Project MED (Medicine, Exposure, and Development): Promoting Access to Healthcare Education for Historically Underrepresented Groups Through Community Engagement, Sustainability, and Technology

Abstract

In the U.S., disparities in the healthcare workforce have led to inadequate health outcomes in communities of historically underserved groups (HUGs). To address the lack of resources and opportunities in health career education for HUG students, Project MED was established. The mission is to expose high school students to the breadth of opportunities in the healthcare field and to prepare students for successful careers in healthcare. Through three main pillars—Learn, Lead, and Launch—Project MED has developed a robust repository of 20 workshops, recruited and trained eight mentors, and curated a database of ≥100 opportunities for over 50 students.

Introduction

Education is an essential social determinant of health and invaluable in resolving many health disparities. The advancement of education propagates a positive feedback loop that motivates literacy, health knowledge, and problem-solving skills—all of which help to increase employment opportunities, enhance socioeconomic standing, and improve health outcomes.¹ Yet, in communities of historically underrepresented groups (HUGs)—those who identify as Black/African American, Hispanic/Latino(a), or Native American/Alaskan Native—the educational pathway is often inhibited by systemic discrimination, institutionalized biases, and other societal burdens.² Given the foundational importance of education, it is evident that bridging educational inequities can alleviate disparities in quality of life measures, such as health outcomes.

Likewise, increasing diversity in the healthcare workforce can immensely improve patient outcomes and the well-being of corresponding patient communities. For example, the American Economic Association found that when Black men were paired with doctors of the same race, the increase in patient trust was correlated with a reduction in the Black-white cardiovascular mortality gap by 19% and the Black-white male life expectancy gap by 8%.³ A study of hospital births in Florida found that the racial mortality disparity for Black newborns compared to white newborns was halved when Black newborns were under the care of Black physicians.⁴ Despite these results, there has been minimal progress in increasing the number of doctors from HUGs, as there has only been a 4% increase in Black doctors in the past 120 years.⁵

Disparities in the Healthcare Workforce

In the U.S., there are significant disparities in the healthcare workforce. Communities of color, specifically African-Americans, Hispanics, and Native Americans, comprise 40% of the nation’s youth but only 14% of those individuals who work in the medical field.⁶ In general, the number of individuals from HUGs entering the healthcare workforce has lagged behind the demand for adequate healthcare in these communities.

Though there have been national efforts to increase representation from HUGs in the healthcare workforce, these efforts have fallen short. In 1991, the American Association of Medical Colleges (AAMC) launched a campaign to accept 3,000 students from HUGs into U.S. medical schools; however, only 1,700 of these students were accepted by 2000. By 2005, among the 15,764 students in the graduating class, 1,047 (6.6%) were African American, 938 (6.0%) were Latino, and 96 (0.6%) were Native American in comparison to the 28.5% of the total United States population these groups make up.⁵ As demonstrated by these statistics, there is a dearth of representation from HUGs in the U.S. healthcare workforce, which further discourages African-American, Latino, and Native American youth from pursuing a health career. The widening opportunity gap for HUGs entering health careers and receiving quality healthcare led us to found Project MED.

In June 2021, Project MED (Medicine, Education, and Development) was established at Northwestern University as a student-led organization that focuses on educating high school students about careers in healthcare, particularly in underserved communities. The mission of Project MED is to expose high school students to the breadth of opportunities in the healthcare field and to prepare students for successful careers in healthcare. This mission has been realized through the formation of close partnerships with students, teachers and faculty, and community-based organizations. Project MED hopes to give underserved students the access and agency they need to explore careers in healthcare and improve healthcare disparities among HUGs.

Overview of Existing Healthcare Pipeline Programs

With a current focus on the Chicago-metro region, Project MED conducted a thorough review of existing pre-healthcare pipeline programs, the gaps they fill, and possible areas of improvement. In particular, we looked at longitudinal programs available to high school students that prioritized exposure to the health sciences amongst underprivileged groups.

Chicago Public Schools (CPS) have implemented a Health Science Career and Technical Education (CTE) pathway available at 19 different high schools in the Chicagoland area. Federally funded by the Department of Education, these CTE programs enroll students during their freshman year and provide them with the opportunity to attend classes taught by health professionals, obtain field experience through paid summer internships and year-round site visits, and earn medical certification as basic nursing assistants, emergency medical technicians, and pharmacy technicians, among others.

The CTE pathways have encountered barriers that have slowed the program’s ability to spur significant change. Although curriculum is developed by the CPS system, implementation is left to the individual school’s discretion. Many schools do not have the fiscal resources or bandwidth to properly carry out the curricula. As expressed by the Chicago Teacher’s Union (CTU), CPS already struggles with a shortage of “staff essential to post-secondary planning for students” and has recently “disinvested in [CTE programs].”⁷ This, in turn, means that the CTE pathways are ineffectively and incompletely implemented at many participating schools.

Additionally, because of the COVID-19 pandemic, it has become necessary and has proven difficult to transition hands-on portions of the Health Science CTE program, such as anatomy lab visits and on-site internship experiences, to accessible virtual platforms for students. To be effective, an approach to improving pre-health career education must go beyond providing individual schools with curricula; it must support students and staff alike, work closely with students to provide more personalized mentorship, and resolve gaps in resource access.

In response to the inability of public school systems to allocate attention and resources equitably, various health career pipeline programs have been launched across the nation. For instance, the Teen Medical Academy (TMA) was a program sponsored in Texas that operated from 2003 to 2006 with the goal of exposing students to health careers and sparking their interest, confidence, and sense of belonging in the medical field. Through a nine-month program for teenagers from economically disadvantaged backgrounds, students were able to delve into topics like anatomy, physiology, and pathology and obtain unique hands-on experiences.⁵ Following the program, students reported that by offering these academic enrichment opportunities, it increased their “potential for success” in pursuing a health career. By using this medical pipeline program as a model, Project MED has differentiated itself by centralizing STEM outreach efforts through the three program pillars.

Objectives

This process paper reports on learnings from the first year of Project MED’s operations to reflect on lessons learned and plans for the future. We first contextualize healthcare workforce disparities as well as existing pipeline programs. From there, we describe Project MED’s organizational structure and our efforts to root ourselves in the local community. The final section considers three important lessons learned and Project MED’s future directions to address healthcare inequities through diversification of the workforce and collaboration with the community.

Methods

The Three Pillars: Learn, Lead, and Launch

At Project MED, we seek to build on existing pre-health programs to avoid redundancy and address the needs for more personalized, structured, and scalable pre-health career mentorship and exposure. We are partnered with Northwestern University’s Office of Community Education Partnerships (OCEP), Northwestern Medicine, and Science in Society (SiS). We serve 50 students across three underserved high schools in the Chicagoland area, including Round Lake High School (RLHS), Evanston Township High School (ETHS), and Lindblom Math and Science Academy (LMSA). Project MED’s programming is divided into three pillars: Learn, Lead, and Launch (Figure 1a).

Figure 1:

(a) Project MED organizational structure as divided by its three pillars of Learn, Lead, and Launch; (b) Project MED partnership structure through high schools, community organizations, and other community stakeholders

MEDLearn is centered around providing students with tangible and personalized curricula. Built on a model of self-sufficiency and open access, our curriculum aims to expose students to healthcare while holistically preparing them for their post-secondary goals. To this end, our curricula span exploratory presentations in medicine and public health, soft skill development workshops (i.e. resume review, interview strategies, public speaking drills), and college preparation (i.e. application review and financial aid guidance). Project MED compiles all handouts, presentations, and workshop materials in a centralized repository, enabling students to carry their learnings with them. Throughout our programming, we have emphasized a hands-on approach, particularly through offerings such as dissections, suturing kits, and CPR and First Aid workshops. All meetings are carried out by Project MED team members in close collaboration with faculty and student leadership from each high school.

MEDLead is founded on near-peer mentorship, underlining the importance of developing student-mentor relationships in order to foster visible diversity and improve post-secondary education preparation, particularly for students with a demonstrated interest in a health career. Project MED has recruited and trained eight undergraduate student mentors with a robust set of modules covering sensitivity training and student-centered counseling. Not only do we partner students one-on-one with mentors with similar backgrounds and interests, but we give undergraduate students the opportunity to share their stories and give back to the community.

MEDLaunch⁸ is a database that serves to tackle the inequity in access to healthcare education opportunities, such as research, shadowing, volunteering, and other internship and enrichment programs. For high schoolers and undergraduates alike, these are some of the most fundamental experiences that provide exposure to a STEM topic. Yet, oftentimes it is the process of searching for a match that is most confusing and time-consuming. Acknowledging that many schools do not have the time and/or resources to provide students with information on such opportunities, MEDLaunch curates these opportunities to bypass high barriers to accessibility. Through an accessible interface and robust filtering capabilities including areas of study, location, and age, MEDLaunch directly matches students’ interests and eligibility to programs, particularly pipeline programs and those that provide stipends.

A Community-Based Approach

Project MED aimed to follow the Principles of Engagement outlined by Northwestern University’s Center for Community Health: Collaboration, Respect, Equity, Transparency, and Impact.⁹ Guided by these principles, we aimed to work alongside our student partners and community stakeholders in order to build trust and use feedback cycles to achieve sustainability.

Project MED is rooted in its partnerships, ensuring that there is consistent and comprehensive communication with the community. Our collaboration with the Baxter Center for Science Education (BCSE), housed within OCEP, allowed us to partner with the high schools RLHS and LMSA (Figure 1b). Specifically, within RLHS, we partnered with the existing Future Medical Panthers Club of about 30 students interested in exploring the healthcare field. Finally, the high school ETHS and its Health Science Careers class became our third partner after connecting with us through the BCSE. RLHS, LMSA, and ETHS each serve significant proportions of students from historically underrepresented communities. For example, 52%, 64%, and 33% of students are low-income at RLHS, LMSA, and ETHS, respectively. Further, all three schools serve high proportions of racial and ethnic minorities. At RLHS, 17% of students are Black and 78% are Hispanic; at LMSA, 67% of students are Black and 27% are Hispanic; and at ETHS, 25% of students are Black and 19% are Hispanic (Figure 2).^10–12

Figure 2:

Total distribution of low income, Black, and Hispanic students within three partner schools: RLHS (Round Lake High School), LMSA (Lindblom Math and Science Academy), and ETHS (Evanston Township High School). On average, 50% of all students come from a low-income background, 41% are Hispanic, and 36% are Black.

In trying to serve the needs of these students, we conducted widespread outreach to gain insight from those already in this educational space. We met with the cluster manager of the Health Science CTE of the CPS system, coordinators of pipeline programs including the Northwestern Health Professions Recruitment and Exposure Program (HPREP), and teachers and students at our partner schools, among others. These conversations provided valuable perspectives on the current needs of underserved high school students interested in healthcare. In order to address these unmet needs, we shaped our program to align with these conversations.

Lessons Learned

Emphasis on Depth Over Breadth

From its inception, Project MED has aimed to base itself deeply within the community, ensuring that our scope of involvement matches the needs of community partners and stakeholders. In that regard, our emphasis over the course of the year has been on depth of engagement over breadth of connections. To realize this goal, Project MED has prioritized communicating with our community-based partners, such as Northwestern OCEP and SiS, on a consistent basis both to update them on our progress and to receive feedback and advice for future operations.

Furthermore, when interacting with individual schools, Project MED consciously decided that we desired to remain engaged with a small number of schools (RLHS, BSCE, and ETHS) in order to facilitate a deeper level of connection. In conversations with faculty at RLHS and ETHS, we found that prior experiences with undergraduate student groups have been short-lived and lacking commitment. Thus, from our first interaction with each of these schools, we emphasized a long-term, meaningful partnership. This focus on sustained depth has allowed Project MED to form individual and meaningful relationships with students and educators at our three partner schools, which has helped us better understand the needs of each school and carefully develop offerings that align closely with these needs. For example, while we deliver hands-on workshops to RLHS, we coordinate speaker panels of physicians from various specialties for ETHS. Although Project MED aspires to expand the number of high school partners in the future, we intend to carry out that process with caution and prudent consideration of our capacity and ability to continue the same level of connection.

This model of depth over breadth links into our focus on sustainability. Project MED has formed several cross-institutional partnerships that we intend to maintain for several years. We recognize that maintaining sustainability within a program is a long-term commitment requiring unflagging effort, and we aspire to be prepared for this challenge.

Continued Adjustments Based on Students’ Needs

Centering the community can be challenging, especially when the program leaders do not understand on a firsthand basis the needs of the students whom the program is serving. Seeking out regular feedback from stakeholders provided a valuable way to regularly evaluate our program to best serve our target audience. For example, we invited both quantitative and qualitative feedback from students through surveys after each workshop and sent out a more comprehensive evaluative survey at the end of the academic year. We further involved students and teachers in regular conversations to gauge students’ engagement and interest levels as to what improvements we could make to the program. After implementing our program, we invited stakeholders to provide iterative feedback. Through regular conversations with teachers at our partner schools, we adjusted our program to maximize student engagement. Other contacts, such as the CTE cluster manager, served as reference points to whom we reached out for further comments on other parts of the program, including MEDLaunch.

These opportunities to reevaluate Project MED allowed us to shift our focus to best serve the students. For example, one conversation with a teacher at one of the schools informed us that after our online Zoom presentations about various healthcare professions and college preparedness, students were beginning to lose interest. The students were struggling with Zoom fatigue, and wanted more interactive, hands-on activities. This honest account of student engagement helped us make changes to Project MED. We turned to dissections and suturing workshops so that students could actively participate in health-care related, topical activities rather than only hearing about them. These changes led to significantly higher student interest and investment.

Thus, iterative feedback loops have provided a reliable and fruitful way for Project MED to seek input and investment from stakeholders, including students and teachers. From this experience, we inferred that giving and receiving comments and critiques require a sense of trust between engaged parties as well as a shared sense of investment.

Implementation of Sustainable and Accessible Technology

Technology has evolved at an exponential rate in recent years, particularly within the spheres of healthcare and education. Through the MEDLaunch database and social media platforms, Project MED uses technology to increase access to health career education on a local level and to reach students on a larger scale.

First, Project MED faced challenges in finding consistent web developer support. Initially, the majority of the MEDLaunch platform was coded by two primary web developers. However, these web developers were located across different time zones, making it difficult to fix specific bugs and slowing overall progress. Because these technological updates had time-sensitive deadlines, Project MED recruited an additional web developer from the Northwestern campus to address challenges in communication and scheduling. This drastically reduced delays caused by communication difficulties and made it more efficient to debug certain aspects of the website. Having reliable and consistent technical support from the campus community will allow MEDLaunch to further accelerate its expansion and establish continuity.

To properly implement the MEDLaunch technology, Project MED needed to address the inefficiencies in updating the database. In the preliminary iterations of MEDLaunch, the entries were all inputted manually, which required a lot of time and effort. The MEDLaunch database currently relies on the capabilities of Airtable, a platform that is effective in the short term but unsustainable in the long term. In line with our value of sustainability, we are exploring methodologies, such as web scraping and natural language processing, to make the processes more efficient. These technologies would automate the processes of obtaining and updating an opportunity’s description, application requirements, and application deadlines.

The MEDLaunch database is united with Project MED’s robust communication and media platforms to increase awareness surrounding health careers education. Platforms like Instagram and LinkedIn have been actively used to disseminate information to students, mentors, and other community members. This cross-community communication allows us to participate in digital partnerships, creating and continuing conversations with members of the community. Project MED is excited to be a part of a larger movement toward health and professional development knowledge dissemination among HUG youth.¹³

Future Directions

In the short term, Project MED is seeking to leverage its lessons learned through the formalization of a mentorship model, a widespread database launch, and an overall program expansion. While Project MED has already recruited and trained eight undergraduate mentors, the MEDLead model is still in its infancy in regard to its structure and program content. To remain consistent with the goals of limiting redundancies and modeling successful organizations, MEDLead is set to collaborate with SiS, a STEM mentoring program involving Northwestern faculty and graduate students, and its partners at Mather High School. The benefits of STEM mentorship will be explored through establishing essential resources, from a mentorship workbook to college application guides,¹⁴ and diversifying the representation of current mentors.

Likewise, expansion in the technology will require careful planning. In the long run, the objective is to scale MEDLaunch throughout all Chicago Public School branches—and eventually nationwide—so that students will have the agency to immerse themselves in their specific health career interests. With the MEDLaunch tool, we can interweave technology into the local community to sustain growth and encourage a longitudinal partnership that will help close the widening gaps in the healthcare workforce. Finally, in tandem with broadening MEDLaunch, we also plan to add to the Project MED capabilities and programming. On the local level, we will continue to recruit undergraduate volunteers to realize sustainability beyond several years. On the national level, Project MED is aiming to adapt its overall model and workshop repository to other universities to ensure that resources continue to target high schools that demonstrate the highest need.

Conclusion

When examining the social determinants of health in the public health lens, it is essential to acknowledge the depth of building personal relationships with community partners, along with the interconnectivity of bridging together resources across existing community organizations.¹⁵ While inequities in education and disparities in the healthcare workforce can be attributed to a broad range of issues, Project MED has primarily focused on developing sustainable connections with schools and community stakeholders and maintaining an adjustable model that continually addresses specific community needs. Through the three pillars—Learn, Lead, and Launch—Project MED has created a workshop repository and speaker panel directory, trained a set of dedicated near-peer mentors, and curated a database of over 100 healthcare-related opportunities. This community-based approach has been key to the mission of Project MED and has allowed us to create mutually beneficial partnerships with other community education organizations to uplift and empower underserved high schoolers with the resources they need to explore the health career pathway.

In the span of only a year, Project MED has experienced exponential growth in its progress and its ability to adapt to challenges. By entering each project with intention and initiative, a longitudinal model was set, allowing Project MED to differentiate itself as an attentive and reliable organization. Despite any obstacles that came up in the student programming or technology aspects, the Project MED team faced each with a mindset of flexibility and adaptability. All of the lessons learned, including the personalization of partner engagement, the adjustment of approaches based on student and teacher feedback, and the utilization of technology to increase accessibility, will be vital in accelerating the next stages of Project MED. The significant growth from the past year portends a promising future for a vision of program expansion and technological development. Moving forward, Project MED will continue to create sustainable, adaptable, and technology-driven impact among its local communities to bridge gaps in education and advance health equity.