Medical student conscientiousness predicts performance in finals

Introduction: Failure at medical school finals has important implications. The sooner a
struggling student is identified, the sooner remedial interventions can be applied. It is wellrecognised
that poor academic performance in early years can be a predictor of performance in
later exams. What is less well understood is whether non-academic indicators in early years
can also predict results in finals.
Methods: This retrospective cohort study analysed routinely collected data from three
cohorts of third year medical undergraduates that started their year 3 in 2015/2016,
2016/2017, and 2017/2018. Lower conscientiousness in years 3 and 4 was defined by lower
attendance, missing formative deadlines and lower standards of formative work. The
summative Applied Knowledge Test (AKT) in year 5 was the final outcome. Additional data
included routinely collected protected characteristics which were used as potential
confounders in multivariable analyses. Ethical approval was obtained.
Results: 649 medical students had complete data. 63% were female, mean age was 22.6
years (range 20 – 37 years). Around one third of students had markers of lower
conscientiousness present in either year 3 or 4. Those with markers in year 3 scored
approximately 2% lower on the AKT compared to those without markers. Those with
markers in year 4 scored on average 4% lower. Of those with lower conscientiousness in both
years, 21% failed the AKT compared to 13% for those with markers in either year, and 7% of
those with no markers (P=0.008). Adjustment for protected characteristics did not
significantly attenuate any associations.
Discussion: Simple markers of lower conscientiousness, such as handing in formative
assignments later even by a few hours, predict academic performance in finals. We recommend
that all medical schools should view these behaviours as important pointers of a struggling
student.