A pre-matriculation learning program that enables medical students with low prerequisite scores to succeed

Dear Sir

Selection of qualified medical school candidates from a large applicant pool is a challenging process that precludes potentially successful individuals from a career in medicine. Current quantitative measures and non-cognitive indicators do not accurately predict performance. Our group hypothesized that a post-baccalaureate Medical Education Review Program (MERP) would prepare its graduates for Ross University School of Medicine (RUSM) and that success in MERP would correlate with performance at RUSM. MERP, a 15-week basic science curriculum with non-cognitive skill building sessions and repeated assessments, provides an opportunity for the initially rejected applicants to improve their potential as medical students before matriculating to RUSM.

Performance of 896 students, who began RUSM after successfully completing MERP, was compared with 3324 directly admitted non-MERP students. Pre-admission criteria (prerequisite GPA (pGPA) and MCAT scores), performance at RUSM (attrition rates prior to semester two and five), and US Medical Licensing Examination (USMLE) Step 1 pass rates were compared for cohorts matriculating to RUSM between January 2007 and May 2010.

As expected, MERP students had lower average MCAT score (20.99 ± 4.18 for MERP and 23.62 ± 4.23 for non-MERP, p < 0.001) and average pGPA (2.67 ± 0.38 for MERP and 3.14 ± 0.42 for non-MERP, p < 0.001). Despite lower pre-admission credentials, MERP students were more likely to matriculate to semester two. The attrition rate prior to semester two was 5.6% for MERP students, compared to 11.2% for non-MERP students (χ² (1, N = 4220) = 24.48, p < 0.001). The rate of attrition prior to semester five was comparable for both groups. Students who achieved an overall score of 80% or above in MERP were significantly more likely than non-MERP students to reach semester two, χ²(1, N = 3633) = 38.411, p < 0.001, and semester five, χ²(1, N = 3633) = 30.806, p < 0.001. Of the 309 MERP top-performers, 100% reached semester two, while 94.2% reached semester five.

Comparing the USMLE step 1 scores revealed that MERP and non-MERP students did not differ significantly on the probability of passing the Step 1 on their first attempt, χ²(1, N = 2405) = 1.228, p = 0.268. Although MERP students averaged below their non-MERP counterparts (211.1 ± 17.4 and 214.8 ± 19.5, p < 0.001 for MERP and non-MERP, respectively), this effect size (d = 0.20) was less than the pre-existing differences between the two groups on MCAT (d = 0.72) and pGPA (d = 1.04).

Our data suggests that previous academic performance and career background may underestimate true capacity of an individual as a medical student. Achievements in MERP or similar programs can help predict academic success of potential candidates in medical school.