Application to achievement: association between pre-admission factors, admission scores, and medical students’ performance

Background: Students have long been admitted into medical colleges using standardized tests/interviews. However, limited evidence exists on their association with academic achievement during medical education. Moreover, the relationship between its individual components and subsequent academic achievement remains unexplored. This study aims to determine the association between medical students’ demographics and admission scores with their academic performance during medical college. Methods: This cross-sectional study was conducted in 2023 at one of the oldest private medical colleges in a South Asian low- and middle-income country, where data for medical students graduating with a Bachelor of Medicine, Bachelor of Surgery (MBBS) degree in 2018–2022 were retrieved electronically. Through an extreme groups approach (EGA) sampling, factors leading to students falling within the top 20% scorers in preclinical, clinical, procedural, and non-procedural clerkships were identified. Binary logistic regression models assessed the association between demographics and admission scores with their academic performance in medical college. Results: From data of 418 students, EGA sampling included a total of 168 and 169 students for comparison between the top and bottom 20% scorers in preclinical and clinical rotations, respectively. Female sex (adjusted OR:4.10, 95% CI:1.94,8.65) and higher biology, physics, and mathematical reasoning scores on the university’s admission test independently predicted preclinical academic achievement. Female sex and higher mathematical reasoning scores significantly predicted academic achievement in clinical, procedural, and non-procedural clerkships. Higher biology scores also independently predicted achievement in non-procedural clerkships (adjusted OR:1.03, CI:1.01,1.06). Prior schooling from the British education system was significantly associated with higher mean percentage for admission scores and clinical clerkships for applicants compared to the local education system. Conclusion: Higher scores on medical college admission tests can predict medical students’ academic achievement during undergraduate studies. Understanding the specific test components associated with students’ success can refine the selection process, ultimately fostering efficient healthcare professionals.