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Marize Lima de Sousa Holanda Biazotto,1,2 Fernanda Viana Bittencourt,3 Gilson Roberto de Araújo,2 Sérgio Eduardo Soares Fernandes,1 Leila Bernarda Donato Göttems,1 Carlos Manoel Lopes Rodrigues,4 Francisco de Assis Rocha Neves,2 Fábio Ferreira Amorim1,2 1School of Medicine, School of Health Sciences (ESCS), Brasília, Federal District, Brazil; 2Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 3Education and Research Foundation of Health Sciences (FEPECS), Brasília, Federal District, Brazil; 4School of Psychology, Centro Universitário de Brasília (UniCEUB), Brasília, Federal District, BrazilCorrespondence: Fábio Ferreira Amorim, School of Medicine, School of Health Sciences (ESCS), UNIDADE I - SMHN Quadra 03, Conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, Brazil, Tel +55 61 999773516, Email fabio.amorim@escs.edu.brPurpose: Affirmative action policies to provide access to higher education for socially vulnerable students have been implemented in several countries and have faced many questions nowadays. The aim of the study was to compare the socioeconomic background and performance during and after completing the undergraduate course of students admitted through the regular path and social quota systems in a public medical school in Brazil.Methods: A retrospective cohort study including students admitted to a medical school within the School of Health Sciences (ESCS), in Brazil, between 2005 and 2012, and followed until May 2020. In the first phase, data collection was performed by analyzing documents from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey with 12 questions was sent to the medical school alumni. The social quota system criteria were the public school attendance in all primary and secondary education levels.Results: Among 707 students, 204 (28.9%) were from the social quota and 503 (78.5%) from the regular path system. The place of residence of social quota students had a lower Human Development Index (p < 0.001) and per capita income (p < 0.001) when compared to regular path students. Regular path students were associated with the highest dropout from medical school (OR: 50.552, 95% CI: 12.438– 205.453, p < 0.001). There was no difference between regular path and social quota students attending medical residency programs (OR: 1.780, 95% CI: 0.957– 3.309, p = 0.069). Out of the 308 alumni who completed the survey, regular path students had more family members who were health professionals than social quota students (p < 0.001). There were no significant differences regarding monthly income, job satisfaction, employment, or management activities.Conclusion: Affirmative action targeted students with a disadvantaged socioeconomic background. Regular path students had a higher dropout rate than social quota students.Keywords: medical school, medical education, affirmative action, public policy, social mobility, social marginalization