Association of Summer College Academic Enrichment Program Participation With Medical Student Diversity and Intent to Practice in Underserved Areas

US medical schools seek to enroll diverse student populations to address national physician workforce needs. As a strategy to increase diversity, many organizations and institutions sponsor premedical summer college academic enrichment programs (SCAEPs) that may address Liaison Committee for Medical Education Standard 3.3, Diversity/Pipeline Programs and Partnerships.¹ We examined national medical school matriculant cohorts to assess whether participation in an SCAEP is associated with increased student diversity and graduation of students with sustained intentions to practice in underserved areas.

This cohort study included US medical school matriculants from 2013 to 2015 who graduated through 2019 and voluntarily completed the Association of American Medical Colleges (AAMC) Matriculating Student Questionnaire² and Graduation Questionnaire.³ The AAMC Human Subjects Office exempted the study from institutional board review because it did not constitute human participant research and used deidentified data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We identified SCAEP participants in the Robert Wood Johnson Foundation Summer Medical and Dental Education Program (SMDEP), which is a cost-free, 6-week national program to strengthen academic proficiency and career development of students underrepresented in health care professions^4,5, by using program reports to the AAMC and other SCAEP participants (excluding those in SMDEP) by Matriculating Student Questionnaire self-report.² We examined bivariate associations between SCAEP participation and sex, race/ethnicity, and first-generation college graduate (FGCG) identity and examined factors associated with sustained career intention (Matriculating Student Questionnaire and Graduation Questionnaire self-report) to practice in underserved areas by multilevel logistic regression. P values were 2-sided, and statistical significance was set at P < .05. Deidentified individual-level data linked via unique AAMC identifiers were analyzed using Stata, version 15 (StataCorp LLC).

The study sample included 29 456 graduates (all but 3 [missing data on sex] of 29 459 study-eligible graduates and 55% of all 53 079 US matriculants from 2013 to 2015 who graduated through 2019). A total of 15 050 (51%) were women, 4375 (15%) were graduates from racial/ethnic groups that are underrepresented in medicine, and 4255 (14%) were FGCGs (Table 1). Among 29 456 graduates, 360 (1.2%) were participants in SMDEP and 3776 (12.8%) were participants in other SCAEPs. Women, graduates from racial/ethnic groups that are underrepresented in medicine, and FGCGs were overrepresented among SCAEP participants.

Table 2 shows results of multilevel logistic regression models identifying factors associated with sustained intention to practice in underserved areas. In the multivariable model, graduates who were women (vs men: adjusted odds ratio [AOR], 1.9; 95% CI, 1.8-2.0), FGCGs (AOR, 1.5; 95% CI, 1.4-1.7), Black or African American only (vs White and/or Asian: AOR, 3.3; 95% CI, 2.9-3.7), Hispanic, Latino, or of Spanish origin only (vs White and/or Asian: AOR. 2.5; 95% CI, 2.2-2.9), other race/ethnicity underrepresented in medicine (vs White and/or Asian AOR: 1.7; 95% CI, 1.5-2.0), and SMDEP participants (vs non-SCAEP participants: AOR, 1.9; 95% CI, 1.5-2.5) were more likely to report sustained career intentions to practice in underserved areas.

Previous studies⁵ of SCAEPs have shown an increase in the likelihood of application and matriculation to medical school associated with SCAEP attendance. We observed an association between SCAEPs and increased student diversity and that SMDEP participants were more likely to report sustained career intentions to practice in underserved areas. Because career intention to practice in underserved areas at graduation has established predictive validity,⁶ our findings may inform medical schools’ investments in programs to recruit diverse students whose career goals align with national needs to increase access to care.

Our study was limited by small numbers of American Indian or Alaska Native only and Native Hawaiian or other Pacific Islander only graduates, precluding their examination as discrete groups. In addition, we could not further disaggregate the other SCAEPs (a heterogenous group of programs regarding, for example, duration, cost, and curricular content), which limits generalizability of observations for this group. In the context of the current coronavirus disease 2019 (COVID-19) pandemic and recent activism in response to anti-Black racism, SCAEPs such as SMDEP (whose participants comprised 11.6% of all Black or African American only graduates in our national sample) may play a particular role in medical schools’ efforts to recruit and educate a diverse physician workforce that will meet national health care needs.

Accepted for Publication: December 4, 2020.

Published: February 5, 2021. doi:10.1001/jamanetworkopen.2020.34773

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Grbic D et al. JAMA Network Open.

Corresponding Author: Dorothy A. Andriole, MD, Medical Education Research, Association of American Medical Colleges, 655 K St NW, Ste 100, Washington, DC 20001-2399 (dandriole@aamc.org).

Author Contributions: Dr Grbic had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Poll-Hunter, Felida, Andriole.

Acquisition, analysis, or interpretation of data: Grbic, Felida, Andriole.

Drafting of the manuscript: Grbic, Poll-Hunter, Andriole.

Critical revision of the manuscript for important intellectual content: Poll-Hunter, Felida, Andriole.

Statistical analysis: Grbic.

Obtained funding: Poll-Hunter.

Administrative, technical, or material support: Poll-Hunter, Felida.

Supervision: Andriole.

Conflict of Interest Disclosures: Dr Poll-Hunter reported receiving grants from the Robert Wood Johnson Foundation (RWJF) outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Poll-Hunter was supported in part by the RWJF.

Role of the Funder/Sponsor: The RWJF had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed here do not necessarily reflect the views of the RWJF.

Additional Information: The RWJF funded the Summer Medical and Dental Education Program from 2006 to 2016. The program is now the Summer Health Professions Education Program. The Association of American Medical Colleges and American Dental Education Association serve as the National Program Office for the Summer Health Professions Education Program, and Dr Poll-Hunter is the principal investigator.