Date of Award

December 2020

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Higher Education


Catherine M. Engstrom


Conscientiousness, Grit, medical education, Medical school success, Non-cognitive variables, USMLE Step 2 CK

Subject Categories



In an effort to consider additional or alternative variables that predict medical school success and to better identify qualified and more diverse medical school candidates to serve their communities, this study investigated the impact of two noncognitive traits, conscientiousness and grit, on the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) national examination. The assessment used to measure conscientiousness was Costa and McCrae’s (1992) NEO-FFI-3 and the assessment used to measure grit was Duckworth and Quinn’s (2009) Grit S scale. This study also examined the correlation of sociodemographic (gender, age, race/ethnicity, socioeconomic background, and first-generation college status) and academic variables (undergraduate major, undergraduate science GPA, MCAT scores, and master’s degrees and post-baccalaureate coursework) on USMLE Step 2 CK performance. The conceptual framework that informed this study was Sternberg’s (1999) theory of successful intelligence which considers life circumstances and individual strengths to achieve one’s goals. Additionally, Yosso’s (2005) cultural wealth theory emphasized the need to consider variables that recognized the talents, strengths, and experiences that underrepresented students bring with them to educational environments. The sample eligible for this study was from two cohorts of medical students from Northeast Medical University, a public college of medicine, located in an urban city of approximately 150,000 people. The College of Medicine is the largest of four colleges that comprise a comprehensive academic medical center. At the time of this study there was approximately 666 students enrolled in Northeast Medical University’s College of Medicine. One hundred and ninety-two students (N = 192) participated in this study. Students completed both instruments (the NEO-FFI-3 at the point of admission and the Grit-S during their clinical years of medical school). Sociodemographic and prior academic information were retrieved from participant medical school application. The relationship among these variables on the dependent variable, USMLE Step 2 CK, were assessed using descriptive and multivariate statistical analysis. The grit and conscientiousness variables were then regressed on the USMLE Step 2 CK national examination scores. The results of this study demonstrated that participants from higher socio-economic backgrounds (p = .023), those from educated families (p = .046), males (p = .040), White/Asian students (p < .001), and those under the age of 26 (p = .011) performed significantly higher than their peers on the USMLE Step 2 CK. Findings indicated that prior college undergraduate science GPAs (p < .001) and MCAT percentile scores (p < .001) were significantly predictive of Step 2 CK performance, with moderate effect sizes (r = .335, r = .378) respectively. The magnitude of the effect sizes within this study were likely impacted by the small sample size (Slavin & Smith, 2009; Turner, Paul, Miller, & Barbey, 2018) and also by the lack of persistence of those deemed ineligible for participation in this study. Conscientiousness was shown to be significantly predictive of USMLE Step 2 CK (p = 0.002) and also predictive of undergraduate science GPA. These results further revealed that grit had no significant impact on USMLE Step 2 CK performance. Underrepresented students (p < .001) and those 26 and older (p < .006) scored significantly higher on grit than their peers. Chi square analyses were completed and showed that this sample was not representative of this medical school or the national profile of matriculated medical students. This was a significant limitation in this study and the results should not be generalized to this institution or other medical schools. Based on the need to offset the anticipated national physician shortage, meet the needs of a more ethnically and racially diverse patient population, lessen residency burnout, and retain more medical students during their long and arduous medical education, the results of this study suggest the need for continued research on measures other than cognitive skills to predict success in medical school and beyond. Considering non-cognitive skills in the admissions process will promote a more diverse physician population and potentially allow for the recruitment of students able to persist through the narrow medical education pipeline, stay the course and eventually become desperately needed physicians within the United States.


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