Medical School Matriculants Research Articles

Viewpoint: Developing a Physician Workforce for America???s Disadvantaged

Eliminating health disparities will be difficult as long as many rural and disadvantaged inner-city communities remain medically underserved. The authors argue that the current debate on physician workforce policy has not adequately emphasized medical schools' social mission to educate physicians who will improve health care access and equity; fulfilling that mission means training students who will deliver primary care to underserved people. But fewer medical students are entering primary care specialties and practicing in underserved areas, and students who have the characteristics that make them likely to select such careers are increasingly uncommon among medical school matriculants. Unless there is a dramatic change, the imbalance will only become worse. The authors argue that the epidemiology of medical student career choice is sufficiently understood to permit schools to accept applicants with those characteristics, both demographic and individual, that are known to increase the probability of students caring for populations in need after graduation. Programs that have selected students on the basis of those predictors have been successful in increasing the distribution of doctors to primary care specialties and underserved areas, but these have not been of sufficient scope. The authors present a proposal for prioritizing medical school admissions to favor applicants who, rather than delivering just high grades, will contribute to improving America's health care outcomes.

Increasing Medical School Matriculation for Minority Students

Increasing Medical School Matriculation for Minority Students

Increasing Medical School Matriculation for Minority Students

Increasing Medical School Matriculation for Minority Students

Increasing Medical School Matriculation for Minority Students—Reply

Increasing Medical School Matriculation for Minority Students—Reply

Effectiveness of University of California Postbaccalaureate Premedical Programs in Increasing Medical School Matriculation for Minority and Disadvantaged Students

Many medical schools administer postbaccalaureate premedical programs targeting underrepresented minority and disadvantaged students, with the goal of increasing the number of these students matriculating into medical school. To determine whether University of California (UC) postbaccalaureate programs are effective in increasing medical school matriculation rates for program participants. Retrospective cohort study assessing 5 UC medical school postbaccalaureate programs. The cohort comprised 265 participants in the postbaccalaureate programs in the 1999 through 2002 academic years and a control group of 396 college graduates who applied to the programs but did not participate. Of the participants, 66% were underrepresented minorities, and for 50% neither parent had attended college. Matriculation by 2005 into a US medical school accredited by the Liaison Committee on Medical Education. By 2005, 67.6% of participants and 22.5% of controls had matriculated into medical school (P<.001). After adjusting for baseline student characteristics, students who participated in postbaccalaureate programs had a higher probability of matriculating into medical school in a regression model controlling for grade point average and demographic characteristics (odds ratio, 6.30; 95% confidence interval, 4.08-9.72) and in a model further controlling for preparticipation Medical College Admissions Test score (odds ratio, 8.06; 95% confidence interval, 4.65-13.97). Postbaccalaureate premedical programs appear to be an effective intervention to increase the number of medical school matriculants from disadvantaged and underrepresented groups.

Progressive Specialization Within General Surgery: Adding to the Complexity of Workforce Planning

Although most general surgeons receive comparable training leading to Board certification, the services they provide in practice may be highly variable. Progressive specialization is the voluntary narrowing of scope of practice from the breadth of skills acquired during training; it occurs in response to patient demand, rapid growth of medical knowledge, and personal factors. Progressive specialization is increasingly linked to fellowship training, which generally abruptly narrows a surgeon's scope of practice. This study examines progressive specialization by evaluating trends in fellowship training among general surgeons. Because no database exists that tracks trainees from medical school matriculation through entrance into the workforce, data from multiple sources were compiled to assess the impact of progressive specialization. Trends in overall number of trainees, match rates, and proportion of international medical graduates were analyzed. The proportion of general surgeons pursuing fellowship training has increased from > 55% to > 70% since 1992. The introduction of fellowship opportunities in newer content areas, such as breast surgery and minimally invasive surgery, accounts for some of the increase. Meanwhile, interest in more traditional subspecialties (ie, thoracic and vascular surgery) is declining. Progressive specialization confounds workforce projections. Available databases provide only an estimate of the extent of progressive specialization. When surgeons complete fellowships, they narrow the spectrum of services provided. Consequently, as the phenomenon of progressive specialization evolves, a larger surgical workforce will be needed to provide the breadth of services encompassed by the primary components of general surgery.

Participation in the Academic Associate Program: Effect on Medical School Admission Rate

Several emergency medicine programs are using premedical students as research assistants for clinical research in the emergency department (ED). These programs have been shown to enhance faculty research productivity, but the effects of these programs on the students' goals have not been assessed. The authors evaluated the effect of the Academic Associate Program (AAP) on medical school acceptance rates. From 1997 to 2002, premedical students who attended informational sessions about the AAP completed a 28-item survey including demographic information, educational experiences, career goals, grade point average (GPA), and prior research participation. Premedical students who had a career goal of becoming a physician were included in the study if they matriculated into medical school or changed their career plans by the fall of 2003. Medical school acceptance was determined by contacting students or their parents via telephone and e-mail. Students enrolled in the AAP were compared with Association of American Medical Colleges (AAMC) data to determine whether they were more or less likely to be accepted into medical school. During the study period, 198 students enrolled in the AAP had attained a final disposition with respect to medical school matriculation. Students were a mean age of 22.4 +/- 3.0 years, 55% female, and 43% nonwhite. Most students (91%) were junior year or later with respect to educational level. Prior research experience included being an author on an abstract (25%), being an author on a manuscript (17%), and presenting research at a scientific meeting (14%). The mean GPA ( +/- standard deviation) for Academic Associates was 3.38 ( +/- 0.31). Medical school acceptance rates were 79% for students in the AAP (95% confidence interval [95% CI] = 73.1 to 84.5). This is higher than expected based on AAMC published data with a 49% (95% CI = 48.5 to 49.5) acceptance rate for students with a mean GPA of 3.46. Compared with AAMC data, students in the AAP have a higher medical school acceptance rate despite a slightly lower GPA. This finding suggests that participation in the program enhances a student's likelihood of matriculating in medical school.

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.

Undergraduate institutional MCAT scores as predictors of USMLE step 1 performance.

Medical schools using formal undergrad-uate selectivity measures do so to compensate for the psychometricinadequacies of college grade-point averages, believing that moremeaning can be derived from the GPA if it is attached to a measureof institutional performance (academic rigor) or selectivity (strin-gent admission standards).Researchers have reported mixed results on whether formal mea-sures of undergraduate institution selectivity are useful contributorsto predicting medical student performance.

Critical factors for designing programs to increase the supply and retention of rural primary care physicians.

The Physician Shortage Area Program (PSAP) of Jefferson Medical College (Philadelphia, Pa) is one of a small number of medical school programs that addresses the shortage of rural primary care physicians. However, little is known regarding why these programs work. To identify factors independently predictive of rural primary care supply and retention and to determine which components of the PSAP lead to its outcomes. Retrospective cohort study. A total of 3414 Jefferson Medical College graduates from the classes of 1978-1993, including 220 PSAP graduates. Rural primary care practice and retention in 1999 as predicted by 19 previously collected variables. Twelve variables were available for all classes; 7 variables were collected only for 1978-1982 graduates. Freshman-year plan for family practice, being in the PSAP, having a National Health Service Corps scholarship, male sex, and taking an elective senior family practice rural preceptorship (the only factor not available at entrance to medical school) were independently predictive of physicians practicing rural primary care. For 1978-1982 graduates, growing up in a rural area was the only additionally collected independent predictor of rural primary care (odds ratio [OR], 4.0; 95% CI, 2.1-7.6; P<.001). Participation in the PSAP was the only independent predictive factor of retention for all classes (OR, 4.7; 95% CI, 2.0-11.2; P<.001). Among PSAP graduates, taking a senior rural preceptorship was independently predictive of rural primary care (OR, 2.5; 95% CI, 1.3-4.7; P =.004). However, non-PSAP graduates with 2 key selection characteristics of PSAP students (having grown up in a rural area and freshman-year plans for family practice) were 78% as likely as PSAP graduates to be rural primary care physicians, and 75% as likely to remain, suggesting that the admissions component of the PSAP is the most important reason for its success. In fact, few graduates without either of these factors were rural primary care physicians (1.8%). Medical educators and policy makers can have the greatest impact on the supply and retention of rural primary care physicians by developing programs to increase the number of medical school matriculants with background and career plans that make them most likely to pursue these career goals. Curricular experiences and other factors can further increase these outcomes, especially by supporting those already likely to become rural primary care physicians.

Measuring the emotional intelligence of medical school matriculants.

507 and professionalism during the first semester, using lectures, small groups, communication labs, and interactions with standardized patients. Within the first few weeks, the students and faculty complete the Emotional Quotient Inventory (EQi) developed by Bar-On, listen to one lecture on emotional intelligence, and subsequently receive personal EQi results, which are distributed at a small-group session. The faculty tutors share personal interpretations and reflections on their own scores and permit the students, if they so choose, to discuss their own scores in a safe setting. The focus on professionalism continues throughout the two-year course with additional small-group sessions and standardizedpatient experiences promoting the ideas of self-reflection and growth. Plans are to readminister the EQi in the students’ second and third years. Discussion: Most students are selected into medical school based on history of academic and cognitive successes, yet each possesses a unique emotional make-up that reflects personal life experience, coping skills, and core values and beliefs. To be able to practice medicine, the student must have the ability to understand the views and needs of a wide variety of people, remain sensitive and empathic to patient concerns, and be able to keep his or her personal emotional reactions in perspective, handle stress, and promote social responsibility—all concepts that the EQi attempts to measure. We believe the first step is for students to examine and understand their own emotional intelligence, which will, if developed, assist them in the ability to identify and accept the views of their patients. This process has long been expected to occur on its own through the hidden curriculum of medical education and the presence of excellent role models. Use of the EQi will formalize this process, will direct both faculty and students to utilize opportunities to become skilled in the physician–patient interaction, and will provide a means for assessment of intrapersonal change. Inquiries: Peggy J. Wagner, PhD, Department of Family Medicine, HB3040, Medical College of Georgia, August, GA 30912-3500.

Recruiting and selecting generalist-oriented students at New York Medical College

This paper describes the strategies developed for student recruitment and selection at New York Medical College (NYMC), a private medical school with a consortium of 22 teaching hospitals, to meet its goal of 50% of graduating medical students entering generalist careers. With funding from The Robert Wood Johnson Foundation Generalist Physician Initiative, NYMC developed strategies to attract applicants interested in primary care and to select primary care applicants for matriculation. These strategies included use of recruiting newsletters to describe the primary care curriculum, on-campus open houses for undergraduates, visits to regional undergraduate schools by generalist faculty, changes in the admission committee to include more generalists, and changes in the interview format to stress nonacademic qualities in applicants. The authors present data from the Association of American Medical Colleges (AAMC) Pre-Medical Student Questionnaire and from the AAMC Medical School Matriculation Questionnaire that indicate NYMC achieved its objectives. They warn, however, that it is unclear whether these changes occurred solely as a result of NYMC's strategies, as a result of market forces driving career choices, or as a result of some combination of these factors.

Recruiting and selecting generalist-oriented students at New York Medical College.

This paper describes the strategies developed for student recruitment and selection at New York Medical College (NYMC), a private medical school with a consortium of 22 teaching hospitals, to meet its goal of 50% of graduating medical students entering generalist careers. With funding from The Robert Wood Johnson Foundation Generalist Physician Initiative, NYMC developed strategies to attract applicants interested in primary care and to select primary care applicants for matriculation. These strategies included use of recruiting newsletters to describe the primary care curriculum, on-campus open houses for undergraduates, visits to regional undergraduate schools by generalist faculty, changes in the admission committee to include more generalists, and changes in the interview format to stress nonacademic qualities in applicants. The authors present data from the Association of American Medical Colleges (AAMC) Pre-Medical Student Questionnaire and from the AAMC Medical School Matriculation Questionnaire that indicate NYMC achieved its objectives. They warn, however, that it is unclear whether these changes occurred solely as a result of NYMC's strategies, as a result of market forces driving career choices, or as a result of some combination of these factors.

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

The authors reviewed the literature published from 1966 to 1996 to identify enrichment programs for underrepresented minority college students sponsored by medical schools and affiliated programs, finding 20 such programs. The programs reported in the literature underestimate the number and variety of programs known to exist by about two thirds. The authors categorized the reported programs according to the types of components they contained. Most programs contained more than one component type. Eighteen of the programs had an academic enrichment component. Thirteen programs included components focused on preparation for the admission process. Mentoring activities were a component of only four of the programs. Eighteen of the 20 programs were evaluated in the literature. The largest focus of evaluation activities was the success of program participants entering medical school. While the medical school matriculation rate was quite high, these results were difficult to interpret as the studies did not use control groups. The evaluations could not demonstrate, therefore, that the programs were responsible for increased admission of minorities to medical schools. Relatively few studies measured the immediate effects of the programs' efforts. Further, there was even less evidence of which program components in particular were effective. A more public and energetic discussion of these programs in the medical education literature is essential. In a political and social environment that calls for accountability, programs must be able to clearly and truthfully declare what they have accomplished. Without this type of public discussion, enrichment programs for underrepresented minorities may continue to appear to be worthwhile endeavors, but lacking solid support and foundation and vulnerable to losing funding.

Finishing the bridge to diversity.

While much progress has been made to diversify the medical workforce in regard to gender, there is a long way to go with regard to race and ethnicity. The author emphasizes that seeking diversity in the medical professions is imperative to achieve just and equitable access to rewarding careers, improved access to health care for the under-served, culturally competent care (which includes the issue of patients' satisfaction with their care), comprehensive research agenda targeted to the problems of all areas of the population, and use of the rich and diverse pool of the nation's talent to better manage the health care system. In the 1960s the civil rights movement and civil unrest woke up the nation's institutions to the need for affirmative action initiatives, and academic medicine was one of the first to respond: there was a dramatic rise in the percentage of underrepresented minority medical school matriculants. But in the mid-1970s, this trend stalled. To state it again, the AAMC in 1991 created Project 3000 by 2000 as a longterm strategy to effect small scale educational reform in the K-12 schools and colleges that are responsible for the academic preparation of potential underrespresented-minority (URM) applicants. For a few years, the attention to URMs created by this program, and other factors, spurred a significant increase in the percentage of URM matriculants and proved the power of affirmative action. But the increase has not continued. The author maintains that this may be largely because affirmative action is being pursued with less vigor and in some cases has been stopped by law. He concludes with a vigorous defense of affirmative action and maintains that it must be used alongside more long-term solutions such as project 3000 by 2000 to achieve true diversity in the medical professions.

Medical school admission and generalist physicians

To examine the medical school applications of physicians who are now established in their careers to see whether any of the applicants' data might have had predictive value for the admission process of a medical school wishing to increase its production of generalist physicians. Three members of the Committee on Admissions of the University of North Carolina at Chapel Hill School of Medicine followed the same procedure they use when reviewing current medical school applicants in reading the applications of 148 graduates of the class of 1985. The readers recorded data from all parts of the American Medical College Application Service form--face sheet, personal statement, and the record of course work--and used alumni records and published physician locators to determine these class members' whereabouts and the specialties (and subspecialties) they were practicing 13 or 14 years after applying to medical school. Thirty-four percent of the class had elected generalist medical careers (the practice of family medicine, general internal medicine, or general pediatrics). A high service index (reflective of a demonstrated orientation toward community service prior to medical school matriculation) predicted strongly the choice of a generalist medical career. Conversely, the absence of any clear evidence of a service orientation predicted still more strongly a non-generalist career. Less strong predictors of a generalist practice included the selection of a generous number of non-science-content courses as an undergraduate, lower socioeconomic family origin, and a record of leadership in one or more extracurricular activities during college. If an admission committee informs itself of "what finally happens" to those it admits, its decisions can contribute to achieving whatever policy its medical school adopts with respect to the mix of physicians it wishes to produce.

Relationship of interviewer and applicant variables to admission interview ratings of medical school matriculants and nonmatriculants.

Relationship of interviewer and applicant variables to admission interview ratings of medical school matriculants and nonmatriculants.

Can Trait Anxiety, Grades, and Test Scores Measured Prior to Medical School Matriculation Predict Clerkship Performance?

Can Trait Anxiety, Grades, and Test Scores Measured Prior to Medical School Matriculation Predict Clerkship Performance?

Baccalaureate preparation for medical school

Four groups of medical school matriculants (43 with a B.A. degree in social sciences, 68 with a B.A. degree in the humanities, 49 with a B.A. degree in science, and 40 with a B.S. degree in science) were studied. No significant difference was found among the four groups on yearly grade-point averages in medical school or on parts I, II, and III of the examinations of the National Board of Medical Examiners. Those with an undergraduate degree in the humanities considered leaving medical school more frequently than the others. A substantial proportion of medical students with an undergraduate major in the sciences and social sciences reported they would choose the humanities if they were once again high school seniors. Those with a science background were disproportionately more likely than the others to choose residencies in internal medicine and surgery, and those with undergraduate degrees in the humanities and social sciences were more likely to choose psychiatry residencies.

Recruitment and retention program for minority and disadvantaged students.

Attracting ethnic minority and disadvantaged students to health careers and facilitating their successful completion of training program requirements have been major activities of the University of Colorado Medical Center since 1969. As a result of extensive college campus recruitment efforts, high school and college level preprofessional programs, and the participation of ethnic minority faculty members in the medical school admissions process, the number of applicants to the medical school increased from 45 in 1971 to 265 in 1977. Concurrently, medical school matriculants increased from 12 in 1971 to 24 in 1977, with a maximum of 30 in 1975. However, significantly fewer minority students have shown interest in nursing, dentistry, or allied health professions careers. Because of support programs for matriculants (including preadmission and postadmissions personal, academic, study skills, and test-taking counseling and a prefreshman year summer orientation course), 71 percent of the minority students entering medical school in 1971-73 have received the M.D. degree.