Open Access
Medical Education  |   February 2021
Diversity in osteopathic medical school admissions and the COMPASS program
Author Affiliations & Notes
  • Nadege Dady, EdD
    Touro College of Osteopathic Medicine, New York City, NY, USA
  • Kelly Ann Mungroo, OMS III
    Touro College of Osteopathic Medicine, New York City, NY, USA
  • Ta’Loria Young, OMS III
    Touro College of Osteopathic Medicine, New York City, NY, USA
  • Jemima Akinsanya, DO
    Department of Neurology, Emory University, Atlanta, GA, USA
  • David Forstein, DO
    Touro College of Osteopathic Medicine, New York City, NY, USA
  • Corresponding author: Nadege Dady, EdD, Dean of Student Affairs, Touro College of Osteopathic Medicine, 235 W 125th St, New York City, NY 10027-4408, USA, E-mail: Nadege.dady@touro.edu  
Article Information
Medical Education
Medical Education   |   February 2021
Diversity in osteopathic medical school admissions and the COMPASS program
The Journal of the American Osteopathic Association, February 2021, Vol. 121, 157-161. doi:https://doi.org/10.1515/jom-2019-0260
The Journal of the American Osteopathic Association, February 2021, Vol. 121, 157-161. doi:https://doi.org/10.1515/jom-2019-0260
Abstract

In the United States, the 37 colleges of osteopathic medicine and 154 schools of allopathic medicine face challenges in recruiting underrepresented minority (URM) applicants, and gaps in racial disparity appear to be widening. In this Special Communication, the authors describe a URM recruitment and support strategy undertaken in 2015 through a special interest group called Creating Osteopathic Minority Physicians who Achieve Scholastic Success (COMPASS) at the Touro College of Osteopathic Medicine—New York.

Medical schools are challenged by efforts to recruit qualified, underrepresented minority (URM) candidates in medicine. As of 2019, Black or African American applicants had lower medical school acceptance rates than peer groups. 1 There is a gap amongst the percentages of graduating medical students by race and ethnicity in that White (54.5%) and Asian (21.6%) candidates represent the largest proportion of medical school graduates. 2 Medical school graduates in 2019 were 6.2% Black or African American and 5.3% Hispanic or Latino. 2 Historical data presented by the American Association of Medical Colleges (AAMC) indicates these gaps are unchanged and demonstrates a decline in Black men applying to and attending medical school since 1978; specifically, the number of Black male applicants to medical school dropped to 1,337 in 2014 from 1,410 in 1978. 3 Recognizing the level of complexity around recruitment and retention, the American Association of Colleges of Osteopathic Medicine (AACOM) and others have developed key communications and strategies to help colleges, recruiters, administrators, and faculty prioritize diversity through effective collaboration and accurate data collection. 4, 5  
The competition to recruit qualified students traditionally underrepresented in medicine (i.e., minority students) remains a challenge for both the 37 colleges of osteopathic medicine 6 and 154 schools of allopathic medicine 7 in the United States, as reflected by the data cited from both AACOM 4 and the AAMC. 5 Traditional objective measures for assessing student performance include the Medical College Admission Test (MCAT) score and grade point average (GPA); socioeconomic factors such as family income and parental education may also influence a student’s academic progress and success in higher education regardless of race or ethnicity. 8 There is known predictive relatability between osteopathic medical school performance and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA Level 1 and Level 2-CE results 8 and a correlation between the MCAT and United States Medical Licensing Examination (USMLE) one score. 9 Family income is also strongly correlated with success in higher education as measured by standardized test scores and GPA. 10  
The mission of Touro College of Osteopathic Medicine—New York (TouroCOM—NY) is to train osteopathic physicians, with an emphasis on practicing medicine in underserved communities and increasing the number of URMs in medicine. The TouroCOM—NY campus opened in 2007, and the first graduating class completed their education in 2011. In this inaugural class, 19 of 135 students (14.1%) were URM. Recognizing a need for student participation in the recruitment of minority students, a TouroCOM alumna created the student interest group Creating Osteopathic Minority Physicians who Achieve Scholastic Success (COMPASS). This article discusses how COMPASS supports TouroCOM—NY’s recruitment efforts to increase federally-designated URM 11 representation in medicine and can serve as a model for other colleges. 
The COMPASS program
In the spring of 2013, Jemima Akinsanya, DO, then a first-year medical student at TouroCOM—NY, was tutoring a local high school sophomore through MedAchieve, a medical science enrichment program at TouroCOM for local high school students. She saw that this student was bright and ambitious but lacked a clear road map to achieve her goals. Around the same time, Dr. Akinsanya had also spoken with classmates about their paths to medical school. These conversations illuminated some of the difficulties URM students experience in obtaining useful guidance on the college and medical school path. Dr. Akinsanya thought that starting a program to help future minority students might also help those already enrolled at TouroCOM—NY by providing a stronger support system. With this in mind, the seeds of COMPASS were planted. 
The need for recruitment work was critical. During academic year 2013, the nationwide percentage of URM student matriculants at osteopathic medical schools was only 6%; 12 this was among the reasons that TouroCOM—NY made an institutional commitment to recruit URM and promote cultural competency for all students. After a few recruitment initiatives, such as emails and phone calls to minority candidates, Dr. Akinsanya received positive feedback from the prospective student participants. The feedback from the prospects included informal email and verbal responses that her communications made them feel welcomed at and positive about TouroCOM—NY. Motivated by the positive response, Dr. Akinsanya and her peers set out to make COMPASS a part of the college’s admission process. 
In 2015, COMPASS student interest group leaders searched for creative ways to engage in the admissions process while enhancing their efforts toward recruitment of minority students. COMPASS leaders looked for a path that would ensure continued support while also providing a specific role in the college’s admission recruitment cycle. In 2016, COMPASS began an energetic peer-to-peer program with specific goals and strategies. Working collaboratively with the Dean of Student Affairs office, the COMPASS welcoming program brought minority student prospect candidates from the application cycle together with current TouroCOM—NY URM medical students. 
Utilizing the American Association of Colleges of Osteopathic Medicine’s Application Service (AACOMAS), an invitation was sent to students who self-identified as URM applicants to the COM on behalf of the COMPASS program. COMPASS student leaders organized an agenda for a single in-person welcoming program specifically for invited applicants. The Office of Student Affairs provided funding for refreshments through a specific budgeted allocation for student activities. The program was student-led and did not include administration or admissions officers. Student leaders were instructed to refer specific questions related to a candidate’s academic/admissions standing to admissions officers, which kept the focus of events on providing a social, supportive, and welcoming atmosphere. TouroCOM admissions materials were also distributed; these included information about admissions requirements, processes and procedures, and the principles of osteopathic manipulative medicine (OMM), as well as Touro-branded promotional materials (e.g., t-shirts, pens, bags) typically distributed during recruitment. COMPASS leaders also invited other TouroCOM student leaders representing the Student National Medical Association, Latino Student Medical Association, and the Student Diversity Committee to participate in the welcoming event on campus. Again, the event focused primarily on answering questions about student life and providing applicants with direct exposure to URM students currently attending TouroCOM—NY. The rationale for this approach was that by fostering a positive social atmosphere with current minority medical students with whom they could relate, prospective minority students could envision themselves as potential members of TouroCOM—NY. From an admissions perspective, this was an important strategy in reassuring URM students that they could “accept” us. 
From 2015 to 2018, approximately 700 invitations were sent each year through the AACOMAS system. A mean of 33.4 candidates accepted the invitation each year (range, 24–42 candidates), typically students already living in the New York, New Jersey, and Connecticut tristate area. A total of 124 (74.3%) respondents attended COMPASS events from 2015 to 2018 (Table 1). Beginning with the graduating class of 2020 (enrollment year 2016), our URM student enrollment has steadily increased at TouroCOM (Table 2). The Mann-Kendal test of trend for URM matriculation over time was tau=0.5 with p=0.022, indicating a significant upward trend regarding the matriculation of URM students to TouroCOM—NY. Statistical comparisons were made with R version 3.4.4 (2018-03-15) (Microsoft, Mountain View, CA). 
Table 1:
TouroCOM COMPASS student welcoming event.
COMPASS invitation sent AACOMAS invitations sent Total URM applicant RSVPs % URM applicants who RSVP’d Total URM applicant attendees % URM attendees who RSVP’d COMPASS event date
09/2015 700 30a 4.3% 25 83.3% October 1, 2015
10/2016 700 24 3.4% 21 87.5% November 2, 2016
09/2017 700 34 4.9% 30 88.2% October 25, 2017
09/2017 700 42 6.0% 25 59.5% October 18, 2018
09/2018 700 37 5.3% 23 62.1% October 10, 2019
Total 167 124
aFive students who accepted the invitation to attend later indicated scheduling conflicts or financial constraints. Those students were offered an opportunity to meet with a COMPASS leader via Skype. AACOMAS, American Association of Colleges of Osteopathic Medicine’s Application Service; COMPASS, Creating Osteopathic Minority Physicians who Achieve Scholastic Success; URM, Underrepresented minority.
Table 1:
TouroCOM COMPASS student welcoming event.
COMPASS invitation sent AACOMAS invitations sent Total URM applicant RSVPs % URM applicants who RSVP’d Total URM applicant attendees % URM attendees who RSVP’d COMPASS event date
09/2015 700 30a 4.3% 25 83.3% October 1, 2015
10/2016 700 24 3.4% 21 87.5% November 2, 2016
09/2017 700 34 4.9% 30 88.2% October 25, 2017
09/2017 700 42 6.0% 25 59.5% October 18, 2018
09/2018 700 37 5.3% 23 62.1% October 10, 2019
Total 167 124
aFive students who accepted the invitation to attend later indicated scheduling conflicts or financial constraints. Those students were offered an opportunity to meet with a COMPASS leader via Skype. AACOMAS, American Association of Colleges of Osteopathic Medicine’s Application Service; COMPASS, Creating Osteopathic Minority Physicians who Achieve Scholastic Success; URM, Underrepresented minority.
×
Table 2:
Matriculation and graduation rates of underrepresented minority students for TouroCOM—NY, 2011–2023.
Matriculation year Graduation year Total class size Total URM matriculation Total MS2DO matriculation URM matriculation, % of total class size No. of URM graduated
2007 2011 135 19 14 12
2008 2012 135 9 7 8
2009 2013 135 20 5 15 15
2010 2014 135 18 7 13 15
2011 2015 135 24 14 18 23a
2012 2016 136 19 18 14 17
2013 2017 135 27 15 20 22
2014 2018 134 24 15 18 23
2015 2019 135 13 10 10 12
2016 2020 154 23 11 15 21
2017 2021 113 24 17 22
2018 2022 135 38 22 28
2019 2023 135 31 13 23
2020 2024 135 35 15 26
aIncludes student(s) who have deferred from a previous year. MS2DO, students who successfully completed the one-year MS program at TouroCOM and were promoted into the DO program, upon meeting promotion criteria; URM, underrepresented minority.
Table 2:
Matriculation and graduation rates of underrepresented minority students for TouroCOM—NY, 2011–2023.
Matriculation year Graduation year Total class size Total URM matriculation Total MS2DO matriculation URM matriculation, % of total class size No. of URM graduated
2007 2011 135 19 14 12
2008 2012 135 9 7 8
2009 2013 135 20 5 15 15
2010 2014 135 18 7 13 15
2011 2015 135 24 14 18 23a
2012 2016 136 19 18 14 17
2013 2017 135 27 15 20 22
2014 2018 134 24 15 18 23
2015 2019 135 13 10 10 12
2016 2020 154 23 11 15 21
2017 2021 113 24 17 22
2018 2022 135 38 22 28
2019 2023 135 31 13 23
2020 2024 135 35 15 26
aIncludes student(s) who have deferred from a previous year. MS2DO, students who successfully completed the one-year MS program at TouroCOM and were promoted into the DO program, upon meeting promotion criteria; URM, underrepresented minority.
×
The issue of matriculation in medical school is a complex, multifactorial process. The addition of the COMPASS program helped to change the atmosphere on campus, adding a sense of belonging that was difficult to promote prior to this type of activity. As the COMPASS program began with the class matriculating in the fall of 2016, only one cohort of students who participated in the COMPASS program has graduated. Of the 25 students who attended the inaugural COMPASS event, two students matriculated into TouroCOM—NY; one graduated with the Class of 2020 and one is expected to graduate with the class of 2021. As more cohorts complete their education, we will be able to provide comprehensive data on student performance. 
Lessons learned
The most valuable lesson we have learned is that it is not enough to simply recruit diverse candidates—the environment on campus must also mirror that diversity and provide opportunities to connect with faculty who can provide necessary mentorship. A candidate’s decision to attend medical school, and subsequently selecting an appropriate school, are among the most life-changing decisions an applicant can make. The COMPASS program has helped revitalize the energy at TouroCOM—NY for URM applicants and help them assess its appropriateness for them. 
The process of applying to medical school can be daunting, particularly for first-generation and economically-disadvantaged students. 13 A lack of access or exposure to mentors in the healthcare professions heightens the sense of uncertainty about successfully applying to medical school. 14 Often, students have questions that are difficult to address during the traditional interview day. Therefore, creating a welcoming environment during the COMPASS event, void of the pressure to perform in front of an interviewer, was a well-received effort for applicants and enabled them to ask questions and interact with current URM medical students. 
Research about URM students who attend predominantly White institutions (PWI) indicates that these students feel a sense of loss after matriculating to a campus that is less diverse than they expected. 13 In such instances, the belonging uncertainty theory provides needed context through heightened levels of the imposter syndrome when a student subconsciously forms the impression that they are not meant to be there. 15 This feeling further affects their ability to form the necessary relationships with other students, faculty, and administration—the very relationships that are critical to success. 16 As it pertains to mentorship and within the context of academic achievement, at-risk students who participate in co-curricular activities and feel socially integrated dropout of school less. 15 Students who have trusting relationships with mentors are better able to take advantage of critical feedback and other opportunities to learn. 17, 18 At TouroCOM—NY all matriculated students are assigned a faculty mentor at the time of enrollment. This early introduction to a faculty mentor provides a foundation for a relationship that is used for guidance on academic progress, clinical advancement, and long-term career trajectory. Faculty mentors also play a significant role in advising medical student organizations that are structured around particular specialty interest. 
People of color, 19 first-generation college students, 20 and women 21 may experience difficulties academically because they feel anxious about confirming negative social beliefs or stereotypes about their groups. These stereotypes are more powerful when students feel that they are not welcome in a community. Yet reassuring students that they indeed belong in a group protects them against negative stereotypes, allowing them to learn more, earn better grades, and even avoid illness. 16 Understanding the larger effect of the belonging uncertainty theory on an applicant’s perception of the school environment, additional keys to success in the recruitment of URM applicant were added to the TouroCOM interview day. These strategies were implemented outside of the COMPASS welcoming event and are specific to the admissions interview day. First, during admissions interview day, steps are taken to ensure that the student ambassadors who greet the students on interview day are as diverse as our student body. Second, additional effort is placed on ensuring that applicants interface with faculty and executive administration who further reinforce our campus diversity. In combination, these collective efforts create a comfortable, diverse environment that eases the stress of interviewing for medical school. 
An additional pathway to TouroCOM
While the COMPASS peer welcoming program is an attractive draw for candidates in the application cycle, it is not the only method by which minority students matriculate into TouroCOM—NY. The school’s Master’s program in Biomedical Sciences is a pathway program into our medical school and contributes approximately 20% of our incoming class each year (Table 2). The program is designed to offer students the opportunity to demonstrate that they can succeed with advanced-level science work. Students who are successful, earning a 3.50 GPA or better, are offered guaranteed admission into TouroCOM. 
Other support efforts at TouroCOM—NY
COMPASS is a volunteer student initiative that assists solely with student recruitment. To address the ongoing needs of URM students after they matriculate, the TouroCOM—NY director of diversity, the Student Government Association’s Diversity Task Force, and other student organizations (including the aforementioned Student National Medical Association, Latino Medical Student Association, and Muslim Medical Student Organization) lead student efforts around diversity and inclusion on campus. 
Conclusion
Successful recruitment of URM applicants requires a variety of approaches, such as ensuring that prospective medical school students have opportunities to interact with current URM students, faculty, and administration who reflect diversity. Pathway programs also serve as a way to enhance the opportunities for prospective medical students. These programs help students recognize their academic capacity and provide the college with an assessment their potential for success. A student-led program like COMPASS that helps welcome and support applicants, allowing them to socialize with URM students, can also provide a greater understanding of the medical school’s culture. We recommend that all colleges of osteopathic medicine explore their current efforts to recruit prospective URM students and consider additional efforts that would be effective in their local community. 
  Research funding: None reported.
 
  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.
 
  Competing interests: Authors state no conflict of interests.
 
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Table 1:
TouroCOM COMPASS student welcoming event.
COMPASS invitation sent AACOMAS invitations sent Total URM applicant RSVPs % URM applicants who RSVP’d Total URM applicant attendees % URM attendees who RSVP’d COMPASS event date
09/2015 700 30a 4.3% 25 83.3% October 1, 2015
10/2016 700 24 3.4% 21 87.5% November 2, 2016
09/2017 700 34 4.9% 30 88.2% October 25, 2017
09/2017 700 42 6.0% 25 59.5% October 18, 2018
09/2018 700 37 5.3% 23 62.1% October 10, 2019
Total 167 124
aFive students who accepted the invitation to attend later indicated scheduling conflicts or financial constraints. Those students were offered an opportunity to meet with a COMPASS leader via Skype. AACOMAS, American Association of Colleges of Osteopathic Medicine’s Application Service; COMPASS, Creating Osteopathic Minority Physicians who Achieve Scholastic Success; URM, Underrepresented minority.
Table 1:
TouroCOM COMPASS student welcoming event.
COMPASS invitation sent AACOMAS invitations sent Total URM applicant RSVPs % URM applicants who RSVP’d Total URM applicant attendees % URM attendees who RSVP’d COMPASS event date
09/2015 700 30a 4.3% 25 83.3% October 1, 2015
10/2016 700 24 3.4% 21 87.5% November 2, 2016
09/2017 700 34 4.9% 30 88.2% October 25, 2017
09/2017 700 42 6.0% 25 59.5% October 18, 2018
09/2018 700 37 5.3% 23 62.1% October 10, 2019
Total 167 124
aFive students who accepted the invitation to attend later indicated scheduling conflicts or financial constraints. Those students were offered an opportunity to meet with a COMPASS leader via Skype. AACOMAS, American Association of Colleges of Osteopathic Medicine’s Application Service; COMPASS, Creating Osteopathic Minority Physicians who Achieve Scholastic Success; URM, Underrepresented minority.
×
Table 2:
Matriculation and graduation rates of underrepresented minority students for TouroCOM—NY, 2011–2023.
Matriculation year Graduation year Total class size Total URM matriculation Total MS2DO matriculation URM matriculation, % of total class size No. of URM graduated
2007 2011 135 19 14 12
2008 2012 135 9 7 8
2009 2013 135 20 5 15 15
2010 2014 135 18 7 13 15
2011 2015 135 24 14 18 23a
2012 2016 136 19 18 14 17
2013 2017 135 27 15 20 22
2014 2018 134 24 15 18 23
2015 2019 135 13 10 10 12
2016 2020 154 23 11 15 21
2017 2021 113 24 17 22
2018 2022 135 38 22 28
2019 2023 135 31 13 23
2020 2024 135 35 15 26
aIncludes student(s) who have deferred from a previous year. MS2DO, students who successfully completed the one-year MS program at TouroCOM and were promoted into the DO program, upon meeting promotion criteria; URM, underrepresented minority.
Table 2:
Matriculation and graduation rates of underrepresented minority students for TouroCOM—NY, 2011–2023.
Matriculation year Graduation year Total class size Total URM matriculation Total MS2DO matriculation URM matriculation, % of total class size No. of URM graduated
2007 2011 135 19 14 12
2008 2012 135 9 7 8
2009 2013 135 20 5 15 15
2010 2014 135 18 7 13 15
2011 2015 135 24 14 18 23a
2012 2016 136 19 18 14 17
2013 2017 135 27 15 20 22
2014 2018 134 24 15 18 23
2015 2019 135 13 10 10 12
2016 2020 154 23 11 15 21
2017 2021 113 24 17 22
2018 2022 135 38 22 28
2019 2023 135 31 13 23
2020 2024 135 35 15 26
aIncludes student(s) who have deferred from a previous year. MS2DO, students who successfully completed the one-year MS program at TouroCOM and were promoted into the DO program, upon meeting promotion criteria; URM, underrepresented minority.
×