Enrichment programs for undergraduate college students intended to increase the representation of minorities in medicine

A systematic review of barriers to pursuing careers in medicine among Black premedical students

Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.

Gender Differences in Mental Health Disorder and Substance Abuse of Chinese International College Students During the COVID-19 Pandemic

Introduction: The outbreak of coronavirus disease has negatively impacted college students' mental health across the world. In addition, substance abuse also is trouble among these students. This study aims to find the gender difference in Chinese international college students' mental health and substance abuse during the COVID-19 pandemic. Method: We conducted an online survey using PHQ-9, GAD-7, and several questions related to substance abuse frequency, self-injury, and suicidal thoughts, 535 male and 475 female Chinese international college students whose ages ranged from 18 to 23 years old (x = 20.19, SD = 1.50) were recruited during the epidemic. We utilized t-test and binary logistic regression in our study to find out the difference and statistical significance between substance abuse issues and mental health problems across gender. Results: Both male and female Chinese international college students had statistical significance with self-injury ideas and behaviors (t = -2.21, p < 0.05). Furthermore, the male college students with anxiety problems had positive statistical significance with medicine (OR = 3.47, 95%CI = 1.45-8.30, p < 0.01) and negative statistical significance with drinks (OR = 0.23, 95%CI = 0.08-0.65, p < 0.01). While for female college students with an anxiety problem, they had positive statistical significance with medicine (OR = 4.88, 95%CI = 1.53-15.57, p < 0.01), drugs (OR = 4.48, 95%CI = 1.41-14.25, p < 0.05) and cigarettes (OR = 6.63, 95%CI = 1.95-22.57, p < 0.01) and negative statistical significance with drinks (OR = 0.18, 95%CI = -0.05 to 0.65, p < 0.01). Conclusion: This is the first cross-sectional study focusing on the Chinese international college students' mental health and substance abuse problems during the COVID-19 pandemic. We found that Chinese international college students' mental health and substance abuse situation has been negatively influenced during this period. In addition, the self-injury ideas and behaviors also showed a high tendency for these students. The findings of our study also highlight the need to find more interventions and preventions to solve the different mental health and substance abuse problems for college students, especially for female Chinese international college students.

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.

Pipeline programs in the health professions, part 1: preserving diversity and reducing health disparities

BACKGROUND

Racial and ethnic minorities are underrepresented in the health professions. Affirmative action and educational pipeline programs play a vital role in increasing the diversity of health professions, addressing educational opportunity gaps, and reducing health disparities. Part 1 of this 2-part series discusses the need for educational pipeline programs to assist underrepresented minorities (URMs) in entering the health professions and the importance of these programs in developing a cadre of diverse providers to reduce health care inequality.

METHODS

Part 1 presents an overview of diversity in the medical and health care workforce, educational enrichment programs, key components of successful pipeline programs, and notable pipeline examples for underrepresented students at the University of Nebraska Medical Center. Recommendations for improving and developing pipeline programs are also included. Part 2 reviews affirmative action case law and legislation along with recommendations for maintaining and reviewing diversity pipeline programs in light of recent anti-affirmative action challenges.

CONCLUSION

Pipeline programs are an important strategy for addressing the shortage of URMs in the health professions. Anti-affirmative action initiatives threaten the existence of these student preparation programs and the ability of our nation to produce physicians of color and other health care providers who are more likely to serve in underrepresented communities and work to reduce related health disparities. Programs at universities and academic medical centers must develop innovative partnerships with underserved communities, adopt strategies that demonstrate a strong commitment to increasing racial and ethnic minorities in the health professions, and develop viable funding mechanisms to support diversity enrichment programs.

Health careers for Native American students: Challenges and opportunities for enrichment program design

Native Americans are severely underrepresented among US health care professionals, medical researchers, and public health officials. This low representation presents a substantial challenge to addressing the urgent need to improve health care in Native communities. Increasing the number of Native American clinicians and scientists can help to improve the health of these communities through direct provision of health care and by driving a targeted research and policy agenda. Low enrollment of Native American students in medical school and other health-related degree tracks has numerous root causes, ranging from financial constraints to the lack of appropriate mentorship. Academic institutions can play a vital role in reaching out to provide the appropriate experiences and resources that will engage Native students and help them take the next step towards a career in health care. These programs should always be accompanied by an appropriate evaluation structure that ensures continued improvement and facilitation of particular student needs.

Why are there so few working-class applicants to medical schools? Learning from the success stories

OBJECTIVES

Students from lower socio-economic circumstances remain under-represented in UK medical schools despite recent shifts in other demographic variables and specific policy emphasis on widening participation (WP). This study aimed to further understanding of the reasons for this.

METHODS

Volunteer participants at three English medical schools took part in narrative-style, in-depth interviews examining their pathways into medicine and the relationships between these pathways and participants' socio-cultural, educational and family backgrounds. This analysis uses findings from interviews with 12 mature students from working-class backgrounds. It employs theoretical work from the wider field of education sociology that has investigated the relationship between higher education decision making and class.

RESULTS

This study demonstrates how 'normal working-class biographies', constructed by the majority of students targeted by WP activity, result from the influences of socio-cultural context, as well as familial and institutional habitus. The resultant influence on habitus as identity and, in particular, the disjuncture between working-class perceptions of medicine and individual identities are key to understanding the reasons behind the low number of working-class applicants to medical school.

CONCLUSIONS

Interventions that aim to increase participation rates in medicine must address this disjuncture. This might be achieved by re-orienting working-class identities and perceptions of medicine as a profession. However, it should be acknowledged that 'identity conflict' is related to the elite image that medicine maintains within contemporary society and, as such, efforts to re-orient individual working-class identities may have only a limited impact on overall participation rates.

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.

Medical education research at the University of Washington School of Medicine: lessons from the past and potential for the future

Faculty in the Department of Medical Education and Biomedical Informatics at the University of Washington School of Medicine received over $1.2 million in direct grant and contract support in 2003. In this case study, the authors provide some of the history and background of the evolution of the department's structure and its role in providing leadership in medical education research at the university, as well as regionally, nationally, and internationally. The authors offer their observations and reflections on what has helped and hindered the department's success, and end with some predictions on medical education research in the future. The University of Washington's five-state regional WWAMI educational program, establishing a single medical school for the states of Washington, Wyoming, Alaska, Montana, and Idaho, has been an important environmental influence on the direction of the department's educational and research activities. External support has helped the department to create the Northwest Consortium for Clinical Performance Assessment, the Center for Medical Education Research, the Teaching Scholars Program, and a Biomedical and Health Informatics graduate and fellowship training program, as well as a number of international programs.

A review of medical school records to investigate the effectiveness of enrichment programs for "at risk" students

BACKGROUND

Although considerable attention has been given to the establishment of enrichment programs, almost none has focused on evaluating their effectiveness.

PURPOSE

To assess whether or not skills acquired during enrichment programs contributed to students' academic success in medical school.

METHODS

Success in medical school, as characterized by lack of delaying events (DE), student status, and United States Medical Licensing Examination-Step I scores were analyzed using a general linear model procedure to determine the effect of participation in 1 or more enrichment programs. Proportional program participation was analyzed using a chi-square test of equal proportion.

RESULTS

Participants from the "serious research" enrichment programs experienced significantly fewer DE (p <.01), which contributed to student success. Some enrichment programs had disproportionately higher attendance.

CONCLUSIONS

Participation in research-based enrichment programs for matriculating students who are "at risk" may develop critical thinking and problem-solving skills that help students to minimize DE.

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.

Blueprint for establishing an effective Postbaccalaureate medical school pre-entry program for educationally disadvantaged students

The purpose of this article is to provide public and private medical schools with a pragmatic blueprint for the development and implementation of an effective medical school pre-entry program that increases the pool of students interested in returning to health care shortage areas. An ancillary benefit of this program is an increase in the number of underrepresented minority students to medical schools. The structure, experiences, and results of the University of California, Davis, School of Medicine's Postbaccalaureate Reapplicant Program are used as a case study to construct the blueprint for returning 85-90% of program participants to shortage areas while increasing minority student admissions. The UC Davis program has been in place since 1991 and post-program acceptance rates have varied from 57% to 100% with an overall acceptance rate of 90.4% through 1999-00. Of 115 participating students who had previously been rejected by medical schools, 104 were accepted to health professional programs: 95 students were accepted to major U.S. medical schools and nine were accepted to masters in public health programs, physician's assistant programs, and one international medical school. This success rate has been achieved through a combination of intense assistance in study skills and test-taking skills, academic course work, and academic and pre-professional counseling.

America's best medical schools: a critique of the U.S. News & World Report rankings

Rankings of American medical schools published annually by the news magazine U.S. News & World Report are widely used to judge the quality of the schools and their programs. The authors describe and then critique the rankings on methodologic and conceptual grounds, arguing that the annual U.S. News medical school evaluation falls short in both areas. Three categories of program quality indicators different from those used by U.S. News are presented as alternative ways to judge medical schools. The authors conclude that the annual U.S. News & World Report rankings of American medical schools are ill-conceived; are unscientific; are conducted poorly; ignore medical school accreditation; judge medical school quality from a narrow, elitist perspective; and do not consider social and professional outcomes in program quality calculations. The medical school rankings have no practical value and fail to meet standards of journalistic ethics.

A pre-admission program for underrepresented minority and disadvantaged students: application, acceptance, graduation rates and timeliness of graduating from medical school

PURPOSE

To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate.

METHOD

Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables.

RESULTS

In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals.

CONCLUSIONS

Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

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.