|PRACTICAL ADVICE PAPER
|Year : 2016 | Volume
| Issue : 3 | Page : 259-265
Doctors of tomorrow: An innovative curriculum connecting underrepresented minority high school students to medical school
Jordan Derck1, Kate Zahn1, Jonathan F Finks2, Simanjit Mand1, Gurjit Sandhu3
1 Medical School, University of Michigan, Ann Arbor, Michigan, USA
2 Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
3 Department of Surgery, University of Michigan Health System; Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, Michigan, USA
|Date of Web Publication||11-Apr-2017|
Department of Surgery and Learning Health Sciences, University of Michigan, 2207 Taubman Center, 1500 E. Medical Center Dr., SPC 5346, Ann Arbor, MI 48109-5346
Source of Support: None, Conflict of Interest: None
Background: Racial minorities continue to be underrepresented in medicine (URiM). Increasing provider diversity is an essential component of addressing disparity in health delivery and outcomes. The pool of students URiM that are competitive applicants to medical school is often limited early on by educational inequalities in primary and secondary schooling. A growing body of evidence recognizing the importance of diversifying health professions advances the need for medical schools to develop outreach collaborations with primary and secondary schools to attract URiMs. The goal of this paper is to describe and evaluate a program that seeks to create a pipeline for URiMs early in secondary schooling by connecting these students with support and resources in the medical community that may be transformative in empowering these students to be stronger university and medical school applicants. Methods: The authors described a medical student-led, action-oriented pipeline program, Doctors of Tomorrow, which connects faculty and medical students at the University of Michigan Medical School with 9th grade students at Cass Technical High School (Cass Tech) in Detroit, Michigan. The program includes a core curriculum of hands-on experiential learning, development, and presentation of a capstone project, and mentoring of 9th grade students by medical students. Cass Tech student feedback was collected using focus groups, critical incident written narratives, and individual interviews. Medical student feedback was collected reviewing monthly meeting minutes from the Doctors of Tomorrow medical student leadership. Data were analyzed using thematic analysis. Results: Two strong themes emerged from the Cass Tech student feedback: (i) Personal identity and its perceived effect on goal achievement and (ii) positive affect of direct mentorship and engagement with current healthcare providers through Doctors of Tomorrow. A challenge noted by the medical students was the lack of structured curriculum beyond the 1st year of the program; however, this was complemented by their commitment to the program for continued longitudinal development. Discussion: The authors propose that development of outreach pipeline programs that are context specific, culturally relevant, and established in collaboration with community partners have the potential to provide underrepresented students with opportunities and skills early in their formative education to be competitive applicants to college and ultimately to medical school.
Keywords: Curriculum, mentorship, underrepresented minority
|How to cite this article:|
Derck J, Zahn K, Finks JF, Mand S, Sandhu G. Doctors of tomorrow: An innovative curriculum connecting underrepresented minority high school students to medical school. Educ Health 2016;29:259-65
|How to cite this URL:|
Derck J, Zahn K, Finks JF, Mand S, Sandhu G. Doctors of tomorrow: An innovative curriculum connecting underrepresented minority high school students to medical school. Educ Health [serial online] 2016 [cited 2021 Sep 16];29:259-65. Available from: https://www.educationforhealth.net/text.asp?2016/29/3/259/204219
| Background|| |
Racial minorities are projected to constitute a majority of the US population by 2050 yet are underrepresented in medicine (URiM). For example, African Americans represent 13% of the population but only 4% of physicians, a proportion that is largely unchanged over the past 30 years. The American Association of Medical Colleges defines minorities URiM as those ethnic and racial populations that are underrepresented in the medical profession relative to their numbers in the general populations. In the US, this group historically consists of Blacks, Mexican-Americans, Native Americans (American Indians, Alaskan Natives, and Native Hawaiians), and mainland Puerto Ricans. These racial groups made up 31% of the US population, but just 15% of the total medical student body in 2011.
Increasing provider diversity is integral to eliminating health disparities and delivering effective care for all populations. Minority physicians more frequently pursue primary care specialty training and practice in underserved communities than their nonminority counterparts., With an additional 30 million healthcare consumers projected to access the health system through the 2010 US Affordable Care Act, intentional efforts to better enable minority students to enter the medical field can address this increased demand for providers while leading to improved health outcomes.
The impact of diversity extends beyond patient-provider interactions. A cross-sectional study of 20,000 medical students found that nonminority students attending institutions with greater diversity reported feeling better equipped to care for racial and ethnic minorities while also indicating stronger attitudes about healthcare accessibility. Cross-cultural peer exchange facilitates culturally competent learning, which enables all future physicians to be leaders toward equitable health.
Despite this growing recognition of the importance of diversity, the lack of progress has been disappointing. Medical training programs in the US have been slow to rethink admissions criteria. More importantly, URiMs often face challenges with inequitable primary and secondary education and encounter barriers accessing resources for success in postsecondary education and career-specific mentoring, so can be less competitive for medical school positions., The Sullivan Commission, a group of experts assembled to provide recommendations on diversifying health professions in the US, argues that health professional schools need to initiate outreach collaborations with primary and secondary schools in order to attract and foster the pool of URiMs.
Robust programs, such as the Stanford Youth Summer Medical Program, have engaged high school students for over 25 years and have successfully seen participants graduate from medical school. A team of students and faculty at the University of Michigan Medical School (UMMS) created Doctors of Tomorrow by building on successful tenets of these prior programs, including hands-on clinical experience and direct mentorship, while identifying new opportunities for innovation and sustainability. Doctors of Tomorrow differs from existing medical school-high school collaborations in its: (1) Longitudinal educational relationship; (2) extensive near-peer mentorship; and (3) medical student leadership that drives the sustainability and relevancy of curriculum programming.
Doctors of Tomorrow is a pipeline program designed to inspire and invest in 9th grade URiM students who express interest in pursuing a career in medicine. A partnership was established with Cass Technical High School (Cass Tech) in Detroit, MI. Detroit, MI is a metropolitan city with a large population of minorities (for example, 86% of the population is African American/Black). The Detroit school system is struggling to provide quality education for its students: in 2014 only 6.9% of 11th grade Detroit students performed at or above the Michigan Merit Examination proficient level, compared to 28.8% for the state of Michigan. The performance of 11th grade students as Cass Tech is notably higher at 14.4% for proficient level measures; however, it is essential that the Cass Tech community also be consider in context as an integral part of the Detroit community. Finally, Detroit is in close proximity to the UMMS. Through this partnership, a pipeline program was designed as a way to provide students interested in medicine with opportunities and skills early in their formative education to be competitive applicants to college and ultimately medical school.
The goal of this paper is to describe and evaluate a program that seeks to create a pipeline for URiMs early in secondary school by connecting these students with support and resources in the medical community that may be transformative in empowering these students to be stronger college and medical school applicants.
| Methods|| |
Doctors of Tomorrow was developed using a theory-based approach. Learning theories associated with adolescent thinking and behaviors, as well as the influence of modeling and active engagement, informed programming content, context, and teaching methods. This was complemented by social cognitive and social cultural models of learning that emphasize the importance of cultural values, social relationships, and personally significant knowledge on how adolescents make meaning.
This theory-based approach resulted in a curricular framework that optimizes students' previous knowledge and experiences, is grounded in health concerns that are relevant in students' local communities, and incorporates a breadth of teaching methods from direct instruction to experiential learning.
Institutional collaboration and student participation
In selecting a partner high school, the leadership team (including medical students and medical faculty) considered: student demographics; institutional support at the school; proximity to UMMS; and existing educational opportunities to pursue health professions. The focus of programming was on 9th graders as this is a critical transition year from primary to secondary school. Cass Tech, Detroit's most established magnet school whose student body is racially representative of Detroit high schools with 90% of students identifying as Black or Hispanic, was approached, and the Doctors of Tomorrow partnership was established in June 2012. Doctors of Tomorrow specifically sought out a magnet school because it is a public school with specialized curriculum that draws students from a greater geographical area than typical school zones, and there are often admissions criteria, such as test scores and grades, for this type of school.
To enrich the quality of the program and ensure its self-sufficiency, a team of medical student leaders was selected to manage all parts of the program with oversight from a faculty advisor. In September 2012, the opportunity to be a medical student mentor was presented to the entire 1st-year UMMS class of 170 students. All 1st-year students were welcome to participate, and ultimately 20 students volunteered to be mentors for the 2012–13 year and 28 for the 2013–14 year.
Doctors of Tomorrow was advertised to all Cass Tech 9th grade students with the invitation to apply. Prior to applying, the students were informed about the opportunity for monthly visits to UMMS with a full day curriculum at each visit and longitudinal support from a medical student mentor. The 2012–2013 and 2013–14 Doctors of Tomorrow Cass Tech student cohorts comprised 17 and 25 students, respectively. Student applications consisted of two essays and a letter of recommendation from a science teacher. The Doctors of Tomorrow leadership team reviewed the applications and selected students who were in good standing. Selected Cass Tech students participated in the core curriculum, designed a rigorous capstone project, and were mentored by a UMMS 1st-year medical student.
The Doctors of Tomorrow Core Curriculum consisted of once-monthly experiences at Cass Tech and UMMS [Table 1]. Educational events at UMMS were full-day experiences that utilized small groups, personal stories, case discussions, brainstorming, shadowing, and direct instruction to engage and challenge students. The students were provided with exposures to a breadth of experiences in healthcare, recognizing that medicine is only one component of healthcare. Through these experiences, the Doctors of Tomorrow core curriculum emphasizes hands-on learning, independent and collaborative scholarship, and near-peer mentorship. The medical student leadership team organized and executed the curriculum, including recruiting UMMS faculty, staff, and medical students to participate in shadowing, lectures, and experiential learning activities.
Teams of Cass Tech students developed a capstone project on a health issue affecting their community with guidance from their respective medical student mentors. Medical students helped identify credible sources on relevant epidemiology, health disparities, and treatment options, such as NIH factsheets, Medscape, and the National Conference of State Legislature Unhealthy Differences database.,, Cass Tech students created a proposal for a health improvement strategy, which demonstrated how they could be agents of change. At each monthly visit to UMMS, Cass Tech students spent 2 hours working on their capstone project. Two additional visits were scheduled at Cass Tech where medical student mentors assisted with finalizing presentations. Capstone projects were presented to family, mentors, and peers, offering the opportunity to enhance public speaking skills.
First-year medical student mentors attended 4 hours of orientation led by the faculty advisor and medical student leadership team. The orientation covered program goals, strategies for communicating with and mentoring high school students, and mentor responsibilities. Mentors were consented for a background check (required by Cass Tech in order to work directly with their students). During each program year, mentors were expected to attend a 1 hour lunch at UMMS with their mentees each month. In addition, mentors were invited to participate in all parts of the Cass Tech students' day at UMMS each month. There were three events held at Cass Tech including the Capstone presentation that mentors were strongly encouraged to attend. Mentors were encouraged to contact their mentee at least once per month via E-mail in addition to the contact made at Doctors of Tomorrow events. Mentoring is foundational to the program as it provides the 9th graders a near-peer guide and longitudinal support. With progression through high school, mentors offer insight on academic success strategies.
Cass tech feedback
Because formal feedback information was not collected immediately following the 2012–2013 program, all 42 students from the first two cohorts (2012–2013 and 2013–2014) of Doctors of Tomorrow were invited in 2014 to participate in the feedback process. Letters of information and consent forms were distributed to Cass Tech students participating in Doctors of Tomorrow. There were letters and forms for each Cass Tech student and their parent/guardian describing the purpose and methods for collecting feedback. Students had to return signed consent forms from themselves and their parent/guardian in order to participate. Thirty students (71%) volunteered to participate [Table 2]. Collection of feedback was deemed to be quality improvement for the program and considered “not regulated” by the UMMS Institutional Review Board.
|Table 2: Demographics of thirty Doctors of Tomorrow students who participated in the feedback process|
Click here to view
Meaningful curricular feedback was obtained through qualitative assessment of how the curriculum was enacted and experienced by students. Focusing on Doctors of Tomorrow programming, participating students was asked to describe critical incidents – positive or negative – that had a significant impact on them. These incidents, known as educational critical incident narratives, were framed in the context of transformation: An experience that interrupts or changes an individual's prior knowledge.
From March 2014 to April 2014, feedback was obtained using focus groups and written narratives by all Cass Tech students who participated in focus groups. All students who submitted a narrative were interviewed using a set of questions designed to better understand the narrated individual experiences [Table 3]. Transcriptions of all three feedback methods were thematically analyzed. We also included a priori themes derived from adolescent learning theories and critical incident concepts, specifically: (i) Barriers to success, (ii) support systems for success, and (iii) motivation and goal setting.
JD and SM individually and collaboratively coded the feedback using QSR NVivo10 (QSR International Pty Ltd., Doncaster, Victoria, Australia). GS independently examined a subsection of the feedback and reviewed all of the thematic analysis. Discrepancies were reconciled among the study team members.
Mentor and faculty feedback
Medical student and faculty advisor feedback was not formally collected for this project, but ongoing dialog by the medical student-led leadership team and the faculty advisor was recorded at monthly leadership meetings. The medical student leaders reflected on the successes and shortcomings of each Doctors of Tomorrow event based on their direct observations and feedback from medical student mentors and Cass Tech students. At the end of the 1st 2 years, the medical student leadership team reviewed these thoughts, and created a visioning document that was intended to consolidate the successes and lessons learned from the previous years and plan changes that should be made to the program. The research team interrogated these notes retrospectively to evaluate the successes and shortcomings of the program from the medical student perspective. JD performed thematic document analysis on these records.
| Results|| |
Themes from Cass Tech student feedback
Cass Tech student responses from focus groups, educational critical incident narratives, and follow-up individual interviews consisted primarily of two themes: (1) Personal identity and its perceived effect on goal achievement and (2) direct mentorship and engagement with current healthcare providers through Doctors of Tomorrow positively affects students.
Personal identity and its perceived effect on goal achievement
Many students associated their personal identity as motivation for pursuing postsecondary education, specifically noting the desire to better provide for themselves, their families, and their community. One of the 9th grade girls described unstable employment that her parents faced because of their education level and compared this to a prospective future for herself and classmates, “now that we actually have an opportunity, we should take it. I really want to go to college and prove that I can do it.” Another 9th grade female student extended this sense of personal opportunity to a larger social responsibility and explained, “It's not about being famous. It's about being legendary - changing people's lives. Doctors change people's lives. They make a mark. I just really want to make an impact on this world.”
At the same time, the majority of students readily identified race, socioeconomic status, and education level of family members as barriers that could challenge their educational goals. One 9th grade student poignantly summarized a commonly articulated concern of many of his African American peers:
When people see me, a tall, black guy, they think, “Oh, he's probably good at basketball.” I'm really not. They immediately go to stereotypes and they're not good. They're not. So I have to prove myself to them. I have to work 10 times as hard as most people just to get in the same position as them and twenty times to go above that position.
Students additionally raised concerns about being a first-generation college student. A 9th grade female explained, “I never really had anybody sit down and talk to me about when you get to college it's going to be hard. This is what is going to happen. I've had to figure all that out on my own.” This was often coupled with financial worries as shared by another 9th grade girl, “if it wasn't for financial issues, there would be really no problem with me becoming the kind of doctor I want.”
Direct mentorship through Doctors of Tomorrow positively affects students
The opportunity to work with UMMS health professionals - from faculty to medical students - was the most frequently cited critical incident. Students described how the interactions reshaped their preconceived notions of doctoring and provided a new perspective on health professions. A 9th grade male student reflected on new awareness and deepened critical thinking from his shadowing experience:
I couldn't wrap my finger around the reality that doctors didn't always know what was wrong with their patients.(…) I was introduced to not only the daily lives of some doctors, but how they think, come to conclusions, provide diagnosis, and even why they take so long and leave you waiting for hours.(…) Their job is kind of like putting pieces together of a puzzle. They use symptoms, and background knowledge of their patients to come to a diagnosis.
Students' descriptions of active learning at UMMS illustrated heightened feelings of motivation and confidence to pursue postsecondary education and medical professions. A 10th grade female student shared that the experience, “changed what was once an unknown to what is now a known. It is no longer an illusion within my head. It is now a reality. It is a reality that can be mine if I choose.”
The most explicit influence of the shadowing experience was described by a 10th grade male student:
I realized that these people were not just showing us how to become doctors. They actually wanted us to be the Doctors of Tomorrow.
Lessons learned based on mentor and faculty feedback
Reviewing the notes from the faculty and medical student leadership team demonstrated that the most commonly occurring discussion point was increasing longitudinal experiences. The team described disappointment from both the Cass Tech students and mentors about the lack of structured curriculum beyond the 9th grade year. The medical student mentors felt less encouraged to keep in touch with their mentees than they would have if the Doctors of Tomorrow program continued to engage with the mentees beyond 9th grade.
The leadership team noted that interactive activities that involved both mentors and mentees were more engaging for mentees and strengthened their relationship with the mentors. The leadership team documented that future events should contain fewer didactic lectures and more experiential learning activities.
A particularly successful aspect of the program was the medical student involvement. Mentors and medical student leaders felt that the amount of time required to participate in Doctors of Tomorrow was reasonable and comparable to any other extracurricular activity that a medical student might participate in during medical school. There is clear mentor enthusiasm for the program highlighted by the growing number of medical students volunteering to be mentors each year. In 2014, 37 medical students applied to be mentors. This is an increase from 28 mentors in 2013 and twenty mentors in 2012. The leadership team enthusiasm was, especially striking in this review based on the desire to continue to build on and broaden the reach of the Doctors of Tomorrow program.
| Discussion|| |
This evaluation is limited by a lack of understanding of students' perspectives prior to their participation in Doctors of Tomorrow. Students reported having significant goals for their education, but when these goals were formed in relation to entering the program is unclear. Regardless of this timeline, it is clear from student feedback that Doctors of Tomorrow strongly reinforced these aims. Continuing evaluation into subsequent high school years and throughout postsecondary education is necessary to evaluate final program goals.
Components of the Doctors of Tomorrow curriculum, such as hands-on context-specific learning at UMMS, interactions with physicians, and mentoring by medical students were described as critical and transformative. Expanding programming for 10–12th grade that builds on the strengths of the existing curriculum and aligns with the specific needs of each year could maintain longitudinal engagement of students. On a broader scale, we envision Doctors of Tomorrow connections through undergraduate education; disseminating our model and findings to other medical schools; and exploring the effect of the program not only on Cass Tech students but also on medical student mentors.
Doctors of Tomorrow is a medical student-led curriculum that builds on the strengths of collaboration, context specificity, and cultural relevance. This model could be replicated or modified as part of a vision to address the disparities present in other communities and medical schools in the US as well as in countries where underrepresentation and inequities in health systems are also present. Engaging and supporting youth who come from communities that are URiM and collaborating with medical students early in their training to be mentors and educational partners, has significant potential to raise the level of social accountability in health systems. Expanding this curriculum would better prepare students for their pursuit of higher education, and ultimately careers in medicine.
Financial support and sponsorship
Jeffrey Cappo and the Victory Automotive Group have financially supported this work.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]