The path to health professions is challenging for all students, but for immigrants and first-generation (first-gen) prehealth students, it can feel like navigating uncharted territory without a map. These students often enter higher education with limited exposure to academic culture and professional networks, creating invisible barriers to success that persist throughout their educational journey (Posid 2021, Ruiz 2021). While universities have begun implementing targeted support systems, research shows that these challenges multiply exponentially when these students pursue competitive health professional programs (Joy 2018, Havemann 2023). The HPSA/SDN Fall 2024 Applicant Experience Survey offers compelling new evidence that highlights these systemic disparities and suggests pathways toward more equitable outcomes.
The Health Professional Student Association’s Fall 2024 Applicant Experience Survey examined how immigrant/F1-visa-holding (immigrant/F1), first-gen US, and other-generation US (other-gen, students who are not immigrants or first generation students) prehealth students prepared for the 2024-2025 application cycle. For premed applicants, we compared each cohort’s standardized exams (MCAT) and situational judgment tests (Casper and PREview). We also examined how each group sought advice about the application process from prehealth advisors versus internet sources.
Survey Methodology
The data in this report were analyzed from the HPSA Fall 2024 Applicant Experience Survey. The survey was declared IRB-exempt (IRB00012821, IORG00100811; IRB Protocol 12424601). Anonymous, volunteered responses were captured from an open call to 2024-2025 prehealth applicants between October and December 2024 using RedCap. Additional figures and detailed demographic data are available in a downloadable PDF.
Key Findings on Test Performance (MCAT, Casper, and PREview)
112 respondents self-disclosed their performance on the MCAT, Casper, and PREview exams as part of their application profile. Figure 1 compares immigrant/F1, first-gen, and other-generational respondents. 18 immigrant/F1 respondents reported lower overall performance on the MCAT as shown by the interquartile range (506 to 515.5) and median (507). First-gen respondents’ performance was better (IQR 507 to 518.5, median 512), but was lower than other-gen respondents (IQR 509 to 519, median 514).
Smaller performance differences were observed with the CARS section scores. Immigrant/F1 respondents had lower performance (IQR 124 to 129, median 126) compared to first-gen (IQR 127 to 129.75, median 128.5) or other-gen (IQR 126 to 130, median 128).
Smaller numbers of respondents took situational judgment tests. Among those taking the AAMC PREview exam, immigrant/F1 respondents reported lower scores (IQR 4 to 6.5, median 5.5) compared to first-gen (IQR 4.75 to 7, median 6.5) or other-gen respondents (IQR 6 to 7.25, median 7).
In contrast, other-gen respondents reported better performances on the Casper assessment; 38 of 56 had third- or fourth-quartile (highest) results. 4 of 10 first-gen and 4 of 10 immigrant/F1 respondents reported third- or fourth-quartile results. 5 of 10 immigrant/F1 respondents had first-quartile (lowest) performances.
While our results must be cautiously viewed through the lens of our small sample, they affirm that immigrant/F1 and first-gen applicants tend to have lower exam performance. Immigrant/F1 Casper and PREview performance may be due to English comprehension challenges (CARS scores) or less awareness of expected social norms about academic culture (tested with AAMC PREview) or American society (tested with Casper). If these results represent their cohorts in larger applicant pool, the immigrant/F1 and first-gen applicants may be less successful without broader, holistic consideration of their lived experiences that are of value towards a more skilled and socially responsive healthcare workforce.
Support for International and First-Generation Prehealth Students
We have previously highlighted F1doctors, a non-profit organization helping international health professions students navigate the US admissions process. FGLIMed is a national non-profit organization helping first-generation low-income prehealth students.
Insights on Advising Resources and Satisfaction
Our survey also suggests how immigrant/F1 and first-gen respondents sought information and resources about the application process. Roughly half of all applicants used undergraduate prehealth advising offices (18/31 (58.1%) immigrant/F1, 12/30 (40.0%) first-gen, 67/123 (54.5%) other). Using a 7-point Likert scale, immigrant/F1 respondents were slightly more satisfied with prehealth advisors than first-gen and other-gen respondents, as shown by both the median and interquartile range (Figure 3).
However, respondents relied more on internet resources, as affirmed by 24/31 (77.4%) immigrant/F1, 20/30 (66.7%) first-gen, and 106/124 (85.5%) other-gen respondents. Their satisfaction scores were higher than those given for undergraduate prehealth advising, and immigrant/F1 respondents were more satisfied than US advisees (Figure 4).
Few hired independent, for-profit consultants for application support: 2/30 (6.7%) immigrant/F1, 2/30 (6.7%) first-gen, and 17/125 (13.6%) other-gen. Finally, a small number had access to postbac advisors: 5/31 (16.1%) immigrant/F1, 4/30 (13.3%) first-gen, and 9/124 (7.3%) other-gen.
Action Steps
Immigrant and First-Generation Prehealth Students
Immigrant/F1 and first-gen students should seek communities where they can not only find safe spaces to connect with similar students but also reach out to available university resources. Early connections with advisors, professors, and other champions will help prehealth students understand the experiential steps needed to build a strong applicant profile. Access to these opportunities may be limited for immigrant/F1 students, but university resources can connect them to research, clinical, and community volunteer opportunities. Additionally, first-gen and low-income students may also leverage these resources to find convenient jobs or opportunities. The FirstGen Society offers leadership opportunities and a national network for college and professional students through formation of chapters and partners. Undocumented students should also be familiar with the Pre-Health Dreamers society.
Advisors and Administrators
Faculty, advisors, and student services should welcome immigrant and first-gen students to low-stakes professional opportunities, such as meet-and-greets, “happy hours,” and celebrations of institutional research or community impact. Those interested in scholarship on the first-generation college experience should engage with the FirstGen Forward network.
The results from this survey affirm that, compared to other-gen applicants, immigrant/F1 and first-gen prehealth applicants risk having lower performance on critical admissions tests such as the MCAT and lower representation among matriculating health professions students (Mason 2022). Situational judgment test results suggest they may need more guidance navigating social norms and expectations in US academic settings. While many lean on institutional resources such as prehealth offices, many first-gen respondents remain relatively dissatisfied. Although some prehealth offices have organized special workshops for prehealth first-gen applicants (for example, Florida Atlantic University), more work must focus on improving prehealth advising services for first-gen and immigrant/F1 applicants’ preparation and desirability as future academic health professionals.
Demographic Breakdown of Respondents
186 responses were analyzed for this report. Specifically, we compare 31 self-identified as immigrant/F1 applicants who are not United States permanent residents with 155 US citizens or permanent residents; 30 of the 155 self-identified as first-gen students/alumni. The remainder is referred to as other-generational (other-gen).
Most respondents were pursuing a degree in medicine (23 immigrant/F1, 23 first-gen, and 92 other-gen), but we had responses from those interested in dentistry, veterinary medicine, or other health professions. Majorities were observed for female respondents and those taking gap years or not currently in school.
16 of 29 first-gen respondents said they grew up in a medically underserved/health professional shortage area. In contrast, 11 of 25 immigrant//F1 and other-gen US (44 of 125) applicants said they grew up in a medically underserved area. 21 of 29 first-gen respondents also self-identified as financially independent of their parents; 13 of 30 immigrant/F1 and 51 of 124 other-gen US applicants self-identified as financially independent.
Immigrant/F1 respondents self-identified as Asian (14), White (6), Black (5), and Middle Eastern (3). First-gen respondents identified as White (14), Asian (10), and Latinx/Hispanic (6). Other-gen respondents identified as White (90), Asian (21), Latinx/Hispanic (13), Black (6), Middle Eastern (5), and Native American/Indian (4).
Among their faith identities, immigrant/F1 respondents identified as Muslim (6), Agnostic (5), Atheist (4), and Christian (3 mainline Protestant, 3 Roman Catholic, and 3 non-denominational). First-gen respondents identified as Agnostic (7), Non-denominational Christian (6), Hindu (4), and Atheist (3). Other-gen respondents identified as Atheist (27), Roman Catholic (25), Agnostic (25), and Non-denominational Christian (20).
Most immigrant/F1 respondents began their education after arriving in the United States before high school (14) or during high school (7), and they consider their mastery of English as native as a health professional program applicant (26).
The demographics of survey respondents, as well as additional figures, are available for download.
HPSA Survey Insights
The Health Professional Student Association (HPSA) conducts research surveys on the experiences of health professional school applicants and students.
References
Boxplots were generated with Box and whisker plot maker – offering advanced plot with a wide range of customization options, statskingdom.com. Accessed April 4, 2025.
Havemann C, Mason HRC, Russell RG, et al. Challenges Facing First-Generation College Graduates in Medical School: A Qualitative Analysis. JAMA Netw Open. 2023;6(12):e2347528. Challenges Facing First-Generation College Graduates in Medical School: A Qualitative Analysis.
Joy (2018). Advice for First Generation Students in Medical School, University of Michigan. Accessed April 5, 2025.
Mason, H. R. C., Ata, A., Nguyen, M., Nakae, S., Chakraverty, D., Eggan, B., Martinez, S., Jeffe, D. B. (2021). First-generation and continuing-generation college graduates’ application, acceptance, and matriculation to U.S. medical schools: a national cohort study. Medical Education Online, 27(1). https://doi.org/10.1080/10872981.2021.2010291.
Posid (2021). A first-generation pre-medical program for underrepresented undergraduate students to promote matriculation to medical school | Student Success Research Lab, Ohio State University. Accessed April 5, 2025.
Ruiz (2021). To My Fellow First-Generations Pursuing Medicine | Aspiring Docs Diaries, AAMC. Accessed April 5, 2025.
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 interprofessional 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 is an expert on admissions, has been quoted by the Association of American Medical Colleges (AAMC), and has volunteered as a workshop facilitator on holistic admissions for the American Dental Education Association (ADEA). He has also contributed to the essay collection The Perfect Doctor by Pager Publications and has developed competency-based rubrics supporting holistic review.