INTRODUCTION:Performance in an admission test and carefully conducted, structured interview provides a uniform basis for the assessment of applicants prepared in different systems of education for admission to an institute of higher professional learning. We studied the predictability of the system of education followed by the students prior to entrance into the Medical College, the admission test scores, and interview ratings on performance after five trimesters at the Aga Khan University Medical College. METHOD:A cohort of 374 medical students who were admitted during 1989--1994, were considered. The associations between the admission test score, interview ratings, system of education, and the scores obtained for anatomy, physiology, biochemistry and community health sciences examinations held after five trimesters were analysed using appropriate statistical procedures. RESULTS:Interview ratings were associated with the scores in Physiology but not other subjects. The chief finding of this study was the association between the system of education and performance in both the admission test and the examination after five trimesters. Students who followed the British school curricula for 13 years scored significantly higher than those who followed the 12 years of the Pakistani system. When controlled for the admission test score, the difference in mean scores of the two groups was still evident for two subjects; community health sciences and physiology. CONCLUSION:We believe that the evidence indicates differences in learning methods inculcated by the system of education prior to entry into the Medical College, notwithstanding the 1-year difference in duration of education.