Anthony Kulukulualani knew from age 11 years that he wanted to become a physician. Even though he received support and encouragement from his family, the road to medical school was tough at times, he said, especially as an African American man from a lower socioeconomic background who did not have anyone to coach him on preparing for medical school.
“The majority of my journey to medical school was self-discovery. I intuitively guessed at what courses to take and also pursued the advanced-level versions when possible,” recalled Kulukulualani, now in his third year at Tufts University School of Medicine. He is also president of the Student National Medical Association.
Kulukulualani said his journey became easier after he participated in 2 summer enrichment programs for premed students from underrepresented demographic groups. In the Travelers Summer Research Fellowship Program at Weill Cornell Medical College, he participated in research and attended medical lectures, as well as presentations by minority physicians. At the University of Pittsburgh School of Medicine’s Summer Premedical Academic Enrichment Program, he assisted with biomedical research and attended medical school admissions preparation workshops.
Kulukulualani’s challenges as a black man preparing to become a physician, as well as the support and guidance he received in the enrichment programs, represent challenges and strategies for success addressed in a 2015 Association of American Medical Colleges (AAMC) report, “Altering the Course: Black Males in Medicine” (http://bit.ly/1IH3Bua). The underrepresentation of minority students in medical schools has been addressed in previous AAMC reports in 2008 and 2012 (http://bit.ly/1OjxKDC, http://bit.ly/1PgF0iC), but the most recent one focuses specifically on the challenges facing black men interested in careers in medicine. It highlights factors that support their success and addresses the role of academic medicine in increasing the numbers of African American men in medical school.
In 2014, only 515 black men matriculated to medical school, less than the 541 who did so 36 years ago in 1978. Black men constitute the only minority demographic group to have fewer students starting medical school in 2014 than in 1978, according to Jennifer Eliason, a lead research analyst at the AAMC. Even as the number of black men entering medical school in 2014 has slipped compared with 1978, African American women gained ground in applications and enrollment in that same time span, with 1016 applying and 391 matriculating in 1978 and 2200 applying and 712 matriculating in 2014.
The challenges for black males aspiring to medical school begin early, starting with their disproportionate representation in underperforming elementary, middle, and high schools that may not have the finances or staff to provide a solid educational foundation for premed studies.
Perhaps because of their disproportionate enrollment in underperforming schools, black students lag behind their white and Latino peers in college readiness in English, reading, and math, according to a report on minority male achievement in community colleges (http://bit.ly/1OiUt0W).
To better prepare black males for medical school, it’s crucial that advanced placement and enrichment classes be available to minority students in elementary school and middle school, said Marc Nivet, EdD, the AAMC’s chief diversity officer. Such enrichment courses may require a creative use of limited resources in cash-strapped school districts, such as online programs, he noted.
The perception among school instructors that black males are troublemakers or have poor academic potential is another obstacle facing black males aspiring to medical careers, the report noted. Furthermore, negative media images combined with lower expectations may “indirectly perpetuate stereotypes and systemic biases” that affect black boys’ career aspirations, the report stated. Adding to these negative perceptions that black boys face, parents of black children may have lower academic expectations for their sons than for their daughters (Rowley SJ. Adv Child Dev Behav. 2014;47:301-332).
Such bias may follow minority students into postgraduate education, according to a research study that found professors were less likely to answer email queries from prospective doctoral students who had names signaling that they were female or nonwhite (Milkman KL et al. Psych Sci. 2012;23:710-717). Black students may also face the headwind of “stereotype threat,” in which the fear that they may confirm a prevailing negative racial stereotype can cause students to underperform, even in contexts where active or overt prejudice is unlikely or absent (http://bit.ly/1OiUt0W).
A lack of black male physicians and medical school faculty members who can serve as role models, mentors, and coaches is another hurdle for black men pursuing medical careers. Only 2% of full-time medical school faculty members are African American men, according to the AAMC report, and yet black male medical school faculty members can provide valuable networking advice and encouragement to black men applying to or enrolled in medical school, noted Curtiland Deville, MD, assistant professor of radiation oncology and molecular radiation sciences at Johns Hopkins University School of Medicine. Deville mentors minority medical students by, for example, by giving students tips about navigating medical school, informally discussing residency program interviewing strategies, and connecting medical students to researchers and faculty members who have expertise in clinical and research fields of interest to the students.
The cost of medical school can be another barrier, the report states. While the price tag for a medical degree is steep for any student, the cost of tuition may seem especially daunting to black students, who are more likely to have families unable to provide financial support, Nivet noted. A 2013 study determined that black students were the most likely to report anticipated medical school debt in excess of $150 000, which, according to the study authors, may in part explain why medical school enrollment for African American students dipped from 7.4% in 2004 to 7% in 2011 (Dugger RA et al. PLoS One. 2013;8(9):e74693).
Despite the numerous obstacles facing black men pursuing medical careers, enrichment and mentoring programs can help, the recent AAMC report notes. The Student African American Brotherhood, an organization with chapters at more than 200 colleges, as well as middle schools and high schools, is a mentoring and support program targeted specifically to minority males. The Summer Medical and Dental Education Program, jointly administered by the AAMC and American Dental Education Association, is available for minority undergraduates at 12 medical schools: all costs except travel are covered, and some sites offer travel stipends. The program provides prepping for medical and dental school entrance examinations, financial advice, and opportunities to observe a practicing physician or dentist. At the University of North Carolina School of Medicine , a targeted program called Minority Men in Medicine (http://uncmmm.blogspot.com/) offers mentoring, study groups, a listserv, and social events for minority men interested in health care careers, explained Claudis Polk, MA, the school’s associate director of the Office of Special Programs.
As helpful as such programs are, coordination of enrichment and mentoring programs is crucial so students stay the course, said Nivet. Administrators of science enrichment, mentoring, and advanced placement programs from elementary school through college need to work together to ensure that students are referred to such programs at the next grade level. Too often, he said, after students complete these programs, administrators do not follow up with the students to refer them to additional enrichment programs. This may be one reason why longstanding enrichment programs have not boosted the number of African American men attending medical school, he explained.
“We lose too many students simply because they are unaware of these programs,” Nivet said. “Also, while there are a few programs targeting black male youth, there are not enough.”
Limited data are available on what types of outreach programs offered to minority students interested in careers in medicine are successful, which may be another factor why existing enrichment programs have not done more to increase the number of minority medical students, Deville said. More evidence needs to be gathered, he observed, regarding what works, what doesn’t, and why.
It’s also important for medical schools to reach out to underserved neighborhoods in the community so that minority children will be exposed to medicine as a career option, said Nivet. In Baltimore, for example, several physicians from Johns Hopkins University School of Medicine and the University of Maryland School of Medicine serve on the advisory board for Medical Education Resources Initiative for Teens (MERIT), a program that offers 7 years of academic support and mentoring from sophomore year of high school through college to minority teens interested in medical careers (http://www.meritbaltimore.org). Students in the MERIT program attend weekly academic enrichment programs, receive mentoring, and are placed in summer internships at hospitals and laboratories.
More widespread adoption of holistic medical school admissions policies, which take into account nonacademic factors such as a student’s life experiences and personal attributes, as well as a school’s commitment to increasing the representation of minorities in medicine may also help increase the number of black men entering medical school, Deville said. In a 2014 survey, 38% of medical schools reported using some aspects of holistic review, and 48% indicated they incorporated some aspects of holistic review into the admissions process. Beyond rethinking admissions policies, cultural competency training for faculty may also help colleges better serve black male students who are preparing for medical careers. Such training, which teaches faculty members to understand and appreciate cultural differences, has been recognized as an important tool in helping minority male students achieve their educational goals (http://bit.ly/1OiUt0W).
Increasing the racial and ethnic diversity of students entering medical school is important for 2 reasons, Nivet said. First, as the country becomes more racially diverse, it will become more important to have a physician workforce that mirrors the US population (http://1.usa.gov/1M3diky). In fact, ensuring cultural sensitivity of the health care workforce is one of the objectives listed in the federal Healthy People 2020 initiative to help eliminate health disparities (http://1.usa.gov/1McBILs). That’s because nonwhite and poor individuals are more likely to have health conditions such as diabetes and cardiovascular disease, and minority physicians more often opt than their white peers to care for racial and ethnic minority patients in medically underserved areas, noted a Health and Human Services report (http://1.usa.gov/1tfOAoW). In fact, 54.6% of black medical school students plan to practice in underserved areas compared with 36% of Latino students, 21.4% of white students, and 19.4% of Asian students, according to the AAMC’s 2012 report on diversity in medical education (http://bit.ly/1PgF0iC).
“Sometimes patients want a provider who looks like them, understands them, and may have grown up in a similar neighborhood,” Nivet said.
Second, it’s also important not to waste the talents of black men, Nivet noted. “We can’t afford to have any large segment of the population not reaching their full potential.”
Jacob JA. AAMC Report Examines How to Increase the Pipeline of Black Men Entering Medical School. JAMA. 2015;314(21):2222–2224. doi:10.1001/jama.2015.12005