Why students drop out of the pipeline to health professions careers: a follow-up of gifted minority high school students.

PURPOSE: To track gifted underrepresented minority (URM) students who entered the pipeline to health professional school when they were in high school and to determine whether and why students left the pipeline to enter other professions. METHOD: A questionnaire was mailed to 162 students who had participated in the Student Educational Enrichment Program (SEEP) in health sciences at the Medical College of Georgia between 1984 and 1991; 123 (75%) responded. RESULTS: Students in the study population had higher graduation rates than the average state or national student. Fifty-nine (48%) of the students had entered health care careers; 98% had stated that intention when they were in high school. Although some of the students stated trouble with course work and GPA as reasons for their decisions to change career tracks, many students said that their interests in non-medical careers had been fostered by mentors or by opportunities to serve internships. CONCLUSION: Early intervention is important to retaining students in a pipeline that leads to a health care career. Summer programs are successful, but may not be enough to help students with difficult science courses in college, especially chemistry. However, another important conclusion is that much more needs to be done to help students find mentors with whom they can develop relationships and to give them opportunities to work in health care settings.

Predicting the admission into medical school of African American college students who have participated in summer academic enrichment programs.

PURPOSE: To identify cognitive and noncognitive variables as predictors of the admission into medical school of African American college students who have participated in summer academic enrichment programs (SAEPs). METHOD: The study sample comprised 309 African American college students who participated in SAEPs at the Medical College of Georgia School of Medicine from 1980 to 1989 and whose educational and occupational statuses were determined by follow-up tracking. A three-step logistic regression was used to analyze the data (with alpha = .05); the criterion variable was admission to medical school. The 17 predictor variables studied were one of two types, cognitive and noncognitive. The cognitive variables were (1) Scholastic Aptitude Test mathematics (SAT-M) score, (2) SAT verbal score, (3) college grade-point average (GPA), (4) college science GPA, (5) SAEP GPA, and (6) SAEP basic science GPA (BSGPA). The noncognitive variables were (1) gender, (2) highest college level at the time of the last SAEP application, (3) type of college attended (historically African American or predominately white), (4) number of SAEPs attended, (5) career aspiration (physician or another health science option) (6) parents who were professionals, (7) parents who were health care role models, (8) evidence of leadership, (9) evidence of community service, (10) evidence of special motivation, and (11) strength of letter of recommendation in the SAEP application. For each student the rating scores for the last four noncognitive variables were determined by averaging the ratings of two judges who reviewed relevant information in each student's file. RESULTS: In step 1, which explained 20% of the admission decision variance, SAT-M score, SAEP BSGPA, and college GPA were the three significant cognitive predictors identified. In step 2, which explained 31% of the variance, the three cognitive predictors identified in step 1 were joined by three noncognitive predictors: career aspiration, type of college, and number of SAEPs attended. In step 3, which explained 29% of the variance, two cognitive variables (SAT-M score and SAEP BSGPA) and two noncognitive variables (career aspiration and strength of recommendation letter) were identified. CONCLUSION: The results support the concept of using both cognitive and noncognitive variables when selecting African American students for pre-medical school SAEPs.

Refining a method of identifying CUNY Medical School graduates practicing in underserved areas.

PURPOSE: To determine what percentage of graduates from the City University of New York (CUNY) Medical School/Sophie Davis School of Biomedical Education practiced in underserved areas of New York State and, in the process, to develop a reliable way of collecting and verifying the information needed to carry out such an outcomes study. METHOD: The study group consisted of the 414 CUNY graduates who had completed their MD degrees by 1986. Addresses of graduates' practices were confirmed for 79% of the graduates, 49% of whom practiced in New York State. New York State zip codes were used as a way to identify underserved areas throughout the state. RESULTS: Of the 160 graduates with practices in New York State, 33% had practices in underserved areas (and 81% of these were located in New York City). In all, 26% of the whites, 73% of the African Americans, 43% of the Asian Americans, 50% of the Latinos, 34% of the women, and 32% of the men had practices in underserved areas. CONCLUSION: The graduates' race-ethnicity was an important factor in the likelihood of their practicing in an underserved area, whereas gender was not, a finding consistent with previous studies. Medical schools and residency programs need to institute long-term programs to track the career paths of all their graduates so that questions about the proportions of graduates in underserved areas will be relatively easy to answer.

College majors and career choices of minority high school student research apprentices.

This study's purpose was to determine the college majors and career choices of students who participated in the Minority High School Student Research Apprentice Program (MHSSRAP) at the Medical College of Georgia School of Medicine, sponsored by the National Institutes of Health. A tracking system was initiated to follow up the participants to determine college majors during matriculation and career choices after graduation. The tracking included telephone interviews and questionnaires mailed to 55 participants from 1981 to 1994, the length of the program. The typical student in the cohort is an African-American man residing in a metropolitan area (70%) of Georgia. Sixty percent of the research apprentices come from working class parents. All 55 (100%) apprentices matriculated to a college or university. Thirty-one students (56%) had biology as their undergraduate major in college; 15%, liberal arts; 11%, chemistry; 7%, allied health disciplines; and 11%, other. Twenty-nine (53%) of these students graduated from college. Twenty-three of 29 (79%) graduates chose a medical or health science career, and 17 of 29 students (59%) matriculated into medical school. In Georgia, 30.1% of white students graduate from high school, and 14.6% obtain a baccalaureate degree. In contrast, 28% of blacks graduate from high school, and 7.5% graduate from college. We concluded that the Minority High School Student Research Apprentice Program is an important link in the student pipeline from high school to research careers and/or biomedical science careers. The research experience at an academic medical center and a college science major have great influence in the choice of medicine as a career.

Task Force 1: The underserved.

The ACC has affirmed its commitment to universal access to health care. Underserved populations exist in urban and rural centers. Common to each is a paucity of personnel trained in cardiovascular care and a lack of access to preventive and highly technologic services. These factors contribute to a poor health outcome (75). Part of the rural problem can be corrected by the transfer of information to local providers by the use of new information systems. Included would be real-time electronic consultation, on-site subspecialty visits and the appropriate use of nonphysician providers (15). The urban problem requires changes in priorities and responsibilities of the academic health centers toward the communities they serve. Curricula changes of cardiovascular specialists, internists, generalists and nonphysician health care personnel must include diversity in training, physician training of ethnically matched providers in addition to technical excellence and research into methods of patient education and motivation for a healthier life-style (51). Reimbursement must appropriately reward those caring for underserved patients and those providing evaluation and management services (43,52).

Hemoptysis in a patient with congestive heart failure and pulmonary emboli.

This article reports a case of profuse hemoptysis in pulmonary embolism and reviews the literature. A 74-year-old patient with hypertension and dilated cardiomyopathy was admitted to the hospital for exacerbation of congestive heart failure and hemoptysis. During hospitalization, the patient had hemoptysis of 270 cc during a 24-hour period. Chest radiograph showed bilateral lower lobe infiltration. Fiberoptic bronchoscopy was performed and revealed active bleeding from both lower lobes of the lungs. An endobronchial lesion was not seen, and the patient had an open lung biopsy. Histological examination of the lung tissue revealed an organized thrombus.

Careers in academic medicine and clinical practice for minorities: opportunities and barriers.

The United States has a shortage of physicians from underrepresented minorities. Under-representation of ethnic minority academic faculty is due to multiple factors, including an inadequate number of minority medical school graduates, indebtedness of minority postgraduate trainees, lack of awareness of opportunities in academic medical centers, lack of mentors, a shortage of role models, and environmental factors. Over recent years, the government, private industry, and some universities and medical schools have made efforts to remedy this situation. The problems, however, are complex and difficult to solve. There is a need to increase the pool of underrepresented minority students interested in careers in medicine; to promote medical student, graduate student, and house staff awareness of career opportunities in academics; to provide resources that enable students, house staff, and fellows to develop the skills necessary to succeed and survive in the academic arena; and to offer ongoing support for career development of junior faculty. A number of programs exist for attracting more minorities to academic medicine, but obtaining information on them is often difficult. The development of a centralized resource center where program information is readily available should be a priority. An effort to coordinate activities of existing programs by the Institute of Medicine and/or the Association of American Medical Colleges (AAMC) is needed. A target goal should be developed for increasing minorities in graduate medical education and academic medicine similar to the AAMC's Project 3000 by 2000.

Specialty choices and practice locales of black graduates from a predominantly white medical school.

PURPOSE: To determine the specialty choices, practice locales, patient populations, and professional achievements of black graduates from a predominantly white medical school. METHOD: Of the 136 black graduates from the Medical College of Georgia School of Medicine (MCGSM) who graduated between 1971 and 1992, 95 had completed residency training and were otherwise eligible to be surveyed regarding their specialty choices, practice locales, and other characteristics. RESULTS: Seventy of the 95 graduates (74%) responded to the survey, and 50 (73%) were men. Fifty-six (80%) were in primary care (including obstetrics-gynecology as well as family medicine, internal medicine, and pediatrics). Fifty (71%) practiced in their home state of Georgia, and 32 (46%) served low-income populations. Forty-six (66%) were board-certified, and 20 (28%) had faculty appointments. CONCLUSION: The black graduates of the predominantly white MCGSM chose primary care specialties and remained in Georgia to a greater extent than did other MCGSM graduates. Like their counterparts from the historically black medical schools, the black graduates from MCGSM--in relatively large percentages--chose primary care specialties and served minority patients, low-income populations, and/or rural areas.

Assessed diversity within a regional organization of student representatives group.

This pilot study assessed diversity within an Organization of Student Representatives (OSR) group attending the 1990 Annual Meeting of the Southern Region Group on Student Affairs. In contrast to the Southern Region medical student population, the OSR group had a higher rate of students who were older, female, non-science majors in college, and in preclinical years of medical school. While the findings suggest that barriers are being overcome, underrepresented minority students also were underrepresented in the OSR group. A larger study should be conducted to determine OSR minority representation nationwide.

Enrichment programs to create a pipeline to biomedical science careers.

The Student Educational Enrichment Programs at the Medical College of Georgia in the School of Medicine were created to increase underrepresented minorities in the pipeline to biomedical science careers. Eight-week summer programs are conducted for high school, research apprentice, and intermediate and advanced college students. There is a prematriculation program for accepted medical, dental, and graduate students. Between 1979 and 1990, 245 high school students attended 12 summer programs. Of these, 240 (98%) entered college 1 year later. In 1986, after eight programs, 162 (68%) high school participants graduated from college with a baccalaureate degree, and 127 responded to a follow-up survey. Sixty-two (49%) of the college graduates attended health science schools, and 23 (18%) of these matriculated to medical school. Of college students, 504 participated in 13 summer programs. Four hundred (79%) of these students responded to a questionnaire, which indicated that 348 (87%) of the 400 entered health science occupations and/or professional schools; 179 (45%) of these students matriculated to medical school. Minority students participating in enrichment programs have greater success in gaining acceptance to college and professional school. These data suggest that early enrichment initiatives increase the number of underrepresented minorities in the biomedical science pipeline.

Antithrombotic therapy in left ventricular thrombosis and systemic embolism.

Left ventricular (LV) thrombi are responsible for significant morbidity and mortality in our society. Twenty-five percent of cardiogenic emboli are associated with acute and chronic myocardial infarction. With the development of noninvasive imaging techniques LV thrombi have been increasingly recognized as an important clinical entity; the imaging method of choice is two-dimensional echocardiography. LV mural thrombi occur in one third of Q wave anterior myocardial infarctions; their occurrence in patients with non-Q wave infarction and inferior Q wave myocardial infarction is less than 5%. More than half of all LV thrombi are formed within 48 hours of acute myocardial infarction, and nearly all thrombi have been formed within a week of infarction. The development of an LV thrombus is associated with some risk of systemic embolization. To prevent LV thrombosis and systemic embolism, full-dose heparin followed by warfarin therapy for at least 3 months is indicated for patients with large anterior infarctions and those with heart failure. The use of thrombolytic therapy does not reduce the risk of LV thrombus formation; few data exist on whether early coronary angioplasty reduces the risk of LV thrombus formation and the risk of embolization. The proper treatment for patients with chronic LV thrombi remains unknown.

Cocaine: the newest risk factor for cardiovascular disease.

Cocaine-related cardiovascular events escalated during the 1980s as cocaine became purer, cheaper, and easier to obtain. Cocaine abuse is a risk factor for myocardial ischemia and/or infarction, cardiac arrhythmias, pulmonary edema, ruptured aortic aneurysm, cerebral infarction, infective endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy. As medical and social complications of cocaine have become evident, and with the growing negative image of cocaine, the number of first-time users has begun to decline. Cocaine abuse is seen on all levels of our society and has emerged as an issue of significant medical and public health importance. All routes and forms of cocaine abuse are potentially cardiotoxic and can be lethal. Fatal cardiac complications can occur in a first-time user. All physicians should be alert for cocaine abuse when confronted with unexplained cardiac symptoms. Cocaine is the newest and sometimes unrecognized risk factor for cardiovascular disease in young individuals otherwise free of cardiovascular risk factors.

Left ventricular diastolic dysfunction in patients with congestive heart failure.

This study reviewed 372 male patients with congestive heart failure. Two hundred and eighty-three (77%) had congestive heart failure due to systolic dysfunction as demonstrated by radionuclide angiography. Eighty-seven (23%) with congestive heart failure were identified who had normal ejection fractions. All patients met the Framingham criteria for congestive heart failure. These 87 individuals had unrecognized diastolic heart failure. It is important to distinguish between systolic and diastolic heart failure because the pathophysiology, treatment, and prognosis differ significantly. The most frequent cause of diastolic heart failure in this study was hypertension. Diastolic dysfunction should be considered in patients with acute heart failure and severe uncontrolled hypertension, or in patients with ischemic heart disease who develop acute pulmonary edema. Patients who do not respond or deteriorate when treated for heart failure using conventional therapy may also have diastolic dysfunction. These patients warrant special recognition and tailored management.

Myopericarditis in acquired immunodeficiency syndrome diagnosed by gallium scintigraphy.

Myocarditis is among the cardiac complications of acquired immunodeficiency syndrome and, yet, is often not discovered until autopsy. Gallium scintigraphy has been employed in diagnosing this entity, but few data are available about its diagnostic accuracy and value. Here, the authors report two cases of myopericarditis as diagnosed by gallium scan.