Tertiary education experience
Of the 202 students in 1st year in 2007, 166 were straight out of high school, 19 had a year or more of tertiary education behind them, 10 had previously completed other degrees, and 7 were repeating the year. Students‟ academic background at tertiary level might be expected to predict their future achievements. Dividing the 1st year class of 2007 into the four groups described above, their marks in successive tests are depicted in Figure 5.2.
GLM analysis confirms what the graph depicts: that students‟ previous academic status made a significant impact (p = 0.002) on their test marks. The statistic demonstrates that the four groups are not equal; however, because of small numbers in some of the groups, post-hoc tests could not be performed to determine exactly what the nature of that difference was. It can be seen that those seven students who had already failed 1st year and were repeating it in 2007 continued to do poorly (line 2). The exception was the test at the end of Theme 1.5. The greater clinical relevance of this Theme (Reproductive health) may have helped these weak students. However, when they encountered new material in 2nd and 3rd year (ETTs 2.1-3.6), their marks progressively deteriorated.
Figure 5.2 Test results over three years according to student status in 1st year.
40 45 50 55 60 65 70 75 80
1.1 1.2 1.3 1.4 1.5 1.6 2.1 2.2 2.3 2.4 2.5 2.6 3.1 3.2 3.3 3.4 3.5 3.6
mean group marks (%)
Tests over three years
Degree: Students who had previously completed a degree
Students straight out of high school did quite comfortably over the years, and both those with a year or more of tertiary-level study behind them and those who had previously completed degrees excelled. A general pattern of dips at ETT 2.1 (test 7), 2.4 (test 10) and 3.2 (test 14) can be seen (see Figure 5.3 – Year of Study – p. 103). Although the gap between school-leavers and those with prior tertiary experience narrowed over the course of 1st year, degreed students maintained an advantage throughout the period studied.
Those with limited tertiary experience tended in most tests to do slightly better than did the school-leavers. This counters the argument that students who were perhaps not good enough to be selected on the basis of their school-leaving exams had found a „back door‟ into medical school. These students, accepted by transfer from other degree programmes, appear to have established by their results that they did in fact have the capacity to cope with medical studies.
Comments on the relative achievements of the four groups of students reflect the expectation that students with some prior tertiary experience would fare better.
I always have just thought that they would be the upper notch. Even during exam stress time, those that we do stay with around close, they are our friends – they have it all planned out. We‘re like ‗OK, I‘m still struggling‘. Zodwa 1;519-521
I was expecting that the mature students would do better, because they are familiar with
tertiary learning ... Dr Hlubi 13;408-409
Those, like Lungi, who came to medical school from a background of a prior degree, have their own view of students coming straight from school, namely that the latter are too young and inexperienced.
I think for, like the students that are coming from high school, it might have been a bit of a shock for them, and a bit of, like ‗Wow – what‘s going on?‘ because for them, I remember in high school, we used to sit down from 8 to 6, get lectures, and the teacher would be there to solve the solutions and go through everything with you, and you study whatever‘s
in the class. There‘s no – if you do a little extra work – the cum laude questions type of thing. So for them I think it might have been a bit of a difficult thing because you also have to remember it‘s not just about studying; it‘s about the, the mental maturity of the
person. Lungi 3;37-43
There is a general sense that students repeating 1st year are destined to struggle academically.
The repeats struggle is because they were isolated, or lost souls, or –?
Dr Pillay 11;438-439
In terms of those that are repeats, this is in keeping with what one observed in practice.
[Mm] These repeat students tended to do very badly when they came to the clinical years and it‘s this group of students that there were a lot of failures and repeats, and even their
performance was very poor. Dr Hlubi 13;401-404
Given that my respondents are commenting on a graph39 that shows less of a distinction between school-leavers and mature students, the smaller number of explanations for the latter‟s greater success in medical studies is understandable. My judgement, nevertheless, is that the various explanations advanced could well be valid for the groups of students referred to in this section. The literature appears somewhat equivocal as to whether or not previous tertiary education (as distinct from age) is a significant influence on academic performance. An extensive meta-analysis suggested that past academic performance – without separating tertiary from secondary education – was a significant influence on future achievement, as one might expect (Ferguson, James, &
Madeley, 2002). A study that looked specifically at medical students with prior degrees concluded that age might be a more weighty influence than having a degree (Wilkinson, Wells, & Bushnell, 2004); however, this study focused on students‟ approaches to learning, their motivation and attitudes, but not their actual marks. Others have commented on the risk of younger students allowing the mature students to take over
the group process (Benbow & McMahon, 2001), but again that would not necessarily be reflected in the students‟ marks.
Students‟ tertiary education background (StuStatus in Appendix I) is the second most influential parameter in the GEE. Having already completed a degree or having spent any time successfully in tertiary studies confers an advantage – the latter having half the impact of the former. Not surprisingly, repeating 1st year has a negative effect compared to coming straight from high school. Relating this to PBL, I suggest that any university programme entails becoming accustomed to a way of thinking for oneself and organising one‟s activities, rather than passively absorbing other people‟s thoughts and ideas. The change to PBL for students with prior tertiary experience is thus likely to be more successful than for those coming straight from school. Students who have had a year‟s unsuccessful experience of PBL have evidently failed to make an effective transition from school to university. The seven repeating students in the cohort included two from the same rural school (Q1); the rest were from Q5 and Q6 schools, implying that having attended such does not guarantee an advantage.
‘Year of study’ (sequence of assessments)
Of the 202 students who began 1st year medical studies in 2007, 10 failed or dropped out in 1st year, another 10 in 2nd year, and 23 in 3rd year, leaving 159 of the original cohort at the end of 3rd year, which meant an overall pass rate of 78.7% (95%, 94.8% and 87.4% in successive years). The 159 successful students who started their medical studies in 2007 scored an average of 62.2% over the first three years. This score varied from test to test.
Figure 5.3 Class average test marks over three years.
Over the three years, a greater than 10% difference is evident between the highest (1.4) and the lowest (2.4) class average. Theme 2.4 („Body in motion‟) is known to be a difficult theme, as are the others with relatively low marks: 2.1 („Cardiorespiratory‟) and 3.2 („Cell dysfunction‟), all of which contain content and concepts that students tend to find difficult.
As seen in the graph, students‟ marks were worse in 2nd year (year average: 61.1%) than in 1st year (year average: 64.0%). They improved again in 3rd year (year average: 61.6%).
This movement – particularly in the light of the smaller contribution of „matric points‟ as a factor (see the following section) – suggests that the transition from high school to university may have been less momentous than the increased difficulty of the 2nd year syllabus. The failure rates in the three years (based on end-of-semester exam results combined with end-of-Theme tests results) reinforce this perception: there were 8 failures in 1st year (plus two who left for other reasons), 9 (plus one) in 2nd year, and 22 (plus one) in 3rd year40. Of the student interviewees, only Krish and Marcus remark on
40 2009 was a bad year for 3rd year students: the proportion of time allocated to Themes compared to ward 45
50 55 60 65 70
1.1 1.2 1.3 1.4 1.5 1.6 2.1 2.2 2.3 2.4 2.5 2.6 3.1 3.2 3.3 3.4 3.5 3.6
Mean class mark (%)
Tests over three years