How Medical Students Get Into School May Shape Whether They Ever Do Research

When medical schools admit students through several different doors, do those doors shape what happens behind them? A new study from Thailand suggests the answer may be yes, at least when it comes to one of the most consequential activities a future physician can pursue outside the classroom: research. The study, published in BMC Medical Education, tracked more than a thousand medical students across six admission cohorts and found that those admitted through a portfolio-based pathway were roughly nine times more likely to have documented extracurricular research participation than classmates who entered through an examination-based route. The finding, the authors stress, is an association rather than proof of cause, but its magnitude has caught the attention of medical educators who have long suspected that admission systems do more than sort applicants.

The research team, led by Tanatuch Tiratrakoonseree and colleagues at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, in Bangkok, set out to answer a deceptively simple question: does the way students get into medical school relate to whether they later engage in research on their own initiative? To find out, they designed what methodologists call a sequential explanatory mixed-methods study, a two-phase architecture in which quantitative patterns are first established from large datasets and then interrogated through interviews that probe why those patterns might exist. This design is increasingly favored in education research because numbers alone rarely reveal the mechanisms behind disparities, and anecdotes alone rarely establish whether disparities are real.

The quantitative phase drew on institutional records from 1,021 students admitted between 2017 and 2022 through two distinct pathways of the Thai University Central Admission System, known as TCAS. The first, TCAS1, is a portfolio-based route in which applicants are evaluated on documented achievements, including academic records and extracurricular accomplishments. The second, TCAS3, is an examination-based route that relies primarily on standardized test performance. The outcome measure was deliberately concrete: at least one eligible extracurricular research activity recorded in institutional documentation from the moment of entry until graduation or 30 September 2023, whichever came first. Eligible activities included securing a research grant, presenting a conference abstract, or publishing a scholarly paper. Crucially, the researchers excluded research that was mandatory within the curriculum or tied to concurrent degree programs, ensuring that the measure captured voluntary, student-initiated engagement rather than required coursework.

The headline numbers were striking. Overall, only 103 of the 1,021 students, or 10.1 percent, had documented extracurricular research participation. But the distribution between pathways was lopsided: 52 of 246 TCAS1 students, or 21.1 percent, had such documentation, compared with just 51 of 775 TCAS3 students, or 6.6 percent. In statistical terms, the team used logistic regression, a modeling technique that estimates the odds of an outcome while adjusting for other variables, to quantify the gap. In a minimally adjusted model accounting for admission pathway and cohort year, portfolio-admitted students showed dramatically higher odds. In the primary model, which additionally adjusted for selected pre-admission characteristics, the adjusted odds ratio was 9.19, with a 95 percent confidence interval of 4.96 to 17.03. A confidence interval that excludes 1.0 by a wide margin indicates a statistically robust association, and this one does not come close to crossing that threshold.

A natural objection is that portfolio-admitted students might simply arrive with stronger academic credentials, particularly higher pre-university grade point averages, and that GPA rather than pathway explains the difference. The researchers addressed this directly with paired complete-case models run on the 854 students for whom pre-university GPA data were available. Before adjusting for GPA, the pathway estimate was 11.25; after adjustment, it was 10.63. The estimate barely moved, which is a classic sign that the pathway association is not confounded by prior academic performance in any meaningful way. Notably, GPA itself produced an imprecise estimate that was not statistically significant, meaning the data could not establish that pre-university grades predicted later research engagement at all. In other words, the admission route, not the report card, carried the signal.

Numbers this stark demand explanation, and that is where the qualitative phase earned its keep. Using the same eligibility criteria extended through 30 September 2024, the team sampled participants for interviews and ultimately spoke with 24 students or graduates, three faculty research advisors, and three members of the institution’s research-support committee. The interviews were analyzed thematically, a method in which researchers code transcripts for recurring patterns of meaning and organize them into overarching themes. Five interlocking themes emerged: prior exposure to research before medical school, research self-efficacy or the confidence to carry out scholarly work, the availability of mentoring and visible entry routes into research, competing priorities and academic pressure that crowd out voluntary activities, and unclear pathways that leave students unsure how to begin.

Perhaps the most intellectually honest element of the study is what the interviews revealed about the limits of the quantitative signal. Contrasting cases, in which the researchers deliberately compared participants and non-participants with similar backgrounds, showed that prior research exposure was neither necessary nor sufficient for later participation. Some students with no pre-medical research history became productive researchers once they found mentors and accessible entry points, while others with substantial prior exposure never engaged, deterred by the relentless demands of the medical curriculum or by other priorities. This nuance matters because it undercuts any temptation to read the odds ratio as a verdict on student potential. The authors are explicit on this point: the association should not be interpreted as causal, nor should admission pathway be treated as a proxy for what a student is capable of achieving.

What the evidence does support is a more structural interpretation. Students admitted through the portfolio route may arrive with different research-related starting conditions, including familiarity with how research works, existing contacts, and a self-image that includes scholarly contribution. But the interviews make clear that post-admission circumstances carry real weight too. Where mentoring is visible, where entry routes into labs and projects are clearly signposted, and where academic pressure leaves room to breathe, students from both pathways participate. Where those supports are opaque or scarce, participation withers regardless of background. The 10.1 percent overall participation rate is itself a sobering datum: even in an environment with institutional research support structures, the large majority of future doctors complete training without a single documented voluntary research activity.

The implications ripple outward well beyond a single Thai institution. Many medical schools worldwide operate multi-track admissions, blending portfolio assessment, standardized examinations, interviews, and holistic review, precisely because each method captures different dimensions of applicant quality. This study suggests that such systems may inadvertently create divergent trajectories that persist for years, quietly shaping who enters the physician-scientist pipeline. With concerns about shortages of clinician-researchers mounting globally, an admission decision made at age eighteen or nineteen appearing to correlate with a nine-fold difference in documented scholarly output is the kind of finding that should prompt institutional self-audits everywhere. The remedy the authors propose is refreshingly practical rather than structural upheaval: make research opportunities visible and accessible across all admission groups, invest in mentoring that reaches students who lack pre-existing networks, and respect that students have diverse priorities, some of which legitimately lie outside the laboratory. Equity in medical education, this study implies, is not only about who gets in, but about what doors remain open once they arrive.

Subject of Research: The association between medical school admission pathways and extracurricular research participation during medical training

Article Title: Association between medical school admission pathways and documented extracurricular research participation: a sequential explanatory mixed-methods study

Article References: Tiratrakoonseree, T., Suppawittaya, P., Srisatidnarakul, I., Kaewkamjornchai, P., & Sungkaworn, T. (2026). Association between medical school admission pathways and documented extracurricular research participation: a sequential explanatory mixed-methods study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10525-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10525-y

Keywords: medical school admission, research engagement, medical education, mixed-methods study, portfolio-based admission, examination-based admission, scholarly activity, mentoring, research self-efficacy, physician-scientists, logistic regression, Thailand