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Ara Tekian and Laura Hruska, A Review of Medical School Records to Investigate the Effectiveness of Enrichment Programs for "At Risk" Students Teaching and Learning in Medicine 2004. 16(1): 28-33. Reviewed by Randy Rockney, Brown University


Ara Tekian and Laura Hruska, A Review of Medical School Records to Investigate the Effectiveness of Enrichment Programs for "At Risk" Students Teaching and Learning in Medicine 2004. 16(1): 28-33.

Reviewed by Randy Rockney, Brown University

There has been an effort in place for at least the past 30 years to increase the number of underrepresented minorities (URMs) in US medical schools. In recognition of the fact that many URMs matriculate with educational deficiencies, a number of enrichment programs have been in place at many medical schools to either better prepare URMs and other "at risk" students prior to matriculation, or support them during medical school, or both. The authors of this paper note that the costs of these programs "are staggering," and ask the question, "how effective are they?"

The records of all "at-risk" students, both URM and non-URM, who matriculated at the University of Illinois at Chicago in 1992 and 1993 were evaluated. At-risk status was determined by averaging the student's three MCAT subset scores and total undergraduate GPA weighted by the competitiveness of the undergraduate school giving a score labeled the "cognitive index" or CI. The at-risk students, those with low CI scores, comprised 26.2% of the student population, 92 students, for those two years. A low CI was felt to suggest an increased likelihood of encountering academic difficulty during medical school. Instances of academic difficulty included the failure of one or more medical school courses or multiple attempts at passing either USMLE-1 or USMLE-2. The authors labeled these difficulties "delaying events" or DEs. The authors then compared the number of DEs to student graduation status labeled as no delay before graduation, delay before graduation, and withdrawal from medical school. They also compared the number of DEs to the type of enrichment programs, if any, in which the students participated either before and/or during medical school. Classification of student participation in enrichment programs included no program, involvement in "serious research," summer enrichment, summer enrichment and exposure to research, motivational activities, post-baccalaureate, post-baccalaureate and exposure to research. Research exposure in which students spent relatively short periods observing or assisting research was differentiated from serious research in which students were actively involved in the design, implementation, writing, and presenting of the research.

The study claims to test the hypothesis that the skills acquired during the enrichment program "will facilitate a medical education and be manifested at graduation." Students experiencing no DEs had significantly higher USMLE-1 scores. Students participating in serious research had the fewest DEs. The authors felt that conclusions about other types of enrichment programs had to be made cautiously because of small numbers of participants in each different program type.

COMMENTS

The opening of the Discussion section of this paper reads, "The results of this investigation may seem meager at first glance…" They follow that statement with an exhortation to medical schools to develop uncontaminated baseline measures of student ability that can be compared to measurable outcomes for enrichment programs. That such programs are necessary is evident from the difficulties encountered by students who matriculate at medical schools with evidence of academic vulnerability, and a high percentage of those students are underrepresented minorities. These issues are well reviewed in the introduction to the paper. The authors conclude, "Medical education programs are rigorous and have high standards. Accountability for our enrichment programs should be equally rigorous."

(Interesting article and methodology. See the next review for comparison. Steve Miller)

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