Burbage Amanda K, Hewitt Eushekia Y
Macon & Joan Brock Virginia Health Sciences at Old Dominion University, School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Student Affairs in the Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Med Educ. 2025 Jun;59(6):640-651. doi: 10.1111/medu.15539. Epub 2024 Sep 22.
Recruiting and training a diverse pool of physicians from historically excluded groups is vital to solving complex scientific problems and increasing access to patient care. Disparate educational and health outcomes of COVID-19 amplified this need. In stratified higher education systems, underfunded institutions that serve greater numbers of underrepresented in medicine (URM) students face unique barriers to entering physician training. However, pathways from historically underfunded minority-serving institutions (MSIs) in the United States to medical school (MD) are not well understood.
A hierarchical logistic regression analysis of 328 488 de-identified applicants to US MD-granting medical schools for academic years 2017-2018 through 2022-2023 was used to determine predictors of acceptance based on MSI attendance compared to predominantly White institutions (PWI) and other literature-informed predictors. An interrupted time series analysis determined the significance in changes in observed differences in application acceptance before and after the COVID-19 pandemic.
In model 1, MSI attendance was associated with significantly lower odds of acceptance, with a 42% to 52% chance of acceptance compared to PWI applicants. Adding MCAT and GPA significantly increased odds of acceptance for most MSI applicants in model 2. MSI attendance, MCAT, GPA and socio-economic status indicators were useful predictors, improving the acceptance model by 39% better than the null model. Although some predictors showed a change in odds over time, none changed significantly when comparing before and after COVID-19.
MSI attending students were less likely to be admitted to MD programmes, highlighting systemic stratification until other academic factors were introduced to the model that alleviated lower odds, and the COVID-19 pandemic did not substantially change these trends. Improved pathways and strengthened institutional relationships between institutions that have greater proportions of underrepresented students and medical schools may help improve MSI applicant odds furthering diversity within the physician-trained workforce.
从历史上被排斥的群体中招募和培养多元化的医生群体对于解决复杂的科学问题以及增加患者获得医疗服务的机会至关重要。新冠疫情造成的不同教育和健康结果进一步凸显了这一需求。在分层的高等教育系统中，资金不足但服务于大量医学领域代表性不足（URM）学生的机构在进入医生培训方面面临独特障碍。然而，美国历史上资金不足的少数族裔服务机构（MSI）通往医学院（MD）的途径尚不清楚。
对2017 - 2018学年至2022 - 2023学年申请美国授予MD学位医学院的328488名身份不明的申请人进行分层逻辑回归分析，以确定基于就读MSI与主要为白人的机构（PWI）相比以及其他文献中已知的预测因素对录取的预测情况。中断时间序列分析确定了新冠疫情前后申请录取中观察到的差异变化的显著性。
在模型1中，就读MSI与录取几率显著降低相关，与PWI申请人相比，录取几率为42%至52%。在模型2中加入医学院入学考试（MCAT）成绩和平均绩点（GPA）显著提高了大多数MSI申请人的录取几率。就读MSI、MCAT成绩、GPA和社会经济地位指标是有用的预测因素，使录取模型比空模型提高了39%。尽管一些预测因素显示录取几率随时间变化，但在比较新冠疫情前后时，没有一个因素有显著变化。
就读MSI的学生被MD项目录取的可能性较小，这突出了系统性分层，直到将其他学术因素引入模型以缓解较低的录取几率，而新冠疫情并没有实质性改变这些趋势。改善就读学生代表性比例较高的机构与医学院之间的途径并加强机构关系，可能有助于提高MSI申请人的录取几率，进一步促进医生队伍的多样性。
