Academic performance of Brazilian medical students during internship: Regular path versus affirmative action system

Introduction Affirmative action policies have been implemented to promote equitable access to higher education for socially vulnerable students, although their influence on student outcomes remains debated. This study compared the academic performance of students admitted through the regular path (RP) and affirmative action (AA) system, at a Brazilian public medical school.Methods This prospective cohort study included 236 fifth-year medical students from the School of Health Sciences (ESCS), between 2022 and 2024. Sociodemographic and economic data were obtained from institutional and national databases. Academic performance was assessed through cognitive, practical, and professionalism evaluations, as well as the final annual grade.Results Of 236 students, 134 (56.8%) entered via RP and 102 (43.2%) via AA. AA students were older, less often self-declared white, had lower parental education, and worse socioeconomic indicators (all p < 0.001). In univariate analyses, RP students scored higher in three of four evaluations (p < 0.001). After adjustment, admission type was not associated with performance. Cognitive scores correlated with younger age at admission (β: −0.039; 95% CI: −0.065 to −0.014; p < 0.001). Mini-CEX showed no significant associations. Professionalism scores were higher among female (β: 0.165; 95% CI: 0.013 to 0.316; p = 0.033), married (β: 0.589; 95% CI: 0.151 to 1.027; p = 0.009), those with a parent holding higher education (β: 0.242; 95% CI: 0.036 to 0.448; p = 0.021), and younger entrants (β: −0.033; 95% CI: −0.055 to −0.011; p = 0.003). Final grades were higher among female (β: 0.146; 95% CI: 0.032 to 0.261; p = 0.013), married (β: 0.376; 95% CI: 0.044 to 0.708; p = 0.027), and younger students (β: −0.032; 95% CI: −0.048 to −0.015; p < 0.001).Conclusion After adjusting for sociodemographic and economic factors, RP and AA students performed similarly, supporting AA as an effective inclusion policy.