CURRENT CHALLENGES
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 stu-
dents 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 usu-
ally the first opportunity for premeds to meet
an academic physician. Enrichment pro-
grams 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 fac-
ulty-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 com-
fortable 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 encour-
age 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 adjust-
ment. Many minority students are the first
members of their family to have reached
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