 2005; 331:555-9. predictive accuracy of success over & beyond IQ 11. Reede JY. Predictors of success in medicine. Clin &meticulousness1. Together, these resultspropose Orthop Relat Res.1999;372():72- that success of challenging goals requires not only 12. Muhammad Luqman. Relationship of Academic ability but also the continuous&intensiveuse of Success of Medical Students with Motivation and Pre- admission Grades. JCPSP. 2013;23(1):31-36 capabilityovertime which demands passion and 13. Keith Steele, Ulster Med J.2011;80(2):62- perseverance. Another study indicates a relationship 14. Priyanga Ranasingh PR , Non-cognitive characteristics between Grit and GPA19.Assessment of non- predicting academic success among medical students cognitive skills alone may not be sufficient but it is a in Sri Lanka. BMCmedical education.2012;12():66. constantoutcome that few factors, like personality, 15. Angela L. Duckworth. Grit: Perseverance and Passion creativity,interests, motivation & attitude, shouldbe for Long-Term Goals. Journal of Personality and deliberated in medical admissions. It is believed that Social Psychology.2007;92(6):1087-1101 counting these factors may enhance equality & 16. Arshad Ali, Zulfiqar Ali ZA. Admission Policy of rationality of current admissions criteria20. Medical Colleges: Evaluating Validity of Admission Test in Pakistan. Journal of To cut long story short, medical educationists Research and Reflections in Education. June 2013; are challenged to develop an admission criteria 7(1):77-88 which accurately predicts both the cognitive and non- 17. Junaid Sarfraz Khan, John SG Biggs, Tahira Bano, cognitive abilities of the candidates. Osama Mukhtar, Saima Tabasum. Medical Colleges Admission Test In Punjab, Pakistan. J Ayub Med Coll REFERENCES . 2013; 25(2): 64-67 18. Daniel Edwards1*, Tim Friedman2. Same admissions 1. Duckworth, A.L., Peterson, C., Matthews, M.D., & tools, different outcomes: a critical perspective on Kelly, D.R. (2007). "Grit: Perseverance and passion for predictive validity in three undergraduate medical long-term goals". Personality Processes and Individual schools. BMC medicaleducation.2013;13():173 Differences, 92(6), p. 1087. 19. W. Camara, E. Kimmel (Eds.). The case for 2. Vicki davis. True Grit : the best measure of success noncognitive measures. Choosing students: Higher and how to teach it?. education admission tools for the 21st 3. http://www.edutopia.org/ (accessed 9 December, century..2005;():177-193 2014). 20. Amit amin. Grit: Perseverance and Passion for Long- 4. Albanese MA, Snow MH, Skochelak SE, Huggett KN, Term Goals. www.happierhuman.com (accessed Dec Farrell PM. Assessing personal qualities in medical 28 , 2014). school admissions. Acad 21. Patrick C. Kyllonen , Alyssa M. Walters. Noncognitive 5. Tyrone Donnon. The Predictive Validity of the MCAT Constructs and Their Assessment in Graduate for Medical School Performance and Medical Board Education: A Review. educational assessment. Licensing Examinations: A Meta Analysis o the

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