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.

Enseñanza de las bases de la ecocardioscopia en el pregrado: los estudiantes como mentores / Teaching the basics of echocardiography in the undergraduate: students as mentors

Objetivo. Analizar la capacidad de los alumnos de Medicina para integrarse en la enseñanza práctica de los planos básicos en ecocardioscopia mediante un diseño de mentoría paritaria. Metodología. Treinta y seis alumnos de Medicina previamente adiestrados en la obtención de planos en ecocardioscopia (mentores) enseñaron al resto de alumnos de 5.o curso (n=126). La metodología docente incluyó 3 etapas: teoría (curso online), entrenamiento básico (3 sesiones con 15h de experiencia práctica en ultrasonidos y un mínimo de 20 estudios ecocardiográficos por mentor) y evaluación clínica objetiva estructurada (ECOE) en la que se puntuaba la adecuación de los planos ecográficos básicos y la correcta identificación de 16 estructuras cardiacas. Resultados. La puntuación media ponderada obtenida por los alumnos en la ECOE fue de 8,66±1,98 puntos (sobre un máximo de 10). Solo 10 alumnos (8,4%) obtuvieron una puntuación inferior a 5 y 15 (12,6%) inferior a 7. Cincuenta alumnos (42%) obtuvieron 10 puntos. La estructura más fácilmente identificada fue el ventrículo izquierdo en el plano paraesternal eje corto, con un 89,9% de respuestas correctas. La estructura peor identificada fue la válvula mitral en el plano subxifoideo, con un 69,7% de respuestas correctas. Conclusiones. La enseñanza basada en la mentoría paritaria consigue un nivel de entrenamiento adecuado en la obtención de planos básicos en la ecocardioscopia. El periodo de formación es relativamente corto. El sistema de mentoría paritaria puede facilitar la implantación de la enseñanza sobre aspectos básicos en ultrasonidos a un elevado número de alumnos de pregrado (AU)

Objective. To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Methodology. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. Results. The students’ weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Conclusions. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students (AU)

The pipeline of physiology courses in community colleges: to university, medical school, and beyond.

Community colleges are significant in the landscape of undergraduate STEM (science technology, engineering, and mathematics) education (9), including biology, premedical, and other preprofessional education. Thirty percent of first-year medical school students in 2012 attended a community college. Students attend at different times in high school, their first 2 yr of college, and postbaccalaureate. The community college pathway is particularly important for traditionally underrepresented groups. Premedical students who first attend community college are more likely to practice in underserved communities (2). For many students, community colleges have significant advantages over 4-yr institutions. Pragmatically, they are local, affordable, and flexible, which accommodates students' work and family commitments. Academically, community colleges offer teaching faculty, smaller class sizes, and accessible learning support systems. Community colleges are fertile ground for universities and medical schools to recruit diverse students and support faculty. Community college students and faculty face several challenges (6, 8). There are limited interactions between 2- and 4-yr institutions, and the ease of transfer processes varies. In addition, faculty who study and work to improve the physiology education experience often encounter obstacles. Here, we describe barriers and detail existing resources and opportunities useful in navigating challenges. We invite physiology educators from 2- and 4-yr institutions to engage in sharing resources and facilitating physiology education improvement across institutions. Given the need for STEM majors and health care professionals, 4-yr colleges and universities will continue to benefit from students who take introductory biology, physiology, and anatomy and physiology courses at community colleges.

Commentary: Adopting postbaccalaureate premedical programs to enhance physician workforce diversity.

Postbaccalaureate premedical programs increase the likelihood that students from groups underrepresented in medicine will succeed in matriculating into medical school. Although about 20 U.S. medical schools administer academic enhancer postbaccalaureate programs, they often do so with some ambivalence about whether these premedical programs are truly part of the school's mission as a professional-degree-awarding institution. As a result, these programs often are orphans in the world of medical education and lack adequate institutional support. This commentary discusses findings from recent research demonstrating low attrition rates for postbaccalaureate program completers who attend medical school, and the relatively high interest these students have in practicing in underserved communities after completing their training. The author proposes that a comprehensive strategy for health career pipeline programs should emphasize high-yield strategies at the distal stages, such as postbaccalaureate programs, and then work backward up the educational pipeline toward interventions at earlier educational stages. The Association of American Medical Colleges (AAMC) could play a key role in this effort by creating a standing committee on postbaccalaureate programs within its Group on Diversity and Inclusion. Creating such a committee could send a statement to AAMC member schools about postbaccalaureate programs being integral to the medical school mission and schools' ability to meet Liaison Committee on Medical Education standards on diversity, and could provide an organizational nidus for a national consortium of academic enhancer postbaccalaureate programs. Postbaccalaureate premedical programs deserve to be fully adopted as essential components of a comprehensive physician workforce development strategy.

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.

Propuesta para la introducción de temas de historia, arte y literatura en la asignatura urología / Proposals for the introduction of history, art and literature issues on the urology subject

Objetivo: Contribuir a la educación humanística de los estudiantes de Medicina. Material y Métodos: Se realizó una investigación bibliográfica sobre temas de historia, arte y literatura relacionados con la Urología. Resultados: Se propone la introducción de temas culturales en la asignatura Urología como motivación y complemento de los temas biomédicos, lo que se ilustra mediante ejemplos. Conclusiones: La asignatura Urología puede contribuir a la educación humanística de los estudiantes de Medicina (AU)

Objective: To contribute to the humanistic education of medical students. Material and Methods: A bibliographic review was done on history, art and literature items in relation with Urology. Results: The introduction of cultural items in the Urology subject, as a motivation and complement of the biomedical items, is proposed and illustrated by examples. Conclusions: The Urology subject can contribute to the humanistic education of medical students (AU)

Working with schools in deprived areas to raise aspirations for medicine and other healthcare science careers.

Educational attainment is inversely related to socio-economic status. The achievement gap widens as children progress through the system. Take up of science options is particularly poor and difficulties are compounded by lack of relevant science-based work experience in deprived areas. The interaction of these factors is examined in some detail in an area of socio-economic deprivation. High attainment in sciences is usually considered a core requirement for acceptance into medicine and widening access to medicine for school leavers is therefore very difficult in these circumstances. A partnership between hospitals and local schools, including science-based work placements, is described. Cooperation between the NHS and schools by provision of work experience and teaching materials could help to address these issues as well as potential staffing difficulties in other healthcare science careers in the future. Expenditure can be justified on the grounds of known links between health, education and employment.

Perspective: "How to fix the premedical curriculum" revisited.

The authors celebrate the 30th anniversary of Lewis Thomas's provocative essay, "How to Fix the Premedical Curriculum," by reexamining its three central themes: the influence of medical schools on undergraduate education, the selection of students for admission to medical school, and a radical proposed reform of premedical education. At issue are fundamental questions concerning the relationship between the liberal arts and medical education--questions that are no less vital today than when Thomas first posed them: What is the purpose of undergraduate education? How closely aligned are the undergraduate and graduate phases of medical education? What do future physicians need to know that is not taught in medical school? Thomas reminds us that the undergraduate curriculum is no less vital to the future of medicine than medical school itself, and that premature specialization does not serve the best interests of future physicians or patients. Instead of treating premedical education as a mere prelude to medical school, we should encourage undergraduates to take full advantage of their college years as an opportunity to develop as human beings.

Addressing physician shortages in New Mexico through a combined BA/MD program.

The University of New Mexico School of Medicine and College of Arts and Sciences developed its combined BA/MD degree program, which will increase the medical school class from 75 students to 100 in the fall of 2010, to address the critical issue of physician shortages in underserved New Mexico. The program, which began operation at the undergraduate (i.e., college) level in 2006, expands opportunities in medical education for New Mexico students, especially those from rural and underserved minority communities, and prepares them to practice in underserved areas of New Mexico. In the BA/MD program, students will earn a bachelor of arts, a medical degree, and a proposed certificate in public health. A challenging liberal arts curriculum introduces the principles of public health. Students have unique rural medicine and public health preceptorship opportunities that begin in the undergraduate years and continue throughout medical school. Students work with a community physician mentor in summer service-learning projects during the undergraduate years, then they return for required rural medicine rotations in the first, third, and fourth years of medical school. Simultaneously, the classroom curriculum for these rural medicine experiences emphasizes the public health perspective. High priority has been placed on supporting students with academic advising and counseling, tutoring, supplemental instruction, on-campus housing, and scholarships. The program has received strong support from communities, the New Mexico state legislature, the New Mexico Medical Society, and the faculties of arts and sciences and the school of medicine. Early results on the undergraduate level demonstrate strong interest from applicants, retention of participants, and enthusiasm of students and faculty alike.