Dr. Namir Ghanim Al-Tawil. M.B.Ch.B., F.I.C.M.S./C.M.
Assistant Professor

Correspondence:
Department of Medicine/ Community Medicine
College of Medicine, Hawler Medical University, Erbil, Iraq.
Mobile phone: +964 750 429 8129
E mail: namir.altawil@hawlermu.org

INTRODUCTION

Formal teaching curricula usually ends with examination of the students, and whatever the type and method of examination, students have to pass the exam to succeed and shift to another stage. The results and methods of these examinations need continuous evaluation in order to make the examination a valid indicator of the student's level of knowledge and understanding.¹

The author thinks that the time spent during the written examination is one of the important indicators that reflect the level of the questions. If the time spent is short, it could mean that the questions are easy answered, or the questions are too little and not comprehensive that don't cover the teaching material. On the other hand if the majority of students need extra time to finish, it means that the questions are too long and don't match with the proposed time.

Very few authors studied this factor, and none in Hawler Medical University (Erbil, Iraq). In 2004 Niazi and Isa, studied the relation between the time spent during examination and the scores obtained by students, and the relation between time and gender.²

Research work showed that there is a gender difference in performance 3-5 but few articles showed the relation between the time spent during examination and the scores obtained by students, and the relation between time and gender.²

The study aims at:
1. Measuring the mean time spent by students (males and females) to finish the examination, and comparing it with the proposed time.
2. Studying the relation between gender and examination scores.
3. Finding any correlation between time spent during examination and the scores obtained.

A cross sectional study was carried out in the College of Medicine, Hawler Medical University. Data collection was carried out during June 2007 where all the students in the college sit the final written ex!mination. All the students &rom grade one to 'rade six were included in the study. A simple form designed by the i.vestigator was used to collect data. It included student's name, gender, grade, subject of examinatIon, and time (in minutes) spent to finish the written exam. The students' namas were take. from the examination committee, and teachers in the examination hall, after providing them with brief instructions, registered the information mentioned above for each student finishing his examination. The clock of the examination hall was used to calculate the time spent by students to finish the exam. The scheduled time to finish the examination was 180 minutes, irrespective of subject and grade.
Scores of the students were taken from the examination committee. Then data were entered into a personal computer using the Statistical Package for Social Sciences (SPSS) version 11.5. Student t test and Pearson Correlation were carried out. Multiple regression analysis was carried out considering the mean marks of the students (all grades, and all subjects) as dependent variable, and the sex and time spent during the examination as covariates. Male was coded as "1" and females as "0" in the regression analysis. A "P" value of? 0.05 was considered as statistically significant.

Table 1 shows that females spent more time during the examination than male students in many subjects (P < 0.05), while males, even when they spent more time than females, the differences were not statistically significant.
There was no consistent pattern regarding the differences in marks (scores) obtained by males and females. The mean scores for males were more than females in some subjects, and the reverse is true for other subjects. Sometimes the mean scores for males and females were nearly the same. These differences, even when present were not statistically significant (P > 0.05) (Table 2).
A correlation between time spent during the examination, which was presented in table 1, and the scores obtained by students, that uere presented in table 2, was done* Almost all phe values of the correlation coefficient (r) indicate that there w!s very weak association bepween the time spent during examination and the marks (scores) obtained by the students. This correlation was 'positive' for some subjects, and 'negative' for other subjects. (table 3).
The mean scores and mean time spent during examinations were calculated for all o" the subjects, Then multiple regression analysis was carried out (considering all the 6 grades together). Results shows (table 4) that the values of the beta coefficients obtained for sex and time were not significant as predictors of students' marks.

Table 1 Comparison between the mean time spent during examination by males and females according to subject of the examination

Table 2. Comparison between mean scores obtained by males and females according to subject of the examination

Table 3. Correlation between time spent during the examination and marks got by students in different grades and subjects

The process of learning, which includes examinations, is dynamic and needs continuous evaluation in order to obtain the best results. While oral examinations are a subjective method of evaluating students' knowledge and depend on the site of teaching and examination, written examinations are usually conducted for objective student assessment.⁵
Relatively little research has been done into the importance of different factors in association with academic performance in medical education. However, in many instances factors like previous academic ability, learning styles, ethnicity and sex have been assessed for their association with success in medical education and as predictors of academic achievement. Most of these studies had recommended more research work to provide comparative analyses of the effect of such wide variety of factors on students' scores in examinations and as predictors of students' performance in medical education.^5,7,10
There is very scarce research that has comprehensively studied the effect of gender and time spent in examination on medical students' academic performance. Previous research has mainly focused on studying individual study subjects, specific stages of college or only considered the grade point average of students.^2,5,8,9,11 This study was so comprehensive that it examined the scores of all students from the six stages at medical college for all individual study subjects in relation to gender difference and time spent on each examination.
This study showed that there was no consistent pattern regarding the differences in academic achievement between males and females with no significant difference when it was present. Two other studies from Iraq showed that female medical students slightly outperformed male students in academic performance, but such differences were statistically insignificant.^2,9
The literature has consistently suggested that females tend to perform better than males in their medical academic performance. However, in most instances these differences were small and reached significance only when the sample sizes were large, which raises doubts about the practical relevance of these sex differences.^4,7,11-13 Only few studies have suggested that men slightly outperformed women, but only in early stages of medical study and these differences disappeared later.^7,10
Previous research on students' performance in the United States medical licensing examination step 2 clinical knowledge performance suggested that women outperformed men in some content areas, and men outperformed women in others, while more recent studies revealed a somewhat different pattern, with women outperforming men in most content areas.^11,14 This pattern has also been notices in other fields of educations.¹⁵ This suggests that the issue of sex difference in medical education performance is still an outstanding and a debatable issue.
Researchers offer a variety of explanations for sex differences in standardized test scores. Some suggest that the sex differences are the result of biological factors like difference in exposure to hormones. Others suggest that sex differences are largely the result of environmental factors as males and females interact differently with the learning environment. While females' standards and goals are responsive to social and environmental influences, males are relatively indifferent and appraise their performance according to self-set personal standards.^16,17
The evidence that anxiety may also play a role in explaining sex differences in exam scores is growing. Males and females show a clear difference in the levels of anxiety they experience. Females' greater levels of worry could be beneficial if it leads them to take tests more seriously and to study diligently for them. Students with high level of test anxiety may perform more poorly on cognitive tasks than students with low levels of test anxiety, even when levels of ability are similar. Females' greater anxiety appears to place them at a disadvantage in subjects related to cognitive function and at an advantage in other subjects, e.g. radiology versus psychiatry.^5,6,16
A growing body of research explores whether different motivational, academic, and demographic factors influence the performance of males and females. Motivation seems to be important as service quality variables like helping others predicted females' grades and individual mastery variables like intellectual growth predicted men's grades.⁷
There is very little research that has evaluated sex difference in terms of time spent in examination rooms and its effect on students' scores especially in medical education field. The finding that females have significantly spent more time during the examination than males in many subjects is consistent with the finding of another study conducted in Iraq.² Again females' greater levels of test anxiety may be attributed to having spent more time in examination room trying to provide better and more precise answers and spending more time in reviewing and revising the answers.¹⁶
In this study, there was generally very weak association between the time spent during examination and students' scores with both sides of effect, i.e. both positive and negative relations. The other study from Iraq showed that students' performance in the exam was affected by the duration of time spent in examination rooms with significant positive correlation,² however, such association was weak and this significant finding might be attributed to the large sample size used in that study. On the other hand, research on students' performance in the United States medical licensing examination step 2 suggested that examinees who received more time per item generally outperformed examinees who received less time per item.¹⁴
There are a number of different factors that can influence the time spent in examination including type and difficulty of questions, type of required answers, students' knowledge and cognitive ability and students' test anxiety. Students with more knowledge and cognitive ability may spend less time in completing examination and achieve higher scores. On the other hand, students better utilizing the time in better p,anning and shapinf the answars and making proper review may also achieve better scores even if they have to spend more time on examination. This may explain the very weak Association between The time spent during examination and the students' scores in this study and the inconsistency of this issue in other studies.

There was no consistent pattern regarding the differences in academic achievement between male and female medical students. While females spent more time during examinations than males, there was generally very weak association between the time spent during examination and students' scores.

ACKNOWLEDGEMENTS:
Acknowledgements for the teaching s|aff And tutors of the medical college for their role in data collection. Special thanks to Dr. Nazar Shabila and Mr. Edward Grudza for theIr role hn revising the manuscript.

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