In medical and health science schools, the selection of the right students is considered a challenge that requires a lot of prerequisites and efforts. El Says et al., (7) summarized the admission requirement and specified the importance of each requirement regarding the Faculty of Medicine-KAU (FOM-KAU). Students’ scores in high school, standard achievement admission tests (SAAT and GAT), as well as their scores in preparatory year are the measures that can evaluate the cognitive skill of students. GAT is specifically designed to evaluate the student’s general characteristics and gained abilities. GAT also measures the learned skills in critical thinking and the ability of non-verbal problem solving and reflections. On the other hand, SAAT is designed to measure the overall achievement of students during their education journey. Finally, multiple mini-interviews (MMIs) come to assess the non-cognitive aptitude since MMIs can measure some importantly required personal capabilities like professionalism, empathy, and communication skills (8, 9).
Whether these tests and prerequisites for selecting the students to health science schools predict their academic achievement remains to be questionable. Hence, this study aimed firstly to assess the correlation of admission exams (the SAAT and GAT exams) to health science colleges and preparatory years scores in KAU, with academic performance in the basic science subjects such as Clinical Biochemistry and Clinical Pharmacology.
The current study revealed a significant positive correlation between SAAT and GAT results in the programs of the study (Nursing 1& 2 and C.Nutrition 1&2). SAAT and GAT are the eligibility tests that are documented in Saudi Arabia for science and health science schools. These tests are carried out by the National Centre for Assessment in Higher Education (NCAHE)- Ministry of Education. The type and procedure of these fair assessments are MCQ exams, which can be taken as a maximum of three attempts with the best score of those three considered for students’ admission. This procedure could allow a fair evaluation of the students at all levels of education.
Moreover, it is considered an effective eligibility examination for the university graduation programs (10). It is therefore logical to find a significant positive correlation between SAAT and GAT for students, as documented in the current study. This correlation was also previously reported by Alnahdi (11), and Al-Qahtani & Alanzi (12).
Moreover, in the current study, there was no significant correlation between their admission exams scores and the students’ academic achievement in Clinical Pharmacology, and with only a weak correlation detected between SAAT and the overall achievement in Clinical Biochemistry. Yet, this correlation would not seem to have a strong effect size since only 3% of the variation in Clinical Biochemistry scores would be explained with variation in the SAAT scores.
The predictive value of standardized admission tests scores for academic achievements remains to be controversial and a matter of debate in several institutes worldwide. Many studies have reported opposing results to the results of the current study as they have reported predictive values of standardized admission tests with academic performance in nursing (13-15). However, non-conclusive and conflicting findings between these standardized admission tests and the students’ college performance in Saudi Arabia (6) India, and Canada (16) were also reported. For example, in one of the earlier studies in Saudi Arabia conducted at King Saud bin Abdulaziz University for Health Sciences, a strong correlation between the academic performance and the achievement exam, aptitude exam and high school final grade was found; although this was most seen with the achievement exam (5) . However, the study was done on a very small sample of 91 students. In a larger study on 737 students, the SAAT, but not GAT, was a positive predictor of cGPA but only in the pre-clinical years and not clinical years (6).
Such poor association can be explained by the fact that teaching methods and assessment plans in the university programs (Nursing and C.Nutrition programs in the current study) have changed dramatically over the past years and are entirely different from that of high school. The high school teaching strategy depends mainly on the students’ ability to recall data and knowledge while our programs aim at using different teaching and assessment strategies that depend on cognitive achievement rather than recall, such as practical and clinical application, analysis, and critical thinking, scientific problem solving as well as synthesis abilities. Such competencies are usually not fully covered in high schools and might be poorly assessed by the already used eligibility tests, which support the explanations that are previously stated in the literature (11, 12). Moreover, some non-academic competencies are gained in university programs rather than in high schools. These include leadership, communication skills, community and social services, and interpersonal and teamwork activities (19). All of these competencies are extracurricular activities that motivate students and enhance their academic achievement and are usually part of the overall assessments in medical and health science schools in KAU.
In this study, a significant positive correlation between the overall results of Clinical Biochemistry and that of Clinical Pharmacology is important as it ensures internal validity, and indicates that the poor correlation between performance and admission criteria might be a feature to all basic science subjects, but this would require further studies to confirm. This result can be explained by the fact that both departments use nearly similar instructional methods and teaching strategies (traditional lecturing, problem-based learning, mini-projects, and students directed learning activities), and follow the same protocols of assessment. Consequently, a positive correlation between the overall results of both (Clinical Biochemistry and that of the Clinical Pharmacology) is a logical finding of the current study.
Given the lack of previous studies in KAU on the matter, investigating the possible correlation between the preparatory year GPA with academic performance in our basic science subjects was our second aim in this study, and indeed no significant correlation was found.
The preparatory year in Saudi universities, including KAU aims to be an educational program that lasts for two semesters. The objectives of the preparatory year are not for purely educational purposes only but also aim to prepare university students at the social, psychological, and cultural levels. It aims to enable them for skillful communication and self-learning ability.
Despite these valuable objectives, students’ satisfaction with the preparatory year is below expected (7). This lack of satisfaction could be explained by the interplay of students, faculty, and program-related factors (7, 20). Consequently, failure to meet students' expectations and achievement of the program objectives is the overall result, which leads to a negative impact on students. This can also result in its failure to be a predictive indicator of students' academic achievement later on in the subsequent university years, which was seen in our current study. Overall these results could also validate the need for various tracks and programs in KAU preparatory year, which could serve the different colleges’ needs and competencies rather than having a general program for all science colleges.
Most studies have looked at the link between admission criteria and the overall final academic achievement; i.e final GPA. However, we were keen in this study to evaluate how admission criteria can specifically predict success in basic science courses which are given during the early years. This can, first of all, give us a better reflection of the importance of the admission criteria since in the later years many variables can interfere with interpreting the relationship including the adaptation of students to new teaching stratgies along their academic years. In addition, this can help us predict the value of admission criterias for basic science courses and identifiy gaps which can be addressed.
With a growing number of competency based curriculums in health science colleges worldwide, basic science courses are shifting from being a list of topics and a fixed body of knowledge that needs to be covered towards a more structured experience that should lead to the ability to apply knowledge, to havng strong observations and hypothesis testing, and to acquire problem-solving skills. Further studies would be needed to indicate the sorts of skills required for basic science courses and how it can be incorporated in entry exams and evaluations. The results also encourage the need of a culture shift of introducing various cognitive and non-cognitive tests for medical schools and health sciences colleges’ admission criteria. Such tests need to predict whether the students carry some of the skills that would most likely help them to succeed in the new competency based currciulums set by local and regional accreditation institutes . This is specifically important in a region (the Middle East) where there remains to be challenges in higher education, and where interactive learning in both formal and higher education is still relatively new in application.
There are a few limitations in our study. First of all, the results represent a single institution which might limit its generalisability, specifically that basic science courses can be taught and assessed differently from one institute to another. Second of all, digging into more of the participant characteristic can identify if any of these characteristic can interfere with the findings. An important factor, for example, would be differentiating between public and international schools graduates. In addition , a larger sample size would increase the predictive value of the results.