Abstract
BACKGROUND: Medical school learning environment (MSLE) is highly related to medical students' academic performance. However, the grade point average (GPA) rankings have not been studied together with MSLE. We aim to figure out the relationship between GPA rankings and MSLE. METHODS: We gathered data from 12 medical schools in mainland China, employing the Johns Hopkins Learning Environment Scale (JHLES) to assess students' subjective perceptions of MSLE. Subsequently, we performed a cross-sectional study examining GPA rankings and JHLES scores. We conducted Pearson's Chi-square test and Welch's analysis of variance (ANOVA) with GPA rankings as the exposure variable and JHLES score as the outcome variable. Furthermore, we conducted a multivariate logistic regression analysis. Additionally, we developed a nomogram to forecast the outcome of JHLES and evaluated the model's accuracy and performance. RESULTS: In Pearson's Chi-square test and Welch's ANOVA. We found a statistically significant difference (p < 0.001) between GPA rankings and JHLES scores. Specifically, students with higher GPA rankings might have a significantly higher proportion of high JHLES scores than those with lower GPA rankings. Through a multivariate logistic regression analysis involving seven variables, including GPA rankings, we took the group whose GPA ranked in the top 20-50% of the population as our reference benchmark. We obtained the odds ratio (OR) values for all GPA groups, along with their 95% confidence intervals (CI) and corresponding p-values. Notably, a nomogram containing seven variables was constructed. Diagnosed by decision curve analysis (DCA), a Receiver Operating Characteristic (ROC) curve, and a calibration curve plot, the nomogram was considered accordant (AUC = 0.627) and accurate. CONCLUSION: GPA ranking is an independent predictor of MSLE. Students with higher GPA rankings are more likely to have higher JHLES scores, which in turn indicates higher satisfaction with the learning environment.