Association of MCAT Scores Obtained With Standard vs Extra Administration Time With Medical School Admission, Medical Student Performance, and Time to Graduation

IMPORTANCE Individuals with documented disabilities may receive accommodations on the Medical College Admission Test (MCAT). Whether such accommodations are associated with MCAT scores, medical school admission, and medical school performance is unclear. OBJECTIVE To determine the comparability of MCAT scores obtained with standard vs extra administration time with respect to likelihood of acceptance to medical school and future medical student performance. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of applicants to US medical schools for the 2011-2013 entering classes who reported MCAT scores obtained with standard time (n = 133 962) vs extra time (n = 435), and of students who matriculated in US medical schools from 2000-2004 who reported MCAT scores obtained with standard time (n = 76 262) vs extra time (n = 449). EXPOSURES Standard or extra administration time during MCAT. MAIN OUTCOMES AND MEASURES Primary outcome measures were acceptance rates at US medical schools and graduation rates within 4 or 5 years after matriculation. Secondary outcome measures were pass rates on the United States Medical Licensing Examination (USMLE) Step examinations and graduation rates within 6 to 8 years after matriculation. RESULTS Acceptance rates were not significantly different for applicants who had MCAT scores obtained with standard vs extra time (44.5%[59 585/133 962] vs 43.9%[191/435]; difference, 0.6%[95% CI, -4.1 to 5.3]). Students who tested with extra time passed the Step examinations on first attempt at significantly lower rates (Step 1, 82.1%[344/419] vs 94.0% [70 188/74 668]; difference, 11.9% [95% CI, 9.6% to 14.2%]; Step 2 CK, 85.5%[349/408] vs 95.4%[70 476/73 866]; difference, 9.9%[95% CI, 7.8% to 11.9%]; Step 2 CS, 92.0% [288/313] vs 97.0%[60 039/61 882]; difference, 5.0%[95% CI, 3.1% to 6.9%]). They also graduated from medical school at significantly lower rates at different times (4 years, 67.2% [285/424] vs 86.1%[60 547/70 305]; difference, 18.9% [95% CI, 15.6% to 22.2%]; 5 years, 81.6%[346/424] vs 94.4%[66 369/70 305]; difference, 12.8%[95% CI, 10.6% to 15.0%]; 6 years, 85.4%[362/424] vs 95.8% [67 351/70 305]; difference, 10.4%[95% CI, 8.5% to 12.4%]; 7 years, 88.0%[373/424] vs 96.2%[67 639/70 305]; difference, 8.2%[95% CI, 6.4% to 10.1%]; 8 years, 88.4%[375/424] vs 96.5%[67 847/70 305]; difference, 8.1%[95% CI, 6.3% to 9.8%]). These differences remained after controlling for MCAT scores and undergraduate grade point averages. CONCLUSIONS AND RELEVANCE Among applicants to US medical schools, those with MCAT scores obtained with extra test administration time, compared with standard administration time, had no significant difference in rate of medical school admission but had lower rates of passing the USMLE Step examinations and of medical school graduation within 4 to 8 years after matriculation. These findings raise questions about the types of learning environments and support systems needed by students who test with extra time on the MCAT to enable them to succeed in medical school.