1Academic Department, USAMEDIC, Lince, Peru
2Peruvian University Cayetano Heredia, San Martín de Porres, Peru
3Red EsSalud Tacna, Tacna, Peru
© 2022 Korea Health Personnel Licensing Examination Institute
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Authors’ contributions
All work was done by Javier Alejandro Flores-Cohaila.
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
Data files are available from Harvard Dataverse: https://doi.org/10.7910/DVN/69GIM5
Dataset 1. Raw analysis data of 12 selected articles
Study | Research type | Study design | Sample | Students’ demographic | Socioeconomic status | Students’ environment | Learning activities | Psychological factors | Prior academic achievement |
---|---|---|---|---|---|---|---|---|---|
Arenas-Significance [14] (2014) | Journal article | Cross-sectional | 146 | Sex; academic status | ND | Internship setting | ND | ND | GPA, simulation test |
Baldera-Aquino [15] (2021) | Thesis | Case-control | 123 | Sex | Working status | Internship setting | ND | Self-regulated learning (CEVEPEAU); test anxiety (CAFEU) | ND |
Flores Cohaila [16] (2020) | Thesis | Cross-sectional | 45 | Sex; age | ND | ND | ND | ND | GPA |
Franco Miranda [17] (2020) | Thesis | Cross-sectional | 187 | Sex; age; marital status | Socioeconomic level; career funding | ND | Study resources | ND | ND |
Huamaní [18] (2011) | Journal article | Cross-sectional | 6,556 | Nationality | ND | Medical school | ND | ND | GPA |
Mendoza [7] (2021) | Journal article | Cross-sectional | 30,750 | Nationality | ND | Medical school | ND | ND | ND |
Quispe [19] (2018) | Thesis | Cross-sectional | 120 | Sex; age; marital status; academic status | ND | ND | Study resources | ND | GPA |
Ramos Supa [20](2020) | Thesis | Cross-sectional | 72 | Sex; age; academic Status | ND | Internship setting | Study resources, preparation time | Study technique, study habits (CASM 85), motivational scale (EME) | GPA, simulation test |
Salazar Saavedra [21] (2015) | Thesis | Cross-sectional | 256 | Sex | ND | Internship setting | ND | ND | GPA, simulation test |
Sosa Espinoza [22] (2018) | Thesis | Cross-sectional | 98 | Sex; age; academic status | Career funding | Internship setting | Study resources, preparation time | ND | GPA |
Vojvodic Hernandez [23] (2019) | Thesis | Cross-sectional | 42 | Sex; age; marital status | ND | ND | ND | Resilience (CRE-U) | ND |
Zuni Chavez [24] (2017) | Thesis | Cross-sectional | - | Sex; age; marital status | ND | Internship setting | Learning styles (Honey-Alonso Scale) | Self-perceived barriers | ND |
Medical school |
Study | Study design | Sampling | Type of data | Validity of evaluation instrument | Data analysis | Outcome | Total score |
---|---|---|---|---|---|---|---|
Arenas-Significance [14] (2014) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Baldera Aquino [15] (2021) | 2 | 0.5 | 3 | 2 | 3 | 1.5 | 12 |
Flores Cohaila [16] (2020) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Franco Miranda [17] (2020) | 1 | 2 | 3 | 2 | 3 | 1.5 | 12.5 |
Huamaní [18] (2011) | 1 | 2 | 3 | 0 | 3 | 1.5 | 10.5 |
Mendoza Chuctaya [7] (2021) | 1 | 2 | 3 | 2 | 3 | 1.5 | 12.5 |
Quispe Chacon [19] (2018) | 1 | 1 | 3 | 0 | 3 | 1.5 | 9.5 |
Ramos Supa [20] (2020) | 1 | 0.5 | 3 | 2 | 3 | 1.5 | 11 |
Salazar Saavedra [21] (2015) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Sosa Espinoza [22] (2018) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Vojvodic Hernandez [23] (2019) | 1 | 0.5 | 3 | 2 | 3 | 1.5 | 11 |
Zuni Chavez [24] (2017) | 1 | 0.5 | 1 | 2 | 3 | 1.5 | 9 |
Domain | Factor | Significant association | No association |
---|---|---|---|
Students’ demographics | Age | Older age was associated with poorer outcomes across 3 studies [17,18,22]. | In one study no association was found between age and ENAM score [16]. |
Gender | Male gender was associated with better outcomes in ENAM score [17]. | No association was found between gender and ENAM in 5 studies [14,16,19,20,22]. | |
Marital status | In one study being single was associated with higher ENAM scores [17]. | - | |
Nationality | In 2 studies, being non-Peruvian was associated with poorer scores in the ENAM [7,17]. | - | |
Academic status | Regular academic status was positively associated with the ENAM score [14,19,20]. | In 2 studies, academic status was not associated with ENAM scores [16,21]. | |
Socioeconomic status | Socioeconomic level | Higher economic level was associated with higher ENAM score [17]. | - |
Career funding | Students whose careers were funded by their parents had higher ENAM scores than their peers [17]. | There was no association between career funding and ENAM in the study of Sosa Espinoza and Sulca Correa [22]. | |
Working status | - | Baldera Aquino and Alvarado Alva [15] found that working status was not associated with ENAM scores. | |
Students’ environment | Medical school | Belonging to a public medical school or province medical school was associated with higher ENAM scores [7]. | - |
Internship setting | Medical students who conducted their medical internships in EsSalud had better outcomes than their peers [14,19,20,22]. | - | |
Learning activities | Study resources | Using study resources, mainly medical education videos through commercial learning platforms was positively associated with ENAM scores [17]. | In 3 studies the use of commercial learning platforms was not associated with ENAM scores [19,20,22]. |
Preparation time | Daily preparation time was associated with ENAM scores [22]. | There was no association between preparation time in months and ENAM scores [20,22]. | |
Learning styles | Among learning styles, active learning was associated with ENAM scores [24]. | - | |
Psychological factors | Self-regulated learning strategies | Metacognitive strategies, information seeking, and information processing strategies were positively associated [15]. | Affective and resource management strategies were not associated with ENAM scores [15]. |
A lack of motivation was negatively associated with ENAM scores [20]. | |||
Test anxiety | Moderate to high levels of test anxiety were negatively associated with ENAM scores [15]. | - | |
Resilience | All resilience domains were positively associated with ENAM scores [23]. | - | |
Prior academic achievement | GPA | Higher GPA represented by a higher rank in class, or raw GPA was positively associated with ENAM scores [14,16-22]. | - |
Progress test and simulation tests | Higher scores on practice tests (progress or simulation) were positively associated with ENAM scores in 2 studies. | In one study the scores on progress tests were not associated with ENAM scores [20]. |
Study | Previous academic achievement | Students’ demographics | Students’ environment | Outcome |
---|---|---|---|---|
Flores Cohaila [16] (2020) | GPA (>13): OR, 0.62 (95% CI, 0.01 to 0.7) | - | - | Disapproval of ENAM (<11); adjusted by gender, academic status, progress test, and GPA. |
Mendoza Chuctaya [7] (2021) | - | Nationality: Cuba (PR, 8.45; 95% CI, 7.93 to 8.99); Venezuela (PR, 2.26; 95% CI, 1.93 to 2.65); Bolivia (PR, 1.66; 95% CI, 1.61 to 1.71) | Private medical school: PR, 1.42 (95% CI, 1.37 to 1.47) | Disapproval of ENAM (<11); adjusted by year that students took the ENAM, class GPA, nationality, and medical school. |
Arenas-Significance [14] (2021) | Academic honors: OR, 0.24 (95% CI, 0.1 to 0.58) | Regular academic status: OR, 0.36 (95% CI, 0.14 to 0.88) | - | Disapproval of ENAM (<11); adjusted by academic status, internship setting, and academic honors |
Salazar Saavedra [21] (2015) | GPAa): OR, 10.94 (95% CI, 4.12 to 28.98) | Male gender: OR, 2.733 (95% CI, 1.30 to 5.74) | Internship in EsSalud: OR, 6.419 (95% CI, 2.07 to 19.87) | ENAM score >12.5; adjusted by gender, internship setting, academic honors, GPA, number of simulation tests, and graduation modality. |
ENAM, National Licensing Examination; GPA, grade point average; OR, odds ratio; CI, confidence interval; PR, prevalence ratio;
a) For each point in GPA, the OR increased by 10.94. Academic honors: being on equal or higher than the 66th percentile. Graduation modality: If the acquisition of the degree was by thesis dissertation or by an examination.
Study | Research type | Study design | Sample | Students’ demographic | Socioeconomic status | Students’ environment | Learning activities | Psychological factors | Prior academic achievement |
---|---|---|---|---|---|---|---|---|---|
Arenas-Significance [14] (2014) | Journal article | Cross-sectional | 146 | Sex; academic status | ND | Internship setting | ND | ND | GPA, simulation test |
Baldera-Aquino [15] (2021) | Thesis | Case-control | 123 | Sex | Working status | Internship setting | ND | Self-regulated learning (CEVEPEAU); test anxiety (CAFEU) | ND |
Flores Cohaila [16] (2020) | Thesis | Cross-sectional | 45 | Sex; age | ND | ND | ND | ND | GPA |
Franco Miranda [17] (2020) | Thesis | Cross-sectional | 187 | Sex; age; marital status | Socioeconomic level; career funding | ND | Study resources | ND | ND |
Huamaní [18] (2011) | Journal article | Cross-sectional | 6,556 | Nationality | ND | Medical school | ND | ND | GPA |
Mendoza [7] (2021) | Journal article | Cross-sectional | 30,750 | Nationality | ND | Medical school | ND | ND | ND |
Quispe [19] (2018) | Thesis | Cross-sectional | 120 | Sex; age; marital status; academic status | ND | ND | Study resources | ND | GPA |
Ramos Supa [20](2020) | Thesis | Cross-sectional | 72 | Sex; age; academic Status | ND | Internship setting | Study resources, preparation time | Study technique, study habits (CASM 85), motivational scale (EME) | GPA, simulation test |
Salazar Saavedra [21] (2015) | Thesis | Cross-sectional | 256 | Sex | ND | Internship setting | ND | ND | GPA, simulation test |
Sosa Espinoza [22] (2018) | Thesis | Cross-sectional | 98 | Sex; age; academic status | Career funding | Internship setting | Study resources, preparation time | ND | GPA |
Vojvodic Hernandez [23] (2019) | Thesis | Cross-sectional | 42 | Sex; age; marital status | ND | ND | ND | Resilience (CRE-U) | ND |
Zuni Chavez [24] (2017) | Thesis | Cross-sectional | - | Sex; age; marital status | ND | Internship setting | Learning styles (Honey-Alonso Scale) | Self-perceived barriers | ND |
Medical school |
Study | Study design | Sampling | Type of data | Validity of evaluation instrument | Data analysis | Outcome | Total score |
---|---|---|---|---|---|---|---|
Arenas-Significance [14] (2014) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Baldera Aquino [15] (2021) | 2 | 0.5 | 3 | 2 | 3 | 1.5 | 12 |
Flores Cohaila [16] (2020) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Franco Miranda [17] (2020) | 1 | 2 | 3 | 2 | 3 | 1.5 | 12.5 |
Huamaní [18] (2011) | 1 | 2 | 3 | 0 | 3 | 1.5 | 10.5 |
Mendoza Chuctaya [7] (2021) | 1 | 2 | 3 | 2 | 3 | 1.5 | 12.5 |
Quispe Chacon [19] (2018) | 1 | 1 | 3 | 0 | 3 | 1.5 | 9.5 |
Ramos Supa [20] (2020) | 1 | 0.5 | 3 | 2 | 3 | 1.5 | 11 |
Salazar Saavedra [21] (2015) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Sosa Espinoza [22] (2018) | 1 | 0.5 | 3 | 0 | 3 | 1.5 | 9 |
Vojvodic Hernandez [23] (2019) | 1 | 0.5 | 3 | 2 | 3 | 1.5 | 11 |
Zuni Chavez [24] (2017) | 1 | 0.5 | 1 | 2 | 3 | 1.5 | 9 |
Domain | Factor | Significant association | No association |
---|---|---|---|
Students’ demographics | Age | Older age was associated with poorer outcomes across 3 studies [17,18,22]. | In one study no association was found between age and ENAM score [16]. |
Gender | Male gender was associated with better outcomes in ENAM score [17]. | No association was found between gender and ENAM in 5 studies [14,16,19,20,22]. | |
Marital status | In one study being single was associated with higher ENAM scores [17]. | - | |
Nationality | In 2 studies, being non-Peruvian was associated with poorer scores in the ENAM [7,17]. | - | |
Academic status | Regular academic status was positively associated with the ENAM score [14,19,20]. | In 2 studies, academic status was not associated with ENAM scores [16,21]. | |
Socioeconomic status | Socioeconomic level | Higher economic level was associated with higher ENAM score [17]. | - |
Career funding | Students whose careers were funded by their parents had higher ENAM scores than their peers [17]. | There was no association between career funding and ENAM in the study of Sosa Espinoza and Sulca Correa [22]. | |
Working status | - | Baldera Aquino and Alvarado Alva [15] found that working status was not associated with ENAM scores. | |
Students’ environment | Medical school | Belonging to a public medical school or province medical school was associated with higher ENAM scores [7]. | - |
Internship setting | Medical students who conducted their medical internships in EsSalud had better outcomes than their peers [14,19,20,22]. | - | |
Learning activities | Study resources | Using study resources, mainly medical education videos through commercial learning platforms was positively associated with ENAM scores [17]. | In 3 studies the use of commercial learning platforms was not associated with ENAM scores [19,20,22]. |
Preparation time | Daily preparation time was associated with ENAM scores [22]. | There was no association between preparation time in months and ENAM scores [20,22]. | |
Learning styles | Among learning styles, active learning was associated with ENAM scores [24]. | - | |
Psychological factors | Self-regulated learning strategies | Metacognitive strategies, information seeking, and information processing strategies were positively associated [15]. | Affective and resource management strategies were not associated with ENAM scores [15]. |
A lack of motivation was negatively associated with ENAM scores [20]. | |||
Test anxiety | Moderate to high levels of test anxiety were negatively associated with ENAM scores [15]. | - | |
Resilience | All resilience domains were positively associated with ENAM scores [23]. | - | |
Prior academic achievement | GPA | Higher GPA represented by a higher rank in class, or raw GPA was positively associated with ENAM scores [14,16-22]. | - |
Progress test and simulation tests | Higher scores on practice tests (progress or simulation) were positively associated with ENAM scores in 2 studies. | In one study the scores on progress tests were not associated with ENAM scores [20]. |
Study | Previous academic achievement | Students’ demographics | Students’ environment | Outcome |
---|---|---|---|---|
Flores Cohaila [16] (2020) | GPA (>13): OR, 0.62 (95% CI, 0.01 to 0.7) | - | - | Disapproval of ENAM (<11); adjusted by gender, academic status, progress test, and GPA. |
Mendoza Chuctaya [7] (2021) | - | Nationality: Cuba (PR, 8.45; 95% CI, 7.93 to 8.99); Venezuela (PR, 2.26; 95% CI, 1.93 to 2.65); Bolivia (PR, 1.66; 95% CI, 1.61 to 1.71) | Private medical school: PR, 1.42 (95% CI, 1.37 to 1.47) | Disapproval of ENAM (<11); adjusted by year that students took the ENAM, class GPA, nationality, and medical school. |
Arenas-Significance [14] (2021) | Academic honors: OR, 0.24 (95% CI, 0.1 to 0.58) | Regular academic status: OR, 0.36 (95% CI, 0.14 to 0.88) | - | Disapproval of ENAM (<11); adjusted by academic status, internship setting, and academic honors |
Salazar Saavedra [21] (2015) | GPA |
Male gender: OR, 2.733 (95% CI, 1.30 to 5.74) | Internship in EsSalud: OR, 6.419 (95% CI, 2.07 to 19.87) | ENAM score >12.5; adjusted by gender, internship setting, academic honors, GPA, number of simulation tests, and graduation modality. |
ND, not detected; GPA, grade point average; CEVEPEAU, Questionnaire for the Evaluation of Higher Education Student Learning Strategies; CAFEU, Questionnaire for Test Anxiety in Higher Education; EME, Motivational Education Scale; CRE-U, Resilience Questionnaire in Higher Education.
ENAM, National Licensing Examination; EsSalud, Social Insurance in Peru; GPA, grade point average.
ENAM, National Licensing Examination; GPA, grade point average; OR, odds ratio; CI, confidence interval; PR, prevalence ratio; For each point in GPA, the OR increased by 10.94. Academic honors: being on equal or higher than the 66th percentile. Graduation modality: If the acquisition of the degree was by thesis dissertation or by an examination.