Background: The Austrian State medical universities had to change their admission system in 2005. Until this year admission to medical studies was unrestricted. Innsbruck Medical University chose the Eignungstest fü r das Medizinstudium in der Schweiz (EMS) aptitude test for admission testing. Aims and objectives: Did the implementation of a selection process affect the academic performance and drop-out rates of students according to gender? Methods: Two groups of students were compared: 'open admission ' (2002-2004), and 'selected ' (2006-2009). Academic performance was tested according to results in the final exams after year 1 (SIP 1; SIP, summative integrierte Prü fung) and after year 3 (SIP 3). Drop-out rates were recorded using the registration system of the university. Results: Both, male and female 'selected' students had a higher passing rate regarding SIP 1 and they passed SIP 1 in shorter time and using fewer attempts than the open admission group. The percentage in passing SIP 3 did not change due to change in admission. The drop-out rates were significantly reduced for male and female students. 'Unselected' female students had a significantly higher drop-out ratio than 'unselected' male counterparts. After EMS testing, the drop-out ratios of female and male students were not significantly different. Conclusion: Selected applicants were more able and better motivated to study medicine.