Alternate list matriculants: Outcome data from those medical students admitted from the alternate list

Background: Medical schools are increasing class size to meet future health care needs for our nation. This may lead to more students being accepted from an alternate list (vs. primary acceptances). Given these trends, performance outcomes were compared for alternate list matriculants and primary acceptances. Our hypothesis was that those students accepted from an alternate list would perform equally to the primary acceptances on these outcomes. Method: We compared medical school performance of students who received a primary recommendation of "accept" and compared them to those who received a recommendation of "alternate" over a 10-year period. Given the small sample size of this alternate list group (N = 23), descriptive statistics are reported. Results: No consistent differences between alternate and primary acceptance matriculants in terms of cumulative medical school grade point average, United States Medical Licensing Examination (USMLE) Step 1 scores and USMLE Step 2 Clinical Knowledge scores were found. Only three alternates (13.0%) were presented to student promotion committee compared to 17.2% for matriculants who were primary acceptances. Three alternates were required to repeat a year (average percentage of 8.7%) compared to 5.6% of matriculants who were primary acceptances. Conclusions: This observational study provides some reassurance that as long as the qualifications of the applicant pool remain adequate, admissions policies that provide for alternate list acceptances may not produce poorer performing students, at least by our current outcome measures.