Learning from the Past: A Five‐Year Analysis of the Exam Preparations of Students Repeating an Integrated Medical Anatomy Course
Authors: Cale Andrew S. , McNulty Margaret A. , Hoffman Leslie A. 
Published: May 2022

INTRODUCTIONDue to the rigor and pace of undergraduate medical anatomy courses, it’s not uncommon for medical students to struggle and fail initially. However, repetition of failed coursework places an additional burden on the time, energy, and resources on both the student and the institution. The purpose of this study was to compare the exam preparation strategies of repeating and non‐repeating students to identify areas where struggling students can be supported prior to course failure.METHODSAs part of their integrated anatomy course, first‐year medical students at Indiana University completed a metacognitive Practice‐Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the pre‐exam PBLI, students were asked to reflect on their grasp of the material, study strategies and resources, confidence, and predicted exam score. The post‐exam PBLI asked students to reflect on their exam satisfaction, study strategies, resources, and plans for future exams. PBLIs and course grades from repeater and non‐repeater students between 2016 to 2020 were compared using the Mann‐Whitney U test. PBLIs and grades from the repeaters’ first and second attempts were compared using Wilcoxon Ranked Signed test and Spearman’s correlation. Open‐ended responses from repeater PBLIs were thematically analyzed using inductive coding.RESULTSA total of 1803 medical students were included in this study. Non‐repeaters (n=1752) exhibited significant positive correlations between their actual and expected exam scores, confidence, and satisfaction (p<0.001). Conversely, repeaters (n=51) did not show any significant correlations between these factors in their first attempt (p>0.05). However, in their second attempt, expected score positively correlated with confidence (r=0.34, p=0.003). The repeaters also significantly increased their actual exam score, confidence, and satisfaction between their first and second attempts (p<0.001). When compared to non‐repeaters, repeaters’ first and second attempts had significantly lower actual exam scores and exam confidence (p<0.05) but did not significantly differ in their expected exam score. Several specific themes were also identified. For example, repeaters relied consistently on lectures to determine their learning needs and noted poor time management to be a major flaw in their exam preparations. On their second attempt, however, many repeaters felt more confident in their study strategies and opted not to modify them further.CONCLUSIONUnlike their non‐repeater counterparts, medical students who failed and repeated coursework demonstrated a disconnect between their actual and expected exam performances, confidence, and satisfaction. This suggests repeaters may lack metacognitive awareness of their own exam preparedness when compared to non‐repeaters.SIGNIFICANCEThese insights into repeater and non‐repeater exam preparation practices can help anatomy educators better support struggling students before they fail a course. These students may benefit from more opportunities to self‐assess their progress and improve their metacognitive awareness.