From MCAT to USMLE: how familial background shapes medical student success

Students from families with higher levels of educational attainment are consistently overrepresented in medicine, whereas first-generation college students remain markedly underrepresented. Early evidence indicates that these inequities begin before matriculation, as lower parental education and family income are strongly associated with lower Medical College Admission Test (MCAT) scores. However, less is known about whether the performance gaps evident at the admissions stage persist into subsequent stages of medical training. This study examines whether familial educational background is associated with performance across three key milestones: MCAT, Step 1, and Step 2 CK. This study aims to explore whether students’ familial backgrounds significantly affects their academic progression through medical school. This retrospective cohort study analyzed a deidentified dataset of 425 medical students from the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, categorized into first-generation students, continuing-generation students, and children of physicians. Academic performance data included MCAT, United States Medical Licensing Examination (USMLE) Step 1, and Step 2 Clinical Knowledge (CK) scores. One-way analysis of variance (ANOVA) with Bonferroni-corrected post-hoc comparisons evaluated between-group differences. MCAT scores differed significantly across groups, with first-generation students scoring lower than continuing-generation students and children of physicians, and children of physicians outperforming continuing-generation students. No statistically significant differences were observed on Step 1 or Step 2 CK. These findings demonstrate that although students from less advantaged familial backgrounds begin medical school at a measurable disadvantage, these differences do not persist. This highlights the need to reconsider how admissions committees weigh standardized tests and underscores the importance of holistic approaches that recognize resilience, adaptability, and perseverance.