Effect of two Howard Hughes Medical Institute research training programs for medical students on the likelihood of pursuing research careers.

PURPOSE: To assess the effect of Howard Hughes Medical Institute's (HHMI) two one-year research training programs for medical students on the awardees' research careers. METHOD: Awardees of the HHMI Cloister Program who graduated between 1987 and 1995 and awardees of the HHMI Medical Fellows Program who graduated between 1991 and 1995 were compared with unsuccessful applicants to the programs and MD-PhD students who graduated during the same periods. Logistic regression analyses were conducted to assess research career outcomes while controlling for academic and demographic variables that could affect selection to the programs. RESULTS: Participation in both HHMI programs increased the likelihood of receiving National Institutes of Health postdoctoral support. Participation in the Cloister Program also increased the likelihood of receiving a faculty appointment with research responsibility at a medical school. In addition, awardees of the Medical Fellows Program were not significantly less likely than Medical Scientist Training Program (MSTP) and non-MSTP MD-PhD program participants to receive a National Institutes of Health postdoctoral award, and awardees of the Cloister Program were not significantly less likely than non-MSTP MD-PhD students to receive a faculty appointment with research responsibility. Women and underrepresented minority students were proportionally represented among awardees of the two HHMI programs whereas they were relatively underrepresented in MD-PhD programs. CONCLUSIONS: The one-year intensive research training supported by the HHMI training programs appears to provide an effective imprinting experience on medical students' research careers and to be an attractive strategy for training physician-scientists.     

Baylor College of Medicine's support of Tulane University School of Medicine following Hurricane Katrina.

The authors describe how Baylor College of Medicine (BCM), with three other Texas medical schools, "adopted" virtually all the 620 medical students and 526 house officers of Tulane University School of Medicine and continued their education for eight months after most of New Orleans, including Tulane, was flooded on August 29, 2005, after Hurricane Katrina. Soon after, BCM's president asked all senior staff to take whatever actions were necessary to sustain Tulane, and on September 7, leaders from BCM and three other Texas medical schools met to plan the relocation of Tulane's students and programs. The authors explain how problems were overcome (e.g., locating the scattered Tulane students and staff, finding them lodging, obtaining their records, and providing financial aid and counseling), and how high-quality educational experiences were maintained for both Tulane's and BCM's students and residents while assisting Tulane's faculty in numerous ways, helping Tulane plan the enrollment of its following year's students, and undergoing Liaison Committee for Medical Education and Accreditation Council on Graduate Medical Education site visits to BCM.After the BCM-Tulane experience, BCM developed a disaster-management plan (available online) that could help other schools as they plan for disasters. The authors also offer lessons learned in the areas of communication, cooperation, curriculum, collaboration, contact with accrediting bodies, and compassion. They close by stating that when BCM faculty are asked "how could you take Tulane's medical school in?" their response is, "how could we not?" They continue: "In medical education, a frequent discussion is how to teach humanism and professionalism; we teach it best by modeling it."     

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.     

Preparing high school students for a career in the health sciences

The Summer Scholars Programs at the University of Missouri-Kansas City School of Medicine are designed to identify talented minority or economically disadvantaged high school students and to encourage these students toward careers in the health sciences. In the summer of 1984, 31 students participated in a one-month educational program during which they observed and participated in selected patient care procedures. They developed interpersonal and interviewing skills needed for successful application to health education programs. Students were provided information about numerous health careers to help them clarify their perceptions of health roles.     

Minority enrichment programs at the New Jersey Medical School: 26 years in review.

In 1971 the New Jersey Medical School formed a task force to address the training of physicians from minority and disadvantaged backgrounds, and in 1972 the Students for Medicine Program (SMP) was launched. The program, one of the first of its kind, provided previews of college science courses to help minority students develop their noncognitive skills and make the transition to medical school. The school has also established other minority programs. The programs have been designed to form a health careers pipeline for college-bound students, beginning in the eighth grade. Grade-specific summer experiences, as well as year-round monthly workshops, are offered to all participants. The workshops for pre-college and college students and their parents are designed to strengthen students' academic skills, address issues such as self-esteem, provide exposure to health professions, and increase parents' knowledge and involvement. From 1972 to 1998, there had been 1,722 participants in the pre-college, 1,875 in the college, and 683 in the prematriculation programs, respectively. They were from the inner city, most of them African American, but with a growing number of Hispanics. From 1987 to 1994, 36% of the SMP participants entered health professions schools. In 1996, the medical school created the New Jersey Partnership for Health Professions Education, a collaboration of high schools, universities, community-based organizations, the federal government, and the health professions schools. It works to strengthen the medical school's "pipeline" for underrepresented minority students while eliminating competition among programs for the same students and simultaneously developing a larger pool.     

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.     

Health science learning academy: a successful "pipeline" educational program for high school students.

OBJECTIVE: The objective of the Health Professions Partnership Initiative is to increase the number of underrepresented minority Georgia residents who become health care professionals by (1) creating a pipeline of well-qualified high school and college students interested in health care careers, (2) increasing the number of well-qualified applicants to medical and other health professions schools, and (3) increasing the number of underrepresented minority students at the Medical College of Georgia (MCG). DESCRIPTION: The Health Professions Partnership Initiative at MCG was created in 1996 by collaboration among the MCG Schools of Medicine and Nursing, two Augusta high schools attended primarily by underrepresented minority students, three historically black colleges and universities, the Fort Discovery National Science Center of Augusta, community service organizations, and MCG student organizations. The project was funded by the Association of American Medical Colleges and The Robert Wood Johnson Foundation. The high school component, the Health Science Learning Academy (HSLA), was designed to strengthen the students' educational backgrounds and interest in professional careers as evidenced by increased standardized test scores and numbers of students entering college and health professions schools. Additional goals included a system to track students' progress throughout the pipeline as well as professional development sessions to enrich faculty members' knowledge and enhance their teaching expertise. The HSLA began with ninth-grade students from the two high schools. During its second year, funding from the Health 1st Foundation allowed inclusion of another high school and expansion to ninth grade through twelfth grade. The HSLA's enrichment classes meet for three hours on 18 Saturday mornings during the academic year and include computer-interactive SAT preparation and English composition (tenth grade); biology, algebra, calculus, and English composition (eleventh grade); and advanced mathematics and biology (twelfth grade). DISCUSSION: The ultimate solution to the paucity of underrepresented minority physicians resides largely in successful pipeline programs that expand the pool of well-qualified applicants, matriculants, and graduates from medical schools. Intermediate results of the HSLA support the success of the program. Since its creation in the 1996-1997 academic year, 203 students have participated in the HSLA and all 38 (from the original two schools) who completed the four-year program have enrolled in college. The mean SAT score for students who completed the HSLA program was 1,066, compared with a mean of 923 for all college-bound students in the participating schools. The mean increases in SAT scores for students who completed the four-year program were.5% (1,100 to 1,105) for students attending a magnet high school and 18% (929 to 1,130) for students attending the comprehensive high school. The mean overall increases in SAT scores for students in the two high schools were 1% (1,044 to 1,048) and 9.1% (765 to 834), respectively. The HSLA is accomplishing its goals and, while it is too early to know if these students will participate in MCAT preparatory programs and apply to medical and other health professions schools, their sustained commitment and enthusiasm bode well for continued success.     

Increasing minority recruitment to the health professions by enlarging the applicant pool.

Over an eight-year period, 707 students from minority groups or with economically disadvantaged backgrounds were selected from junior and senior-high-school classes throughout the state of Arizona and admitted to a Med Start program emphasizing careers in the health professions. The program featured recruitment into clubs, training in leadership, counseling by other minority students, work experience and specialized courses in English, mathematics and basic biologic sciences. Attrition was remarkably low. At the time of follow-up study, 369 of these students had sought further education beyond high school, and 220 of this group had enrolled in or completed health-education programs. Although obviously not a controlled experiment, this experience suggests that the pool of minority and economically disadvantaged applicants for careers in the health professions can be enlarged.     

Mentoring for women and underrepresented minority faculty and students: experience at two institutions of higher education

Women and minority faculty and students are seriously underrepresented in university and academic healthcare institutions. The role of mentoring has been identified as one of the significant factors in addressing this underrepresentation. We have described the mentoring efforts at two institutions of higher learning in assisting women and minority students and faculty in being accomplished in their academic pursuits. One-hundred-thirty students and >50 women and minority faculty have participated in the mentoring programs described. The number of participants has increased dramatically over the years and continues to evolve positively. These programs appear to be quite successful in the short term. Further evaluation of measurable outcomes will be necessary to fully determine their true impact. The mentoring models for women and underrepresented minority faculty and students at Creighton University Health Sciences Schools and Wake Forest University School of Medicine will serve as a guide for other Health Sciences Schools.     

A medical school-based program to encourage native Hawaiians to choose medical careers.

Native Hawaiians are highly underrepresented in the field of medicine, both nationally and in Hawaii. Since 1991, the Native Hawaiian Center of Excellence (funded by the Bureau of Health Professions) at the John A. Burns School of Medicine in Honolulu has developed programs to encourage Native Hawaiians to enter and complete medical school. In this article, the authors focus on a revised version of a six-week summer enrichment program for high school students developed by the Center in 1995 and funded by the Hawaii State Department of Education and the federal government. The authors trace the difficulties in attracting Native Hawaiian students and how these difficulties were overcome. They show that once Native Hawaiians have entered the academically rigorous, culturally rich program, their academic and career ambitions have been kindled, and some are planning careers in medicine. The history of the program illustrates that a committed medical school and dedicated individuals in the community, with the support of the federal and state governments, can increase interest among underrepresented students in medical and other health professions careers. Eventually, when such students graduate, there is a likelihood that some of them will go back to serve the health needs of their communities.     

Factors related to medical school application and acceptance in minority summer enrichment program students

Baylor College of Medicine has conducted a summer enrichment program for minority/disadvantaged premedical students since 1969. Follow-up data on medical school application and acceptance for participants from 1980 through 1984 were analyzed in relation to selected preprogram variables--cumulative college grade point average, total Scholastic Aptitude Test score, competitiveness of undergraduate college, sex, and ethnicity. Results of univariate and multivariate analyses indicated that: 1) females were significantly less likely to apply to medical school than males, 2) females had significantly lower mean MCAT scores (5.9 vs 7.2) even though their preprogram academic performance was comparable to that of the males, and 3) after controlling for MCAT scores, none of the preprogram variables were significant in predicting medical school acceptance. These findings suggest the need for research to explain the discrepancy between male and female MCAT performance and frequency of medical school application in summer program participants. The findings also have implications for the type of counseling provided to female participants in summer enrichment programs.     

Introduction to the medical professions through an innovative medical student-run pipeline program

Underrepresented minorities (URMs) make up a disproportionately small percentage of medical school applicants, matriculants, and physicians relative to the general US population. Preprofessional pipeline programs may help introduce URMs to careers in the medical field. MiniMeds was developed as a paracurricular enrichment program that targeted URM students. The curriculum was designed and administered by medical students, and 2 trials of this program were conducted. Data were collected pre and post program through a survey that assessed knowledge of medical concepts and knowledge of and interest in careers in medicine. Attendance at program sessions correlated with baseline knowledge about medical professions. Knowledge about medical concepts increased significantly from baseline to follow-up for boys, a group significantly represented by URMs in our cohort. Median scores for knowledge of medical careers increased significantly from baseline to followup for URMs as well as for boys and girls. Preprofessional pipeline programs such as MiniMeds are able to engage and develop medical knowledge in URM students at a critical developmental age. Further evaluation and implementation of programs that incorporate medical students to actively develop and lead pipeline programs are warranted.     

The Jefferson-Penn State B.S.-M.D. program: a 26-year experience.

Since the 1960s a number of physicians have completed both their baccalaureate and their M.D. degrees in six or fewer years. In this longitudinal study the authors track the academic performances, clinical ratings, and career follow-up data of 659 students in one of these accelerated programs, the Jefferson Medical College-Pennsylvania State University B.S.-M.D. program, from entering years 1964 through 1989. The medical school performances, clinical performances in residencies, and rates of board certification and faculty appointment of the accelerated students compared favorably with those of a control group of medical students with similar high school credentials who had followed a four-year baccalaureate program. The authors conclude that a carefully chosen group of students can achieve high academic standards in an accelerated medical school program, graduate as younger physicians able to perform well in postgraduate training, and go on to highly productive careers in medicine.     

Women's attitudes toward careers in academic medicine at the University of California, San Francisco.

In order to identify the concerns and possible barriers for women considering careers in academic medicine, in 1990 the authors surveyed both men and women medical students, housestaff, postdoctoral students, and junior faculty at The University of California, San Francisco (UCSF). The authors achieved a 58% response rate from students and faculty, a 21% response rate from postdoctoral students, and a 15% response rate from housestaff. Results indicated that women at all levels were less interested in academic careers than were their male colleagues. Concerns about balancing family responsibilities, clinical practice, and teaching in addition to the research required of an academic career were mentioned most frequently. Women, especially those among the housestaff and junior faculty, reported fewer mentor relationships and role models. The authors discuss these findings in relation to other studies and describe what they are doing to foster women's interest and success in academic medicine at UCSF.     

Meeting the needs of regional minority groups: the University of Washington's programs to increase the American Indian and Alaskan native physician workforce.

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.     

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.     

Survey of 1975-1987 graduates of Houston's High School for Health Professions

Baylor College of Medicine and the Houston Independent School District created in 1972 the Houston High School for Health Professions (HSHP). Fifteen years later, Baylor conducted a follow-up study of HSHP graduates to determine whether the high school has been successful in encouraging and supporting young people to pursue health professional careers. Of the 2,033 students who graduated from the HSHP between 1975 and 1987, 951 (46.8%) returned usable responses to the survey. The results raised some concerns about the value of the high school's counseling services and showed that financial barriers posed problems for many students in their pursuit of health-related careers. Also, the results suggest that gender stereotyping may influence the students' career choices. Overall, however, the results of the survey were clearly favorable and provide evidence that the HSHP has been successful in fostering its students' pursuit of careers in the health professions and related careers.     

Academic outreach: health careers enhancement program for minorities

This article describes the 6-week Health Careers Enhancement Program for Minorities inaugurated in the summer of 1988 at Case Western Reserve University School of Medicine. The program was developed for minority and economically disadvantaged college undergraduates and postbaccalaureate premedical students. Its major objectives were to stimulate and maintain the interest of minority students in health careers and prepare these students for entry into health professions and for successful completion of these programs. A unique aspect of the program was academic outreach. Case Western Reserve University minority alumni and community minority physicians participated as clinical role models, mentors, and teachers; community and state minority leaders served as inspirational speakers and role models. The program was designed not only to incorporate cognitive and skill development activities, but to also include features distinctive to the Case Western Reserve University curriculum, specifically, organ system teaching, preceptor groups, medical apprenticeship program, and student tutors.     

Increasing access to medical education for students from medically underserved communities: one program's success.

The Premedical Honors College (PHC) is an eight-year, BS-MD program created in 1994 by Baylor College of Medicine (BCM) and The University of Texas-Pan American (UT-PA) to increase the number of physicians addressing the health care needs of underserved populations in Texas. The PHC targets South Texas, a 13-county, medically underserved area with a population that is 82% Hispanic. To date, the PHC has had 159 matriculants and 71 graduates, of whom 60 (84.5%) have matriculated into medical school. These results are significant considering that in 1996, only four students from all five South Texas colleges (combined enrollment of 30000 students) were accepted to medical school. An outcomes study comparing PHC matriculants with students of similar academic ability, ethnicity, and interest in medicine revealed that the odds of medical school matriculation were seven times higher for PHC students than for non-PHC students. The PHC's initial success has been acknowledged by the Texas legislature, which recently passed a bill to promote the PHC's replication. In addition, the number of PHC students-of whom 95% are Mexican American-who matriculate into medical school annually is significant nationally. In 2001, only 386 U.S. medical school matriculants (2.3% of all matriculants) were Mexican American; 17 of these students (4.4%) were PHC graduates. If current trends continue, the PHC could significantly expand the number of physicians serving minority and medically underserved populations in Texas and the nation. Also, the PHC provides an opportunity for research on programs designed to create pathways from high school to medical school.     

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.