Clinical experience can compensate for inferior academic achievements in an undergraduate objective structured clinical examination

Stefanos A. Tsikas, Kambiz Afshar

Practical and non-cognitive skills are essential to medical professions; yet, success in medical studies is primarily assessed with cognitive criteria. We show that practical exams can benefit students who have only average high school final grades, but working experience in medical professions. With a cross-sectional study, we compare the performance of undergraduate medical students with working experience in adjacent health-care professions (and below-average school leaving-grades) with students who entered medical school directly based on their excellent school records in an Objective Structured Clinical Examination (OSCE). For a sample of more than 1,200 students, we use information on OSCE scores in medical and practical skills, doctor-patient communication/interaction, performance in MC-exams, and core sociodemographic variables. Waiting list students outperformed their classmates in the demonstration of practical skills. Students admitted via their excellent school grades scored best overall. This difference vanishes once we control for school-leaving grade and age, the two main factors separating the analysed groups. Students from the waiting list have a significantly smaller overall chance to reach excellent grades in the first two years of study. Students who gathered experiences in health-care professions before enrolling at medical school can benefit from an expanded role of practical elements in medical studies. Student selection instruments should take these different starting positions and qualities of applicants into account, for example with a quota for the professionally experienced.