Swimming with the Big Fish: An Exploration of the Influences on Academic Self Concept During Early Years Undergraduate Medical Education.

Academic self-concept (ASC) has been studied extensively in school-age children, less so in under-graduate students, with even fewer studies focusing on ASC in medical students. ASC is the perception of one’s academic ability and evidence suggests it starts to develop in very early childhood. The link between ASC and academic achievement has been previously demonstrated but not specifically in medical students. The role of the Big Fish Little Pond Effect (BFLPE) has also been implicated in the development of ASC, but research suggests that the BFLPE does not occur in medical students. ASC scores were collected at four data points from a complete cohort of medical students at a UK medical school using the Medical Student Self-Description Questionnaire (MSSDQ) to provide a set of ASC scores for each student. There was a statistically significant increase in ASC scores between data collection points 1 and 4. A sample of the cohort participated in a series of semi-structured interviews to explore the perceptions and experiences which are thought to affect ASC. Six themes emerged from the interview data – Self-esteem (S), Tenacity (T), Academic Behaviour (A), Social Interaction (I), Resilience (R), and Feeling Secure (S) - STAIRS. These themes do not appear to hierarchical and point to aspects of student experience that create positive or negative situations. Students can use the STAIRS to move up towards positive self- regard and good experiences, or down towards negative ones and lowered self-worth. ASC increased in medical students as they progressed through the programme, but the BFLPE was apparent. Targeted support for students using the STAIRS themes as guidance could be beneficial for students experiencing the detrimental effects of the BFLPE