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JAOA/AACOM Medical Education  |   April 2018
Educational Intervention in a Medically Underserved Area
Author Notes
  • From the Edward Via College of Osteopathic Medicine-Carolinas in Spartanburg, South Carolina. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Joel Atance, MSc, PhD, 350 Howard St, Spartanburg, SC 29303-3515 Email: jatance@carolinas.vcom.edu
     
Article Information
Medical Education / Preventive Medicine
JAOA/AACOM Medical Education   |   April 2018
Educational Intervention in a Medically Underserved Area
The Journal of the American Osteopathic Association, April 2018, Vol. 118, 219-224. doi:10.7556/jaoa.2018.047
The Journal of the American Osteopathic Association, April 2018, Vol. 118, 219-224. doi:10.7556/jaoa.2018.047
Abstract

Context: Medical students from rural and medically underserved areas (MUAs) are more likely than their peers to practice medicine in rural areas and MUAs. However, students from MUAs are also more likely to face socioeconomic barriers to a career in medicine.

Objective: To determine whether a week-long summer enrichment experience (SEE) at Edward Via College of Osteopathic Medicine-Carolinas could successfully teach high school students from MUAs basic biomedical concepts and foster an interest in medicine and the health sciences.

Methods: The SEE program is open to high school students in the Spartanburg, South Carolina, area. The program includes interactive lectures, laboratories, demonstrations on gross anatomy prosections, demonstrations on medical simulation models, tours of emergency vehicles, an introduction to osteopathic manipulative medicine, and student-led research projects. Participants were asked to complete a 15-question quiz that assessed their knowledge of basic biomedical concepts and a 10-question survey that assessed their attitudes toward careers in medicine and health sciences. Both the quiz and the survey were completed on both the first and final days of the program. The data were analyzed using paired t tests.

Results: Participant knowledge of basic biomedical concepts, as determined by the quiz scores, increased after completion of the program (9.1 average correct answers vs 12.6 average correct answers) (P<.001). Participant attitude toward medicine and the health sciences improved in 9 of the 10 items surveyed after completion of the program (P<.05).

Conclusions: Participant knowledge of basic biomedical concepts and their knowledge of and interest in careers in the health sciences improved after completing the SEE program. These findings suggest that educational interventions for high school students could help to develop primary care physicians for rural areas and MUAs and that there is a role for osteopathic medical schools to nurture these students as early as possible.

A key social determinant of health for people living in rural areas is access to health care.1 In South Carolina, 40% of the population lives in medically underserved areas (MUAs), particularly with respect to primary care physicians. As of late 2017, 216 additional primary care physicians were needed to resolve this shortage.2 Osteopathic medical schools have a long tradition of successfully producing primary care physicians who practice in rural areas and MUAs.3-5 Part of this success can be attributed to recruiting medical students from rural areas and MUAs, because these students are more likely to practice in rural areas and MUAs.6-10 However, people living in rural areas and MUAs have fewer opportunities for educational achievement.1 Therefore, part of recruiting medical students from MUAs involves reaching these prospective students before matriculation into medical school. 
Educational interventions are an important component in removing socioeconomic barriers to educational success.11-13 In the 1970s, recognition of the socioeconomic barriers that were preventing women from pursuing careers in science began to emerge.14 By the 1980s, systematic research on addressing and removing such barriers was done, and these findings may be transferable to other disadvantaged groups.14 Pipeline programs that seek to increase representation of specific groups in science, math, and engineering have been successful.8,15-19 Programs specifically geared toward medicine vary widely in scope and duration, but they generally feature an underlying theme of improving accessibility to careers in medicine. For instance, the University of Arkansas for Medical Sciences created a national outreach program that targets kindergarten through twelfth-grade students and teachers and uses various modalities, including weekly sessions, intensive workshops, and individual courses, to inform participants about the health sciences.20 Similarly, the University of Alabama Rural Health Leaders Pipeline is a comprehensive program with the goal of improving health care in small towns and rural areas in Alabama. The program targets rural students from elementary school through residency, with an emphasis on minorities.21 
Although these programs are very large in scale and require considerable institutional support, smaller-scale programs can also be effective in igniting interest in careers in medicine. The West Virginia School of Osteopathic Medicine hosted a 1-day mini-medical school program for high school students that successfully inspired students to pursue careers in medicine.22 The Royal College of Surgeons in Ireland hosted a 4-day mini-medical school program for suburban and rural high school students, and they found that the program was effective in introducing students to careers in medicine.23 
We sought to expand on these types of assessments by measuring the effectiveness of the week-long summer enrichment program at the Edward Via College of Osteopathic Medicine (VCOM). The summer enrichment experience (SEE) was initiated at the Virginia campus in 2008 and the Carolinas campus (VCOM-Carolinas) in 2014. In particular, we wanted to assess students’ acquisition of basic knowledge during the program. We hypothesized that the SEE program would increase participant knowledge of basic biomedical concepts and improve their knowledge of and attitudes toward the practice of medicine and the health sciences. 
Methods
This study was determined to be exempt by VCOM's institutional review board. As such, parental consent was not required for participation of the high school students involved. Nonetheless, all SEE participants were informed that the collected data might be used for curriculum write-up or publication purposes, and they were free to decline participation. Participants in the 2015 SEE program were included in the study. 
Program Description
The VCOM-Carolinas SEE program is designed for high school students from MUAs who demonstrate academic aptitude and an interest in medicine and the health sciences. The program is open to all rising sophomores, juniors, and seniors in the Spartanburg, South Carolina, area with a minimum cumulative grade point average of 3.0. Participants were primarily recruited by the VCOM website and promotional flyers that were delivered to all Spartanburg County high schools. Flyers were also distributed to churches, clubs, and community organizations. Applications were reviewed by SEE program administrators to ensure that applicants met the specified criteria. The SEE program is free of charge and takes place over 2 weeks in summer (1 week for boys and 1 week for girls). The program is nonresidential, with participants attending Monday through Thursday from 9 am to 4 pm and Friday from 9 am to 12 pm. 
To teach participants basic biomedical knowledge, the program includes short interactive lectures, hands-on laboratories, demonstrations on gross anatomy prosections, demonstrations on medical simulation models, tours of emergency vehicles, an introduction to osteopathic manipulative medicine, and student-led research projects. The lectures are delivered by medical school faculty, and the laboratories and demonstrations are conducted by faculty, medical students, or outside medical professionals. Each day focuses on a different body system, which allows participants to experience a simulation of VCOM's systems-based academic blocks. To instill a desire in participants to pursue careers in medicine and the health sciences, structured time was allotted daily for participants to engage in basic career counseling with medical students, VCOM admissions specialists, practicing physicians, other medical professionals, and PhD faculty. 
Interventions
To analyze the first part of our hypothesis, a 15-question multiple-choice quiz was designed by participating faculty (including J.A.) and administered to participants. The quiz was taken by all participants on the first morning of the program, before any content was delivered, and again on the final morning of the program. Participants were allowed as much time as needed to complete the quiz. To analyze the second part of our hypothesis, a 10-question survey was administered immediately after completion of the quiz on the mornings of the first and last day of the program. Each question was rated on a 5-point Likert scale ranging from 1 (“did not feel very sure about the statement”) to 5 (“felt very sure about the statement”). Participants were allowed as much time as needed to complete the survey. 
All of the responses from the quizzes and surveys were collected, deidentified, and input into a spreadsheet. The data were analyzed using paired t tests to determine whether the program resulted in significant differences in participants’ knowledge and attitudes. Statistical significance was defined as P<.05. 
Results
The quiz was taken by all 45 students (12 boys and 33 girls) at the start and conclusion of the program. One participant failed to complete both quizzes, so that data point was discarded. Therefore, the response rate was 98% (44 of 45 participants). The mean (SD) number of correct answers for all participants was 9.1 (2.06) on the preprogram quiz and 12.6 (1.65) on the postprogram quiz (P<.001). 
The survey was taken by all 45 participants at the start and conclusion of the program. Survey results are shown in the Table. Participants’ attitudes toward the practice of medicine and the health sciences and knowledge of careers in medicine and the health sciences significantly increased (P<.05) between the pre- and postprogram survey for all but 1 of the questions. In response to the question, “I would like to go to medical school in the future,” scores increased from a mean (SD) of 4.2 (1.08) to 4.3 (0.86) from the pre- to postprogram survey; however, this increase was not statistically significant (P=.22). 
Table.
Mean Scores of a 10-Item Pre- and Postprogram Survey That Assessed the Knowledge and Attitude of Students Toward the Practice of Medicine (N=45)
Survey Item Mean Scorea
Preprogram Survey Postprogram Survey
I understand the difference between an osteopathic and allopathic doctor 2.20 4.73b
I would like to pursue a career as an osteopathic physician 2.00 3.13b
I know what steps I must take in order to get into medical school 3.58 4.80b
I would like to go to medical school in the future 4.20 4.30
I understand what students do day-to-day in medical school 2.38 4.51b
I understand what faculty and staff do day-to-day in medical school 2.16 4.36b
I understand what physicians do day-to day in their job 3.29 4.64b
I like anatomy and physiology 3.91 4.64b
I am looking forward to school next fall 3.56 4.07b
I am looking forward to my science classes next year 4.24 4.47c

a Mean scores ranging from 1 to 5, with 1 indicating unsureness about the statement and 5 indicating the highest level of sureness.

b P<.001.

c P<.05.

Table.
Mean Scores of a 10-Item Pre- and Postprogram Survey That Assessed the Knowledge and Attitude of Students Toward the Practice of Medicine (N=45)
Survey Item Mean Scorea
Preprogram Survey Postprogram Survey
I understand the difference between an osteopathic and allopathic doctor 2.20 4.73b
I would like to pursue a career as an osteopathic physician 2.00 3.13b
I know what steps I must take in order to get into medical school 3.58 4.80b
I would like to go to medical school in the future 4.20 4.30
I understand what students do day-to-day in medical school 2.38 4.51b
I understand what faculty and staff do day-to-day in medical school 2.16 4.36b
I understand what physicians do day-to day in their job 3.29 4.64b
I like anatomy and physiology 3.91 4.64b
I am looking forward to school next fall 3.56 4.07b
I am looking forward to my science classes next year 4.24 4.47c

a Mean scores ranging from 1 to 5, with 1 indicating unsureness about the statement and 5 indicating the highest level of sureness.

b P<.001.

c P<.05.

×
Discussion
Many osteopathic medical schools are dedicated to producing primary care physicians, in particular, to work in rural areas and MUAs. It has been shown that medical students recruited from rural areas and MUAs are more likely to return to these areas to practice.6-10 One concern is that prospective medical school candidates from rural areas and MUAs face barriers to realizing their potential. However, there is evidence that educational outreach to students from MUAs is part of a successful strategy in overcoming barriers to scholastic achievement.11-13 
Results of the quiz demonstrate that participants’ knowledge of basic biomedical concepts significantly improved after the 1-week program (P<.001). According to the instructions given, participants knew they would be retested on the same questions at the conclusion of the week, but answers were not discussed until after the postprogram quiz was completed. As a further means of reducing bias, no effort was made to specifically teach quiz content during the week. 
Similar findings have been observed in other science programs. For instance, Moore24 showed that eighth graders demonstrated process skills acquisition after completing a 3-week science program. Williams et al25 demonstrated that attending a 2-week robotics camp enhanced middle schoolers’ knowledge of physics. These results, along with results of the current study, suggest that middle and high school students can learn about basic biomedical knowledge in just 1 week, even outside of the regular school year. 
Perhaps more importantly than knowledge accrued, we anticipated that the SEE program would improve participants’ attitudes toward and knowledge of careers in medicine and the health sciences. The results of the survey demonstrate significant increases in knowledge and improvement in attitude regarding the practice of medicine and the health sciences. This result has been demonstrated by others, which confirms that programs like SEE are fulfilling their objective of enhancing youth interest in medicine and the health sciences.22,23,26,27 
Results of only 1 of the 10 survey questions did not show a statistically significant improvement from the pre- to postprogram survey. In response to the question, “I would like to go to medical school in the future,” scores increased, but not significantly (P=.22). There are a few ways to interpret this finding. Most likely, participants already displayed a strong desire to attend medical school before the program began. Students with a demonstrated aptitude for and interest in medicine and the health sciences were purposely recruited for the program, so medical school may have already been a consideration for them. It is also possible the question was misinterpreted. Participant desire to pursue a career as an osteopathic physician increased, so, presumably, desire to attend medical school should mirror desire for a career in osteopathic medicine. However, it is possible that 1 or both of these closely related questions caused confusion among participants. 
Our main future direction will be to evaluate the long-term effects of the SEE program (eg, examining whether students who complete the SEE program attend medical school or other health science programs). This endeavor will most likely be achieved by directly tracing education and career outcomes for program participants, a process that may take several years to accomplish but would lend credibility to the effectiveness of educational interventions. In subsequent years, collection of data similar to those in this study would improve sample size and reduce bias arising from analysis of a single year. 
Conclusion
The results of this study indicate that a week-long summer enrichment program for high school students is effective in successfully imparting or reinforcing basic biomedical concepts and improving student attitudes toward and knowledge of careers in medicine and the health sciences. These findings suggest that basic educational interventions for high school students should be part of a long-term strategy to develop primary care physicians for rural areas and MUAs. We believe there is a role for osteopathic medical schools to nurture these students as early as possible in their scholastic development. 
Author Contributions
All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 
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Table.
Mean Scores of a 10-Item Pre- and Postprogram Survey That Assessed the Knowledge and Attitude of Students Toward the Practice of Medicine (N=45)
Survey Item Mean Scorea
Preprogram Survey Postprogram Survey
I understand the difference between an osteopathic and allopathic doctor 2.20 4.73b
I would like to pursue a career as an osteopathic physician 2.00 3.13b
I know what steps I must take in order to get into medical school 3.58 4.80b
I would like to go to medical school in the future 4.20 4.30
I understand what students do day-to-day in medical school 2.38 4.51b
I understand what faculty and staff do day-to-day in medical school 2.16 4.36b
I understand what physicians do day-to day in their job 3.29 4.64b
I like anatomy and physiology 3.91 4.64b
I am looking forward to school next fall 3.56 4.07b
I am looking forward to my science classes next year 4.24 4.47c

a Mean scores ranging from 1 to 5, with 1 indicating unsureness about the statement and 5 indicating the highest level of sureness.

b P<.001.

c P<.05.

Table.
Mean Scores of a 10-Item Pre- and Postprogram Survey That Assessed the Knowledge and Attitude of Students Toward the Practice of Medicine (N=45)
Survey Item Mean Scorea
Preprogram Survey Postprogram Survey
I understand the difference between an osteopathic and allopathic doctor 2.20 4.73b
I would like to pursue a career as an osteopathic physician 2.00 3.13b
I know what steps I must take in order to get into medical school 3.58 4.80b
I would like to go to medical school in the future 4.20 4.30
I understand what students do day-to-day in medical school 2.38 4.51b
I understand what faculty and staff do day-to-day in medical school 2.16 4.36b
I understand what physicians do day-to day in their job 3.29 4.64b
I like anatomy and physiology 3.91 4.64b
I am looking forward to school next fall 3.56 4.07b
I am looking forward to my science classes next year 4.24 4.47c

a Mean scores ranging from 1 to 5, with 1 indicating unsureness about the statement and 5 indicating the highest level of sureness.

b P<.001.

c P<.05.

×