First-generation and continuing-generation college graduates’ application, acceptance, and matriculation to U.S. medical schools: a national cohort study

Figures & data

Table 1. Characteristics of 2001–2006 PMQ respondents who completed the MCAT and the comparison of subsequent application, acceptance and matriculation rates by student characteristics

	Total Sample^a	Applied^b	Accepted^c	Matriculated^d
	N = 211,216	N = 142,847	N = 86,486	N = 84,844
College-graduate generation based on parent’s education, No. (%)
Continuing-generation	158,914 (75.2)	112,527 (70.8)	71,778 (63.8)	70,426 (98.1)
First-generation	52,302 (24.8)	30,320 (58.0)	14,708 (48.5)	14,418 (98.0)
PMQ/MCAT year, No. (%)
2001	29,480 (14.0)	20,298 (68.9)	13,116 (64.6)	12,827 (97.8)
2002	34,514 (16.3)	23,316 (67.6)	14,399 (61.8)	14,110 (98.0)
2003	35,851 (17.0)	24,520 (68.4)	15,062 (61.4)	14,777 (98.1)
2004	35,826 (17.0)	24,220 (67.6)	14,505 (59.9)	14,253 (98.3)
2005	37,678 (17.8)	25,295 (67.1)	14,823 (58.6)	14,577 (98.3)
2006	37,867 (17.9)	25,198 (66.5)	14,581 (57.9)	14,300 (98.1)
MCAT score, mean (SD) †	24.9 (6.7)	26.6 (6.1)	29.1 (5.0)	29.1 (5.0)
Sex
Male	96,983 (45.9)	68,894 (71.0)	43,464 (63.1)	42,725 (98.3)
Female	114,233 (54.1)	73,953 (64.7)	43,022 (58.2)	42,119 (97.9)
Race/ethnicity, No. (%)
Non-Hispanic White	125,535 (59.4)	86,654 (69.0)	54,685 (63.1)	53,563 (97.7)
Non-Hispanic Asian/PI	42,207 (20.0)	27,876 (66.0)	16,025 (57.5)	15,766 (98.4)
URiM	34,087 (16.1)	22,607 (66.3)	13,157 (58.2)	12,983 (98.7)
Other/multiple/unknown	9,387 (4.4)	5,710 (60.8)	2,619 (45.9)	2,532 (96.7)
Carnegie classification, No. (%)
Research universities with very high research activity, No. (%)	89,686 (42.5)	72,385 (80.7)	48,791 (67.4)	48,099 (98.6)
Other Doctoral universities, No. (%)	33,312 (15.8)	23,631 (70.9)	12,943 (54.8)	12,694 (98.1)
Master’s colleges and universities, No. (%)	30,336 (14.4)	19,807 (65.3)	9,334 (47.1)	9,136 (97.9)
Baccalaureate A&S colleges, No. (%)	19,371 (9.2)	15,201 (78.5)	10,276 (67.6)	10,080 (98.1)
Other institutions, No. (%)	6,613 (3.1)	3,950 (59.7)	1,793 (45.4)	1,756 (97.9)
Not specified, No. (%)	31,898 (15.1)	7,873 (24.7)	3,349 (42.5)	3,079 (91.9)
Age on PMQ, No. (%)
< 23 years	158,138 (74.9)	111,221 (70.3)	70,788 (63.6)	69,507 (98.2)
≥ 23 years	53,078 (25.1)	31,626 (59.6)	15,698 (49.6)	15,337 (97.7)
MCAT-preparation course, No. (%)
No	91,587 (43.4)	56,598 (61.8)	32,748 (57.9)	31,969 (97.6)
Yes	119,629 (56.6)	86,249 (72.1)	53,738 (62.3)	52,875 (98.4)
College laboratory research apprenticeship, No. (%)
No	139,246 (65.9)	89,437 (64.2)	50,874 (56.9)	49,834 (98.0)
Yes	71,970 (34.1)	53,410 (74.2)	35,612 (66.7)	35,010 (98.0)
College academic-enrichment summer program, No. (%)
No	185,587 (87.9)	124,333 (67.0)	75,036 (60.4)	73,583 (97.8)
Yes	25,629 (12.1)	18,514 (72.2)	11,450 (61.8)	11,261 (98.3)
Paid or volunteer work in hospitals/clinics/labs, No. (%)
No	60,206 (28.5)	36,748 (61.0)	21,130 (57.5)	20,659 (97.8)
Yes	151,010 (71.5)	106,099 (70.3)	65,356 (61.6)	64,185 (98.2)
Other paid work, No. (%)
No	99,978 (47.3)	67,837 (67.9)	42,087 (62.0)	41,370 (98.3)
Yes	111,238 (52.7)	75,010 (67.4)	44,399 (59.2)	43,474 (97.6)

Abbreviations: PMQ, Pre-Medical College Admission Test Questionnaire; MCAT, Medical College Admission Test; PI, Pacific Islanders, including Native Hawaiian; URiM, underrepresented in medicine, including Black/African American, Hispanic, and American Indian/Alaska Native groups; A&S, Arts & Sciences.

^aDistribution of characteristics of the study population (column percents).

^bComparison of frequency and proportion of total eligible students who applied for admission, by each student characteristic. All comparisons were statistically significant at p < 0.001 except ‘Other paid work’ being significant at p = 0.039.

^cComparison of frequency and proportion of applicants to medical school who were accepted, by each student characteristic. All comparisons were statistically significant at p < 0.001

^dComparison of frequency and proportion of accepted students who matriculated, by each student characteristic.

†MCAT is a continuous variable, therefore only mean and standard deviation of those who applied, were accepted and, matriculated are presented

Table 2. Multivariable logistic regression models identifying variables independently associated with medical school application, acceptance, and matriculation

	Applied to Medical School	Accepted to Medical School	Matriculated into Medical School
	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
College-graduate generation based on parent’s education
Continuing-generation	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
First-generation	0.84 (0.82–0.86)	0.86 (0.83–0.88)	1.01 (0.88–1.15)
MCAT score^a	1.18 (1.18–1.19)	1.31 (1.30–1.31)	1.02 (1.01–1.04)
PMQ/MCAT year^b	1.00 (0.99–1.01)	0.88 (0.88–0.89)	1.03 (1.003–1.06)
Sex
Male	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Female	0.94 (0.92–0.96)	1.17 (1.14–1.21)	0.78 (0.70–0.86)
Race/Ethnicity
Non-Hispanic White	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Non-Hispanic Asian/PI	1.06 (1.03–1.09)	0.73 (0.70–0.76)	1.13 (0.98–1.30)
URiM	2.23 (2.16–2.31)	3.68 (3.53–3.84)	1.76 (1.48–2.10)
Other/multiple/unknown	0.93 (0.89–0.98)	0.54 (0.50–0.57)	0.59 (0.47–0.73)
Carnegie classification
Research universities with very high research activity	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Other Doctoral universities	1.06 (1.02–1.09)	1.12 (1.08–1.16)	0.80 (0.69–0.93)
Master’s colleges/universities	0.93 (0.90–0.96)	0.90 (0.86–0.93)	0.77 (0.65–0.91)
Baccalaureate A&S colleges	1.01 (0.97–1.05)	1.20 (1.14–1.25)	0.83 (0.70–0.97)
Other institutions	0.90 (0.85–0.95)	1.03 (0.96–1.12)	0.83 (0.59–1.16)
Not specified	0.07 (0.07–0.08)	0.34 (0.33–0.36)	0.17 (0.15–0.20)
Age on PMQ
< 23 years	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
≥ 23 years	0.79 (0.77–0.81)	0.58 (0.57–0.60)	0.85 (0.75–0.96)
MCAT-preparation course
No	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Yes	1.26 (1.23–1.28)	1.05 (1.02–1.08)	1.42 (1.29–1.58)
College laboratory research apprenticeship
No	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Yes	1.10 (1.07–1.13)	1.14 (1.11–1.17)	1.05 (0.94–1.17)
College academic-enrichment summer program
No	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Yes	1.27 (1.23–1.32)	1.28 (1.23–1.34)	1.00 (0.85–1.18)
Paid or volunteer work in hospitals/clinics/labs
No	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Yes	1.36 (1.32–1.39)	1.18 (1.14–1.21)	1.18 (1.06–1.33)
Other paid work
No	1.00 (Reference)	1.00 (Reference)	1.00 (Reference)
Yes	0.90 (0.88–0.92)	0.86 (0.84–0.88)	0.83 (0.74–0.92)

Abbreviations: aOR, adjusted odds ratio; 95% CI, 95% confidence interval; MCAT, Medical College Admission Test; PMQ, Pre- MCAT Questionnaire; PI, Pacific Islanders, including Native Hawaiian; URiM, underrepresented in medicine, including Black/African American, Hispanic, and American Indian/Alaska Native groups; A&S, Arts & Sciences.

^aaOR > 1.00 indicates greater likelihood of application, acceptance, and matriculation for each unit increase in MCAT score.

^baOR < 1.00 indicates lower likelihood of acceptance, and aOR > 1.00 indicates greater likelihood of matriculation, for each increase in PMQ year.

Table 3. Comparison of respondent characteristics, by first-generation and continuing-generation college-graduate status. (N = 211,216)

	First-generation	Continuing-generation	p-value *
	N = 52,302 (%)	N = 158,914 (%)
PMQ/MCAT year
2001	7,534 (14.4)	21,946 (13.8)	<0.001
2002	8,827 (16.9)	25,687 (16.2)
2003	8,936 (17.1)	26,915 (16.9)
2004	8,786 (16.8)	27,040 (17.0)
2005	9,106 (17.4)	28,572 (18.0)
2006	9,113 (17.4)	28,754 (18.1)
MCAT score, mean (SD)	22.2 (6.5)	25.8 (6.5)	<0.001
Sex
Male	22,447 (42.9)	74,536 (46.9)	<0.001
Female	29,855 (57.1)	84,378 (53.1)
Race/ethnicity
Non-Hispanic White	28,045 (53.6)	97,490 (61.3)	<0.001
Non-Hispanic Asian/PI	8,853 (16.9)	33,354 (21.0)
URiM	13,021 (24.9)	21,066 (13.3)
Other/multiple/unknown	2,383 (4.6)	7,004 (4.4)
Carnegie classification
Research universities with very high research activity	17,326 (33.1)	72,360 (45.5)	<0.001
Other Doctoral universities	9,437 (18.0)	23,875 (15.0)
Master’s colleges and universities	10,814 (20.7)	19,522 (12.3)
Baccalaureate A&S colleges	3,746 (7.2)	15,625 (9.8)
Other institutions	2,451 (4.7)	4,162 (2.6)
Not specified	8,528 (16.3)	23,370 (14.7)
Age on PMQ
< 23 years	34,837 (66.6)	123,301 (77.6)	<0.001
≥ 23 years	17,465 (33.4)	35,613 (22.4)
MCAT-preparation course
No	25,744 (49.2)	65,843 (41.4)	<0.001
Yes	26,558 (50.8)	93,071 (58.6)
College laboratory research apprenticeship
No	36,407 (69.6)	102,839 (64.7)	<0.001
Yes	15,895 (30.4)	56,075 (35.3)
College academic-enrichment summer program
No	45,287 (86.6)	140,300 (88.3)	<0.001
Yes	7,015 (13.4)	18,614 (11.7)
Paid or volunteer work in hospitals/clinics/labs
No	15,295 (29.2)	44,911 (28.3)	<0.001
Yes	37,007 (70.8)	114,003 (71.7)
Other paid work
No	22,808 (43.6)	77,170 (48.6)	<0.001
Yes	29,494 (56.4)	81,744 (51.4)

Abbreviations: PMQ, Pre-Medical College Admission Test Questionnaire; MCAT, Medical College Admission Test; PI, Pacific Islanders, including Native Hawaiian; URiM, underrepresented in medicine, including Black/African American, Hispanic, and American Indian/Alaska Native groups; A&S, Arts & Sciences.

*p-values for difference in mean MCAT scores is based on ANOVA. The remainder are based on Chi-square tests.