Recruitment of underrepresented minority students to medical school: minority medical student organizations, an untapped resource

Recruitment of more underrepresented minority students (black, Hispanic and native American) to increase racial diversity in the physician workforce is on the agenda for medical schools around the nation. The benefits of having a racially diverse class are indisputable. Minority physicians are more likely to provide care to minority, underserved, disadvantaged and low-income populations. Therefore, medical schools would benefit from diversity through utilizing strategies for recruitment of underrepresented minority (URM) students. Numerous recruitment strategies have been employed to increase the number of underrepresented minority students. However, formal collaboration with minority medical student organizations is an underutilized tool in the recruitment process. Many medical schools have informally used minority medical students and members of various minority organizations on campus in the recruitment process, but a formal collaboration which entails a strategic approach on using minority medical student organizations has yet to be included in the literature. This paper discusses the innovative collaboration between the University of Toledo College of Medicine (UTCOM) chapter of the Student National Medical Association (SNMA) and the college of medicine's admissions office to strategize a recruitment plan to increase the number of underrepresented minority students at the UTCOM. This paper suggests that minority medical student organizations, particularly the SNMA, can be used as a recruiting tool; hence, admissions offices cannot negate the usefulness of having formal involvement of minority medical student organizations as a recruiting tool. This approach may also be applicable to residency programs and other graduate professional fields with a severe shortage of URM students.     

Student perspectives on diversity and the cultural climate at a U.S. medical school.

PURPOSE: To obtain the perspectives of medical students at one school on racial/ethnic campus diversity and cultural competence and to gain their perceptions of the institutional climate around diversity at their university and of reasons for minority underrepresentation at their medical school. METHOD: A student-driven survey of all medical students (N = 398) at a single medical school in the spring of 2003, supplemented by four focus groups from all racial and ethnic groups on the campus. RESULTS: A large majority of the responding students (n = 216; 54%) endorsed the value of campus diversity and the importance of cultural competence to the process of becoming a clinician. Most students felt their university had achieved a positive cultural climate, characterized by openness to diverse perspectives and attention to equity. Most students also felt that the university's programs and policies reflected a commitment to diversity, but fewer students--those from underrepresented minorities (URMs) in particular--felt that the university truly valued having a diverse student body and faculty. Most students felt that the lack of diversity on campus was a barrier to recruiting and retaining minority candidates. Some minority students also blamed the medical school's limited social, academic, and financial support, as well as inadequate efforts to recruit minority students. CONCLUSIONS: Medical students generally place a high value on campus diversity and cultural competence. URM students in particular felt that their university could do more to implement its commitment to diversity, including making greater efforts to recruit and retain URM students. These views constitute a barometer for medical schools to gauge and track their efforts to enhance campus diversity, incorporate cultural competence education, and create an inclusive and welcoming climate for students of all backgrounds.     

Academic ranks and medical schools of underrepresented minority faculty in family medicine departments.

PURPOSE: To examine academic rankings and educational backgrounds of underrepresented minority (URM) family medicine faculty and compare their academic ranks with national trends. The authors also determined the extent to which international and historically black educational institutions contributed URM faculty to family medicine. METHOD: In 1999 questionnaires were sent to 129 family medicine departments asking for academic ranks and educational institutions attended by their URM faculty. Comparisons were made between URM faculty's academic ranks and all family medicine faculty, medical school minority faculty, and medical school faculty. RESULTS: A total of 80% of URM faculty were assistant professors or instructors, and 4.4% were professors. URM family medicine faculty had significantly lower rankings compared with medical school minority faculty and all family medicine faculty. URM family medicine faculty at historically black medical schools were more likely to have received their degrees from historically black undergraduate institutions and medical schools than were URM family medicine faculty at non-historically-black medical schools. CONCLUSIONS: URM family medicine faculty appear to experience a double disadvantage: being minority and working for family medicine departments. Their academic ranks remain far below those of both minority medical school faculty and family medicine faculty, a discouraging finding considering the current shortage of URM faculty in family medicine departments. Historically black medical schools cannot address the shortage alone, so non-historically-black medical schools need to both recruit URM faculty and follow up with appropriate mentoring of those faculty.     

Postbaccalaureate Medical/Dental Education Preparatory Program (MEDPREP) at Southern Illinois University School of Medicine.

Between 1972 and 1998, the state and federally funded Medical/Dental Education Preparatory Program (MEDPREP) at Southern Illinois University School of Medicine served approximately 900 qualified minority and disadvantaged students, in an effort to increase the number of underrepresented-minority (URM) students accepted into and retained in health professions schools. To help students improve their application credentials, this post-baccalaureate program establishes high expectations for student progress, designs individual curricula, offers extensive academic and personal counseling, has its own teaching faculty, and operates in a specially equipped, designated facility. This supportive educational environment has demonstrated success. By 1998 over 500 MEDPREP students had been accepted into medical or other health professions schools, and 86% of them had graduated or were scheduled to graduate. And while the number of new URM entrants to medical schools declined nationwide from 1995 to 1997, 70 URM students from MEDPREP matriculated to 28 different allopathic medical schools, eight entered three different osteopathic medical schools, and two entered dental schools. Recent data indicate that the score changes of Medical College Admission Test (MCAT) repeaters who were MEDPREP students were larger than those of all MCAT repeaters reported by the Association of American Medical Colleges (AAMC). In fact, the MEDPREP repeaters' score changes were two to nearly six times greater than the overall changes reported by the AAMC. These gains suggest that a carefully designed, long-term post-baccalaureate intervention such as MEDPREP can increase the pool of qualified URM and disadvantaged students accepted into and retained in health professions schools.     

Affirmative action in medical education and its effect on Howard and Meharry: a study of the class of 1975

During the decade of the 1970s, affirmative action programs were introduced in US medical schools for the purpose of increasing the number of black and other minority medical students and of improving the medical care resources for black and other minority communities. Having for many years served as the main sources of black physicians in the US, Howard University College of Medicine and Meharry Medical College School of Medicine were also affected by affirmative action. No previous studies have compared the black graduates from Howard and Meharry with black and other minority graduates from the other US medical schools.     

From enrichment to equity: comments on diversifying the K-12 medical school pipeline

Educating a physician workforce that reflects the increasing racial and ethnic diversity of our nation is an ongoing challenge of urgent concern. Many medical school kindergarten through 1 2th grade (K-12) pipeline programs focus on "enriching" underrepresented minority (URM) students using strategies to change or "improve" individual students. This discussion raises concerns over longstanding racial and ethnic inequities in America's public schools that, in part, result in the predictable and systematic underachievement of URM students. These insidious processes can disqualify URM students from successful participation in the medical school pipeline at its earliest stages. The paper also discusses the cultural challenges URM students often face in aspiring to exceptional academic achievement within America's schools. Finally, this paper highlights the need for illustrative examples of medical school-public school partnerships that pursue an agenda of equity to balance the current downstream focus on the enrichment of individual students.     

The need for diversity in higher education.

The author states that there is a need in all higher education, including the health professions, for racial, ethnic, and other kinds of diversity, and describes two court cases involving the University of Michigan's undergraduate and law school affirmative action admission policies. The outcomes of these cases will profoundly affect the quality of U.S. higher education, professional education, and graduate education. Affirmative action is one of the tools that many universities use to ensure the kind of comprehensively diverse student body that helps teach students to participate fully in this country's heterogeneous democracy and the global economy. Students are exposed to classmates with different life experiences, their prior assumptions are challenged, and they discover what they and their classmates have in common. And a variety of Fortune 500 corporations state that employees and managers who graduated from institutions with diverse student bodies demonstrate a variety of key skills that are crucial in the U.S. workplace. The author discusses why "colorblind" and "socioeconomically oriented" admission policies do not work and that they have only a tiny effect on white students' chances of acceptance. Until K-12 education is greatly improved for minorities, affirmative action is needed to give a "leg up" to students who might not otherwise be admitted but who can do the academic work. In medical education, there is a special urgency for diversity, since it is known that minority physicians are more likely to practice in areas where there are high concentrations of minorities.     

Training African-American residents in the 20th century

Bellevue Hospital, the oldest public hospital in the United States and a lineal descendant of an infirmary for slaves, accepted its first African-American resident, Dr. Ubert Conrad Vincent, in 1918. This occurred at a time when many medical centers were not accepting African-American residents. At the end of WWII, one-third of the accredited medical schools still barred African Americans. However, Bellevue Hospital continued to train African-American residents. Between the 1920s and 1940s four African Americans matriculated at Bellevue Hospital. There were six in the 1950s, four in the 1960s, and 25 in the 1970s. By the 1980s, 40 African Americans matriculated, and between 1990 and 1995, 61 matriculated. Despite its historic first, Bellevue lagged slightly behind the national average. While the number of African-American residents occupying U.S. residency slots increased from 2.8% in 1978 to 6.5% in 1996, African Americans comprised 3.6% of residency slots at Bellevue between 1985-1995. Currently, only 7% of practicing physicians and 5% in faculty positions are latino, African-American, and Native American. Increasing the number of under-represented minority (URM) physicians is important to the United States, as URM physicians are more likely to serve the poor and uninsured, therefore improving the overall healthcare of the underprivileged. A study by the Association of American Medical Colleges indicated that minority medical school graduates were five times more likely to report that they planned to serve minority populations than other graduates. In their position paper, the American College of Physicians expressed the belief that increasing the number of URM physicians will help reduce healthcare disparities that can hurt minority populations and lead to poor health outcomes. The Supreme Court acknowledged the importance of racial diversity by upholding the University of Michigan affirmative action admissions policy in its June 2003 ruling. URM physicians are needed not only to serve minority populations but also to serve as mentors and role models for prospective and current students. The first African-American resident to graduate from the Bellevue Residency Program did indeed treat the underserved, as Dr. Vincent founded the Vincent Sanatorium, dedicated to treating African-American patients, and training African-American nurses and doctors. Over the course of the 20th century, Bellevue Hospital has trained increasing numbers of African-American physicians. It is hoped that, like their predecessor, Dr. Vincent, they will provide care to underserved communities and to the community as a whole, as well as serve as role models for generations to come.     

Do pre-admission programs make a difference in the enrollment of underrepresented-minority students at U.S. medical schools?

PURPOSE: To assess the association between the presence of pre-admission programs directed at underrepresented minority (URM) students at medical schools accredited by the Liaison Committee on Medical Education (LCME) and the first-year and total enrollments of URM students during the 1993-94 academic year. METHOD: The authors ranked 119 LCME-accredited medical schools by the percentages of their first-year classes and total enrollments made up of URM students. They then compared the schools in three ways: (1) schools ranking above versus below the median in terms of numbers of URM students; (2) the top 25% versus the lower 75%; and (3) the top 25% versus the lowest 25%. Logistic regression was used to determine the association between the presence of pre-admission programs and URM enrollment. RESULTS: Fifty-six percent of the medical schools had pre-admission programs. For both first-year and total enrollments, each comparison showed that schools ranked as having higher percentages of URM students (above the mean and in the top 25%) were more likely to have pre-admission programs than were the schools ranked lower (below the mean, lower 75%, and lowest 25%). CONCLUSION: This study suggests that the presence of pre-admission programs is positively associated with enrollment of URM students at U.S. medical schools.     

Progress and pitfalls in underrepresented minority recruitment: perspectives from the medical schools

PURPOSE: To assess current initiatives at U.S. medical schools to recruit underrepresented minorities (URM) and to identify perceived barriers to enrollment of URM students. METHODS: We developed a survey that was mailed to the dean of Student Affairs of all U.S. allopathic and osteopathic medical schools in 2002. Respondents were asked to list their schools' URM recruitment programs and rate the effectiveness of these programs. They were also asked to indicate barriers to URM recruitment from a list of 37 potential barriers and rate their overall success with URM recruitment. RESULTS: The study had a 59% response rate. All schools reported a wide variety of initiatives for URM recruitment with > or =50% of all schools using each of the 11 strategies. The three most commonly listed barriers to URM recruitment were MCAT scores of applicants (90%), lack of minority faculty (71%) and lack of minority role models (71%). Most schools rated their recruitment efforts highly; on a scale of 1 to 10 (10 being very successful), the average score was an 8. CONCLUSION: While schools continue to invest tremendous efforts in recruiting minority applicants, admissions criteria, lack of URM faculty and the need for external evaluation remain important barriers to achieving a diverse physician workforce.     

Evaluation of Racial Microaggressions Experienced During Medical School Training and the Effect on Medical Student Education and Burnout: A Validation Study

IntroductionMicroaggressions in the learning environment have been documented at various levels of medical training. However, there is lack of data detailing the prevalence and effects of racial microaggressions in medical school. This limits interventions that might improve the learning environment for underrepresented minority medical students (URMMS). This study describes the creation and validation of a survey instrument characterizing the experience of microaggressions in medical school and their impact on medical student education and burnout.MethodsAn anonymous survey instrument was adapted for medical students from the validated Racial and Ethnic Microaggressions Scale (REMS) and distributed to the national listservs of the Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), and the Asian Pacific American Medical Student Association. Responses were categorized into two cohorts: under-represented minority (URM) and non-URM based on self-reported race or ethnicity.ResultsA total of 217 responses were collected from medical students across the United States, with 148 (68.2%) students identifying as URM. URM respondents were significantly (p < 0.05) more likely to report experiencing race-related microaggressions during medical school (55% vs 31%), and to report that these microaggressions contributed to feelings of burnout (62% vs 29%) and compromised learning (64% vs 49%). URM students were significantly less likely to feel that adequate resources were available to address microaggressions (26% vs 39%, p < 0.05).ConclusionsOur results suggest that microaggressions experienced by URMMS can be evaluated using an adapted REMS. Additionally, the experience of microaggressions negatively impact the learning environment, and students feel the availability of sufficient resources to address microaggressions and their effects are lacking. Further research is needed to evaluate microaggressions and their impact on a larger scale. This should be followed by interventions to minimize the frequency and impact of these microaggressions.     

Educating future physicians for a minority population: a French-language stream at the University of Ottawa.

The Faculty of Medicine at the University of Ottawa has recently developed a French-language undergraduate medical education stream in order to train physicians for the francophone minority population of the province of Ontario. This new program was planned with the following societal requirements in mind: the need to receive health care in one's mother tongue, the need to have physicians who know the community, and the expectation of receiving good medical care in an ambulatory setting. A systematic educational planning model was used in order to develop three educational innovations in response to these needs and expectations: a communication skills laboratory; early student exposure to the ambulatory, primary care setting for development of clinical skills; and clerkship rotations in a francophone community hospital. Program developers provided ongoing faculty development activities in order to prepare francophone faculty for their new roles. They also considered student participation in program development an essential element of its success. The program has positive outcomes both within and outside the Faculty of Medicine. These include an enrichment effect on the English-language stream, an increased interest in medical education, student satisfaction with their community hospital clerkship rotations, and the recognition of the educational program as a national resource for francophone minority groups. Medical schools that serve minority population groups may benefit from the experience gained at the University of Ottawa.     

The Urban Health Program to encourage minority enrollment at the University of Illinois at Chicago College of Medicine.

Since 1969, the University of Illinois at Chicago College of Medicine has worked to recruit, admit, and graduate a more diverse population of physicians. The state of Illinois ranks third in the nation in the number of African American residents, and fifth in the number of Latinos, and these groups together account for approximately 60% of Chicago's population. To attract applicants from these groups, the medical school created the Medical Opportunities Program and its successor, the Urban Health Program, to maximize this pool of applicants. Outreach activities at undergraduate colleges, in association with premedical organizations, identify underrepresented-minority (URM) students who should receive support in their applications. The organizations assist in monitoring the applications of URM candidates. Also, the medical college created academic and social support programs for its URM students: a prematriculation program, small-group review sessions for every major course in the first two years of the curriculum, help for second-year students preparing for the United States Medical Licensing Examination Step 1 and fourth-year students preparing for Step 2, and support for organizations for minority students. Over its 30 years, the program has had a substantial impact on the number of URM students entering the medical college, other medical schools, and other health professions. Over these years, the proportion of URM students in the medical college's overall enrollment rose from 10% to 23%. Also, a higher proportion of the college's URM graduates than its non-URM graduates practice in the Chicago area.     

Preadmissions programs and enrollment of underrepresented minority students before and during successful challenges to affirmative action.

The association between the percent change in first-year and total underrepresented minority student enrollment and the presence of preadmission programs at Liaison Committee on Medical Education (LCME) accredited medical schools was assessed before and during successful legal and legislative challenges to affirmative action. The percent change in under-represented minority student enrollment was determined by comparing enrollment data for the academic years 1993-94 and 1996-97. Schools were categorized as having either a negative or positive percent change in their enrollment of underrepresented minority students. Logistic regression was used to determine the association of the percent change in under-represented minority student enrollment and the presence of a preadmission program while controlling for schools' financial support and the presence of postbaccalaureate programs. Fifty-six percent of the included medical schools had preadmission programs. Schools with a positive percent change were significantly more likely to have preadmission programs compared with schools with a negative percent change. There was no association between the presence of preadmission programs and the percent change in total enrollment. These results indicate that the presence of preadmission programs is positively associated with increases in first-year underrepresented minority student enrollment during the successful challenges to affirmative actions.     

The University of Louisville Medical School's comprehensive programs to increase its percentage of underrepresented-minority students.

Since 1981, the University of Louisville (U of L) School of Medicine has developed several programs to increase the number of its underrepresented-minority (URM) matriculants and help them succeed during their medical education. The first such effort, begun in 1981, was the Professional Education Preparation Program for Kentucky high school students from underserved counties. Programs in Louisville's elementary and middle schools were initiated in 1996, and others continue through medical education and residency training. These existing supports for local URM students (most of whom are African Americans) were enhanced in 1996 by the Health Professions Partnership (HPP), a program sponsored by The Robert Wood Johnson Foundation and the Association of American Medical Colleges. With the HPP, the U of L intensified its focus on health careers preparation at the elementary and secondary education levels, and increased exchanges and collaboration between U of L health sciences faculty and teachers and students in the Jefferson Country Public Schools. Several funding sources have been used to maintain and develop the U of L's education pathway programs, including institutional, state, federal, and foundation funds. The authors describe the U of L's programs, focusing on the HPP, and state that as of 1998, the number of URM students enrolled in the U of L School of Medicine had reached almost 10% (up from 2-3% before 1993) and the graduation rate was 90%, (up from 76% before 1993). These increases are the result of many years of developing and implementing a continuum of preparation and retention programs.     

Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine.

PURPOSE: Despite efforts to increase the numbers of underrepresented minorities (URMs), only 3.9% of medical school faculty are URMs. The authors compared the specialty choices, compensation, and career satisfaction of minority faculty with those of their majority counterparts to determine whether there were differences that might affect the recruitment and retention of minority faculty. METHOD: In 1995, the authors mailed a self-administered survey to a stratified random sample of 3,013 eligible full-time salaried faculty in 24 randomly selected medical schools. Those schools, which had at least 200 faculty, did not include the Puerto Rican or historically black medical schools. RESULTS: Of the eligible faculty surveyed, 1,807 (60%) responded; 1,463 were majority faculty, 195 were URM faculty, and 149 were other-minority faculty. Similar proportions of the three groups were in the primary care specialties. Only 11% of the URM respondents were in basic science departments. There was no significant difference in adjusted mean compensation between majority, URM, and other-minority faculty. However, URM faculty were significantly less satisfied with their careers (adjusted scores: 60 versus > 65; p = .001) and more often considered leaving academic medicine within five years (58% versus < 45%). CONCLUSION: Given the demographic changes of the U.S. population, these issues should be addressed by deans and department heads in order to enhance recruitment and facilitate retention of URM faculty in academic medicine.     

The Academy at Harvard Medical School: nurturing teaching and stimulating innovation.

The Academy at Harvard Medical School, established in 2001, was formed at a critical moment for medical schools in this country. Several decades of enormous growth in the biomedical research and clinical care activities of medical school faculty have resulted in great societal benefit. The unintended consequence has been a decline in faculty time and reward for the educational mission that is unique to a medical school. The impact of this decline is particularly felt now because the explosive growth in the science and technology relevant to medical practice, coupled with dramatic changes in the health care delivery system, calls for new models for the education of the next generation of physicians. The mission of the academy is to renew and reinvigorate the educational mission of Harvard Medical School (HMS). By bringing together a select group of some of the school's most talented and dedicated faculty and providing direct support for their work related to education, the academy has created a unique mechanism for increasing the recognition of teaching contributions of both academy members and the teaching faculty at large, fostering educational innovation, and providing a forum for the exchange of ideas related to medical education that cross departmental and institutional lines. The authors describe the academy's membership criteria, structure, governance, activities, institutional impact, and plans for long-term evaluation, and indicate challenges the academy will face in the future.     

Unique medical education programs at Nippon Medical School

In an attempt to improve the content of the educational programs offered by Nippon Medical School and to better prepare our students to work in the rapidly changing world of medicine, the school has recently revamped its teaching methodology. Particular emphasis has been placed on 1) simulator-based education involving the evaluation of students and residents in a new clinical simulation laboratory; 2) improving communication skills with the extensive help of simulated patients; 3) improving medical English education; 4) providing early clinical exposure with a one-week clinical nursing program for the first year students to increase student motivation at an early stage in their studies; 5) a new program called Novel Medical Science, which aims to introduce first-year students to the schools fundamental educational philosophy and thereby increase their motivation to become ideal physicians. The programs have been designed in line with 2006 guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology to allow flexibility for students to take part in education outside their own departments and year groups as part of the Ministry's program to encourage distinctive education at Japanese universities.     

A survey of basic technical skills of medical students.

PURPOSE: In 1998, the Medical Schools Objectives Project (MSOP) Report listed the minimum routine technical procedures that graduating medical students should be proficient to perform. The authors conducted a survey to determine to what extent basic technical skills are being taught formally and how student competence in these skills is being evaluated in U.S. medical schools. METHOD: A questionnaire of five items, designed to supplement existing information in CurrMIT, the national curriculum database for medical schools, was transmitted electronically via the AAMC listserv to associate deans for academic affairs. RESULTS: Sixty-two of the 126 medical schools (52%) responded to the survey. Most agreed that graduating medical students should be proficient to perform basic technical skills. Fifty-five percent of the respondents required students to keep logs of procedures performed. A majority responded that their students were proficient to perform venipuncture, IV placement, suturing lacerations, Foley catheter placement, and arterial puncture. The responding schools stated that few students are proficient in thoracentesis and intubation of children and neonates. CONCLUSIONS: It is likely that half of the medical schools are not attaining the MSOP objective of rigorously teaching and evaluating technical procedures. Currently, more measures and more sophisticated measures of physicians' performance are being implemented in medical practice. The authors' findings call attention to this educational need and act as a stimulus to improve this aspect of medical education.     

A mentoring program for underrepresented-minority students at the University of Rochester School of Medicine.

Mentoring underrepresented-minority (URM) students poses a special challenge because most medical schools have few URM faculty and many non-URM faculty hesitate to be mentors for URM students. Some medical students perform less well in the clinical years than would be expected from their pre-clinical performances. One factor is some students' difficulty in adapting to the culture of medicine, which mentors can help students overcome. The University of Rochester School of Medicine created the Medical Student Mentoring Program to address the needs of URM students and non-URM faculty who could be mentors. The program, offered in 1995-96 and 1996-97, trained mentors, created a bicultural support group for URM students, and provided structured mentoring. Interviews were conducted with faculty and students to identify critical areas that influence the success of URM students in their clinical years; URM faculty, residents, and advanced students shared their experiences with the program students at reflection group meetings. Mentors participated in an initial orientation. Of the 42 students eligible during 1995-1997, 30 participated and were assigned to 15 mentors. At the end of the program's first year, the students and mentors gave their reactions, and although there were some differences in their viewpoints, overall they considered the program useful. Non-URM faculty appreciated the support and guidance that allowed them to mentor URM students more effectively. The program ran formally for two years, and some of the mentoring relationships continued into the third year. Loss of funding and change in administrative leadership contributed to the ending of this program. Mentoring continues to be a priority at the medical center, and a new mentoring program has been developed for URM and non-URM medical students.