Early prediction of medical students' performance in high-stakes examinations using machine learning approaches

Since the advent of medical education systems, managing high-stakes exams has been a top priority and challenge for all policymakers. However, considering machine learning (ML) techniques as a replacement for medical licensing examinations, particularly during crises such as the COVID-19 outbreak, could be an effective solution. This study uses ML models to develop a framework for predicting medical students' performance on high-stakes exams, such as the Comprehensive Medical Basic Sciences Examination (CMBSE).

Prediction of students' status and score on high-stakes examinations faces several challenges, including an imbalanced number of failing and passing students, a large number of heterogeneous and complex features, and the need to identify at-risk and top-performing students. In this study, two major categories of ML approaches are compared: first, classic models (logistic regression (LR), support vector machine (SVM), and k-nearest neighbors (KNN)), and second, ensemble models (voting, bagging (BG), random forests (RF), adaptive boosting (ADA), extreme gradient boosting (XGB), and stacking).

To evaluate the models' discrimination ability, they are assessed using a real dataset containing information on medical students over a five-year period (n = 1005). The findings indicate that ensemble ML models demonstrate optimal performance in predicting CMBSE status (RF and stacking). Similarly, among the classic regressors, LR exhibited the highest root-mean-square deviation (RMSD) (0.134) and coefficient of determination (R2) (0.62), whereas the RF model had the highest RMSD (0.077) and R2 (0.80) overall. Furthermore, Anatomical Sciences, Biochemistry, Parasitology, and Entomology grade point average (GPA) and grades demonstrated the strongest positive correlation with the outcomes.

Comparing classic and ensemble ML models revealed that ensemble models are superior to classic models. Therefore, the presented framework could be considered a suitable alternative for the CMBSE and other comparable medical licensing examinations.