Factor

Urban

Lower

Intervention

Early emphasis on education

Likely, especially reading Higher income parents pour tens of thousands into their children before elementary school

Depends on parent status and interest, challenging for single parents, cultural issues   Age 0 - 8 critical, cannot catch up later without more years and older admission

Mentors

Deferred gratification, amount of effort vs amount of reward

Pressures to do well

Expectations of parents by socioeconomic levels.

Tendency to stand out too much if doing too well

Role models

Teacher Quality

Teacher quality higher in upper income areas and relative difference increasing

Great disparity in quality (certification, experience) and numbers available in rural and many inner city areas, same factors for all professionals, doctors, teachers, lawyers, etc. Property tax base, school funding formulas, all a problem

State efforts to distribute better

Expectations of teachers

7 – 9 % lower expectations of teachers for black and Hispanic students

Cultural education

Interest in health careers

Easier to shadow, often professional parents

Barriers to shadowing, no access, HIPAA myth, liability concerns myth

Address myths, establish high school summer programs at rural hospitals and clinics

Higher education advising

A focal point of the high schools common to such kids

High school advisors more familiar with problem kid programs than “gifted” ones.

Mentors, career programs

Drawback of poor development of discipline in such high schools and high freshman college failure rate

More distractions in schools, More kids not really interested in education. Schools funding based on attendance so schools do classes with no education. Kids without hs diploma make less not because of a piece of paper, it is because of other factors such as drugs, mental health, home situation, need work training not HS.

School boards close campuses, kids do relevant education for college or for future work 

PreMed Research, Fellowships

Aware of early

Travel to other nations/broadening

More accessible

Colleges

Top notch colleges, in state and out of state

Intellectual folks from underserved areas taken on a pathway away from underserved areas, often attending college at distant locations, breaking contact with needs of birthplace, seeing only the subspecialty role models instead of primary care

Small and rural colleges not quite the preparation and twice the medical school failure rate (Wheat)

RHOP program impact on academics where internal competition generates better performance in a few years

College Health Advisors

Advantage

Some students less likely to access advisors, tend to be more independent

College advisor ed, list serves, med school involvement

Centralization of education

Larger schools retain funding

Smaller and rural schools forced to cut expensive classes and degree efforts with fewer students, i.e. preprofessional courses

State education policy and property tax issues, RHOP impact

Students adaptations

Students learn to say what is important about getting admitted rather than the truth

Less coaching and socialization, however clearly there are those in minority and rural camps that embrace service and making a difference, while others are using higher education as an escape

More use of health advisors, third party resources

Affirmative Action impact on college admissions

Major gains for blacks and Hispanics over a number of years, then major setbacks, particularly for the less intellectual students

Affirmative impact on medical school admissions

A few parents with higher incomes fighting special admissions programs.

Many years of consistent gains followed by rapid descent as if schools in fear or really did not believe in such efforts. Tendency for the more intellectually gifted to be admitted over service oriented

Use of income and more global measures, not race or rurality

Concern regarding special admissions programs of other types, such as rural

Tendency for the more intellectually gifted to be admitted with possible loss of those more oriented toward service

Research emphasis due to NIH grant funding increases, up to 50% in indirect costs to dean

Moves the admissions process more to the intellectual side and less to the service side

Moves the admissions process more to the intellectual side and less to the service side

Accreditation pushes acceptance of students with higher scores and grades who are likely to have higher board scores and pass rates, thus helping the institution avoid dealing with accrediting bodies much and making faculty and administration efforts much easier

Moves the admissions process more to the intellectual side and less to the service side

Moves the admissions process more to the intellectual side and less to the service side. Difficult to predict performance of students that are different, those with families, those that with distractions such as family, doing work during college

Lots more resources to admissions committees, gifted and experienced leadership, staff training

Scholarship impact, Military, Research

Less need for

Tendency to choose military programs, especially if lower income, family obligations, service oriented. Studies of rural interested senior medical students confirm marriage in college, older, more kids. Also osteopathic docs more likely to choose rural and military. Similar findings in those staying in rural communities long term regarding marriage in college, more kids.

Level this playing field

Primary care moves from a secure career to bottom of the heap

Less interest, lifestyle perceived too much work for too little reward.

Same as rich kids plus job looks less secure, less likely to make a difference, pressures to do better economically for ones family and "people"

Decrease hassle factors, longer term primary care experiences