Clinical experience, performance in final examinations, and learning style in medical students: prospective study.

OBJECTIVE To assess whether the clinical experience of undergraduate medical students relates to their performance in final examinations and whether learning styles relate either to final examination performance or to the extent of clinical experience. DESIGN Prospective, longitudinal study of two cohorts of medical students assessed by questionnaire at time of application to medical school and by questionnaire and university examination at the end of their final clinical year. SUBJECTS Two cohorts of students who had applied to St Mary's Hospital Medical School during 1980 (n = 1478) and 1985 (n = 2399) for admission in 1981 and 1986 respectively. Students in these cohorts who entered any medical school in the United Kingdom were followed up in their final clinical year in 1986-7 and 1991-2. MAIN OUTCOME MEASURES Student's clinical experience of a range of acute medical conditions, surgical operations, and practical procedures as assessed by questionnaire in the final year, and final examination results for the students taking their examinations at the University of London. RESULTS Success in the final examination was not related to a student's clinical experiences. The amount of knowledge gained from clinical experience was, however, related to strategic and deep learning styles both in the final year and also at the time of application, five or six years earlier. Grades in A level examinations did not relate either to study habits or to clinical experience. Success in the final examination was also related to a strategic or deep learning style in the final year (although not at time of entry to medical school). CONCLUSIONS The lack of correlation between examination performance and clinical experience calls into question the validity of final examinations. How much knowledge is gained from clinical experience as a student is able to be predicted from measures of study habits made at the time of application to medical school, some six years earlier, although not from results of A level examinations. Medical schools wishing to select students who will gain the most knowledge from clinical experience cannot use the results of A level examinations alone but could assess a student's learning style.