Language-Related Factors Affecting the Academic Performance of International Medical Students

291 Pages·2014·4.25 MB·English

Language-Related Factors
Affecting the Academic
Performance of
International Medical
Students

Collette Mann

Submitted in partial fulfillment of the requirements for the
degree of

Doctor of Philosophy
2012

Department of Physiology
Monash University
Notice 1
Under the Copyright Act 1968, this thesis must be used only under the normal conditions
of scholarly fair dealing. In particular no results or conclusions should be extracted from it,
nor should it be copied or closely paraphrased in whole or in part without the written
consent of the author. Proper written acknowledgement should be made for any
assistance obtained from this thesis.
Notice 2
I certify that I have made all reasonable efforts to secure copyright permissions for third-
party content included in this thesis and have not knowingly added copyright content to
my work without the owner's permission.
General Declaration
I n accordance with Monash University Doctorate Regulation 17/ Doctor of
Philosophy and Master of Philosophy (MPhil) regulations the following
declarations are made:
I hereby declare that this thesis contains no material which has been accepted for the
award of any other degree or diploma at any university or equivalent institution and that,
to the best of my knowledge and belief, this thesis contains no material previously
published or written by another person, except where due reference is made in the text
of the thesis.
This thesis includes two original papers published in peer reviewed journals and one
unpublished publication. The core theme of the thesis is neurophysiological and
language-related factors that affect academic outcomes of international medical
students. The ideas, development and writing up of all the papers in the thesis were the
principal responsibility of me, the candidate, working within the Department of
Physiology, Monash University under the supervision of Associate Professor Ramesh
Rajan and Professor Benedict Canny.
The inclusion of co-authors reflects the fact that the work came from active collaboration
between researchers and acknowledges input into team-based research.

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In the case of chapters 2 to 4, my contribution to the work involved the following:
Thesis Publication title Publication Nature and extent of
chapter status candidate’s contribution
Two The Influence of Language published Study design, data collation,
Family on Academic statistical analysis and
Performance in Year 1 and 2 manuscript preparation
MBBS Students
Three Medical School Assessment is rejected Study design, data collation,
Affected by Student Origin statistical analysis and
but not Language Family and manuscript preparation
varies with Year Of Study:
Implications for the Education
of International Medical
Students
Four Poorer verbal working published Study design, data collection,
memory for a second neurophysiological testing,
language selectively impacts statistical analysis and
academic achievement in manuscript preparation
university medical students
I have renumbered sections of submitted or published papers in order to generate a
consistent presentation within the thesis.

Signed:

Date:

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Acknowledgements
T here are many people who have made this thesis possible, so it is a
pleasure to be able to thank them.
First and foremost my primary supervisor, Dr Ramesh Rajan, I cannot
thank enough for giving me this opportunity in the first place. Dr Rajan to me is a true
scientist who has a genuine love and curiosity about how we use our sensory systems to
navigate this world. He has such incredible intellect and has been instrumental in my
journey to becoming a researcher. Dr Rajan’s enthusiasm is infectious and I will miss his
inimitable sense of humour! Dr Ben Canny has taught me more than he would probably
realise with his pearls of wisdom scattered throughout our conversations. I am also
grateful for his vast knowledge of statistics, something which I knew very little about at
the beginning of my PhD, but with his help, now have a much better understanding (and
unexpected love) of the subject. I was very fortunate to have had brilliant teachers in my
supervisors and truly indebted to both.
To Ms Jennifer Lindley who has been simply amazing. Not only does Jen have such a vast
knowledge of the MBBS curriculum, but she always went out of her way to help me,
whether it was work-related to a friendly cup of coffee or even a shoulder to cry on when
it all got too much. I thank Dr Tony Luff and Dr Sheila Vance who, as supervisors for a
short time at the beginning of my studies, were always supportive; Tony I wish you a
happy retirement, and Sheila I wish you all the best in the future and hope we can keep in
touch. Thanks must also go to Ms Kathleen Guevara for the wonderful, and demanding,
job she does as Dr Canny’s PA, for always treating me with equal priority and for being a
genuinely kind person. To Mandy Curd, PA to the HOD, I would like to thank for being an
administrative magician and always smiling that lovely smile no matter how inconvenient
my requests.
A special mention and thank you must go to Dr David Reser who took his responsibility as
Independent Assessor very seriously and has been a constant source of encouragement,
knowledge and mentorship and I am eternally indebted.
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My work would not have been possible without financial support so I would like to thank
Dr Ben Canny and Dr Tony Luff for the initial funding, the Australian Postgraduate
Association, the Department of Physiology and Dr Ramesh Rajan. I would also like to
thank Monash University for providing such wonderful postgraduate student support
programs such as free statistical advice and thesis writing workshops.
To all my family, friends and fellow postgraduates, thank you for your patience and for
really believing I could do this even when I didn’t! Above all thank you for the much-
needed laughs to keep me on track.
Finally, to the two most important people in my world, my husband and son, how can I
really say what I feel when there is no word in any language for how much I love and
adore you? Thank you Spiderman and Mr Bean
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Abstract
C oncerns regarding the poorer scholastic performance of international
students in western tertiary institutions have generated studies to
determine which factors affect academic success. A significant factor
appears to be proficiency in the classroom language, generally a second language (L2) for
the international students. There is also growing evidence that some sociological
attributes and neuropsychological skills, such as cultural dissimilarities and working
memory (WM), impact on academic attainment in L2 learners. The present study was
conducted to examine the role of language-related factors that may affect academic
differences between local and international Bachelor of Medicine/Bachelor of Surgery
(MBBS) students in an Australian university.
Data were obtained from two separate cohorts of medical students for both their 1st and
2nd years of study. Altogether, academic data from a total of 13 years were used and
analysed for this thesis. Studies 1 and 2 examined the same cohort of students who
commenced their studies in 2002-2006 (i.e. 1st year 2002-2006 and 2nd year 2003-2007;
data from the 2004 cohort (i.e. 1st year 2004 & 2nd year 2005) was incomplete and,
therefore, not useable). This data was from a pool of previously collected information
obtained by the Faculty of Medicine, Nursing and Health Sciences for census and other
academic purposes. For Study 3, data were obtained from students who commenced
their 1st year studies in 2008-2010 and 2nd year studies for only the 2008 and 2009
students (i.e. 1st year 2008-2010 and 2nd year 2009-2010; due to time constraints 2nd
year information for the 2010 students was not collected) and data were obtained
specifically for the present doctorate studies.
For all three studies, information on social demographics, first language (L1) and/or L2
usage and various psychometric scales were obtained via questionnaire and academic
assessment outcomes were gathered from official university records. Additionally, 103
students in Study 3 undertook a well-established Speech-in-Noise (SiN) measure of verbal
working memory.
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In Study 1, overall End of Year academic totals were compared between 872 local and
international students categorized by the Language Family (LF) of their L1. In Study 2, the
individual assessments that made up the End of Year Totals were examined for 707
students from the same cohort of Study 1. Assessment instruments varied, but included
Examinations, Coursework and Objective Structured Clinical Examinations (OSCEs). In
Study 3, the SiN task was used to develop a model correlating verbal WM and various
measures of English usage to the 103 students’ academic outcomes of overall End of Year
Totals and individual Assessment instruments.
In Study 1, the local students, generally, outperformed their international counterparts
academically and this depended not only on Origin (i.e. Local versus International) but
also on Language Family of their first language. Given that language proficiency is
somewhat controlled for, this indicated that the differences may be due to acculturative
stressors rather than English language skills. This was elaborated in Study 2, which
examined the details of performance differences in the varying assessment types making
up the course assessment each year of Years 1 and 2. There were year-specific differences
between local and international students, suggesting that varying factors occurred. In the
1st year, international students showed poorer performance only in communications-
based tasks, but in the 2nd year, international students performed worse than the locals
in all assessments. After establishing that English proficiency did not appear to be the
main influencing factor in academic achievement by international students in the Monash
MBBS course, the final study 3 in this thesis examined one major neurophysiological
factor that has been suggested to impact on learning, i.e. working memory, and
specifically verbal working memory in the language of instruction in the Monash MBBS
course (a language that is L2 for a significant number of the international students in the
course). In this study, a model was developed to significantly predict the performance
difference in a communications-based assessment, but not in other assessments requiring
mainly factual knowledge.
Overall, evidence from all three studies suggests that international students show poorer
performance in academic attainment compared to their local peers as a probable result of
impaired verbal WM for the L2 in specific communications-based assessments. Possible
greater demands on English language skills and acculturative stress in the 1st year may
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also be contributing factors. Therefore, support for international students to do well will
differ as a function of their progression and language background through the different
years of the course.

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