Admission criteria and academic performance in first-year medical and dental students at a new medical school in Zambia: a historical cohort study

Abstract

Abstract Background Sub-Saharan Africa carries 25% of the global burden of disease yet has only 3% of the world’s health workers. Zambia, with a population of approximately 19.7 million (2024), reported a physician density of 0.93 per 10,000 population — far below the WHO-recommended threshold. The Copperbelt University School of Medicine (CBU SOM), established in 2011, uniquely admitted two groups of first-year students: those with conventional university-level science qualifications (University group) and those with college-level dental science diplomas (College group). This created a natural experiment to examine whether alternative admission criteria compromise academic performance. Methods A historical cohort study was conducted among all 70 first-year students admitted to CBU SOM in the academic year 2011/12. Students were grouped by admission pathway: University ( n = 44) and College ( n = 26). Academic performance was assessed by summated mean percentage scores across seven courses over three terms and final examinations. Primary analysis used independent samples t-tests to compare overall end-of-year performance. Secondary analyses examined performance by term, by course type, and by sex and socioeconomic subgroups. Multivariate linear regression assessed independent predictors of performance. Results Sixty-seven students completed the full academic year. No statistically significant difference was found in overall end-of-year performance (University: 64.8% vs. College: 62.1%; p = 0.455). The University group performed better in Term 1 (65.3% vs. 61.2%; p = 0.003), Term 3 (64.0% vs. 60.0%; p = 0.026), and in both basic science (63% vs. 61%; p = 0.019) and clinical science courses (68% vs. 65%; p = 0.035). Female-subgroup analysis showed borderline overall difference (66.8% vs. 62.0%; p = 0.044) with convergence by Term 3. Socioeconomic status was the only significant predictor in multivariate analysis ( p = 0.017); sex and age were non-significant. Conclusions Students admitted through an alternative diploma-level pathway performed equivalently to conventionally admitted students in overall first-year academic outcomes. The University group showed an early advantage, particularly in basic sciences, which attenuated across the year — consistent with academic adaptation. Socioeconomic status was the dominant predictor of performance. These findings support the feasibility of alternative admission pathways as part of health workforce expansion strategies in low-resource settings.