Open Access Peer-reviewed

Impact of Self-Efficacy Beliefs on Short- and Long-Term Academic Improvements for Underperforming Medical Students

Bunmi S. Malau-Aduli1,, Wendy Page1, Nick Cooling1, Richard Turner1

1School of Medicine, University of Tasmania, Hobart, Australia

American Journal of Educational Research. 2013, 1(6), 168-176. DOI: 10.12691/education-1-6-1
Published online: August 25, 2017


This study investigated the effectiveness of an innovative remediation program, based on promoting self-efficacy, a construct of self-regulation theory, which was developed to provide sustainable improvements in academic and clinical performance of underperforming medical students. Eighteen medical (eight 4th and ten 5th year) students participated in the remediation program. Interventions were multi-faceted and composed of a wide range of group activities. The efficacy of the intervention was evaluated using mixed-method approach consisting of interviews, questionnaire and quantitative analysis of OSCE outcomes (pre and post intervention). The in-depth interviews were used to explore the short- and long-term causal effects of the remediation program on improved performance. Students demonstrated significant improvements across 3 of the 5 domains measured in OSCE performance (management, diagnosis and communication). There was a 44% improvement in number of stations passed by participants post-remediation (95% CI = -52.25 to -35.64; r = 0.82). Large effect sizes were obtained, indicating the substantive significance of the results. Self-efficacy beliefs were markedly increased post-intervention with the total score increasing from 33.52 (SD=4.9) points pre-remediation to 45.71 (SD=5.1) points post-remediation (95% CI = -14.52 to -9.83; p<0.001; r = 0.77). Subsequent qualitative data suggested that beyond summative exam results, gains were translated to the clinical context with enhanced confidence and self–belief, enabling perceived improved performance in the workplace. Multi-dimensional, group orientated remediation, which emphasises self-efficacy beliefs, may enhance outcomes for students in both high stakes assessment and in the clinical context, thus allowing translational and longitudinal benefits.


self-efficacy, underperforming medical students, effective intervention, support, objective structured clinical examination (OSCE)
[1]  Yates J, James D. Predicting the “strugglers”: A case-control study of students at Nottingham University Medical School. British Medical Journal. 2006;332:1009-1013.View Article  PubMed
[2]  Faustinella F, Orlando PR, Colletti LA, Juneja HS, Perkowski LC. Remediation strategies and students’ clinical performance. Medical Teacher. 2004;26:664-665. PubMed
[3]  White C, Ross P, Gruppen L. Remediating student’s failed OSCE performances at one school: the effects of self-assessment, reflection and feedback. Academic Medicine. 2009;84: 651-654View Article  PubMed
[4]  Hauer KE, Teherani A, Kerr KM, O’Sullivan PS, Irby DM. Student performance problems in medical school clinical skills assessments. Academic Medicine. 2007;82 (supplement) S: 69-72.
[5]  Sayer M, Chaput De Saintonge M, Evans D, Wood D. Support for students with academic difficulties. Medical Education. 2002;36:643-650.View Article  PubMed
[6]  Beckert L, Wilkinson TJ, Sainsbury R. A needs-based study and examination skills course improves students' performance. Medical Education. 2003; 37:424-428.View Article  PubMed
[7]  Chou CL, Chang A, Hauer KE. Remediation workshop for medical students in patient–doctor interaction skills. Medical Education. 2008;42:537.View Article  PubMed
[8]  Klamen DL, Williams RG. The efficacy of a targeted remediation process for students who fail standardised patient examinations. Teaching and Learning in Medicine. 2011;23: 3-11View Article  PubMed
[9]  Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Papdakis MA, Irby DM. Remediation of the deficiencies of physicians across the continuum from medical school to practice: A thematic review of the literature. Academic Medicine. 2009;84(12):1822-1832.View Article  PubMed
[10]  Cleland J, Leggett H, Sandars J, Costa MJ, Patel R, Moffat,M. The remediation challenge: theoretical and methodological insights from a systematic review. Medicine Education. 2013;47:242-251.View Article  PubMed
[11]  Cleland J, Mackenzie RK, Ross S, Sinclair HK, Lee AJ. A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations. Medical Teacher. 2010;32:e185-190.View Article  PubMed
[12]  Pell G, Fuller R, Homer M, Roberts T. Is short-term remediation after OSCE failure sustained? A retrospective analysis of the longitudinal attainment of underperforming students in OSCE assessments. Medical Teacher. 2012;34:146-150.View Article  PubMed
[13]  Winston KA, van der Vleuten CPM, Scherpbier AJJA. An investigation into the design and effectiveness of a mandatory cognitive skills programme for at-risk medical students. Medical Teacher 2010;32 (3):236-43.View Article  PubMed
[14]  Winston KA, van der Vleuten CPM, Scherpbier AJJA. At-risk medical students: implications of students’ voice for the theory and practice of remediation. Medical Education. 2010: 44:1038-1047.View Article  PubMed
[15]  Bandura A. Social Foundations of thought and action: A social cognitive theory. Englewood Cliffs NJ Prentice-Hall Inc 1986.
[16]  Gist ME, Schwoerer C, Rosen B. Effects of alternative training methods on self-efficacy and performance in computer software training. Journal of Applied Psychology. 1989;74:884-891.View Article
[17]  Zimmerman BJ. Attaining self-regulation: A social cognitive perspective. In: Boekaerts, M., Pintrich, P. R., and Zeidner, M. (eds.), Handbook of Self-Regulation, JAI. Press, New York, 2000; pp. 13-39.View Article
[18]  Pololi LH, Potter S. Behavioural change in preventive medicine: An efficacy assessment of a physician education module. Journal of General Internal Medicine, 1996;11:545-547.View Article  PubMed
[19]  Bower DJ, Wolkomir MS, Schubot DB. The effects of the ALSO course as an educational intervention for residents. Family Medicine. 1997;28:187-193.
[20]  Lorenz RA, Gregory RO, Davis DL. Utility of a brief self-efficacy scale in clinical training program evaluation. Evaluation and the Health Professions. 2000;23:182-192.View Article
[21]  Bruning RH, Schraw GJ, Ronning RR. Cognitive psychology and instruction. Upper Saddle River, NJ: Merrill, 1999.
[22]  Cleary TJ, Zimmerman BJ. Self-regulation differences during athletic practice by experts, non-experts, and novices. Journal of Applied Sport Psychology. 2010;13:185-206.View Article
[23]  Sandars J, Cleary TJ. Self-regulation theory: applications to medical education: AMEE Guide No. 58. Medical 2011;33(11):875-886.
[24]  Zimmerman BJ. Investigations self-regulation and motivation: historical background, methodological developments and future prospects. American Educational Research Journal. 2008;45(1):166-183.View Article
[25]  Weinstein CE, Husman J, Dierking DR. Self-regulation interventions with a focus on learning strategies. In: Boekaerts, M., Pintrich, P. R., and Zeidner, M. (eds.), Handbook of Self-Regulation, JAI. Press, New York, 2000; pp. 727-747.View Article
[26]  Zimmerman BJ, Bonner S, Kovach R. Developing self-regulated learners: Beyond achievement to self-efficacy. Washington, DC: American Psychological Association, 1996.View Article
[27]  Schunk DH., Ertmer PA. Self-regulation and academic learning: self-efficacy enhancing interventions. In: Boekaerts, M., Pintrich, P. R., and Zeidner, M. (eds.), Handbook of Self-Regulation, JAI. Press, New York, 2000; pp. 631-649.View Article
[28]  Bandura A. Self-efficacy: Toward a unifying theory of behaviour change. Psychological Review. 1977;84:191-215.View Article  PubMed
[29]  Locke EA, Frederick E, Lee C, Bobko P. Effect of self-efficacy, goals, and task strategies on task performance. Journal of Applied Psychology. 1984;69:241-2.View Article
[30]  Wood RE, Bandura A. Impact of conceptions of ability on self-regulatory mechanisms and complex decision making. Journal of Personality and Social Psychology. 1989;56:407-415.View Article
[31]  Chemers M, Hu L, Garcia B. Academic self-efficacy and first year college student performance and adjustment. Journal of Educational Psychology. 2001;93:55-64.View Article
[32]  Mavis B. Self-Efficacy and OSCE Performance Among Second Year Medical Students Advances in Health Sciences Education. 2001;6: 93-102.View Article  PubMed
[33]  Allen R, Heard J, Savidge M, Bitterqle J, Cantrell M, Huffmaster T. Surveying students’ attitudes during the OSCE. Advances in Health Sciences Education. 1998;3:197-206.View Article  PubMed
[34]  Schifferdecker KE, Reed VA. Using mixed-methods research in medical education: Basic guidelines for researchers. Medical Education. 2009;43:637-644.View Article  PubMed
[35]  Skeff KM, Stratos GA, Bergen MR. Evaluation of a medical faculty development program: a comparison of traditional pre/post and retrospective pre/post self-assessment ratings. Evaluation of the Health Professions. 1992;15:350-366.View Article
[36]  Hewson MG, Copeland HL, Fishleder AJ. What’s the use of faculty development? Program evaluation using retrospective self-assessments and independent performance ratings. Teaching and Learning in Medicine. 2001;13:153-160.View Article  PubMed
[37]  SPSS Inc. IBM SPSS Statistics 19.0 for Windows User's Guide. SPSS Inc. Chicago IL.
[38]  Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.View Article
[39]  Frith H, Gleeson K. Clothing and embodiment: men managing body image and appearance. Psychology of Men & Masculinity. 2004;5(1):40-48.View Article
[40]  Boyatzis RE. Transforming qualitative information: thematic analysis and code development, Sage, 1998.
[41]  Pajares F. Self-efficacy theory. [Internet, cited 2013 March 12] Available from
[42]  Malau-Aduli BS. Exploring the experiences and coping strategies of international medical students. BMC Medical Education 2011;11:40.View Article  PubMed
[43]  Tooth D, Tonge K, McManus IC. Anxiety and study methods in preclinical students: causal relation to academic performance. Medical Education 1989;23:416-21.View Article  PubMed
[44]  Usher EL, Pajares F. Self-efficacy for self-regulated learning: A validation study. Educational and Psychological Measurement. 2008;68:443-463.View Article
[45]  Nillsen R. Can the love of learning be taught? Journal of University Teaching and Learning Practice. 2004;1(1):1-9.
[46]  Winston KA, van der Vleuten CPM, Scherpbier AJJA. The role of the teacher in remediating at-risk medical students. Medical Teacher. 2012;34:e732-734.View Article  PubMed
[47]  Sinclair HK, Cleland JA. Undergraduate medical students: who seeks formative feedback? Medical Education. 2007;41:580-582.View Article  PubMed