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 Table of Contents  
Year : 2018  |  Volume : 31  |  Issue : 1  |  Page : 48-51

Enhancing medical student diversity through a premedical program: A Caribbean school case study

1 Medical Education Readiness Program, Adtalem Medical and Healthcare Education Group, Miramar, FL, USA
2 Biomedical Science Program, University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA
3 Department of Medicine, Ross University School of Medicine, Miramar, FL, USA

Date of Web Publication14-Aug-2018

Correspondence Address:
Inna Lindner
2300 S.W. 145th Ave. Suite 132, Miramar, FL 33027
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.239047


Background: Physicians with backgrounds underrepresented in medicine (URiM) are more likely to practice in underserved communities. Recruitment into and assistance during medical education has the potential to increase the number of URiM physicians. This study analyzes URiM students' academic performance at a well-established Caribbean school with and without prior successful completion of the Medical Education Readiness Program (MERP). Methods: A retrospective analysis of premedical school requirements and achievements in medical school were performed for URiM students enrolled in Ross University School of Medicine between 2006 and 2012, through either MERP or direct admission. For MERP and non-MERP students, an independent sample two-tailed Student t-test was used to compare prerequisite Grade Point Average (p GPA), Medical College Admission Test (MCAT), and The United States Medical Licensing Examination (USMLE) Step 1 scores. Chi-square analysis was performed to compare the attrition rates for MERP and non-MERP URiM students in the first years of medical schools well as USMLE Step 1 pass rates. Results: A total of 1299 students entering medical school directly (n = 981) or through MERP (n = 318) were evaluated. The mean MCAT (19.6 for MERP vs. 21.6 for non-MERP, P < 0.001) and prerequisite GPA (2.8 for MERP vs. 3.1 for non-MERP, P < 0.001) were significantly lower for the MERP students. A similar percentage of MERP and non-MERP students reached the 2nd year (83.0% and 80.9% respectively, P = 0.407) and 3rd year (80.5% and 79.0% respectively, P = 0.565) of medical school. USMLE Step 1 pass rates for MERP (90.6%) and non-MERP (92.3%) as well as USMLE Step 1 mean scores (208.9 and 210.0 for MERP and non-MERP, respectively) were also comparable. Discussion: MERP-like programs can help URiM students with lower undergraduate scores succeed in medical school.

Keywords: Diversity, pipeline programs, premedical education, student achievement, Underrepresented minorities

How to cite this article:
DeCarvalho H, Lindner I, Sengupta A, Rajput V, Raskin G. Enhancing medical student diversity through a premedical program: A Caribbean school case study. Educ Health 2018;31:48-51

How to cite this URL:
DeCarvalho H, Lindner I, Sengupta A, Rajput V, Raskin G. Enhancing medical student diversity through a premedical program: A Caribbean school case study. Educ Health [serial online] 2018 [cited 2022 Jan 23];31:48-51. Available from:

  Background Top

Underrepresented minorities comprise a large portion of >96 million people in the United States who live in medically underserved areas with a shortage in health professionals.[1] The Association of American Medical Colleges defined the term underrepresented in medicine (URiM) as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”[2] Analysis of access to healthcare showed that minority patients receive fewer clinical services and a lower quality of care with low levels of awareness about disparities that disproportionately affect their own communities.[3],[4] Minority patients who do have a choice in healthcare are more likely to select physicians of their own racial or ethnic background, while URiM physicians are more likely than non-URiM counterparts to practice in areas with high proportion of minority residents.[5] Yet, the growing diversity of the US population and the health needs of the underserved communities does not reflect the proportion of minority physicians in the workforce.

Underrepresented minority students typically score lower on traditional predictors of medical school success (MCAT, GPA) than do white students, lowering their chances of acceptance into the US medical schools.[6] If enrolled, these students are predisposed to poorer outcomes in performance.[7] Therefore, a commitment to increased minority recruitment must be paired with assistance in achievement of their success in higher education.

This study's objective was to examine the efficacy of the Medical Education Readiness Program (MERP), a 15-week preparatory, nondegree-granting program with a curriculum focused on the intensive study of Anatomy/Histology, Biochemistry/Molecular Biology, Microbiology/Immunology, and Physiology/Biophysics. To enhance the learning and studying skills, MERP also integrates an extensive supplemental Academic Success Program which addresses the students' individual shortcomings in study habits such as time management, active learning, and exam-taking skills.

MERP is offered to applicants who are conditionally accepted into Ross University School of Medicine (RUSM). In addition to the campus in the United States, a recently established campus in Toronto, Canada, provides an opportunity for eligible Canadian students to participate in MERP through live video conference.

MERP has previously been shown to help correct less rigorous academic preparation before entry into medical school and translate into students' success at RUSM.[8] Since minority students comprise a sizable proportion of overall students enrolled into MERP (~20%), this study builds on the previous findings to compare medical school performance of URiM students either directly admitted or matriculating after the successful completion of MERP.

  Methods Top

Students' admission and outcome data were reviewed from 2006 to 2012 classes using the School Integrated Student Information System. Data for the URiM students were gathered by the Institutional Solutions Reporting Team at RUSM. Three minority groups, Black/nonHispanic, American Indian/Alaskan Native, and Hispanic were included in the study. URiM status was self-reported by the students. The URiM students were divided into two subcohorts based on whether they participated in MERP or not before entering RUSM.

The following data were extracted: start date of matriculation, MERP participation status, and number of students who successfully completed the 1st year of medical school, reached clinical clerkships (3rd year of medical school), qualified to take the USMLE Step 1, and passed the USMLE Step 1. Average USMLE Step 1 score for MERP versus non-MERP students was also obtained. In addition, prematriculation data including the average MCAT and pGPA scores for MERP and non-MERP cohorts were analyzed.

Rates for reaching 2nd or 3rd year at RUSM were calculated as the percent of MERP or non-MERP URiM students reaching these time points relative to the initial number of students in each subcohort. For USMLE Step 1 passing rates (considering all attempts), the percent of students who passed USMLE Step 1 relative to the number of students who attempted this exam was determined. Comparisons were done using Chi-square tests. P < 0.05 was used to define statistical significance.

MCAT, pGPA, and USMLE Step 1 scores are reported as means of MERP versus non-MERP students. For statistical analysis of the means, an independent sample two-tailed Student's t-test was used. The large sample size (n = 1299) is well above n = 60 and reduces concerns regarding external validity. The study was approved by the Institutional Review Board committee of the medical school. All data were analyzed using SPSS v23.0 (Chicago, IL, USA) software.

  Results Top

Comparison of prematriculation criteria

The participants in this study were URiM students (n = 1299) admitted to RUSM either through direct admission (n = 981) or after successfully completing MERP (n = 318). The mean MCAT score and pGPA were significantly lower for the URiM students admitted to RUSM through MERP than directly admitted students. Mean MCAT score of 19.6 (±4.0) was observed for the MERP students and 21.6 (±3.7) for the non-MERP students (P < 0.001). MERP students had a mean pGPA of 2.8 (±0.8), while non-MERP students' pGPA mean was 3.1 (±0.4, P < 0.001) [Table 1].
Table 1: Prerequisite criteria for underrepresented in medicine students who successfully completed Medical Education Readiness Program compared to underrepresented in medicine non-Medical Education Readiness Program first-year classmates

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Progression through medical school curriculum – reaching the 2nd year

Attrition rate in the 1st year was chosen because the impact of participation in MERP should be comparatively high at this point. As indicated in [Table 2]a, successful completion of the 1st year is comparable for URiM MERP and non-MERP students. 83.0% of MERP and 80.9% of nonMERP students reached the 2nd year of medical school. There was no significant relationship between MERP status and reaching the 2nd year of medical school, Chi-square (1, n = 1299) =0.688, P = 0.407 (α ≤ 0.05).
Table 2: (a and b) Retention in medical school (a) and USMLE Step 1 performance (b) for underrepresented in medicine Medical Education Readiness Program students compared to underrepresented in medicine non-Medical Education Readiness Program classmates

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Progression through medical school curriculum – reaching clinical clerkships (3rd year)

Completion of the 2nd year of medical school marks the successful completion of a basic science curriculum and a transition from basic science courses to clinical rotations in the United States. As indicated in [Table 2]a, no significant difference was observed in reaching the 3rd year of medical school between MERP (80.5%) and non-MERP students (79.0%), Chi-square (1, n = 1299) =0.331, P = 0.565 (α ≤ 0.05).

Progression through medical school curriculum – USMLE Step 1 mean scores and pass rates

As indicated in [Table 2]b, for those students who reached clinical rotations, the USMLE Step 1 pass rates were 90.6% for MERP versus 92.3% for non-MERP URiM students. No significant difference between these groups was observed, Chi-square (1, n = 1031) =0.797, P = 0.372 (α ≤ 0.05). The mean USMLE Step 1 score did not significantly differ between MERP and non-MERP students with a mean score of 210.4 (±15.0) and 211.7 (±15.2), respectively (P = 0.252).

Of particular interest are the relative effect sizes for the differences between the two URiM groups on the dependent variables: PGPA, MCAT, and USMLE Step 1 scores. Although MERP students earned USMLE Step 1 scores that were, on average, 1.30 points below their non-MERP counterparts, this difference was only 0.09 standard deviations and was not significant. By comparison, MERP students who reached USMLE Step 1 began their medical education with a significantly lower average MCAT score and mean pGPA which were 0.51 standard deviations and 0.84 standard deviations below their non-MERP peers.

  Discussion Top

Despite significantly lower average MCAT score and pGPA, MERP and non-MERP URiM students perform similarly in the first years of medical school. Similar quantitative outcomes include the following: (1) the percentage of MERP and non-MERP students who reached the 2nd year of medical school, (2) rates of students successfully reaching clinical year 3 of medical school, (3) cumulative USMLE Step 1 pass rates, and (4) mean USMLE Step 1 scores. We propose that a rigorous core curriculum integrated with a structured Academic Success Program leads to these positive outcomes. MERP Academic Success Program imparts noncognitive abilities through coaching students one-on-one and in small groups in areas of self-motivation, resilience, time management, and critical thinking. Students then practice applying these skills in activities designed for team-based learning.

URiM students tend to score lower on traditional objective assessment methods such as MCAT and undergraduate GPA.[6] Numerous studies over the years have documented that factors before the students' entry to as well as factors encountered during higher education contribute to these poorer outcomes.[9] Socioeconomic and educational barriers, lack of leadership, limited partnerships between undergraduate institutions, and medical schools collectively decrease URiM students' competitiveness as potential medical profession candidates.[9],[10] One strategy to increase diversity in medical schools is to change the relative weight criteria in the admission process by placing more emphasis on noncognitive criteria.[11] Another approach is to focus on academic preparedness of URiM students before medical school. Postgraduate prematriculation pipeline programs affiliated with medical schools in North America (e.g., MedPath, Ohio State; ABLE Program, Michigan State) aim to enhance minority students' scientific foundation.[12] However, few studies have looked at the effect of such programs on the performance of URiM students at offshore Caribbean medical schools that help the US medical schools meet the demand for physicians especially in rural and other underserved areas. Minority status remains a strong predictor for practicing in underserved communities, yet the number of practicing URiM physicians relative to the growing minority population is disproportionally low and has stagnated over time.[5],[13]

Helping minority students succeed in medical school would increase the number of graduating physicians who can help provide healthcare in underserved communities. If our results can be extended to others in the US, Caribbean, and international medical schools, this could help galvanize support for obtaining resources and promoting policy initiatives for programs similar to MERP, not only in the United States but also globally.


Ethics approval and consent to participate

This study was approved by the IRB committee at RUSM, reference number 12-7292016.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Rosenbaum S, Jones E, Shin P, Ku L. National Health Reform: How Medically Underserved Communities Fare? Policy Brief No. 10. Washington, D.C: Geiger Gibson/RCHN Community Health Foundation Research Collaborative; 2009.  Back to cited text no. 1
Association of American Medical Colleges. The Status of the New AAMC Definition of “Underrepresented in Medicine” Following the Supreme Court's Decision in Grutter. Washington, D.C: Association of American Medical Colleges; 2004. Available from: [Last accessed on 2018 May 10].  Back to cited text no. 2
Frieden TR; Centers for Disease Control and Prevention (CDC). CDC health disparities and inequalities report – United States, 2013. Foreword. MMWR Suppl 2013;62:1-2.  Back to cited text no. 3
Benz JK, Espinosa O, Welsh V, Fontes A. Awareness of racial and ethnic health disparities has improved only modestly over a decade. Health Aff (Millwood) 2011;30:1860-7.  Back to cited text no. 4
Wayne SJ, Kalishman S, Jerabek RN, Timm C, Cosgrove E. Early predictors of physicians' practice in medically underserved communities: A 12-year follow-up study of University of New Mexico School of Medicine graduates. Acad Med 2010;85:S13-6.  Back to cited text no. 5
Davis D, Dorsey JK, Franks RD, Sackett PR, Searcy CA, Zhao X, et al. Do racial and ethnic group differences in performance on the MCAT exam reflect test bias? Acad Med 2013;88:593-602.  Back to cited text no. 6
Orom H, Semalulu T, Underwood W 3rd. The social and learning environments experienced by underrepresented minority medical students: A narrative review. Acad Med 2013;88:1765-77.  Back to cited text no. 7
Lindner I, Sacks D, Sheakley M, Seidel C, Wahlig BC, Rojas JD, et al. A pre-matriculation learning program that enables medical students with low prerequisite scores to succeed. Med Teach 2013;35:872-3.  Back to cited text no. 8
McCluskey N. Many Factors at Play in Minority Access to Higher Education. Cato Institute. Available from: [Last accessed on 2017 Apr 28].  Back to cited text no. 9
Simmons SW. Predictors of academic success for underrepresented minorities in physician assistant program. J Phys Assist Educ 2003;14:110-3.  Back to cited text no. 10
Ballejos MP, Rhyne RL, Parkes J. Increasing the relative weight of noncognitive admission criteria improves underrepresented minority admission rates to medical school. Teach Learn Med 2015;27:155-62.  Back to cited text no. 11
Andriole DA, McDougle L, Bardo HR, Lipscomb WD, Metz AM, Jeffe DB, et al. Postbaccalaureate premedical programs to promote physician-workforce diversity. J Best Pract Health Prof Divers 2015;8:1036-48.  Back to cited text no. 12
U.S. Department of Health and Human Services, Health Resources and Services Administration. National Center for Health Workforce Analysis. Sex, race, and ethnic diversity of U.S. health occupations (2010-2012). U.S. Department of Health and Human Services, Health Resources and Services Administration; 2014. Available from: [Last accessed on 2017 Apr 28].  Back to cited text no. 13


  [Table 1], [Table 2]


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