Impact of Undergraduate Courses On Medical Student Performance in Basic Sciences Stephen D. Canaday, Ph.D., and Carol J. Lancaster Abstract—Many students planning to apply to medical school take undergraduate courses (for example, biochemistry, embryology, histology, and vertebrate anatomy) covering concepts that are taught within the medical school curriculum. Do these students perform better in similar courses in medical school than students without prior exposure? In the study reported here of 310 medical students, approximately 50 percent had taken biochemistry, 50 percent had taken a course dealing with vertebrate anatomy, 25 percent had taken embryology, and 25 percent had taken histology as undergraduates. In comparisons of the students with prior exposure to these courses and those without prior exposure, no statistical difference was noted in cumulative grade-point averages for the first year in medical school or in the students’ scores in three of the four individual medical courses examined. In addition, there was no significant difference in the academic performances in the four courses between the students in the upper and the lower quartiles of the class. Implications regarding undergraduate preparation of medical school applicants are discussed. Many premedical students feel or are ad- vised that a strong undergraduate back- ground in science will increase their chances of getting into medical school and will ensure success in the basic sci- ence component of the medical school curriculum (1-6). As a result, many stu- dents planning to apply to medical school pursue undergraduate degrees in the life or physical sciences, particularly in the areas of biology and chemistry (6-8). In the past few years, some authors (2, 9, 10) have suggested that a broadly educated physician might be more effective in deal- ing with patients than the physician who began specialized training early, and they Dr. Canaday is an associate professor of anatomy and Ms. Lancaster is an instructor in education, Medical University of South Carolina, Charleston, questioned whether extensive undergrad- uate training in science actually leads to higher grades in medical school. The re- sults presented in three published reports indicate that the undergraduate student majoring in science has no higher yearly grade-point average in medical school and no higher scores on Part I or Part II of the examinations of the National Board of Medical Examiners (NBME) than the undergraduate who matriculates with a nonscience major (2, 11, 12). Most medical students have some com- mon undergraduate background in sci- ence, In addition to basic introductory courses, a varying number of upper-level science courses are found on the under- graduate transcripts of most medical stu- dents, While many of these upper-level courses are taken because the student is 757758 Journal of Medical Education genuinely interested in some particular area of science or because they fulfill the requirements of a specific major, other courses are taken in the belief that they will provide background experience that will be particularly useful in gaining ad- mission to and succeeding in medical school. Some of these courses have names (for example, biochemistry and histology) and course descriptions which are similar to those in the basic science component of the curricula in many medical schools. Ifan undergraduate who majors in a non- science area takes one or more of these particular science courses, he might be better prepared for similar courses in medical school than many science majors who take a large number of science courses. In addition, if a significant num- ber of nonscience majors enroll in one or more specific science courses and some of the science majors do not, simply di- viding students into two categories based on undergraduate (science versus nonsci- ence) major to compare academic per- formance in medical school courses might not be an appropriate way to assess the importance of a science background in preparation for medical school. Rather than comparing the academic performances of science and nonscience majors, a more direct and more meaning- ful approach to the evaluation of the im- portance of undergraduate science courses to medical school performance would be to compare the performances of students in specific medical school courses on the basis of whether they had taken a similar undergraduate course. While majoring in science as an under- graduate might not influence medical school performance, taking some specific upper-level science courses could be val- uable. In addition, perhaps certain stu- dents should be encouraged to take spe- cific courses before entering medical VoL. 60, OcroBER 1985 school. In a 1982 study, Steele and Barn- hill (13) showed that students who had taken an undergraduate course in genetics did no better in a genetics course in med- ical school than students without prior exposure. However, the authors conceded the possibility that students with prior exposure might have spent less time studying genetics (thereby decreasing their initial advantage in that course) to concentrate on a larger, more demanding course. No attempt was made to deter- mine whether this occurred. In addition, no effort was made to identify specific groups of students who might have ben- efited from prior exposure. Like the study of Steele and Barnhill, the investigation reported here involved a comparison between the performances of two groups of students, those with “prior exposure” versus those with “no prior exposure.” In the present study, the au- thors compared the performances of stu- dents in four medical basic science courses (biochemistry, embryology, gross anatomy, and histology) during two aca- demic years at the Medical University of South Carolina (MUSC). Exposure to the principles taught in all four courses at the MUSC can be gained on the undergrad- uate level. Gross anatomy and biochem- istry are very demanding courses and are both taught in the first semester at the MUSC. A very large proportion of the students’ total effort is spent mastering the concepts in these two courses. Based on observations of fluctuating class at- tendance and verbal comments, students at the MUSC divide their academic ef- forts primarily between the two courses and periodically away from both to study embryology and another less demanding course in preparation for approaching ex- aminations in those courses. Hence, if prior exposure is important but is signi icantly decreased by the need for in-Impact of Undergraduate Courses/Canaday and Lancaster creased efforts in other courses, it should be possible to monitor this shift in aca- demic effort by comparing gross anatomy and biochemistry grades of the groups with and without undergraduate exposure to these courses. Finally, students with and without exposure were subdivided on the basis of academic ability (Medical College Admission Test [MCAT] total score) to investigate whether there were differences in grades at MUSC with re- gard to exposure to related undergraduate courses. Procedure The study encompassed 310 first-year stu- dents entering the MUSC during the fall semesters of 1981 and 1982. Data col- lected on each student included under- graduate major and university, subtest and total MCAT scores, credit hours and grades in any of the four undergraduate courses taken (comparative anatomy, biochemistry, embryology, and_histol- ogy), grades in four similar courses in medical school, and grade-point averages (GPA) for each of the first three semesters of medical school. Grades in the medical school courses are assigned on the basis of performances on two to five tests, which consist primarily of multiple- choice questions. Two courses have lab- oratory components. Test scores on the laboratory examinations, involving iden- tification of structures, contribute to the compilation of the final grade. The data were analyzed using /-tests, analyses of variance and covariance, and multiple range comparison tests (14). An alpha level of .05 was used for all tests of signif- icance. Results Of the 310 students studied, 135 had un- dergraduate majors in biology, 64 in chemistry, 22 in zoology, 13 in microbi- 759 ology, 38 in other areas of science, and 38 in nonscience backgrounds. In this sample, 152 had already taken one or more courses in biochemistry as under- graduates. A total of 150 students had had comparative anatomy (or some basic introductory course in vertebrate anat- omy), 85 had taken a course in embryol- ogy, and 80 had had a course in histology. Twenty of the 38 nonscience majors had taken either biochemistry, comparative anatomy, or both as undergraduates. Thirty-nine of the 272 undergraduate ma- jors in science had not taken any of the four courses. Do students with prior exposure to any of the four courses derive some general academic advantage in medical school as a result of this exposure? The students were divided into two groups (those with exposure to the courses and those with- out). The students who had taken one or more of the courses prior to entering med- ical school received significantly higher grades in the medical school course in enbryology (Table 1), However, there were no significant differences in the stu- dents’ performances in the three other courses or in their first-year cumulative grade-point averages (p > .05). Even the students who had taken all four courses performed as a group at approximately the same level as the students without exposure to any of the courses. Does the student with exposure to a particular course in undergraduate school achieve a higher grade in that course in medical school than the student with no exposure? If he did, the differences in course grade might be due to differences in ability (as measured by total MCAT score), differences due to prior exposure, or both. If differences in course grades for the two groups are adjusted (by using total MCAT score) to a common ability level, significant diversity in the adjusted means