Effectiveness of a formal post-baccalaureate pre-medicine program for underrepresented minority students

Redefining the term "Disadvantaged student": A post baccalaureate program's role in underrepresented students' success and reclaiming of narratives

PURPOSE

Racial/ethnic minority groups and low-income students continue to be underrepresented in medicine (URiM) despite years of diversity and inclusion efforts. Post baccalaureate programs (PBP) are shown to prepare underrepresented students to successfully matriculate to medical school. However, identification of the aspects of a PBP that are key to future success in medicine from the student perspective is lacking. Therefore, this study was designed to answer the question, "What aspects of a post baccalaureate program do URiM students see as valuable to their future success?"

METHODS

This is a qualitative analysis of semi-structured interviews with alumni of the UCSF PBP who completed the program between 2015-2020. Interviews were conducted via phone or video call, audio recorded, and transcribed verbatim. Names and years of attendance were removed from the transcripts prior to review to protect confidentiality. Transcripts were coded following an inductive qualitative approach using methodology rooted in grounded theory. Demographic data was collected upon enrollment in the program.

RESULTS

Forty study participants were interviewed (58% of eligible subjects). Participants self-identified as Latinx (70%), African American (8%), Southeast Asian (10%), Native American (2%), Multiethnic (10%), and 60% female. The average age at enrollment was 24 years. Most participants (75%) were first-generation college students and 85% grew up with a family income <$49,999. Qualitative findings were categorized into five main themes: (1) Academic, Professional, and Personal Skills Development, (2) Supportive Student Cohort, (3) Resources, Personalized Advising, and Mentorship, (4) Gaining Confidence and a Sense of Belonging in Medicine, and (5) Redefining "Disadvantaged" Status. A novel finding was the importance of redefining the narrative of belonging to a "disadvantaged" community. During the program, the study participants reported gaining confidence and a sense of belonging in medicine as they recognized the unique qualifications and advantages they bring to medicine.

CONCLUSIONS

Our findings suggest that in addition to academic preparation, PBPs for students who are underrepresented in medicine should empower students to recognize their strengths and qualifications in the field of medicine. Our study participants rejected the term "disadvantaged" as they celebrated the value of their backgrounds and what they bring to medicine.

Aspiring physicians program: description and characterization of the support processes for an undergraduate pathway program to medicine

Latinx physician rates are lower than non-Latinx white physicians. Many pathway programs to careers in medicine have been established for underrepresented students, yet few focus on premedical college education or undergraduate pathway programs, which marks a critical junction in the commitment to and preparation for application to medical school. Moreover, little is known about the program components which prepare and support learners. Framed by Swail's Model for Persistence and Achievement, we characterize how a given program's components impact support and growth for participating students. Using the process step of the Context, Input, Process, and Product evaluation model, we conducted focus groups at the end of the program, with four cohorts of student participants between 2019 and 2022. Focus groups identified strengths and limitations in content and delivery to improve program effectiveness and plan for the future of a program. We used thematic analysis, following an inductive approach, to analyze data from transcribed focus groups. A total of 66 of 81 (81.5%) students participated in focus groups. Students described that supportive program components include long-term mentorship and advising that builds trust, academic preparation for medical school, early exposure to clinical career exploration, tools to articulate students' personal narrative, methods to recognize and address challenging situations in the professional environment, community leadership development, and leveraging health policy and advocacy to empower students to create systems change within communities. Our findings affirm and provide a needed account of program components known to be contributors to student success in undergraduate pathway programs. Our evaluation also characterizes additional supportive processes not discussed elsewhere. Our findings contribute to knowledge about development and implementation of undergraduate pathway programs and the components by which these programs create opportunities for success among underrepresented students aspiring to careers in medicine.

Factors and barriers that influence the matriculation of underrepresented students in medicine

Despite many initiatives over more than 4 decades, the diversity of United States physicians still does not reflect the diversity of the United States population. The present study undertakes a literature review of the last 30 years to investigate barriers and protective factors underrepresented college students encounter as applicants for medical school. Known barriers that influence matriculation into medical school were analyzed such as academic metrics and test scores. Additionally, elements that are less well studied were investigated such as factors perceived as barriers by underrepresented applicants in addition to protective factors that allow them to persist in their journey in the face of difficulties and adversity.

Underrepresented in medicine students' perspectives on impactful medical education

BACKGROUND

Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture.

METHODS

We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation.

RESULTS

Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health.

CONCLUSION

Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.

Relationships between preadmission variables and academic outcomes for postbaccalaureate students in medical school

There is currently little guidance for medical school admissions committees regarding how to weigh postbaccalaureate program grades relative to undergraduate grades. This study was designed to address this issue. Admissions data, preclerkship course performance and United States Medical Licensing Exam (USMLE) Step 1 results were analyzed over three years for University of California, San Diego (UCSD) postbaccalaureate premedical (PBPM) students (n = 25), students who participated in other postbaccalaureate programs (n = 34), and for the remainder of the medical students who did not participate in any postbaccalaureate programs (n = 329). UCSD PBPM program alumni did not significantly differ in their cumulative academic performance on exams in preclerkship courses and USMLE Step 1 pass rates compared to the rest of the class despite their significantly lower GPA, lower Biology, Chemistry, Physics and Math (BCPM) GPA, and Medical College Admissions Test (MCAT) percentiles. For students who participated in the PBPM programs, PBPM program GPA was a significant predictor of preclerkship academic performance and USMLE Step 1 performance. When assessing academic readiness of applicants who have completed postbaccalaureate programs, admissions committees might closely consider the postbaccalaureate program GPA in addition to other academic metrices such as BCPM GPA and MCAT score.

Implementation of a Post-Baccalaureate Program at a Pediatric Academic Medical Center: A Pathway to Graduate School

Post-baccalaureate programs are increasingly common and have demonstrated success in preparing students for graduate programs. Most post-baccalaureate programs have a pre-medical focus, and the few existing clinical psychology-focused programs are centered on coursework, situated within a university, costly to students, and/or geared towards career change. The post-baccalaureate program at Nationwide Children's Hospital was created in 2017 and is uniquely positioned within a pediatric academic medical center. The program provides research skill training, mentorship, professional development, and graduate school preparation to employed clinical research coordinators. An early program assessment, based on self-reports, revealed the program attracts diverse participants that are primarily interested in pediatric or child psychology and rate themselves as "somewhat confident" in their current research skills. This manuscript summarizes the three phases of development and key components of the post-baccalaureate program, which can serve as a model to other medical centers interested in developing training programs for research staff, particularly underrepresented racial and ethnic minorities, and those from disadvantaged backgrounds.

Mentoring for diversity and inclusion in pediatric radiology: nurturing the next generation of physicians from underrepresented minorities

The increasing recognition of the need for a diverse workforce as a tool for excellence in medicine has fortified the efforts toward recruitment, retention and development of faculty from racial and ethnic minorities. Despite these efforts, individuals of Black, Hispanic, American Indian and Alaska Native, Native Hawaiian and other Pacific Islander backgrounds remain vastly underrepresented in the radiology workforce. The main impediments to increasing their representation are an insufficient pipeline and the long time required to train a pediatric radiologist. A greater representation of minorities can only be achieved through the enduring nurturing of future pediatric radiologists along every step in the professional life cycle of a physician, from high school through fellowship completion. Restructuring of faculty recruitment and faculty development policies is also required. A key component of faculty development and overall wellness is mentorship. Junior faculty, particularly those from racial and ethnic minorities, benefit from the experience, advice and support of more experienced radiologists. Successful mentorship is key to ensuring that staff from underrepresented backgrounds thrive within their institutions and in turn become successful mentors to younger individuals, thus completing a virtuous cycle of minority mentorship.

Advanced Placement Courses for Medical School: A Novel AMed Track to Reduce Financial Burden and Attract Nontraditional Students

Medical school admissions have become increasingly competitive, creating a pool of nontraditional applicants that seek postbaccalaureate training in biomedical sciences. Several postbaccalaureate and graduate programs developed curricula that, except for learning clinical skills, mirror the learning objectives of the foundational science curricula in medical schools. This education structure provides applicants with a competitive advantage when applying to medical schools. However, basic science curriculum assessments in medical schools have changed to pass/fail scoring systems. As a result, students that participate in preparatory postbaccalaureate and graduate programs cannot show their superior level of knowledge and may find some core foundational science subjects redundant during their pre-clerkship medical education. The aim of this article is to propose an innovative system for matriculation into medical school through the AdvancedMed (AMed) Track, a three-year accelerated medical curriculum in which graduate curricula adopt an advanced placement course called AMed courses. This system would mirror the structure of the high school Advanced Placement (AP) system; therefore, students would take AMed courses similar in rigor to medical school basic science courses. These courses include Anatomy, Histology, Physiology, Cellular Biology, Biochemistry, Genetics, Microbiology, Immunology, Biostatistics, and Epidemiology. All courses would require a scored national standardized test to receive medical school credit toward a three-year accelerated track curriculum. Nontraditional students could choose to study independently and take the AMed standardized examination for credit to enter the AMed Track. Medical schools have the incentive to start an AMed Track because its implementation could lessen the financial burden, reduce time spent in medical school, and increase the participation of nontraditional medical students.

Postbaccalaureate Premedicine Programs: A Path to Diversity in Physician Assistant Education

The importance of diversity in the physician assistant (PA) profession is well understood. Some of the benefits of diversity include improved patient care and patient satisfaction. In recent times, efforts at increasing diversity in PA education have involved implementing a holistic admissions process and targeted recruitment of applicants who are underrepresented in medicine. Historically, postbaccalaureate programs have been an effective tool for increasing enrollment of both underrepresented and disadvantaged matriculants in medical school. A larger than expected proportion of these students go on to work with underserved patient populations. The authors suggest that similar postbaccalaureate programs could help underrepresented and disadvantaged students be successful in PA education.

A Narrative Study of Equity in Clinical Assessment Through the Antideficit Lens

PURPOSE

Efforts to address inequities in medical education are centered on a dialogue of deficits that highlight negative underrepresented in medicine (UIM) learner experiences and lower performance outcomes. An alternative narrative explores perspectives on achievement and equity in assessment. This study sought to understand UIM learner perceptions of successes and equitable assessment practices.

METHOD

Using narrative research, investigators selected a purposeful sample of self-identified UIM fourth-year medical students and senior-level residents and conducted semistructured interviews. Questions elicited personal stories of achievement during clinical training, clinical assessment practices that captured achievement, and equity in clinical assessment. Using re-storying and thematic analysis, investigators coded transcripts and synthesized data into themes and representative stories.

RESULTS

Twenty UIM learners (6 medical students and 14 residents) were interviewed. Learners often thought about equity during clinical training and provided personal definitions of equity in assessment. Learners shared stories that reflected their achievements in patient care, favorable assessment outcomes, and growth throughout clinical training. Sound assessments that captured achievements included frequent observations with real-time feedback on predefined expectations by supportive, longitudinal clinical supervisors. Finally, equitable assessment systems were characterized as sound assessment systems that also avoided comparison to peers, used narrative assessment, assessed patient care and growth, trained supervisors to avoid bias, and acknowledged learner identity.

CONCLUSIONS

UIM learners characterized equitable and sound assessment systems that captured achievements during clinical training. These findings guide future efforts to create an inclusive, fair, and equitable clinical assessment experience.

How Postbaccalaureate Career Changer and Traditional Medical Students Differ Academically

OBJECTIVE

This retrospective descriptive study compared the academic performance of postbaccalaureate career changer students with that of traditional students during the classroom-based, science-dominated early years of medical school. Earlier studies documented the eventual success of nontraditional medical students, although we found little information specific to the medical school performance of career changers. Our objective was to determine whether postbaccalaureate career changer medical students perform differently from traditionally prepared medical students in the science-dominated early years of medical school classroom education.

METHODS

This study analyzed the admission data and academic performance of medical students at the University of Central Florida College of Medicine across 8 years (N = 630). Differences in performance were assessed using examination grades from the first 2 years of medical school, and US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores.

RESULTS

Statistically significant differences were found between traditional and career changer students for all science modules in year 1, and 4 of the 5 modules in year 2. Traditional students performed better on USMLE Step 1. Significant differences between the groups disappeared by USMLE Step 2.

CONCLUSIONS

Career changer medical students show a small, persistent academic lag in the first 2 years of medical school and on USMLE Step 1 scores. By USMLE Step 2 the difference disappears. Similar undergraduate grade point averages and Medical College Admission Test scores suggest that science exposure, not ability may explain these differences. An unexpected finding is the number of career changer students is not increasing proportional to the proliferation of postbaccalaureate programs in the United States. This study may benefit student advisors and residency directors, and, it is hoped, provide reassurance to career changer students.

Meaningful Patient Care Experiences for Minority Graduate School Students

BACKGROUND

Increasing numbers of underrepresented in medicine minority (URMM) physicians has garnered increased attention. Pipeline programs aid this effort and are designed to expose learners to the healthcare experience and strengthen academic preparedness. This paper describes the clinical experiences of students who participated in a bridge to medical school Master's Degree pipeline program at a community based medical school.

METHODS

Using qualitative methodology, the authors sought to explore the clinical experiences of three cohorts of graduate school pipeline students on a path to medical school. Thirty six master's level students responded to an evaluation of opened-ended questions at the conclusion of their clinical preceptorship. The responses to three open-ended questions were analyzed via the constant comparison analysis method.

RESULTS

The total number of clinical encounters during the clinical preceptorship over the three-year period was 633, a total of 144 h. The most common diagnoses seen were related to cardiovascular disease and diabetes. Three primary themes were identified regarding students' experiences in the pipeline program: connecting academic and clinical skills, learning the needs of and how to advocate for underserved patients and the need to increase exposure to underserved patient populations across specialties in medicine.

CONCLUSIONS

The clinical preceptorship linked academic knowledge with clinical skills and provided an avenue for learning about health disparities and patient advocacy for underserved patients. It also identified a need for increased exposure to underserved patient populations across medical specialties.

What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50

BACKGROUND/PURPOSE

There is interest to increase diversity among health professions trainees. This study aims to determine the features/effects of interventions to promote recruitment/admission of under-represented minority (URM) students to health professions programs.

METHODOLOGY

This registered BEME review applied systematic methods to: title/full-text inclusion review, data extraction, and quality assessment (QA). Included studies reported outcomes for interventions designed to increase diversity of health professions education (HPE) programs' recruitment and admissions.

RESULTS

Of 7225 studies identified 86 met inclusion criteria. Interventions addressed: admissions (34%), enrichment (19%), outreach (15%), curriculum (3%), and mixed (29%). They were mostly single center (76%), from the United States (81%), in medicine (45%) or dentistry (22%). URM definition was stated in only 24%. The dimension most commonly considered was ethnicity/race (88%). The majority of studies (81%) found positive effects. Heterogeneity precluded meta-analysis. Qualitative analysis identified key features: admissions studies points systems and altered weightings; enrichment studies highlighted academic, application and exam preparation, and workplace exposure.

DISCUSSION/CONCLUSIONS

Several intervention types may increase diversity. Limited applicant pools were a rate-limiting feature, suggesting efforts earlier in the continuum are needed to broaden applicant pools. There is a need to examine underlying cultural and external pressures that limit programs' acceptance of initiatives to increase diversity.

AACP Special Taskforce White Paper on Diversifying Our Investment in Human Capital

The 2015-2017 American Association of Colleges of Pharmacy (AACP) Special Taskforce on Diversifying our Investment in Human Capital was appointed for a two-year term, due to the rigors and complexities of its charges. This report serves as a white paper for academic pharmacy on diversifying our investment in human capital. The Taskforce developed and recommended a representation statement that was adapted and adopted by the AACP House of Delegates at the 2016 AACP Annual Meeting. In addition, the Taskforce developed a diversity statement for the Association that was adopted by the AACP Board of Directors in 2017. The Taskforce also provides recommendations to AACP and to academic pharmacy in this white paper.

A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity.

METHODS

We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002).

RESULTS

The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations.

CONCLUSION

The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

The significance of recruiting underrepresented minorities in medicine: an examination of the need for effective approaches used in admissions by higher education institutions

The purpose of this paper is to examine the significance of recruiting underrepresented minorities in medicine (URM). This would include African Americans, Hispanics, and Native Americans. The research findings support the belief that URMs, upon graduating, are more likely to become practitioners in underserved communities, thereby becoming a resource that prompts us to find effective ways to help increase their college enrollments statewide. This paper analyzes the recruitment challenges for institutions, followed by a review of creative and effective approaches used by organizations and universities. The results have shown positive outcomes averaging a 50% increase in minority enrollments and retention. In other areas, such as cognitive development, modest gains were achieved in programs that were shorter in duration. The results nevertheless indicated steps in the right direction inspiring further program developments.

Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79

In a paradigm of physician performance we propose that both "cognitive" and "noncognitive" components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the "noncognitive" component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.

Survey of care for the underserved: a control group study of practicing physicians who were graduates of The Ohio State University College of Medicine premedical postbaccalaureate training program

PURPOSE

Multiple publications describe short- term and intermediate outcomes of premedical postbaccalaureate programs (PBPs). However, the authors could find no control group studies reporting the service provided by graduates of PBPs to patients who are medically indigent (e.g., on Medicaid or uninsured) and/or poor. The authors explored the relationship between successful completion of a midwestern PBP and providing care for the underserved.

METHOD

In 2008, the authors surveyed 1996-2002 graduates of The Ohio State University College of Medicine who had been in practice for at least one year about their current practice population. The authors compared two groups: (1) physicians who completed the PBP and (2) a stratified random control group of physicians who graduated from the same medical school, in the same graduating classes, but did not participate in the PBP.

RESULTS

The survey return rate was 70.9% (73/103). Findings suggest that PBP graduates were more likely to be practicing medicine in a federally designated underserved area (29.4% versus 5.1%, P < .009) or providing service where 40% or more of the patients were medically indigent or poor (67.6% versus 33.3%, P < .003). PBP graduates were also more likely to be volunteering their services to patients who were indigent (47.1% versus 10.3%, P < .001).

CONCLUSIONS

This is likely the first control group study demonstrating the increased likelihood of graduates of a PBP providing health care to patients who are medically indigent and/or poor.

Using the personal background preparation survey to identify health science professions students at risk for adverse academic events

In the first predictive validity study of a diagnostic and prescriptive instrument for averting adverse academic status events (AASE) among multiple populations of diverse health science professions students, entering matriculates' personal background and preparation survey (PBPS) scores consistently significantly predicted 1st- or 2nd-year AASE. During 1st-year orientations, 441 entering matriculates in four southwestern schools from dental, medical, and nursing disciplines completed the 2004 PBPS. The following year during 1st-year orientations, 526 entering matriculates in five schools from dental, medical, nursing, and biomedical science disciplines completed the 2005 PBPS. The PBPS identifies and quantifies a student's noncognitive and cognitive academic performance risks. One standard deviation increments in PBPS risks consistently multiplied 1st- or 2nd-year AASE odds by approximately 140% (p < .05), controlling for underrepresented minority student (URMS) status and school affiliation. Odds of 2nd-year AASE for URMS one standard deviation above the 2004 PBPS mean reached 494% of odds for nonURMS at the mean. PBPS total risks, school affiliation, and URMS status together provided 70-76% correct predictions of 1st- or 2nd-year AASE. PBPS predictive validity did not differ significantly among dental, medical, nursing, or biomedical science schools, or URMS/nonURMS. PBPS sensitivity and specificity approached those for FDA-approved screening mammograms for breast cancer and PSA tests for prostate cancer. PBPS positive predictive values of 42-60% exceeded those for both. The diagnostic and prescriptive PBPS can facilitate proactive targeting of corrective interventions aimed at reducing AASE and attrition among health science education students at risk for academic difficulties.

The effectiveness of a postbaccalaureate program for students from disadvantaged backgrounds

BACKGROUND

This study examines the long-term effectiveness of an institutional postbaccalaureate program designed to provide an opportunity for students from disadvantaged backgrounds to enter medicine in response to diversity needs.

METHOD

An 18-year retrospective analysis of the academic outcomes, performance, progress, and specialty choices of postbaccalaureate participants. Comparisons across cohorts were conducted using chi-square tests, t tests, and ANOVA.

RESULTS

Ninety-four percent (94%) of the postbaccalaureate students successfully completed the program and matriculated into medical school. Sixty-four percent (64%) of the matriculants have graduated from medical school, and 26% are still enrolled. More than 50% of the graduates selected primary care specialty fields.

CONCLUSIONS

The implementation of the postbaccalaureate program provided a successful strategy to diversify the medical school student body and increase the number of physicians from disadvantaged backgrounds in the medical profession following the mission-driven commitment of the medical school.

The post-baccalaureate premedical certification program at the University of North Texas Health Science Center strengthens admission qualifications for entrance into medical school

The Post-Baccalaureate (postbac) Premedical Certification Program at the University of North Texas Health Science Center provides an opportunity for individuals to enhance their credentials for entry into medical school by offering a challenging biomedical science core curriculum in graduate biochemistry, cell biology, physiology, and pharmacology. In addition, students (called postbacs) receive instruction in human gross anatomy, histology, and embryology with first-year medical students. More than 90% of the students accepted into the postbac program have applied to medical school previously but have been rejected by admission committees at least once, primarily because of low cognitive scores. In spring 2001, seven postbacs completed the program, of which only one was admitted into the Texas College of Osteopathic Medicine (TCOM), the medical school affiliated with the University of North Texas Health Science Center. Three postbacs went to other medical schools. Thirty-one completed the program by spring 2006, of whom 13 were admitted to TCOM, and eight to other medical schools. After six years, 101 postbacs have completed the program, and 70 have been accepted into medical schools. Postbacs admitted into TCOM have performed well compared with their medical school classmates. Overall, average scores for postbacs are above those of their medical school classmates. In addition, postbacs have taken class leadership positions, served as tutors and mentors, and have served as school ambassadors for new applicants. The postbac premedical program has proven to be very successful in preparing students for the rigors of a medical school curriculum by allowing these students to develop the skills and confidence necessary to compete.

Exploring obstacles to and opportunities for professional success among ethnic minority medical students

PURPOSE

To explore the barriers and facilitators experienced by ethnic minority medical students in achieving personal and professional success.

METHOD

In 2002 and 2003, 43 minority medical students participated in one of six two-hour focus groups located in Philadelphia, Pa; Kansas City, Mo; Baltimore, Md; Miami, Fl; New York, NY; and Los Angeles, Calif. Focus groups consisted of an average of seven (range 5-10) individuals. Eighty-eight percent were of black/African descent, 10% were Hispanic, and 2% were Asian/Pacific Islanders. Students discussed their views of personal and professional success, including opportunities and obstacles, and completed a brief demographic survey. Discussions were audiotaped, transcribed verbatim, and reviewed for thematic content in a three-stage independent review/adjudication process.

RESULTS

All 748 comments were grouped into themes relating to definitions of success (35%) and to perceived facilitators (25%) or inhibitors (40%) of success. Participants strove to achieve professional/academic status, financial security, and quality of life. In so doing, participants identified facilitators of success, including support systems, professional exposure, financial aid, and personal characteristics. Lack of financial and social support, challenges with standardized tests, experiences with racial stereotyping and discrimination, and self-imposed barriers were among inhibitors to success.

CONCLUSIONS

The opportunities for and barriers to academic success identified by minority students should be heeded by educators and administrators who develop programs and policies to recruit minority medical students and to ensure their professional development. To enhance the institutional climate for diversity, programs that improve cultural awareness and reduce biases among all students, faculty, staff, and administrators are needed.

The predictive validity of the MCAT for medical school performance and medical board licensing examinations: a meta-analysis of the published research

PURPOSE

To conduct a meta-analysis of published studies to determine the predictive validity of the MCAT on medical school performance and medical board licensing examinations.

METHOD

The authors included all peer-reviewed published studies reporting empirical data on the relationship between MCAT scores and medical school performance or medical board licensing exam measures. Moderator variables, participant characteristics, and medical school performance/medical board licensing exam measures were extracted and reviewed separately by three reviewers using a standardized protocol.

RESULTS

Medical school performance measures from 11 studies and medical board licensing examinations from 18 studies, for a total of 23 studies, were selected. A random-effects model meta-analysis of weighted effects sizes (r) resulted in (1) a predictive validity coefficient for the MCAT in the preclinical years of r = 0.39 (95% confidence interval [CI], 0.21-0.54) and on the USMLE Step 1 of r = 0.60 (95% CI, 0.50-0.67); and (2) the biological sciences subtest as the best predictor of medical school performance in the preclinical years (r = 0.32 95% CI, 0.21-0.42) and on the USMLE Step 1 (r = 0.48 95% CI, 0.41-0.54).

CONCLUSIONS

The predictive validity of the MCAT ranges from small to medium for both medical school performance and medical board licensing exam measures. The medical profession is challenged to develop screening and selection criteria with improved validity that can supplement the MCAT as an important criterion for admission to medical schools.

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students

PURPOSE

To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.

METHOD

Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted.

RESULTS

The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development.

CONCLUSIONS

Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.