Learning and Study Strategies Inventory subtests and factors as predictors of National Board of Chiropractic Examiners Part 1 examination performance

Self-regulated learning is an important concept in higher education research.¹  Self-regulated learners are more effective in learning and have a repertoire of learning and study strategies to match different situations.²  Learning and study strategies include “thoughts, behaviors, attitudes, motivation and beliefs related to successful learning.”³  Research studies have shown that learning and study strategies are significantly related to academic achievement in higher education^4–6  and can be enhanced through educational interventions.³ 

Few studies have explored learning and study strategies in graduate health-care education, and only two specifically in chiropractic education.^7,8  Understanding the relationship between learning and study strategies and academic performance in chiropractic education is important in curriculum planning, educational intervention design, as well as national board examination preparation and performance.⁸  The National Board of Chiropractic Examiners (NBCE) examinations are the primary licensing examinations for the chiropractic profession and are similar in function to the National Board of Medical Examiners examinations.⁹  According to Cunningham et al,¹⁰  students spend considerable time and money on short-term preparation and coaching courses for these examinations with no significant improvement in results.

Previous studies have found pre-enrollment grade point average (GPA)^10,11  and in-curriculum GPA^10–12  to be predictors of NBCE examination scores. Research identifying factors associated with NBCE examination performance can be useful to educators for identifying students who might be at risk of poor performance and for designing interventions that improve students' NBCE outcomes.

Self-regulated learning is measured by the Learning and Study Strategies Inventory (LASSI),¹³  a widely utilized instrument in higher education. Psychometric properties of the LASSI have been examined in several studies,^3,14–19  showing good reliability and validity.^4,5  The LASSI subtests have shown generalizability to different samples in higher education, including undergraduates,^4–6  pharmacy students,²⁰  and medical students.^21,22 

Designers of the LASSI originally proposed that it measure 3 latent factors of self- regulated learning: (1) Skill (Information Processing, Selecting Main Ideas, and Test Strategies); (2) Will (Anxiety, Attitude, and Motivation); and (3) Self-Regulation (Concentration, Self-Testing, Study Aids, and Time Management).²³ 

Using factor analysis, other researchers have found different 3-factor subtest combinations that are a better fit for the data.^14,15,17  The 3 latent factors found by Olejnick and Nist¹⁷  are (1) Effort-Related Activities (Motivation, Time Management, and Concentration); (2) Cognitive Activities (Information Processing, Study Aids, and Self-Testing); and (3) Goal Orientation (Anxiety, Selecting Main Ideas, and Test Strategies). Olaussen and Braten¹⁵  and Cano¹⁴  also found a 3-factor latent structure similar to that of Olejnick and Nist¹⁷  with one difference: including the subtest of Attitude in the Effort-Related Activities factor.

Three studies have investigated the relationship between LASSI subtest scores, latent factors, and GPA in college students.^14,15,24  Cano¹⁴  found that 2 of 3 factors, similar to Effort Related Activities and Goal Orientation, were positively related to GPA in undergraduate students. Olaussen and Braten¹⁵  found a similar factor structure also in college students. Loomis²⁴  found a significant relationship between the LASSI subtest scores and undergraduate online course performance.

Four studies have investigated the relationship between LASSI subtest scores and academic performance in health-care graduate students.^20–22,25  Sleight and Mavis divided second-year medical students into low, medium, and high cohorts based on Medical College Admission Test (MCAT) scores.²²  The high cohort had the highest scores in Motivation and Concentration and the lowest scores in Study Aids compared with the low and medium cohorts. West and Sadoski²⁵  found that two LASSI subtests, Time Management and Self-Testing, were stronger predictors of first-semester academic performance in medical students than aptitude as measured by the MCAT. In a study of pharmacy students, Lobb et al²⁰  demonstrated that subtests Motivation, Anxiety, Concentration, Selecting Main Ideas, and Test Strategies had significant positive correlations with first-year GPA. The LASSI subtests were not significant predictors of first-year academic performance over GPA. Filho and Vieira²¹  found that the subtests Anxiety, Motivation, and Selecting Main Ideas predicted progress in basic science courses for anesthesiology residents.

The two studies utilizing chiropractic students have found mixed results. Schutz et al⁸  divided a sample of trimester-one chiropractic students into high and low GPA groups and found that the high GPA group scored significantly higher on LASSI subtests Anxiety, Attitude, Concentration, Motivation, Test Strategies, and Selecting Main Ideas, as well as the factors Effort-Related Activities and Goal Orientation. Pringle and Lee⁷  compared LASSI subtest scores from sixth-trimester students with scores on the NBCE Part 1 examination and with entering and cumulative GPAs and found moderately high correlations between all of the LASSI subtest scores and NBCE scores and cumulative GPA.

The purpose of the current study was to extend the research on the relationship between LASSI subtest and factor scores and NBCE Part 1 examination performance.

This was an observational study designed to investigate the 10 LASSI subtests (Information Processing, Selecting Main Ideas, Test Strategies, Anxiety, Attitude, Motivation, Concentration, Self-Testing, Study Aids, and Time Management) and the 3 LASSI factors (Effort-Related Activities, Goal Orientation, and Cognitive Activities) as predictors of NBCE Part 1 examination scores. The current study utilized the 3-factor latent structure supported by the most current research^14,15,17  (Fig. 1). The study was approved by the Logan Chiropractic College institutional review board.

A convenience sample of 102 consenting volunteer students from the spring and summer 2009 trimester-one classes at Logan Chiropractic College completed the LASSI. Inclusion criteria for the current study required the students to complete the LASSI questionnaire in trimester one and take the NBCE Part 1 examination in 2010. Sixty-nine volunteers (Fig. 2) met the inclusion criteria for the study (26 female and 43 male participants, mean age 24 years, SD = 4.70). Tertiles were formed from the distribution of the means of the 6 NBCE Part 1 test scores. As can be seen in Table 1, scores for the low NBCE group (Tertile 1, n = 22) ranged from 351.5 to 518.33, the middle NBCE group (Tertile 2, n = 24) ranged from 518.33 to 570.67, and the high NBCE group (Tertile 3, n = 23) ranged from 570.67 to 684.5.

The LASSI²³  is a self-administered and self-scored assessment instrument consisting of an 80-item, 10-subtest questionnaire using a 5-point Likert scale. Each of the 10 subtests comprises 8 items. The Likert items refer to the degree to which a statement is perceived as typical of the respondent, with 5 representing the highest (“very much typical of me”) to 1 representing the lowest (“not at all typical of me”) degree of agreement. Only the Anxiety subtest is reverse scored, meaning that the higher the score, the less anxiety is reported by the subject.

The NBCE Part 1 examination consists of 6 basic science tests including general anatomy, spinal anatomy, physiology, chemistry, pathology, and microbiology/public health.⁹  The NBCE Part 1 examination is a standardized test consisting of 110 multiple-choice questions in each basic science area.

Subjects signed consent forms, received instructions, and then completed the LASSI in one class period during the third or fourth week of Trimester 1 in spring and summer of 2009. The standard administration of the LASSI, which includes student access to their respective scores, was utilized. The tests were scored by trained data analysts to ensure consistency and then returned confidentially to students.

The principal investigator (PI) was authorized by the Registrar in the Division of Enrollment Management to obtain NBCE test scores from the transcript record database in a manner consistent with Family Educational Rights and Privacy Act (FERPA) guidelines. Identification numbers were assigned to participants to maintain confidentiality throughout the study. All data collected and compiled were verified by the PI.

The 6 NBCE Part 1 examinations, the 10 LASSI subtests, and 3 factor scores were analyzed. An overall NBCE examination score was computed for each subject by calculating the mean of the 6 tests. Linear trends tests (for continuous variables) and Mantel-Haenszel trend tests (for categorical variables) were used to determine whether the LASSI subtest scores were different between high, medium, and low levels of NBCE Part 1 test scores. A multiple regression model was used to predict the average NBCE Part 1 examination scores using the 3 LASSI factor scores as predictor variables. All analyses were performed with SAS version 9.2 (SAS Inc, Cary, NC), and a 2-tailed p value of .05 was used to determine statistical significance.

Four LASSI subtests were significantly different between the NBCE Part 1 tertiles: Anxiety, Concentration, Selecting Main Ideas, and Test Strategies. In each instance, Tertile 1 LASSI subtest scores were significantly lower than Tertiles 2 and 3, while Tertiles 2 and 3 were no different (Table 2). The LASSI factor score Goal Orientation was significantly different between the NBCE Part 1 tertiles. Tertile-1 Goal Orientation factor scores were significantly lower than Tertiles 2 and 3, while Tertiles 2 and 3 were no different from each other (Table 2). The LASSI factor Goal Orientation was significantly associated with NBCE Part 1 overall examination scores, and all 6 of the NBCE Part 1 basic science tests; however, the other 2 factors Effort-Related Activities and Cognitive Activities did not reach statistical significance (Table 2).

Overall the model R-squares for NBCE Part 1 and the 6 basic science tests were weak to moderate (R² range .09–.22) (see Table 3). Specifically, for every 1-point increase in the LASSI factor Goal Orientation, the NBCE Part 1 overall increased by 8 points (p = .0028); Chemistry increased by 9.33 points (p = .0035); General Anatomy increased by 7.35 points (p = .03); Microbiology increased by 7.71 points (p = .007); Pathology increased by 7.61 points (p = .015); Physiology increased by 7.09 points (p = .012); and Spinal Anatomy increased by 9.0 points (p = .004) (Table 3).

Results from this study show that 4 of the 10 LASSI subtests and 1 of the 3 LASSI factors are statistically significant predictors of NBCE Part 1 examination performance. For participants in this study, the LASSI subtests Anxiety, Concentration, Selecting Main Ideas, and Test Strategies, and the Goal Orientation factor predicted differences between low vs middle and high test scores on the NBCE Part 1 examination. The finding that Tertile-1 scores were significantly lower than Tertiles 2 and 3 for 4 subtests and 1 factor may be useful in identifying students at risk for poor NBCE Part 1 examination performance.

Results of the current study have agreements and disagreements with previous research about which LASSI subtests and factors predict standardized test performance. Pringle and Lee⁷  found significant correlations between all the LASSI subtest scores and NBCE examination scores for chiropractic students. Sleight and Mavis²²  showed that Motivation, Concentration, and Study Aids differentiated low, medium, and high performance on the MCAT. West and Sadoski²⁵  demonstrated that Self-Testing and Time Management subtests were predictors of success on the MCAT. Variability in the results of these studies may be due to differences in sampling, instrumentation, and/or experimental procedures. A consensus of studies concludes some of the LASSI subtests and factors are useful in predicting standardized test performance^7,22,25  and GPA in several educational contexts.^8,14,15,20 

Considering that short-term coaching courses have not significantly increased NBCE examination scores,¹⁰  the results of this study suggest that designing interventions based on LASSI subtest performance, such as online tutorials or short courses to improve learning and study strategy skills, may be more beneficial for chiropractic students' NBCE examination preparation. Continuing research is needed to investigate which LASSI tests and factors are the best predictors in various performance categories and to examine the effects of learning and study skills training on NBCE performance.

Limitations of the current study include the inherent biases in self-report instruments and uncertain generalizability owing to the unique characteristics of the sample of trimester-1 chiropractic students. Additionally, our multiple regression models (Table 3) showed weak to moderate R² values. While the LASSI factor of Goal Orientation is a significant predictor of the differences between lower and higher performers on NBCE Part 1, a complete model would consider multiple covariates that contribute to predicting NBCE performance. However, the goal of the current study was to study the association between NBCE test scores and LASSI scores, not to build a predictive model for NBCE.

The most consistent support from the research, considering the variation in samples and methodologies, is for the LASSI subtests Anxiety and Concentration and the LASSI factor of Goal Orientation in relationship to academic performance, including GPA and national board examination scores. A consensus of research for chiropractic students shows the LASSI subtests of Anxiety, Concentration, Selecting Main Ideas, and Test Strategies, and the LASSI factor Goal Orientation are the best predictors of academic success with regard to GPA and NBCE Part 1 examination and test scores. It may be useful to include aspects of learning and study strategies from the LASSI factors and subtests to aid chiropractic students in preparation for national board examinations as well as to assist educators in designing performance-enhancing interventions.

The authors have no conflicts of interest to declare.