Prematriculation variables associated with suboptimal outcomes for the 1994-1999 cohort of US medical school matriculants.
BACKGROUND
The relationship between increasing numbers and diversity of medical school enrollees and the US physician workforce size and composition has not been described.


OBJECTIVE
To identify demographic and prematriculation factors associated with medical school matriculants' outcomes.


METHODS
Retrospective study using deidentified data for the 1994-1999 national cohort of 97,445 matriculants who were followed up through March 2, 2009, and had graduated, had withdrawn, or were dismissed. Data were analyzed using multivariable logistic regression to identify factors associated with suboptimal outcomes.


METHODS
Academic withdrawal or dismissal, nonacademic withdrawal or dismissal, and graduation without first-attempt passing scores on the US Medical Licensing Examination Step 1 and/or Step 2 Clinical Knowledge (CK) compared with graduation with first-attempt passing scores on both of the examinations.


RESULTS
Of 84,018 matriculants (86.2%), 74,494 graduated and had first-attempt passing scores on both the Step 1 and Step 2 CK (88.7%), 6743 graduated and did not have first-attempt passing scores on the Step 1 and/or Step 2 CK (8.0%), 1049 withdrew or were dismissed for academic reasons (1.2%), and 1732 withdrew or were dismissed for nonacademic reasons (2.1%). Variables associated with greater likelihood of graduation without first-attempt passing scores on the Step 1 and/or Step 2 CK and of academic withdrawal or dismissal, respectively, were (1) Medical College Admission Test scores (scores of 18-20 [2.9% of sample] vs > 29: adjusted odds ratio [AOR], 13.06 [95% confidence interval {CI}, 11.56-14.76] and AOR, 11.08 [95% CI, 8.50-14.45]; scores of 21-23 [5.6% of sample] vs > 29: AOR, 7.52 [95% CI, 6.79-8.33] and AOR, 5.97 [95% CI, 4.68-7.62]; and scores of 24-26 [13.9% of sample] vs > 29: AOR, 4.27 [95% CI, 3.92-4.65] and AOR, 3.56 [95% CI, 2.88-4.40]), (2) race/ethnicity (Asian or Pacific Islander [18.2% of sample] vs white: AOR, 2.15 [95% CI, 2.00-2.32] and AOR, 1.69 [95% CI, 1.37-2.09]; underrepresented minority [14.9% of sample] vs white: AOR, 2.30 [95% CI, 2.13-2.48] and AOR, 2.96 [95% CI, 2.48-3.54]), and (3) premedical debt (> or = $50,000 [1.0% of sample] vs no debt: AOR, 1.68 [95% CI, 1.35-2.08] and AOR, 2.33 [95% CI, 1.57-3.46]).


CONCLUSIONS
Lower scores on the Medical College Admission Test, nonwhite race/ethnicity, and premedical debt of at least $50,000 were independently associated with a greater likelihood of academic withdrawal or dismissal and graduation without first-attempt passing scores on the US Medical Licensing Examination Step l and/or Step 2 CK.
Andriole
Dorothy A
DA
Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8210, St Louis, MO 63110, USA. andrioled@wustl.edu
Jeffe
Donna B
DB
D000328:Adult; D015331:Cohort Studies; D004521:Educational Measurement / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008007:Licensure, Medical / Q000706:statistics & numerical data; D008297:Male; D010820:Physicians / Q000600:supply & distribution*; D044469:Racial Groups; D012189:Retrospective Studies; D012577:Schools, Medical / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult