Table 4.
Characteristics and results of studies evaluating the effectiveness of interventions dedicated to improving medical students attitudes toward (MS-ATU) or intention to work with the underserved (MS-IWU)
| Source | Medical school | Educational program or selection strategies | Duration | Outcome | Results | Qualitya |
|---|---|---|---|---|---|---|
| Global curriculum | ||||||
| Campos-Outcalt et al. 1997 [36] | University of Arizona |
“Commitment to Underserved People” Program • Visits to agencies providing services to the underserved (Y1) • Volunteer projects and community health externship (Y1–2) • Assistance in selecting site for Y3 clerkships • Primary-care preceptorships among underserved populations (Y4) • Discussions and annual retreat for faculty and students (Y1–4) |
4y | Practice in underserved area | Improved** | 11.5 |
| Ko et al. 2005 [20] | University of California, Charles R. Drew University |
UCLA/Drew Medical Education Program • Clinical placement in underserved areas • Longitudinal primary care rotation • Research project in an underserved area • Didactics on minority and multicultural health • Health disparities thesis |
4y | MS-IWU | Improved** | 9.5 |
| Cox et al. 2006 [46] | University of Wisconsin School of Medicine |
“Caring for the Underserved” Curriculum • Faculty-led and web-based curriculum for third-year medical students during the pediatric clerkship • Case-based videos & interactive problem-based learning • Development of a screening tool for recognizing underserved patients (“I CARE”) • Independent clinical project on the situation of an underserved family met during a clinic visit |
6w | MS-ATU | Improved* | 10.5 |
| Godkin et al. 2006 [47] | University of Massachusetts Medical School |
“Longitudinal Pathway on Serving Multicultural and Underserved Populations” • Family curriculum (Y1): visits to an underserved family • Longitudinal 2-year preceptorship (Y1–2): placement at a site serving underserved populations • Summer immersion: 6-week immersion in a developing country (at the end of Y1) • Domestic community service project family medicine clerkship (Y3): serving in or organizing a community service project for the underserved • Electives (Y3–4): placement in a community or rural health center and/or in a developing country • Seminar series |
4y | MS-ATU | Unchangedb | 11.5 |
| Buchanan et al. 2007 [48] | Rush University, Chicago |
Primary care internal residency program • Series of 8 lectures on homeless’ conditions • Journaling, discussions with homeless individuals • Tours of community programs serving homeless people • Intensive clinic sessions in homeless shelters and visits to service providers |
2w | MS-ATU | Improved*** | 11.5 |
| Ko et al. 2007 [50] | University of California, Charles R. Drew University |
UCLA/Drew Medical Education Program • Clinical placement in underserved areas • Longitudinal primary care rotation • Research project in an underserved area • Didactics on minority and multicultural health • Health disparities thesis |
2y | Practice in underserved area | Improved* | 12.5 |
| Crandall et al. 2007 [51] | Wake Forrest University School of Medicine | • Preclinical problem-based learning curriculum | 4y | MS-ATU | Unchangedb | 11.5 |
| Huang & Malinow, 2010 [53] | Baylor College of Medicine |
“Longitudinal Ambulatory Care Experience Underserved Pathway” • Half-day seminar/journal clubs on underserved care topics • Clinical preceptorship: visits to a preceptor practicing in an underserved area • Community visits: group visits to organizations caring for the underserved • Year-long group project: development of a community-based intervention for the underserved • Health care funding assignment: assistance to a patient applying for health care funding |
1y | MS-ATU | Improved* | 7 |
| Cox et al. 2015 [60] | University of Wisconsin School of Medicine |
“Caring for the Underserved” Curriculum • Faculty-led and web-based curriculum for third-year medical students during the pediatric clerkship • Case-based videos & interactive problem-based learning • Development of a screening tool for recognizing underserved patients (“I CARE”) • Independent clinical project on the situation of an underserved family met during a clinic visit |
6w | MS-ATU | Unchangedc | 10 |
| Girotti et al. 2015 [61] | University of Illinois College of Medicine |
“Urban Medicine Program” • Seminar series (Y1–2): didactic learning followed by breakout sessions • Web-based learning curriculum (Y3–4): three modules covering cultural competency, leadership and communication skills • Longitudinal community project (Y3–4): team-based collaborative engagement with community agencies in underserved areas • Policy and advocacy forum (Y4): two-weeks didactic presentations and discussions |
4y | MS-ATU | Improved* | 15 |
| Larkins et al. 2018 [21] |
James Cook University, Townsville (AU) Ghent University (BE) Walter Sisulu University (ZA) Gezira University (SD) Ateneo de Zamboanga School of Medicine (PH) Northern Ontario School of Medicine (CA) Flinders University School of Medicine (AU) University of the Philippines School of Health Sciences (PH) |
Training for Health Equity Network (THEnet) • Medical schools with a social accountability mandate • Didactics on social determinant of health and health needs of underserved people • Clinical placements in underserved areas |
– | MS-IWU | Unchangedb | 10 |
| Kost et al. 2018 [72] | University of Washington School of Medicine |
The Underserved Pathway Program • Online curriculum, • Preclinical underserved preceptorship • Electives on underserved topics • Mentorship with a physician with experience caring for underservedpopulations, • Service learning, • Scholarly project with an underserved focus, • Clinical clerkships at underserve sites |
4y | MS-IWU | Improved* | 11 |
| Jacobs et al. 2019 [77] | Saint Louis University |
The Longitudinal Underserved Community Curriculum (LUCC) • 12 monthly day-long community health workshops • Monthly community-focused 1-h seminars • Practice in a diverse urban federally qualified health center |
3y | MS-ATU | Improvedb | 10 |
| Experiential learning | ||||||
| O’Toole et al. 1999 [37] | University of Pittsburgh |
“Program for Health Care to Underserved Population” • Service-learning program at a health care clinic for homeless including patient admission, physical examination, health education talks, treatment |
4y | MS-IWU | Improved*** | 8.5 |
| Godkin et al. 2003 [41] | University of Massachusetts Medical School | • International electives | 4-8w | MS-ATU | Improved*** | 8.5 |
| Briggs et al. 2018 [70] | Geisel School of Medicine at Dartmouth |
“Beyond the Book” Program • Classroom didactics (lectures, panelist and journal article discussions, workshops) • Community-based learning: partnership with underserved individuals, meetings in nonprofit organizations serving the underserved |
8 m | MS-ATU | Improved*** | 11 |
| Volunteering in SRFC | ||||||
| Sheu et al. 2012 [55] | School of Medicine, University of California |
• Classroom didactics • Volunteering in free clinics: performing histories and physicals, providing patient education |
1y | MS-ATU | Unchangedb | 10.5 |
| Smith et al. 2014 [58] | University of California San Diego |
Student-run Free Clinic Project • Half-day clinical sessions • Two-hours didactic sessions • Structured oral and written reflection activities • Clinical sessions including managing all functions of the clinic |
– | MS-ATU | Improved*** | 7.5 |
| Tran et al. 2017 [69] | University of Central Florida College of Medicine | • Volunteering at the KNIGHTS (Keeping Neighbors In Good Health Through Service) Clinic | – | MS-ATU and MS-IWU | Unchangedb | 7.5 |
| Heller et al. 2019 [76] | University of Cape Town School of Medicine | • Volunteering at the SHAWCO (Students’ Health and Welfare Centers Organisation) | – | MS-IWU | Unchangedb | 11.5 |
| Traditional learning | ||||||
| Maisiak et al. 1980 [31] | University of Alabama in Birmingham | • Lectures on social determinants of health | 10w | MS-ATU | Unchangedb | 12 |
| Markham et al. 2001 [39] | Jefferson Medical College, Thomas Jefferson University | • Seminar series (Y3): one-hour sessions of articles discussions about health care environment | 4 h | MS-ATU | Improvedb | 7.5 |
| Leung et al. 2016 [65] | Warren Alpert Medical School of Brown Uni-versity | • Seminars on topics related to the health of underserved population and collaboration on a presentation or workshop | 1y | MS-ATU | Unchangedb | 8 |
| Online curriculum | ||||||
| Godfrey et al. 2019 [75] | Columbia Vagelos of Physicians and Surgeon | • Six modules incorporating mobile-optimized media content: health systems, social determinants of health, race and health, injury and violence, substance use and harm reduction, alternative health systems and current health policy | 5w | MS-IWU | Improvedc | 8.5 |
| Selection strategies | 11.0 | |||||
| Larkins et al. 2015 [62] |
James Cook University, Townsville (AU) Ghent University (BE) Walter Sisulu University (ZA) Gezira University (SD) Ateneo de Zamboanga School of Medicine (PH) |
• Selection on academic merit (AU, BE, ZA, SD, PH) • Interview by panel including members from underserved communities (AU, PH, ZA) • Quota system for students from underserved communities (AU, PH, SD, ZA) • Marketing strategy to attract socially minded students (BE) |
– | MS-IWU | Unchangedc | 10 |
| Wooley et al. 2018 [73] |
University of the Philippines School of Health Sciences (PH) Ateneo de Zamboanga School of Medicine (PH) |
• Selection on academic merit • Interview • Quota-system for students from underserved communities |
4y | Practice in underserved area | Improved*** | 12 |
a Measured using the Medical Education Research Study Quality Instrument (MERSQI)24: MERSQUI score range from 5 to 18
* p < 0.05
** p < 0.001
*** p < 0.001
b Not significant
c No measure of significance
Abbreviations: MS-ATU Medical students attitudes toward the underserved; MS-IWU Medical students intention to work with the underserved; SRFC Student-run free clinic; AU Australia, BE Belgium; CA Canada; PH Philippines; SU Sudan; ZA = South Africa