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

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