Survey of care for the underserved: a control group study of practicing physicians who were graduates of The Ohio State University College of Medicine premedical postbaccalaureate training program

Redefining the term "Disadvantaged student": A post baccalaureate program's role in underrepresented students' success and reclaiming of narratives

PURPOSE

Racial/ethnic minority groups and low-income students continue to be underrepresented in medicine (URiM) despite years of diversity and inclusion efforts. Post baccalaureate programs (PBP) are shown to prepare underrepresented students to successfully matriculate to medical school. However, identification of the aspects of a PBP that are key to future success in medicine from the student perspective is lacking. Therefore, this study was designed to answer the question, "What aspects of a post baccalaureate program do URiM students see as valuable to their future success?"

METHODS

This is a qualitative analysis of semi-structured interviews with alumni of the UCSF PBP who completed the program between 2015-2020. Interviews were conducted via phone or video call, audio recorded, and transcribed verbatim. Names and years of attendance were removed from the transcripts prior to review to protect confidentiality. Transcripts were coded following an inductive qualitative approach using methodology rooted in grounded theory. Demographic data was collected upon enrollment in the program.

RESULTS

Forty study participants were interviewed (58% of eligible subjects). Participants self-identified as Latinx (70%), African American (8%), Southeast Asian (10%), Native American (2%), Multiethnic (10%), and 60% female. The average age at enrollment was 24 years. Most participants (75%) were first-generation college students and 85% grew up with a family income <$49,999. Qualitative findings were categorized into five main themes: (1) Academic, Professional, and Personal Skills Development, (2) Supportive Student Cohort, (3) Resources, Personalized Advising, and Mentorship, (4) Gaining Confidence and a Sense of Belonging in Medicine, and (5) Redefining "Disadvantaged" Status. A novel finding was the importance of redefining the narrative of belonging to a "disadvantaged" community. During the program, the study participants reported gaining confidence and a sense of belonging in medicine as they recognized the unique qualifications and advantages they bring to medicine.

CONCLUSIONS

Our findings suggest that in addition to academic preparation, PBPs for students who are underrepresented in medicine should empower students to recognize their strengths and qualifications in the field of medicine. Our study participants rejected the term "disadvantaged" as they celebrated the value of their backgrounds and what they bring to medicine.

Impact of a 50-Year Premedical Postbaccalaureate Program in Graduating Physicians for Practice in Primary Care and Underserved Areas

PURPOSE

To evaluate the effectiveness of Wayne State University School of Medicine's (WSUSOM's) 50-year premedical postbaccalaureate program (PBP)-the first and oldest in the United States-in achieving its goals, as measured by medical school matriculation and graduation, primary care specialization, and current practice location.

METHOD

A retrospective study of a complete comparative dataset of 9,856 WSUSOM MD graduates (1979-2017) was performed in July-August 2018. This included 539 graduates who were admitted to the PBP between 1969 and 2012. Data collected included PBP students' sociodemographics, postgraduate specialization, residence location at time of admission to the PBP, and current medicine practice location. Health professional shortage areas (HPSAs) and medically underserved areas/populations (MUA/Ps) were determined for residence at admission to the PBP and current medicine practice location.

RESULTS

Of the 539 PBP students, 463/539 (85.9%) successfully completed the PBP and matriculated to WSUSOM. Of those, 401/463 (86.6%) obtained an MD, and of those, 233/401 (58.1%) were female and 277/401 (69.1%) were African American. Average investment per PBP student was approximately $52,000 and for an MD graduate was approximately $77,000. The majority of PBP MD graduates with current practice information resided in HPSAs or MUA/Ps at admission to PBP (204/283, 72.1%) and were currently practicing in HPSAs or MUA/Ps (232/283, 82.0%), and 139/283 (49.1%) became primary care physicians (PCPs). Comparison of WSUSOM PBP and non-PBP MD graduates showed PBP physicians become PCPs and practice in HPSAs or MUA/Ps at higher rates than non-PBP physicians (P < .001).

CONCLUSIONS

The PBP was successful in graduating a large proportion of physicians from socioeconomically disadvantaged and diverse backgrounds, who practice as PCPs and who practice in HPSAs and MUA/Ps, thereby accomplishing the PBP's goals of helping to address the broad health care needs of all people in the United States.

Process, outcome, and impact evaluation of the ohio state university DentPath postbaccalaurate program

Despite the progress in increasing racial and ethnic diversity in dental school programs in the United States, minority dental students still remain underrepresented when compared with the total population. As a result, dental education programs have been attempting to increase the number of students from underrepresented and underserved communities in their programs.

PURPOSE

The purpose of this study was to conduct process, outcome, and impact evaluations of the Ohio State University (OSU) College of Dentistry's (CoDs) DentPath Program.

METHODS

Upon Institutional Review Board approval, this study utilized a computer-assisted telephone interview research design of graduates from the OSU CoD DentPath Program. Forty closed and open-ended questions were asked during the structured interview. Descriptive and thematic analyses were used to analyze the data.

RESULTS

The data from 25 eligible graduates were analyzed, which represented a 100% response rate. Process evaluation revealed 100% (n = 25) of the participants expressed satisfaction with their DentPath experiences and recommendations for improvement were provided. Outcome evaluation revealed the participants treated patients using Medicaid (range: 20%-90%, n = 5) or a sliding scale (range: 5%-85%, n = 3) for payment and 36% (n = 9) of the participants regularly treated underserved populations outside of their regular practice settings. Impact evaluation revealed 68% (n = 17) participants reported the DentPath Program had no impact on their practice location.

CONCLUSIONS

Future research is needed to determine methods to promote the transition of DentPath students through dental school and into underserved communities.

The Diversity and Success of Medical School Applicants With Scores in the Middle Third of the MCAT Score Scale

Admissions officers assemble classes of medical students with different backgrounds and experiences who can contribute to their institutions' service, leadership, and research goals. While schools' local interests vary, they share a common goal: meeting the health needs of an increasingly diverse population. Despite the well-known benefits of diversity, the physician workforce does not yet reflect the nation's diversity by socioeconomic status, race/ethnicity, or other background characteristics.The authors reviewed the Medical College Admission Test (MCAT) scores and backgrounds of 2017 applicants, accepted applicants, and matriculants to U.S. MD-granting schools to explore avenues for increasing medical school class diversity. They found that schools that accepted more applicants with midrange MCAT scores had more diverse matriculating classes. Many schools admitting the most applicants with scores in the middle of the MCAT score scale were public, community-based, and primary care-focused institutions; those admitting the fewest of these applicants tended to be research-focused institutions and to report pressure to accept applicants with high MCAT scores to maintain or improve their national rankings.The authors argue that reexamining the use of MCAT scores in admissions provides an opportunity to diversify the physician workforce. Despite evidence that most students with midrange MCAT scores succeed in medical school, there is a tendency to overlook these applicants in favor of those with higher scores. To improve the health of all, the authors call for admitting more students with midrange MCAT scores and studying the learning environments that enable students with a wide range of MCAT scores to thrive.

I Am an African American: Distinguishing Between African American and African Applicants in Medical School Admissions Matters

Ignoring the diverse and rich cultures and histories of Africa and the African diaspora by applying the term African American to anyone of sub-Saharan African ancestry in medical school admissions does a disservice to applicants, medical schools, and the communities they serve. To determine how applicants can contribute to a diverse educational environment, admissions decisions must go beyond racial and ethnic self-reporting and recognize the diversity that applicants bring to their medical school. Using a holistic approach, institutions can fairly evaluate applicants and strategically fill their incoming classes. What each medical school is looking for based on its mission and how each student reflects that mission and enhances the educational environment should be revisited as each application is considered. Medical schools must adopt practices that strategically enroll applicants who help achieve their mission and better the communities they serve. The benefits of diversity are not achieved in a linear fashion but require a critical mass for each diverse group. Different strategies are needed to enhance the educational environment, address underrepresentation in medicine, and eliminate health disparities. If racial justice and health equity are to be realized, diversity policies need to recognize the differences between African and Afro Caribbean immigrants and African Americans.In this Perspective, the author argues for distinguishing between these groups in medical school admissions. He explores the differences in their history, culture, and experiences and demonstrates their uniqueness. He concludes by discussing diversity in medicine and offering suggestions for considering diversity in medical school admissions.

A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity.

METHODS

We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002).

RESULTS

The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations.

CONCLUSION

The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review

PURPOSE

The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.

METHOD

In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles.

RESULTS

Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas.

CONCLUSIONS

Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

After-School Program for urban youth: Evaluation of a health careers course in New York City high schools

Mentoring in Medicine (MIM) addresses an urgent national need for minority health professionals and promotes careers in health care for urban youth. The MIM After School Program (ASP or The Course) has as its primary objectives to provide academic enrichment in human biology and motivate disadvantaged youth to pursue a career in the health professions. Secondary objectives of The Course, although not evaluated here, are to improve students' health literacy and knowledge of healthy living behaviors. Since 2009, over 1500 middle and high school students have completed the New York City based Course, which is offered once a week over a 10 week semester in an out-of-school venue. This study assesses the success of The Course in achieving its primary objectives with 84 students at five New York City high schools during the fall 2014 semester. The Course curriculum was created especially for MIM, comprises the body's 11 organ systems, and is presented in discrete modules (one each semester), along with complementary educational activities, including field trips and class projects. This study reports on a formal evaluation using quantitative and qualitative methods. The quantitative evaluation found that the students significantly increased their knowledge of the Gastrointestinal System. Students across the academic spectrum appeared to have learned the MIM ASP Course content - high school GPA was not a predictor of knowledge acquisition. The students also reported that The Course significantly increased their self-confidence in their ability to succeed (self-efficacy). The students expressed a significant increase in five health care related attitudes and an additional increase in their ability to overcome personal issues to succeed in their career and significantly improving their feeling toward, and likely pursuit of, a health career. The students stated that The Course significantly increased their interest and intent to seek out more information about health care, participate in health care activities, and take more health care courses in high school. The qualitative evaluation found that the students and their parents were pleased with the MIM ASP Course's composition, presentation, and effectiveness. With a large majority of the parents stating that their child got out of The Course what they had hoped for and that The Course made it more likely that they would recommend a health career for their child. The students and instructional staff also identified The Course elements that they felt were most and least effective. Best practices that were used in designing and conducting The Course were identified. The MIM ASP Course appears to have achieved its principal educational objectives of providing academic enrichment in human biology and improving attitudes towards a health career for a self-selected population of disadvantaged, underrepresented minority high school students in an urban setting.

Public health and community medicine instruction and physician practice location

BACKGROUND

Experts have historically recommended better integration of public health content into medical education. Whether this adoption is associated with physician practice location has not been studied.

PURPOSE

To examine the association between medical student perception of their public health and community medicine instruction and practice location in a Health Professional Shortage Area.

METHODS

Descriptive analysis and a regression model assessed the significance and strength of the association between medical student perception of their public health and community medicine instruction and practice location using data from the Medical School Graduation Questionnaire 1997-2004, 2013 American Medical Association Physician Masterfile, and 2013 Health Professional Shortage Areas.

RESULTS

A higher proportion of medical students with an intent to practice in underserved areas reported inadequate instruction in public health and community medicine than those without such intentions. Students reporting adequate public health and community medicine instruction are slightly more likely to practice in a Health Professional Shortage Area, controlling for their intent to practice in underserved areas.

CONCLUSIONS

Findings suggest an association between perceptions of public health and community medicine instruction and practice location. Improved public health and community medicine instruction may support medical students' preparation and ability to integrate public health skills into practices in underserved settings. More research is needed to ascertain factors enabling better incorporation of public health and community medicine in medical education.

Promoting careers in health care for urban youth: What students, parents and educators can teach us

There are many obstacles that urban youth experience in pursuing health careers, but the benefits of diversifying the classroom and workforce are clear. This is especially true today as educators and policymakers seek to enhance underrepresented minority students' access to health careers, and also achieve the health workforce needed to support the Affordable Care Act. The creation of student pipeline programs began more than 40 years ago, but success has been equivocal. In 2008, Mentoring in Medicine (MIM) conducted a research project to identify how students learn about health careers; develop strategies for an integrated, experiential learning program that encourages underrepresented minority students to pursue careers in health; and translate these into best practices for supporting students through their entire preparatory journey. Six focus groups were conducted with educators, students, and their parents. The inclusion of parents was unusual in studies of this kind. The outcome yielded important and surprising differences between student and parent knowledge, attitudes and beliefs. They informed our understanding of the factors that motivate and deter underrepresented minority students to pursue careers in health care. Specific programmatic strategies emerged that found their place in the subsequent development of new MIM programming that falls into the following three categories: community-based, school-based and Internet based. Best practices derived from these MIM programs are summarized and offered for consideration by other health career education program developers targeting underrepresented minority students, particularly those located in urban settings.

Specialty choice and practice location of physician alumni of University of California premedical postbaccalaureate programs

PURPOSE

To investigate the longer-term career outcomes, such as specialty choice and practice location, of underrepresented minority and disadvantaged students who finished a University of California postbaccalaureate (UCPB) premedical program.

METHOD

The authors compared 303 UCPB alumni from the 1986-1987 to 2001-2002 cohorts who matriculated into medical school and could be matched to the 2008 American Medical Association Physician Masterfile with 586 randomly selected control physicians who graduated from the same medical schools in the same years as the UCPB alumni. Outcome variables included specialty, practice in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA), and practice in a California community with high concentrations of African American, Latino, or low-income residents.

RESULTS

A greater percentage of UCPB alumni (161/303 [53.1%]) than control physicians (235/586 [40.1%]) were in primary care (P < .001). Although there were no differences between the two groups in the percentages of physicians working in HPSAs or MUAs, a greater percentage of UCPB alumni than control physicians working in California practiced in high-poverty communities (31/191 [16.2%] versus 22/252 [8.7%], P < .016), high-Latino communities (35/191 [18.3%] versus 22/252 [8.7%], P <. 01), and high-African American communities (57/191 [29.8%] versus 50/252 [19.8%], P <. 02).

CONCLUSIONS

UCPB programs have enhanced the number of physicians entering primary care and working in disadvantaged California communities. However, many UCPB alumni practice in disadvantaged communities in California that are not federally designated as HPSAs or MUAs.

Early predictors of physicians' practice in medically underserved communities: a 12-year follow-up study of University of New Mexico School of Medicine graduates

BACKGROUND

Substantial numbers of people are medically underserved because of rural residence and/or economic circumstances. The mission of many medical schools is service to this group, so the ability to identify applicants likely to serve this population is valuable.

METHOD

In 2009, the authors asked graduates from their medical school, class of 1997 and forward, if they practiced in a medically underserved community in the past year. Variables obtained from medical school applications and scores from a survey of attitudes toward the underserved measured at matriculation were analyzed using logistic regression.

RESULTS

Of 244 practitioners, 35% reported working in an underserved community. Rural background, older age (25+) at matriculation, and being a member of an underrepresented minority were independent, statistically significant predictors of practice in an underserved community.

CONCLUSIONS

Schools wanting to increase the number of practitioners caring for the underserved could consider older as well as rural and minority applicants.