Cause or effect? The relationship between student perception of the medical school learning environment and academic performance on USMLE Step 1.

BACKGROUND: A school's learning environment is believed to influence academic performance yet few studies have evaluated this association controlling for prior academic ability, an important factor since students who do well in school tend to rate their school's environment more highly than students who are less academically strong. AIM: To evaluate the effect of student perception of the learning environment on their performance on a standardized licensing test while controlling for prior academic ability.
METHODS: We measured perception of the learning environment after the first year of medical school in 267 students from five consecutive classes and related that measure to performance on United States Medical Licensing Examination (USMLE) Step 1, taken approximately six months later. We controlled for prior academic performance by including Medical College Admission Test score and undergraduate grade point average in linear regression models.
RESULTS: Three of the five learning environment subscales were statistically associated with Step 1 performance (p < 0.05): meaningful learning environment, emotional climate, and student-student interaction. A one-point increase in the rating of the subscales (scale of 1-4) was associated with increases of 6.8, 6.6, and 4.8 points on the Step 1 exam.
CONCLUSION: Our findings provide some evidence for the widely held assumption that a positively perceived learning environment contributes to better academic performance.