Opportunities for Minorities

This subject will be considered from two perspectives, enrollment and retention.

Enrollment

Over the past decade, the overall composition of the entering medical school classes has changed from predominantly white male to a very substantial number of women and a modest, yet significant, number of minority members. This radical change is in response to the drastic alteration in the social climate of the United States.

Currently, although African-Americans make up 12% of the population, they account for only 3% of the physicians in the United States and 8% of the medical students in the country. Similarly, Hispanic-Americans comprise 9% of the population and 4% of the nation's physicians. Native Americans fare worse, making up 0.8% of the public and 0.1% of its doctors. These three groups are thus considered underrepresented minorities. The medical education establishment responds to these facts by maintaining an ambitious recruitment campaign.

Retention

Many medical schools make special efforts to assist disadvantaged students. They provide summer enrichment programs for premeds to help prepare for MCATs, as well as an experience in basic premed science coursework and research. This is usually the first opportunity for premeds to meet an academic physician. Enrichment programs were found to improve subsequent academic performance. Many schools also offer postbaccalaureate and prematriculation programs to accepted minority students in order to prepare them academically before they must face the pressures of their first year in medical school. These programs are attractive because they have a small faculty-student ratio and provide early exposure to the basic medical sciences. In some schools, students are permitted to lighten the load of the first year by satisfactorily completing part of it in advance. Flexible curricula and five-year programs are becoming more common in medical schools. Many schools also make special efforts to prepare minority students for the USMLE. All of the aforementioned strategies enhance both recruitment and retention of disadvantaged students. In addition, such students have access to the wide variety of academic and social support services offered to all students.

The cost of medical education remains high and can reach $150,000 for four years of tuition and fees at some schools. This can be especially burdensome for minority students. The average debt of African-American students after college and medical school exceeds $55,000. Yet the dropout rate does not seem to have been heavily influenced by the financial demands of medical education. A potentially disturbing issue is the possibility that federally funded minority scholarships may be in danger of being curtailed.

Recognizing the demographic shift toward a multiethnic and multiracial society, the AAMC has established a special recruitment campaign—Project 3000 by 2000—to enhance science education in public schools, thus helping to nurture the potential pool of minority applicants.

Minority applicants can now explore the opportunities that are offered to them at the schools to which they are considering applying and can determine if they will feel comfortable there for four years.

While enrollment efforts have had a positive impact on increasing minority class representation, it is now recognized that these efforts need to be strengthened to encourage students to endure the rigors of the training process and to complete their medical studies. This is indicated by the fact that the dropout rate for freshman minority students is close to 10%, as compared with 3% for all other students.

The cause of the increased dropout rate among minority students may not be exclusively academic, but, rather, due to cultural conflicts and lack of social adjustment. Many minority students are the first members of their family to have reached such an educational level and are under intense pressure to succeed. Many minority students have attained admission to medical school without encouragement, and may even have been advised against pursuing higher education or a professional career. Therefore, for most of them, medical school is a pioneering experience in a not too supportive environment. This makes the process an extremely challenging one. A major element influencing this situation is a lack of role models, since few minority members come from physician families. Moreover, only about 3% of all medical school faculty are minority physicians. (Included in this figure are those at predominantly black institutions.) There is the perception that minority faculty are more approachable and responsive to disadvantaged students. Such support can be critical to a student's progress. The number of minority residents is unfortunately not large enough to have them serve as role models. In all, the lack of role models is considered a critical issue in the retention of minority students.

Medical schools that have been successful in recruitment and retention of minorities have made use of mentoring programs. A mentor can provide a direct vision of what it means to be a physician. The mentor can not only offer support during difficult intervals, but also can help students make pivotal career choices relative to such issues as choosing electives, specialization, and where to do one's residency training. At some institutions, white faculty members have been used to serve as mentors, due to the shortage of minority faculty.

A lack of social interaction in medical school leads to a sense of isolation among minority students. This leads them to form their own networks, which helps to a degree. Having a chapter of a national minority student organization on campus also can be useful as a form of protection against social isolation.

Because of alienation early in their education, minority students frequently do not acquire desirable skills for group learning. Also, they often are not prepared for the demanding workload in medical school. For some minority students who lack adequate academic preparedness, improvement in study skills is essential.

Success in handling standardized tests — the SAT I or ACT exam, MCAT, or USMLE—is especially challenging for minority students. Hispanic students, who frequently speak English as a second language, are at a special disadvantage. Remaining in medical school is often closely tied to performance on Step 1 of the USMLE.