Year : 2009 | Volume
: 20 | Issue : 3 | Page : 448--453
Association between scores in high school, aptitude and achievement exams and early performance in health science college
Ibrahim A Al-Alwan
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Ibrahim A Al-Alwan
Associate Dean, Academic and Student Affairs College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh 11426
This retrospective study was carried out to assess the correlation between admission criteria to health science colleges, namely, final high school grade and Saudi National Aptitude and Achievement exams, and early academic performance in these colleges. The study included 91 male students studying in the two-year pre-professional program at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. Records of these students were used to extract relevant information and their academic performance (based on the grade point average achieved at the end of the first semester of the pre-professional program), which were analytically studied. Pearson correlation coefficient was used to assess the associations between the different scores. SPSS statistical program (version 12.0) was used for data analyses. We found a strong correlation between the academic performance and the Achievement Exam, Aptitude Exam and high school final grade, with Pearson Correlation Coefficients of 0.96, 0.93, 0.87, respectively. The Saudi National Achievement Exam showed the most significant correlation. Our results indicate that academic performance showed good correlation with the admission criteria used, namely final high school grade, Saudi National Aptitude and Achievement Exams.
|How to cite this article:|
Al-Alwan IA. Association between scores in high school, aptitude and achievement exams and early performance in health science college.Saudi J Kidney Dis Transpl 2009;20:448-453
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Al-Alwan IA. Association between scores in high school, aptitude and achievement exams and early performance in health science college. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2021 Dec 4 ];20:448-453
Available from: https://www.sjkdt.org/text.asp?2009/20/3/448/50777
Selection of medical school students is a high profile, high stakes exercise. The selection typically serves two distinct purposes: the first is to reduce the large number of otherwise qualified and capable applicants to fill the number of places available, and the second is to enroll students who will most likely succeed in what is considered a rigorous program, and to subsequently become effective members of the profession. 
Although most medical schools use different criteria for admission, these criteria are generally based on a combination of academic achievement, written test and an interview. 
There is little consistency among schools worldwide in terms of the weightage given to each of the admission criteria.
To be defensible, the selection method must be reliable, within and across successive cohorts of applicants. It must select on the basis that it claims to test (that is, have constructive validity) and it should predict the eventual performance of the potential doctor who is selected, i.e. have predictive validity. 
The aim of this study was to assess the correlation of admission criteria to health science colleges (i.e. final high school grade and Saudi National Aptitude and Achievement Exams) with early academic performance in these colleges.
The study was performed at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. A total of 1905 applications were received, through online registration, for admission to the Health Science Colleges for the 2007-2008 academic year. Of these, 91 male students were accepted based on their admission criteria. The scores of the final high school exam as well as Saudi National Aptitude and Achievement Exams of the enrolled students were recorded, and used in accepting the students. Additionally, we recorded their performance, i.e total marks, in the different topics offered in the first semester of the college.
The College of Health Sciences at The King Saud bin Abdulaziz University for Health Sciences, runs a two-year pre-professional program, which is a pre-requisite for the College of Applied Medical Sciences and the College of Medicine. The Health Sciences College was established in 2007, with the first students enrolled directly from high school. The admission criteria included the final high school marks, the results of the Saudi National Aptitude and Achievement Exams, and the weightage accorded to each of these exams in the final score was 35%, 35% and 30%, respectively.
In the final high school class (Grade 12), students have two semesters; the first semester examination is conducted by the individual high schools and the final exam is prepared and scored by the Ministry of Education at the national level. Health science colleges accept students from the sciences division, where students have taken chemistry, biochemistry, mathematics, biology and physics, along with Arabic language, English language and religious studies. The final mark for high school is based on the accumulative scores of the first and second semesters.
The Saudi National Aptitude and Achievement Exams were established in 2002 and are prepared and administered by the National Centre for Assessment at the Ministry of Higher Education. The National Aptitude Exam is composed of two sections: linguistics and mathematics. The assessment exam is conducted using a multiple choice question (MCQ) format. The student has three attempts in the final year of high school; the final score, which is the best score of the three attempts, is used by all health sciences and emerging colleges as part of the admission criteria (not specific to health sciences colleges).
The Saudi National Achievement Exam is held once a year, following the final high school exams. It is in the MCQ format and composed of English language, biology, chemistry, physics and mathematics (20% each). 
Descriptive analyses were carried out by calculating the mean and the standard deviation for the continuous variables considered in the study. Pearson correlation coefficient was used to assess the associations between the different scores. Statistical significance was assessed by calculating P value, where 0.05 was the cutoff. Statistical analyses were carried out using SPSS statistical program (version 12.0).
For the 91 accepted male students, the mean high school mark was 95.5 out of 100 (± 2.0), Saudi National Aptitude Exam mean was 82.3 out of 100 (± 8.0), and the mean Saudi National Achievement Exam was 80.2 out of 100 (± 9.7).
At the end of the first semester of health sciences college, the total marks out of 100, for all 91 students was a mean of 86.2, ranging bet-ween 69.0 and 96.0 (SD +/-6.4).
The result of the Saudi National Achievement Exam showed statistically significant correlation with the total score of the first semester in the health sciences college, followed by the Saudi National Aptitude Exam and the final high school marks, with Pearson correlation coefficients equal to 0.96, 0.93, and 0.87, respectively [Figure 1].
There are no previously published studies in Saudi Arabia to compare or to analyze factors used in admission criteria, with the progress of selected students in health sciences colleges. The aim of this study was to evaluate the correlation between admission criteria used and early performance of selected students in health sciences colleges. The admission criteria included cognitive and non-cognitive assessments.
The cognitive assessment uses previous academic performance, final high school mark and the result of the Saudi National Achievement Test. The non-cognitive assessment was the Saudi National Aptitude Test.
Worldwide, there is heterogeneity in the selection process which exists both between and within countries. ,,,, In the United Kingdom, a review of all schools (N = 22) showed some common criteria across schools used to select future students (academic ability coupled with a well-rounded personality assessment). The process varies substantially: some schools do not interview, others use a wide range of nonacademic criteria including candidates' personal statements, references and supplementary questionnaires. If interviews are done, the duration, panel composition, structure, content and scoring of interviews vary between schools.  Ferguson et al. systematically reviewed the literature for factors associated with success in medical schools. The review examined data on the productive validity of the eight criteria that have been studied in relation to the selection of medical students: cognitive factors (previous academic ability), non-cognitive factors (personality, learning styles, interviews, references, personal statements) and demographic factors (sex and ethnicity). The findings were that previous academic performance showed good correlation of 23% with performance in the undergraduate medical training, with only 6% of that correlation with post-graduate competency. Also, there was little research on the importance of learning styles, interviews, ethnicity, sex, personal statements and references. However, a strategic learning style, white ethnicity, and female sex were associated with success in medical training.  A comparative study of the roles of personality, references and personal statements on performance was conducted on 167 entrants at the Nottingham Medical School in the United Kingdom over a period of five years, starting in 1995. The outcome result was that teachers' references did not consistently predict performance. Personal statements were predictive of the clinical aspects of training. The personality domain of conscientiousness was consistently the best predictor across the course.  McManus et al. assessed achievements (A-Level marks) and intelligence (ability) in predicting future physicians' careers. They studied 500 physicians who had entered the Westminster Medical School as clinical students between 1975 and 1982, with follow-up in January 2002. The results of achievement tests (A-Level marks) showed high predictability for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of low predictive validity for subsequent medical careers.  With regard to aptitude predictions, similar findings were noted in a couple of studies from Australia. In Australia, the Graduate Medical School Admission Test (GAMSAT), is a test that focuses on reasoning in humanities, social sciences, psychological and physical sciences and written communications.  Wilkinson et al. analyzed the academic performance of 706 students in three consecutive cohorts of fouryear graduates in entry level medical programs at the University of Queensland and found poor correlation of GAMSAT marks with their performance in school.  Groves et al. studied the performance of students in years two and four of graduates entering medical programs in Sydney and Queensland and found poor correlation of GAMSAT marks with school performance. 
The findings of our study are consistent with those of current literature, in that cognitive components of admission to health sciences colleges showed significant correlation with students' academic performance. Although both final high school marks and the Saudi National Achievement Test are used in the cognitive components, the Saudi National Achievement Test showed a higher correlation with the progress of students. This may be explained by the fact that 50% of the final high school marks are carried out by local schools. There is, therefore, increased possibility of inflated student marks.  The Saudi National Achievement Test is a standardized, cognitive test focused on English language and basic sciences, all of which are taught in the first semester at health sciences colleges. Although not specific to health sciences colleges, the Saudi National Aptitude Test showed significant correlation with early academic performance, in contrast to several international studies. The fact that the final score of the Aptitude Test is the best score of three attempts may explain the differrence of significant correlations when compared with results of other studies.
The present study has several limitations. First, accepted students represent a relatively small sub-group of all applicants to health sciences colleges. Secondly, accepted students in this study were a highly restricted cohort as they were from a large number of applicants all of whom obtained admission to our college successfully and all had high academic and non-academic admission scores. Finally, first semester academic performance may not predict the student's academic progress in the coming years in the health sciences college. However, the benefit of early correlation lies in providing a true reflection on the value of admission criteria. Later evaluation may be affected by students' adaptation to the new learning strategy used in their university studies. 
There is no previously published data in Saudi Arabia on admission criteria and their prediction for progress in health sciences colleges. Many new health sciences colleges are currently in development or have recently opened and would benefit from the experience of more established colleges in avoiding errors. Despite the limitations of the study, the results are in favor of using the current admission criteria and may suggest that the weight of the Achievement Test should be increased for better correlation with early academic performance.
The most relevant impact on admission criteria is on the outcome well beyond medical school, i.e. the performance of doctors in practice.  Therefore, future national research is needed, with a multivariable approach, studying the success in health sciences colleges and the performance of health professionals in practice.
I would like to take this opportunity to thank Professor Bashir Hamad, Dr. Ali Hajeer and Dr. Hani Tamim for their editing and input on this project. I would also like to thank Ellener Smith for her secretarial support.
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