Asano-Gonnella Center for Research in Medical Education & Health Care

The Jefferson Longitudinal Study of Medical Education is the most comprehensive, extensive and uninterrupted tracking system of its kind maintained in a single academic medical center. It was implemented in 1970 with the intention to track all medical students at Thomas Jefferson University throughout their medical education and professional careers. Data were collected retrospectively for those who matriculated between 1964 and 1970 and prospectively from 1971 to date: AM Last Page: The Jefferson Longitudinal Study. The 50^th anniversary of the JLS was celebrated in 2015.

The database includes demographics, personal qualities, performance measures in medical college, medical licensing examination scores, responses to matriculation and graduation questionnaires, postgraduate program directors' ratings of clinical competence in residency, and career follow-up surveys. The Longitudinal Study is routinely updated for all students and graduates using data from local sources as well as the Association of American Medical Colleges (AAMC), American Medical Association (AMA) and American Board of Medical Specialties (ABMS). Follow-up data also includes career outcomes from the AMA’s national data file, faculty appointments from the AAMC, board certification from the ABMS and periodic alumni surveys. Important statistics retrieved from the Longitudinal Study database on demographics, performance on licensing examinations, geographic location, specialty, board certification, evaluations of clinical competence in residency and perceptions of students and graduates on medical education at Thomas Jefferson University are routinely prepared for the Sidney Kimmel Medical College’s annual report.

The Longitudinal Study serves as a unique tool for institutional research and academic management of the outcomes assessment requirements of accrediting bodies, including the Liaison Committee on Medical Education (LCME) for the medical college, the Accreditation Council for Graduate Medical Education (ACGME) for residency programs and the Middle States Commission on Higher Education for the University. The most recent LCME accreditation review observed that:

“The Longitudinal Study continues to represent a unique information resource that serves as an invaluable tool for evaluation of educational program effectiveness. The Longitudinal Study enables the Center to provide the medical college with vital information about the intermediate and long-term outcomes of the curriculum.”

As part of the JLS, we developed 11 psychometrically sound instruments (PDF) for the assessment of educational and patient outcomes and monitoring professional development of physicians-in-training and in-practice.

The JLS has been very productive. Two hundred and thirteen research studies (PDF) using information from the Longitudinal Study have been published in peer-reviewed journals. Following are a few publication samples:

Gonnella, J.S., & Veloski, J.J. (1982).  The impact of early specialization on clinical competence of residents. The New England Journal of Medicine. 306, 275-277.

The purpose of this study was to examine the relationship between first year postgraduate training and performance on a medical licensing examination of general clinical competence (Part III of the National Board Examinations, NBE). Participants included 1,514 graduates from Jefferson (currently Sidney Kimmel) Medical College. Results showed that those who pursued their first year residency training in family medicine, internal medicine, and transitional programs scored higher on Part III of the NBE than did those in surgery, pediatrics, obstetrics/gynecology, psychiatry and pathology. Results remained unchanged when controlled for variation in Part II of the NBE. Although the differences in performance among the various training programs could be due to other factors, it was strongly suggested that changes were needed in some programs to strengthen the general capabilities of residents. The notion of specialization by “addition” and by “subtraction” was discussed.

This study was replicated 15 years later with similar results reported in;

Gonnella, J. S., Hojat, M., Erdmann, J. B., & Veloski, J. J. (1997). The impact of early career specialization on licensing requirements and related educational implications. Advances in Health Sciences Education, 1, 125-139.

Gonnella, J.S., Erdmann, J.B., & Hojat, M. (2004). An empirical study of predictive validity of number grades in medical school using 3 decades of longitudinal study: Implications for a grading system. Medical Education, 38, 425-434.

The purpose of this study was to examine the predictive validity of number grades in medical school, and to determine whether any important information is lost in a shift from number to Pass/Fail and Honor/Pass/Fail grading systems. Participants included 6,656 medical students at Jefferson (currently Sidney Kimmel) Medical College over three decades. Results supported the short- and long-term predictive validity of the number grades. It was demonstrated that small differences in number grades are statistically meaningful, and that important information for identifying students in need of remedial education is lost when students who narrowly meet faculty’s expectations are included with the rest of the class in a broad ‘pass’ category. Results of this study raise questions about abandoning number grades in favor of a pass/fail system. Consideration of these findings in policy decisions regarding assessment system of medical students was recommended.

Hojat, M., Gonnella, J. S., Erdmann, J. B., & Veloski, J. J. (1997). The fate of medical students with different levels of knowledge: Are the basic medical sciences relevant to physician competence? Advances in Health Sciences Education, 1, 179-196.

The purpose of this study was to test the hypothesis that an early gap in knowledge of sciences basic to medicine could have a sustained negative effect throughout medical school and beyond. Participants included 4,437 students who entered Jefferson (currently Sidney Kimmel) Medical College over three decades who were divided into three groups based on their performance in the first year of medical school. Results showed significant differences on retention and dismissal rates, assessment measures in medical school, scores on medical licensing examinations, ratings of clinical competence in residency, board certifying rates, and medical school faculty appointments in favor of those who performed well in the first year of medical school, as opposed to those who failed at least one of the first year courses, and others who obtained marginal grades in the first medical school year. Implications for early diagnosis of academic deficiencies and for better preparation of medical students were discussed.

Hojat, M., Vergare, M.,  Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., Veloski, J. J., & Gonnella, J. S. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school.  Academic Medicine, 84, 1182-1191.

The purpose of this longitudinal study was to examine changes in students’ empathy during medical school and to determine when the most significant changes occur. Participants included 456 students in two entering classes to Jefferson (currently Sidney Kimmel) Medical College who were followed up during medical school education. Results showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed in the third year  when the curriculum shifts  toward patient-care activities and empathy is most essential. Implications for retaining and enhancing empathy are discussed.

We are pleased to announce the release of: “Fifty Years of Findings from the Jefferson Longitudinal Study of Medical Education,” a book published by Springer in 2022. A compendium of medical education research published in professional peer-reviewed journals, it describes findings from the most comprehensive, extensive, and uninterrupted longitudinal study of medical students and graduates maintained in a single medical school. The study began in 1970 based on the conviction that medical schools have a social responsibility and ethical obligation to monitor the quality of their educational programs, assess their educational outcomes, and ensure that their educational goals have been achieved. As described in the book’s Preface, the content of the book is classified into seven chapters addressing: admissions, demographics, medical school evaluations, postgraduate and career, psychosocial attributes, professionalism, and “miscellaneous” issues in medical education. Samples of remarks by medical education experts appearing in the book include: “From preclinical to postgraduate and beyond, this book provides a high-level view of the remarkable accomplishments over 50 years of study” (Leonard Calabrese, DO); “A wonderful compilation of outstanding work from a superb team of scientists, this book offers critical insights throughout the continuum of medical education” (Steven Kanter, MD); “For 50 years, Jefferson has conducted a series of studies of virtually every aspect of the process and outcomes of medical education. It is like an IMAX theatre presentation of the journey from applicant to student to resident to physician” (Geoffrey Norman, PhD).