Last Updated on January 9, 2024 by Laura Turner
How can applicants avoid the stress of applying to medical school? Well, a few of their incoming classmates may have already found a different path to earn their seat through articulation “early assurance” or “early decision” pathways.
Addressing concerns that individuals from low socioeconomic backgrounds cannot access an undergraduate education, universities have created pathways to directly admit eligible high school graduates, allowing the students to continue their education at community colleges or state universities. Many private universities provide full financial aid to incoming students from those backgrounds, and some medical schools are making similar commitments to limit student debt burdens (such as the Pritzker University of Chicago School of Medicine and Rowan University-Virtua School of Osteopathic Medicine).
Families whose children are focused on becoming healthcare professionals may want to consider these tracks to bypass the more stressful and competitive college and medical school admissions processes. For many years, these attractive guaranteed admissions tracks usually involved three or four years of undergraduate coursework before starting up to four years of professional school, generally at the same university or with a partnering graduate program. Progression is contingent on meeting academic standards and avoiding any severe institutional actions. Such a pathway was brought to national attention in 2022 when a young STEM student-advocate, Analeigh Wicker, received a direct offer of admission from the UAB Heersink School of Medicine through the Burroughs Wellcome Scholars Early Assurance Program.
However, guaranteed admissions tracks are also getting their share of scrutiny. While few details are given about students taking these tracks, anecdotally, many students who make it to medical school seem to share a similar family financial background in the upper quartile as their regular decision peers and do not seem to come from lower socioeconomic or historically underrepresented communities.
In this article, we help students and their families with guidance on whether these early assurance tracks address both the career aspirations and social/developmental maturation of these future physicians.
How Articulation Agreements Are Established
Articulation agreements are educational contracts between two higher education institutions with the goal of helping transition eligible enrolled students from one program to the other. For example, agreements can be set up between a community college and a nursing program to help streamline the process of getting registered nurses to earn a bachelor’s degree in a shorter period of time by acknowledging community college coursework that counts towards the degree (AACN directory). Other agreements streamline entry for students attending their home university or nearby undergraduate institutions (Ferris State/Michigan College of Optometry, West Virginia School of Osteopathic Medicine).
Many undergraduate colleges – especially small liberal arts colleges or minority-serving institutions – will also have information on articulation agreements they have with health professions programs (Skidmore College; Hampton University; Stockton University; University of Hawaii; University of Tampa; Gannon University Pre-Chiropractic, Pre-Optometry, Pre-Podiatry, and Pre-Veterinary tracks). Admission to these guaranteed tracks may occur concurrently with undergraduate admission or after a year or two of successful college coursework, with the exact process agreed upon by both programs.
“Guaranteed Admissions Tracks” with College Admission
Which schools offer guaranteed admissions tracks? According to the AAMC Medical School Admissions Requirements (entering class 2024), 41 AMCAS schools have a BS/MD guaranteed admissions track. The ADEA Dental School Explorer (entering class 2024) lists only three dental schools with a BS/DMD or BS/DDS track (Howard, Rutgers, Detroit Mercy), but other schools may also have guaranteed admissions tracks. The PharmCAS Pharm.D. school directory has filters to identify programs with guaranteed admission “Primary Program Structures” including a 2-year (undergrad)+ 3-year (pharmacy), 2 + 4, or 3 + 4-year programs. Like Ferris State/Michigan College of Optometry, Nova Southeastern University offers a B.S./O.D. track for those pursuing optometry. Some veterinary programs have set up a similar track with their undergraduate programs for veterinary students (Cornell University and University of Missouri).
During college recruitment events, families and students should ask the undergraduate admissions office about any health professional school guaranteed admissions tracks. Information may be limited on the admissions office website, so it is best to reach out to college recruiters to speak with the appropriate administrators in charge. Additionally, you should reach out to the college’s prehealth advising office, who may play a role in advising students on the guaranteed admissions track.
One should pay attention to the college GPA requirements and expectations to remain in the guaranteed admissions track as an undergraduate. In addition to required coursework, it should be clear whether applications (such as AMCAS, AACOMAS, AADSAS, PharmCAS, OptomCAS), exams (MCAT, DAT, OAT, SJTs), and interviews are just required or if students need to meet a specific performance threshold before being admitted to the professional program. Conditions for student conduct should also be clearly stated.
Before deciding to place an enrollment deposit at the college, students and parents should meet current undergraduate students who are in the track. It is vital to gauge the services students receive from the undergraduate program and from the health professions program when it comes to academic support, mentoring, shadowing, community service activities, or research opportunities in preparation for professional school. The ideal program will help the undergraduate students make a seamless transition to professional school without awkwardly standing out in their class. Frequently, I have seen guaranteed admission students wind up in the top decile of their class.
Often, the undergraduate program will offer scholarships to guaranteed admission students. Other benefits may include selective housing for the guaranteed admission students, which may include exclusive co-curricular activities. Students may also get separate advising sessions with the prehealth advising and academic advising offices.
There is usually no limit to the number of students that can be accepted, but professional school admissions officers must still plan on reserving seats for the guaranteed admission students down the road (three or four years away). Consequently, depending on the year, up to a dozen seats may be set aside for guaranteed admission students in each class. These applicants may be required to take entrance exams and perform above a specific threshold set by the professional school admissions committee. There may also be a prohibition from “applying outside” the guaranteed admission track to other schools.
After consulting with the professional school admissions committee, the undergraduate admissions office sets the entry standards for guaranteed track students. Since entry to medical school is considered academically competitive, one would expect accepted applicants to have a strong academic profile, leadership potential, and some limited experience with healthcare or research. This may include taking advanced placement or dual enrollment courses while a high school student. In addition, high school applicants may need to complete an additional essay or interview for the program before being admitted.
Pharmacy guaranteed admissions tracks offer students different schedules where they can complete two, three, or four years of undergraduate coursework before beginning pharmacy school (examples: NEOMED, Albany, D’Youville, University of Florida, University of Arizona). Students may also be offered additional assistance with coursework or mentoring as an undergraduate.
“Early Assurance” Tracks: Applying as an Undergraduate
Current college undergraduates may be eligible to apply for “early assurance” tracks around the time they complete their sophomore year of coursework. Requirements for these programs include a minimum college GPA with specific prerequisite courses, very strong SAT/ACT scores, and strong recommendations from high school teachers, college professors, or the institutional prehealth advisors. Students should review the criteria carefully for experience requirements, student conduct expectations, and other conditions for acceptance, which may include a prehealth committee letter. Usually, an application to the professional school is involved, and the shortlisted candidates may need to interview with the admissions committee.
Desirable applicants to these tracks should also show academic breadth beyond premedical prerequisites and biomedical courses. Showing a deeper interest in humanities, social sciences, or fine arts coursework and through community service is a distinct advantage. Strong candidates also exhibit high maturity levels, leadership, interpersonal skills, and integrity as self-driven scholars and problem-solvers. Finally, shortlisted applicants should articulate their purpose as future healthcare professionals and an alignment with the mission of the professional program they wish to enter.
Benefits of being admitted to these highly selective tracks may include having a lower-stress transition to professional school. This includes less urgency when submitting primary applications, taking their entrance exams, completing scheduled interviews, and waiving of application fees. There is also the comfort of knowing that they are assured of their seat in the incoming class, provided the admissions committee approves them at their transition step.
Many early assurance program students may also benefit from networking with current health professions students who were part of their program as undergraduates. These students may receive additional mentoring or guidance from faculty when preparing for admissions exams (like the MCAT), arranging mock interviews, connecting with clinical faculty, or networking with prospective research mentors.
“Early Decision” Process: Putting Your Eggs in One Basket
Similar to the Early Decision process for college admissions, some medical schools have an Early Decision process (EDP) to reward applicants who are committed to attending one specific medical school. According to guidelines from AMCAS and AACOMAS, EDP applications must be submitted by August, with all letters and admissions requirements (like MCAT scores) received no later than early September. Decisions are made in early October, and any rejected applicants are then allowed to apply to other schools through the regular decision process. You can only apply early decision to one medical school, so you cannot apply to an AACOMAS EDP school while having an active AMCAS application for regular admission. Furthermore, you should not apply to a medical school EDP and have active applications in other disciplines (dental, vet, physician assistant, etc.).
SDN Experts caution that the rejected applicants who want to continue with regular admission will have a more challenging time getting admitted to an AMCAS program because they will submit their application in October.
Applicants are highly recommended to contact admissions offices before submitting Early Decision applications to gauge their chances. Applicants who may be geographically limited by extraordinary personal circumstances that do not allow the applicant to move away from the medical school campus should reach out to see if their school has an EDP. Some schools may suspend their EDP process without notice, even during an active application cycle, so submitting an application would effectively lock out any EDP applicants from the admission process until much later.
Undergraduate EDPs are facing scrutiny as the pool of applicants that enter through this process tend to have much higher metrics and come from higher socioeconomic backgrounds. Although little data about the characteristics of medical school matriculants who enter through EDPs are publicly available, med school EDPs may also face similar criticism.
Leaving an Early Assurance Track
Many forum posters ask SDN Experts for advice on leaving their early assurance track. These applicants want to “test the waters” with the larger application pool, confident that their current academic and extracurricular record will make them competitive.
Before starting an early assurance track, determine the trade-offs of giving up your guaranteed seat. Many assurance track programs are binding commitments to attend their specific program, while others allow for students to opt-out. Most programs will admit you with a much lower entrance exam threshold than the regular decision applicant average. You will not be sheltered from the stress of the regular application process and will likely have to set aside more money for application fees and costs.
Most students leave their early assurance tracks because they have a change of heart in their professional goals. Some have found that a different profession fits what they want from a career. Others want their own post-baccalaureate “growth/gap” year doing research or pursuing an internship before starting professional school, which may not be allowed according to the early assurance track. Others simply feel they can upgrade to a school with better resources and student support. Finally, some drop out of the track by not meeting academic or program expectations (GPA, test scores, student conduct sanctions).
Are You a Good Candidate for Early Assurance?
What would make a strong candidate for guaranteed admissions or early assurance tracks? It is always prudent to talk with those who oversee the track’s admissions process, but here are a few characteristics that show how well you are prepared to be part of these programs.
- Have a strong commitment to a health professional career with early clinical volunteering or shadowing.
Although legal regulations limit those under 18 from working in clinical settings, successful candidates enroll in pipeline programs or are part of a science-rigorous high school that offers experiential opportunities (such as observing surgeries in a hospital). Such early K-12 pipeline programs are often run by nearby universities or non-profit organizations dedicated to diversifying the healthcare workforce.
College freshmen or sophomores should focus on hospital or clinical volunteering and shadowing during their breaks to secure strong letters of recommendation from the professionals they shadow or work with. In the summer of their freshman or sophomore year, they could participate in pipeline or academic enrichment programs that offer shadowing opportunities. Participating in prehealth fairs with activities such as suturing or First Aid also shows a strong interest in healthcare.
- Be academically well-rounded but successful with math and science courses.
Successful progress in a strong, well-rounded curriculum is a highly desirable characteristic for college admissions. Good candidates show an ability to discuss interests in literature, history, and the arts as well as a strong interest in math, science, and health. Transcripts from high school and college that show strong performance help allay concerns that a potential student on the guaranteed admissions track will only remain focused on biomedical science courses. Instead, desirable students should expand their academic interests to other non-science disciplines with their intended academic plans.
One of the criticisms of college-entry tracks is the bias towards students who come from strong college-preparatory high schools with a fully-funded program of Advanced Placement or International Baccalaureate classes. A lack of infrastructure and teacher training can disproportionately prevent minority students from accessing AP coursework and getting credit through the exams. Specifically, high school students who can pass college-level math and science classes are more likely to continue in these majors when they go to college, so there is a strong advantage to having a highly rigorous college-prep schedule in high school. This is also supported by a 90th percentile or better SAT or ACT score, which is a common requirement for these tracks.
College freshmen or sophomores also need a similarly high college and BCP GPA (3.8+) with no remediation and no student institutional sanctions. A few tracks may explicitly consider other factors for those who may be from a historically disadvantaged background, but science and math proficiency is still expected.
- Demonstrate maturity and professional decision-making early.
Candidates must show they are critical thinkers with a mature sense of integrity, self-awareness, and situational awareness. Applicants should demonstrate an awareness of ethical decision-making, an aversion to cheating and plagiarism, a persistence to succeed when confronting challenges, and humility while reflecting upon failures. Many of these applicants will be in their early twenties when they begin meeting patients, so having maturity and serious focus helps the patient to trust the future healthcare professional. Any institutional action – no matter how slight – could jeopardize a spot through early assurance or guaranteed admission.
- Demonstrate a commitment to their community.
Candidates who have shown a purpose to impact health and well-being in the communities where they grew up are highly preferred. These candidates align strongly with a professional program’s mission using the resources available at the undergraduate institution. The candidate must show how they will incorporate their ongoing commitment to serving their campus and local communities while excelling in their studies before joining the professional program.
Applicant Questions to Consider about Early Assurance or Guaranteed Admission
- Do I need to complete a bachelor’s degree, or can I earn one? Can I pursue other interests (double major, certificate) that can also prepare me for professional school? Must the bachelor’s degree be in a recognized “premed/prehealth” major?
- Can I transition to professional school earlier if I have sufficient advanced placement credits to complete the undergraduate phase earlier?
- What is the minimum GPA required for the guaranteed offer of admission? How are withdrawals or repeated coursework considered, even in non-prerequisite classes? Do I lose my eligibility with a leave of absence or being placed on probation?
- Is an offer of admission guaranteed if I “pass” an interview? Do I need to take the MCAT/DAT/Casper/PREview or other exam for the guaranteed offer? If so, what is the minimum score?
- Do participants have exclusive opportunities to shadow other professionals? Do students get additional mentoring or advising support?
- If there is more than one early assurance track, can I switch tracks (for example, from predental to premedical)? For example, if I don’t meet the minimums for your “premed” track, can I switch to a pre-optometry track if there are different minimums and expectations?
- Do I need an institutional committee letter? Can a prehealth advisor help me complete a transitional application to the professional school phase?
- What challenges do most of your early assurance track students have in completing the undergraduate phase? During their professional school phase?
- If I am interested in applying to other schools with a regular application, do I forfeit my guaranteed seat? How will this be represented in my prehealth committee letter?
- Do I need to take a situational judgment test (like Casper or PREview)?
- Can I talk with successful students who have gone on and graduated from the professional program to see how the accelerated track helped them?
- Am I eligible for professional school scholarships as a guaranteed admitted student? Would I get help applying for any additional financial support from the undergraduate or the professional program financial aid counselors?
- If I chose to go to the same professional school where I attended undergraduate, but decided to curtail my undergraduate studies (two or three years instead of four), can I stay in undergraduate university housing?
- How many seats in the professional program are set aside for early assurance students?
Tips for Early Assurance or Guaranteed Admission Program Applications
- Directly answer your application essay questions.
It is essential to communicate your overall focus and fit with the early assurance track. Ensure you can reflect on situations you observed in your clinical experiences and elsewhere (employment, in school, etc.). Reviewers understand that you reserve the right to be flexible with your career path, but if the track supports pre-pharmacy students, you must articulate why pharmacy is the career you want to pursue.
- Get supportive references.
High school students may have fewer options, but they should work with their counselors to find strong references for their early assurance applications.
College students should start very early by connecting with their first-semester professors who hold large lecture science classes. Most of the time, these professors will be the only ones you can lean on to fulfill any requirements for reference letters. In addition, they should ask staff (not student) supervisors for references at volunteering experiences they undertake. You should ask prehealth and academic advisors to plan for your future semesters properly should you be accepted.
- Apply early, or at least pay attention to deadlines.
The professional school admissions office wants to bring early assurance petitions to the admissions committee leadership as early as possible. The committee wants to know how many seats in the incoming class need to be set aside, so the earlier you send in your request, the better. If you don’t meet the deadline, the admissions committee will assume you are no longer interested in your guaranteed seat.
Finding Bridges to a Health Professional Career
Many states have prioritized creating healthcare workforce pipelines to address their challenges with access inequities and poorer public health outcomes. Parents and students should be on the lookout for the pipeline opportunities offered by their local hospitals, community colleges, schools, universities, and libraries. Developing a strong appreciation not only for a desired career but also for others engaged in the healthcare system will be extremely important for any future doctor, nurse, or healthcare provider for the next few decades. Knowing how one’s mission aligns with the overall needs of a community serves as the ultimate motivation to become a healthcare professional.
Emil Chuck, Ph.D., is Director of Advising Services for the Health Professional Student Association. He brings over 15 years of experience as a health professions advisor and an admissions professional for medical, dental, and other health professions programs. In this role for HPSA, he looks forward to continuing to play a role for the next generation of diverse healthcare providers to gain confidence in themselves and to be successful members of the inter-professional healthcare community.
Previously, he served as Director of Admissions and Recruitment at Rosalind Franklin University of Medicine and Science, Director of Admissions at the School of Dental Medicine at Case Western Reserve University, and as a Pre-Health Professions Advisor at George Mason University.
Dr. Chuck serves an expert resource on admissions and has been quoted by the Association of American Medical Colleges (AAMC).