How Postbaccalaureate Career Changer and Traditional Medical Students Differ Academically

I. Cori Baill, MD; Bertha Ben Khallouq, MA; Oloruntomi Joledo, PhD; Anna Jacobs, BA; Robert Larkin, BA; Nyla Dil, DVM, PhD

Disclosures

South Med J. 2019;112(12):610-616. 

In This Article

Abstract and Introduction

Abstract

Objective: This retrospective descriptive study compared the academic performance of postbaccalaureate career changer students with that of traditional students during the classroom-based, science-dominated early years of medical school. Earlier studies documented the eventual success of nontraditional medical students, although we found little information specific to the medical school performance of career changers. Our objective was to determine whether postbaccalaureate career changer medical students perform differently from traditionally prepared medical students in the science-dominated early years of medical school classroom education.

Methods: This study analyzed the admission data and academic performance of medical students at the University of Central Florida College of Medicine across 8 years (N = 630). Differences in performance were assessed using examination grades from the first 2 years of medical school, and US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores.

Results: Statistically significant differences were found between traditional and career changer students for all science modules in year 1, and 4 of the 5 modules in year 2. Traditional students performed better on USMLE Step 1. Significant differences between the groups disappeared by USMLE Step 2.

Conclusions: Career changer medical students show a small, persistent academic lag in the first 2 years of medical school and on USMLE Step 1 scores. By USMLE Step 2 the difference disappears. Similar undergraduate grade point averages and Medical College Admission Test scores suggest that science exposure, not ability may explain these differences. An unexpected finding is the number of career changer students is not increasing proportional to the proliferation of postbaccalaureate programs in the United States. This study may benefit student advisors and residency directors, and, it is hoped, provide reassurance to career changer students.

Introduction

Despite the increasing proliferation of postbaccalaureate (PB) premedical programs for career changers (CCs) during the last 4 decades, little is known about the medical school performance of these students.[1,2] This article focuses on the eventual academic success of CCs in the modern era of PB program proliferation. CCs as a group met few, if any, premedical science requirements while earning their undergraduate degrees. Most CCs used nondegree postbaccalaureate certificate programs for the minimum required year-long premedical courses with laboratory in general chemistry, organic chemistry, biology, and physics. These requirements are widespread and largely unchanged from 1930.[3] CC PB programs, similar to traditional undergraduate premedical programs, variably include preparation for the Medical College Admission Test (MCAT), access to clinical volunteer hours, basic science research opportunities, and application counseling. In contrast to CC students, traditional premedical students complete the upper-level science courses necessary for an undergraduate degree in a core bioscience.

Before this study, we could identify a single brief observation contrasting the academic performance of CC students to their classmates during the basic science component of the medical school curriculum.[4] Forty-four PB CCs were admitted in 1985 and 1986 to a medical school with a pass/fail/honors grading system. The study noted, without additional specifics, that CCs got off to a slower academic start, but later, did equally well as their classmates. Twice as many PB CCs failed US Medical Licensing Examination (USMLE) Step 1; however, the finding did not reach statistical significance.

There is another type of PB program for which a larger body of literature exists. Academic record enhancer (ARE) PB programs were conceived in the 1960s and 1970s to support academically capable socially and economically disadvantaged students, many of whom had unsuccessfully applied to medical school. ARE PB programs often include classes similar to those in the first year(s) of medical school. Academically, ARE program graduates perform as well as or better than traditional medical students (TSs).[1,2,5–7]

As the success of ARE programs became established, both types of PB programs have become more widely offered. In 2012, there were 135 PB programs listed on the Association of American Medical Colleges (AAMC) centralized application service Web site, American Medical College Application Services, an increase of 45% from 2009.[8] In July 2018, there were 253 PB programs, 149 of which were designated for CCs.[9]

Precise historical data are difficult to come by because the listings are voluntary and may be incomplete. The AAMC began listing PB programs online in 2003 (B. Hunter, personal communication, 2018). The AAMC does not track the number of PB applicants or matriculants to Liaison Committee on Medical Education–accredited US medical schools; however, indirect data are available through the Matriculating Student Questionnaire (MSQ) sent annually to all first-year matriculants of Liaison Committee on Medical Education–accredited US medical schools. Annual computerized MSQ aggregate data are available from the AAMC beginning with 1998.[10]

Between 2009 and 2017, approximately 70% (64.1%–78%) of all admitted students responded to the MSQ. The response rate ranged at individual schools from ≤25% to 100%. The percentage of matriculating students deciding to study medicine after achieving their bachelor's degree, the percentage of students who took premedical courses for the first time between college and medical school, and the number who participated in nondegree PB programs to complete premedical coursework or improve academic skills does not appear to have increased proportional to the proliferation of PB programs (Table 1).

The self-identified percentage of CCs based on the MSQ cohort and additional AAMC data of 57,276 first-year US medical students from 1996 to 2000 suggests only a modest upward trend.[11] In that cohort, as in more recent years, the percentage of CC matriculants (6.9%) exceeded the percentage of ARE PB students (6.2%), although ARE PB students may be underestimated because only nondegree postbaccalaureate programs are addressed by the MSQ. In other words, ARE programs offering a degree are possibly underrepresented. The 1996–2000 MSQ data showed that ARE and PB CC were older, more likely to plan to practice in underserved areas, and more likely to be female, as did a smaller study of 460 medical students graduating between 1999 and 2002, comprising 209 PB students from 10 schools matched to 251 non-PB classmates not separated into CC or ARE categories.[12] Although the methodology described that the 10 schools were selected "on the basis of their specific mission to prepare disadvantaged and underrepresented students for medical school," many of the schools had programs for both types of PB participants. The study found that survey respondents graduated in equal percentages and that PB students become board certified in an equal percentage compared with the national average (85.6%), although less so than their matched, non-PB classmates (98%).

The purpose of our study was to describe the academic performance of PB CCs and TSs at the University of Central Florida College of Medicine (UCFCOM) from 2009 to 2017. We wanted to investigate whether the PB CCs would lag academically behind traditionally prepared medical students in the science-dominated first years of medical school. We used admission data, classroom test scores from year 1 and year 2 examinations, and the standardized USMLE Step 1 and 2 Board scores to answer our research question.

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