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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.

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., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

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., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

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.

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.

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.

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., Competing Interests: The authors have no competing interests to declare., (© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.)

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., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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.

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 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.

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., (© 2012 The Author. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

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.

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., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Underrepresented minorities (URMs) make up a disproportionately small percentage of medical school applicants, matriculants, and physicians relative to the general US population. Preprofessional pipeline programs may help introduce URMs to careers in the medical field. MiniMeds was developed as a paracurricular enrichment program that targeted URM students. The curriculum was designed and administered by medical students, and 2 trials of this program were conducted. Data were collected pre and post program through a survey that assessed knowledge of medical concepts and knowledge of and interest in careers in medicine. Attendance at program sessions correlated with baseline knowledge about medical professions. Knowledge about medical concepts increased significantly from baseline to follow-up for boys, a group significantly represented by URMs in our cohort. Median scores for knowledge of medical careers increased significantly from baseline to followup for URMs as well as for boys and girls. Preprofessional pipeline programs such as MiniMeds are able to engage and develop medical knowledge in URM students at a critical developmental age. Further evaluation and implementation of programs that incorporate medical students to actively develop and lead pipeline programs are warranted.

Objective: To identify contributors to the success of students in medical school that graduate from a 1-year postbaccalaureate bridge program., Method: In 2010, using rigorous qualitative methodology, the principal investigator interviewed a random sample of 15 (23%) of current and past graduates of The Florida State University College of Medicine Bridge program. The investigators recorded and transcribed the interviews, utilized consensual qualitative research methodology to analyze the data, and identified an overarching theoretical construct., Results: Content analysis of all 15 interviews yielded 73 themes, which were grouped into 6 broad categories/domains: The Florida State University College of Medicine Bridge Program attributes, personal attributes, proof of competence, support systems, exposure to medical programs, and faith/religion., Conclusion: Postbaccalaureate programs prepare students for success in medical school. The Florida State University College of Medicine Bridge Program has been particularly successful in identifying and educating students who demonstrated promise upon application, despite noncompetitive grades and Medical College Admission Test scores. The authors identify the characteristics and individual experiences of the students and program that relate to success.

Ever since Abraham Flexner formalized the idea of premedical education in 1910, medical educators have argued about how best to prepare students for medical school. This back-and-forth about the premedical years has focused almost exclusively on the range and content of the required course work; noticeably absent from the debate is consideration of the ways in which the experience of the premedical years-including the curricular and noncurricular demands placed on students-shape the moral education of the next generation of physicians. The authors review the century-long conversation about premedical education, highlighting the themes of that discussion and the important aspects of being a "premed" that have not been a part of the conversation. From their systematic review of college and university Web sites designed for premedical students and from comments collected from a symposium on the premedical years, the authors describe how life as a premedical student, and not just curricular content, teaches important lessons about what it means to be a professional. The authors also report important disparities in attitudes about premedical education; for example, premedical advisors regard the "sifting process" of premedical education as a "journey of discovery," whereas students describe their premedical years as a competition. The authors' work suggests a new approach to premedical education, an approach that combines the coursework needed to succeed in medical school with formal opportunities to reflect on both the positive and pernicious effects of the premedical years.

Imperative to increasing diversity in the physician workforce is increasing the pool of qualified underrepresented minority applicants to medical schools. With this goal in mind, the Texas A&M Health Science Center College of Medicine (A&M College of Medicine) has partnered with Prairie View A&M University (PVAMU), a historically black college and university that is a component of the Texas A&M university system, to develop the undergraduate medical academy (UMA). The UMA was established by legislative mandate in 2003 and is a state-funded program. The authors describe the development of partnership between the A&M College of Medicine and PVAMU, focusing on the key attributes that have been identified for success. The administrative structure of the UMA ensures that the presidents of the two institutions collaborate to address issues of program oversight and facilitates a direct relationship between the dean and associate dean for academic affairs of A&M College of Medicine and the director of the UMA to define the program objectives and structure. The authors delineate the admission process to the UMA, as well as the academic requirements of the program. Students attend lecture series during the academic year and participate in summer programs on the A&M College of Medicine campus in addition to receiving intensive academic counseling and opportunities for tutoring in several subjects. The authors also describe the initial success in medical school admissions for UMA students. This partnership provides a model blueprint that can be adopted and adapted by other medical schools focused on increasing diversity in medicine.

Medicine is a uniquely powerful platform for teaching science and ethics, technology and humanity, life and death. Yet, society has historically limited medical education to a select few, and only after an advanced course of premedical studies. In an era when biomedical literacy is increasingly viewed as a national imperative, the authors hypothesized that advanced instruction in medicine could be intellectually transformative among a broad range of young people. Using high-fidelity patient simulators, a group of college and high school students was immersed in a weeklong course designed to replicate the practice of modern medicine. On the basis of the students' reported experiences, the authors feel that patient simulation can foster forceful interest in the life sciences at an early age. Such efforts could catalyze a significant expansion of interest in biomedical science among students nationwide.

The Post-Baccalaureate (postbac) Premedical Certification Program at the University of North Texas Health Science Center provides an opportunity for individuals to enhance their credentials for entry into medical school by offering a challenging biomedical science core curriculum in graduate biochemistry, cell biology, physiology, and pharmacology. In addition, students (called postbacs) receive instruction in human gross anatomy, histology, and embryology with first-year medical students. More than 90% of the students accepted into the postbac program have applied to medical school previously but have been rejected by admission committees at least once, primarily because of low cognitive scores. In spring 2001, seven postbacs completed the program, of which only one was admitted into the Texas College of Osteopathic Medicine (TCOM), the medical school affiliated with the University of North Texas Health Science Center. Three postbacs went to other medical schools. Thirty-one completed the program by spring 2006, of whom 13 were admitted to TCOM, and eight to other medical schools. After six years, 101 postbacs have completed the program, and 70 have been accepted into medical schools. Postbacs admitted into TCOM have performed well compared with their medical school classmates. Overall, average scores for postbacs are above those of their medical school classmates. In addition, postbacs have taken class leadership positions, served as tutors and mentors, and have served as school ambassadors for new applicants. The postbac premedical program has proven to be very successful in preparing students for the rigors of a medical school curriculum by allowing these students to develop the skills and confidence necessary to compete.

Objective: Since 1994 a state-wide program has been operating in Queensland to provide non-metropolitan secondary school students with information about health careers. Determination of the factors influencing the career decisions of rural and remote students was one objective of the evaluation of that program., Design: Telephone interviews., Setting: Secondary schools., Subjects: People who had previously attended Year 10 residential health career workshops run by Queensland Health. Ninety-four of 277 past participants to Year 10 Health Careers Workshops responded to a postal questionnaire and were invited to take part in a telephone questionnaire to collect further information related to the course and career choices., Main Outcome Measures: Self-reported factors affecting career decisions of students from rural and remote areas., Results: Of the 94 past workshop participants, interviews were held with 70. All participants had left secondary education and had either undertaken or were undertaking some form of tertiary study. The most influential of nine factors to both undergraduate and postgraduate course choices was self-interest. Various other factors differentially contributed to undergraduate and postgraduate course choices among them were the health careers workshops, which played a major influence on undergraduate course decisions of students., Conclusion: Self-interest is the largest self-reported factor to career decision making among students from rural and remote areas. Finance and career advice from school are not considered to be highly influential. However, these independent decisions can be substantially influenced by external information provided through health career workshops.

Objective: Since 1994, as part of the Health Careers in the Bush program, Queensland Health has run residential workshops to provide secondary school students from rural and remote areas with information about health careers. This study reports on the influence of the program on tertiary course selection., Design: Self-administered mail survey and telephone interviews., Setting: Secondary schools., Participants: Past students who had in year 10 attended residential career workshops run by Queensland Health., Main Outcome Measures: Tertiary courses; self-reported influence of the workshop program on raising awareness and course selection., Results: Over 90% of participants reported that the workshops had a major impact on their course and career selection. The workshops provided exposure to a wide variety of health-related disciplines, enabling students to be better informed about their course and career plans within the industry. Half of the students changed their course as a result of attending a workshop, and 83% enrolled in a health-related course. The 17% who did not enrol in a health-related course also recognised the value of the workshop program., Conclusion: The workshop program raised awareness of health professions and offered valuable information to rural students about a wide range of health careers. Results suggest that provision of such information in a residential-workshop format contributed significantly to tertiary course selection of rural and remote students. The benefit to the health industry from these workshops has been substantial in relation to the small amount of funds invested.

The Stanford Medical Youth Science Program (SMYSP) is a biomedical pipeline program that seeks to diversify the health professions by providing academic enrichment in the medical sciences and college admissions support to very low-income high school students. Each summer 24 students are recruited from over 250 California high schools for the five-week residential program, led by 10 undergraduate students. Participants divide their time between classroom instruction, anatomy practicums, hospital field placements, research projects, and college admissions advising. Since its inception in 1988, 405 students have completed SMYSP and 96% have been observed for up to 18 years. The majority are from underrepresented minority groups (33.3% Latino, 21.7% African American, 4.0% Native American), many with poor academic preparation. One hundred percent of age-eligible participants have graduated from high school, and 99% have been admitted to college. Of those admitted to college (and not currently college students), 81% have earned a four-year college degree, the majority majoring in biological and physical sciences (57.1%). Among four-year college graduates, 52% are attending or have graduated from medical or graduate school. Many of the four-year college graduates (44.4%) are becoming or have become health professionals. This program, distinguished by direct participation in the sciences, strong mentoring, college admissions preparation, and long-term career guidance, has been highly successful in reaching low-income students and preparing them for medical and other careers. Results highlight the need to track students for as long as 10 to 15 years to accurately assess college graduation rates and acceptance to medical and graduate school.

Objective: To develop a one week widening access summer school for 16 year old pupils from non-traditional backgrounds who are considering applying to medical school, and to identify its short term impact and key success factors., Design: Action research with partnership schools in deprived inner city areas in five overlapping phases: schools liaison, recruitment of pupils and assessment of needs, programme design, programme delivery, and evaluation. The design phase incorporated findings from one to one interviews with every pupil, and workshops and focus groups for pupils, parents, teachers, medical student assistants, NHS staff, and other stakeholders. An in-depth process evaluation of the summer school was undertaken from the perspective of multiple stakeholders using questionnaires, interviews, focus groups, and observation., Participants: 40 pupils aged 16 years from socioeconomically deprived and under-represented ethnic minority groups., Results: The summer school was popular with pupils, parents, teachers, and staff. It substantially raised pupils' confidence and motivation to apply to medical school. Critical success factors were identified as an atmosphere of "respect"; a focus on hands-on work in small groups; the input of medical students as role models; and vision and leadership from senior staff. A particularly popular and effective aspect of the course was a grand round held on the last day, in which pupils gave group presentations of real cases., Conclusion: An action research format allowed us to draw the different stakeholders into a collaborative endeavour characterised by enthusiasm, interpersonal support, and mutual respect. The input from pupils to the programme design ensured high engagement and low dropout rates. Hands-on activities in small groups and social drama of preparing and giving a grand round presentation were particularly important.

The Jackson Heart Study Undergraduate Training Center (UTC) at Tougaloo College was developed to increase the numbers of African-American students entering public health and health related fields. The UTC includes a scholars program for undergraduate students at Tougaloo College, three four-week programs for high school students called the SLAM (science, language arts, and mathematics) workshops, and an introductory epidemiology course for healthcare professionals and graduate students. The scholars program recruits 12 Tougaloo College freshmen annually for the duration of their undergraduate education. As of the 2005 summer, 512 students have enrolled in the SLAM workshops. The introduction to epidemiology course has provided training for 155 individuals from 1999 to 2004. This paper documents the need for this program based on the conspicuously small proportion of African Americans who are health practitioners in Mississippi. The content and selection process for each program is described, and a summary of the enrollment history, characteristics of the program participants, and their accomplishments is presented. Finally, the methods of program assessment and tracking are discussed.

The purpose of this study was to assess the career maturity of 168 minority and disadvantaged premedical students upon entry into a medical education preparatory program. All took the Medical Career Development Inventory as a pre-assessment in the course. Students' scores identified three instructional groups: on, below, and above instructional level. A model for career intervention for postbaccalaureate premedical programs is presented.

Background: Many countries in Latin America are seeking to expand primary care services provided through their health care systems. Family physicians are an essential component of an effective primary care workforce, but we know little about the status of family practice training in Latin America. This study examines predoctoral training in family practice in four Latin American countries and identifies factors affecting its incorporation into medical training institutions., Methods: A Spanish language survey was mailed to the heads of all medical schools in Argentina, Colombia, Mexico, and Panama (n=100), asking about the status of family practice training at the school and factors perceived as facilitating or impeding its acceptance by the institution. Quantitative data were analyzed for frequency, and qualitative data were analyzed for content and theme., Results: Sixty-five of the 100 schools responded to the survey. Of these, only 34 (52%) provide training in family practice at the predoctoral level, and only nine (14%) have established departments of family medicine. Barriers to inclusion of family medicine include lack of financial and human resources, definition of family practice as a subject rather than a specialty, and a perceived lack of interest among students., Discussion: Inclusion of family medicine into medical education in Latin America has been slow. Unless strategies can be developed to increase training for family physicians in Latin American countries, governments in the region will have difficulty expanding primary health care services in their systems. Support is needed from governments, public health officials, funding agencies and organizations, and the academic community to increase training of family physicians in Latin America.

Context: Small local colleges may be sources of medical students with the gender, ethnicity, and background that promote identity with and empathy for underserved populations., Purpose: This study examined the impact of attendance at these premedical colleges on outcomes of medical education., Methods: Data for 2508 matriculates to the University of Alabama School of Medicine, a state-supported medical school, were examined according to premedical colleges attended., Findings: Medical students who had graduated from small local colleges were more diverse in gender, race, and rural background than other students. They had slightly lower academic performance in medical school, were more likely to drop out (10.6% versus 5.3% overall), and were more likely to locate in rural areas of the host state., Conclusions: Small local colleges may be rich sources of student diversity and medical students who choose rural practice, outcomes that are gained at a cost in terms of drop-out rate. Compared with other students, minor differences in performance and larger differences in the drop-out rate raise the question of cultural context and social support during medical school as points for intervention.

The objective of this study was to examine the students' views on a transitional course for Asian freshers in a revised medical curriculum. Data were collected through the year-end questionnaire distributed to all first-year students over three academic years from 1997 to 2000. The students considered the transitional course had encouraged them to become more active and self-directed although there were different views about its overall effectiveness. Students appeared uncertain as to the depth in which they were expected to master the subjects, thus leading them to call for more clearly stated learning objectives to help relieve the anxiety they had towards the examinations. Lectures and self-assessment exercises were seen to be providing the general guides for that.

Recent studies have shown that the most effective strategy to increase the number of practicing rural physicians is to admit more students with affinity for rural practice to medical school. A significant limitation of this strategy is the generally lower scores made on standardized tests by those from smaller high schools in rural areas. Although once admitted these students perform on a par with their urban counterparts, admission remains an obstacle for many. This report summarizes the second year of an innovative program that placed rising high school seniors in shadowing opportunities in their home towns while providing preparation for the ACT exam in a virtual classroom environment. Results show that the 20 students involved increased their knowledge of the strengths and weaknesses of health care in their towns as well as their understanding of how various health professionals function. The ACT composite score increased by 1.2 points, to 23. The reading and science subscores showed the largest increase. Although labor-intensive for the coordinators, the program was successful in meeting the stated goals.

The Special Premedical Studies Program (SPSP) has been successful in preparing Aboriginal students in Canada for admission to medicine, dentistry, medical rehabilitation, and pharmacy at the University of Manitoba. The success rate for admission to these faculties is 20%. There is a higher failure rate in the basic years of medical/dental education, but remediation has been 100% successful. Failure rates in the clinical years do not differ from those of the mainstream population. Grade point averages and MCAT scores are given less weight in the special consideration category of application at the University of Manitoba. SPSP students can and do apply to this category. The higher rate of first unsuccessful attempt in the basic years of medical education specifically can be attributed to a variety of factors, including reading skills. Although the numbers are small, we show that there is a correlation between the comprehension score of the Nelson-Denny test and the verbal score of MCAT. But there was no difference on the average between verbal score in MCAT and pass/fail in basic medical years. Students who scored above the 80th percentile on the comprehension portion of the Nelson-Denny test were successful in their first attempt at examinations in medical school.

Background: Since 1973 the Sophie Davis School of Biomedical Education, City University of New York Medical School, has integrated baccalaureate education with preclinical medical education; its graduates earn BS degrees in five years and are then eligible for entry into the traditional third year of medical school at one of seven participating medical schools in New York State. The school has a twofold mission: (1) to expand access to medical careers among inner-city youths, particularly among underrepresented minorities, and (2) to encourage the pursuit of primary care specialties among its graduates., Method: To assess the extent to which the two goals of the school have been met, the authors collected and analyzed information on the 1,402 students who entered Sophie Davis between 1973 and 1992, especially the 1,068 students from the 15 classes that entered the school from 1973-74 through 1987-88. In particular, the analysis focused on data on academic achievement and on choice of practice specialty. Where possible, state and national data were used for comparison., Results: The results suggest that the school has achieved varying degrees of success: (1) The program has expanded access to medical careers among underrepresented-minority students at success rates well above national averages for college freshmen entering traditional premedical curricula. (2) Graduates have chosen primary care specialties at a somewhat higher rate than the national average, despite the school's lack of official involvement with students once they began clinical training in medical school., Conclusion: The aggregate data show that the school has achieved success in expanding access to medical careers for inner-city youth (especially among underrepresented minorities) and has been at least partially successful in nurturing primary care physicians. The latter goal may be realized more fully if the school becomes more involved in the clinical education of its graduates.

Baylor College of Medicine has conducted a summer enrichment program for minority/disadvantaged premedical students since 1969. Follow-up data on medical school application and acceptance for participants from 1980 through 1984 were analyzed in relation to selected preprogram variables--cumulative college grade point average, total Scholastic Aptitude Test score, competitiveness of undergraduate college, sex, and ethnicity. Results of univariate and multivariate analyses indicated that: 1) females were significantly less likely to apply to medical school than males, 2) females had significantly lower mean MCAT scores (5.9 vs 7.2) even though their preprogram academic performance was comparable to that of the males, and 3) after controlling for MCAT scores, none of the preprogram variables were significant in predicting medical school acceptance. These findings suggest the need for research to explain the discrepancy between male and female MCAT performance and frequency of medical school application in summer program participants. The findings also have implications for the type of counseling provided to female participants in summer enrichment programs.