|Year : 2016 | Volume
| Issue : 1 | Page : 47-50
Medical education resources initiative for teens program in baltimore: A model pipeline program built on four pillars
Tyler E Mains1, Mark V Wilcox1, Scott M Wright2
1 Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
|Date of Web Publication||18-Mar-2016|
Scott M Wright
Department of Internal Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224
Source of Support: None, Conflict of Interest: None
Background: Less than 6% of U.S. medical school applicants are African-American. The lack of diversity among physicians, by race as well as other measures, confers a negative impact on the American healthcare system because underrepresented minority (URM) physicians are more likely to practice in underserved communities and deliver more equitable, culturally competent care. Methods: MERIT (Medical Education Resources Initiative for Teens) is a nonprofit organization based in Baltimore, Maryland, USA. MERIT prepares URM high school students for health careers by providing a holistic support system for seven consecutive years. The program model, which utilizes weekly Saturday sessions, summer internships, and longitudinal mentoring, is built on four foundational pillars: (1) Ignite the Fire, (2) Illuminate the Path, (3) Create the Toolkit, and (4) Sustain the Desire. Results: Since 2011, MERIT has supported 51 students in the Baltimore City Public School System. For the past two years, 100% (n = 14) of MERIT seniors enrolled in universities, compared to only 20.2% of Baltimore City students overall. While it is too early to know whether MERIT alumni will realize their goals of becoming healthcare professionals, they are currently excelling in universities and over 75% (n = 17) are still planning to pursue graduate degrees in health-related fields. Discussion: After piloting an effective program model, MERIT now has three key priorities moving forward: (1) Creating a sustainable and thriving organization, (2) increasing the number of scholars the program supports in Baltimore, and (3) expanding MERIT to other cities.
Keywords: Diversity, education, pipeline programs, under-represented minorities, youth
|How to cite this article:|
Mains TE, Wilcox MV, Wright SM. Medical education resources initiative for teens program in baltimore: A model pipeline program built on four pillars. Educ Health 2016;29:47-50
| Background|| |
The fraction of U.S. medical students from the lowest quintile of family income has never been more than 5.5%. Similarly, while over 13% of the U.S. population is African American, only 6% of US medical school applicants are. Besides inequality, there are two other reasons this lack of diversity among physicians is concerning. First, physicians from racial and ethnic backgrounds underrepresented in medicine are more likely to practice primary care and work in medically underserved communities. Second, the quality of patient care improves with a more diverse physician workforce., Ultimately, America's healthcare disparities may only be fixed if the next generation of physicians more closely mirrors the communities they serve.
Because of these public health concerns, the Association of American Medical Colleges initiated a challenge “3000 by 2000” in the year 1991 to increase the number of minority medical school applicants in the US from 1,485 to 3000 by the year 2000. While the numeric goal was not met, myriad pipeline programs have been implemented since then. Most are built on some combination of components including academic enrichment, mentoring relationships, career exposure opportunities and internships, and college admissions guidance. There is still a need to establish best practices for pipeline programs. This manuscript aims to illustrate one potential program model, MERIT (Medical Education Resources Initiative for Teens), that has shown early signs of success.
MERIT is a nonprofit organization founded in January 2011 by a group of public school teachers and health professionals in Baltimore, Maryland, USA. MERIT's mission is to eliminate healthcare disparities by transforming underrepresented high school students into healthcare leaders. Baltimore served as an ideal city to pilot the program because of the city's distinctive inequalities. For example, an infant born in Roland Park, a wealthy neighborhood, is expected to live nearly twenty years longer than a Baltimorean raised in Sandtown, a low-income neighborhood just five miles south. Furthermore, 64.3% of the city's population is African American and 22.9% live below the poverty line. Only 6% of Baltimore City Public School students will eventually earn a Bachelor's Degree.
| Methods|| |
For its first four years, MERIT supported about 30 scholars with a small operating budget, raised through philanthropic donations, by utilizing nearly 300 volunteers. During the past year, MERIT secured additional funding from local foundations, corporations, and institutions so that more scholars will be able to participate in the program.
To be eligible for MERIT, students must either live in a low-income household (defined as up 185% of the U.S. poverty threshold) and/or be from a family wherein neither parent has received a Bachelor's Degree. Eligible students first complete a written application that includes personal statements and letters of support from teachers. From that pool, 45 students are invited annually to attend a three-week tryout called the Medical Leadership Course (MLC). During the MLC, applicants' arrival time, interaction with peers, and homework completion are tracked. Example sessions include an ethical debate on genetic testing, a role-play scenario with an angry patient, individual interviews, and a poster presentation. Parent/guardian meetings are also held to clarify the program's expectations. Through this holistic review process, MERIT staff is able to thoughtfully select the students with the most passion and potential to succeed in MERIT, rather than students with the best academic achievements. Demographics of the selected MERIT scholars are shown in [Table 1].
|Table 1: Demographic information for the 51 Medical Education Resources Initiative for Teens scholars supported over the past 4 years|
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Program model: The four pillars
High school teachers in Baltimore City partnered with medical professionals from Johns Hopkins to create a paradigm for a longitudinal program model based on four foundational pillars.
Ignite the fire
MERIT must transform scholars' initial interest in healthcare into a burning passion founded on the belief that healthcare disparities are unacceptable. To that end, some of what MERIT provides includes:
- Healthcare disparities lessons - Through readings, videos, case discussions, and personal experiences, Scholars delve into the root causes of health inequities and systemic oppression while brainstorming possible solutions
- Diversity in health speaker series - Minority healthcare professionals speak to our scholars about the challenges they faced throughout their lives, why they continue to pursue their goals, and the impact they have on patients' lives
- The art of medicine (summer internship #1) - Sophomore scholars shadow various healthcare professionals in a wide range of clinical departments and experience various career paths including medicine, nursing, social work, and pharmacy
- The human body lessons - Medical students teach basic physiology and pathophysiology through interactive case-based discussions with hands-on simulations related to physical diagnosis and treatment plans.
Illuminate the path
Once scholars have committed to a health career, they need to understand how to achieve their goals. Select ways in which MERIT illustrates the requirements include:
- Longitudinal mentoring - Each Scholar is paired with one mentor (graduate student or working professional) throughout high school, and then a second College Support Coach during the transition to university to show each Scholar what it takes to succeed in health careers by example
- University Admissions and Financial Aid Guidance - MERIT provides college application guidance, financial aid support, and career counseling. Campus tours to local universities are also incorporated
- University Transition Support - Senior scholars participate in sessions focused on diversity, personal identity development, and tangible skills essential for collegiate success to prepare them for the difficult transition to post-secondary education.
Create the toolkit
Because many academic and professional skills are needed to succeed in college and thereafter, scholars learn proficiencies that are likely to increase their chances of thriving. A few of the lessons and principles are described here:
- Professionalism and Leadership Development - MERIT explicitly teaches skills such as writing emails, setting ambitious goals, and speaking and dressing appropriately, so scholars will be viewed as budding healthcare professionals
- Academic Remediation - Through MERIT, scholars receive more than 100 hours of quality standardized test preparation and academic coaching from high school English and math teachers
- The Science of Medicine (Summer Internship #2) - Using inquiry-based experiments, junior scholars learn college-level biology, chemistry, and physics. Scholars also rotate through research laboratories to learn basic lab safety and technical skills
- Laboratory Research (Summer Internship #3) - Upon graduating, MERIT seniors are encouraged to participate in an eight-week independent research program through partnerships with existing summer research programs.
Sustain the desire
MERIT is truly the antithesis of a “touch and go” program. To this end, MERIT provides seven years of social and academic support to keep scholars engaged along the arduous journey to medical school in a welcoming community.
- Health and Wellness Sessions - Before beginning the academic content of each Saturday session, each Scholar is encouraged to keep his or her mind, body, and soul in balance to avoid burnout through activities such as yoga, meditation, and Zumba dance
- Learning environment - Much attention is paid to MERIT's learning community so that all feel safe, welcomed, and supported. Our scholars and alumni describe a “family feel” that permeates throughout all programs
- Community Events - To foster a stronger sense of community, scholars, mentors, teachers, and families attend events such as an Annual Symposium where scholars present their summer research and an End-of-Year barbecue.
- Parent/Guardian Sessions - Family support at home is critical to scholars' success. To partner most effectively, MERIT holds quarterly sessions to discuss strategies to help caregivers embolden and motivate scholars.
| Results|| |
For the past two years, every MERIT scholars (n = 14) has enrolled in universities that grant Bachelor's Degrees, compared to only 20.2% of Baltimore City students overall. While it is too early to measure MERIT's long-term outcome of increasing diversity of the healthcare workforce, over 75% of MERIT alumni (17 out of 21) still plan to pursue a graduate degree in the health sciences.
The Scholastic Aptitude Test (SAT) is a U.S. national standardized exam that is an important factor in university admissions. The maximum score a student could earn on the 2014 SAT was 2400. MERIT scholars sat for the exam in fall 2013 before MERIT's academic remediation course (“pre-test”). Scholars sat for the exam again in fall 2014 at the conclusion of MERIT's test preparation (“post-test”). The mean pre-test score was 1060. The mean post-test score increased by 440 points to 1500. For comparison, the national average score increase on the SAT for a student in one year is 57 points according to the College Board, and the mean score for Baltimore City students was 1125 in 2014 [Figure 1].
|Figure 1: Scholastic aptitude test results showing the impact of MERIT tutoring and a comparison to students in Baltimore, Maryland, USA|
Click here to view
| Discussion|| |
MERIT has intentionally remained small for the past four years to create an effective program model. Moving forward, MERIT's leadership team has identified three priorities: Creating a sustainable organization, increasing the program's impact locally, and expanding the program nationally. First, MERIT staff will continue to critically analyze Scholar and alumni data such as SAT scores, university grades, and ultimately admission to graduate schools, not only for formative assessment to improve the program model but also to create more compelling evidence to secure sustainable funding resources. Additional funding will be needed to hire more full-time employees to reach the second priority of increasing the number of MERIT scholars in Baltimore. By 2019, MERIT plans to support 120 high school students, in addition to the expanding alumni pool enrolled in universities. While implementing this growth plan will have an impact on students in Baltimore, the real beneficiaries of MERIT will ultimately be patients. Finally, MERIT's leadership team is currently identifying other cities that can serve as new operating sites.
In Nivet's commentary, Diversity 3.0: A Necessary Systems Upgrade, the author describes three phases of diversity thinking: (1) Removing social and legal barriers, (2) peripherally raising awareness that diversity and excellence are not competing interests but rather synergistic, and (3) integrating diversity practices into the core practices of an institution. With MERIT as a model, we propose a fourth phase: Forming partnerships within the community to ensure programs promoting diversity are sustainable. To truly achieve a diverse physician workforce, we need to look outside our institutions to incorporate expertise broadly, including that from community organizations, and education experts at all levels. We must advance our thinking beyond recruitment and admissions at the undergraduate and medical school levels to incorporate systemic policies and best practices that support students from underrepresented backgrounds throughout the entire pipeline. Ultimately, institutions and programs such as MERIT cannot operate in independent silos and must work with their surrounding communities, including public school systems, to effect change.
Dr. Wright is a Miller-Coulson Family Scholar and is supported through the Johns Hopkins Center for Innovative Medicine.
Financial support and sponsorship
MERIT is currently funded by the following corporations and foundations in Baltimore, Maryland, USA: The Abell Foundation, Annie E. Casey Foundation, BD Diagnostics, East Baltimore Community Affairs, Erwin and Stephanie Greenberg Foundation, Family League of Baltimore, Harry and Jeanette Weinberg Foundation, Henry and Ruth Blaustein Rosenberg Foundation, Johns Hopkins Alumni Association, Johns Hopkins Bayview Medical Center, Johns Hopkins Center for Innovative Medicine, Johns Hopkins Hospital Department of Medicine, Johns Hopkins School of Medicine, Aaron and Lillie Straus Foundation, Wells Fargo, Generous Individual Donors.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jolly P. Diversity of U.S. Medical students by parental income. Assoc Am Med Coll Anal Brief 2008;8:1-2.
Imam XM, Castillo-Page L, Conrad S, Nivet M. Analyzing physician workforce racial and ethnic composition associations: Geographic distribution (Part II). Assoc Am Med Coll Anal Brief 2014;14:9.
Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff (Millwood) 2002;21:90-102.
Thomas B. Health and health care disparities: The effect of social and environmental factors on individual and population health. Int J Environ Res Public Health 2014;11:7492-507.
Terrell C, Beaudreau J. 3000 by 2000 and beyond: Next steps for promoting diversity in the health professions. J Dent Educ 2003;67:1048-52.
Durham RE, Olson LS. College Enrollment and Degree Completion for Baltimore City Graduates through the Class of 2012. Baltimore Education Research Consortium; July, 2013.
SAT Seniors Mean Score Trends by Year, Baltimore City. Maryland State Department of Education; 2014.
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