MILITARY MEDICINE, 180, 4:77, 2015
Physical Fitness and Academic Performance: A Pilot Investigation in USU Medical Students CAPT Mark B. Stephens, MC USN*; Ting Dong, PhDf; Steven J. Durning, MD PhDf
ABSTRACT This study examined the correlations between physical fitness parameters and standard measures of aca demic performance in a cohort of students at the Uniformed Services University. Significant positive correlations were noted between the average aerobic fitness score and preclerkship grade point average (GPA; r = 0.37, p < 0.05) and cumulative GPA O' = 0.38, p < 0.05). Positive correlations were also noted between the average overall fitness score and preclerkship GPA (r = 0.34, p < 0.05), medical school cumulative GPA (r = 0.34, p < 0.05), and the score on Step 1 of the national board examination (r = -0.33, p < 0.05). Physical fitness may serve as one indicator to predict which students will succeed in medical school and to identify those who are at risk for poor performance and might benefit from a wellness intervention.
INTRODUCTION Physical fitness is a cornerstone o f holistic wellness. The rigors o f m edical school lead to predictable declines in fitness among students.1 Recent work has also shown that burnout is a signif icant concern for m edical professionals and that its prevalence increases during m edical school.2 Burnout adversely affects quality o f care, job satisfaction, and career longevity.3 A ddi tionally, depression and suicidal ideation has been shown to be prevalent am ong m edical students.4 It is therefore plausible that personal wellness, m easured through perform ance on stan dard fitness tests, m ay be associated w ith academ ic success through one or m ore of these or other m echanism s. In the uniform ed services, individuals are required to m aintain a m inim um level o f physical fitness. In each service, a m inim um o f annual fitness testing is conducted according to standardized protocols. Individuals failing to m eet m inim um fitness standards are at risk o f adverse action. W e therefore correlated longitudinal academ ic perform ance data and standardized fitness tests to ask the follow ing research questions: (1) Is there an association betw een m edi cal stu d ents’ fitness scores (averaged across 4 years) and im portant academ ic perform ance m easures? (2) Is there a correlation betw een changes in fitness scores and changes in academ ic perform ance? W e hypothesized that there w ould be positive con-elation betw een fitness and these academ ic per form ance m easures.
METHODS
Participants and Measures The study cohort included 89% (141 out o f 170) o f the m ed ical students from the U niform ed Services U niversity o f the ♦Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814. tDepartment of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. Government. doi: 10.7205/MILMED-D-14-00559
MILITARY MEDICINE, Vol. 180, April Supplement 2015
H ealth Sciences (USU) w ho graduated in 2011. Follow ing institutional review and approval, we collected fitness data from students in the A rm y, N avy, and A ir Force. The fitness m easures included tim ed push-ups (m axim um repetitions), tim ed sit-ups (m axim um repetitions), run, a swim or bike tim es (students can often self-select a test o f aerobic fitness), and an overall fitness score. To answ er the first research ques tion, we included academ ic perform ance m easures o f pre clerkship grade point average (GPA), clerkship year GPA, m edical school cum ulative GPA, and the U SM LE Step exams scores (Step 1 score, Step 2 clinical know ledge score, Com m u nication and Interpersonal Skills (CIS) and Integrated Clinical E ncounter (ICE) com ponent scores o f Step 2 clinical skill, and Step 3 score). To address the second research ques tion, w e calcu lated the change o f the overall fitness score from year to year and the change o f GPA from year to year. Correlations were exam ined using the Pearson correlation coefficient analysis.
RESULTS W e found the follow ing statistically significant correlations betw een the fitness m easures and the academ ic perform ance m easures. For A rm y students, there w ere significant positive correlations betw een the average aerobic fitness score and preclerkship G PA (r = 0.37, p < 0.05, 95% C l = 0.08, 0.60) as w ell as the m edical school cum ulative GPA (/• = 0.38, p < 0.05, 95% C l = 0.09, 0.61). There were also significant positive correlations betw een the average overall fitness score and preclerkship G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58), m edical school cum ulative G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58), and Step 1 score (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58). T here w ere significant posi tive correlations betw een the average running score and preclerkship G PA (r = 0.37, p < 0.05, 95% C l = 0.08, 0.60) and m edical school cum ulative G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58). For N avy students, there was a negative significant correlation betw een average run tim e and Step 1 score (r = -0 .3 3 , p < 0.05, 95% C l = -0 .5 8 , -0 .0 3 ). The bivariate scatterplots indicated a linear relationship betw een
77
Physical Fitness and Academic Performance: A USU Pilot Investigation
the variables for which the above Pearson correlation coeffi cients were calculated. No significant correlations were found between change in the overall fitness score and change in yearly GPA. Likewise, we did not find any significant corre lations between the fitness measures and the academic per formance measures for Air Force students. DISCUSSION Using this pilot sample, we found positive correlations between some measures of physical fitness and selected aca demic performance outcomes. There are several potential reasons for these associations that should be confirmed in larger samples. The first is the potential association between physical wellness (as measured by the fitness test) and emo tional wellness (e.g., reduction in burnout). Students who are in better physical condition may also be more resilient and better able to prepare for required academic assessments. A second possible explanation centers around the concept of motivation. Maintaining physical fitness requires discipline. Students who sustain good levels of fitness, therefore, may also be more disciplined in terms of their approach to academic preparation. A third reason could be a concomitant behavioral health disorder and its negative impact on wellness. Also, the lack of significant correlations between the fitness measures and the academic performance measures for Air Force stu dents might be related to the fact that we had more missing data of Air Force students than Navy or Army students. We did not find associations between academic perfor mance and changes in fitness from one year to the next. The reasons for this are unclear. The reason for the negative correlation between Navy students’ run time and Step 1 score is also unclear. We believe that both findings (lack of associ ation and our one negative association) could be as a result of sample size and/or that multiple factors influence fitness. For example, we did not measure prematriculation fitness
78
levels and academically stronger students may have more time available to devote to personal fitness. A prospective investigation with additional variables such as resilience, depression screening, and burnout could improve our under standing of the relationship, if any, between fitness and aca demic performance. This study had a number of limitations. First, we had a relatively small sample size in this pilot report. Second, the fitness test is only given twice annually and while associa tions were small, it is possible that the strength of association would improve with more frequent fitness testing. The fitness test is a required component of military service. Third, we did not directly measure burnout or resiliency. Although our findings are preliminary, we did find that some fitness scores did correlate with accepted measures of academic performance. This needs to be verified through larger studies. As medical schools grapple with students who are poor performers, novel systems are needed for the early detection of at-risk students (or residents or physicians). If demonstrable with larger cohorts, low fitness scores could be a measure of “at-risk” performance. This could allow for earlier intervention and potentially be of tremendous value to the health care system. REFERENCES 1. Stephens MB, Cochran C, Hall JM, Olsen C: Physical fitness during medical school: a 4-year study at the Uniformed Services University. Fam Med 2012; 44(10): 694-7. 2. Brazeau CMLR. Shanafelt T, Duming SJ. et al: Distress among matricu lating medical students relative to the general population. Acad Med 2014; 89(11): 1520-5. 3. Dyrbye LN, West CP, Satele D. et al: Burnout among U.S. medical students, residents and early career physicians relative to the general U.S. Population. Acad Med 2014; 89(3): 443-51. 4. Dyrbye LN, Thomas MR, Massie FS, et al: Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008; 149(5): 334-41.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Physical Fitness and Academic Performance: A Pilot Investigation in USU Medical Students CAPT Mark B. Stephens, MC USN*; Ting Dong, PhDf; Steven J. Durning, MD PhDf
ABSTRACT This study examined the correlations between physical fitness parameters and standard measures of aca demic performance in a cohort of students at the Uniformed Services University. Significant positive correlations were noted between the average aerobic fitness score and preclerkship grade point average (GPA; r = 0.37, p < 0.05) and cumulative GPA O' = 0.38, p < 0.05). Positive correlations were also noted between the average overall fitness score and preclerkship GPA (r = 0.34, p < 0.05), medical school cumulative GPA (r = 0.34, p < 0.05), and the score on Step 1 of the national board examination (r = -0.33, p < 0.05). Physical fitness may serve as one indicator to predict which students will succeed in medical school and to identify those who are at risk for poor performance and might benefit from a wellness intervention.
INTRODUCTION Physical fitness is a cornerstone o f holistic wellness. The rigors o f m edical school lead to predictable declines in fitness among students.1 Recent work has also shown that burnout is a signif icant concern for m edical professionals and that its prevalence increases during m edical school.2 Burnout adversely affects quality o f care, job satisfaction, and career longevity.3 A ddi tionally, depression and suicidal ideation has been shown to be prevalent am ong m edical students.4 It is therefore plausible that personal wellness, m easured through perform ance on stan dard fitness tests, m ay be associated w ith academ ic success through one or m ore of these or other m echanism s. In the uniform ed services, individuals are required to m aintain a m inim um level o f physical fitness. In each service, a m inim um o f annual fitness testing is conducted according to standardized protocols. Individuals failing to m eet m inim um fitness standards are at risk o f adverse action. W e therefore correlated longitudinal academ ic perform ance data and standardized fitness tests to ask the follow ing research questions: (1) Is there an association betw een m edi cal stu d ents’ fitness scores (averaged across 4 years) and im portant academ ic perform ance m easures? (2) Is there a correlation betw een changes in fitness scores and changes in academ ic perform ance? W e hypothesized that there w ould be positive con-elation betw een fitness and these academ ic per form ance m easures.
METHODS
Participants and Measures The study cohort included 89% (141 out o f 170) o f the m ed ical students from the U niform ed Services U niversity o f the ♦Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814. tDepartment of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. Government. doi: 10.7205/MILMED-D-14-00559
MILITARY MEDICINE, Vol. 180, April Supplement 2015
H ealth Sciences (USU) w ho graduated in 2011. Follow ing institutional review and approval, we collected fitness data from students in the A rm y, N avy, and A ir Force. The fitness m easures included tim ed push-ups (m axim um repetitions), tim ed sit-ups (m axim um repetitions), run, a swim or bike tim es (students can often self-select a test o f aerobic fitness), and an overall fitness score. To answ er the first research ques tion, we included academ ic perform ance m easures o f pre clerkship grade point average (GPA), clerkship year GPA, m edical school cum ulative GPA, and the U SM LE Step exams scores (Step 1 score, Step 2 clinical know ledge score, Com m u nication and Interpersonal Skills (CIS) and Integrated Clinical E ncounter (ICE) com ponent scores o f Step 2 clinical skill, and Step 3 score). To address the second research ques tion, w e calcu lated the change o f the overall fitness score from year to year and the change o f GPA from year to year. Correlations were exam ined using the Pearson correlation coefficient analysis.
RESULTS W e found the follow ing statistically significant correlations betw een the fitness m easures and the academ ic perform ance m easures. For A rm y students, there w ere significant positive correlations betw een the average aerobic fitness score and preclerkship G PA (r = 0.37, p < 0.05, 95% C l = 0.08, 0.60) as w ell as the m edical school cum ulative GPA (/• = 0.38, p < 0.05, 95% C l = 0.09, 0.61). There were also significant positive correlations betw een the average overall fitness score and preclerkship G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58), m edical school cum ulative G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58), and Step 1 score (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58). T here w ere significant posi tive correlations betw een the average running score and preclerkship G PA (r = 0.37, p < 0.05, 95% C l = 0.08, 0.60) and m edical school cum ulative G PA (r = 0.34, p < 0.05, 95% C l = 0.05, 0.58). For N avy students, there was a negative significant correlation betw een average run tim e and Step 1 score (r = -0 .3 3 , p < 0.05, 95% C l = -0 .5 8 , -0 .0 3 ). The bivariate scatterplots indicated a linear relationship betw een
77
Physical Fitness and Academic Performance: A USU Pilot Investigation
the variables for which the above Pearson correlation coeffi cients were calculated. No significant correlations were found between change in the overall fitness score and change in yearly GPA. Likewise, we did not find any significant corre lations between the fitness measures and the academic per formance measures for Air Force students. DISCUSSION Using this pilot sample, we found positive correlations between some measures of physical fitness and selected aca demic performance outcomes. There are several potential reasons for these associations that should be confirmed in larger samples. The first is the potential association between physical wellness (as measured by the fitness test) and emo tional wellness (e.g., reduction in burnout). Students who are in better physical condition may also be more resilient and better able to prepare for required academic assessments. A second possible explanation centers around the concept of motivation. Maintaining physical fitness requires discipline. Students who sustain good levels of fitness, therefore, may also be more disciplined in terms of their approach to academic preparation. A third reason could be a concomitant behavioral health disorder and its negative impact on wellness. Also, the lack of significant correlations between the fitness measures and the academic performance measures for Air Force stu dents might be related to the fact that we had more missing data of Air Force students than Navy or Army students. We did not find associations between academic perfor mance and changes in fitness from one year to the next. The reasons for this are unclear. The reason for the negative correlation between Navy students’ run time and Step 1 score is also unclear. We believe that both findings (lack of associ ation and our one negative association) could be as a result of sample size and/or that multiple factors influence fitness. For example, we did not measure prematriculation fitness
78
levels and academically stronger students may have more time available to devote to personal fitness. A prospective investigation with additional variables such as resilience, depression screening, and burnout could improve our under standing of the relationship, if any, between fitness and aca demic performance. This study had a number of limitations. First, we had a relatively small sample size in this pilot report. Second, the fitness test is only given twice annually and while associa tions were small, it is possible that the strength of association would improve with more frequent fitness testing. The fitness test is a required component of military service. Third, we did not directly measure burnout or resiliency. Although our findings are preliminary, we did find that some fitness scores did correlate with accepted measures of academic performance. This needs to be verified through larger studies. As medical schools grapple with students who are poor performers, novel systems are needed for the early detection of at-risk students (or residents or physicians). If demonstrable with larger cohorts, low fitness scores could be a measure of “at-risk” performance. This could allow for earlier intervention and potentially be of tremendous value to the health care system. REFERENCES 1. Stephens MB, Cochran C, Hall JM, Olsen C: Physical fitness during medical school: a 4-year study at the Uniformed Services University. Fam Med 2012; 44(10): 694-7. 2. Brazeau CMLR. Shanafelt T, Duming SJ. et al: Distress among matricu lating medical students relative to the general population. Acad Med 2014; 89(11): 1520-5. 3. Dyrbye LN, West CP, Satele D. et al: Burnout among U.S. medical students, residents and early career physicians relative to the general U.S. Population. Acad Med 2014; 89(3): 443-51. 4. Dyrbye LN, Thomas MR, Massie FS, et al: Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008; 149(5): 334-41.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
