Correlating Prematriculation Metrics With Preclerkship and Board Examination Performance: A Systematic Review and...

This study meta-analyzed associations between academic prematriculation metrics (undergraduate GPA and MCAT scores) and performance outcomes (preclerkship and board examination performance) among US allopathic and osteopathic medical students. Given the evolving landscape of medical school admissions, we examined whether these associations have changed over time.

Following PRISMA guidelines, we systematically searched MEDLINE, Scopus, Google Scholar, and ERIC for studies published before June 2023. Inclusion criteria required studies to report correlations between prematriculation metrics and medical school preclerkship performance (e.g., first-year GPA, preclerkship GPA) or board examination scores (e.g., USMLE Step 1, COMLEX-USA Level 1). Random-effects meta-analyses estimated pooled correlation coefficients, with subgroup analyses assessing differences by medical program type and publication era.

A total of 23 studies met the inclusion criteria, encompassing a maximum of 4965 students across the 14 analyses. All prematriculation metrics showed statistically significant but weak positive correlations with preclerkship performance and board examination scores (R_pooled = 0.22-0.37). MCAT Biological Science and Total scores had the strongest associations with USMLE Step 1 scores, while science GPA had weaker associations. No significant trend in correlation strength was observed over time.

These findings support using holistic admissions review practices to account for non-academic attributes. Future research should explore alternative associations or predictors and assess their impact on longer-term clinical performance.

The online version contains supplementary material available at 10.1007/s40670-025-02546-x.