In September 2002, MEDPREP, at Southern Illinois University (SIU) School of Medicine at Carbondale, celebrated 30 years of continuous operation, preparing minority and disadvantaged students for careers in medicine and dentistry. Upon the occasion of this anniversary, it is appropriate to reflect on the history of the program and to examine the factors that contributed to its success for so many years.
ORIGIN, MISSION, AND INSTITUTIONAL COMMITMENT
The origin of MEDPREP can be attributed to several factors. First, in the 1960s there was a perception in the United States that there were not enough physicians being trained to meet future health care needs. More specifically, there was a need for community-based medical schools that would recruit students from underserved areas and train them as primary care physicians who would establish rural and inner-city practices. As a result, in the 1970s, 20 new medical schools were created throughout the United States to meet this perceived need. One of these schools was the School of Medicine at Southern Illinois University at Carbondale, which was authorized by the State of Illinois in 1969. The founding dean was appointed in 1970.
A second factor was the recognition in 1970 by the Association of American Medical Colleges (AAMC) that there was a need to increase the number of underrepresented minority students in U.S. medical schools. At the time of the AAMC task force report, minority enrollment in U.S. medical schools was only 2.8%.
In response the dean challenged the faculty to come up with a modest, one-year educational program that would use available Carbondale-based facilities and faculty, yet would not interfere with the primary task of getting the undergraduate medical education program ready to start in 1973. A proposal was approved that would create a special program titled Medical Education Preparatory Program (MEDPREP) to prepare disadvantaged and minority students for success in medical school, hopefully the SIU School of Medicine. It was funded (at approximately $47,000) in the spring of 1972.
By the start of the fall semester of the 1972–73 academic year, a small cadre of faculty and staff were assembled, and 13 minority and disadvantaged students had been selected from an applicant pool of 30 interested candidates.
When I was floundering as an undergraduate student and uncertain how to accomplish my dream of becoming a physician, I learned of MEDPREP and its mission to help underrepresented students get into medical school. MEDPREP embraced me, taught me the admissions process, polished my academic skills, and gave me new ones. It's hard to imagine this journey without MEDPREP and its faculty and staff.—WESLEY G. MCNEESE, MD, emergency medicine
Over the next 30 years the mission of MEDPREP remained the same: assist minority students and other students with disadvantaged backgrounds to prepare for admission and success in medical school. In the early '80s the MEDPREP student population was defined as black, Mexican American, Puerto Rican, American Indian (Native American), low income–rural background, veterans with medical training, and women, with priority given to legal residents of central and southern Illinois. As more women entered medical schools and fewer military personnel with medical training left the service, these groups became less of a focus for the program. Program literature in the late '80s no longer identified these types of individuals as targeted populations.
The need to increase enrollment of underrepresented minority students around the country was highlighted by the launching of Project 3000 by 2000 by the Association of American Medical Colleges in 1991. However, strides made by that effort were tempered by court decisions on affirmative action. In a changing national political environment, MEDPREP maintained its resolve to meet its mission with a period of growth and expansion of the student population, evolution of curriculum, renovation of facilities, and extension of its services.
MEDPREP has continued to keep its promises by providing the proper support, guidance, and resources in assisting us to become successful medical school applicants. Prior to entering MEDPREP, I did not realize how much of a difference self-confidence and self-appraisal could make, especially during my “transformation” here at MEDPREP.—SONYA KUHAR, medical student, University of Rochester College of Medicine and Dentistry
Throughout the history of the program a number of Health Careers Opportunity Program (HCOP) grants supplemented the state allocations. MEDPREP became a certificate program, a change that was accompanied by student eligibility for better financial aid packages. In addition, the university began providing 24 tuition waivers for MEDPREP students. These were used to help alleviate some of the financial burdens of students in the program. However, it was the school's commitment and the stability of its funding that enabled—and continues to enable—the program to carry out its mission.
ADMINISTRATION AND FACULTY
The School of Medicine was fortunate to have the creator of the program (MR) as its first administrator. His vision was valuable in the early years as MEDPREP became established. The program was able to hire full- and part-time faculty and graduate students who were already at SIU to form the core faculty. Over time, some medical school faculty also taught in the program. The addition of reading and testing specialists, as well as a counselor for recruitment and retention, was also important to the early success of the program. The first director left the program in 1979, but some of the staff from these early years are still involved today.
MEDPREP and School of Medicine faculty were appointed to two standing committees in the program that served the interests of students. The admission committee developed an application process that included a day of testing and interviewing applicants. The student progress committee monitored academic performance and provided letters of recommendation. Both of these committees provide these valuable services today.
In the '80s, the director of MEDPREP (HRB) encouraged faculty to become more active professionally, attend meetings, make presentations, do educational research, and publish their work.
MEDPREP pushed me, showed me my weaknesses and helped me understand what was important. MEDPREP faculty really invest a lot of time in helping students.—JOSE CRESPO, MD, emergency medicine
During the '80s the MEDPREP science faculty status changed from being mostly tenure-track, PhD positions to term-appointment instructor positions. The impetus for this change was the difficulty for MEDPREP science faculty to fulfill the research expectations of the promotion and tenure guidelines of the school. During this transition, graduate students taught chemistry and physics for a number of years. Two basic-skills faculty, with education backgrounds, were appointed to tenure-track positions in the Department of Medical Education in Springfield. All of these personnel changes translated into the decade of the '80s as a holding period in terms of growth of program activities.
MEDPREP's third decade was characterized by stability in administration and faculty. By 2002 the average faculty tenure in MEDPREP was 17 years. The director encouraged innovations in teaching, outcome assessments, and expansion of opportunities through MEDPREP. Annual two-day faculty meetings were used for setting goals and providing a forum for communication and coordination of activities. Students valued the faculty, as these comments indicate:
Without question, the unwavering support of the MEDPREP faculty has also been crucial to my success in the program. Everyone wants to see you succeed. Faculty members are readily willing to offer assistance to help you understand a difficult concept, often on a moment's notice. I can recall many instances where I have walked into the office of a faculty member, unannounced or late in the evening, and was able to obtain help.—MALIK KELLY, medical student, St. Louis University School of Medicine
If you really reached out, found the positive things that were available and made an effort to make contact with people, then you received a lot of feedback, a lot of support, and a lot of encouragement.—STEVEN CLAY, MD, internal medicine
Seasoned faculty with experience and expertise in teaching the skills and sciences began to revise courses with more focus on problem solving, critical thinking. and writing. The faculty was encouraged to publish and make presentations at national conferences—e.g., of the AAMC, the National Association of Advisors for the Health Professions (NAAHP), the National Association of Medical Minority Educators (NAMME)—and conduct workshops across the country. The program director assumed leadership roles in professional organizations. The recruiter visited and disseminated information to 15 to 20 Midwest institutions per year. These visits established a network that facilitated student applications to the program. MEDPREP's visibility was enhanced through all of this activity.
In the early years, most accepted students were Illinois residents. More than half were minority students and the others were from rural or disadvantaged backgrounds (Table 1). In addition to academic credentials that were not competitive, students had had some exposure to health care as practical nurses, emergency medical technicians, or medical corpsmen in Vietnam, were highly motivated and had graduated from college. The program provided no financial aid, charged the standard undergraduate tuition, and provided no housing or textbooks. It did provide tee-shirts and large amounts of academic enrichment opportunities and personal support. The program awarded academic credit but no degree.
All MEDPREP applicants took a premedical science admission test, were interviewed, and were observed in group situations. MEDPREP was looking for highly motivated candidates with good interpersonal skills and demonstrated leadership skills who would most likely benefit from an intensive preparatory program. A typical admission hurdle was telling applicants that there was a party at the end of their admission day, but providing them only vague information about the location of the party and making no arrangements for transportation to the event. Applicants who surmounted this hurdle were those who arrived on time, showed creativity in finding out where the party was to be held, or helped to organize transportation. Those applicants were accepted into the program.
After less than a year in the program, several of the initial MEDPREP students were able to secure acceptance to a medical school, including the SIU School of Medicine, for the 1973–74 academic year. After one year in the program, most participating students increased their MCAT scores. Many students remained in the program for more than one academic year before applying to medical school. Later, pre-dental students were accepted into the program. While the acronym remained the same, the official name of the program changed to Medical/Dental Education Preparatory Program.
Probably one of the most important things I gained from MEDPREP was the lifelong friendships I made while there. When I come across other “medpreppies” at other institutions we share a feeling of familiarity and belonging. Being a MEDPREP student was the best thing that ever happened to me in my entire academic career.—MONIQUE BURNETT HANIBLE, MD, family practice
In the '80s a big change in the program was recruiting out-of-state students (Table 1). The MEDPREP recruiter attended conferences and visited schools primarily throughout the Midwest and Southeast to attract students. The target population was still members of groups underrepresented in medicine and others from educationally disadvantaged backgrounds. MEDPREP also saw an increase in the number of students served, with women outnumbering men for the first time. African Americans still constituted the largest group of students. The percentage of MEDPREP students who were successful in applying to medical school remained fairly constant over this decade (Table 2).
The MEDPREP environment dissolved the obstacles and distractions that existed in each of our personal backgrounds. In addition, the warm nurturing attitudes of my peers and faculty were more than contagious. Studying and preparing applications was made easier and more delightful than I ever imagined possible.—JOSE CLAY FLORES, MD, pediatrics
The number of students enrolled in the program increased in the '90s. Approximately 500 students participated in MEDPREP during this third period. A shift in the population toward more women and African Americans was evident (Table 1). Approximately 30% were Illinois residents. While the overall population of MEDPREP increased, the relative number of pre-dental students decreased in the '90s.
The rate of acceptance to professional schools also improved (Table 2), with an increasing trend during this decade. Approximately 92% of those who matriculated have graduated or are still in school and scheduled to graduate over the next three years. MEDPREP students have attended 90 medical schools across the country.
I have made friends here in MEDPREP who will be spread out at various medical schools across the country, but I know that I can call them up anytime and ask them questions and they will find an answer for me. The ties that are made here will become an invaluable resource in the future, for these individuals will be my colleagues.—DANIELLE WALDROP, medical student, Southern Illinois University School of Medicine
SITE AND FACILITIES
MEDPREP was given its own building on campus. Wheeler Hall, one of the oldest buildings on campus, was an identifiable home for MEDPREP, with faculty and students sharing the same space, which provided ample opportunities for frequent contact in and out of the classroom. The nontraditional MEDPREP students found Wheeler Hall to be a good academic home on the university campus, which served more traditional undergraduate and graduate students.
The renovations and reconfiguration of space in Wheeler Hall in the early '90s facilitated some of the curricular changes. The formerly unused attic was converted to a student-learning environment. New discussion rooms provided meeting places for small-group learning activities in courses as well as study rooms around the clock. Students continued to have access to books, microscopes, anatomical models, and charts. Two new computer labs permitted use of Internet resources.
MEDPREP developed its own Web site, providing a resource for prospective applicants, alumni, and others interested in the program. With the acquisition of computer facilities a new database was developed that enhanced record keeping and tracking of MEDPREP alumni.
The core curriculum, which has remained relatively constant since MEDPREP began, focuses on the basic concepts of inorganic and organic chemistry, physics, and general biology. More advanced science courses were added in an effort to assist students' success in medical school. Students are helped to improve reading, writing, and test-taking skills. In addition, students are provided with information on how to apply to medical school, how to be effective interviewees, and how to write a personal statement. Students take more advanced premedical courses offered on the SIU Carbondale campus after they have completed the core curriculum.
In the '80s more extensive diagnostic testing of applicants was developed. The faculty worked to enhance that component of the admission process and testing in biology, chemistry, and problem solving, and they added self-report instruments measuring noncognitive skills.
Curriculum innovations were initiated with a new course, Reasoning in Reading and Writing, in 1990, which was devoted to skill development for the Verbal Reasoning section and Writing Sample on the 1991 MCAT. When the science sections on the 1991 MCAT shifted to a test measuring application of science concepts and problem solving, the problem-set format used by the MCAT was adopted for many quizzes and exams. Instructors utilized small-group activities, which promoted more active learning and helped maintain a low student-to-teacher ratio, even as the enrollment increased. In addition, a new problem-based learning course was developed to help students experience this learning approach before going to medical school. Many students continued to gain clinical experiences while in the program by shadowing physicians in the community.
I have found that I am a strong self-directed learner, and that I work well in a group. My critical thinking and problem-solving skills have greatly improved. I have developed more efficient note-taking and study skills, and I have come to respect the importance of good organization skills when attempting to handle voluminous amounts of information.—KARI JONES, medical student, Southern Illinois University School of Medicine
Higher enrollment in MEDPREP was accompanied by broad efforts to provide individualized attention to students outside the classroom also. The MEDPREP faculty and staff still offered extensive academic and personal counseling. Staffings—periodic meetings of the student, advisor, counselor, and director—played an important role in supporting the students.
In the second year of the program, state funding increased, and it was supplemented with $600,000 in federal grant funds over the next six years. This included funds for an outreach program, directed at undergraduate minority and disadvantaged students (already enrolled at SIU Carbondale) who were interested in any health career. The OUTREACH program easily doubled the number of minority and disadvantaged students who were helped to achieve their goals of entry to a health profession or allied health school.
The OUTREACH program benefited MEDPREP students as well. Students enrolled in MEDPREP became tutors for the OUTREACH students. MEDPREP students received training in listening and basic counseling skills as part of their formal tutor training. Many of the MEDPREP students were from less-than-successful backgrounds, and were themselves high-risk students, without the traditional preparation to be competitive for medical school. The effect of tutor training and tutoring on MEDPREP students resulted in more confident and poised students. Their confidence and altruism were important components of their ability to persist through MEDPREP, which often meant one or two additional years preparation for medical school. Their successes percolated other successes, both in MEDPREP and in the OUTREACH program. Unfortunately, funding for OUTREACH was not continued after 1979.
A summer prematriculation program was started in the late '80s as a means of assisting student retention in the School of Medicine. Grant funds provided stipends for those participating, and School of Medicine faculty offered classroom and lab experiences that would ease the transition into the professional school curriculum. Other retention efforts included the MEDPREP director's and the counselor's being available to all medical students for counseling.
Two summer programs were offered for high school students. The Health/Science Careers Pathway (HSCP) Program, a four-week residential summer program was designed to provide high school minority students, primarily from the East St. Louis area, with experiences to increase awareness of and interest in careers in the health professions. In the Summer Research Apprenticeship Program, southern Illinois high school disadvantaged students were matched with faculty mentors in a School of Medicine research laboratory six to seven hours per day. Training included laboratory safety, hands-on research, and collecting and managing data, as well as preparation and presentation of a research paper. In the late '90s a Science on Saturday program was initiated for students in the community middle school. MEDPREP students also began tutoring in math and science at the community high school and middle school.
All of the growth in curriculum and activities is a reflection of the stability of the administration and faculty who remained focused on the mission of the program.
In 1997 MEDPREP celebrated its 25th year with a reunion of former MEDPREP students. MEDPREP traditions were highlighted during the weekend activities. From that time on, in the fall of each year, during a solemn ceremony, students pledged to live up to the MEDPREP ideals, including integrity, diligence, personal responsibility, cooperation, and communication. Upon arrival in MEDPREP, students participated in team-building exercises at the Underway Wilderness Program. Through this activity students began their training in small-group problem solving and interpersonal communication. In addition to these program activities, the student MEDPREP Club planned and implemented community service projects and social activities, including a formal banquet. These enriching projects enhanced student bonding in the academic arena as well as in their personal lives.
Several factors are responsible for the success of MEDPREP. The SIU School of Medicine has a well-deserved reputation for medical education innovation. MEDPREP was another example of a School of Medicine program that tried new strategies to maximize the success of enrolled students. The founding dean of the school was a strong proponent of the program and protected it during the early years. The dean also agreed to match, with new state funds, any federal grant funds that MEDPREP received.
There clearly was a need for a program of this type to help ensure that the new SIU School of Medicine would achieve its goal of meeting the health care needs of underserved areas of central and southern Illinois. It was evident that the existence of MEDPREP helped the school to promote its mission. The increased national emphasis on increasing minority enrollments in medical school, and the trend towards more generally improving the diversity of medical school classes, were additional major influences.
MEDPREP was very fortunate to receive early, generous, and flexible funding from the Department of Health and Human Services in the form of HCOP grants, in addition to base funding from the State of Illinois. These funds allowed the program to expand enrollment, develop new programs, hire additional faculty and staff, and offer more courses to students.
Most of the credit for the success of the program goes to the MEDPREP students. They were risk takers when they left home, gave up jobs, borrowed tuition and living expenses, and decided to participate in a program that provided no guarantee of acceptance to medical school. These were highly motivated students who saw MEDPREP as perhaps their last chance of achieving their goals of becoming physicians or dentists. MEDPREP students continue to take advantage of their opportunity and strive to meet the challenges they face, with the support of the faculty and staff.