Admission Exam and Preparatory Year Scores’ Association with Performance in Basic Science Courses in Health Science Colleges

Aliaa Amr Alamoudi (  aaalamoudi2@kau.edu.sa ) King Abdulaziz University https://orcid.org/0000-0001-5428-8853 Hind Ibrahim Falattah King Abdulaziz University Faculty of Medicine Basmah Medhat Eldakhakhny King Abdulaziz University Faculty of Medicine https://orcid.org/0000-0002-6962-5848 Fatemah Omar kamel King Abdulaziz University Faculty of Medicine Lana Adey AlSawwa King Abdulaziz University Faculty of Medicine Ayman Zaky Elsamanoudy King Abdulaziz University Faculty of Medicine


Background
Pre-admission criteria have been introduced in medical schools and health sciences colleges worldwide to help enroll students with the highest standards that are more likely to succeed in the eld (1)(2)(3). Such criteria are often in the form of academic achievement such as cumulative high school scores, and achievement tests set to assess cumulative knowledge acquired throughout the nal years in school. Other cognitive tests that can measure analytical, deductive, and problem-solving skills, in addition to non-cognitive performances such as multiple mini-interview (MMI), are also usually involved in various medical schools (1)(2)(3). The weight given to each criterion is different between various medical and health sciences schools and remains to be under continuous assessment and development to ensure a meticulous ltration with a growing number of applicants.
In Saudi Arabia, medical and health science schools are no different and depend on pre-admission variables in their students' selection. These include the cumulative high school average, the Scholastic Achievement Admission Test (SAAT) (known as Tahsili), and the General Aptitude Test (GAT) (known as Qudrat). In addition to the mentioned criteria, in King Abdulaziz University (KAU), students need to nish a preparatory year before being able to enroll in their selected colleges. After nishing all preparatory year courses, students can choose to apply to their desired colleges if their GPA (which is calculated based on a speci c formula) achieves the requirements of the selected college. In the recent years, there has been much controversy on whether the preparatory year achieves some of its goals such as adjust admission to guide students to the appropriate college that matches students' abilities and skills, and prepare students for their subsequent colleges. Furthermore, this has been the trigger for the call of establishing more de ned tracks in the preparatory year, such as a health colleges' track. In addition, there has been great interest in assigning weights on non-academic assessments such as the current MMI.
A few studies, the majority being in Riyadh, have evaluated the predictive validity of the Saudi national pre-admission criteria (cumulative high school average, SAAT, GAT) on health science or medical students' performance (4)(5)(6). This was done through assessing the cumulative GPA whether during their early performance in the rst semester or at the end of their pre clinical and/or clinical years. To date, however, there have been no published studies investigating the role of KAU preparatory year for predicting academic success in health science colleges or speci cally for predicting success in basic science courses given during the early years of colleges.
The aim of this study was to assess the correlation of admission criteria (the SAAT and GAT exams) to health science colleges, in addition to the preparatory year GPA, with academic performance in the basic science subjects such as Clinical Biochemistry and Clinical Pharmacology.

Methods
The study was performed in KAU and included second-year Nursing students, Faculty of Nursing, and second-year Clinical Nutrition(C. Nutrition) students, Faculty of Applied Medical Sciences. The study included data of four cohorts; two faculty of nursing cohorts; Nursing students (2017-2018) referred to as Nursing 1 (n = 146 ), Nursing students (2018-2019) referred to as Nursing 2 (n = 81), and two faculty of applied medical sciences cohorts, C.Nutrition students (2017-2018) referred to as C.Nutrition 1(n = 33), C.Nutrition students (2018-2019) referred to as C.Nutrition 2 (n = 28). All students were female as there are no male students in either faculty.
The students' scores of GAT, SAAT, and preparatory year GPA were all recorded at the beginning of each semester before the beginning of courses. Clinical Biochemistry and Clinical Pharmacology exam results were recorded at the end of the semester. A summary of the exams is mentioned in the sections below.
General Aptitude Test: The GAT was established to use mathematical and verbal skills to measure:1-Reading comprehension,2-Logical relations,3-Problem solving skills,4-Inductive skills ,5-Deductive skills. The test is scored out of 120 and is divided verbal and quantitative questions (Table 1). Overall, the test aims to measure the student's capacity for learning in general rather than measuring a speci c skill required for speci c topics or elds.
Students are allowed to take GAT more than once. However, it is expected that students' scores do not change drastically with further trials. In addition, students can use any of the GAT scores obtained to apply for university.

Scholastic Achievement Admission Test (SAAT)
The SAAT test measures the overall achievement of students during their education journey.

Clinical Biochemistry Course and exam
During their second year, both groups receive the same course of Clinical Biochemistry (BCHM 207) during their rst semester, which covers basic cell metabolism, bioenergetics, and molecular biology. The course is given in the form of traditional lectures, tutorials and practical sessions. The 100 nal score is divided between; two quizzes, a practical exam, and a nal exam. All exam questions were in the form of MCQs that are divided into recall questions (70%) and reasoning questions (30%).

Clinical Pharmacology
Third-year nursing students were divided into two groups; both groups received the same course of Pharmacology (PHAN311) during their rst semester. The course consists of general pharmacology, autonomic nervous system, cardiovascular, renal, endocrine systems and autacoid. Students learned about: how drugs act on the covered systems, the use of the drug in treating various diseases, its adverse effects and possible interactions with other drugs taken at the same time. The course was given in the form of scheduled lectures, self-directed learning, and tutorials, which ensure smooth ow of the scienti c material, in a controlled manner, through several pathways to achieve course objectives. The 100 nal scores was divided between; mid-block exam, assignment, and a nal exam. All exam questions were in the form of MCQs that are divided into recall questions (70%) and reasoning questions (30%).

Statistical analysis
All analysis was carried out using GraphPad Prism Version 8.3.1 (332). Descriptive analyses were described as mean ± standard deviation (SD), minimum and maximum scores. Analysis of variance (ANOVA) with post hoc test was used for testing the signi cance between groups. Pearson correlation coe cient was used to assess the correlation between the different exam results. p < 0.05 was taken as a cut off value for signi cance.

Results
Preparatory year GPA, GAT, SAAT, and Clinical Biochemistry results in all cohorts.
Descriptive statistics of all four cohorts are described in Table 2. There was no signi cant difference between the Preparatory year GPA between the two Nursing cohorts, or the two C.Nutrition cohorts Fig. 1. However, C.Nutrition cohorts showed a signi cantly higher GPA than the Nursing groups Fig. 1

Discussion
In medical and health science schools, the selection of the right students is considered a challenge that requires a lot of prerequisites and efforts. El Says et al., [7] summarized the admission requirement and speci ed the importance of each requirement regarding the Faculty of Medicine-KAU (FOM-KAU). Students' scores in high school, standard achievement admission tests (SAAT and GAT), as well as their scores in preparatory year, are the measures that can evaluate the cognitive skill of students. GAT is speci cally designed to evaluate the student's general characteristics and gained abilities. GAT also measures the learned skills in critical thinking and the ability of non-verbal problem solving and re ections. On the other hand, SAAT is designed to measure the overall achievement of students during their education journey. Finally, multiple mini-interviews (MMIs) come to assess the non-cognitive aptitude since MMIs can measure some importantly required personal capabilities like professionalism, empathy, and communication skills (7,8).
Whether these tests and prerequisites for selecting the students to health science schools predict their academic achievement remains to be questionable. Hence, this study aimed rstly to assess the correlation of admission exams (the SAAT and GAT exams) to health science colleges and preparatory years scores in KAU, with academic performance in the basic science subjects such as Clinical Biochemistry and Clinical Pharmacology.
The current study revealed a signi cant positive correlation between SAAT and GAT results in the programs of the study (Nursing 1& 2 and C.Nutrition 1&2). SAAT and GAT are the eligibility tests that are documented in Saudi Arabia for science and health science schools. These tests are carried out by the National Centre for Assessment in Higher Education (NCAHE)-Ministry of Education. The type and procedure of this fair assessments are MCQ exams, which can be taken as a maximum of three attempts with the best score of those three considered for students' admission. This procedure could allow a fair evaluation of the students at all levels of education.
Moreover, it is considered an effective eligibility examination for the university graduation programs (9). It is therefore logical to nd a signi cant positive correlation between SAAT and GAT for students, as documented in the current study. This correlation was also previously reported by Alnahdi (10), and Al-Qahtani & Alanzi (11).
Moreover, in the current study, there was no signi cant correlation between their admission exams scores and the students 'academic achievement in Clinical Pharmacology, and with only a weak correlation detected between SAAT and the overall achievement in Clinical Biochemistry.
The predictive value of standardized admission tests scores for academic achievements remains to be controversial and a matter of debate in several institutes worldwide. Many studies have reported opposing results to the results of the current study as they've reported predictive values of standardized admission tests with academic performance in Nursing (12)(13)(14). However, non-conclusive and con icting ndings between these standardized admission tests and the students' college performance in Saudi Arabia (6) India, and Canada (15) were also reported. All of these studies presented no relationship between the scores of the eligibility tests and the overall students' academic performance, which matches the ndings of the current study. This could be explained by the fact that teaching methods and assessment plans in the university programs (Nursing and C.Nutrition programs in the current study) are entirely different from that of the high school. The high school teaching strategy depends mainly on the students' ability to recall data and knowledge while our programs aim at using different teaching and assessment strategies that depend on cognitive achievement rather than recall, such as practical and clinical application, analysis, and critical thinking, scienti c problem solving as well as synthesis abilities. Such competencies are usually not fully covered in high schools and might be poorly assessed by the already used eligibility tests, which support the explanations that are previously stated in the literature (10,11). Moreover, some non-academic competencies are gained in university programs rather than in high schools. These include leadership, communication skills, community and social services, and interpersonal and teamwork activities (16). All of these competencies are extracurricular activities that motivate students and enhance their academic achievement and are usually part of the overall assessments in medical and health science schools in KAU.
In this study, a signi cant positive correlation between the overall results of Clinical Biochemistry and that of Clinical Pharmacology is a prominent nding. This result can be explained by the fact that both departments use nearly similar instructional methods and teaching strategies (traditional lecturing, problem-based learning, mini-projects, and students directed learning activities) and follow the same protocols of assessment. Consequently, a positive correlation between the overall results of both (Clinical Biochemistry and that of the Clinical Pharmacology) is a logical nding of the current study.
Given the lack of previous studies in KAU on the matter, investigating the possible correlation between the preparatory year GPA with academic performance in our basic science subjects was our second aim in this study, and indeed no signi cant correlation was found.
The preparatory year in Saudi universities, including KAU aims to be an educational program that lasts for two semesters. The objectives of the preparatory year are not for purely educational purposes only but also aim to prepare university students at the social, psychological, and cultural levels. It aims to enable them for skillful communication and self-learning ability Despite these valuable objectives, students' satisfaction with the preparatory year is below expected (17). This lack of satisfaction could be explained by the interplay of students, faculty, and program-related factors (17,18). Consequently, failure to meet students' expectations and achievement of the program objectives is the overall result, which leads to a negative impact on students. This can also result in its failure to be a predictive indicator of students' academic achievement later on in the subsequent university years, which was seen in our current study. Overall these results could also validate the need for various tracks and programs in KAU preparatory year, which could serve the different colleges' needs and competencies rather than having a general program for all science colleges.

Conclusion
In this study, our results show that admission tests and preparatory year scores are not predictive of academic performance in basic science courses in health science colleges. This could indicate the need to revisit the admission criteria for these colleges. In recent years with the founding of the National Commission for Academic Accreditation and Assessment (NCAAA) center, which aims at contributing to the enhancement of quality and excellence in higher education institutions through evaluation and accreditation, there has been a shift in teaching and assessment strategies in health science colleges.
More competencies and learning outcomes are being required from graduate students of these colleges. It is, therefore important that cognitive and non-cognitive admission instruments can assess these competencies. Furthermore, speci c preparatory year tracks for health science colleges can ensure that students improve the speci c skills and knowledge required for their future college years.  Error bars represents mean and SD. **** represents P<0.0001 between Nursing 1 and C. Nutrition 1 & 2, and Nursing 2 and C. Nutrition 2 .*** represents P<0.001 between Nursing 2 and C. Nutrition 1.