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Does academic excellence predict non-cognitive competencies? Insights from a situational judgement test among medical students in Nigeria

BMC Medical Education volume 25, Article number: 623 (2025) Cite this article

Abstract

Background

Situational judgment tests (SJTs) are becoming more widely accepted for assessing medical students’ behavioral (non-cognitive) competencies. However, the correlation between behavioral and clinical competencies is under-explored, particularly in sub-Saharan Africa. Using a validated SJT questionnaire, this study examined the association between SJT and the academic performance of clinical medical undergraduates in Enugu state, Nigeria.

Method

This was a cross-sectional study of 279 clinical medical students at the Enugu State University of Science, Management and Technology (ESUT), Nigeria. The results of the SJT of behavioral competencies were collected using a pre-tested, validated, and self-administered questionnaire. Cronbach’s alpha for SJT competencies was below 0.7, which reflects domain heterogeneity rather than poor tool precision. The association between the dependent variable (SJT performance) and individual-level predictors was assessed using both bivariate and multivariate linear regressions. Statistical significance was set at p < 0.01.

Results

An increase in students’ academic performance predicted a decrease in their SJT performance by 3% (β= -0.03; p = 0.21), but this finding was not statistically significant. Having a grade of A or B in chemistry, compared to a grade of C4 or below, predicted a statistically significant increase in SJT performance by 15% (β = 0.15; p = 0.01). Being a male student predicted a decrease in the SJT score by 8% (β= -0.08; p = 0.09). The results also showed that students’ state of origin (β = 0.28; p = 0.04) correlated with their SJT performance.

Conclusion

Our study findings suggest that students who perform better clinically are less likely to have higher behavioral competence. However, the negative association between clinical performance and SJTs is not always statistically significant. This has implications for training and implies that excellent clinical education may not facilitate the production of better doctors, but this is not always the case. Hence, there may be a case for incorporating mechanisms to specifically build behavioral competencies in medical students being trained. There is a need for studies that examine these associations in other contexts and test the impact of trainings and other mechanisms in building behavioral competencies in medical professionals.

Clinical trial registration

Not applicable.

Peer Review reports

Background

The assessment of students in medical school traditionally focuses on academic abilities [1, 2]. In Nigeria, the two main assessments used for selection and entry into undergraduate medical schools are the Joint Matriculation Examination (JAMB) and university admission screening and assessment. These assessments consist of five core subjects: English, Mathematics, Biology, Chemistry, and Physics [3, 4]. Medical admission assessments are used in conjunction with an individual’s performance on the Senior School Certificate Examination (SSCE). However, many aspiring medical undergraduates are sidetracked by pre-existing tribal preferences and ethnic favoritism during the selection process [4].

In Nigeria, the curriculum in medical schools is enormous and requires a longer period of six years of study when compared to other degree programs at universities [5]. The rigorous training standards make medical education challenging but are believed to mould students to become medical professionals who should manage patients with optimal ethical and moral standards as required by the professional oath [5]. They are also expected to withstand the stress of the medical profession while delivering health services. It is expected that an individual’s achievements in medical practice will largely depend on their academic records in medical schools [5]. Although studies have shown that the method of admission to a medical school has a strong correlation with good academic performance [2, 5], this approach of selection for medical training has several limitations [1]. The predictive power of academic performance in the medical profession has been shown to decline gradually as students progress to clinical and real-life professional practice [2, 6, 7]. This indicates that although academic assessments are necessary for medical education, they are not sufficient to guarantee that students will become competent health professionals in clinical practice. Therefore, it may be useful to assess both the behavioral and academic competencies of prospective students and trainees in the medical profession.

Behavioral attributes such as emotional intelligence, empathy, professionalism, resilience, and self-discipline, are qualities that are not related to academic ability but are essential for competent medical practice. In both developed and developing countries, there is an increasing emphasis on the need for the assessment of behavioral attributes necessary for competent medical practice in the training of medical professionals [1, 8,9,10]. These findings have prompted recommendations to incorporate behavioral assessments in the selection and training processes [8, 11]. Situational Judgment Tests (SJTs) can be defined as a scenario-based evaluation approach designed to assess an individual’s judgment or decision in multifaceted and contextualized workplace situations [12, 13]. This scenario-based evaluation approach can be used as a diagnostic tool for the selection, assessment, training, and identification of individual training needs [1, 14, 15]. The application of SJTs to medical training has been considered a cost-effective approach [1] and could provide a resource beneficial for monitoring and training individuals on relevant non-academic attributes as they progress through medical training.

Researchers have compared video- and text-based SJTs across subgroups to understand their relationship patterns [16]. However, this assessment was carried out among STEM (science, technology, engineering, and mathematics-focused) applicants for teacher training programs. Hence, different approaches to SJTs can be adopted and applied to measure the non-cognitive attributes of different population groups. Several factors, such as ethnicity, sex, and socioeconomic status, have been identified as predictors of SJTs in medical education and practice [10, 16, 17]. However, it is important to note that these studies have presented data from most developed countries. This significant empirical evidence on the predictive validity of SJTs underlines the added value of using this approach for selecting candidates from different professions [18, 19].

Despite a plethora of research evidence supporting the use of SJTs for training medical professionals [1, 10, 14,15,16, 18], there are still notable knowledge gaps and areas in need of more research as regards SJTs [1, 16], particularly in developing countries. A study that focused on using three SJT methods to investigate the mean differences in applicant reactions and SJT scores suggested the need for future studies to examine the relationships between SJTs and measures of cognitive abilities [16]. Although SJTs have been widely integrated into medical selection in most developed countries [14], this selection method has not been explored within Nigerian medical school systems. Current research in Nigeria has focused on the determinants of good academic performance in medical schools [5, 20]. However, no studies have examined the relationship between SJT scores (behavioral behavioralcompetencies) and the academic performance of trainees using a context-specific data collection instrument.

While SJTs have been validated for medical selection in many contexts [21,22,23], and behavioral competencies have been identified as important for Nigerian medical practice [24], the relationship between academic performance and behavioral competencies remains unexplored in the Nigerian context. This study specifically aimed to determine whether academic performance is associated with behavioralbehavioral competencies (SJT performance). It is hoped that understanding the relationship between SJTs and the medical performance of students in Nigeria will contribute to the existing literature. The findings of this study can inform the development of actionable guidelines for integrating SJT-based assessments into medical school admissions and curricula. When SJT is optimally implemented in Nigeria’s medical training it would reduce the risk of professionalism lapses, thus improving healthcare patient safety and outcome.

Research questions

  1. 1.

    What is the association between behavioralbehavioral competencies, as measured by Situation Judgement Test (SJT) performance, and academic performance among medical students?

  2. 2.

    What are the predictors (demographic and academic performance factors) of behavioralbehavioral competencies among medical students?

Literature review

Situational Judgment Tests (SJTs) are widely used for assessing such behavioral competencies in various professional settings, including medical education [25]. This tool is designed to measure an individual’s judgment in response to hypothetical work-relevant scenarios. SJTs assess attributes such as empathy, effective communication, empathy, professionalism, and teamwork [23, 24]. Unlike traditional academic assessments, SJTs focus on evaluating behavioral tendencies and decision-making in context rather than purely knowledge-based outcomes [24].

Studies, including those conducted in low- and middle-income countries, have consistently shown the predictive validity of SJTs for performance in both educational and professional settings [18, 21, 23]. A recently published study provides systematic evidence that SJT items can reliably assess behavioral competencies for best medical professional practice [21]. Specifically, SJTs have been found to correlate with indicators of academic success, academic discipline, and practical competencies demonstrated during clinical training [14, 25]. SJTs offer a reliable and valid means of assessing non-cognitive skills that are often overlooked in conventional academic tests [2, 5]. While SJTs are not designed to replace traditional assessments, they provide complementary insights into a student’s potential to excel in environments requiring behavioral adaptability and interpersonal effectiveness [18, 26].

The integration of behavioral competencies into medical education and medical admission is gaining traction globally [23, 26, 27]. Medical practice demands not only technical expertise, but also the ability to navigate complex interpersonal dynamics and make ethical decisions under pressure. Behavioral competencies are incorporated into medical curricula through innovative pedagogical approaches, including problem-based learning, role-playing, and simulation exercises [28,29,30]. SJTs play a pivotal role in this context by offering an objective and standardized method for evaluating these competencies. Moreover, research has shown that behavioral competencies, as measured by SJTs, are not only indicative of clinical performance but also correlate with positive professional behaviors, such as empathy and ethical responsibility [24]. Chukwuma et al. (2020) emphasize that in Nigeria, where healthcare systems often face resource constraints and high patient loads, the cultivation of behavioral competencies is particularly critical [24]. Despite the importance of these skills in enabling the delivery of effective care amidst systemic challenges, they are not explicitly considered during the admission of Nigerian medical students in postgraduate training or doctors’ appointments in hospitals [24].

In the Nigerian medical education system, there has been a growing recognition of this need to balance cognitive and behavioral competencies. Chukwuma et al. highlight that while traditional metrics, such as Joint Matriculation Examination (JME) scores and Senior School Certificate Examination (SSCE) results, remain central to admissions and academic evaluations, they fail to capture the non-cognitive skills essential for effective medical practice [24]. The systematic validation of SJTs by Obi et al. [21] highlights their importance in addressing this gap within Nigeria by providing well-developed, adapted, and validated questions designed to assess non-cognitive skills essential for effective medical practice.

This study was guided by Trait Activation Theory (TAT) [31]. TAT, introduced by Tett and Burnett, provides a framework for understanding how personality traits are expressed in response to situational cues [32, 33]. TAT theory posits that traits are latent tendencies that become activated when individuals encounter environments or tasks that are relevant to those traits [32, 33]. The theory identifies three primary sources of trait-relevant cues: task, social, and organizational cues. These cues interact with an individual’s inherent traits, leading to observable behavior. In the context of this study, TAT is particularly relevant, as it explains how situational judgment tests (SJTs) can serve as a mechanism to activate and assess specific non-cognitive traits, such as empathy, integrity, and teamwork. For instance, the scenarios presented in SJTs are designed to simulate real-world challenges in professional medical practice, thereby eliciting responses that reflect the activation of relevant traits among medical students. Furthermore, TAT distinguishes between trait expression (how traits are triggered by situations) and job performance within a specific context [32, 33]. This distinction is critical to understanding the relationship between SJT performance and academic excellence. By situating this study within the framework of TAT, we examined how non-cognitive traits revealed through SJTs correlate with academic achievement among clinical medical undergraduates.

This study builds on the insights provided by Chukwuma et al. [24] and Obi et al. [21] by examining the associations between behavioral competencies, as measured by Situation Judgement Test (SJT) performance, and academic performance among medical students using validated SJT scenarios [21].

Methods

Study design and study area

This was a cross-sectional study undertaken at the College of Medicine, Enugu State University of Science, Management, and Technology (ESUT), Southeast Nigeria. The University was established in 1981 and is located in the Enugu metropolis [34]. The institution is a state-owned university that trains undergraduate and postgraduate medical professionals [35].

Study population and sampling

The study population consisted of undergraduate medical students enrolled in the 4th and 5th years of medical school. A total of 314 students were enrolled in their 4th and 5th years at the time of the survey. There were 120 students in the 5th-year class. The 4th year students were divided into junior and senior classes, with 100 students in the senior class and 94 students in the junior class. Eight students recruited to assist in the data collection were excluded from the study. Three research assistants were recruited from the 5th year class, three from the 4th year senior class, and two from the 4th year junior class. Course leaders and those with previous experience in data collection served as research assistants. Although nine research assistants were invited (three from each class), only eight attended the training. This number of research assistants was selected to reduce the burden and ensure minimal disruption to their academic activities.

Considering the limited study population, a census research approach was employed and participation was voluntary [36,37,38]. This approach focused on including the entire target population when the population size was manageable, rather than selecting a subset [36,37,38]. An invitation to join the study was extended to all medical students in both the senior and junior divisions of the 4th year, as well as those in the 5th year, except for the research assistants who were selected from these classes. Hence, 306 of 314 students were included in the final study. Approximately 20 students either chose not to participate in the study or were unavailable during the survey period, resulting in 286 submissions.

Students were informed about the study in each class, and the link to access the survey form was shared via email. They were fully informed of the study’s purpose, procedures, and potential risks. They were assured that their participation was entirely voluntary, and that they could decide not to participate or withdraw at any time without any repercussions. This was also incorporated into the online survey tool, and participants were mandated to provide signed consent before proceeding with the questions. The role of the research assistants and the nature of their involvement were communicated to the participants. Research assistants facilitated participant engagement by sending weekly reminders through their classes’ general WhatsApp groups. To address potential ethical concerns, all communications were conducted in a manner that protected participants’ personal information, as nobody had access to the uploaded data, except the authors. Individual identities were not disclosed as the link to the survey was sent to their emails. Efforts were made to ensure that the participants did not feel coercive or pressured to participate. Research assistants were trained to send reminders respectfully and emphasize the voluntary nature of the study.

Development and validation of data collection tool

The development of clinical scenarios involved (i) a scoping review to identify behavioral competencies that were prioritized through nominal group discussions [24], and (ii) the development and validation of the SJT questions for each behavioral competency. Nominal group technique exercises were conducted with medical students and resident doctors to develop a list of contextual behavioral competencies associated with effective medical practice in Nigeria [24]. Following this, a workshop was scheduled with medical consultants from different clinical specialties to develop scenarios that capture each behavioral competency.

Finally, the authors validated the SJT questions [21] among 192 undergraduate clinical medical students and 111 postgraduate (resident) doctors and faculty members directly involved in the training and supervision of medical students and resident doctors at the College of Medicine, University of Nigeria, Nsukka [21], using Kane’s framework [22]. Fifty scenarios were designed to measure doctor-client/doctor-colleague interactions. The ten attributes measured were as follows: empathy, ethical responsibility, patient-centeredness, diligence, good judgement, tolerance, teamwork, respectfulness, team leadership/conflict management, and ability to take corrections. Five scenarios were designed to test each of the ten attributes individually. Cronbach’s alpha for the SJT competencies was below 0.7, which reflects domain heterogeneity rather than poor tool precision [21]. A detailed description of the development and validation of the instrument is provided in a previous article [21]. The final version of the questionnaire developed for this study is provided in the supplementary file.

Data collection

Data were collected on (i) behavioral competencies, using the validated SJT tool, (ii) demographic characteristics [age, gender, religion, ethnicity, and state of origin], (iii) academic performance in five subjects [Pharmacology, Histopathology, Medical Microbiology, Hematology, and Chemical pathology], and (iv) medical admission criteria, including Joint Matriculation Examination scores (JAMB), SSCE Senior School Certificate Examination [English, Mathematics, Biology, Chemistry, and Physics], and other university admission screening/assessment scores. These variables were informed by the study objectives and a review of the factors described in the empirical literature to predict academic performance [11, 24].

Eight research assistants were recruited and trained to assist with the data collection. The training involved didactic lessons on study objectives, study design, data collection instruments, and standard operating procedures (SOPs) for data collection. During training, the proficiency of the research assistants was verified through role practice and pre- and post-testing exercises.

Data were collected over two months [December 2021 to January 2022] using the KoBo Collection Toolbox, an open-source tool for mobile data collection.

Data analysis

Data analysis was performed using the STATA statistical software version 16.1. Univariate, bivariate, and multivariate linear regression analyses were performed using STATA statistical software to understand whether academic performance predicted the behavioral competencies (SJT performance) of medical students. The regression model was as follows:

$$\:{\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:Y}_{i}=a+bX+E$$
(1)

Where Yi is the dependent variable (SJT score), X are the independent variables, a is the intercept, b is the slope, and E is the residual (error term). The SJT score is a logged composite score generated using the agreed scoring pattern during the validation of the data collection instrument. An award of 25 points was given if all options were in the correct order, 20 points if the correct order was off for one item, 15 points if the correct order was off for two items, 10 points if the correct order was off for three items, 5 points if the correct order was off for four items and zero point if all five items were off or incorrect. This scoring order was conclusively proposed by the research team after data cleaning and preliminary analysis.

The independent variables included demographic characteristics (age, sex, state of origin, education level), pre-medical school entry assessments, and academic performance scores. The pre-medical school entry assessment variables were developed at the subject level for the SSCE [English, Mathematics, Biology, Chemistry, and Physics], the Joint Matriculation Examination (JAMB), and the University Entrance Screening/ Examination score. For each subject, the value ‘1’ was assigned to each subject (e.g., Physics) in SSCE if the individual had a grade of A or, B, and the value ‘0’ was assigned to a grade of C or below. The total average score for individual academic performance from the five subjects was generated and included as an independent variable. Statistical significance was set at 90% (p < 0.01).

Results

Out of 286 students who were invited to fill the survey form, a total of 279 forms were judged to be completely filled without errors, giving a response rate of 94.30%. Table 1 shows the demographic and background characteristics of the medical students who participated in this survey. The mean age of the medical students was 25.62 and approximately 59% of them were male. The highest (34.41%) proportion of students was in the senior 4th MBBS class, 32.26% in the junior 4th MBBS class, and 33.33% in the 5th MBBS class. The mean score for the SJT assessment was 71.88 while 277.40 was the mean score for the university admission screening assessment.

Table 1 Descriptive statistics of participants
Full size table

The bivariate analysis of the factors associated with SJT is presented in Table 2. Some modes of admission (university screening and JAMB) in medical schools were not significantly associated with SJT. However, the SSCE chemistry subject and being in the 4th MBBS class were significantly associated with SJT (p < 0.1). Being a male medical student decreases SJT performance by 7% but with no statistically significant effect (β= -0.07; p = 0.11).

Table 2 Bivariate analysis of factors associated with the SJT
Full size table

Table 3 shows the linear regression analysis of factors associated with the SJT. Predictors of behavioral competencies required for medical practice were an SSCE (Chemistry) subject, and students’ State of origin (Anambra state). Medical students having a grade of A or B in chemistry, compared to those having C4 and below, increase the SJT score by 15% (β=-0.01; p = 0.01). There is also a statistically significant association between the SJT score and the state of origin Anambra (β = 0.28; p = 0.04). Increasing age by one year predicts a decrease in the SJT score by 1% however, the estimate was found to be statistically insignificant at the 90% level. Being a male student is associated with a decrease in the SJT score by 8% when compared to being a female and, the estimate is statistically significant at the 90% level (β=-0.08; p = 0.09). Having a higher grade of A/B in the English Language predicts an increase in the SJTs by 0.8% (β=-0.08; p = 0.09). An increase in medical school performance predicts a decrease in the SJT score by 3% (β=-0.03; p = 0.21).

Table 3 Linear regression of factors associated with the SJT
Full size table

Discussion

This study utilized a quantitative research approach to examine the predictors of behavioral competencies (SJT performance). We found that an increase in medical school performance predicts a 3% decrease in students’ SJT performance, although this effect is not statistically significant. The inverse and non-significant relationship between academic performance and SJT scores suggests that traditional measures of academic success in medical school may not adequately capture the interpersonal skills that SJTs are designed to assess. Dissimilar to that observed in our study, a Canadian study reported a significant association between behavioral assessment and subsequent medical performance [39]. However, the SJT/behavioral assessment was administered through a computer/video-based strategy in that study [39], which differs from the text-based SJTs administered to the medical students surveyed in our study. Korman & Stubblefield observed in their study that academic performance is unrelated to professional behavioral competencies [40]. Previous studies have observed an association between SJT scores and misconduct in medical students [41, 42]. Though, the relationships were no longer statistically significant [41, 42], after adjusting for academic and demographic factors. A systematic review highlighted that cognitive tests like the UKCAT show weak correlations with non-cognitive assessments in medical training [43]. Similarly, Hosseinpour and Keshmiri (2024) found significant variability in SJT scores across different medical professions, emphasising the distinct nature of situational judgment capabilities [44]. This highlights the need for a more comprehensive approach to medical student evaluation.

Using a developed and validated SJT assessment tool, this study found that the mode of admission into medical schools such as JAMB and University screening is not significantly associated with SJT performance. Although some modes of medical admission were not significantly associated with SJT performance, an SSCE Chemistry subject was found to be significantly associated with SJT performance. This implies that there is an association between students’ previous academic performance in a specific subject and non-cognitive attributes required in medical practice. Higher achievers in some pre-medical screening courses may be more likely to exhibit qualities such as diligence, tolerance, empathy, patient-centeredness, and the ability to accept corrections during their interactions with clients or colleagues. Colliver and colleagues documented that the traditional method of admitting students into medical school has the utility for selecting students who will perform effectively in medical education and professional practice [45]. However, an earlier study reported that students’ previous academic performance does not necessarily predict their achievement in medical school and practice [2]. The study stated that previous academic records may account for only 6% of postgraduate competency and 23% alteration in undergraduate medical performance [2]. To gain a more comprehensive understanding of factors influencing SJT outcomes, future studies could consider incorporating variables such as emotional intelligence or students’ work experience.

Our finding that chemistry subject and students’ State of origin (Anambra state) were associated with SJT performance clings with Lievens, who suggested that using behavioral assessment to complement academic examination is important in medical admission and training as there are other predicting factors of SJTs [46]. According to Roth and colleagues, students’ previous academic scores could predict professional performance [47]. Incorporating behavioral assessment methods that assess the interpersonal procedural knowledge of students is important for Nigerian medical schools to consider during the admission selection procedure. Although standardized scores are used as criteria for medical admission, Edmond, et al. noted that using only these scores could have a detrimental effect on minority medical students’ applications to medical training [48].

In this study, students who achieved higher scores in medical school may be less likely to exhibit empathy, good judgement, tolerance, ethical responsibility, patient-centeredness, diligence, teamwork, respectfulness, team leadership/conflict management skills, and the ability to take correction. This inverse association could indicate that students with strong cognitive abilities prioritize academic rigor over the development of non-cognitive skills, such as empathy, teamwork, and adaptability, which are crucial for clinical practice [14, 43]. Alternatively, it may reflect differences in the ways cognitive and non-cognitive skills are cultivated during medical training, with limited emphasis on holistic skill development in academically focused curricula [49]. Research emphasizes the need to address non-cognitive skills in education policy by advocating for their inclusion to enhance student outcomes [49, 50]. These findings underscore the need to balance academic excellence with the intentional integration of behavioral competencies into medical education, ensuring graduates are well-equipped for the interpersonal demands of clinical practice.

We found that in SJT performance, male medical students were more likely to score about 8% lower than female medical students, which aligns with previous findings in the literature [10, 46]. These studies reported a significant association between gender and SJT scores where female medical students consistently performed better than male students [10, 46]. The authors argued that the reason why females tend to perform better than males was because of the SJT items that measure interpersonal interactions relating to conscientiousness and emotion regulation [10, 15, 46, 51]. In contrast, Bardach et al., [16] found no association between a video-based behavioral assessment and gender but found a significant association between a text-based behavioral assessment and gender. This may mean that text-based and video-based SJT scenarios could be interpreted and responded to differently by individuals [17]. However, the gender variations remain underexplored, especially within the Nigerian context. This gap highlights the need to clearly understand the diversity impact regarding gender and modalities of SJT administration in different contexts. Further qualitative investigation should consider exploring the socio-cultural and psychological factors that may contribute to these disparities. For instance, our previous study showed that both medical students and doctors identified humility and respectfulness as essential behavioral competencies for effective practice [24]. This may reflect the influence of cultural context that shape perspectives, values and behaviours in professional practice [24]. Future research could delve into aspects such as gender norms, educational experiences, and social expectations that influence decision-making and behaviors in situational contexts among male and female medical students and professionals in Nigeria.

Study limitations

The possible limitation of this study is the use of self-reported data. The use of a self-administered questionnaire to obtain students’ assessment scores (university screening and clinical assessment scores) could affect the accuracy of information on performance scores provided by students. The authors hoped to collect students’ performance scores directly from the University College of Medicine records to avoid bias. However, the College did not consent to sharing students’ academic records with the authors. Despite this limitation, researchers structured the data collection instrument to obtain the assessment scores for five different clinical subjects and generated an average score for each individual. This was done to ensure the cogency of the assessment score provided. Further studies should consider a direct collection of academic performance records from the medical school instead of students to enhance data accuracy. Another limitation of this study is the different ways of scoring which would have implications for performance and may change the rank order of participants if the weights on questions change. This study’s sample is confined to one institution, Enugu State University of Science and Technology (ESUT), limiting the generalizability of the findings to other Nigerian medical schools or global contexts. Future research should involve multiple medical schools within different states and across various regions in Nigeria.

Conclusion

The findings of this study suggest that students who perform better clinically are also not likely to have higher behavioral competence. However, the negative association between clinical performance and SJTs is not always statistically significant. This has implications for training and implies that an excellent clinical education may facilitate producing better doctors, but this is not always the case.

This research stands as the initial investigation into the role of academic success in predicting the behavioral competencies of medical students. There may be a case for incorporating mechanisms to specifically build behavioral competencies in medical students being trained. Studies that examine these associations in other contexts and test the impact of trainings and other mechanisms in building behavioral competencies in medical professionals could be considered. Future studies should consider using both quantitative and qualitative methods for in-depth exploration of how each behavioral competency influences clinical performance and overall patient outcomes.

Policy implications and recommendations

Based on the findings, policymakers may consider revisiting admission processes and educational strategies to foster a balance between academic excellence and behavioral competencies in medical training. There is a need to develop actionable guidelines for integrating SJT-based assessments into medical school admissions and curricula to enhance their effectiveness. We also recommend advocating for targeted training programs aimed at fostering behavioral competencies alongside academic excellence. This ensures that medical students develop skills critical to patient care and teamwork.

Future studies should explore alternative SJT formats beyond text-based approaches, such as video-based formats or the combination of both, as this may better capture behavioral competencies by providing more engaging and contextually rich scenarios. An in-depth exploration using a qualitative research approach is needed to further understand the cultural and systemic factors influencing gender differences in SJT performance is necessary to address potential disparities. Conducting gender-sensitive analyses will be critical in informing the development of equitable training and assessment practices.

Data availability

The dataset used for this study is available for download at https://kf.kobotoolbox.org/#/forms/aHQfC9pWDQHFwo7pvjm5U4.

Abbreviations

SJTs:

Situational Judgment Tests

ESUT:

Enugu State University of Science, Management and Technology

JAMB:

Joint Matriculation Examination

SSCE:

Senior School Certificate Examination

STEM:

Science, Technology, Engineering, and Mathematics

SOPs:

Standard Operating Procedures

UNTH:

University of Nigeria Teaching Hospital

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Acknowledgements

We thank all the medical students who willingly consented to participate in the study.

Funding

Authors did not receive any funding for this study.

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Authors and Affiliations

  1. Health Policy Research Group, College of Medicine, University of Nigeria Nsukka, Enugu, 40001, Nigeria

    Ifunanya Clara Agu, Uche Shalom Obi & Chinyere Ojiugo Mbachu

  2. Institute of Public Health, University of Nigeria Nsukka, Enugu, 40001, Nigeria

    Ifunanya Clara Agu & Chinyere Ojiugo Mbachu

  3. Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, 40001, Nigeria

    Chinyere Ojiugo Mbachu

  4. Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, 20433, US

    Adanna Chukwuma

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Contributions

AC and COM conceptualized the study; ICA, USO, COM, and AC designed the study. ICA coordinated the data collection, and all the authors carried out data analysis. ICA wrote the first draft of the manuscript. The final version of the manuscript was reviewed and approved by all the authors for journal submission.

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Correspondence to Ifunanya Clara Agu.

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Ethical approval and consent to participate

Ethical approval for this study was sought and obtained from the Health Research Ethics Committee, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla. Written informed consent was obtained from the participants after the study objectives, their rights as participants, potential risks and benefits of participation, and measures to ensure the confidentiality of data were presented to them. Consent to participate was included in the survey questionnaire and participants documented their consent using the KoBo collection Toolbox.

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Not applicable.

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Agu, I.C., Obi, U.S., Mbachu, C.O. et al. Does academic excellence predict non-cognitive competencies? Insights from a situational judgement test among medical students in Nigeria. BMC Med Educ 25, 623 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12909-025-07167-x

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BMC Medical Education

ISSN: 1472-6920

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