Widening the Road to Health Professions Education: Expanding Access for Diverse and Underserved Populations

Abstract

The Spring 2023 Webinar Audio Seminar (WAS) of the International Association of Medical Science Educators (IAMSE), titled "Widening the Road to Health Professions Education: Expanding Access for Diverse and Underserved Populations," was designed to help health science educators explore innovative practices in recruiting and enrolling students from underserved populations into health sciences programs. From March 2, 2023, to March 30, 2023, this five-part webinar series was broadcast live to institutions and educators worldwide. This series helped participants learn about creating pathways for students to meet the unique needs of their communities.

Building Pathways and Bridges on the Bumpy Road Towards Equity in STEM & Medicine

Presenters: Jacqueline Ekeoba and Mariam Manuel of the University of Houston College of Natural Sciences and Mathematics, Houston, TX, USA; Thomas Thesen of the Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Lily Lam of the City University New York School of Medicine, New York City, NY, USA.

In the first webinar, Drs. Ekeoba, Manuel, Thesen, and Lam introduced challenges and obstacles students from Underrepresented in Medicine (URiM) groups may face in Science, Technology, Engineering, Mathematics, and Medicine (STEMM). Dr. Ekeoba introduced the “leaky pipeline” problem, a model to understand student attrition along the educational continuum. Dr. Thesen described disparities in the proportions of URiM populations in medical education and practice compared to the proportions of URiM groups in the general population [1]. He stated that the lack of physicians sharing the cultural and lived experiences of their patients can lead to unequal outcomes along the lines of race and socioeconomic status in medicine. Graduating doctors from underserved groups is an important strategy to improve access and quality of care in underserved communities, as medical students from URiM groups are more likely to return to underserved communities to practice medicine. Dr. Thesen then discussed challenges to the expansion of URiM representation in medicine, emphasizing that neither the application rate nor the acceptance rate for medical school from certain URiM groups have changed significantly since the 1970s [2]. He also suggested that URiM students may struggle to find role models and mentors to help navigate medical school, as relatively few medical school faculty are from URiM backgrounds [2]. Dr. Thesen proposed that schools must consider socioeconomic, educational, and psychosocial realities and barriers when creating pipeline programs to support URiM students on their path to STEM careers.

Next, Dr. Manuel presented an example of a successful pathway program beginning at the high school level: the NSF-funded STEM Research Inquiry Summer Enrichment (STEM-RISE) program at the University of Houston. The STEM-RISE program is a community-based partnership arising from an interdepartmental collaboration among the College of Natural Sciences and Mathematics, the Tilman J. Fertitta Family College of Medicine, and the Jack Yates High School, a high-needs public high school in the historic neighborhood of Third Ward in Houston. STEM-RISE is a 6-week summer program with 3 participant groups: medical students, undergraduate STEM majors, and high school students. Drs. Ekeoba and Manuel shared a video testimonial from a first-generation URiM medical student program participant. They described the end-of-program Research Symposium, where high school student participants present their research projects and career goals. Dr. Lam outlined the Health Professions Mentorship Program (HPMP) at the Sophie Davis Biomedical Education Program CUNY School of Medicine, an 18-month pipeline program designed for rising high school juniors and seniors. This program includes multi-tiered mentoring and culminates in a final poster presentation of a research project, followed by continued mentorship to prepare for college. After discussing program funding and the financial support for participants, Dr. Lam presented program outcomes, including testimonials from HPMP graduates. Drs. Thesen and Manuel concluded by sharing lessons learned with audience members considering developing pathway programs at their institutions, including possible funding streams. Factors vital to building a supportive community for URiM students are nurturing environments that focus on strengths and opportunities rather than on deficit mitigation, near-peer mentorship, team-building exercises, and icebreakers between participants and community members.

Lessons Learned in Developing Accelerated 3-Year M.D. Programs

Presenters: Joan Cangiarella of the New York University Grossman School of Medicine, New York City, NY, USA; Catherine Coe of the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gladys Ayala of the New York University Long Island School of Medicine, Mineola, NY, USA.

In the second session of the series, three experts from the Consortium of Accelerated Medical Pathway Programs (CAMPP) presented their institutions’ accelerated medical pathway programs which allow students to earn their M.D. degree in less than 4 years. According to Dr. Cangriella, these programs usually retain the MS1 and MS2 curriculum (including the intervening summer) and compress MS3 and MS4 clerkships into 1 year. Most of these accelerated programs include a directed pathway to affiliated residency programs. The primary mission of 3-year accelerated programs is debt reduction, alleviating some of the financial burden that students may experience, along with other potential objectives such as serving underserved communities or increasing the likelihood of graduates choosing a primary care residency. Initiated from a Josiah Macy Jr. Foundation grant in 2014, the CAMPP includes its original seven programs: New York University (NYU), University of California, Davis, Pennsylvania State University, University of Louisville, Medical College of Wisconsin, Mercer University, and McMaster University, with new programs joining every year. A core goal of this group is to identify and disseminate best practices in accelerated pathway programs.

Dr. Cangiarella next described the NYU Grossman accelerated 3-year M.D. pathway. The program aims to provide individualized choice, reduce debt, and improve the continuum between Undergraduate Medical Education (UME) and Graduate Medical Education (GME). Dr. Coe then discussed the Fully Integrated Readiness for Service Training (FIRST) program at the University of North Carolina, which aims to reduce barriers to medical school and increase the physician workforce in the state through an accelerated and enhanced 3-year curriculum. Dr. Ayala discussed the 3-year medical school program at the NYU Long Island School of Medicine, which trains physicians committed to primary care and high-need disciplines. Dr. Coe listed additional benefits of accelerated 3-year M.D. pathways for students as accelerating and individualizing entry into the students’ desired specialties, adding value for students with advanced degrees and career interests, and providing intensive mentorship. Dr. Coe described the consortium and its outcomes, sharing the many benefits, resources, and data published by the CAMPP, including a roadmap for creating an accelerated 3-year program [3]. The webinar concluded with an invitation to join CAMPP for collaboration, networking, and sharing of best practices [4].

Fostering Community Through Rural Pipelines and Pathways

Presenters: Natasha Bray of the Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA; Machelle Linsenmeyer of the West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA.

Drs. Bray and Linsenmeyer presented the third webinar of the series, discussing pathway programs implemented by their institutions to address the health challenges experienced in rural, underserved, and tribal communities. Dr. Bray began by describing the pathway program developed by the Oklahoma State University (OSU) and the OSU College of Osteopathic Medicine (COM) at the Cherokee Nation (OSU-COMCN). OSU-COMCN is the first COM with a tribal affiliation and focuses on providing care for Oklahoma's tribal communities. OSU-COMCN's program goal is to recruit rural students to medical school, educate them in rural environments, and place graduates in rural-based residency programs. Using this approach, the program intends to train physicians more likely to practice medicine in rural communities. Dr. Bray then discussed several recruitment programs focusing on elementary and high school students. Students recruited from rural communities are supported by OSU throughout their college education and are paired with mentors to help navigate the process of medical school application and matriculation. OSU also offers programs to support specific populations, such as Native American students and other URiM students. OSU-COM’s Tribal and Rural Medical training tracks for 3rd and 4th year rotations, providing clinical, research, and leadership experiences in rural or tribal settings. For the Tribal Medical track, OSU conducts 85% of core rotations in tribally operated health centers. For the Rural Medical track, OSU schedules core rotations in critical access and community-based hospitals. Dr. Linsenmeyer next presented the pathway programs developed by the West Virginia School of Osteopathic Medicine (WVSOM). These programs address specific health challenges faced by West Virginia’s rural populations by bolstering the primary care physician pipelines, beginning in local communities and high schools. Part of WVSOM’s success is due to tailored pathway programs that target multiple levels of education in local communities, including high school and college students, medical residents, community members, and first responders. Dr. Linsenmeyer described the different programs allowing WVSOM to reach out to the community and increase awareness of the health professions in grade and middle school students.

Academic Readiness for the Pre-Clerkship Curriculum: a Closer Look at the Metrics in Pathway Students

Presenter: Stephen Schneid of the University of California, San Diego School of Medicine and the Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA.

Mr. Schneid discussed academic readiness in the preclinical medical curriculum for students with a gap between college and the beginning of medical school. He noted that some students with this gap need additional preparation to help them gain entry to medical school, including pre-matriculation courses or completing a postbaccalaureate premedical (PBPM) program. Success in PBPM programs can result in students earning higher grade point averages (GPAs) and Medical College Admission Test (MCAT) scores, which are associated with a higher acceptance rate to medical school [5]. He then contrasted two types of PBPM programs: academic record-enhancer programs (ARE) and career changer (CC) programs, although some programs contain elements of both. ARE programs make up ~ 39% of PBPM programs and are more likely to have formal curricula because they target students seeking to enhance their GPA and MCAT scores, whereas CC programs comprise ~ 27% of PBPM programs and are more likely to have individualized curricula because they target students who still need to complete premedical coursework [6]. PBPMs may also constitute a significant pathway into medicine for URiM students [7]. Mr. Schneid reported that graduates from one diversity-based mission PBPM program were more likely to practice medicine as primary care physicians in medically underserved areas/populations, underscoring the critical impact of these programs [8].

The University of California, San Diego (UCSD) created a 1-year ARE PBPM Program in 2012, which consists of foundational science courses and provides resources such as workshops, MCAT preparation, faculty advisors, PBPM program student liaisons, and program committee letters of recommendation for medical school applications [9]. Additionally, students from the UCSD PBPM program were more likely to be URiM or graduates with social science majors. Importantly, the UCSD School of Medicine students who completed PBPM programs had strong academic performances in those programs. Mr. Schneid concluded that PBPM GPA can provide important information about a student’s academic readiness as it is a more recent snapshot than cumulative GPAs, suggesting that health professions programs should look more closely at applicants from PBPM programs.

Progress and Challenges of Pathway Programs

Presenter: Leila Amiri of the University of Vermont Larner College of Medicine, Burlington, VT, USA.

Dr. Amiri presented the final session of this Webinar series and discussed the role of admissions processes in pathway programs designed to address inequities in the medical education admission process. She noted that data from the AAMC’s 2022 Matriculating Student Questionnaire showed that 24.4% of respondents decided to apply to medical school before high school, with an additional 33.9% making this decision during high school [6]. However, only 28.8% of matriculating students decided to apply to medical school during or after completing their baccalaureate degree. Dr. Amiri contrasted these data with the current distribution of recruitment efforts and resources: most resources focus on recruiting students in community colleges, universities, and postbaccalaureate or master’s degree programs, with relatively few concentrating on high school or K-12 students. She suggested that, based on these data, schools should give more attention to early recruitment of K-12 students, possibly with more training for K-12 teachers to help increase interest in medicine and science knowledge.

Dr. Amiri stressed that while it is essential to ensure that individuals targeted for admission fit the medical school's mission, schools should also consider their missions in a broader (national) context and carefully consider those individuals who do not make it into the first part of the pipeline, i.e., the larger pre-college applicant pool. Dr. Amiri suggested using a more fluid approach to selecting applicants for pathway programs, stressing the importance of flexibility in the applicants’ recruitment location or specialty of interest parameters. Additionally, she highlighted that schools should be aware of the potential impact of “tracking,” which refers to the expectations placed on students from target populations during admissions and recruitment to return to a specific region or practice area. Dr. Amiri speculated that tracking might unintentionally burden or limit accepted students’ potential and cause schools to overlook otherwise qualified individuals. Thus, schools should be intentional to avoid these pitfalls when implementing this practice. Finally, as many programs are initiated because of grant support or receive discrete, time-limited funding from the school, continued and dedicated budget support for these programs is crucial to providing the resources and staffing necessary for sustained support and training of individuals in the pathway. Dr. Amiri concluded with a plea for consortium-level data collection on pathway programs to enable the needed long-term and reliable funding and organizational support at the local and national levels.

Author Contribution

Andrea N. Belovich and Tracey A.H. Taylor wrote the manuscript, and all authors contributed to the editing of the manuscript. All authors contributed to the design, planning, and execution of the series.

Declarations

Ethical Approval

Not applicable.

Informed Consent

Not applicable.

Conflict of Interest

The authors declare no competing interests.