¹Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

²Undergraduate Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

³Department of Public Health, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

⁴Department of Biomedical Sciences, Biochemistry and Molecular Biology Division, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

Corresponding author Email: a.berbudi@unpad.ac.id 

Article Publishing History

Introduction

English is recognized internationally and is the dominant language in various fields, such as science, medicine, international business, technology, and education (Clyne and Sharifian, 2008; McKay, 2018); this includes medical education (Boulet et al., 2001).

Problem-based learning (PBL) is a method that encourages students to learn actively through problems embedded in cases (Barrows, 1996). In PBL, medical students discuss trigger cases in small groups and are expected to be able to understand the learning objectives based on the problems presented in the cases. In 2004, PBL became the main learning method in the undergraduate program in the Faculty of Medicine at Padjadjaran University; English was used as the language of delivery. Even though English is not in daily use in Indonesia, most learning materials, such as study guides, course materials, laboratory modules, and clinical skills modules are written in English. Moreover, all student evaluation methods, including multiple-choice questions (MCQs) in the form of multidisciplinary examinations (MDEs), are written in English.

The Test of English as a Foreign Language (TOEFL) is one of the tools used to assess the English ability of those who do not use English as their main or mother language (Alderson and Hamp-Lyons, 1996). It tests listening, reading, writing, and speaking ability (Alderson, 2009). There are three types of TOEFL: paper-based TOEFL (PBT), computer-based TOEFL (CBT), and internet-based TOEFL (IBT). To assess students’ ability in English, the Faculty of Medicine at the University conducted the TOEFL-Institutional Testing Program (TOEFL-ITP) among first grade students, with a pass mark of 550 for promotion to second grade. The TOEFL-ITP series was the TOEFL-PBT implemented by universities to assess students’ English-language skills by means of a convenient, affordable and reliable assessment.

Since in-depth studies relating to the relationship between medical students’ academic achievement and their English ability are still scarce in Indonesia, this study aims to investigate the correlation between the TOEFL-ITP and MDE scores of first grade medical students of Padjadjaran University.

Methods

Ethical statement: This study was approved by the Ethical Committee of Padjadjaran University No. 6482/UN6.C1/DL/2017.

Study design: This is a cross-sectional analytical study that uses secondary data. The data used were the institutional TOEFL-PBT scores and MDE results of Reproductive System I, one of the learning modules delivered in the first grade in the academic year 2015–2016.

The Reproductive system 1 module covers the application of basic concepts of human development and reproduction in related cases and the application of biosciences including biology, anatomy, biochemistry, and physiology of female and male reproductive organs.

The TOEFL-ITP was held by the Language Center within the University’s Faculty of Literacy.

Materials and/or subjects: The research population were first grade students on the undergraduate program in the Faculty of Medicine, Padjadjaran University, in the academic year 2015­–2016.

The variables analyzed in this study were the TOEFL-ITP and MDE scores in the module Reproductive System I achieved by first grade medical students. The data were obtained from the Academic Assessment Unit in the University’s Faculty of Medicine.

Statistics: This study used the total sampling technique. The size of the minimum sample was estimated using the sample size formula for the correlation test. Statistical analysis was performed using Pearson correlation testing and processed using GraphPad Prism software version 7.

Results

One hundred and ninety-four (194) students met the inclusion criteria and were included in this study (Supplementary data 1). The average TOEFL score for those students was 517.1+66.7. Seventy-two subjects (37.1%) passed the cut-off TOEFL score for promotion to second grade (TOEFL-PBT score 550), with the average score being 584+29.

The average MDE score in Reproductive System I was 64.6+9.2. Of all subjects, 160 students (85.2%) achieved the minimum MDE pass mark (56).

Correlation analysis using the Pearson test showed a positive correlation between TOEFL and MDE scores (r=0.49, IK 95% (0.37; 0.59), p<0.001) (see Figure 1). These data also revealed that the higher the TOEFL score, the higher the MDE score achieved by the students.

Figure 1: Correlation between TOEFL score and the 1st Reproductive System MDE score. Data were analyzed using Pearson correlation test (r=0.49, IK 95% (0.37; 0.59), p<0.001).

Discussion

Our study showed a significant positive correlation between TOEFL and MDE scores. This implies that ability in English, which can be measured by TOEFL, is one of the factors that might influence students’ academic performance (Johnson, 1988).

Our findings are consistent with the study conducted by Srikrai et al. in 2016, which revealed that the ability to understand English-based text can influence the academic performance of those students who do not use English as their main language, but who are being taught in English, using learning materials written in English. The study also identified two challenges that might be faced by students in that situation: difficulty in understanding the meaning of the English text and understanding the learning material itself. Therefore, low English ability might result in low academic performance.

A study conducted in 2011 suggested that students who receive education in English but do not use English as their main language will have a complex cognitive process in understanding the learning materials (Bernardo, Jennifer and Gaerlan, 2011). Conceptual cognitive process is influenced by the students’ ability to understand English in the learning materials. The better a student’s English proficiency, the better he or she will understand the learning materials (Bernardo and Gaerlan, 2012). Learning materials involve the use of memory, language consistency during the learning process, and examination, which is one of the most important factors that influence academic results. Furthermore, high English language ability in students who do not use English as their main language becomes an advantage during the learning process as there could be more variation in the learning materials available.

The results of our study are in line with research conducted by Martirosyan et al. in 2015, which showed a positive correlation between TOEFL scores and the academic performance of foreign students who undergo education in English at university level. This research found that students with a TOEFL score of 500 or more had higher cumulative GPA compared with those with a score of less than 500 (Martirosyan, Hwang and Wanjohi, 2015).

In addition, the study proposed several factors other than English ability that might affect academic performance, such as confidence, motivation, and a positive attitude to receiving education in a foreign language (Martirosyan, Hwang and Wanjohi, 2015). This phenomenon might also apply in our study as several students with a TOEFL score of higher than 550 (the pass mark for TOEFL) did not achieve the minimum pass mark (56) in the Reproductive System I MDE (56). Conversely, several students with a TOEFL score of less than 550 achieved an MDE score of higher than 56. In addition to the factors already mentioned, students’ ability to understand the questions written in English in the MDE may have affected their academic performance (Srikrai et al., 2016).

Conclusion

In this study, we have shown the positive correlation between TOEFL scores and the results of a multidisciplinary examination. One of the main factors that may have influenced students’ academic achievement is their ability to understand learning materials written in English.

The results of this research might be used as a reference by the Faculty of Medicine to improve students’ English skills, starting from the first grade, to help them understand medical sciences through an enjoyable learning process.

Authors’ contributions

Conceptualization: AB.

Data curation: APM.

Formal analysis: KW.

Methodology: AB KW.

Project administration: APM.

Visualization: AB.

Writing – original draft: APM.

Writing – review & editing: AB EFA.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

The authors received no specific funding for this work.

Acknowledgments                                                                                 

We thank undergraduate program and academic assessment unit of Faculty of Medicine, Padjadjaran University for supporting data in this study.

Supplementary data

Supplement 1. Data files are available from: Open data repository address https://osf.io/yxwf3/.

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