PURPOSE
Medical students frequently struggle during the early transition into the
curriculum, especially in gross anatomy. Many matriculate without prior
anatomy coursework, and existing evidence on its impact is mixed. Lower MCAT
scores also predict early academic difficulty, yet the impact of both is
unclear. This study examines how prior anatomy coursework and MCAT
performance relate to early anatomy exam and block outcomes to identify
students who may need early support.
 
METHODS
This study used admissions and anatomy course data from 2019–2024 at our
medical school. Pre-admission variables included MCAT scores and any
undergraduate anatomy coursework. We selected separate random samples of 60
students per year—30 each from the upper and lower tertiles—for analyses,
totaling 300 per analysis. Multivariable logistic regression assessed
associations of prior anatomy coursework, MCAT scores, and their interaction
with odds of scoring in the lower third on the first exam and final course
grade.
 
RESULTS
Prior anatomy coursework was linked to lower odds of scoring in the bottom
third on the first exam (OR = 0.21, 95% CI: 0.12–0.35). Higher MCAT scores
independently predicted lower odds of poor performance. The interaction
between anatomy coursework and MCAT score was not significant for the first
exam, so only main effects are reported. A similar pattern was observed for
final course performance (OR = 0.23, 95% CI: 0.14–0.39), though the effect of
prior anatomy became non-significant when the interaction was included.
Students with MCAT scores in the 25th–75th percentile benefited significantly
from prior anatomy coursework (OR = 0.19, 95% CI: 0.04–0.79).
 
CONCLUSIONS
Students lacking prior anatomy experience were significantly more likely to
score in the bottom third on the first exam, as well as overall block
average, a position that can predispose learners to broader academic
struggles if unaddressed.