Review Article

Undergraduate College Pathway Programs Designed to Attract and Matriculate Students from Underrepresented Groups into Medicine

Authors: Kristina Kaljo, PhD, Michael T. Braun, PhD, Ragasnehith Maddula, BS, Catherine C. Ferguson, MD, Eliana Bonifacino, MD, MS, Amy Farkas, MD

Abstract

Objectives: Undergraduate college pathway (or pipeline) programs support students’ interests as they explore advanced degree and career pathways. Many programs aim to diversify the medical workforce by reducing barriers that may have otherwise prevented desired academic and career goals; however, variability in structure, expectations, benefits, and outcome data exist. This systematic review was conducted to identify and evaluate undergraduate college pathway programs designed to increase the diversity of medical school matriculants.

Methods: We searched Ovid Medline, PsycInfo, Scopus, and the Education Resources Information Center for peer-reviewed, original research publications (1996–2019) describing US pathway/pipeline programs designed for undergraduate-level college students from underrepresented groups to apply and enter medical school. Data extraction included application processes, participant demographics, curricular components, social support systems, mentorship, funding, and program/participant outcomes. We reviewed the journal impact factor to inform us about where articles are being published.

Results: Our full-text review included 137 articles; 25 articles met the inclusion criteria. All of the papers were descriptive, requiring an application, minimum grade point average, letters of recommendation, and personal statements. All of the programs aimed to diversify medicine, yet some could not request identification of race/ethnicity because of changes in affirmative action or legal restrictions when reporting demographics. Women represented the majority of enrollees. The program length varied; all reported having one or a combination of academic enrichment, research, field observation/experience, and mentorship. All of the programs included career development and various supplemental social supports. Only two programs provided comparison data; four reported no outcomes.

Conclusions: Pathway programs support the acquisition and enhancement of professional skills. Lacking longitudinal or comparison data leads to questions of the long-term impact on diversifying the medical workforce. This article highlights a need for rigorous data collection methods and transparent reporting of participant outcomes to inform programmatic efficacy.

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References

1. Association of American Medical Colleges. Matriculants to U.S. MDgranting medical schools by race, selected combinations of race/ethnicity and gender, 2019-2020 through 2022-2023. https://www.aamc.org/data-reports/students-residents/data/2023-facts-applicants-and-matriculants-data. Accessed March 15, 2023.
 
2. Mora H, Obayemi A, Holcomb K, et al. The national deficit of Black and Hispanic physicians in the US and projected estimates of time to correction. JAMA Netw Open 2022;5:e2215485.
 
3. Weiner S. More students are entering medical school. https://www.aamc.org/news/more-students-are-entering-medical-school. Published December 16, 2020. Accessed September 12, 2021.
 
4. Smedley BD, Stith Butler A, Bristow LR, eds. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press; 2004.
 
5. Morris DB, Gruppuso PA, McGee HA, et al. Diversity of the national medical student body—four decades of Inequities.N Engl J Med 2021;384:1661–1668.
 
6. US Census Bureau. Profiles. Nation. United States. https://data.census.gov/ cedsci/profile?g=0100000US. Accessed March 15, 2023.
 
7. Noe-Bustamante L, Lopez MH, Krogstad JM. U.S. Hispanic population surpassed 60 million in 2019, but growth has slowed. https://www. pewresearch.org/fact-tank/2020/07/07/u-s-hispanic-population-surpassed-60- million-in-2019-but-growth-has-slowed. Published July 7, 2020. Accessed October 11, 2021.
 
8. Stowers JA, Desrosiers S, Zeleke K, et al. The life of a Black medical trainee in the United States: past, present, future. J Natl Med Assoc 2021;113:43–45.
 
9. Association of American Medical Colleges. 2022 physician specialty data report. Executive summary. https://www.aamc.org/media/63371/download? Published January 2023. Accessed March 17, 2023.
 
10. Serchen J, Doherty R, Hewett-Abbott G, et al. Understanding and addressing disparities and discrimination in education and in the physician workforce. https://assets.acponline.org/acp_policy/policies/understanding_discrimination_in_education_physician_workforce_2021.pdf. Published 2021. Accessed October 11, 2021.
 
11. American Medical Association. Protecting underrepresented students and residents during COVID-19. https://www.ama-assn.org/delivering-care/public-health/protecting-underrepresented-students-and-residents-during-covid-19. Published July 6, 2020. Accessed September 19, 2021.
 
12. Association of American Medical Colleges. A healthier future for all. The AAMC Strategic Plan. https://www.aamc.org/about-us/strategic-plan/healthier-future-all-aamc-strategic-plan. Published October 2020. Accessed October 21, 2021.
 
13. Byrd CD, Mason RS. Academic Pipeline Programs: Diversifying Bachelor’s to the Professoriate. Ann Arbor: University of Michigan Press; 2021.
 
14. Smith SG, Nsiah-Kumi PA, Jones PR, et al. Pipeline programs in the health professions, part 1: preserving diversity and reducing health disparities. J Natl Med Assoc 2009;101:836–851.
 
15. Ladson-Billings G. From the achievement gap to the education debt: understanding achievement in U.S. schools. Educ Res 2006;35:3–12.
 
16. Strayhorn TL. Bridging the pipeline: Increasing underrepresented students’ preparation for college through a summer bridge program. Am Behav Sci 2011;55:142–159.
 
17. Rice VM. Diversity in medical schools: a much-needed new beginning. JAMA 2021;325:23–24.
 
18. Carline JD, Patterson DG, Davis LA, et al. Enrichment programs for undergraduate college students intended to increase the representation of minorities in medicine. Acad Med 1998;73:299–312.
 
19. Kmet LM, Lee RC, Cook LS. Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. HTA Initiative #13. Edmonton, Alberta, Canada: Alberta Heritage Foundation for Medical Research; 2004.
 
20. Saha S, Saint S, Christakis DA. Impact factor: a valid measure of journal quality? J Med Libr Assoc 2003;91:42–46.
 
21. Jackson JL, Srinivasan M, Rea J, et al. The validity of peer review in a general medicine journal. PLoS ONE 2011;6:e22475.
 
22. Rackley BP, Wheat JR, Moore CE, et al. The Southern Rural Access Program and Alabama’s rural health leaders pipeline: a partnership to develop needed minority health care professionals. J Rural Health 2003;19(suppl):354–360.
 
23. Srinivasan A, Brown J, Fahmy N, et al. Preparing African Americans for careers in health care: the Jackson Heart Study. Ethn Dis 2005;15(4 suppl 6): S6-71–S6-75.
 
24. Parrish AR, Daniels DE, Hester RK, et al. Addressing medical school diversity through an undergraduate partnership at Texas A&M Health Science Center: a blueprint for success. Acad Med 2008;83:512–515.
 
25. Salto LM, Riggs ML, Delgado de Leon D, et al. Underrepresented minority high school and college students report STEM-pipeline sustaining gains after participating in the Loma Linda University Summer Health Disparities Research Program. PLoS ONE 2014;9:e108497.
 
26. Guerrero AD, Holmes FJ, Inkelas M, et al. Evaluation of the pathways for students into health professions: the training of under-represented minority students to pursue maternal and child health professions. Matern Child Health J 2015;19:265–270.
 
27. Kuo AA, Verdugo B, Holmes FJ, et al. Creating an MCH pipeline for disadvantaged undergraduate students. Matern Child Health J 2015;19:2111–2118.
 
28. Campbell KM, Brownstein NC, Livingston H, et al. Improving underrepresented minority in medicine representation in medical school. South Med J 2018;111:203–208.
 
29. Upshur CC, Wrighting DM, Bacigalupe G, et al. The health equity scholars program: innovation in the leaky pipeline. J Racial Ethn Health Disparities 2018;5:342–350.
 
30. Taylor S, Iacobelli F, Luedke T, et al. Improving health care career pipeline programs for underrepresented students: program design that makes a difference. Prog Community Health Partnersh 2019;13:113–122.
 
31. Crews DC, Wilson KL, Sohn J, et al. Helping scholars overcome socioeconomic barriers to medical and biomedical careers: creating a pipeline initiative. Teach Learn Med 2020;32:422–433.
 
32. Stewart KA, Brown SL, Wrensford G, et al. Creating a comprehensive approach to exposing underrepresented pre-health professions students to clinical medicine and health research. J Natl Med Assoc 2020;112:36–43.
 
33. Holsti M, Clark EB, Fisher S, et al. Lessons from the first decade of the Native American summer research internship at the University of Utah. Acad Med 2021;96:522–528.
 
34. Michalek AM, Johnson CR. Cancer research training for high school and college students at a comprehensive cancer center. J Cancer Educ 2004;19: 209–211.
 
35. Cervantes L, Chu E, Nogar C, et al. A hospitalist mentoring program to sustain interest in healthcare careers in under-represented minority undergraduates. J Hosp Med 2014;9:586–589.
 
36. Odedina FT, Reams RR, Kaninjing E, et al. Increasing the representation of minority students in the biomedical workforce: the ReTOOL Program. J Cancer Educ 2019;34:577–583.
 
37. Campbell KM, Berne-Anderson T, Wang A, et al. USSTRIDE program is associated with competitive Black and Latino student applicants to medical school. Med Educ Online 2014;19:24200.
 
38. White WB, Srinivasan A, Nelson C, et al. Capacity-building for career paths in public health and biomedical research for undergraduate minority students: a Jackson Heart Study success model. Ethn Dis 2016;26:399–406.
 
39. Podawiltz A, Richardson J, Gleason W, et al. What the Joint Admission Medical Program (JAMP) can do for Texas physicians; what Texas physicians can do for JAMP. Tex Med 2012;108:e1.
 
40. Coronado GD, Shuster M, Ulrich A, et al. Strategies for diversifying the pool of graduate students in biomedical sciences. J Cancer Educ 2012;27: 436–442.
 
41. Collins TW, Aley SB, Boland T, et al. BUILDing SCHOLARS: enhancing diversity among US biomedical researchers in the Southwest. BMC Proc 2017;11(suppl 12):12.
 
42. Fang WL, Woode MK, Carey RM, et al. The medical academic advancement program at the University of Virginia School of Medicine. Acad Med 1999; 74:366–369.
 
43. Alfred L, Beerman PR, Tahir Z, et al. Increasing underrepresented scientists in cancer research: the UCSD CURE program. J Cancer Educ 2011;26: 223–227.
 
44. Vaidyanathan B. Professional socialization in medicine. AMA J Ethics 2015; 17:160–166. .
 
45. Keith L, Hollar D. A social and academic enrichment program promotes medical school matriculation and graduation for disadvantaged students. Educ Health (Abingdon) 2012;25:55–63.
 
46. Bliss C, Wood N, Martineau M, et al. Exceeding expectations: students underrepresented in medicine at University of Utah Health. Fam Med 2020; 52:570–575.
 
47. Johnson JC, Jayadevappa R, Taylor L, et al. Extending the pipeline for minority physicians: a comprehensive program for minority faculty development. Acad Med 1998;73:237–244.
 
48. Hussar B, Zhang J, Hein S, et al. The condition of education 2020 (NCES 2020-144). https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2020144. Published 2020. Accessed October 5, 202.
 
49. Solchanyk D, Ekeh O, Saffran L, et al. Integrating cultural humility into the medical education curriculum: strategies for educators. Teach Learn Med 2021;33:554–560.
 
50. Callaham M, Wears RL, Weber E. Journal prestige, publication bias, and other characteristics associated with citation of published studies in peer-reviewed journals. JAMA 2002;287:2847–2850.
 
51. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, and Office of Public Health and Science, Office of Minority Health. Pipeline programs to improve racial and ethnic diversity in the health professions: an inventory of federal programs, assessment of evaluation approaches, and critical review of the research literature. https://www.aapcho.org/wp/wp-content/uploads/2012/11/PipelineToImproveDiversityInHealthProfessions.pdf. Published April 2009.
 
52. American Medical Association. AMA Physician Professional DataTM. https://www.ama-assn.org/about/physician-professional-data/ama-physician-professional-data. Accessed October 2021.
 
53. Burgos JL, Yee D, Csordas T, et al. Supporting the minority physician pipeline: providing global health experiences to undergraduate students in the United States-Mexico border region. Med Educ Online 2015;20:27260.