Minorities, Rural, Service Orientation, Career Orientation, and Other Characteristics vs MCAT and GPA
At 04:23 PM 6/26/01 -0500, you wrote:
It is a dilemma, legally and politically, to not admit the best and
brightest. After a century of improvements for gifted education in high
school and college, the national pressures to admit the brightest are
enormous. Unfortunately, the brightest may not be the students most likely
to choose underserved locations.
It is discrimination to exclude or include candidates based on racial or
other background. Medical schools in the past century have excluded
minorities and Jews (Ludmerer, Time to Heal). In more recent decades
minorities have had some degree of preference, but this time seems to have
ended.
From the perspective of service to the underserved, it would be preferable
to admit minorities generally, as they are 4 times more likely to choose
underserved locations. These are almost entirely urban locations.
Minorities except for blacks are far less likely to choose rural locations.
From a rural underserved standpoint, few Asians and Hispanics choose such
locations. It is clear that there are successful programs that will allow
more minorities and rural people to be admitted, but these programs do not
have the support that they need.
The question remains: How do you choose candidates that are likely to
serve the populations that most need help?
As with most decisions of this magnitude, it is a matter of political will.
Clearly institutions will not change without leadership and example. After
models are established, it again takes leadership to implement these
changes more broadly.
Some research studies suggest a solution. There are also some past and
present models. This solution involves a determination on the part of the
school regarding what medical school candidates should be doing after
graduation. It involves the extra work of collecting data on candidates
before admission and comparing it to the outcomes years after graduation.
This study gives an inkling of what could happen if a school made such a
determination. Although this study links service orientation to primary
care choice, other studies and models imply that service orientation would
result in care of those needing care the most.
There are also some potential benefits for this "treatment." The side
effects might be that the resulting physicians would be more mature, less
inclined for income and more likely to communicate better (AAMC GQ 1995,
data comparing rural interested students vs their peers).
Madison, Donald L Medical School Admission and Generalist Physicians A
Study of the Class of 1985 Academic Medicine Vol 69 Number 10 October
1994 p 825 - 831 This study tracked 148 grads over 13 or 14 years of
practice. 34% choose generalist careers.
Results A high service index predicted strongly the choice of a
generalist medical career. Conversely the absence of any clear evidence of
a service orientation predicted still more strongly a non-generalist
career.
Conclusion in Abstract If an admission committee informs itself of
"what finally happens" to those it admits, its decisions can contribute to
achieving whatever policy its medical school adopts with respect to the mix
of physicians it wishes to produce.
About Service Orientation in the article The candidates were
interested in service through the vehicle of medicine. Service was first,
with medicine the means. Candidates with service orientation noted a
general concern for society or a community of people (women, home town,
underserved, elderly, third world). This was separate from the desire to
"work with people, being a people person, wanting to cure cancer, desire to
help people who are ill, or how much I want a medical career."
There were two service oriented items evaluated in the medical school AMCAS
application for the UNC Chapel Hill Class of 1985
I. Demonstrated Service Orientation through CV, background, work record,
extracurricular activities
II. Personal Statement - beyond helping sick people or non-specific
mention of service intent
I. Demonstrated Service Orientation - Reminder: AMCAS application asked for
this area specifically, as opposed to the essay which was left entirely up
to the candidate
Exceptionally Strong - 4% of class of students, 83% of this exceptionally
strong service oriented group or 5 out of 6 became generalists. These
students had a consistent history of work in a service career such as Peace
Corps, pastor, teacher, community organizer
Strong - 17% of students, 60% of these became generalists. Full record of
volunteer activity in college or after, vocational on non-vocational, some
lack of service continuity over time
Modest - 43%, 37% of this group became generalists. Some record of
volunteer activity usually in an organized group. Has to be a different
activity than just gaining medically-related experience. Helping but not a
clear humanitarian (vs vocation) orientation.
Low or no service record - 36% of class, 19% of these became generalists
II. Essay - Candidate statements that were beyond helping sick people,
beyond a non-specific mention of service
Strong service orientation - 18% of the class, 77% of these became
generalists
Modest 32% of the class, 45% became generalists
Weak/none 32% of the class, 12% became generalists
The above 2 categories (background and essay) were combined into a Service
Index on a 1 thru 5 scale
0 ? no service record or essay mention
5 ? Exceptionally strong service record and strong essay mention
A separate analysis looked at a logistic regression of factors regarding
generalist career choice. Service orientation was the number 1 factor,
socioeconomics of family was number 2, gender drops out as a factor.
There were some great quotes in the article including: The careers of
twentieth century US physicians shows a general tendency to drift from the broad
toward the narrow and never, so far, in the opposite direction. - Don
Madison
Selections based on service
The admissions choices in some of the newer primary care schools have
examined service. The RMED track at Rockford has a service scale that is
evaluated. Other schools also look at this area, including many that
graduate more in primary care.
We can choose better than the brightest, by choosing for service
orientation. We can also work to insure that socioeconomics are not a
hindrance.
If we do so there is an increasing probability that we will be more likely
to get the physicians that would choose underserved locations.
Some other possibilities: These physicians, chosen for service
orientation, would be less likely to want more income. They would be more
willing to deal with complex problem solving involving the community level.
They would be more likely to be leaders.
There is a warning: These students would be more intolerant of bad learning
environments and bad health care environments.
rbowman@unmc.edu
Continued discussion of this thread involved minority issues: Click this link to continue: Discrimination and Vice Versa