Can we predict failure in licensure exams from medical students’ undergraduate academic performance?


  • Janeve Desy University of Calgary
  • Sylvian Coderre University of Calgary
  • Pamela Veale University of Calgary
  • Kevin Busche University of Calgary
  • Wayne Woloschuk University of Calgary
  • Kevin McLaughlin University of Calgary



Background: In 2015, the Medical Council of Canada increased the minimum pass level for the Medical Council of Canada Qualifying Examination Part I, and students had a higher rate of failure than in previous years. The purpose of this study was to predict students at an increased odds of examination failure to allow for early, targeted interventions.  

Methods: We divided our dataset into a derivation cohort and two validation cohorts and used multiple logistic regression to predict licensing examination failure. We then performed receiver operating characteristics and a sensitivity analysis using different cutoffs for explanatory variables to identify the cutoff threshold with the best predictive value at identifying students at increased odds of failure.

Results: After multivariate analysis, only pre-clerkship GPA was a significant independent predictor of failure (OR 0.76, 95% CI [0.66, 0.88], p < 0.001). The probability of failure increased steeply when the pre-clerkship GPA fell below 80% and 76% was found to be the most efficient cutoff for predicting failure (OR 9.37, 95% CI [3.08, 38.41]).

Conclusions: Pre-clerkship performance can predict students at increased odds of licensing examination failure. Further studies are needed to explore whether early interventions for at-risk students alter their examination performance.


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2021-06-30 — Updated on 2021-12-31


How to Cite

Desy J, Coderre S, Veale P, Busche K, Woloschuk W, McLaughlin K. Can we predict failure in licensure exams from medical students’ undergraduate academic performance?. Can. Med. Ed. J [Internet]. 2021 Dec. 31 [cited 2024 May 27];12(6):6-13. Available from:



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