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Why does the leaky pipeline leak?


Freeman BK, Landry A, Trevino R, Grande D, Shea JA.  Understanding the Leaky Pipeline: Perceived Barriers to Pursuing a Career in Medicine or Dentistry Among Underrepresented-in-Medicine Undergraduate Students.  Acad Med 2016;91:987-993. http://dx.doi.org/10.1097/ACM.0000000000001020

Reviewed by Jeanine Ronan

Tags: preclinical, qualitative study, learning environment

What was the study question?

What do undergraduate underrepresented-in-medicine (URiM) students perceive as barriers to pursuing future careers in medicine and dentistry?

How was the study done?

Focus groups were conducted at 11 schools already participating in a program to improve minority recruitment into the health professions.  A total of 82 undergraduate students participated.  Two authors reviewed transcripts and identified challenges for URiM students through a thematic analysis.

What were the results?

            After an iterative coding process, there were 4 major themes that emerged:

  1. Inadequate institutional support and resources: There is inadequate course work in high school and college, as well as the inability for URiM students to develop contacts within the medical profession.
  2. Limited personal resources and social/family conflict: Students are worried about their ability to pay for the application process and the insurmountable debt they may incur.  In addition, they fear the competitive environment and nonacceptance.  They also face undue pressure from families to succeed while concurrently being pressured with other obligations due to the families’ lack of understanding of their academic demands.
  3. Lack of access to information, mentoring and advising: Extending all the way back to high school and while at college, students feel lost and confused about the application process.  They want access to mentors with first-hand experience.
  4. Societal Barriers: These students are also concerned with work-life balance and the demands of being a physician, while simultaneously concerned about opportunities for adequate training and the future job market.

What are the implications of these findings?

Based on these results, the authors emphasized the importance of a multifaceted approach to increase URiM student recruitment and retention.  They discussed the need for outside organizations to get involved with improved dissemination of information as well as increased access to national outreach programs.

Editor’s Note: Previous attempts to increase the proportion of minorities in medical school and medical practice have made little difference.  Many are now focusing their energies, like these authors, on interventions in college, high school or even earlier.  (JG)

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