Association of Socioeconomic Status With Alpha Omega Alpha Honor Society Membership Among Medical Students

This cross-sectional study investigates the association between Alpha Omega Alpha (AΩA) honor society membership and medical student socioeconomic status.


Introduction
Alpha Omega Alpha (AΩA) honor society membership is the hallmark of academic achievement in undergraduate medical education, and AΩA membership is associated with future success in academic medicine. 1 AΩA members are chosen based on academic performance, leadership, patient care, and service. 2 Nevertheless, studies have shown racial/ethnic disparities in AΩA membership. 3,4 Whether similar disparities in AΩA membership exist across socioeconomic strata remains unknown.
To address this knowledge gap, we investigated the association between AΩA membership and medical student socioeconomic status.

Methods
In this cross-sectional study, we obtained deidentified data from the Association of American Medical Colleges (AAMC) describing medical students applying to residency between 2018 and 2020 who matriculated in the 2014-2015 and 2015-2016 academic years. We determined students' AΩA membership through the AAMC's data applications and services 5 along with socioeconomic measures, including parental education, childhood household income, Pell grant assistance, and whether the student had been a beneficiary of state or federal financial assistance programs for low-income families. Additional characteristics included sex, self-reported race/ethnicity, and Medical College Admission Test (MCAT) scores. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and was approved by the Yale University institutional review board.
Our initial cohort included 36 617 students, from which we excluded 1729 (4.9%) because their medical school had no AΩA chapter, 3609 (9.8%) because AΩA elections occurred in senior year and results were not reported to the AAMC, and 1014 (2.7%) because the socioeconomic measures were unknown. Race/ethnicity was reported by students and categorized into the following groups: non-Hispanic White, non-Hispanic Asian, non-Hispanic Black or African American, Hispanic, non-Hispanic American Indian, Alaskan Native, Hawaiian Native, and other Pacific Islander, or other.
Students who identified with more than 1 racial/ethnic category were categorized as multiracial.
We compared differences between AΩA members and nonmembers using the χ 2 test. We used logistic regression to model the association between measures of socioeconomic status and AΩA membership, adjusting for students' demographic characteristics and MCAT scores. Owing to the collinearity between childhood household income, Pell grant assistance, and state or federal financial aid, childhood household income was selected for inclusion in the multivariate model to provide the greatest distinction in economic advantage between students. Statistical analyses were performed using Stata, version 16.1 (StataCorp). A 2-sided P < .05 defined statistical significance.
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Discussion
Our study's major finding is that students from backgrounds with lower income than their peers were less likely to be AΩA members. Consistent with prior studies, 2,3 our results show persistent and striking racial/ethnic disparities in AΩA membership, even after adjusting for socioeconomic measures and standardized test scores. Our study has limitations. Childhood income was selfreported and may not fully reflect parental financial resources, including assets. Furthermore, our