RESEARCH REPORT

Learning and Study Strategies Correlate with Medical

Students’ Performance in Anatomical Sciences
Mohammed K. Khalil,1* Shanna E. Williams,1 H. Gregory Hawkins2
1
Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South
Carolina
2
Department of Academic Affairs and Institutional Research, Flagler College, St. Augustine, Florida

Much of the content delivered during medical students’ preclinical years is assessed
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nationally by such testing as the United States Medical Licensing ExaminationV
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(USMLEV) Step 1 and Comprehensive Osteopathic Medical Licensing ExaminationV
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(COMPLEX-USAV) Step 1. Improvement of student study/learning strategies skills is
associated with academic success in internal and external (USMLE Step 1) examinations.
This research explores the strength of association between the Learning and Study Strate-
gies Inventory (LASSI) scores and student performance in the anatomical sciences and
USMLE Step 1 examinations. The LASSI inventory assesses learning and study strategies
based on ten subscale measures. These subscales include three components of strategic
learning: skill (Information processing, Selecting main ideas, and Test strategies), will
(Anxiety, Attitude, and Motivation) and self-regulation (Concentration, Time manage-
ment, Self-testing, and Study aid). During second year (M2) orientation, 180 students
(Classes of 2016, 2017, and 2018) were administered the LASSI survey instrument. Pear-
son Product-Moment correlation analyses identified significant associations between five
of the ten LASSI subscales (Anxiety, Information processing, Motivation, Selecting main
idea, and Test strategies) and students’ performance in the anatomical sciences and
USMLE Step 1 examinations. Identification of students lacking these skills within the
anatomical sciences curriculum allows targeted interventions, which not only maximize
academic achievement in an aspect of an institution’s internal examinations, but in the
external measure of success represented by USMLE Step 1 scores. Anat Sci Educ 00: 000–
000. V
C 2017 American Association of Anatomists.

Key words: gross anatomy education; medical education; histology education; biomedical
sciences; undergraduate education; Learning and Study Strategies Inventory; study
strategies

INTRODUCTION of the strength of this association (Jones and Thomae-

While traditional indicators of success, such as undergraduate
grade point average (UGPA) and Medical College Admission
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TestV (MCATV) score, have been shown to be predictive of
academic success in medical school, variation exists in terms
Forgues, 1984; Julian, 2005; Dunleavy et al., 2013; Gauer
et al., 2016). Despite the small to moderate effect sizes noted
in the literature, Gauer et al. (2016) reported that low
MCAT scores are more predictive of continued poor perfor-
mance on United States Medical Licensing ExaminationV
R

*Correspondence to: Dr. Mohammed Khalil, University of South Caro-
lina School of Medicine – Greenville, South Carolina, 607 Grove
Road, Greenville, SC 29605, USA. E-mail: khalilmk@greenvillemed.sc.
edu
Received 1 June 2017; Revised 3 September 2017; Accepted 3
September 2017.
Published online 00 Month 2017 in Wiley Online Library
(wileyonlinelibrary.com). DOI 10.1002/ase.1742
C 2017 American Association of Anatomists
V
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(USMLEV) Step 1 and Step 2 examinations than high scores
are predictive of continued high achievement on these exams.
Understanding the diverse learning and study strategies stu-
dents bring to the medical student experience and how defi-
ciencies in these strategies can surface with the pace and
intensity of medical school allows institutions to develop
interventional strategies that could mitigate these issues prior
to USMLE Step examinations.
The Learning and Study Strategies Inventory (LASSI) is a
widely used instrument for evaluating students’ learning and

Anatomical Sciences Education MONTH 2017 Anat Sci Educ 00:00–00 (2017)
study strategies. This 10-subscale, 80-item assessment survey
evaluates students’ self-awareness about and use of learning
and study strategies (Weinstein et al., 1987; Weinstein and
Palmer, 2002). The LASSI provides diagnostic information,
which can be used to design individualized intervention strat-
egies for refining learning strategies, improving student aca-
demic outcomes, and predicting student success. The LASSI
ten-subscales were originally grouped into three major com-
ponents of strategic learning: skill, will and self-regulation.
The skill component includes information processing, select-
ing main ideas and test strategies. The will component of
strategic learning includes Anxiety, Attitude, and Motivation;
whereas the self-regulation component-related subscales are
Concentration, Self-testing, Study aids and Time management
(Weinstein et al., 1987). However, some more recent empiri-
cal studies (Olejnik and Nist, 1992; Olaussen and Bråten,
1998; Cano, 2006; Prevatt et al., 2006) have suggested alter-
native groupings to the original proposed three components.
Despite differences in grouping approaches, numerous studies
have shown multiple LASSI subscales to be associated with
academic performance (Sleight and Mavis, 2006; Schutz
et al., 2011, 2013; West and Sadoski, 2011; West et al.,
2014).
However, minimal research has examined the relationship
between LASSI subscales and medical students’ performance
on internal and external measures of content mastery
(Sleight and Mavis, 2006; West et al., 2014). For instance,
Time management and Self-testing were found to be strong
predictors of medical students’ performance in their first
semester, while Concentration predicted success on USMLE
Step 1 performance (West and Sadoski, 2011; West et al.,
2014). Yet, both studies examined students’ performance
globally, which limits the external validity due to organiza-
tional differences in curricular design. One way to mitigate
this issue is to examine the subscales relative to students’
performance in a specific introductory medical education
discipline, which is universally taught across institutions.
One such discipline that is fundamental to medical educa-
tion is the anatomical sciences (i.e., anatomy, histology, and
embryology). Studies have shown a positive correlation
between medical students’ performance in the anatomical
sciences and performance on the USMLE Step 1 examina-
tion (Peterson and Tucker, 2005; Burns and Garrett, 2015).
Additionally, students entering medical school with a Master
of Science in Applied Anatomy performed better on USMLE
Step 1 examination relative to students lacking this back-
ground (Fredieu and Snyder, 2015). Thus, evaluation of the
relationship between the ten LASSI subscales and anatomi-
cal sciences performance may assist in predicting success
both within the medical curriculum and on the USMLE Step
1 examination. However, the mode and time allocation of
anatomy curricula can vary greatly across institutions, with
increasingly fewer hours being dedicated to this discipline in
recent years (Drake et al., 2014). Indeed, this study utilizes
data from a medical program in which the total course
hours for both cadaver-based gross anatomy and histology
are nearly half the national average noted by Drake et al.
(2014). Despite, such time restrictions, this study hypothe-
sizes that mastery of the anatomical sciences is associated
with one or more of the LASSI subscales. Moreover, this
research predicts that external and internal measures of stu-
dents’ performance improve if these learning strategies are
developed early on during anatomy curricula. To examine
this concept further, this study explored patterns of
2 Khalil et al.
association between the LASSI subscales and students’ suc-
cess in the anatomical sciences, the biomedical sciences (i.e.,
overall academic performance in preclinical basic science
disciplines) and USMLE Step 1 score.
MATERIALS AND METHODS
Participants
The research population consisted of 180 individuals, repre-
senting three cohorts of medical students, Classes of 2016
(n 5 52), 2017 (n 5 51), and 2018 (n 5 77) in their preclinical
years at the University of South Carolina School of Medicine
Greenville (USCSOMG). However, only 174 students had all
the data necessary to complete the correlation analyses per-
formed in this study. Participants were 56% female and 44%
males. Their ages ranged from 21 to 34 years with an
average age of 23 years. Participants’ average UGPA was
3.65 on a four-point scale, and their overall MCAT percentile
was 67%.
Educational Context
Anatomical sciences content is delivered within the Structure
and Function (SF) I and II modules, which span over 50% of
the first-year medical calendar. The total number of hours
dedicated to anatomical sciences teaching within the curricu-
lum is 159 hours. Seventy-three hours (anatomy and embry-
ology 5 53; histology 5 20) in the classroom, and 66 hours in
the laboratory (36 hours anatomy laboratory, and 30 hours
digital histology laboratory). Instructional methods include
lecture preceded by self-learning modules (Khalil et al.,
2010), small and large group discussion, and case-based
instruction. Students are divided into small learning groups
to work collaboratively during cadaveric dissection, and his-
tology laboratory in which they interact with an electronic
laboratory manual that utilizes virtual slides (Khalil et al.,
2013). Clinically-based anatomy problem set activities are
also completed by students during laboratory time. Optional
weekly anatomy laboratory review sessions are available to
students needing assistance in structure identification. Mean-
while, comprehension of classroom content is evaluated
weekly via clinically-oriented, multiple-choice, formative
examinations. Performance within each module is evaluated
via two written and two timed practical summative
examinations.
Instrument
The Learning and Study Strategies Inventory (LASSI, Version
Two) is an 80-item inventory that contains 8 items for each
of the 10 LASSI subscales (Weinstein and Palmer, 2002).
Descriptions of these subscales are summarized in Table 1.
Participants answer each item on a five-point Likert scale
with 1 being “not at all typical of me,” and 5 being “very
much typical of me.” LASSI results provide students with a
diagnosis of their strengths and weaknesses in these arenas.
The reliability of LASSI subscales is measured by Cronbach
Alpha of 0.73–0.89 and the inventory demonstrates good
validity (Albaili, 1997; Weinstein and Palmer, 2002).
Data Collection
Implementation of this research was approval by the Institu-
tional Review Board of the University of South Carolina. The
LASSI instrument was administered to the students during
orientation at the beginning of their second (M2) year. Data
were collected at this point in time based on research that
suggests students overestimate the caliber of their study habits
at the start of medical school (Khalil et al., 2017). Performance
on anatomy, embryology, histology, overall anatomical sciences,
and overall biomedical sciences content within the medical cur-
riculum was extracted for these students. More specifically, this
was accomplished by assessing students’ achievement on the
practical and written summative examinations. Anatomy and
histology laboratory practical examinations are timed examina-
tions wherein students rotate from station to station, identify-
ing 1–2 structures per station. All written summative
examination questions at USCSOMG are vignette style,
multiple-choice questions mapped to a primarily basic science
discipline (i.e., physiology, anatomy, pharmacology, etc.). Based
on this mapping, student performance (i.e., percentage
answered correctly) was calculated relative to the anatomy, his-
tology, and embryology contents. These sub-disciplines were
then calculated in combination with practical examination
scores to represent performance in the “anatomical sciences.”
Biomedical sciences performance during the preclinical years,
which encompasses all basic sciences content delivered during
M1 and M2 years, was also calculated. As the lengths of the
preclinical modules varied, students’ performance in each mod-
ule was weighted based on the duration of the module relative
to the duration of the academic year, and these weighted values
were then averaged. Finally, USMLE Step 1 examinations
scores were gathered for all the three classes. Typically, students
take USMLE Step 1 examination approximately six weeks after
completing their M2 year.
Data Analysis
Data were analyzed using IBM Statistical Package for the
Social Sciences (SPSS) software (IBM Corp., Armonk, NY).
Descriptive statistics (Mean and 6SD) were calculated for
students’ performance on anatomy, embryology, histology,
overall anatomical sciences, overall biomedical sciences, and
USMLE Step 1 examination. To better outline the relation-
ship between anatomical sciences and USMLE Step 1 exami-
nation, Pearson Product-Moment correlations were
performed between anatomical science and its sub-disciplines
with USMLE Step 1 examination.
To analyze the strength of association and correlation
between LASSI ten-subscale scores and these measures of stu-
dents’ performance, Pearson Product-Moment correlation
analyses were performed. These analyses identified the corre-
lations between the LASSI subscales that were shared by the
different performance measures. Only students’ data that
included first time taker USMLE Step 1 examination score,
and complete performance scores on anatomical sciences, and
overall biomedical sciences were included in these analyses.
RESULTS
Pearson correlation analysis revealed that 22.47%, 22.09%,
and 6.92% of the variation (i.e., r2) in USMLE Step 1 score
is explained by students’ performance in anatomy, histology,
Anatomical Sciences Education MONTH 2017
Table 1.
The Scale and Its Description for the LASSI Based on Weinstein
and Palmer (2002)
Scale Description
ANX Anxiety, worry about school and academic
performance
ATT Attitude, interest in academic success
CON Concentration, ability to direct attention on aca-
demic tasks
INP Information processing, knowledge acquisition,
and future application
MOT Motivation, diligence, self-discipline, and willing-
ness for hard working
SFT Self-testing, reviewing, and preparing for classes
SMI Selecting main ideas, identifying important
information
STA Study aide, use of supports and resources
TMT Application of time management principles for
academic situation
TST Test strategies, preparation and test taking
strategies
ANX, Anxiety; ATT, Attitude; CON, Concentration; INP, Infor-
mation processing; MOT, Motivation; SFT, Self-testing; SMI,
Selecting main ideas; STA, Study aids; TMT, Time management;
TST, Test strategies.
and embryology, respectively (Table 2). When these sub-
disciplines are combined to represent the anatomical sciences,
they collectively account for 28.41% of the variation in
USMLE Step 1 scores. A significant relationship was identi-
fied between each anatomical sub-discipline performance
indicator and USMLE Step 1 score (Table 2).
When the sub-disciplines constituting the anatomical sci-
ences are examined individually, 7 of the 10 LASSI subscales
significantly correlate with anatomy, 6 with embryology,
and 5 with histology (Table 3). Motivation, Time manage-
ment and Test taking strategies are the only subscales signif-
icantly correlated with all three sub-disciplines (Table 3).
However, when these sub-disciplines are combined to repre-
sent the anatomical sciences, 8 of the 10 LASSI subscales
significantly correlate with performance (Anxiety, Concen-
tration, Information processing, Motivation, Self-testing,
Selecting main idea, Time management, and Test strategies).
The correlation coefficients between these variables and the
anatomical sciences (i.e., r value) ranged from 0.161 to
0.423 (Table 4). The strongest correlations were observed
between anatomical sciences and LASSI subscales Anxiety,
Concentration, Motivation, Time management, and Test
strategies. Similar correlations were also observed between
the above mentioned LASSI subscales (Anxiety, Concentra-
tion, Motivation, Time management, and Test strategies)
and biomedical science performance. Finally, when the rela-
tionship between the subscales and USMLE Step 1
3
Table 2.
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Descriptive Statistics and Pearson Correlations (r) Between Anatomical Science Sub-Disciplines and USMLEV Step1 Examinations, and
USMLEV Step 1 Score Variation Explained (r2)
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Number of Pearson
Discipline questions Mean (6 SD) correlation (r) r2 P-value

Anatomy 364 81.81 (6 06.63) 0.474 22.47% < 0.001

Histology 112 84.95 (6 08.55) 0.470 22.09% < 0.001

Embryology 052 80.52 (6 11.57) 0.263 06.92% < 0.001

Anatomical sciences 528 82.35 (6 06.22) 0.533 28.41% < 0.001

Correlation is significant at P < 0.01 level (two-tailed).

performance were examined, once again the LASSI subscales
Anxiety, Motivation, and Test strategies demonstrated sig-
nificant correlation with this licensing examination. Interest-
ingly, the Attitude and Study aids subscales were not
significantly correlated with any of the performance mea-
sures examined.
In summary, Motivation and Test strategies are the only
subscales significantly correlated with students’ performance
at all levels of analyses (i.e., anatomy, histology, embryology,
anatomical sciences, biomedical sciences, and USMLE Step 1
(Tables 3 and 4). However, when the individual sub-
disciplines of the anatomical sciences are excluded from the
analyses, Anxiety, Motivation, and Test strategies all signifi-
cantly correlated with the remaining levels of performance
(i.e., anatomical and biomedical sciences, and USMLE Step
1) (Table 4). Time management, Concentration and Self-
testing are the significant LASSI subscales that correlate with
anatomical sciences, biomedical sciences, but not USMLE
Step 1 scores. Interestingly, Time management correlated
with anatomy, histology, embryology, anatomical sciences,
and biomedical sciences, but was not correlated with USMLE
Step 1 scores.
DISCUSSION
The significant relationship between several of the LASSI sub-
scales and key measures of students’ academic performance
highlights the important role study/learning strategies play in
both internal and external performance measures during the
preclinical years. The subscales involved vary depending on
the performance marker examined. For instance, the number
of subscales significantly correlated with performance dimin-
ishes from 8 to 6 when expanding the level of analyses from
anatomical sciences to overall biomedical sciences, and drops
to 5 subscales when examined exclusively in terms of USMLE
Step 1 scores. However, the LASSI subscales Anxiety,

Table 3.
Pearson Correlations Between the LASSI Subscales and Anatomy, Histology, and Embryology

Anatomy (N 5 174) Histology (N 5 174) Embryology (N 5 174)

Scale r-value P-value r-value P-value r-value P-value

ANX 0.211 0.005a 0.198 0.009a 0.045 0.560

ATT 0.109 0.151 0.019 0.804 0.163 0.032b

CON 0.235 0.002a 0.066 0.462 0.196 0.010b

INP 0.133 0.079 0.198 0.009a 0.031 0.685

MOT 0.280 < 0.001a 0.285 < 0.001a 0.388 < 0.001a

SFT 0.182 0.016b 0.089 0.243 0.181 0.017b

SMI 0.194 0.010b 0.075 0.328 0.128 0.092

STA 20.004 0.958 20.093 0.222 0.006 0.941

TMT 0.259 0.001a 0.213 0.005a 0.270 < 0.001a

TST 0.392 < 0.001a 0.294 < 0.001a 0.273 < 0.001a

a
P < 0.01; bP < 0.05 (two-tailed); ANX, Anxiety; ATT, Attitude; CON, Concentration; INP, Information processing; MOT, Motivation;
SFT, Self-testing; SMI, Selecting main ideas; STA, Study aids; TMT, Time management; TST, Test strategies.

4 Khalil et al.
Table 4.
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Pearson Correlations Between the LASSI Subscales and Anatomical Sciences, Biomedical Sciences, and USMLEV Step 1 Examination
Performance

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Anatomical sciences Biomedical sciences USMLEV Step 1
(N 5 174) (N 5 173) (N 5 172)
Scale r-value P-value r-value P-value r-value P-value

ANX 0.221 0.003a 0.186 0.014b 0.311 < 0.001a

ATT 0.115 0.129 0.101 0.187 0.072 0.351

CON 0.249 0.001a 0.206 0.007a 0.141 0.065

INP 0.161 0.033b 0.076 0.319 0.214 0.005a

MOT 0.360 < 0.001a 0.345 < 0.001a 0.178 0.020b

SFT 0.192 0.011b 0.152 0.045b 0.120 0.118

SMI 0.188 0.013b 0.134 0.080 0.234 0.002a

STA 0.029 0.702 20.084 0.270 20.084 0.276

TMT 0.302 < 0.001a 0.173 0.022b 0.123 0.109

TST 0.423 < 0.001a 0.367 <0.001a 0.377 < 0.001a

a
P < 0.01; bP < 0.05 (two-tailed); ANX, Anxiety; ATT, Attitude; CON, Concentration; INP, Information processing; MOT, Motivation;
SFT, Self-testing; SMI, Selecting main ideas; STA, Study aids; TMT, Time management; TST, Test strategies.

Motivation, and Test Strategies remain significantly corre-
lated with students’ success in anatomical sciences, biomedi-
cal sciences, and USMLE Step 1 examinations.
Students’ performance in the anatomical sciences was sig-
nificantly correlated with eight of the LASSI subscales (Anxi-
ety, Concentration, Information processing, Motivation, Self-
testing, Selecting main ideas, Time management, and Test
strategies). However, the incorporation of additional basic
science disciplines (e.g., biochemistry, physiology, genetics,
etc.) eliminates the weakly correlated LASSI subscales (Infor-
mation processing and Selecting main ideas) observed with
anatomical sciences. The anatomical sciences aspect of the
USCSOMG curriculum has a gross anatomy laboratory com-
ponent, which accounts for approximately 30% of the stu-
dents’ overall anatomical science grade. Successful gross
anatomy dissection and comprehension requires independent
thinking and learning (Pawlina and Lachman, 2004). Infor-
mation Processing and Selecting Main Ideas are subscales
which strongly encompass these traits by characterizing stu-
dents’ ability to recognize, acquire, and reason through
important information. While West and Sadoski (2011) only
examined first semester academic performance, they detected
a relationship between two of these six study skills (Self-test-
ing and Time management) and medical school performance.
All five subscales found to be significantly correlated with
USMLE Step 1 scores were also correlated with anatomical
sciences performance (Anxiety, Information Processing, moti-
vation, Selecting main idea, and Test strategies). Conversely,
only 3 of the 5 subscales correlated with USMLE Step 1
scores were also correlated with biomedical sciences perfor-
mance (Anxiety, Motivation, and Test strategies). This sug-
gests that many of the same skills that demonstrate mastery
of the anatomical sciences promote success in USMLE Step 1
examination. Anxiety, Selecting main ideas, and Test strate-
gies were also found to be significant predictors of National
Board of Chiropractic Examiners (NBCE) licensure examina-
tion scores (Schutz et al., 2013). Interestingly, only Concen-
tration was found to be significantly correlated with USMLE
Step 1 performance in West et al. (2014) study of medical
students. No such correlation was identified in this research,
but Concentration was found to be correlated with anatomi-
cal and biomedical science performance. However, the dis-
crepancy may be related to the fact that the aforementioned
research derived their data from a single cohort of students,
as opposed to the multiple cohorts represented in this study
or the timing of collecting the LASSI scores at the beginning
of M1 vs. M2 year. Furthermore, Cano (2006) has identified
affective strategies (Attitude, Concentration, Motivation, and
Time management) and goal strategies (Anxiety, Selecting
main ideas, and Test strategies) as predictors of students’ aca-
demic performance. All the LASSI subscales Cano (2006)
found to be significantly correlated with students’ academic
performance were also correlated in this study with anatomi-
cal sciences performance and USMLE Step 1, with the excep-
tion of the Attitude subscale.
In light of the significant relationship certain subscales
have with multiple measures of performance, establishing
which aspect(s) of performance should be focused on is essen-
tial when designing interventional approaches. Admittedly,
the three aspects of performance examined in this study are
interrelated. The anatomical sciences are a component of the
biomedical sciences, and the biomedical sciences represent
the content evaluated on the USMLE Step 1 score. However,
successful passage of USMLE Step 1 examination in our

Anatomical Sciences Education MONTH 2017 5

curriculum is required for matriculation into the M3 year
(i.e., clinical year). Moreover, despite over two decades of
research indicating that USMLE Step 1 scores are not
designed for use in postgraduate residency selection, and are
not valid predictors of clinical performance (McMahon and
Tallia, 2010; McGaghie et al., 2011), residency program
directors routinely use USMLE Step 1 scores in the applicant
selection process (NRMP, 2016). Thus, interventional strate-
gies should be prioritized around the five subscales found to
be significantly correlated with USMLE Step 1 (Anxiety,
Information processing, Motivation, Selecting main idea, and
Test strategies). As mentioned earlier, all of these subscales
are also significantly correlated with the anatomical sciences.
Modifications in the anatomy curriculum can be imple-
mented to improve student Motivation. For instance, Abdel
Meguid and Khalil (2017) assessed learning effectiveness in
the gross anatomy laboratory relative to student motivation
by implementing specific learning strategies aligned with the
Attention, Relevance, Confidence, and Satisfaction (ARCS)
model of motivational design (Keller, 1987, 2010). They
found that the dissection experience and related learning
activities had a strong impact on student motivation. Abdel
Meguid and Khalil (2017) also noted that as self-professed
knowledge increased, so too did motivation. Thus, creation
and retention of motivation assists in the acquisition of
knowledge. Similarly, Mahyuddin et al. (2009) found a signif-
icant, but low positive correlation between students’ motiva-
tion and academic achievement in their study of higher
public and private institutions.
Given the positive relationship between the application of
study/learning skills and academic success (Pringle and Lee,
1998; Robbins et al., 2004; McKendree and Snowling,
2011), anatomy centric activities which promote student pro-
ficiency in Information processing, Selecting main idea, and
Test strategies should, in turn, improve their academic perfor-
mance. For example, recent technological advances in three-
dimensional interactive multimedia programs and multiuser
virtual environments coupled with innovative instructional
approaches such as progressive drawing and asynchronous
online discussion forums provide numerous opportunities to
design activities that practice and refine such skills (e.g.,
Nayak and Kodimajalu, 2010; Richardson et al., 2011;
Green et al., 2014). Directing special attention to implement-
ing these tactics within the anatomy curriculum, which is typ-
ically delivered early in the medical education process has the
potential to assist individuals entering medical school with
low MCAT scores, as well as address specific skill deficiencies
in academically strong students that surface with the pace
and intensity of medical school.
The issue of student anxiety, however, should not be lim-
ited to the anatomy curriculum, but addressed at an institu-
tional level, since anxiety negatively affects all measures of
student performance. Several strategies can be employed to
promote well-being and equip students with the skills neces-
sary to recognize and address anxiety. Multiple studies have
suggested that faculty-student and peer mentoring programs
and institution-sponsored social events help lower stress and
have a positive effect on overall student well-being (Lee and
Graham, 2001; Mouret, 2002; Murr et al., 2002). The incor-
poration of mindfulness-based stress reduction (MBSR) inter-
vention programs, which teach formal and informal
mindfulness practices, have also been found to improve medi-
cal student coping strategies and reduce anxiety (Rosenzweig
et al., 2003). In addition, research indicates that changing to
6 Khalil et al.
a pass-fail grading system improves student satisfaction with
the evaluation system and learning environment, while not
diminishing academic performance (Robins et al., 1995; Dyr-
bye et al., 2005).
Limitations
The main limitation of this study it relies on LASSI measures,
which are self-reported and thus may not accurately reflect
the actual study strategies employed by the medical students.
Prior research demonstrates that self-reported data signifi-
cantly changes between the onset of M1 and M2 year, and
that M2 results are much more predictive of actual perfor-
mance (Khalil et al., 2017). As such, recognition of study
skill development at that time allows for substantial support
opportunities prior to the USMLE Step 1 examination. Even
though this study attempted to control for the self-reported
nature of LASSI instrument, all data were derived from a sin-
gle institution, which could potentially influence the generali-
zation of our findings. As such, the study results should also
be corroborated with samples derived from other medical
programs to improve the external validity of the study
findings.
CONCLUSION
This study utilized the 10 LASSI subscale scores to examine
the association between learning/studying strategies and stu-
dents’ performance in anatomical sciences, biomedical scien-
ces, and USMLE Step 1 examinations. The LASSI subscales
Anxiety, Motivation, and Test strategies were correlated with
all of these performance measures. However, Time manage-
ment was correlated only with anatomical and biomedical
sciences. Since effective learning and studying strategies are
highly predictive of students’ success in medical school, it is
immensely beneficial for institutions to identify students with
deficiencies in these specific subscales early within the ana-
tomical science curriculum. Once these deficiencies are identi-
fied, targeted interventions can be developed that improve
students’ mastery of internal curricular contents, as well as
maximize their performance on the high stakes USMLE Step
1 examination.
NOTES ON CONTRIBUTORS
MOHAMMED K. KHALIL, D.V.M., Ph.D., is a clinical
associate professor and the Director of the Academic Success
Program, at University of South Carolina School of Medicine
Greenville, in Greenville SC. His research interest is in the
area of learning and instructional technology. He is interested
to advance medical education with innovative strategies and
technology.
SHANNA E. WILLIAMS, Ph.D., is a clinical assistant
professor and Director of the Anatomy Laboratory at the
University of South Carolina School of Medicine Greenville,
in Greenville SC. Her research interests center around learn-
ing strategies and morphometrics.
H. GREGORY HAWKINS, Ph.D., is the Director of Insti-
tutional Research and Effectiveness at Flagler College in St.
Augustine, FL. At the time of the study he was Director of
Academic Effectiveness and Assessment at the University of
South Carolina School of Medicine Greenville, in Greenville
SC.
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