Medical Student Socioeconomic Disadvantage, Self-Designated Disadvantage, and Subsequent Academic Performance.

We previously reported that medical school matriculants with higher scores on a continuous measure of socioeconomic disadvantage (SED) had worse academic performance than those with lower scores. Analyses examining performance concurrently by SED and self-designated disadvantage (SDA) are lacking, an important gap since SDA may reflect perceptions only partly shaped by SED. We examined the associations of the four possible combinations of SED and SDA categories-SED+/SDA+, SED+/SDA-, and SED-/SDA+ (versus SED-/SDA-as reference)-with U.S. Medical Licensing Examination (USMLE) Step 1 and 2 Clinical Knowledge performance and third-year clerkship Honors at one medical school. USMLE scores were lower than reference for SED+/SDA+ and SED-/SDA+ (but not SED+/SDA-) students. SED+/SDA+, SED+/SDA-, and SED-/SDA+ students all received fewer Honors than reference. The findings indicate SED and SDA each predict different features of medical school performance, suggesting avenues for enhancing disadvantaged students' success and the representativeness of the physician workforce.