What is the association between student well‐being and high‐stakes examination scores?

Abstract

IntroductionAs educators seek to improve medical student well‐being, it is essential to understand the interplay between distress and important outcomes. Performance on Step 1 of the United States Medical Licensing Examination has played a significant role in selection for postgraduate residency positions in the United States and consequently has been a source of great stress for medical students. The purpose of this study was to examine whether student well‐being correlates with performance on a high stakes licensing examination.MethodsBetween 2014 and 2016, three sequential cohorts of medical students at the University of Michigan Medical School completed the Medical Student Well‐Being Index (MSWBI) at the end of their 2nd‐year curriculum, shortly before taking Step 1. Associations between well‐being and Step 1 scores were investigated while adjusting for MCAT scores and cumulative second‐year course scores.ResultsIn total, 354 students were included in the analysis (68.1% of potential responders). On bivariate analysis, poor student well‐being (0 = low distress [high well‐being], 7 = high distress [poor well‐being]) was associated with lower Step 1 examination scores (slope = −2.10, P < .01), and well‐being accounted for 5% of overall Step 1 score variability (R2 = .05). However, after adjustment for MCAT scores and cumulative GPA (full model R2 = .51), the relationship between well‐being and Step 1 score was no longer significant (slope = −0.70, P‐value = .06).ConclusionsWhen controlling for metrics of academic performance, student well‐being prior to taking Step 1 was not associated with how well students performed on Step 1 for the study sample.Querying the relationship between well‐being and performance, the authors examined licensing exam data and found well‐being to account for only 5% of the variance, substantially less than academic metrics.