Effects of raising the bar on medical student study progress: An intersectional approach

CONTEXT: Medical schools seek for measures to improve their students’ study progress and are responsible for a diverse student population. OBJECTIVES: The effect of a stricter academic dismissal (AD) policy in medical school on short‐term and long‐term study progress was investigated in a longitudinal cohort study. In addition, differential effects for subgroups were assessed by intersecting gender, ethnicity and prior education (intersectional framework). METHODS: Participants were first‐year Bachelor students enrolled in 2011 to 2016 in a Dutch medical school. For cohorts 2011‐2013, the AD policy consisted of a minimum of 67% of Year‐1 credits required to remain enrolled (67%‐policy, n = 1189), and for cohorts 2014‐2016, this bar was raised to 100% of Year‐1 credits (100%‐policy, n = 1233). Outcome measures on study progress were Year‐1 completion and dropout (short term) and Bachelor completion in three and four years (long term). RESULTS: Overall, Year‐1 completion rates increased under the 100%‐policy compared to the 67%‐policy (OR = 2.50, 95%‐CI:2.06‐3.03, P < .001). Yet, this increase was not present for students with non‐standard prior education – except for males with a migration background (OR = 7.19, 95%‐CI:2.33‐25.73, P < .01). The dropout rate doubled under the 100%‐policy (OR = 2.41, 95%‐CI:1.68‐3.53, P < .001). Mainly students with standard prior education dropped out more often (OR = 3.68, 95%‐CI:2.37‐5.89, P < .001), except for males with a migration background. Bachelor completion rates after three and four years were not positively affected by the 100%‐policy. Notably, females without a migration background and with non‐standard prior education suffered from the 100%‐policy regarding Bachelor completion after three years (OR = 0.29, 95%‐CI:0.11‐0.76, P < .05). CONCLUSIONS: Despite increased dropout rates, the stricter AD policy improved Year‐1 completion rates – especially for under‐represented subgroups, thereby improving study progress without harming student diversity on the short term. However, these positive effects did not hold regarding Bachelor completion rates indicating that long‐term effects require higher performance standards throughout the Bachelor, which in turn may harm other subgroups and thereby student diversity.