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Lessons Learned from FIPSE Projects II - September 1993

University of California-San Francisco School of Medicine

The Medical Scholars Program

Purpose

Nationwide, minority students and women are underrepresented on the faculties of medicine and the basic sciences. An American Association of Medical Colleges study indicates that fewer than 2 percent of the nation's medical school faculty are from the underrepresented minorities. The UCSF Medical Scholars Program (MSP) was launched as a direct response to the need for minority academicians.

A secondary and more immediate aim was to reduce minority attrition and course failure of "at risk" students. MSP is based on the Professional Development Program pioneered in mathematics at the University of California-Berkeley, using small study groups or workshops to promote achievement among minorities. Applying the PDP model, MSP used peer groups and preceptorships to improve learning in pre-clinical courses.

Even though MSP was initially labelled a minority program, it was designed to be open to all first-and second-year medical students, and non-minority students did fully participate. It made the uncommon assumption that students entering the program had the ability to excel, regardless of test scores, and its job was to aid in that achievement. MSP's intent was to be prospective and preventive rather than remedial.

Its student-led workshops met weekly for two hours on the key organizational and conceptual skills necessary to master vast amounts of medical information. To do this, student groups of 20-25 used a series of problem sets to quiz and test each other. These worksheet problems were constructed so that students had to forge solutions collaboratively and use a variety of skills to answer questions posed in physiology, anatomy, and biochemistry courses. Ultimately, the problems led students to examine the relationship between their courses and clinical material by applying basic concepts to abstract situations.

The workshops performed obvious social functions as well. The encouragement and support they provided eased the transition to medical school, helped students build friendship groups, and taught them survival skills.

In the second year, students participated in a special study group review to prepare them to pass the National Board of Medical Examiners Part 1 test, a certification examination taken after pre-clinical studies.

Beyond supporting coursework and preparing for the National Boards, the program oriented its students to research careers through a series of informal "science chats" with faculty and a quarter-long research elective. During summer internships, students participated in basic social science research in laboratory settings, in local communities (AIDS and sexuality), and overseas (diabetes in Italy, cardiovascular disease in Spain).

Evaluation

Historical information from medical school student records was used as a quasi-experimental control for the results observed during the operation of MSP. Data from MSP's three years (1987-89) were compared to data for the three years prior to MSP. The latter indicated that minority students enter UCSF with a slight academic disadvantage: between 1983-1986 minority students failed courses and the National Boards at rates out of proportion to their numbers in class and strongly correlated with their academic disadvantage. Failures among first-year minority students were most pronounced in physiology. In 1983, for example, African-American and Latino students constituted 18 percent of the enrollment in physiology but 54% of those who failed the course.

Significantly, in the program's three years, none of the minority students enrolled in MSP physiology workshops failed, and MSP students passed all of their first-year basic science courses. They achieved this even though their mean undergraduate GPA and their combined MCAT scores were significantly below those of non-MSP students.

Project Impact

In its first three years, MSP served 164 students, 93 white and 71 non-white. It can claim three strong outcomes: minority failures in pre-clinical courses declined, the school's pass rate as a whole improved on the National Boards, and pre-medical school achievement ceased to be a significant predictor of minority and non-minority students' actual exam scores.

Over the years, the number of minority students participating in summer research doubled. One student published her findings in the New England Journal of Medicine and another won a year-long research fellowship at the National Institutes of Health.

Annual interviews with workshop students, leaders and faculty members suggested a school-wide effect of two kinds: MSP led minority students to believe that careers in academic medicine were possible for them, and it showed them the value of group study and of seeking academic help. Two unanticipated benefits were also noted: the workshops helped identify early those students having academic difficulty, and students gained valuable experience as workshop leaders and teachers.

Major Insights and Lessons Learned

Medical school in the United States is reputedly a stressful and demanding experience. As viewed by its students and faculty, MSP positively altered the environment of UCSF without compromising quality--in fact, student performance improved. This holds important lessons for changing the learning climate in other medical schools further. MSP validates the Professional Development Program at UC-Berkeley, which originated this approach to improving minority performance, by demonstrating that PDP can be translated from math to the medical school curriculum without losing its impact on learning.

Project Continuation

Institutional policies were adapted to support MSP as a student-directed initiative, now funded through the Dean's Office. That decision was made on the basis of the evaluation data collected for the program, including feedback from student participants. Even after FIPSE funding ended, the numbers of students served by the program continued to increase every year, and now encompass over 70 percent of the first-year class.

A dissemination grant from FIPSE was used to prepare workbooks from the collection of learning-group worksheets. These workbooks were distributed free of charge to medical schools around the country.

In 1991, Columbia University College of Physicians and Surgeons (P&S) created the Higher Achievement Program (HAP), modeled on MSP and motivated, in part, by a marked increase in the number of minority students entering in the first-year class that fall. Past experience of minority students at P&S suggested that these new entrants would be at high risk of failure. For example, in 1988, three of twelve (25 percent) entering minority students had to repeat their first year coursework, and two of sixteen (13 percent) minority students entering in the 1990 academic year were forced to repeat. Faculty and students agreed that some intervention was needed to ensure the smooth transition of students from undergraduate to medical school study.

In its first year of operation, HAP offered workshops in anatomy, physiology, neurosciences, cell biology and physiology. In addition, special sessions were offered to prepare students for practical examinations in anatomy and cell biology. The program was remarkably effective: the number of students failing courses declined, even though the number of students at risk for failure had increased. None of the minority students entering in 1991 was asked to repeat the year. A full evaluation of the program will be conducted in the future, but faculty and students were encouraged by the results of HAP's first year.

Available Information

Copies of the final report submitted to FIPSE and of the MSP workbook used in the study groups may be obtained from:

Emilie Osborn
Associate Dean of Student and Curricular Affairs
University of California-San Francisco School of Medicine
Room S221
San Francisco, CA 94143
415-476-0714

or

Mindy Fullilove
Associate Professor of Clinical Psychiatry and Public Health
722 W. 168th Street, Box 29
New York, NY 10032
212-740-7292

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Last Modified: 02/22/2006