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Efforts to diversify U.S. medical education face persistent challenges, with underrepresented students disproportionately attending underfunded, less selective colleges that limit preparation for medical school. This study examines how undergraduate students’ individual attributes (e.g., race/ethnicity, socioeconomic status, first-generation status) and alma mater characteristics (e.g., selectivity, minority-serving status, size, location, and type) influence admission to Texas medical schools. Using Texas Medical & Dental Schools Application Services data (2018–2022), we found admissions strongly favored academically strong, Texas-resident, and socioeconomically advantaged applicants. Institutional factors also shaped acceptance: attendance at Texas-based, large, baccalaureate, and Hispanic-Serving Institutions increased odds, while public, urban, and small colleges lowered them. Findings highlight systemic inequalities in admissions and inform strategies to broaden access and diversify the medical workforce.