**4.2 The problem of academic underachievement in medical school**

Concerns about academic under-preparedness associated with the transition from the preprofessional phase to the professional phase of undergraduate medical education are likely to be the same as those associated with transition from the preclinical to the clinical phase [30]. A key feature of low academic achievement in the first two preclinical years of medical school appears to be an underappreciation of the volume and complexity of the information needed to be learned. Students are often hampered by not having developed a systematic method for handling complex information during their preprofessional undergraduate training. A "tried-and-true," albeit highly individualized, method of mastering complex information is usually needed to provide the impetus for developing confidence in test taking skills and for meeting the challenges of translating complex basic science knowledge into evaluation, problem solving and differential diagnosis. The outcome of this difficult transition is twofold: (i) a large number of students exhibit low academic achievement on formative and summative examinations designed to test medical information processing skills and substandard performance on standardized (NBME, USMLE Step 1) examinations designed to evaluate readiness for entry into the clinical phase of undergraduate medical training; and (ii) many students exhibit high academic performance on their formative and summative course examinations but low performance on the standardized NBME and USMLE. We have previously reported that TBR, a measure of attentional control, is negatively correlated with academic achievement in medical students [7–9]. In this chapter, we depict and interpret the qEEG brain maps demonstrating the spectrum of deviations from the normative reference values for qEEG theta and beta voltages and higher versus lower TBR seemed to identify students exhibiting neurophysiological and cognitive deviations from the norms, which could explain their underachievement. To our knowledge, this is the first report depicting qEEG brain

## *Quantitative Electroencephalography for Probing Cognitive and Behavioral Functions… DOI: http://dx.doi.org/10.5772/intechopen.107483*

maps of individuals at two ends of a spectrum of academic performance on a medical school exam. The significance of the qEEG maps is quite obvious from the global changes in color-coded range of voltages shown in **Figure 1** and **2**. The map of the subject with the highest exam score shows colors indicative of substantial increases in both their average theta frequency and their average beta frequency voltages **Figure 1**. The map of the subject with the lowest exam score shows colors indicative of very little change in their theta and beta voltages (**Figure 2**). We speculate that these colorcoded voltage changes suggest that the subject with the highest exam score might have improved neural plasticity, compared to the subject with the lowest exam score. We envisage such usage of qEEG as a putative marker for identifying individuals who might benefit from neurofeedback or other types of brain training and educational counseling. Such targeted interventions might be expected to change the qEEG brain maps and neural plasticity associated with studying for a high-stakes medical school examination, as described in this chapter, or preparing for other rigorous academic challenges.
