Influence of Admission Pathways on Learning Strategies, Assessment Engagement, and Academic Performance Among First-Year Medical Students: Mixed Methods Retrospective Observational and Cross-Sectional Survey Study

Background: Medical school admission pathways are designed to select suitable applicants, with different approaches potentially impacting students' learning behaviors and performance. Objective: This study aimed to compare students' self-regulated learning (SRL) strategies, assessment engagement statistics (AES), nongrading evaluation (Outstanding ["O"]/Satisfactory ["S"]/Unsatisfactory ["U"]) preferences, and academic performance across admission pathways, and analyze correlations and linear regression models among summative scores, AES, and course learning outcome (CLO) scores. Methods: This mixed methods retrospective observational and cross-sectional survey study used census sampling with selection criteria of all enrolled first-year medical students in 2021 (N=319) across 4 admission pathways: academic (n=23), quota (n=6), test (n=261), and rural (n=29). Demographics included age (19-24 years) and sex (167/319, 52.4% male). AES, CLO scores, and summative scores were obtained from institutional databases. Two system-embedded institutional questionnaires assessed SRL strategies (316/319, 99.1% response rate) and "O"/"S"/"U" preferences (299/319, 93.7% response rate). Outcome measures included SRL strategies, AES, "O"/"S"/"U" preferences, CLO scores, and summative scores. Statistical significance was set at P