Revealing Relationships Between Academic Support Services Utilization and Step 1 Outcomes: A Structural Equation Modeling Investigation

Medical schools are increasingly adopting proactive academic support models, yet evidence on how students use these services and whether they are effective remains limited. This study examined Student Academic Support Services (SASS) use at one U.S. medical school and its relationship to United States Medical Licensing Examination (USMLE) Step 1 outcomes using records from 114 students in the Class of 2024. Students used SASS at varying levels, ranging from no visits to more than 10 during the preclerkship years; 14 students (12%) had documented disability accommodations. Students with lower academic performance-based on pre-admission measures (MCAT, GPA) and course exam results-were more likely to use SASS. In regression analyses, course exam performance was positively associated with Step 1 success, while SASS use was inversely associated when examined separately but not when included in the same model. Structural equation modeling clarified these relationships, demonstrating that both poorer course performance and higher SASS use were associated with an increased risk of Step 1 failure, while MCAT scores and undergraduate GPA exerted indirect effects. Disability accommodation status was not associated with Step 1 outcomes and did not improve model fit. These findings suggest that students with prior standardized test and academic difficulty are more likely to seek SASS support, rather than support use itself contributing to poorer outcomes. The study also demonstrates the value of advanced analytic approaches for understanding complex, interrelated predictors. Future research should replicate these findings in larger, multi-institutional samples and more directly evaluate the impact of academic support services.