The fate of medical students with different levels of knowledge: Are the basic medical sciences relevant to physician competence?

Purpose - This study was designed to test the hypothesis that an early gap in knowledge of sciences basic to medicine could have a sustained negative effect throughout medical school and beyond. Method - A longitudinal prospective study of 4,437 students who entered Jefferson Medical College between 1972 and 1991 was conducted in which the students were divided into three groups. Group I consisted of 392 who failed at least one of the basic sciences courses in the first year of medical school, Group II was comprised of 398 who did not fail but had low first-year grade-point averages; and 3,647 of the remaining sample were included in Group III. The groups were compared on retention and dismissal rates, medical school assessment measures, scores on medical licensing examinations, ratings of clinical competency in residency, board certification rates, and faculty appointments. Results - Significant differences were observed among the three groups confirming the hypothesis that students' level of knowledge in sciences basic to medicine early in medical school could predict later performance during medical school and beyond. Implications for early diagnosis of academic deficiencies, in better preparation of medical students, and in the assessment of clinical competency are discussed.