An Effective Methodology to Boost the Socio-Economic Diversity of U.S. Med Students and Future Doctors

The lack of socio-economic diversity among medical students is causing a growing health care and fiscal problem in the United States.

According to Frontiers, “approximately three-quarters of all medical students [and therefore future doctors] come from the top two household income quintiles, with approximately half from the top 20% and one-quarter from the top 5%.”

Because these students (and future doctors) will have little in common with or understanding of the socio-economic backgrounds of the patients for whom they’ll be caring, they’ll have diminished capabilities to build trust and communicate effectively with them. This absence of cultural competency reduces the probability of successful wellness/recovery results.

D.C.-based think tank Third Way elaborates on the disconnect by saying that it can result in patients “skipping yearly check-ups and vital preventive care, leaving chronic illnesses and other health complications to go unchecked. Delayed or missed care creates more visits to the doctor, worse outcomes, and higher costs.”

In 2015, Ponce Health Sciences University (PHSU) – an LCME-accredited medical school with campuses in Ponce, Puerto Rico and St. Louis, MO – collaborated with Tiber Health Innovation (THI), an education technology company, to devise a remedy for this ailment.

Our methodology, which is the first and only of its kind, consists of two essential components: a pathway program and a predictive model. The coupling of these elements creates a data-centered approach to MD admissions that allows for less reliance on the MCAT. The goal is to accept students from varying socio-economic backgrounds into medical school which will increase physician workforce diversity.

Pathway programs are academic offerings designed to help students gain the necessary qualifications, skills, and knowledge to meet the entry requirements for a desired advanced degree. In the case of medical education, pathway programs can enhance opportunities for - and boost the confidence of - students from disadvantaged socio-economic backgrounds who aim to matriculate into medical school.

In the 2015–2016 academic year, PHSU launched a pathway program called a Master of Science in Medical Sciences (MSMS) degree. The tuition-based MSMS uses the same curriculum as the first year of PHSU’s LCME-accredited medical school. We consider the MSMS program to be a longitudinal performance assessment because students must demonstrate grit and persistence, as well as curricular mastery and understanding, throughout the one-year, 42-credit course of study.

According to a study featured in the Journal of Research on Technology in Education, such a longitudinal performance assessment can be a better measure of a student’s knowledge, skills, and abilities compared with a one-time snapshot of knowledge like the MCAT.

Our predictive analytics model estimates performance on the United States Medical Licensing Examination (USMLE) exam, which is the required medical licensure test sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners. All medical students must pass the USMLE to be eligible for hospital residency.

The combination of our pathway program and our predictive analytics model has provided the PHSU medical school admissions committee with new analytical tools and useful metrics to consider. It’s been especially valuable when evaluating students from lower socio-economic backgrounds whose MCAT scores are low, but they are predicted to pass the USMLE Step 1 based on THI’s predictive analytics platform.

Our research is published by the American Association of Medical Colleges and is titled “Increasing Diversity in the Physician Workforce: Pathway Programs and Predictive Analytics”. It found that there was a strong positive correlation between our medical students from lower socio-economic backgrounds who completed our MSMS pathway program and their USMLE Step 1 scores (both predicted and actual). In fact, these students performed as well as and often better on the Step 1 exams than students who entered PHSU directly (no MSMS program enrollment) and had higher MCAT scores.

This discovery is consistent with the LCME’s Standards on Diversity report, which calls for less reliance on the MCAT exam in an effort to enroll capable and diverse med school students and eliminate bias from admissions.

(Interestingly, overreliance on the MCAT as an admissions tool is proving to be a universal impediment to achieving student diversity: researchers Lucey and Sguil found the MCAT to be a weak to moderate predictor of success in medical school, especially for students from underrepresented and lower socio-economic backgrounds.)

To diversify their student bodies, we recommend that U.S. medical schools consider making a pathway program available to prospective enrollees. Such a program, which is exemplified by the MSMS framework that has been established by PHSU/THI along with 10 partner universities, would effectively prepare aspiring doctors from diverse socio-economic backgrounds for the demands of med school academics (as well as the rigors of their Step 1 exams). The MSMS program would also prepare such students who wish to pursue other medical/health care education options - including dental school, veterinarian school, nursing school, etc.

David Lenihan, Ph.D., J.D., FRSM, is the CEO of Ponce Health Sciences University (a medical school with campuses in Ponce, Puerto Rico and St. Louis, MO) and the co-founder of Tiber Health Innovation. His POVs on a variety of leadership, business strategy, and medical education topics have been featured in The HR Director, STAT, Entrepreneur, Fast Company, Forbes, Fierce Healthcare, Washington Post, Cureus, and many more.

Michael Mayrath, M.S., Ph.D, is the President of Tiber Health Innovation. He's co-founded numerous ventures, including Knod Global Learning Network and Magellan Education. He has conducted research and development for such organizations as the U.S. Air Force and Cisco, and was the lead editor of the book “Technology-Based Assessments for 21st Century Skills: Theoretical and Practical Implications from Modern Research” (Information Age Publishing - 2012).