Programs created to increase the enrollment of minority and disadvantaged students to medical schools appear to be effective, according to a study in the September 6 issue of JAMA, a theme issue on medical education.
A racially and ethnically diverse physician workforce is important for increasing access to care for underserved populations and improving the cultural competence of the workforce, according to background information in the article. However, many ethnic groups remain underrepresented among physicians in the United States. In 2000, blacks, Latinos, and Native Americans comprised more than 25 percent of the U.S. population but only 7 percent of the nation's physicians. Students from lower-income families are also much less likely than those from higher-income families to be admitted into medical school. One strategy for increasing the diversity of the physician workforce is to implement interventions to support the academic achievement and health career aspirations of minority and low-income youth.
Among these programs are postbaccalaureate premedical programs targeting minority and disadvantaged students. These programs enroll college graduates, most of whom have previously applied unsuccessfully for admission to medical school, and provide an enrichment experience with the aim of making students more competitive medical school applicants. Currently, more than 75 academic institutions offer nondegree postbaccalaureate premedical programs, many focused on minority and disadvantaged students. However, the educational outcomes of these programs is not well known.
Kevin Grumbach, M.D., and Eric Chen, M.P.H., of the University of California, San Francisco, examined 5 University of California (UC) postbaccalaureate premedical programs to determine if they are effective in increasing medical school admission rates for program participants. The study included 265 participants in the programs in the 1999 through 2002 academic years and a control group of 396 college graduates who applied to the programs but did not participate. Of the participants, 66 percent were underrepresented minorities; for 50 percent, neither parent had attended college.
The UC programs implement a rigorous application process designed to mimic that used by the American Medical College Application Service (AMCAS). All 5 UC programs offer preparation in studying, test taking, writing personal statements, and interviewing, as well as opportunities for clinical or research experiences.
By 2005, 3 times as many program participants as controls had enrolled into medical school (67.6 percent vs. 22.5 percent). After adjusting for baseline student characteristics, students who participated in postbaccalaureate programs had a higher probability (about 6 times higher) of enrolling in medical school after controlling for grade point average and demographic characteristics.
"Among the continuum of educational pipeline programs, postbaccalaureate interventions are relatively high yield because they require only a single year of intervention, target students who have an explicit commitment to a career in medicine, and have a short timeline for achieving their payoff. The continued support and expansion of postbaccalaureate premedical programs is an important strategy for increasing the diversity of the physician workforce. Reductions enacted in the 2006 fiscal year in federal funding for Health Career Opportunities Programs, Health Careers Centers of Excellence, and related pipeline programs may threaten the continued existence of many postbaccalaureate programs that have traditionally received support from these federal programs," the authors write.
(JAMA. 2006;296:1079-1085. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by the Bureau of Health Professions, Health Resources and Services Administration. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Building a Diverse Physician Workforce
In an accompanying editorial, Jordan J. Cohen, M.D., and Ann Steinecke, Ph.D., of the Association of American Medical Colleges, Washington, D.C., comment on the study concerning increasing diversity in medical schools.
"Grumbach and Chen's finding that the University of California's postbaccalaureate premedical programs increased minority and disadvantaged matriculants to medical school adds empirical support for the long-held belief that a sturdy scaffold of academic preparation and mentoring can offset at least some of the accumulated disadvantages experienced by many minority students interested in a career in medicine. Their findings should encourage other schools to establish postbaccalaureate programs that have special appeal to minority students.
"Given the magnitude and complexity of the obstacles to closing medicine's diversity gap, multiple strategies must be aimed at all levels of the educational pipeline. While pursuing efforts at the early K-12 stage, students who have managed to survive the vicissitudes of their early education and who have made it through college must not be neglected. Many college graduates will require a well-designed postbaccalaureate program to be successful medical school applicants; many others might also succeed if only they were well informed about the application process and inspired to join the ranks of aspiring physicians."
(JAMA. 2006;296:1135-1137. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Financial disclosures – none reported.
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