Medical School Performance as Measured by GPA: What Can it Predict?

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Rawan ElAbd, Rashed AlShatti, Shamael Sultan, Nawal AlOtaibi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3860391/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Medical graduates' performance has been an area of interest for medical educators internationally. The objectivity of such measures has made it an essential part in evaluation of applicants. Objectives The aim of our study is to examine the prognostic value of medical school graduation GPA in relation to post-graduation achievements and success. Methods We used an online questionnaire sent to Kuwait university's graduates, whether directly face to face, by messages, or phone calls. The electronic questionnaire consisted of three major area, sociodemographic, medical school GPA, and academic or clinical achievements. The results have been statistically analyzed using satisfaction with life, satisfaction with career, and career progress as dependent variables. Results A total of 552 physicians who graduated from 1983 to 2017 took part in this study. The mean age was 33.31 ± 8.39 years. The highest percentage of participant (33%) were specialized in internal medicine. A higher GPA was found to be associated with pursuing postgraduate clinical fellowship, earning higher monthly income, higher career progress score, and scoring higher personal satisfaction with progress and life scores. Higher GPA was not associated with being a faculty member, pursuing post graduate academic studies like master's degree and doctor of philosophy, practicing internationally, or having publications. Gender was not associated with doing a fellowship or practicing internationally. Conclusion Medical school performance, measured by GPA, might predict higher career progress, having higher monthly income, and satisfaction. However, it is not necessarily prognostic for pursuing postgraduate academic degrees, practicing internationally, or having research publications. Kuwait medical school GPA education progress Figures Figure 1 Figure 2 Figure 3 Introduction Performance of medical students attracts the attention of medical educators internationally. Applicants level of competence has to be measured in reliable and valid ways to assess students’ learning experiences and develop a credible and defensible passing mark (Tavakol, 2017 ). For a long time, academic performance measured by grade point achievement (GPA) score has been used as a major criterion for both selection of medical students and residency program applicants as grades long served as an objective measure that predicts better outcomes (McManus, 2013; McManus, 2003; White, 2009). Although some studies have previously shown that premed GPA can predict performance of the majority of medical students (White, 2009), the same concept might not be for post-graduate degrees. McManus et al reported that higher scores during medical school did not predict diploma or higher academic qualifications and research publications, as these were better correlated with personality traits (McManus, 2003). Thus, some medical educators argue that a heavy dependence on a medical school GPA could produce bias towards selection of students who might be more cognitively capable but lack essential non-cognitive traits that are vital for success (Shaw, 1995; Meredith, 1982; Rolfe, 1997 ). Interestingly, when interviews are used to judge non-cognitive traits of applicants, GPA still was the best predictor of interviewer rating (Shaw, 1995); however, basing selection on judgement of specific traits is difficult as it can result in the unfair exclusion of applicant based on gender, ethnic, or social background (Fernando, 2003; Streyffeler, 2005; Albanese, 2003). The Faculty of Medicine of Kuwait University (FOMKU) follows an integrative and problem-based learning system. It was established in 1973 and offers a seven-year medical program, enrolling a total of around 655 students. It remains the only medical school in Kuwait. Teaching follows an integrative system-based and problem-based learning system. The first part covers basic sciences and major integrative clinical system studies, after which students are awarded a Bachelor of Biomedical Sciences. This is followed by 3 years of focus on clinical system learnt mainly through problem based component and clinical rotations. Assessment in FOMKU relies on Multiple Choice Question (MCQ) examination, Objective Structured Clinical Examinations (OSCE), Objective Structured Practical Examinations (OSPE), and oral interview examinations. The aim of our study is to assess if there is an association between graduation GPA and factors like: demographic characteristics, continuing education, current monthly income, career progress, and rating score on personal satisfaction with life and career progress. This study also briefly investigates the role of gender on international medical practice or doing a fellowship abroad and touches on the effect of specialization with satisfaction in career progress. Methods Sample and Data Collection Our target population was all graduates from FOMKU. We were provided with a full list of names of the graduates since the establishment to 2017. There were 2250 graduates, 754 graduates from 1974 to 1999 and 1496 graduates from 2000 to 2017. Sampling method followed a convenient sample strategy. Participants were contacted depending on availability either directly face to face, by messages, or through phone calls. Of all these methods, electronic messages were more convenient and successful. We introduced ourselves and gained consent through these messages. Then, an electronic questionnaire was used for data collection was sent through a message that were sent to the participants’ phone number. The questionnaire had four sections: the consent, sociodemographic data, medical school information, and academic or clinical accomplishments. Career Progress Scoring We developed a career progress score for each participant that awards one for each of the following: being a faculty member, doing international license examination, pursuing a fellowship, having a Master or PhD degree, practicing internationally, having at least 1 publication, having a monthly income > 4500 Kuwaiti Dinars, scoring a satisfaction with career progress score > 7 out of 10, and scoring a satisfaction with life score > 7 out of 10. The maximum possible score was 9. The aim of this score was to simplify the assessment of those components on an objective matter. Statistical analysis Statistical analysis was performed using SPSS v 25. Descriptive statistics were performed using mean ± SD for continuous variables and counts and percentages for categorical. ANOVA and unpaired t-test were used to assess the association of categorical variables with dependent variables. Three main dependent variables were used in the current analysis: satisfaction with life, satisfaction with progress, and achievement (career progress) score. One-way ANOVA was used to assess the association between GPA and overall career progress score. Ordinal regression was used to assess whether demographic characteristics, education, and career progress were significantly associated with GPA. One-way ANOVA was also used to assess whether satisfaction with life and progress were significantly associated with specialty. Linear regression analysis was used to assess the association of GPA with the first two dependent variables after adjusting for covariates. The main covariates adjusted for in the model were age, monthly income, marital status, children, license exam, international practice, license, hospital, fellowship, and specialization. All variables were inserted initially in the model. Backward stepwise elimination of variables (based on the change in R2) was performed to eliminate non-significant variables. GPA and monthly income were used as ordinal variables rather than categorical variables as we were interested in the overall increasing effect of GPA and income on satisfaction with life and progress rather than the relation of higher levels to a reference category. Hypothesis testing was performed at 5% level of significance. Ethical approval This study was approved by the ethics committees of Kuwait University and the Ministry of Health. Each participant signed the informed consent form, and all information was only accessible for the researchers. Results Descriptive Statistics Descriptive statistics is presented in Table 1. The average age of the included participants was 33.31 ± 8.39 years. Females constituted 62% of our sample. Thirty-three percent of the participants specialized in medicine, 13 % specialized in pediatrics, and 17% specialized in surgery, and the remaining were of a variety of specialties. Association of age and gender with satisfaction scores. Satisfaction with life and progress scores were not statistically different between males and females (P = 0.267, and 0.88, respectively). Higher age was associated with higher satisfaction with progress (r = 0.287, P < 0.001) and life (r = 0.136, P = 0.001). In fact, there was a statistically significant positive correlation between satisfaction with life and satisfaction with progress (r = 0.554, P <0.001). Association of GPA with satisfaction scores Results show a statistically significant difference in the average levels of satisfaction with progress (F = 7.991, P < 0.001) and life (F = 2.599, P = 0.05) scores between the four GPA groups and a statistically significant linear trend in the association between GPA and satisfaction with progress and life (Figure 2-3) i.e. higher GPA is associated with higher levels of satisfaction with progress and life. Association between monthly income with GPA and satisfaction scores Higher monthly income was associated with higher GPA (linear trend F = 19.525, P< 0.001). Monthly income was positively associated with satisfaction with progress (r = 0.408, P < 0.001) and satisfaction with life (r = 0.257, P < 0.001). A linear trend has been noticed for both respectively (F = 54.732, P < 0.001, F = 19.525, P < 0.001). Association of demographic characteristics, education, and career progress with GPA Ordinal regression was used to assess whether demographic characteristics, education, and career progress were significantly associated with GPA. Results showed that pursuing a fellowship (OR = 0.46, P < 0.05) was significantly associated with GPA. The odds of being in a higher GPA category compared to the lower category/ies were 54% lower in participants that did not complete a fellowship compared to those that did. Completing a post-graduate study did not show a statistically significantly association with GPA (OR = 1.009, P > 0.05). International practice (OR = 0.74, P > 0.05) and having publications (OR = 1.01, P > 0.05) did not show a statistically significant association with GPA. Being a faculty member did not have an association with GPA (OR = 0.89, P > 0.05). Results showed that participants who did electives during their undergraduate years were more likely to practice internationally compared to participants who did not (17.7% vs. 6.9%, P < 0.001). Gender did not show a statistically significant association with pursuing a fellowship or practicing internationally (Table 2). When it comes to the association between GPA and career progress, initial exploratory analysis (Figure 1) showed that the average achievement score was higher in participants with a GPA of 3.5-4 compared to the remaining three groups; the observed difference between groups was statistically significant (P < 0.001). Results also showed that there was a statistically significant linear trend in the association between GPA and career progress score i.e. higher GPA is associated with higher career score. Linear Regression Model Univariate analysis reveals the factors that can be used in the multivariate analysis by exploring the distribution and associations between variables. Our findings showed that gender did not show a statistically significant association with satisfaction with life or progress. The strongest predictors of satisfaction with life and progress were GPA, monthly income, and current career status. Older age was also associated with higher levels of satisfaction. Due to the high correlation between age, and year of graduation, only one of them will be used for the multivariate analysis. Similarly, current career was associated, to a high extent, with monthly income. Thus, only monthly income would be used for linear regression analysis. In the linear regression analysis model, six variables: international practice, faculty affiliation, elective during undergraduates years, GPA, monthly income, and fellowship were identified as predictors of satisfaction with progress when linear regression analysis was used. The final model explained 19.3% in the dependent variable (satisfaction with progress). The model explained a statistically significant portion of the variance in the dependent variable compared to the null model (F = 22.92, P < 0.001). Table 10 shows the final regression model coefficients for factors associated with satisfaction with progress score. GPA showed a statistically significant positive association with satisfaction with progress (β = 0.21, P < 0.05). The average levels of satisfaction were higher by 0.672 points in faculty members compared to non-faculty members (β = 0.672, P < 0.1) although the association was significant at the 0.1 level rather than the conventional 0.05 level. Participants who practiced internationally had higher average levels of satisfaction compared to those who did not practice internationally (β = 0.565, P < 0.05). Similarly, participants who did electives during undergraduate years had significantly higher levels of satisfaction compared to other participants (β = 0.43, P < 0.05). Finally, participants who did a fellowship had significantly higher levels of satisfaction compared to participants who did not do a fellowship (β = 0.486, P < 0.1) although the association was significant at the 0.1 level rather than the conventional 0.05 level. Only one variable was identified as a predictor of satisfaction with life score (monthly income) when linear regression analysis was used. Monthly income showed a statistically significant association with satisfaction with life (β = 0.376, P < 0.001) which indicates that the average satisfaction with life increases by 0.376 points for each 1 category increase in monthly income. Discussion In this study we investigated the association of the GPA after graduating from medical school with post graduate achievements and physician career progress with a sample size of 552 and found that higher GPA is associated with pursuing a clinical fellowship post-graduation, having a higher monthly income, scoring higher on career progress score (P < 0.001), and higher score on personal satisfaction with career progress and satisfaction with life scores (P < 0.05). This means that students with higher GPA are not only more likely to achieve a better career outcome, but also destined to report higher satisfaction with their career progress and life in general. As a matter of fact, the literature lacks studies with coinciding objectives to ours, but Puddey et al. reported that GPA at entry to medical school to be predictive of outcomes in the early stages and throughout the course of a graduate-entry medical program (Puddey, 2014), which, altogether, implicate GPA, as a measure of academic competence, to correlate with superior performance during medical school and better progress within the medical field after graduation and can contribute to a positive perspective on life as measured by satisfaction with life score. On the other hand, this study finds that higher GPA was not associated with being a faculty member or pursuing post graduate studies like masters or PhD. This is similar to what McManus et al. described that higher medical school scores did not predict diploma or higher academic qualifications or research publications (McManus, 2003). In contrast, Kuzman et al. recited that medical school grades of today's professors at the Zagreb University School of Medicine could serve as predictors of their subsequent academic success; their results revealed that professors were above-average students and their grades seem to be important predictors of future success in academic career (Kuzman, 2004). Furthermore, Broncati et al., who conducted a longitudinal cohort study on 944 physicians, found that the top 3 students in their class were more likely to choose an academic career (relative risk 2.68, p <.001). It is plausible that the difference observed in the literature could be explained by the different requirements of faculties around the world in recruitment of its physician academic staff. In Kuwait for example, a physician must have completed their residency abroad in an accredited program to be suitable for admission in academia. Carr et al. noticed that GPA at the completion of undergraduate studies had the most significant association with better performance on the overall Junior Doctor Assessment Tool (JDAT); that is performance on integrated assessments from medical school is correlated to performance as a practicing physician (Carr, 2018). Physician-researchers continue to have a crucial role in developing and reforming different aspects in medicine, either through scientific research or that on medical education. The factors associated with being a researcher are of interest. In this study we investigated the effect of academic performance and found that GPA is not associated with having research publications; however, it is important to state that our measurement was either binomial as in yes (ever published) or no (never published). This measurement was due to the fact that most, if not all, of our study participants who were involved in research had one publication. A meta-analysis by Amgad et al.(Amgad, 2015) reported similar results by finding no association between academic success and involvement in research as evidenced by a pooled odds ratio from 4 published studies (OR= 1.00, 0.62-1.64). However, in the literature, Hren et al., who studied the association of GPA with attitudes towards research on 932 medical students in Zagreb University in Croatia, found that students with higher GPA were 1.8 times more likely to have higher attitude scores towards research than students with lower GPA (Hren, 2004). Even more, Brancati et al.( Brancati, 1992) found that students with better academic performance were more likely to have citations to their published work (p <.05). The conflicting results in the literature necessitates more studies on the topic. Wong et al.(Wong, 2016) have published interesting work on factors associated with developing more physician-scientists and found that a training program at the level of specialty training effectively enhances the chances of such as more than 80% of the program graduates were conducting research throughout their career. In Kuwait, the proportion of female medical students and graduates outnumber their male counterpart for the previous couple of years as evidenced by our descriptive table where 62% of graduates are female as compared to 38% males. When it comes to gender, our study found that it was not associated with doing a fellowship abroad or practicing internationally (P > 0.05); that is, women are as likely as men to do a fellowship abroad or have international practice. This is an important finding in our study as women in the medical field could face more challenges, although Cohen-Schotanus et al. reported women to be better performers on clinical competence than men (Cohen-Schotanus, 2008). Borman et al.(Borman, 2008) studied more than 11,000 surgical residents and found the number of women pursuing a fellowship to be doubled from 1993 to 2005 with a greater increase (58 to 75%) than men (67 to 78%). Riska et al.(Riska, 2011) also studied the effect of gender on medical career and concluded that although women medical students and residents still confront obstacles in terms of their career progress, they are more career-oriented than before and their male counterparts are more considerate towards their lifestyle than previously, which is bringing balance to the gender discrepancy equation. Bedoya-Vaca et al.(Bedoya-Vaca, 2016) published their work on a qualitative study examining the effect of gender on pursuing residency training abroad and found that women with children and of low socio-economic class are less likely to practice a desired specialty abroad, however, those of a higher social class, were found to have more opportunities as they can afford high quality child care and pay for residency. This is relevant to our study as in Kuwait, most, if not all, medical graduates who plan to continue their education abroad are fully funded by the government and are given childcare support in terms of child schooling, minimizing their limitations. The wellness of physicians depends in part by their satisfaction, which is associated with many health care outcomes ranging from health care quality to patient satisfaction and compliance(Wallace, 2009). The factors that result in physician satisfaction are not clear in the literature (Wallace, 2009; Smith, 2001). Many factors in this study were found to predict physician satisfaction with career; these are having had a high GPA or having done an elective, having a higher monthly income, being a faculty member, practicing internationally, or pursuing a fellowship. It is hard to do a direct comparison between studies in the literature as the definition of satisfaction was different among different studies. Schmit et al. (Schmit, 2014), for example, assessed the influence of achievement before, during, and after medical school on physician job satisfaction using a 10-point scale and found that prior achievements influenced job satisfaction: higher achievers before and during medical school were more satisfied about their income and professional accomplishments (p < .05). A systematic review on European data carried out by Domagala et al. (Domagała, 2018), found contextual factors, professional development, and support teams to be significant predictors of physician satisfaction. Our study found that only pediatric specialty was significantly associated with higher satisfaction progress score. This is similar to what French et al. reported regarding determinants of job satisfaction with staff in pediatrics, laboratory medicine, and radiology being likely to be more satisfied with their work in comparison to other specialties(French, 2007). Finally, this study found only monthly income to be associated with a higher satisfaction with life among physician graduates of FOMKU. The value of such studies in the academic fields lies in the appropriately weighing the GPA score in regards of the competency of applicants. The variability of associated of each aspect in regards to med school GPA might also differ between different specialties or post-graduate degrees. This research Strengths and Limitations This study has strengths and some limitations to be considered when interpreting its results. The low sample size of 552 might be acceptable for a questionnaire study distributed to a limited population. This study is a cross-sectional one with a convenient sampling method, a limitation we faced due to the difficulty of reaching all graduates personally. In addition, our sample was found to be representable of FOMKU graduates in terms of descriptive characteristics such as distribution of gender and average grades; however, generalizing the data might vary depending on the country of comparison. The questionnaire used in this study is a self-formed measurement tool with clear and specific objectives constituting 5 sections (Appendix 1) and can be used for future comparisons or by other researchers who plan to implement the study on a different population. The data published about the topics we addressed is diverse and sparse and this work could add to the literature valuable information. Conclusion Performance in medical school as measured by GPA can predict several achievements for medical students such as a better progression through their medical career with a higher monthly income and higher career and life satisfaction. It, however, cannot predict the chances of pursuing post graduate studies or publishing research. Therefore, other factors have to be considered when trying to predict the chances of medical graduates in pursuing higher clinical or academic education; such factors include completion of specific programs targeting these objectives. Gender differences in terms of practicing internationally or completing a fellowship abroad can be diminished by social and financial support to female practitioners. Physician satisfaction influences patient care and work in the hospital setting and is affected by academic and career achievements as well as contextual factors and support teams. Declarations Conflicts of Interest All authors declare no conflicts of interest. Funding This project was funded by the Kuwait Association of Surgeons. References Albanese MA, Snow MH, Skochelak SE, Huggett KN, Farrell PM. Assessing personal qualities in medical school admissions. Acad Med. 2003;78(3):313-21. Amgad M, Man Kin Tsui M, Liptrott SJ, Shash E. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis . PLoS One . 2015;10(6):e0127470. Bedoya-Vaca R, Derose KP, Romero-Sandoval N. Gender and physician specialization and practice settings in Ecuador: a qualitative study. BMC Health Serv Res. 2016;16(1):662. Borman KR, Vick LR, Biester TW, Mitchell ME. Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery. J Am Coll Surg . 2008;206(5):782-8; discussion 8-9. Brancati FL, Mead LA, Levine DM, Martin D, Margolis S, Klag MJ. Early predictors of career achievement in academic medicine . 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Descriptive statistics for the study sample (categorical variables) Count % Gender Male 194 38.1% Female 315 61.9% Graduation year 2013 191 34.6% GPA Between 2 - 2.5 144 26.1% Between 2.5 - 3 275 49.8% Between 3 - 3.5 101 18.3% Between 3.5 - 4 32 5.8% Marital status Single 210 38.0% Married 327 59.2% Divorced 12 2.2% Widowed 3 0.5% Children No 261 47.3% Yes 291 52.7% Hospital Adan 86 15.6% Al-Sabah 61 11.1% Amiri 53 9.6% Farwaniya 82 14.9% Mubarak 102 18.5% Polyclinic 57 10.3% Other 111 20.1% Current Career Trainee 56 10.1% Assistant 149 27.0% Registrar 140 25.4% Senior 81 14.7% Specialist 34 6.2% Senior Specialist 23 4.2% Consultant 69 12.5% Monthly income Less than 2500 317 57.4% 2501-3500 76 13.8% 3501- 4500 86 15.6% 4501-5500 53 9.6% 5501-6500 20 3.6% More than 6500 0 0.0% Faculty Member No 523 94.7% Yes 29 5.3% Elective in medical school No 300 57.1% Yes 225 42.9% License exam No 301 54.5% Yes 251 45.5% Fellowship No 463 83.9% yes 89 16.1% Post-graduate study No 477 86.4% Yes 75 13.6% International practice No 489 88.6% Yes 63 11.4% Publication No 378 68.5% Yes 174 31.5% Table 2. Factors associated with GPA. OR Wald df Sig. LLCI ULCI Male 1.044 .064 1 .800 -.295 .383 Female Ref Post-graduate study (No) 1.009 .001 1 .972 -.500 .518 Post-graduate study (Yes) Ref international practice (No) 0.74 1.043 1 .307 -.900 .283 international practice (Yes) Ref Faculty member (No) 0.89 .100 1 .752 -.862 .623 Faculty member (Yes) Ref Fellowship (No) 0.46 7.921 1 .005 -1.318 -.236 Fellowship (Yes) Ref Publication (No) 1.01 .560 1 .454 -.232 .518 Publication (Yes) Ref LLCI: Lower limit of the 95% confidence interval ULCI: Upper limit of the 95% confidence interval OR: Odds ratio Appendix 1 Appendix 1 is not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3860391","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268464845,"identity":"6f4d8ded-b020-4dd7-ba0c-04be0ff80676","order_by":0,"name":"Rawan ElAbd","email":"","orcid":"","institution":"McGill University Health Center","correspondingAuthor":false,"prefix":"","firstName":"Rawan","middleName":"","lastName":"ElAbd","suffix":""},{"id":268464846,"identity":"4f3898c0-2e9e-4b08-918d-d9e2158897a6","order_by":1,"name":"Rashed AlShatti","email":"","orcid":"","institution":"Riyadh first cluster SCFHS","correspondingAuthor":false,"prefix":"","firstName":"Rashed","middleName":"","lastName":"AlShatti","suffix":""},{"id":268464847,"identity":"f37356ec-9472-48c7-9d5c-c37e44eb8394","order_by":2,"name":"Shamael Sultan","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Shamael","middleName":"","lastName":"Sultan","suffix":""},{"id":268464848,"identity":"45026f60-098d-4c07-ad87-e9438c85c539","order_by":3,"name":"Nawal AlOtaibi","email":"","orcid":"","institution":"University of British Colombia","correspondingAuthor":false,"prefix":"","firstName":"Nawal","middleName":"","lastName":"AlOtaibi","suffix":""},{"id":268464849,"identity":"574344a6-6204-4293-8fdc-89630a0d71bc","order_by":4,"name":"Salman AlSabah","email":"data:image/png;base64,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","orcid":"","institution":"Kuwait University","correspondingAuthor":true,"prefix":"","firstName":"Salman","middleName":"","lastName":"AlSabah","suffix":""}],"badges":[],"createdAt":"2024-01-13 14:29:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3860391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3860391/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50112450,"identity":"e22d1af2-8eaf-4390-b064-94748ae3326d","added_by":"auto","created_at":"2024-01-24 17:49:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41865,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation of GPA with achievement score (linear trend F = 36.902, P \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3860391/v1/5a457edbf92657351a00b741.jpg"},{"id":50112448,"identity":"dcd5c432-711c-4e5d-ae21-8af435b727fc","added_by":"auto","created_at":"2024-01-24 17:49:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43938,"visible":true,"origin":"","legend":"\u003cp\u003eMean satisfaction with progress across GPA levels (linear trend F=22.779, P \u0026lt;.000)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3860391/v1/7dd8c76ff090d2b7bf613c73.jpg"},{"id":50112449,"identity":"f8f115db-4353-4d2b-8b6d-eea637f0961a","added_by":"auto","created_at":"2024-01-24 17:49:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42639,"visible":true,"origin":"","legend":"\u003cp\u003eMean satisfaction with life across GPA levels (linear trend F = 4.073, P \u0026lt; 0.05)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3860391/v1/3ee8c858cba3f1ab2a20b2d8.jpg"},{"id":52844112,"identity":"0c4c7ff8-70d2-4acc-bf16-6cfb51ae60fc","added_by":"auto","created_at":"2024-03-17 16:07:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":402637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3860391/v1/96bf89e5-2f53-4586-b8ff-ab4a736bdd52.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMedical School Performance as Measured by GPA: What Can it Predict?\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePerformance of medical students attracts the attention of medical educators internationally. Applicants level of competence has to be measured in reliable and valid ways to assess students\u0026rsquo; learning experiences and develop a credible and defensible passing mark (Tavakol, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). For a long time, academic performance measured by grade point achievement (GPA) score has been used as a major criterion for both selection of medical students and residency program applicants as grades long served as an objective measure that predicts better outcomes (McManus, 2013; McManus, 2003; White, 2009).\u003c/p\u003e \u003cp\u003eAlthough some studies have previously shown that premed GPA can predict performance of the majority of medical students (White, 2009), the same concept might not be for post-graduate degrees. McManus et al reported that higher scores during medical school did not predict diploma or higher academic qualifications and research publications, as these were better correlated with personality traits (McManus, 2003). Thus, some medical educators argue that a heavy dependence on a medical school GPA could produce bias towards selection of students who might be more cognitively capable but lack essential non-cognitive traits that are vital for success (Shaw, 1995; Meredith, 1982; Rolfe, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Interestingly, when interviews are used to judge non-cognitive traits of applicants, GPA still was the best predictor of interviewer rating (Shaw, 1995); however, basing selection on judgement of specific traits is difficult as it can result in the unfair exclusion of applicant based on gender, ethnic, or social background (Fernando, 2003; Streyffeler, 2005; Albanese, 2003).\u003c/p\u003e \u003cp\u003eThe Faculty of Medicine of Kuwait University (FOMKU) follows an integrative and problem-based learning system. It was established in 1973 and offers a seven-year medical program, enrolling a total of around 655 students. It remains the only medical school in Kuwait. Teaching follows an integrative system-based and problem-based learning system. The first part covers basic sciences and major integrative clinical system studies, after which students are awarded a Bachelor of Biomedical Sciences. This is followed by 3 years of focus on clinical system learnt mainly through problem based component and clinical rotations. Assessment in FOMKU relies on Multiple Choice Question (MCQ) examination, Objective Structured Clinical Examinations (OSCE), Objective Structured Practical Examinations (OSPE), and oral interview examinations.\u003c/p\u003e \u003cp\u003eThe aim of our study is to assess if there is an association between graduation GPA and factors like: demographic characteristics, continuing education, current monthly income, career progress, and rating score on personal satisfaction with life and career progress. This study also briefly investigates the role of gender on international medical practice or doing a fellowship abroad and touches on the effect of specialization with satisfaction in career progress.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample and Data Collection\u003c/h2\u003e \u003cp\u003eOur target population was all graduates from FOMKU. We were provided with a full list of names of the graduates since the establishment to 2017. There were 2250 graduates, 754 graduates from 1974 to 1999 and 1496 graduates from 2000 to 2017. Sampling method followed a convenient sample strategy. Participants were contacted depending on availability either directly face to face, by messages, or through phone calls. Of all these methods, electronic messages were more convenient and successful. We introduced ourselves and gained consent through these messages. Then, an electronic questionnaire was used for data collection was sent through a message that were sent to the participants\u0026rsquo; phone number. The questionnaire had four sections: the consent, sociodemographic data, medical school information, and academic or clinical accomplishments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCareer Progress Scoring\u003c/h2\u003e \u003cp\u003eWe developed a career progress score for each participant that awards one for each of the following: being a faculty member, doing international license examination, pursuing a fellowship, having a Master or PhD degree, practicing internationally, having at least 1 publication, having a monthly income\u0026thinsp;\u0026gt;\u0026thinsp;4500 Kuwaiti Dinars, scoring a satisfaction with career progress score\u0026thinsp;\u0026gt;\u0026thinsp;7 out of 10, and scoring a satisfaction with life score\u0026thinsp;\u0026gt;\u0026thinsp;7 out of 10. The maximum possible score was 9. The aim of this score was to simplify the assessment of those components on an objective matter.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS v 25. Descriptive statistics were performed using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables and counts and percentages for categorical. ANOVA and unpaired t-test were used to assess the association of categorical variables with dependent variables. Three main dependent variables were used in the current analysis: satisfaction with life, satisfaction with progress, and achievement (career progress) score. One-way ANOVA was used to assess the association between GPA and overall career progress score. Ordinal regression was used to assess whether demographic characteristics, education, and career progress were significantly associated with GPA. One-way ANOVA was also used to assess whether satisfaction with life and progress were significantly associated with specialty.\u003c/p\u003e \u003cp\u003eLinear regression analysis was used to assess the association of GPA with the first two dependent variables after adjusting for covariates. The main covariates adjusted for in the model were age, monthly income, marital status, children, license exam, international practice, license, hospital, fellowship, and specialization. All variables were inserted initially in the model. Backward stepwise elimination of variables (based on the change in R2) was performed to eliminate non-significant variables. GPA and monthly income were used as ordinal variables rather than categorical variables as we were interested in the overall increasing effect of GPA and income on satisfaction with life and progress rather than the relation of higher levels to a reference category. Hypothesis testing was performed at 5% level of significance.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical approval\u003c/h3\u003e\n\u003cp\u003eThis study was approved by the ethics committees of Kuwait University and the Ministry of Health. Each participant signed the informed consent form, and all information was only accessible for the researchers.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eDescriptive Statistics\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics is presented in Table 1. The average age of the included participants was 33.31 \u0026plusmn; 8.39 years. Females constituted 62% of our sample. Thirty-three percent of the participants specialized in medicine, 13 % specialized in pediatrics, and 17% specialized in surgery, and the remaining were of a variety of specialties. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation of age and gender with satisfaction scores.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSatisfaction with life and progress scores were not statistically different between males and females (P = 0.267, and 0.88, respectively). Higher age was associated with higher satisfaction with progress (r = 0.287, P \u0026lt; 0.001) and life (r = 0.136, P = 0.001). In fact, there was a statistically significant positive correlation between satisfaction with life and satisfaction with progress (r = 0.554, P \u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation of GPA with satisfaction scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults show a statistically significant difference in the average levels of satisfaction with progress (F = 7.991, P \u0026lt; 0.001) and life (F = 2.599, P = 0.05) scores between the four GPA groups and a statistically significant linear trend in the association between GPA and satisfaction with progress and life (Figure 2-3) i.e. higher GPA is associated with higher levels of satisfaction with progress and life. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between monthly income with GPA and satisfaction scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher monthly income was associated with higher GPA (linear trend F = 19.525, P\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eMonthly income was positively associated with satisfaction with progress (r = 0.408, P \u0026lt; 0.001) and satisfaction with life (r = 0.257, P \u0026lt; 0.001). A linear trend has been noticed for both respectively (F = 54.732, P \u0026lt; 0.001, F = 19.525, P \u0026lt; 0.001). \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation of demographic characteristics, education, and career progress with GPA \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOrdinal regression was used to assess whether demographic characteristics, education, and career progress were significantly associated with GPA. Results showed that pursuing a fellowship (OR = 0.46, P \u0026lt; 0.05) was significantly associated with GPA. The odds of being in a higher GPA category compared to the lower category/ies were 54% lower in participants that did not complete a fellowship compared to those that did. Completing a post-graduate study did not show a statistically significantly association with GPA (OR = 1.009, P \u0026gt; 0.05). International practice (OR = 0.74, P \u0026gt; 0.05) and having publications (OR = 1.01, P \u0026gt; 0.05) did not show a statistically significant association with GPA. Being a faculty member did not have an association with GPA (OR = 0.89, P \u0026gt; 0.05). Results showed that participants who did electives during their undergraduate years were more likely to practice internationally compared to participants who did not (17.7% vs. 6.9%, P \u0026lt; 0.001). Gender did not show a statistically significant association with pursuing a fellowship or practicing internationally (Table 2).\u003c/p\u003e\n\u003cp\u003eWhen it comes to the association between GPA and career progress, initial exploratory analysis (Figure 1) showed that the average achievement score was higher in participants with a GPA of 3.5-4 compared to the remaining three groups; the observed difference between groups was statistically significant (P \u0026lt; 0.001). Results also showed that there was a statistically significant linear trend in the association between GPA and career progress score i.e. higher GPA is associated with higher career score.\u003c/p\u003e\n\u003ch3\u003eLinear Regression Model\u003c/h3\u003e\n\u003cp\u003eUnivariate analysis reveals the factors that can be used in the multivariate analysis by exploring the distribution and associations between variables. Our findings showed that gender did not show a statistically significant association with satisfaction with life or progress. The strongest predictors of satisfaction with life and progress were GPA, monthly income, and current career status. Older age was also associated with higher levels of satisfaction. Due to the high correlation between age, and year of graduation, only one of them will be used for the multivariate analysis. Similarly, current career was associated, to a high extent, with monthly income. Thus, only monthly income would be used for linear regression analysis.\u003c/p\u003e\n\u003cp\u003eIn the linear regression analysis model, six variables: international practice, faculty affiliation, elective during undergraduates years, GPA, monthly income, and fellowship were identified as predictors of satisfaction with progress when linear regression analysis was used. The final model explained 19.3% in the dependent variable (satisfaction with progress). The model explained a statistically significant portion of the variance in the dependent variable compared to the null model (F = 22.92, P \u0026lt; 0.001). Table 10 shows the final regression model coefficients for factors associated with satisfaction with progress score. GPA showed a statistically significant positive association with satisfaction with progress (\u0026beta; = 0.21, P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe average levels of satisfaction were higher by 0.672 points in faculty members compared to non-faculty members (\u0026beta; = 0.672, P \u0026lt; 0.1) although the association was significant at the 0.1 level rather than the conventional 0.05 level. Participants who practiced internationally had higher average levels of satisfaction compared to those who did not practice internationally (\u0026beta; = 0.565, P \u0026lt; 0.05). Similarly, participants who did electives during undergraduate years had significantly higher levels of satisfaction compared to other participants (\u0026beta; = 0.43, P \u0026lt; 0.05). Finally, participants who did a fellowship had significantly higher levels of satisfaction compared to participants who did not do a fellowship (\u0026beta; = 0.486, P \u0026lt; 0.1) although the association was significant at the 0.1 level rather than the conventional 0.05 level.\u003c/p\u003e\n\u003cp\u003eOnly one variable was identified as a predictor of satisfaction with life score (monthly income) when linear regression analysis was used. Monthly income showed a statistically significant association with satisfaction with life (\u0026beta; = 0.376, P \u0026lt; 0.001) which indicates that the average satisfaction with life increases by 0.376 points for each 1 category increase in monthly income.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study we investigated the association of the GPA after graduating from medical school with post graduate achievements and physician career progress with a sample size of 552 and found that higher GPA is associated with pursuing a clinical fellowship post-graduation, having a higher monthly income, scoring higher on career progress score (P \u0026lt; 0.001), and higher score on personal satisfaction with career progress and satisfaction with life scores (P \u0026lt; 0.05). This means that students with higher GPA are not only more likely to achieve a better career outcome, but also destined to report higher satisfaction with their career progress and life in general. As a matter of fact, the literature lacks studies with coinciding objectives to ours, but Puddey et al. reported that GPA at entry to medical school to be predictive of outcomes in the early stages and throughout the course of a graduate-entry medical program (Puddey, 2014), which, altogether, implicate GPA, as a measure of academic competence, to correlate with superior performance during medical school and better progress within the medical field after graduation and can contribute to a positive perspective on life as measured by satisfaction with life score.\u003c/p\u003e\n\u003cp\u003eOn the other hand, this study finds that higher GPA was not associated with being a faculty member or pursuing post graduate studies like masters or PhD. This is similar to what McManus et al. described that higher medical school scores did not predict diploma or higher academic qualifications or research publications (McManus, 2003). In contrast, Kuzman et al. recited that medical school grades of today\u0026apos;s professors at the Zagreb University School of Medicine could serve as predictors of their subsequent academic success; their results revealed that professors were above-average students and their grades seem to be important predictors of future success in academic career (Kuzman, 2004). Furthermore, Broncati et al., who conducted a longitudinal cohort study on 944 physicians, found that the top 3 students in their class were more likely to choose an academic career (relative risk 2.68, p \u0026lt;.001). It is plausible that the difference observed in the literature could be explained by the different requirements of faculties around the world in recruitment of its physician academic staff. In Kuwait for example, a physician must have completed their residency abroad in an accredited program to be suitable for admission in academia. Carr et al. noticed that GPA at the completion of undergraduate studies had the most significant association with better performance on the overall Junior Doctor Assessment Tool (JDAT); that is performance on integrated assessments from medical school is correlated to performance as a practicing physician (Carr, 2018).\u003c/p\u003e\n\u003cp\u003ePhysician-researchers continue to have a crucial role in developing and reforming different aspects in medicine, either through scientific research or that on medical education. The factors associated with being a researcher are of interest. In this study we investigated the effect of academic performance and found that GPA is not associated with having research publications; however, it is important to state that our measurement was either binomial as in yes (ever published) or no (never published). This measurement was due to the fact that most, if not all, of our study participants who were involved in research had one publication. A meta-analysis by Amgad et al.(Amgad, 2015) reported similar results by finding no association between academic success and involvement in research as evidenced by a pooled odds ratio from 4 published studies (OR= 1.00, 0.62-1.64). However, in the literature, Hren et al., who studied the association of GPA with attitudes towards research on 932 medical students in Zagreb University in Croatia, found that students with higher GPA were 1.8 times more likely to have higher attitude scores towards research than students with lower GPA (Hren, 2004). Even more, Brancati et al.( Brancati, 1992) found that students with better academic performance were more likely to have citations to their published work (p \u0026lt;.05). The conflicting results in the literature necessitates more studies on the topic. Wong et al.(Wong, 2016) have published interesting work on factors associated with developing more physician-scientists and found that a training program at the level of specialty training effectively enhances the chances of such as more than 80% of the program graduates were conducting research throughout their career. \u003c/p\u003e\n\u003cp\u003eIn Kuwait, the proportion of female medical students and graduates outnumber their male counterpart for the previous couple of years as evidenced by our descriptive table where 62% of graduates are female as compared to 38% males. When it comes to gender, our study found that it was not associated with doing a fellowship abroad or practicing internationally (P \u0026gt; 0.05); that is, women are as likely as men to do a fellowship abroad or have international practice. This is an important finding in our study as women in the medical field could face more challenges, although Cohen-Schotanus et al. reported women to be better performers on clinical competence than men (Cohen-Schotanus, 2008). Borman et al.(Borman, 2008) studied more than 11,000 surgical residents and found the number of women pursuing a fellowship to be doubled from 1993 to 2005 with a greater increase (58 to 75%) than men (67 to 78%). Riska et al.(Riska, 2011) also studied the effect of gender on medical career and concluded that although women medical students and residents still confront obstacles in terms of their career progress, they are more career-oriented than before and their male counterparts are more considerate towards their lifestyle than previously, which is bringing balance to the gender discrepancy equation. Bedoya-Vaca et al.(Bedoya-Vaca, 2016) published their work on a qualitative study examining the effect of gender on pursuing residency training abroad and found that women with children and of low socio-economic class are less likely to practice a desired specialty abroad, however, those of a higher social class, were found to have more opportunities as they can afford high quality child care and pay for residency. This is relevant to our study as in Kuwait, most, if not all, medical graduates who plan to continue their education abroad are fully funded by the government and are given childcare support in terms of child schooling, minimizing their limitations. \u003c/p\u003e\n\u003cp\u003eThe wellness of physicians depends in part by their satisfaction, which is associated with many health care outcomes ranging from health care quality to patient satisfaction and compliance(Wallace, 2009). The factors that result in physician satisfaction are not clear in the literature (Wallace, 2009; Smith, 2001). Many factors in this study were found to predict physician satisfaction with career; these are having had a high GPA or having done an elective, having a higher monthly income, being a faculty member, practicing internationally, or pursuing a fellowship. It is hard to do a direct comparison between studies in the literature as the definition of satisfaction was different among different studies. Schmit et al. (Schmit, 2014), for example, assessed the influence of achievement before, during, and after medical school on physician job satisfaction using a 10-point scale and found that prior achievements influenced job satisfaction: higher achievers before and during medical school were more satisfied about their income and professional accomplishments (p \u0026lt; .05). A systematic review on European data carried out by Domagala et al. (Domagała, 2018), found contextual factors, professional development, and support teams to be significant predictors of physician satisfaction. Our study found that only pediatric specialty was significantly associated with higher satisfaction progress score. This is similar to what French et al. reported regarding determinants of job satisfaction with staff in pediatrics, laboratory medicine, and radiology being likely to be more satisfied with their work in comparison to other specialties(French, 2007). Finally, this study found only monthly income to be associated with a higher satisfaction with life among physician graduates of FOMKU.\u003c/p\u003e\n\u003cp\u003eThe value of such studies in the academic fields lies in the appropriately weighing the GPA score in regards of the competency of applicants. The variability of associated of each aspect in regards to med school GPA might also differ between different specialties or post-graduate degrees. This research\u003c/p\u003e\n\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\n\u003cp\u003eThis study has strengths and some limitations to be considered when interpreting its results. The low sample size of 552 might be acceptable for a questionnaire study distributed to a limited population. This study is a cross-sectional one with a convenient sampling method, a limitation we faced due to the difficulty of reaching all graduates personally. In addition, our sample was found to be representable of FOMKU graduates in terms of descriptive characteristics such as distribution of gender and average grades; however, generalizing the data might vary depending on the country of comparison. The questionnaire used in this study is a self-formed measurement tool with clear and specific objectives constituting 5 sections (Appendix 1) and can be used for future comparisons or by other researchers who plan to implement the study on a different population. The data published about the topics we addressed is diverse and sparse and this work could add to the literature valuable information.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePerformance in medical school as measured by GPA can predict several achievements for medical students such as a better progression through their medical career with a higher monthly income and higher career and life satisfaction. It, however, cannot predict the chances of pursuing post graduate studies or publishing research. Therefore, other factors have to be considered when trying to predict the chances of medical graduates in pursuing higher clinical or academic education; such factors include completion of specific programs targeting these objectives. Gender differences in terms of practicing internationally or completing a fellowship abroad can be diminished by social and financial support to female practitioners. Physician satisfaction influences patient care and work in the hospital setting and is affected by academic and career achievements as well as contextual factors and support teams.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eConflicts of Interest\u003c/h3\u003e\n\u003cp\u003eAll authors declare no conflicts of interest.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThis project was funded by the Kuwait Association of Surgeons.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlbanese MA, Snow MH, Skochelak SE, Huggett KN, Farrell PM. Assessing personal qualities in medical school admissions. \u003cem\u003eAcad Med.\u003c/em\u003e 2003;78(3):313-21.\u003c/li\u003e\n\u003cli\u003eAmgad M, Man Kin Tsui M, Liptrott SJ, Shash E. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis\u003cem\u003e. 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J Grad Med Educ\u003c/em\u003e. 2016;8(1):85-90.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e1\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e.\u003c/u\u003e\u003c/strong\u003e Descriptive statistics\u0026nbsp;for the study sample (categorical variables)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"416\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"73.5576923076923%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"bottom\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e38.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e61.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eGraduation year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e31.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e2009 \u0026ndash; 2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e34.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; 2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e34.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eGPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eBetween 2 - 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e26.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eBetween 2.5 - 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e49.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eBetween 3 - 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e18.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eBetween 3.5 - 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e38.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e59.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eChildren\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e47.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e52.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eAdan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e15.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eAl-Sabah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e11.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eAmiri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e9.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eFarwaniya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e14.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eMubarak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e18.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003ePolyclinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e10.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e20.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eCurrent Career\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eTrainee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e10.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eAssistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e27.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eRegistrar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e25.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eSpecialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e6.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eSenior Specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eConsultant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eMonthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eLess than 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e57.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e2501-3500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e13.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e3501- 4500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e15.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e4501-5500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e9.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e5501-6500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eMore than 6500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFaculty Member\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e94.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eElective in medical school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e57.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e42.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLicense exam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e83.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e16.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePost-graduate study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e86.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e13.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInternational practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e88.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e11.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePublication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.86538461538461%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.096153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e68.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15%\" valign=\"top\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e31.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2.\u003c/u\u003e\u003c/strong\u003e Factors associated with GPA.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"571\" style=\"margin-right: calc(33%); width: 67%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"bottom\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"bottom\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e1.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e.383\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003ePost-graduate study (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e1.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003ePost-graduate study (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003einternational practice (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003einternational practice (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eFaculty member (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eFaculty member (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eFellowship (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e7.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-1.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e-.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003eFellowship (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003ePublication (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e-.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.596491228070175%\" valign=\"top\" style=\"width: 19.8864%;\"\u003e\n \u003cp\u003ePublication (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.701754385964913%\" valign=\"top\" style=\"width: 7.4574%;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\" style=\"width: 7.3331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 10.1918%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.56140350877193%\" valign=\"top\" style=\"width: 6.5849%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"99.82486865148861%\" colspan=\"7\" valign=\"top\" style=\"width: 69.3537%;\"\u003e\n \u003cp\u003eLLCI: Lower limit of the 95% confidence interval\u003c/p\u003e\n \u003cp\u003eULCI: Upper limit of the 95% confidence interval\u003c/p\u003e\n \u003cp\u003eOR: Odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Appendix 1","content":"\u003cp\u003eAppendix 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kuwait, medical school, GPA, education, progress","lastPublishedDoi":"10.21203/rs.3.rs-3860391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3860391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical graduates' performance has been an area of interest for medical educators internationally. The objectivity of such measures has made it an essential part in evaluation of applicants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of our study is to examine the prognostic value of medical school graduation GPA in relation to post-graduation achievements and success.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used an online questionnaire sent to Kuwait university's graduates, whether directly face to face, by messages, or phone calls. The electronic questionnaire consisted of three major area, sociodemographic, medical school GPA, and academic or clinical achievements. The results have been statistically analyzed using satisfaction with life, satisfaction with career, and career progress as dependent variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 552 physicians who graduated from 1983 to 2017 took part in this study. The mean age was 33.31 ± 8.39 years. The highest percentage of participant (33%) were specialized in internal medicine. A higher GPA was found to be associated with pursuing postgraduate clinical fellowship, earning higher monthly income, higher career progress score, and scoring higher personal satisfaction with progress and life scores. Higher GPA was not associated with being a faculty member, pursuing post graduate academic studies like master's degree and doctor of philosophy, practicing internationally, or having publications. Gender was not associated with doing a fellowship or practicing internationally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical school performance, measured by GPA, might predict higher career progress, having higher monthly income, and satisfaction. However, it is not necessarily prognostic for pursuing postgraduate academic degrees, practicing internationally, or having research publications.\u003c/p\u003e","manuscriptTitle":"Medical School Performance as Measured by GPA: What Can it Predict?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-24 17:49:32","doi":"10.21203/rs.3.rs-3860391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f49b5004-9fbf-4a42-b782-e290f1c1e0c2","owner":[],"postedDate":"January 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-17T15:59:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-24 17:49:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3860391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3860391","identity":"rs-3860391","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}