Precollege enrichment programs intended to increase the representation of minorities in medicine

The development and validation of an academic, work health sciences, and community intentions scale for out-of-school-time (OST) participants

This study applies Exploratory Factor Analysis (EFA) to examine the internal structure and reliability of an academic, work, and community intentions scale for a cohort of out-of-school-time (OST) academic/STEM enrichment program participants (N = 533). This study utilizes the SPSS and SAS statistical software packages for comparative analysis. Both provide evidence of a three-factor model for intentions--Academic, Work/Health Science, and Community (i.e., the AWHSCI). The ordinal Cronbach's alpha reliability coefficients were excellent or good. Non-parametric tools were employed to determine differences in participants' academic, work/health science, and community intentions by race and gender.

Health Career Academy: Addition of a Surgical Case-Based Learning Curriculum Captures the Interest of High School Students

OBJECTIVE

The Health Career Academy (HCA) is a national program which provides a structure to introduce underserved high school students to healthcare careers. Utilizing the HCA framework, we adapted the curriculum to emphasize surgical cases and invited physicians to enrich the learning experience.

DESIGN, SETTING, AND PARTICIPANTS

Medical students adapted a surgical case-based learning (CBL) curriculum at a local high school serving students from a primarily ethnic minority and low-income community (61% Black, 20% Hispanic; 58% free or reduced lunch). Each grade level received a minimum of ten, 90-minute CBL sessions. Expert faculty lecturers supplemented lessons. Medical student volunteers and 10th and 11th grade students completed postsemester surveys.

RESULTS

Over four semesters, HCA held 44 sessions, with 81 students graduating from the program. A total of 66% of sessions featured at least one faculty volunteer. A total of 36 students in 10th and 11th grade and 15 medical student volunteers completed postparticipation surveys. A total of 46.2% of 11th grade students previously participated in the 10th grade curriculum. On a scale of 1 to 4, students rated HCA highly in its overview of career options (mean 3.61, [SD 0.5]) and instilling understanding of patient care (3.78 [0.42]). Students enjoyed learning about career paths (3.61 [0.50]) and health topics (3.83 [0.39]). Of 10th and 11th grade students, 100% considered a healthcare career, with 34.8% of 10th and 61.5% of 11th grade students expressing interest in pursuing a surgical specialty. After volunteering, medical students felt like better educators (4.47 [0.64]) and were more likely to pursue teaching roles (4.2 [0.86]).

CONCLUSIONS

The Duke HCA chapter implemented the HCA program featuring CBL sessions emphasizing surgical cases. This program engaged minority students and potentially contributed to student interest in surgical careers. It helped to prepare medical students for future teaching roles. An interactive, surgery-focused program may increase the number of minority youth interested in pursuing health careers.

Addressing Health Disparities with School-Based Outreach: the Health Career Academy Program

Pipeline programs address health disparities by promoting academic achievement and entry of low-income ethnic and racial minority youth into healthcare fields. The Health Career Academy (HCA) is a 3-year pipeline program for high school students from low-income, ethnic, and racial minority communities. Health professional students serve as program mentors. The HCA has been implemented in nine US sites, with partnerships between 17 health professional schools and 17 high schools. A total of 386 10th grade students and 95 11th grade students enrolled as participants in the 2015-2016 HCA program. In post-participation surveys, 10th grade students reported that the HCA helped them learn about different healthcare career options, plan for how to reach career goals, and understand how healthcare workers care for patients. Eleventh grade participants noted the program made them aware of the importance of public health and taught them about medical conditions, self-care, and safety. Eighty-six percent of 10th graders and 71% of 11th graders reported that they are considering healthcare careers. Students' favorite aspects of the HCA included the following: time with mentors, learning about science and health, team collaboration and hands-on experiences, field trips, and team presentations. Teachers noted the following as most important in the program: interaction with mentors and healthcare professionals, learning broadly applicable skills, stimulation of interest in health-related careers, presentation skills, and creating optimism about furthering education. The HCA is well received by participants and can be replicated successfully at multiple sites nationally. By providing mentorship, increasing exposure to health professionals and health careers, offering high-level science and health curriculum, and fostering collaboration and presentation skills, the HCA has potential to increase interest in health professions among racial and ethnic minority youth from low-income communities.

How Cardiac Anesthesiology Can Help "STEM" the Tide of Under-representation of Minorities in Science and Medicine

The field of medicine is built upon science, technology, engineering, and math (STEM), yet the United States is rapidly falling behind when it comes to educating the next generation in these disciplines, especially under-represented populations. The authors reflect on existing educational literature surrounding efforts to promote interest in STEM among students and under-represented populations. The authors advocate for greater efforts toward the development of youth programing. Cardiac anesthesia is uniquely positioned as a subspecialty to advance the goal of promoting interest in STEM in diverse groups of young students. The authors describe their development and implementation of a community outreach program to enhance interest in medicine through a cardiac dissection experience.

An Educational Program for Underserved Middle School Students to Encourage Pursuit of Pharmacy and Other Health Science Careers

OBJECTIVE

To develop and implement an active, hands-on program for underrepresented minority (URM) seventh grade students and to determine if participation in the program increased interest in health care careers and understanding of pharmacy and physician assistant (PA) professions.

DESIGN

A hands-on educational program was developed in conjunction with local middle school administrators and staff for URM 7th grade students. The program was designed to be hands-on and focus on pharmacy and PA laboratory skills. A discussion component was included, allowing participants to interact personally with pharmacy and PA students and faculty members.

ASSESSMENT

Students' responses to survey questions about interest in health care careers and knowledge about health professions were compared before and after 2 separate offerings of the program. After the program, significant increases were seen in participants' understanding of the pharmacy and PA professions. An increased percentage of participants reported interest in health care careers after the program than before the program.

CONCLUSION

Introducing middle school-aged URM students to the pharmacy and PA professions through a hands-on educational program increased interest in, and knowledge of, these professions.

Generic learning skills in academically-at-risk medical students: a development programme bridges the gap

BACKGROUND

Widening access to medical students from diverse educational backgrounds is a global educational mandate. The impact, on students' generic learning skills profiles, of development programmes designed for students at risk of attrition is unknown.

AIMS

This study investigated the impact of a 12-month Intervention Programme (IP) on the generic learning skills profile of academically-at-risk students who, after failing at the end of the first semester, completed the IP before entering the second semester of a conventional medical training programme.

METHODS

This prospective study surveyed medical students admitted in 2009 and 2010, on entry and on completion of first year, on their reported practice and confidence in information handling, managing own learning, technical and numeracy, computer, organisational and presentation skills.

RESULTS

Of 414 first year students, 80 (19%) entered the IP. Levels of practice and confidence for five of the six skills categories were significantly poorer at entry for IP students compared to conventional stream students. In four categories these differences were no longer statistically significant after students had completed the IP; 62 IP students (77.5%) progressed to second year.

CONCLUSIONS

A 12-month development programme, the IP, effectively addressed generic learning skills deficiencies present in academically-at-risk students entering medical school.

Supporting student-doctors from under-resourced educational backgrounds: an academic development programme

OBJECTIVES

Increased student diversity in medical schools is considered necessary. However, very few medical school applicants from under-resourced educational backgrounds achieve competitive academic entrance scores. Pre-admission development programmes that aim to produce competitive applicants may be inefficient in countries where under-represented communities are majority populations. This study set out to determine: (i) whether an academic development programme (ADP) integrated into an existing South African medical training programme retained ADP students and enabled them to graduate within a reasonable period of time; (ii) the academic impact of the ADP, and (iii) whether performance in high school matriculation examinations predicted performance in medical school.

METHODS

This retrospective study analysed records of medical students admitted between 1991 and 2001. Non-ADP and ADP students were compared with respect to: student retention; time to graduation; matriculation scores, and performance in medical school. The association between matriculation scores and third-year examination results was determined.

RESULTS

The average student retention rates for the non-ADP (1992-2001) and ADP (1991-2000) cohorts were 92% and 70%, respectively. Non-ADP and ADP students who graduated were compared with respect to four parameters: the mean additional time required to graduate by each group was 0.16 years (95% confidence interval [CI] 0.13-0.18) and 0.38 years (0.27-0.48), respectively. Mean matriculation scores were 44.5 (95% CI 44.4-44.7) and 37.4 (95% CI 37.0-37.7) points, respectively (effect size = 3.2). Mean marks for third-year courses were 65.0% (95% CI 64.6-65.4) and 58.7% (95% CI 57.7-59.6), respectively (effect size = 1.0). Mean marks for final-year courses were 68.3% (95% CI 68.1-68.5) and 64.2% (95% CI 63.6-64.7), respectively; the effect size remained constant at 1.2. Third-year marks for non-ADP and ADP students, respectively, showed moderate (11%) and low (3%) association with matriculation scores.

CONCLUSIONS

Although the retention of ADP students was lower than that of non-ADP students, the ADP enabled those who graduated to overcome the effects of under-resourced schooling and to perform well in final-year examinations.

What motivates physicians throughout their careers in medicine?

Motivation provides direction and purpose in physicians' work, and motivating factors vary during different career stages. Motivation theories divide sources of motivation into those intrinsic to the work, such as the opportunity for self-expression and intellectual challenge, and those extrinsic to the work, such as salary and time. Although much attention has focused on minimizing negative extrinsic factors, the authors argue that career resilience requires that physicians reflect on and define the sources of their own intrinsic motivation. Opportunities to maximize self-awareness may allow physicians to structure their work in ways that maximize meaning and fulfillment over the long-term.

The Stanford Medical Youth Science Program: 18 years of a biomedical program for low-income high school students

The Stanford Medical Youth Science Program (SMYSP) is a biomedical pipeline program that seeks to diversify the health professions by providing academic enrichment in the medical sciences and college admissions support to very low-income high school students. Each summer 24 students are recruited from over 250 California high schools for the five-week residential program, led by 10 undergraduate students. Participants divide their time between classroom instruction, anatomy practicums, hospital field placements, research projects, and college admissions advising. Since its inception in 1988, 405 students have completed SMYSP and 96% have been observed for up to 18 years. The majority are from underrepresented minority groups (33.3% Latino, 21.7% African American, 4.0% Native American), many with poor academic preparation. One hundred percent of age-eligible participants have graduated from high school, and 99% have been admitted to college. Of those admitted to college (and not currently college students), 81% have earned a four-year college degree, the majority majoring in biological and physical sciences (57.1%). Among four-year college graduates, 52% are attending or have graduated from medical or graduate school. Many of the four-year college graduates (44.4%) are becoming or have become health professionals. This program, distinguished by direct participation in the sciences, strong mentoring, college admissions preparation, and long-term career guidance, has been highly successful in reaching low-income students and preparing them for medical and other careers. Results highlight the need to track students for as long as 10 to 15 years to accurately assess college graduation rates and acceptance to medical and graduate school.

Medical students as teachers and role models for their future colleagues

Medical schools seldom involve students in applicant recruitment. The authors describe the role of junior medical students in recruitment at the University of Ottawa, aiming to increase the Franco-Ontarian applicant pool for the French-language medical program. The students have designed workshops reflecting their study program and offered them, since 1997, to 719 Ontario French-language high school students and to 291 francophone undergraduate university students. The workshops emphasize role modeling by medical students who act as physician-teachers while attendees act as medical students. Evaluation measures include attendee surveys, medical student focus groups and faculty admissions statistics. Attendees give uniformly positive evaluations, highlighting the importance of role modeling. Medical students find teaching enjoyable and highly educational. Admissions statistics show that the Franco-Ontarian applicant pool has more than doubled in spite of an almost fourfold increase in tuition fees. This experience has shown that junior medical student involvement in recruitment activities can benefit both the trainees and their institution.

Promoting minority access to health careers through health profession-public school partnerships: a review of the literature

Partnerships between health profession schools and public schools provide a framework for developing comprehensive, creative solutions to the problem of minority underrepresentation in health careers. This review examines the functioning of partner relationships, focusing on elements of the social context that determine success or failure, and stages of partnership development. Influential aspects of the social context include cultural differences between personnel in higher education and K-12 institutions, the resources available to the partnership, and constraints on partnership activity. Stages of the process that partner institutions must negotiate include initiation, ongoing management, and institutionalization. Strategies to improve minority student achievement are reviewed, including specific types of programmatic interventions and best practices. Strategies available to partnerships for improving minority achievement include academic enhancement, science or math instructional enrichment, career awareness and motivation, mentoring, research apprenticeship, reward incentives, and parental involvement. Of these, academic enhancement and instructional enrichment have the greatest potential for improving minority student outcomes. Partnerships need to take a sustained multipronged approach, providing intensive interventions that target students, teachers, and curricula at appropriate educational stages. Documenting program impact is critical for attracting more resources to increase minority access to health careers: sponsoring organizations should dedicate funds for assessment of the partnership's functioning and for rigorous evaluation of interventions.

Funding medical education research: opportunities and issues

Medical education research is underfunded. Little research focuses on basic issues of learning and teaching in medicine, and few educational innovations are tested across institutions to insure their generalizability. Despite repeated calls for the development of research organizations that would deal with substantial issues in medical education, funding remains a miniscule portion of the total budget for medical education. The author discusses how medical education research is supported in the present economic environment. The majority of published research is accomplished during the course of the researcher's employment. Many universities support pilot studies that lead to larger grants. Faculty development programs and career or academic awards support some research. Small to moderate amounts of funding are available through a variety of sources including medical specialty associations and private foundations. The author lists a variety of resources and strategies for finding foundations to fund research. Funding for larger research projects, particularly those that require more than a few years to accomplish or that involve multiple institutions, is more difficult to obtain. Federal training grants provide the laboratory for innovation and education research, but include inadequate funds to accomplish in-depth evaluation or research. The lack of emphasis on theory building and failure to prove the usefulness of innovations across schools cannot be overcome with current levels of funding. Medical educators must be advocates for the research support needed to move medical education research from a field with limited influence on practice to one that is able to connect sound insights and ideas with actual practices in education and improved patient health.

Characteristics of health professions schools, public school systems, and community-based organizations in successful partnerships to increase the numbers of underrepresented minority students entering health professions education

PURPOSE

To identify characteristics of health professions schools, public schools, and community-based organizations in successful partnerships to increase the number of underrepresented minority students entering health professions. The Robert Wood Johnson Foundation and the W. K. Kellogg Foundation funded the Health Professions Partnership Initiative program developed from Project 3000 by 2000 of the Association of American Medical Colleges.

METHOD

Semi-structured interviews were completed with awardees and representatives of the funding agencies, the national program office, and the national advisory committee between the fall of 2000 and the summer of 2002. Site visits were conducted at ten sites, with representatives of partner institutions, teachers, parents, and children. Characteristics that supported and hindered development of successful partnerships were identified using an iterative qualitative approach.

RESULTS

Successful partnerships included professional schools that had a commitment to community service. Successful leaders could work in both cultures of the professional and public schools. Attitudes of respect and listening to the needs of partners were essential. Public school governance supported innovation. Happenstance and convergence of interests played significant roles in partnership development. The most telling statement was "We did it, together."

CONCLUSIONS

This study identifies characteristics associated with smoothly working partnerships, and barriers to successful program development. Successful partnerships can form the basis on which educational interventions are built. The study is limited by the definition of success used, and its focus on one funded program. The authors were unable to identify outcomes in terms of numbers of children influenced by programs or instances in which lasting changes in health professions schools had occurred.

Minority students, affirmative action, and the admission process: a literature review, 1987-1998

BACKGROUND

Despite numerous initiatives, medical educators have failed to effect a sustainable increase in the number of underrepresented minority students at medical colleges in the United States. This study reviewed the recent literature regarding the admission process to specifically examine and determine if current policies are helping facilitate the proper representation of minority students. Papers were selected on the basis of their relevance to the topic of underrepresented minority students and medical school admission policies and were limited to the years between 1987 and 1998. Each paper was individually evaluated on the basis of its study design and soundness of its contribution to the field.

SUMMARY

The articles are organized under 4 major themes: Cognitive factors (mostly Medical College Admission Test scores and grade point average), noncognitive factors (e.g., leadership ability, interpersonal skills, motivation), the admission interview, and enrichment programs. Table 1 briefly summarizes these constituent articles.

CONCLUSION

It was found that the body of literature is inadequately small and heterogeneous with regard to study design and results. A concerted effort must be made across medical education to correct the deficiencies in this particular area.