Impact of a 50-Year Premedical Postbaccalaureate Program in Graduating Physicians for Practice in Primary Care and Underserved Areas.

PURPOSE: To evaluate the effectiveness of Wayne State University School of Medicine's (WSUSOM's) 50-year premedical postbaccalaureate program (PBP)-the first and oldest in the United States-in achieving its goals, as measured by medical school matriculation and graduation, primary care specialization, and current practice location. METHOD: A retrospective study of a complete comparative dataset of 9,856 WSUSOM MD graduates (1979-2017) was performed in July-August 2018. This included 539 graduates who were admitted to the PBP between 1969 and 2012. Data collected included PBP students' sociodemographics, postgraduate specialization, residence location at time of admission to the PBP, and current medicine practice location. Health professional shortage areas (HPSAs) and medically underserved areas/populations (MUA/Ps) were determined for residence at admission to the PBP and current medicine practice location. RESULTS: Of the 539 PBP students, 463/539 (85.9%) successfully completed the PBP and matriculated to WSUSOM. Of those, 401/463 (86.6%) obtained an MD, and of those, 233/401 (58.1%) were female and 277/401 (69.1%) were African American. Average investment per PBP student was approximately $52,000 and for an MD graduate was approximately $77,000. The majority of PBP MD graduates with current practice information resided in HPSAs or MUA/Ps at admission to PBP (204/283, 72.1%) and were currently practicing in HPSAs or MUA/Ps (232/283, 82.0%), and 139/283 (49.1%) became primary care physicians (PCPs). Comparison of WSUSOM PBP and non-PBP MD graduates showed PBP physicians become PCPs and practice in HPSAs or MUA/Ps at higher rates than non-PBP physicians (P < .001). CONCLUSIONS: The PBP was successful in graduating a large proportion of physicians from socioeconomically disadvantaged and diverse backgrounds, who practice as PCPs and who practice in HPSAs and MUA/Ps, thereby accomplishing the PBP's goals of helping to address the broad health care needs of all people in the United States.

Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status.

BACKGROUND: Medical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity. The aim of this study was to examine variation in socioeconomic status (SES) of applicants to study medicine and applicants with an accepted offer from a medical school, comparing the four UK countries and individual medical schools. METHODS: Retrospective analysis of application data for 22 UK medical schools 2009/10-2011/12. Data were analysed for all 32,964 UK-domiciled applicants aged <20 years to 22 non-graduate medical schools requiring applicants to sit the United Kingdom Clinical Aptitude Test (UKCAT). Rates of applicants and accepted offers were compared using three measures of SES: (1) Postcode-assigned Index of Multiple Deprivation score (IMD); (2) School type; (3) Parental occupation measured by the National Statistics Socio Economic Classification (NS-SEC). RESULTS: There is a marked social gradient of applicants and applicants with accepted offers with, depending on UK country of residence, 19.7-34.5% of applicants living in the most affluent tenth of postcodes vs 1.8-5.7% in the least affluent tenth. However, the majority of applicants in all postcodes had parents in the highest SES occupational group (NS-SEC1). Applicants resident in the most deprived postcodes, with parents from lower SES occupational groups (NS-SEC4/5) and attending non-selective state schools were less likely to obtain an accepted offer of a place at medical school further steepening the observed social gradient. Medical schools varied significantly in the percentage of individuals from NS-SEC 4/5 applying (2.3%-8.4%) and gaining an accepted offer (1.2%-7.7%). CONCLUSION: Regardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine. Postcode-based measures such as IMD may be misleading, but individual measures like NS-SEC can be gamed by applicants. The previously unreported variation between UK countries and between medical schools warrants further investigation as it implies solutions are available but inconsistently applied.

An analysis of the association of American medical colleges' review of minorities in medical education.

The Association of American Medical Colleges publishes an enormous database each year, which encompasses every conceivable category of medical education. This information covers high-school student premedical activities, medical school/student data, demographics of residents and fellows in training, a profile of medical school faculty according to academic rank and the enrollment of each medical school in the country. It is all categorized according to race, ethnicity and gender. Furthermore, it is a longitudinal survey and, therefore, valid comparisons can be made over long periods of time. The extensive coverage of African-American involvement in the system at all levels allows for healthcare planners, administrators, politicians and students/parents at all levels to use this as a roadmap for planning purposes. Much of the data is broken down according to individual states, thus enabling students to make better decisions about selecting private versus public institutions for their training. The data on residents in training and medical school faculty provides very useful information for healthcare planners, state and federal government officials, and medical school deans and university administrators interested in addressing diversity issues within their respective domains.

Xavier University premedicine program's prescription for success: an interview with JW Carmichael Jr., MS, PhD.

This interview of Dr. JW Carmichael was conducted for this special issue of the Journal of the National Medical Association, which highlights American medical education and the experience of African Americans. It was conducted by George Dawson, MD. He serves as editor of the Art in Medicine, History and Health Tidbit sections of the Journal of the National Medical Association. In terms of producing biology and chemistry majors, and, most importantly, from our perspective, premedicine students, the Xavier program is second to none. Under his leadership and with the help of his able staff, it has managed to supply more African-American healthcare students to professional school than any undergraduate programs we could find. Therefore, to us, it seemed fitting that we delved into his vast knowledge, in the hope that his example could be duplicated elsewhere and, perhaps, just maybe we can render the matter of the health disparaties that we speak of so often and that seemingly afflicts our community disproportionally.

The Jefferson-Penn State B.S.-M.D. program: a 26-year experience.

Since the 1960s a number of physicians have completed both their baccalaureate and their M.D. degrees in six or fewer years. In this longitudinal study the authors track the academic performances, clinical ratings, and career follow-up data of 659 students in one of these accelerated programs, the Jefferson Medical College-Pennsylvania State University B.S.-M.D. program, from entering years 1964 through 1989. The medical school performances, clinical performances in residencies, and rates of board certification and faculty appointment of the accelerated students compared favorably with those of a control group of medical students with similar high school credentials who had followed a four-year baccalaureate program. The authors conclude that a carefully chosen group of students can achieve high academic standards in an accelerated medical school program, graduate as younger physicians able to perform well in postgraduate training, and go on to highly productive careers in medicine.