PREview scores and applicant conduct indicators: distinguishing current professional readiness from historical events

Professionalism is a foundational expectation for medical training, yet traditional academic metrics provide limited insight into applicants' professional readiness. The AAMC PREview® Professional Readiness Exam assesses how applicants evaluate and respond to realistic scenarios requiring effective professional behavior. Prior studies have not examined how PREview scores relate to misconduct indicators in medical school applications. This study compares PREview scores across applicants with and without AMCAS misconduct indicators, focusing on differences between contemporaneous professionalism concerns and historical misconduct after accounting for academic preparation.

This quasi-experimental observational study analyzed national-level AMCAS applicant data from the 2021-2025 application cycles for U.S. MD-granting medical schools. Analyses were conducted separately for four misconduct indicators: felony conviction, misdemeanor conviction, prior institutional action, and active investigation during the application cycle. Kernel-based propensity score weighting was used to establish academic comparability based on MCAT score, undergraduate GPA, and application year and to estimate average treatment effects on the treated (ATT) for PREview scores.

After adjustment for academic covariates, applicants under active investigation scored an average of 1.48 PREview points lower than academically comparable applicants without an investigation. Associations between PREview scores and historical misconduct indicators were substantially smaller after adjustment, and estimates for felony convictions were imprecise due to rarity.

After accounting for academic preparation, PREview scores were more strongly associated with contemporaneous professionalism concerns than with historical misconduct indicators. This pattern is consistent with the intended interpretation of PREview scores as a forward-looking assessment of applicants' responses to professionalism-relevant situations in the medical school admissions context.