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.

The process of attrition in pre-medical studies: A large-scale analysis across 102 schools.

The important but difficult choice of vocational trajectory often takes place in college, beginning with majoring in a subject and taking relevant coursework. Of all possible disciplines, pre-medical studies are often not a formally defined major but pursued by a substantial proportion of the college population. Understanding students' experiences with pre-med coursework is valuable and understudied, as most research on medical education focuses on the later medical school and residency. We examined the pattern and predictors of attrition at various milestones along the pre-med coursework track during college. Using a College Board dataset, we analyzed a sample of 15,442 students spanning 102 institutions who began their post-secondary education in years between 2006 and 2009. We examined whether students fulfilled the required coursework to remain eligible for medical schools at several milestones: 1) one semester of general chemistry, biology, physics, 2) two semesters of general chemistry, biology, physics, 3) one semester of organic chemistry, and 4) either the second semester of organic chemistry or one semester of biochemistry, and predictors of persistence at each milestone. Only 16.5% of students who intended to major in pre-med graduate college with the required coursework for medical schools. Attrition rates are highest initially but drop as students take more advanced courses. Predictors of persistence include academic preparedness before college (e.g., SAT scores, high school GPA) and college performance (e.g., grades in pre-med courses). Students who perform better academically both in high school and in college courses are more likely to remain eligible for medical school.

Conhecimento de estudantes de medicina de uma instituição de ensino sobre o Serviço de Atendimento Móvel de Urgência / Knowledge of Medical Students of an education facility about the Emergency Medical Service

Objetivo: Avaliar o conhecimento de estudantes de medicina sobre o funcionamento do Serviço de Atendimento Móvel de Urgência. Métodos: Estudo observacional, transversal, descritivo e analítico. Foi utilizado um questionário semiestruturado e autorresponsivo aplicado a estudantes de medicina matriculados entre o primeiro e o quinto semestres de uma faculdade privada de Belém (PA), utilizando os métodos estatísticos teste do qui-quadrado de aderência e teste G de independência. Resultados: Participaram do estudo 139 discentes, com destaque para a maior participação dos acadêmicos do primeiro e do quinto período (p<0,0001). Houve diferença estatística apenas no primeiro (68,2%; p=0,0237) e no quinto período do curso (84,8%; p<0,0001) quanto ao conhecimento do número para contatar o serviço. Somente o primeiro (79,6% corretos; p=0,0002) e o terceiro períodos (77,8% corretos; p=0,0339) tiveram significância estatística quanto à obrigatoriedade do médico na ambulância. Conclusão: Os dados evidenciados mostram que os alunos possuem lacunas de conhecimento sobre o funcionamento do Serviço de Atendimento Móvel de Urgência, o que pode prejudicar o desfecho clínico de um paciente.

Objective: To evaluate the knowledge of the medical students of an Education Facility about the operation of the Emergency Medical Service. Methods: This is an observational, cross-sectional, descriptive, and analytical study. A semi-structured and self-responding questionnaire was applied to medical students enrolled between the first and fifth years of a private college in Belém (PA), using the statistical methods Chi-square of adherence and G-test of independence. Results: One hundred and thirty-nine students participated in the study, with emphasis on the higher participation of students from the first and fifth terms (p<0.0001). There was statistical difference only in the first (68.2%; p=0.0237) and fifth (84.8%; p<0.0001) terms of the course regarding knowledge of the number to contact the service. Only the first (79.6% correct, p=0.0002) and third (77.8% correct, p=0.0339) terms had statistical significance regarding the compulsory presence of the physician in the ambulance. Conclusion: The evidenced data show that students have knowledge gaps about the functioning of the Emergency Medical Service, which can harm the clinical outcome of a patient.

Premedical anatomy experience and student performance in medical gross anatomy.

Gross anatomy is considered one of the most important basic science courses in medical education, yet few medical schools require its completion prior to matriculation. The effect of taking anatomy courses before entering medical school on performance in medical gross anatomy has been previously studied with inconsistent results. The effect of premedical anatomy coursework on performance in medical gross anatomy, overall medical school grade point average (GPA), and Comprehensive Osteopathic Medical Licensing Examination Level 1 (COMLEX 1) score was evaluated in 456 first-year osteopathic medical students along with a survey on its perceived benefits on success in medical gross anatomy course. No significant differences were found in gross anatomy grade, GPA, or COMLEX 1 score between students with premedical anatomy coursework and those without. However, significant differences and higher scores were observed in students who had taken three or more undergraduate anatomy courses including at least one with cadaveric laboratory. There was significantly lower perceived benefit for academic success in the medical gross anatomy course (P<.001) from those students who had taken premedical anatomy courses (5.9 of 10) compared with those who had not (8.2 of 10). Results suggest that requiring any anatomy course as a prerequisite for medical school would not have significant effect on student performance in the medical gross anatomy course. However, requiring more specific anatomy coursework including taking three or more undergraduate anatomy courses, one with cadaveric laboratory component, may result in higher medical gross anatomy grades, medical school GPA, and COMLEX 1 scores. Clin. Anat. 30:303-311, 2017. © 2017 Wiley Periodicals, Inc.

Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status.

BACKGROUND: Medical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity. The aim of this study was to examine variation in socioeconomic status (SES) of applicants to study medicine and applicants with an accepted offer from a medical school, comparing the four UK countries and individual medical schools. METHODS: Retrospective analysis of application data for 22 UK medical schools 2009/10-2011/12. Data were analysed for all 32,964 UK-domiciled applicants aged <20 years to 22 non-graduate medical schools requiring applicants to sit the United Kingdom Clinical Aptitude Test (UKCAT). Rates of applicants and accepted offers were compared using three measures of SES: (1) Postcode-assigned Index of Multiple Deprivation score (IMD); (2) School type; (3) Parental occupation measured by the National Statistics Socio Economic Classification (NS-SEC). RESULTS: There is a marked social gradient of applicants and applicants with accepted offers with, depending on UK country of residence, 19.7-34.5% of applicants living in the most affluent tenth of postcodes vs 1.8-5.7% in the least affluent tenth. However, the majority of applicants in all postcodes had parents in the highest SES occupational group (NS-SEC1). Applicants resident in the most deprived postcodes, with parents from lower SES occupational groups (NS-SEC4/5) and attending non-selective state schools were less likely to obtain an accepted offer of a place at medical school further steepening the observed social gradient. Medical schools varied significantly in the percentage of individuals from NS-SEC 4/5 applying (2.3%-8.4%) and gaining an accepted offer (1.2%-7.7%). CONCLUSION: Regardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine. Postcode-based measures such as IMD may be misleading, but individual measures like NS-SEC can be gamed by applicants. The previously unreported variation between UK countries and between medical schools warrants further investigation as it implies solutions are available but inconsistently applied.

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college.

OBJECTIVE: To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. DESIGN: Observational cohort study. SETTING: Medical college registry, with internet, phone, and personal follow-up of graduates. PARTICIPANTS: 710 graduate doctors from the first 22 classes (1983-2004) of Nepal's first medical college, the Institute of Medicine. MAIN OUTCOME MEASURES: Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. RESULTS: 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. CONCLUSIONS: A cluster of medical students' characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school.

The influence of pre-admission tracks on students' academic performance in a medical programme: Universiti Sains Malaysia.

CONTEXT: An aim of medical schools is to select the most suitable candidates who are more likely to become good doctors, fulfilling societal expectations. It is imperative to better understand the influence of 'selection' variables on students' academic performance. We conducted a retrospective record review (3R) to examine the predictive power of pre-admission tracks on academic performance in the medical programme at the Universiti Sains Malaysia. METHODS: Data were collected on medical graduates' of the university for the years 2003 through 2007. This represented 805 graduates after exclusion of 42 for incomplete and inconsistent data related to the analysis. RESULTS: A total of 95% of the graduates were included in this analysis; 67% were female. Of the 805 graduates, 75% were from the Matriculation course track, 22% from the High School Certificate (HSC) course and 1% from other pre-admission tracks. There was 2% missing information. The majority (79%) were Biology majors and 13% were Physics majors. Graduates from the HSC course and with a Biology background demonstrated a strong correlation with positive academic performance (P < 0.05) compared with other groups. CONCLUSION: The HSC track and Biology background may be helpful for the medical school in selecting future students.

Use of interactive live digital imaging to enhance histology learning in introductory level anatomy and physiology classes.

Histology is one of the main subjects in introductory college-level Human Anatomy and Physiology classes. Institutions are moving toward the replacement of traditional microscope-based histology learning with virtual microscopy learning amid concerns of losing the valuable learning experience of traditional microscopy. This study used live digital imaging (LDI) of microscopic slides on a SMART board to enhance Histology laboratory teaching. The interactive LDI system consists of a digital camera-equipped microscope that projects live images on a wall-mounted SMART board via a computer. This set-up allows real-time illustration of microscopic slides with highlighted key structural components, as well as the ability to provide the students with relevant study and review material. The impact of interactive LDI on student learning of Histology was then measured based on performance in subsequent laboratory tests before and after its implementation. Student grades increased from a mean of 76% (70.3-82.0, 95% CI) before to 92% (88.8-95.3, 95% CI) after integration of LDI indicating highly significant (P < 0.001) enhancement in students' Histology laboratory performance. In addition, student ratings of the impact of the interactive LDI on their Histology learning were strongly positive, suggesting that a majority of students who valued this learning approach also improved learning and understanding of the material as a result. The interactive LDI technique is an innovative, highly efficient and affordable tool to enhance student Histology learning, which is likely to expand knowledge and student perception of the subject and in turn enrich future science careers.

Predicting medical student performance from attributes at entry: a latent class analysis.

OBJECTIVES: The objectives of this study were two-fold. Firstly, we aimed to model 'typologies' of student examination performance by grouping students into like categories based on measures of prior academic achievement (particularly in the science subjects) and interview rating at time of entry to a medical degree course, and outcome measures of subsequent performance across the course. Secondly, we aimed to illustrate and evidence the utility of the latent class analysis (LCA) clustering technique to provide meaningful information on the effectiveness of a student selection process with respect to the likelihood of poor examination performance. METHODS: For this retrospective study, anonymised data on two sequential cohorts of students who graduated from a 5-year Bachelor of Medicine, Bachelor of Surgery degree course were analysed using LCA. In order to triangulate the findings, the same data were analysed using the more conventional approach of logistic regression. RESULTS: The LCA identified three distinct classes or typologies of student examination performance using measures of prior academic achievement and interview rating at time of course entry. Measures of prior academic achievement and score on a structured admissions interview made significant contributions to the model's ability to discriminate between typologies. Strong prior academic achievement, especially in chemistry, and high interview score were positively related to the likelihood of successful test performance. These findings were supported by the logistic regression analysis. CONCLUSIONS: The LCA clustering technique provided meaningful information on the performance of a selection process. As a complementary tool to existing methods used in this area of research, LCA has the potential to empirically inform the selection process.

Familiarity with Latin and Greek anatomical terms and course performance in undergraduates.

Commonly used technical anatomy and physiology (A&P) terms are predominantly rooted in Latin and Greek vocabulary, so it is commonly inferred that a solid grounding in Latin and Greek roots of medical terminology will improve student learning in anatomy and related disciplines. This study examines the association of etymological knowledge of A&P terms and A&P course performance among 446 undergraduates in their first semester of the study of human gross anatomy and physiology, with a more detailed analysis of the characteristics of 52 students who filled out surveys about their prior knowledge and experiences related to medicine or anatomy. In both data sets, there was only a weak positive correlation between the performance on a quiz of Latin and Greek medical terms and the students' performance on regular assignments. The presumption that familiarity with Latin and Greek word roots has a strong influence on successful learning of anatomy is not supported by these data. Future research should address whether or not there are particular skills associated with using etymological knowledge in improving A&P course performance.

Characteristics of medical school matriculants who participated in postbaccalaureate premedical programs.

PURPOSE: To identify factors associated with U.S. medical school matriculants' postbaccalaureate premedical program participation and to determine whether participation was associated with plans at medical school graduation to practice in underserved areas. METHOD: Deidentified, individualized records of Association of American Medical Colleges (AAMC) Matriculating Student Questionnaire responses for the 1996- 2000 cohort of U.S. medical school matriculants were analyzed using multivariable logistic regression for associations with postbaccalaureate premedical program participation. Postbaccalaureate premedical program participation was analyzed for associations with plans at medical school graduation to practice in underserved areas. Adjusted odds ratios (ORs) significant at P < .05 are reported for independent predictors of postbaccalaureate program participation among matriculants and of graduates' plans to practice in underserved areas. RESULTS: The sample of 57,276 matriculants included 3,561 (6.2%) academic record enhancer (ARE), 3,931 (6.9%) career changer (CC), and 1,354 (2.4%) career changer/academic record enhancer program participants (ARE/CC). Matriculants who participated in summer academic enrichment programs (OR = 1.35), had premedical debt (OR = 1.25), and were underrepresented minorities (OR = 1.21) were more likely to report ARE participation. Women (OR = 1.46) were more likely to report CC participation. Compared with nonparticipants, ARE, CC, and ARE/CC participants were each more likely to plan, at medical school graduation, to practice in underserved areas (OR = 1.14, 1.48, and 1.47, respectively). CONCLUSIONS: Among medical school matriculants, postbaccalaureate premedical program participants were demographically diverse and, at medical school graduation, were more likely than nonparticipants to plan to practice in underserved areas.

How leaky is the health career pipeline? Minority student achievement in college gateway courses.

PURPOSE: To determine whether underrepresented minority (URM) students receive lower grades than do non-URM students in college prehealth gateway courses; the extent to which lower grade performance might be explained by the differences in precollege academic achievement; and whether URM students are less likely than non-URM students to persist in completing at least four gateway courses. METHOD: Administrative data were obtained from six California colleges on 15,000 college students who matriculated in the 1999-2000 or 2000-2001 academic years and enrolled in at least one college course required for application to medical or dental school ("gateway" courses). Students were compared across ethnic groups in gateway course grade performance and persistence in completing at least four gateway courses, using regression methods to control for students' college admission test scores and caliber of high school attended. RESULTS: URM students received significantly lower grades on average in gateway courses than did white students. This gap persisted after adjusting for measures of prior academic performance. However, URM students were nearly as likely as white students to persist in completing at least four gateway courses. After accounting for the lower grades of URM students in their initial classes, URM students were more likely than white students to complete four or more gateway courses. CONCLUSIONS: URM students experienced academic challenges, but many persist in their prehealth courses despite these challenges. Interventions at the college level to support URM student performance in gateway courses are particularly important for increasing the diversity of medical and dental schools.

Risk factors for poor performance on the undergraduate medical course: cohort study at Nottingham University.

OBJECTIVE: To determine the risk factors for poor performance at different stages of the undergraduate medical course. DESIGN: Longitudinal retrospective cohort study of progress on a 5-year undergraduate medical course. SETTING: The University of Nottingham medical school. PARTICIPANTS: All students (594) who joined the course in 3 consecutive years were followed throughout their course until graduation, even if this was delayed. RESULTS: Risk factors for poor performance varied at different stages on the course. Students with lower A levels were at increased risk throughout, but primarily in the pre-clinical course. Non-white ethnicity was also a risk factor, independent of domicile, but this was associated more strongly with lower marks on the clinical course. Males and those who received a later offer of a place were at some risk throughout the course. Overall attrition from the course was 5%, and 34/594 students (6%) spent more than the normal 5 years on the course. CONCLUSION: School performance remains an important indicator of ability to cope with the pre-clinical course. Further research is required to understand why ethnic minority students may be more at risk at all stages, but particularly in the clinical course, and to increase their use of existing support services if necessary.

Effectiveness of University of California postbaccalaureate premedical programs in increasing medical school matriculation for minority and disadvantaged students.

CONTEXT: Many medical schools administer postbaccalaureate premedical programs targeting underrepresented minority and disadvantaged students, with the goal of increasing the number of these students matriculating into medical school. OBJECTIVE: To determine whether University of California (UC) postbaccalaureate programs are effective in increasing medical school matriculation rates for program participants. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study assessing 5 UC medical school postbaccalaureate programs. The cohort comprised 265 participants in the postbaccalaureate 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% were underrepresented minorities, and for 50% neither parent had attended college. MAIN OUTCOME MEASURE: Matriculation by 2005 into a US medical school accredited by the Liaison Committee on Medical Education. RESULTS: By 2005, 67.6% of participants and 22.5% of controls had matriculated into medical school (P<.001). After adjusting for baseline student characteristics, students who participated in postbaccalaureate programs had a higher probability of matriculating into medical school in a regression model controlling for grade point average and demographic characteristics (odds ratio, 6.30; 95% confidence interval, 4.08-9.72) and in a model further controlling for preparticipation Medical College Admissions Test score (odds ratio, 8.06; 95% confidence interval, 4.65-13.97). CONCLUSION: Postbaccalaureate premedical programs appear to be an effective intervention to increase the number of medical school matriculants from disadvantaged and underrepresented groups.

An analysis of the association of American medical colleges' review of minorities in medical education.

The Association of American Medical Colleges publishes an enormous database each year, which encompasses every conceivable category of medical education. This information covers high-school student premedical activities, medical school/student data, demographics of residents and fellows in training, a profile of medical school faculty according to academic rank and the enrollment of each medical school in the country. It is all categorized according to race, ethnicity and gender. Furthermore, it is a longitudinal survey and, therefore, valid comparisons can be made over long periods of time. The extensive coverage of African-American involvement in the system at all levels allows for healthcare planners, administrators, politicians and students/parents at all levels to use this as a roadmap for planning purposes. Much of the data is broken down according to individual states, thus enabling students to make better decisions about selecting private versus public institutions for their training. The data on residents in training and medical school faculty provides very useful information for healthcare planners, state and federal government officials, and medical school deans and university administrators interested in addressing diversity issues within their respective domains.

Academic performance of psychiatrists compared to other specialists before, during, and after medical school.

OBJECTIVE: This study was designed to compare psychiatrists with other physicians on measures of academic performance before, during, and after medical school. METHOD: More than three decades of data for graduates of Jefferson Medical College (N=5,701) were analyzed. Those who pursued psychiatry were compared to physicians in seven other specialties on 18 performance measures. Analysis of covariance was used to control for gender effect. RESULTS: Compared to other physicians, psychiatrists scored higher on measures of verbal ability and general information before medical school and on evaluations of knowledge and skills in behavioral sciences during medical school, but they scored lower on United States Medical Licensing Examinations step 3. CONCLUSIONS: The results generally confirmed the authors' expectations about psychiatrists' academic performance. More attention should be paid to the general medical education of psychiatrists.

Participation in the academic associate program: effect on medical school admission rate.

OBJECTIVES: Several emergency medicine programs are using premedical students as research assistants for clinical research in the emergency department (ED). These programs have been shown to enhance faculty research productivity, but the effects of these programs on the students' goals have not been assessed. The authors evaluated the effect of the Academic Associate Program (AAP) on medical school acceptance rates. METHODS: From 1997 to 2002, premedical students who attended informational sessions about the AAP completed a 28-item survey including demographic information, educational experiences, career goals, grade point average (GPA), and prior research participation. Premedical students who had a career goal of becoming a physician were included in the study if they matriculated into medical school or changed their career plans by the fall of 2003. Medical school acceptance was determined by contacting students or their parents via telephone and e-mail. Students enrolled in the AAP were compared with Association of American Medical Colleges (AAMC) data to determine whether they were more or less likely to be accepted into medical school. RESULTS: During the study period, 198 students enrolled in the AAP had attained a final disposition with respect to medical school matriculation. Students were a mean age of 22.4 +/- 3.0 years, 55% female, and 43% nonwhite. Most students (91%) were junior year or later with respect to educational level. Prior research experience included being an author on an abstract (25%), being an author on a manuscript (17%), and presenting research at a scientific meeting (14%). The mean GPA ( +/- standard deviation) for Academic Associates was 3.38 ( +/- 0.31). Medical school acceptance rates were 79% for students in the AAP (95% confidence interval [95% CI] = 73.1 to 84.5). This is higher than expected based on AAMC published data with a 49% (95% CI = 48.5 to 49.5) acceptance rate for students with a mean GPA of 3.46. CONCLUSIONS: Compared with AAMC data, students in the AAP have a higher medical school acceptance rate despite a slightly lower GPA. This finding suggests that participation in the program enhances a student's likelihood of matriculating in medical school.