Cardiac camp: An outreach program to build health literacy among underrepresented in medicine adolescents and increase diversity in medicine

Abstract

BACKGROUND:

Eliminating racial and ethnic disparities in cardiovascular disease (CVD) requires multilevel action, including improving health literacy and diversifying the healthcare workforce. To contribute to this goal, UCSF medical students designed an immersive summer camp to teach underrepresented minority backgrounds in medical professions (URM) high school students about CVD and encourage interest in healthcare careers.

MATERIALS AND METHODS:

A stipend-supported, 1-week cardiology summer camp for URM Bay Area high school students was implemented by medical students. Participating students completed a preprogram and postprogram survey to assess various metrics, including knowledge of CVD, comfort discussing and teaching concepts of CVD, and interest in medical careers on a Likert scale of 1–5. The mean differences in preprogram and postprogram scores in the second cohort in 2024 (n = 25) were assessed.

RESULTS:

Twenty-five students participated in the second iteration of Cardiac Camp @ UCSF (80% female) from July 24 to 28, 2024. Most identified as URM (84%), and many came from households where English was not the primary language (76%). Postcamp surveys showed increased mean scores in CVD knowledge and awareness of medical careers. Open-ended responses indicated that students enjoyed the camp activities and felt more motivated to pursue healthcare careers.

CONCLUSIONS:

Cardiac Camp @ UCSF provides a novel framework for a pipeline program aimed at inspiring URM high school students to pursue careers in medicine. Short-term survey results showed increased CVD knowledge and confidence teaching others, aligning with Healthy People 2030 goals to reduce cardiovascular disparities and strengthen workforce diversity.

Introduction

Cardiovascular disease (CVD) remains the leading cause of death globally, disproportionately affecting Black patients who experience a higher burden of risk factors such as hypertension and obesity.[1,2,3] While this issue is multifaceted, an impactful strategy to deliver equitable healthcare is the recruitment of diverse healthcare providers versed in cultural humility.[2] Yet, despite efforts to generate pipeline programs to science, technology, engineering, and mathematics careers for students from underrepresented minority backgrounds in medical professions (URM), the underrepresentation of minority groups persists.[4] For example, although 31% of the population in the US identifies as belonging to a URM group, only 15% of medical students identify as belonging to URM groups.[1]

To address this issue, researchers have proposed education outreach programs designed for students from URM backgrounds to encourage an interest in medical professions.[5,6] The goals of these programs are to increase recruitment into healthcare and increase health literacy in areas such as healthy eating or physical activity. For adolescents from URM backgrounds, building health literacy aims to improve health behaviors early on and empower them to share knowledge within their communities.[7,8]

Cardiac Camp @ UCSF aims to introduce URM students in the Bay Area to the physiology, pathology and treatment of the cardiovascular system with the broader goal of addressing racial disparities in cardiovascular health through increased health literacy and workforce diversity. To ensure equitable access and minimize financial barriers, Cardiac Camp @ UCSF is offered at no cost to participants, and students receive a stipend upon completing the program. The program uses a multimodal curriculum developed using Experiential Learning Theory as a framework to scaffold the camp’s activities. In addition, the program cultivates mentorship between participants, undergraduates, medical students, and physicians who serve as mentors and teachers. While similar programs exist, such as Brain Camp and Doctors of Tomorrow, our program fills a unique niche by focusing on CVD, which disproportionately affects participants’ communities.[5,6]

The aim of this study was to evaluate the extent to which Cardiac Camp @ UCSF achieved its core objectives: (1) increasing health literacy among URM high school students, and (2) fostering interest in careers in health and science. To assess the program’s effectiveness, a mixed-methods evaluation grounded in Self-Efficacy Theory was used, incorporating both quantitative presurvey and postsurveys and qualitative narrative feedback. This combination allows for a comprehensive understanding of changes in knowledge, attitudes, and perceptions among participants following completion of the camp. The findings from this study aim to inform the ongoing development of Cardiac Camp @ UCSF and contribute to broader efforts to design effective, equity-focused health education interventions.

Materials and Methods

Study design and setting

Cardiac Camp @ UCSF is a 5-day, tuition-free summer program for high school students interested in cardiovascular health and medicine. Participants receive a stipend of $600 to offset potential financial barriers. The camp began with 10 students in its inaugural year and expanded to 25 students in its second year. The small scale of the camp allows for personalized interaction across the medical education pipeline through the involvement of undergraduate counselors, medical students, and physician instructors. The camp was funded by donations from UCSF academic departments and diversity, outreach, and education initiatives, and developed with long-term sustainability in mind.

The Cardiac Camp @ UCSF curriculum was developed over eight months by a Curriculum Development Committee of UCSF medical students, UC Berkeley undergraduates, and three curriculum directors. The committee met weekly to design an accessible, engaging cardiovascular health curriculum grounded in Experiential Learning Theory, incorporating (1) concrete experiences through skills workshops, (2) reflective observation through discussions with mentors (3) abstract conceptualization through core lectures and small groups, and (4) active experimentation through interactive, integrative activities [Figure 1]. The curriculum was iteratively reviewed for high school–appropriate pedagogy and progressed from foundational cardiac anatomy and physiology to advanced topics such as heart failure and coronary artery disease. Each day’s lessons and activities had a central, cohesive theme [Table 1]. This theory-based, thematic approach resulted in a multimodal curriculum built to enhance comprehension and retention for a variety of learning styles while promoting long-term health literacy.

Figure 1.

Cardiac Camp’s multimodal curriculum developed using experiential learning theory as a scaffold and evaluated through self-efficacy theory

Table 1.

Cardiac Camp@ UCSF 2024 activities

		Day 1		Day 2		Day 3		Day 4		Day 5
Core theme		Anatomy and physiology		Valvular heart disease		Arrhythmias and heart failure		Coronary artery disease		Surgery and interventions
Activity highlights		Anatomy lab		Doctoring skills session		Medicine career talk		Social determinants of CVD discussion		Surgical skills workshop
		POCUS practice		EKG reading		CPR session		DASH diet cooking workshop		Hospital simulation

Our evaluation was based on a modified Self-Efficacy Theory.[9,10] This theory describes how five sources of self-efficacy contribute to efficacy judgements and, ultimately, the desired performance: (1) performance accomplishments (i.e. past experience), (2) vicarious experience (i.e. modeling by others), (3) social persuasion (i.e. coaching and evaluative feedback), (4) physiological and emotional states, and (5) imagined experience (i.e. hypothetical experience).[11] Each source of self-efficacy has a thematic relation to each of the four curricular domains we developed and described above [Figure 1]. Ultimately, using Self-Efficacy Theory provides insight into the camp’s central goals: helping high school students feel more confident in discussing CVD, informing their community and seeing themselves as capable of pursuing a career in medicine.

Study participants and sampling

Students who had completed 9^th or 10^th grade were eligible to apply for Cardiac Camp. The UCSF Office of Opportunity and Outreach definition of URM was used to identify student populations in the Bay Area for outreach and recruitment for Cardiac Camp @ UCSF.[12] To apply for the program, students completed an application which included questions on (1) demographic information (e.g. race/ethnicity, family income, education, primary language spoken at home), (2) relevant high school science courses completed, and (3) responses to short personal statement questions. These prompts were designed to encourage applicants to share their personal stories beyond demographic indicators as well as their interest in the health sciences. After initial screening, an admissions committee conducted a more in-depth evaluation of selected applicants, focusing on their motivation, enthusiasm, and long-term potential to benefit from the camp’s programming and mentorship opportunities.

Data collection tool and technique

Data were collected using precamp and postcamp surveys administered via Qualtrics (Qualtrics, Provo, UT). At the preprogram orientation, students completed a voluntary, anonymous precamp survey assessing demographic information, primary motivations for participating in Cardiac Camp, and self-reported, numeric (1 to 5) sliding scale questions assessing three key domains related to the Self-Efficacy Theory and established program goals: (1) confidence around discussing CVD (2) knowledge of the path to a medical career, and (3) interest in pursuing a medical career. On the final day of the camp, students completed a postcamp survey assessing the four key domains with the same Likert sliding scale. The postcamp survey also included open-ended questions that invited students to reflect on their experiences in the program. Responses were thematically grouped into categories to reflect sources of self-efficacy, such as program highlights (e.g. mastery experiences from specific hands-on activities), peer and mentor interactions (vicarious learning and social persuasion), and personal goals and motivations (emotional engagement and imagined experience through belief in one’s future in medicine).

Ethical consideration

IRB ‘Not Human Subjects Research’ determination for this study was obtained through the UCSF IRB Review Committee. Prior to completing the surveys, each student was informed of the purpose of this survey and that they may or may not consent to proceed further in answering questions. Legal consent from parents or guardians for survey participation was obtained as well. Survey participation was entirely optional and voluntary, and there were no consequences for not completing the survey. Survey results were confidential and de-identified before further analysis to avoid any potential harm.

Statistical analysis method

Quantitative analyses were limited to the camp’s second cohort (2024) due to the small sample size of the inaugural year. Self-reported demographic variables including gender, race/ethnicity, high school grade, primary language spoken at home, and parental education levels were collected during the application process. To analyze the precamp and postcamp survey, a mean score was calculated for each of the six subjective self-rated questions at both the precamp and postcamp time points. A subsequent mean score difference (defined as the mean postcamp score minus the mean precamp score) was calculated for each of the six questions. All data analysis and figure creation were performed in Microsoft Excel for Mac. The qualitative data was reported from the inaugural camp in 2023.

Results

Demographic data

In its second year, Cardiac Camp received 107 applications from Bay Area high school students. Among these students, 65% identified as URM, per the UCSF definition.[12] From the applicant pool, a cohort of 25 students was selected to participate in the program. Table 2 summarizes the demographic information of participants. For self-identified gender, a majority of participating students identified as female (80%). For self-identified race/ethnicity, 84% of the selected participants identified with a racial/ethnic background that is underrepresented in medicine.[12] In addition, 80% of participants came from a household where English was not the primary spoken language, and 64% of students reported that the highest level of parental education attained was a high school diploma or less.

Table 2.

Cardiac Camp@ UCSF cohort demographics 2024

		n=25a
Gender (%)
Female		80
Male		16
Nonbinary		4
Race/ethnicity (%)b
Hispanic or Latino		52
Black/African		16
Asian		28
American Indian or Alaska Native		0
Native Hawaiian or Other Pacific Islander		0
White		4
High school grade (%)
9th grade		48
10th grade		52
Primary home language (%)
English		24
Spanish		16
Other/multiple		60
Highest parental education level (%)
Unknown		8
Less than high school		38
High school		18
Some college		14
Bachelor’s or higher degree		22

^aAll values displayed as percentage of total participants, ^bTotal exceeds 100 as participants endorsed multiple categories

Camp survey quantitative findings

Table 3 presents the mean precamp and postcamp survey scores for the 2024 cohort of Cardiac Camp. Responses were self-rated on a scale of 1 to 5, with 5 being very likely and 1 being not likely at all. The mean postcamp survey scores were greater than mean precamp survey scores across all self-rated domains, with the greatest increase in mean score seen in the question assessing student comfort discussing CVD (mean difference: 1.82 increase in score). The smallest increase in mean score was seen in the question assessing student interest in medical careers (mean difference: 0.12 score increase).

Table 3.

Precamp and Postcamp quantitative survey scores of 2024 cohort

Survey domain		Precamp (n=21)		Postcamp (n=26)
Comfort discussing
Cardiac function		2.71±0.85		4.35±0.80
Cardiac medications		3.00±0.97		4.19±0.80
Cardiovascular disease		2.33±1.24		4.15±0.61
Career knowledge
Physician career		3.50±1.05		4.23±0.91
Medical career		3.33±1.06		4.23±0.76
Career interest
Medical career		4.57±0.60		4.69±0.69

Values presented as mean±standard deviation. Responses could range from 1 to 5, with 5 being very likely and 1 being not likely at all

Camp survey qualitative findings

In addition to the quantitative questions, the postprogram survey also asked students to provide a subjective evaluation of their camp experience. Students most enjoyed viewing heart specimens in the anatomy laboratory (70%). The surgical skills workshop and cardiac-focused Escape Room were also highlights of the program. One student wrote that they enjoyed the group activities because they were “both educational and helped in socializing.” Learning about CVD also cemented their interest in medicine, as one student wrote: “I was able to learn so much about the heart which helped me find even more interest in medicine.” For some participants, Cardiac Camp @ UCSF created excitement about the journey to building a career in medicine. One student wrote, “Not only was I involved, but I really became passionate (this) past week for medicine and cannot wait to pursue it in the future.” Notably, 60% of students entered the camp with goals related to learning more about cardiology, and they each expressed satisfaction in having met these goals by the end of the program.

Discussion

The design and implementation of Cardiac Camp @ UCSF reflect a novel approach to prehealth education, characterized by its focused recruitment, cardiology-focused multimodal curriculum, and diverse faculty at no cost to participants. Recruitment efforts proved effective, with demographic data indicating that 84% of camp participants identified with a racial or ethnic background underrepresented in medicine. Quantitative survey data collected both before and after the camp showed positive increases across all five self-assessed domains. The greatest improvement was observed in the domain of CVD knowledge. While interest in medical careers showed the smallest increase, likely reflecting students’ already high enthusiasm for pursuing a career in healthcare prior to the camp. Students reported increased comfort in discussing and teaching CVD, an important outcome given that many participants come from communities disproportionately affected by CVD. Results suggest successful application of Self-Efficacy Theory, consistent with literature showing that students with high self-efficacy are more likely to succeed academically and pursue healthcare careers, an especially important factor for URM students.[13]

In addition, postcamp survey results highlighted the impact of interactive sessions such as the anatomy laboratory and cardiology-focused Escape Room in deepening interest and engagement. Other studies have similarly found success in small group learning sessions focused on problem-based approaches like the small group sessions and the discussion-based anatomy laboratory sessions that encouraged learners to ask questions and develop their critical thinking skills through knowledge integration.[14] In addition, using escape room games in medical education, as our camp did, has been shown to promote teamwork, collaboration and improve a student’s problem solving skills.[15] Students also valued mentorship, peer connection, and the supportive learning environment.

This study contributes to the growing literature on pipeline and community-based health education programs by providing a mixed-methods evaluation of a scalable and replicable student-led initiative. The camp structure aligns well with evidence-based best practices for physician pipeline programs, in allowing for early exposure to careers in medicine and encouraging near peer mentorship by relying on medical students to help deliver the camp curriculum.[16] The findings suggest that short, well-structured, and creatively designed summer programs can meaningfully enhance health literacy, build confidence, and foster a sense of belonging in medicine among URM high school students. Cardiac Camp @ UCSF serves as a promising model for institutions seeking to both promote diversity in medicine and address community-level gaps in health education, particularly in areas marked by persistent health disparities such as CVD.

Strengths and limitations

A key strength of Cardiac Camp @ UCSF is its small cohort size, which allows for a high-quality, personalized experience for each participant. The program also incorporated both quantitative and qualitative assessments, providing insight into students’ knowledge gains, engagement, and perceptions of the inaugural program.

The primary limitation of this analysis is the small sample size of 25 students in the 2024 cohort, and the qualitative analysis was limited to the first cohort of 10 students in 2023. Camp surveys were voluntary and administered at two time points, so not all respondents completed both surveys, limiting the potential for paired comparisons and formal significance testing. This limitation could be mitigated by the integration of anonymous matching codes in future iterations or comparison of the group of students who did not participate in the camp. In addition, future program assessments could be strengthened by including validated instruments or scales for assessing the efficacy of a curriculum. In addition, there has not yet been longitudinal follow-up to assess the long-term impacts of program participation, such as continued interest in medicine, sustained health knowledge, or eventual matriculation into health professional programs. Finally, we recognize the potential challenges of replicating Cardiac Camp elsewhere, including funding, resources, and sustainability limitations.

Future directions

Given our aim to increase the diversity of the healthcare workforce through the development of a pipeline program, we will maintain ongoing contact with camp participants through the Cardiac Camp Mentorship Program. This longitudinal follow-up will provide insights into how the camp influences student trajectories over time, particularly with regard to their interest in higher education and the medical field.

Beyond the first and second cohort of program participants, the continued success of Cardiac Camp @ UCSF relies on the sustainability and scalability of the program. Despite the small cohort size, the success of Cardiac Camp @ UCSF strongly supports the continued development and expansion of further iterations of the program to accommodate more camp participants.

The success of the inaugural Cardiac Camp was made possible through a robust partnership with various UCSF departments. Maintaining and strengthening these institutional relationships will be essential for future iterations.

We also aim to partner with and expand the reach of Cardiac Camp with medical students and faculty at other University of California (UC) campuses, including UC Los Angeles David Geffen School of Medicine and UC San Diego School of Medicine. These campuses share a similar commitment to community outreach and health equity. Expanding to UC campuses aligns with evidence that medical students in community-based education enhance health promotion and local awareness of disease.[17] By creating a replicable framework and implementation protocol, we hope to support institutions in launching their own versions of Cardiac Camp dedicated to the mission of providing early, equitable health education to students from communities that are disproportionately impacted by CVD and are historically underrepresented in medicine.

Conclusion

Cardiac Camp @ UCSF is a stipend-supported summer pipeline experience for Bay Area high school students from URM backgrounds in medicine. It was designed to foster an interest in medicine and CVD in these students as well as improve the diversity of the medical field in the long term. Results from the first two cohorts suggest that Cardiac Camp @ UCSF successfully provided health education to high school students and introduced them to the field of medicine. The improvement in knowledge of CVD and increased interest in healthcare professions align with the Healthy People 2030 goals on health literacy, prevention, and workforce diversity as key strategies for reducing long-term cardiovascular inequities.[18]

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Abbreviations

CVD: Cardiovascular disease; URM: Underrepresented minority backgrounds in medical professions; UCSF: University of California San Francisco; UC: University of California; POCUS: Point-of-Care Ultrasound; EKG: Electrocardiogram; CPR: Cardiopulmonary resuscitation; DASH: Dietary Approaches to Stop Hypertension; IRB: Institutional Review Board.

Ethical approval

An IRB determination of “Not Human Subjects Research” for this study was obtained from the UCSF IRB Review Committee.

Author’s contributions

NM devised the program, and all authors participated in its execution and in data collection. LP conducted the quantitative analysis, while JA led the qualitative analysis. All authors discussed the results, provided critical feedback, and contributed to the final manuscript.

Data availability statement

The data used for the program are available from the corresponding author on reasonable request.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Cardiac Camp received financial support from the Center for Science Education and Outreach at UCSF, UCSF Health Division of Cardiology, the UCSF Medical Scientist Training Program, and the School of Medicine Office of Medical Education.