Rethinking premedical education.

The world needs more physicians. Increasing their numbers alone won't solve the many problems associated with improving health care. But it doesn't help to have a dearth of doctors, who were generally in short supply before COVID-19 struck. The pandemic has only exacerbated doctor shortages everywhere. This doesn't bode well for a world that must prepare for future pandemics and for populations that are both growing and aging. Better health outcomes require more physicians. So, where are the bottlenecks?

Helping Scholars Overcome Socioeconomic Barriers to Medical and Biomedical Careers: Creating a Pipeline Initiative.

Problem: To achieve their potential in medical and biomedical careers, students (scholars) from under-resourced backgrounds must build sophisticated skills and develop confidence and professionalism. To flourish in an advanced educational system that may be unfamiliar, these scholars also need networks of mentors and role models. These challenges can affect scholars at multiple stages of their education. Intervention: To meet these challenges, we created a broad and innovative biomedical research-focused pipeline program: the Johns Hopkins Initiative for Careers in Science in Medicine (CSM Initiative). This initiative targets three levels: high school, undergraduate, and post-baccalaureate/pre-doctoral (graduate and medical). We provide training in essential academic, research, professional, and social skills to meet the unique challenges of our scholars from under-resourced backgrounds. Scholars also build relationships with mentors who provide career guidance and support. We present an overview of the training and assessment at each level of this initiative. Context: The initiative took place at an institution located in the greater Baltimore area and that is endowed with exceptional doctoral and postdoctoral trainees, staff, and faculty including clinicians, physician-scientists, and scientists who served as key role models and mentors. Our pipeline program draws from local high school students and a local and national pool of undergraduates and post-baccalaureates preparing for medical or graduate school. Impact: Our goals for the high school scholars are significant improvement in academic skills, increased confidence, and matriculation into higher education systems. Currently, at least 83% of high school scholars have matriculated into four-year college programs and 73% have chosen science, technology, engineering, math, and medicine (STEMM)-related majors. Among undergraduate participants, 42% have matriculated thus far into medical or biomedical graduate programs and this number is expected to rise as more scholars graduate from college and either enter graduate training or pursue STEMM careers. Another 25% have returned to our post-baccalaureate program. Among post-baccalaureate scholars, 71% have now matriculated into doctoral-level graduate biomedical programs (medical or graduate school) and the remaining 29% are pursuing careers in STEMM-related fields such as biomedical research with some still aiming at graduate-level education. Our long-term goal is to see a large majority of our scholars become successful professionals in medicine, biomedical research, allied healthcare, or other STEMM fields. Analysis of the early phases of the CSM initiative demonstrates such outcomes are attainable. Lessons Learned: This program provides experiences in which scholars develop and practice core competencies essential for developing their self-identity as scientists and professionals. The most important lesson learned is that mentorship teams must be highly dynamic, flexible, thoughtful, and personal in responding to the wide range of challenges and obstacles that scholars from under-resourced backgrounds must overcome to achieve career success.

Youth Enjoy Science Program at the Case Comprehensive Cancer Center: Increasing Engagement and Opportunity for Underrepresented Minority Students.

The Youth Enjoy Science (YES) Program at the Case Comprehensive Cancer Center is a National Cancer Institute (NCI) R25-funded training grant, designed to increase the pipeline of underrepresented minority (URM) students entering college and pursuing biomedical research and health care careers in the Cleveland Metropolitan and surrounding school districts. The three components of the program include: Learn to Beat Cancer, engaging middle school students and their families; Research to Beat Cancer, designed for high school students and college undergraduates; and Teach to Beat Cancer, focused on enhancing science, technology, engineering, and mathematics (STEM) teaching capacity among high school teachers. This study focuses on Research to Beat Cancer, which, in 2018 enrolled 36 URM students as paid summer scholars. Students were assigned to a faculty mentor, were taught laboratory safety, responsible conduct of research and the scientific method, and then immersed in full-time laboratory cancer research during an eight-week period. Twice each week, students participated in Lunch and Learn Seminars where faculty members provided combined motivational and scientific guidance lectures. In a capstone poster session at the end of the program, students presented their research to peers, medical and graduate students, family members, faculty, community members and leaders. Students' perceptions of the program were reported using descriptive statistics and qualitative thematic analyses. Twenty-four of the 2018 YES students (67%) and 19 (53%) mentors completed the online post-program survey. Opportunity was a major qualitative theme from student and mentor responses. Future research will investigate the long-term impacts of YES, including college enrollment.

The Jackson Heart Study: Preparing African American High School Students for Health Careers and Research.

In 1999, Tougaloo College (TC), located in Jackson, Mississippi, was charged, as a part of its role in the Jackson Heart Study (JHS), with creating a pool of well-trained high school students who, upon entering college, could successfully complete undergraduate and graduate or professional degrees in the health professions, biomedical research, and public health. TC identified the following educational challenges experienced by Mississippi high school students: inadequate exposure to reading, writing, logic, and quantitative skills; inadequate course work in science and mathematics; lack of mentors and role models in science-related fields as well as for exploration and identification of career options in the health professions and biomedical research. To this end, the JHS Undergraduate Training and Education Center (JHS UTEC) developed three four-week summer workshops in Science, Language Arts, and Mathematics (SLAM) for high school students in grades 9 through 11. Since SLAM's inception, more than 900 students have completed the program, and more than 90% have enrolled in college. In addition, according to National Student Clearinghouse and participant-reported data, many of the SLAM participants have earned not only undergraduate degrees in science, but also graduate degrees in a health-related and STEM fields. This article details the SLAM curricula and strategies for recruiting, selecting, training, and retaining high school students; we also present data to illustrate the success of the SLAM program.

The Healthcare Travelling Roadshow: a qualitative study of a rural community engagement initiative in Canada.

INTRODUCTION: Youth from rural communities face significant challenges in the pursuit of healthcare training. Healthcare trainees with a rural background are more likely than those without to practice rurally as healthcare professionals. The Healthcare Travelling Roadshow (HCTRS) is an initiative in Canada that provides rural youth with exposure to healthcare careers, while providing healthcare students with exposure to rural opportunities, and an interprofessional education experience. To the authors' knowledge, this is the first description of an initiative for rural university-high school healthcare career outreach that involves near-peer teaching, highly interactive sessions, and an interprofessional focus. METHODS: Ten HCTRSs took place throughout northern rural and remote British Columbia between 2010 and 2017. Questionnaires were delivered to youth in a pilot research project in 2010. Healthcare students and community members completed questionnaires for ongoing program evaluation from 2010 to 2017. Quantitative elements were graded on a five-point Likert scale. Qualitative elements were analyzed thematically. RESULTS: Participants indicated that the program was very successful (4.71, 95% confidence interval (CI) 4.63-4.79), would likely encourage healthcare students to consider rural practice (4.12, 95%CI 3.98-4.26), and that it inspired local youth to consider careers in health care much or very much (4.45, 95%CI 4.35-4.55). Qualitative analysis led to description of four themes: (1) sincerity and interactivity sparking enthusiasm, (2) learning through rural exposure and community engagement, (3) healthcare student personal growth and (4) interprofessional collaboration and development. Open-ended feedback identified successes outside of the primary goals and illustrated how this program could act in a multi-faceted way to promote healthcare recruitment and retention. Constructive comments emphasized the importance of taking a balanced approach to planning the HCTRS, ensuring the goals of the HCTRS are best met, while meeting the needs of the host communities as much as possible. CONCLUSIONS: The HCTRS is an interdisciplinary experience that successfully engages rural youth, healthcare students, and community stakeholders. Participants consistently indicated that it encouraged rural youth towards healthcare careers and healthcare students towards rural practice. Success of the program requires meaningful engagement with multiple academic and community stakeholders.

Physician Workforce Partnerships in Rural American Indian/Alaska Native Communities and the Potential of Post-Graduate Fellowships.

Rural American Indian and Alaska Native (AI/AN) communities face physician vacancy rates over 25%. A variety of programs aim to address those gaps, from early-life STEM initiatives for AI/ANs to physician loan repayment programs. However, unfilled clinical positions and underrepresentation of AI/AN physicians persist. We review existing workforce initiatives, then demonstrate that three recently developed clinical fellowship programs fill an important gap. The fellowships, led by faculty at large academic health centers, place fellows in clinical positions in rural AI/AN communities in partnership with tribal health systems and/or the Indian Health Service. In addition to providing clinical care, the fellowships seek to enhance health systems' capacity development through community-centered initiatives that include training and health promotion. Other academic health centers should consider working together with tribal communities to assess whether replication of the models could reduce local physician staffing gaps and health disparities.

Utilizing the scholarship of teaching and learning to design an Anatomy Pedagogy Course

Several research articles have reported the shortage of qualified anatomy teachers across different countries. This issue is being addressed by developing graduate anatomy training programs where students are taught the different anatomical sciences. These graduates will also need to be trained as educational scholars in order to face the challenges in their future careers as academics. To address this educational need, in this article we discuss the design and development of a new course in 'Anatomy Pedagogy' that we successfully integrated into a new innovative master's program in human anatomy in our institution. This course was designed by utilizing the different principles of the scholarship of teaching and learning. In this article, the authors aim to outline the content of this course and analyse it in light of the scholarship of teaching and learning. This includes the learning outcomes, faculty-led learning, student-led teaching, teaching practicum and the different assessment techniques used on this course. Some of the principles used to analyse this course includes universal design for learning, teaching for understanding, assessment as learning and peer to peer learning. In the coming academic years, the authors aim to collect qualitative and quantitative data what will help inform the future delivery of this course

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Educación interprofesional a través de la atención domiciliaria: experiencia tras 2 años de implementación en los grados de Medicina y Enfermería de la Universidad Europea de Madrid / Interprofessional education at home care: A 2 year experience in the degrees of Medicine and Nursing at the Universidad Europea (Madrid)

INTRODUCCIÓN: La Organización Mundial de la Salud recomienda la educación interprofesional cuando estudiantes de 2 o más profesiones sanitarias aprenden juntos, para favorecer el desarrollo de las competencias interprofesionales que les van a permitir trabajar en equipo proporcionando la mejor asistencia sanitaria. En la Universidad Europea de Madrid existe un programa de educación interprofesional que trabaja las competencias de clarificación de roles, comunicación y autoridad, con estudiantes de diferentes titulaciones. Una de sus actividades es la de atención domiciliaria, en la que participan estudiantes de último curso de Medicina y de Enfermería. El objetivo de este estudio es analizar la percepción de los estudiantes que han participado en la actividad de atención domiciliaria durante el curso 2016-2017 en relación con las 3 competencias interprofesionales. MATERIAL Y MÉTODOS: Estudio cualitativo descriptivo, de corte fenomenológico. Análisis de los fragmentos de texto de las reflexiones de los estudiantes acerca de la actividad de atención domiciliaria mediante el método de comparaciones constantes (codificación abierta y codificación axial). RESULTADOS: Los estudiantes refieren que la actividad les ha ayudado a conocer mejor el rol y las tareas de los médicos y los enfermeros, de una forma diferente a las prácticas clínicas. En cuanto a la comunicación, la basan en el respeto y la confianza. Por último, en cuando a la autoridad, se decantan mayoritariamente por modelos democráticos y horizontales de toma de decisiones. DISCUSIÓN: Los estudiantes perciben que la actividad resulta útil para el desarrollo de las 3 competencias interprofesionales, lo cual coincide con la literatura científica

INTRODUCTION: The World Health Organization recommends implementing interprofessional education programs, where students from 2 or more health professions learn together, to improve interprofessional competency development that will help them to improve collaboration and the quality of care and services. At the Universidad Europea from Madrid there is a program on interprofessional education that develops the following competences: role, communication and authority, with students from several degrees. Home care is one of those activities, undertaken by students from the last years of medicine and nursing. The purpose of this research is to analyze the perception of the students about the interprofessional competences after taken the home care activity during the 2016-17 academic year. MATERIAL AND METHODS: Phenomenological qualitative design. Student's written comments were analyzed using the constant comparative method (open and axial coding). RESULTS: They got to know better the roles played by each other (doctors and nurses) thanks to the fact of working together. In relation to the way they communicate, they mentioned that adequate communication is based in respect and trust to each other. In relation to the different authority models, most of them tended to use and feel better in more horizontal and democratic ways of decision making. DISCUSSION: Students reported that the activity is useful for improving their interprofessional competencies. It is coincident with other studies

What's Your Style? Enhanced Interprofessional Communication and Practice Using the Communication Wheel.

Today's health care environment requires collaborative teams to provide safe, effective care. This study assessed the extent to which a face-to-face workshop increased nursing and premedical students' awareness of varying communication styles and their potential impact on interprofessional communication and practice. A self-assessment tool was administered before, immediately after, and 1 month after the workshop. Significant increases in familiarity working on interprofessional teams, identifying different communication styles, and ability to apply communication strategies were found immediately after and 1 month after the workshop.

Aproximación a la investigación en el Grado en Medicina de la Universidad de Oviedo / Approach to research in the Degree of Medicine of the University of Oviedo

Objetivo: Presentar iniciativas de fomento de la investigación científica realizadas en el primer curso del Grado en Medicina. Sujetos y métodos: Participaron 150 estudiantes de primer curso que recibieron lecciones teóricas (12 horas, en grupos de 75) y cuatro sesiones (6 horas y 45 minutos) de seminarios sobre descubrimientos científicos, análisis de publicaciones y diseño experimental, en grupos de 4-5. Las tareas de los seminarios estuvieron disponibles con 7-15 días de antelación y, sobre ellas, debían elaborar una presentación para las sesiones y un documento escrito. Ambas actividades fueron objeto de calificación. La evaluación de la satisfacción de los estudiantes se realizó mediante una encuesta. Resultados: Las tareas relacionadas con descubrimientos científicos se refirieron a aspectos relevantes de la fisiología, la patología, la terapéutica y los desarrollos tecnológicos aplicados a la medicina. También, han analizado y discutido publicaciones científicas y han elaborado propuestas de diseños de investigación a partir de textos breves facilitados por el profesor. Las calificaciones globales obtenidas, sobre cuatro puntos, han sido: 3,71 ± 0,07 y 3,9 ± 0,3 en las tareas sobre descubrimientos y comentarios de artículos científicos, respectivamente, y 3,6 ± 0,2 en el diseño experimental. El 84% de los matriculados cumplimentaron la encuesta que reflejó una opinión favorable (sobre cinco puntos) de los contenidos teóricos (4,01 ± 0,07), seminarios sobre descubrimientos (3,97 ± 0,1) y diseño experimental (3,87 ± 0,1). Conclusiones: Los estudiantes tienen una opinión favorable de las actividades realizadas y consideran que pueden contribuir a la formación de los médicos en investigación

Aim: To present initiatives for the promotion of scientific research in the Degree of Medicine. Subjects and methods: The participants included 150 first-year students who received theoretical lessons (12 hours, in groups of 75) and, in groups of 4-5, four sessions (6 hours and 45 minutes) of seminars on scientific discoveries, publication analysis and experimental design. The topics of seminars were available 7-15 days in advance on which students had to prepare a presentation, and a written document. Both activities were scored. The evaluation of student satisfaction was carried out through a survey. Results: The tasks were related to scientific discoveries and referred to relevant aspects of physiology, pathology, therapeutics and technological developments applied to medicine. Students also analyzed and discussed scientific publications and prepared research design proposals based on short texts provided by the lecturer. The marks obtained, out of four points, were 3.71 ± 0.07 and 3.9 ± 0.3 on the tasks of discoveries and comments of scientific articles, respectively, and 3.6 ± 0.2 in the experimental design. 84% of those enrolled completed the survey that indicated a favorable opinion (out of five points) on the theoretical contents (4.01 ± 0.07) and seminars on discoveries (3.97 ± 0.1) and experimental design (3.87 ± 0.1). Conclusions: The students had a favorable opinion on the activities and considered that they could contribute to the training of research doctors

Using a structural competency framework to teach structural racism in pre-health education.

The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The authors describe the interdisciplinary pre-health curriculum, titled Medicine, Health, and Society (MHS) at Vanderbilt University. The authors then use a new survey tool, the Structural Foundations of Health Survey, to evaluate structural skills and sensibilities. The analysis compares MHS majors (n = 185) with premed science majors (n = 63) and first-semester freshmen (n = 91), with particular attention to understanding how structural factors shape health. Research was conducted from August 2015 to December 2016. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors and freshmen, and also demonstrated higher understanding of structural and implicit racism and health disparities. The skills that MHS students exhibited represent proficiencies increasingly stressed by the MCAT, the AAMC, and other educational bodies that emphasize how contextual factors shape expressions of health and illness.

A Pipeline Program to Address the South African Crisis in Human Resources for Health.

BACKGROUND: The WHO Africa Region faces a shortage of health workers due to inadequate production of health workers and emigration of physicians and nurses to wealthier countries. South Africa and the United States share a history of discriminatory policies and practices resulting in groups that are under-represented amongst health professionals. One US response is the Area Health Education Centers Program (AHEC), a pipeline program to recruit members of under-represented groups into the health professions. OBJECTIVES: (1) Compare and contrast the United States' AHEC model with that developed in South Africa by Stellenbosch University Faculty of Medicine and Health Sciences SA AHEC in partnership with Morehouse School of Medicine in the United States. (2) Describe a formative evaluation of the Stellenbosch AHEC Program. Methods: Four hundred students (grades 7-12) and 150 teachers participated in SA AHEC with the goal of preparing the students to better compete for university admission. Students received after-school tutoring, holiday schools, and counselling on study skills, health careers, and university entry. Educators received continuing professional education, classroom observation, and feedback. The program was evaluated through a series of interviews and focus groups involving AHEC staff, educators, and parents and caregivers. RESULTS: Program strengths included educator training, collaboration, and increased student maturity, motivation, and academic success. Challenges included limited time with students, the location of some sites, and the educators' need for more engagement with AHEC staff and schools. Quarterly workshops were conducted to address challenges. Over 50% of program alumni are currently enrolled in institutions of higher education. Students will be tracked to determine whether they are able to complete their health professions studies and return to the communities where they grew up, or to similar communities. CONCLUSIONS: With appropriate adaptation and attention to context, it might be possible to implement similar programmes in other African countries. The comparison of the United States and South African models suggested that more parent and teacher participation in an advisory capacity might help to avoid some challenges.

The Importance of the Premedical Experience in Diversifying the Health Care Workforce.

In light of national calls for increased diversity in medicine, it is critical for academic medicine to remain actively engaged in the conversation about the value of diversity in higher education, specifically for students from underrepresented backgrounds. Too often, the undergraduate premedical experience is excluded from conversations about diversity in medicine. The undergraduate premedical experience, however, is a critical junction for many students from backgrounds underrepresented in medicine, especially for those who enter college underprepared for the academic rigor of the premedical experience.In this Commentary, the authors describe the data that currently exist about the premedical experience for underrepresented students. They posit that academic medicine needs to be involved in promoting success for undergraduate students from underrepresented backgrounds, especially given the known societal and educational benefits of a diverse physician workforce. The authors reference the University of Michigan Health Sciences Scholars Program (HSSP) as an example of a partnership between the medical school and the undergraduate campus. HSSP uses higher education best practices known to promote success for underprepared college students. Innovative collaborations between academic medicine and higher education such as HSSP have the potential to increase the diversity of students who are able to matriculate into the health professions. Finally, the authors review issues related to the programming needed to support success for these students.

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

UNLABELLED: 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.

The strategic impact of a post baccalaureate pre-medicine intervention program on medical school academic performance.

The purpose of this longitudinal (11-year) study of the academic impact on post-baccalaureate graduates' performance profiles from years 2001-2011 is to determine whether or not post-baccalaureate program reinforcement, enrichment, and intervention efforts strategically affected the students' academic performance profile while matriculating at Meharry Medical College-School of Medicine. A second purpose of this study is to provide some predictive information to help identify 'at risk' students to ensure that proactive intervention efforts are provided early in their pursuit of a health professions career, thus avoiding the pitfall of unpreparedness and the lack of counseling.

Creating change: building the capacity of the medical workforce in Aboriginal health.

BACKGROUND: This paper provides an overview of the long-term strategies that have been in place at the University of Western Australia, which aim to build the capacity and preparedness of the health-care workforce in Aboriginal health. In 1996, the Centre for Aboriginal Medical and Dental Health was established within the Faculty of Medicine, Dentistry and Health Sciences to implement a comprehensive approach to Aboriginal health. METHODS: The initial focus was on developing recruitment and retention strategies that meaningfully address the significant under-representation of Aboriginal and Torres Strait Islander people in the medical and broader health professions. At the same time, the Centre developed, implemented and evaluated a comprehensive vertically and horizontally integrated Aboriginal health curriculum initially in the Medicine course and subsequently in the Podiatry and Nursing courses within the faculty. RESULTS: The priority has been to ensure that all graduates will be better prepared to work effectively and safely with Aboriginal and Torres Strait Islander people and communities. Without effective alternative entry processes access to tertiary health courses and health careers would not have been an option for the majority of Aboriginal and Torres Strait Islander students and graduates. CONCLUSION: This paper reflects on the partnerships, structures and approaches that have enabled the achievements to date and on the challenges that confront not only initial implementation but also sustaining the gains already made.

Competencies as the basis for reformed premedical education. The case for an unrestricted liberal arts collegiate education.

As the HHMI-AAMC declared, their report should be taken as a "first step in a continuing conversation about the appropriate skills and knowledge," and, echoing the ACGME and GPEP, "values and attitudes that future physicians should possess." (9pExecSum) As a new formulation evolves, the premedical curriculum must foster "scholastic vigor, analytic thinking, quantitative assessment and analysis of complex systems." (9pExecSum) Based on the Mount Sinai experience, these qualities are not engendered solely nor confined to engagement in natural sciences. Students involved in a variety of baccalaureate liberal arts endeavors appear to acquire similar intellectual competencies. Furthermore, when performed successfully in challenging collegiate environments, a thorough liberal arts education may yield precisely the same values, attitudes, and behavioral characteristics all agree are essential to the medical profession and preparing physicians for the twenty-first century.

An analysis of preclinical students' perceptions of cardiothoracic surgical procedures.

BACKGROUND: Interest in cardiothoracic surgery training has decreased, and there is a predicted shortage of 1,500 cardiothoracic surgeons by 2020. This study aims to analyze the attitudes toward cardiothoracic surgery of premedical and medical students in the preclinical years. METHODS: An anonymous electronic survey assessing interest in the cardiothoracic surgery field was sent to preclinical medical students and interviewees at the University of Michigan Medical School in 2010. Respondents were analyzed as a single population (N=566) and then compared in premedical (n=460) and medical student (n=106) groups. Responses were compared using independent-sample t tests. RESULTS: Forty-six percent of respondents were women. Surgical specialty was ranked the top field of interest. Ninety-four percent reported intellectual interest, and 70% listed lifestyle as important factors when considering a specialty. Ninety-two percent of respondents were unaware of the new integrated training programs. Just 4% had had previous mentorship from a cardiothoracic surgeon. In group comparison, salary and lifestyle were of greater concern to the medical group than the premedical group (salary, 47% vs 33%; p<0.01; lifestyle, 78% vs 68%; p<0.05, respectively). Given the ability to achieve one's personal goals, the premedical group was more interested in cardiothoracic surgery than was the medical group (88% vs 76%; p<0.05). CONCLUSIONS: Cardiothoracic surgeons may be better served by aiming their recruiting and mentoring efforts toward premedical students, who are more open to longer training, less concerned about lifestyle and salary, and are generally more interested in pursuing thoracic surgery than are medical students.