Reeves, Rustin E. PhD; Vishwanatha, Jamboor K. PhD; Yorio, Thomas PhD; Budd, Michael PhD; Sheedlo, Harold J. PhD
The medical school admissions process in the United States weighs heavily on cognitive measures such as Medical College Admission Test (MCAT) scores and GPA, especially science GPA. For many applicants, these are the undeniable deficiencies for entry into medical school. Elam et al1 reported that noncognitive factors such as motivation, exposure to the profession, leadership, ability to overcome adversity, and community service often receive favorable consideration in selection decisions at most medical schools. Additionally, other personal attributes such as character traits, life experiences, and adaptive capabilities are positive professional distinctions that are crucial for success as a medical student and physician.2 However, it is often the case that cognitive factors outweigh perceived benefits of noncognitive factors in the minds of many admission committee members. In these situations, noncognitive factors are regularly overlooked,3 and because of this, many deserving and qualified students are often rejected from medical school through the traditional admissions process.
In the United States, many premedical school postbaccalaureate (postbac) programs4–6 are designed primarily to enhance minority and underrepresented students’ enrollment into medical schools. However, the major focus of the postbac premedical certification program at the University of North Texas Health Science Center (UNTHSC) is to target students who have tried to matriculate into medical school through the traditional admissions process but were rejected because of some limiting factor identified in their application portfolio. Even though we focused on these students, numerous qualified minority students were successfully recruited into the postbac program on the basis of these criteria and were subsequently accepted into medical school.
The Graduate School of Biomedical Sciences (GSBS) at UNTHSC initiated the Post-Baccalaureate Premedical Certification Program in an attempt to alleviate potential shortfalls in the diversity and quality of applicants to the Texas College of Osteopathic Medicine (TCOM), the medical school at the health science center. Knowing that medical school admission committees reject many qualified applicants annually, this program was designed to offer students who had applied to medical school and had been rejected an alternative educational opportunity that would boost their cognitive and noncognitive value as viewed by medical school admission committee members. In effect, the program offered an alternative method of medical school admissions to students who were having difficulty matriculating through the traditional admissions route.
In 1999, the program was proposed by Thomas Yorio, PhD, dean of the GSBS, and Victoria Rudick, PhD, associate dean of the GSBS (retired). They envisioned a program that would improve students’ deficiencies in specific areas of their medical school applications that were preventing their admission to medical school. In addition, this extensive program would give the participants an opportunity to reevaluate their commitment to enter the medical profession. The inaugural class of the UNTHSC postbac program began in the fall of 2000, with seven students (postbacs) enrolled for that semester.
Postbacs accepted into the program are enrolled in the GSBS at UNTHSC and can apply for financial aid through the health science center’s financial aid office. All postbacs are now eligible to receive, through the GSBS policy enacted in the academic year 2005–2006 at UNTHSC, a nonthesis MS degree in medical science on completion of the 36-credit-hour program. The postbac program is intended to be completed in one year, beginning in the summer and continuing through the fall and spring semesters.
The graduate-level postbac program offers a strong, challenging biomedical science core curriculum to students in the structured environment of a health science center. Postbacs enter the program during the summer, taking a biostatics course while actively participating in a clinical practice preceptorship. During the fall semester, students must complete Principles of Biochemistry and Molecular Cell Biology, both core courses required for all UNTHSC graduate students. In addition to these two courses, three other courses are taken in the fall semester: (1) Ethical, Legal, and Social Issues for Responsible Clinical Research, (2) Introduction to Health Disparities/Issues in the United States, and (3) Principles of Epidemiology and Evidence-Based Medicine. An additional activity offered to postbacs in the fall semester is an “interview workshop” where volunteers (clinical and graduate faculty) discuss the medical school interview process and then perform a mock interview with all participants.
In the spring semester, postbacs take the graduate core course, Physiology and Pharmacology. This course, along with the two core courses completed in the fall semester, completes three of the four graduate core courses required of all graduate students at UNTHSC. The postbacs complete their curriculum requirements by taking Structural Anatomy, a seven-credit-hour graduate course offered in the spring semester by the department of cell biology and genetics faculty. This course provides extensive instruction in human gross anatomy, histology, and embryology. Most important, students actively participate in cadaver dissection and receive laboratory practical test-taking skills in a medical human anatomy course with first-year medical students. The cadaver-based dissection experience is unique to this postbac program and has proven to be a very popular activity with the students. The human anatomy taught in this course represents about 38% of the total anatomy course presented to first-year medical students at TCOM.
Interviews and Admissions Requirements
To initiate the medical school admissions process during the spring semester, postbacs have interviews scheduled by the office of admissions at the Texas College of Osteopathic Medicine (TCOM) with clinical and basic science faculty at the health science center. Those students who complete the yearlong program with a minimum of a 3.5 GPA, score at least 20 on the MCAT, and have acceptable interviews with faculty will be considered for admission into TCOM during a special meeting of the admissions committee. Most postbacs who fall short of these requirements do so because of their GPA in the program. If not considered for admissions to TCOM, they have several options. They can pursue a traditional MS degree in biomedical sciences, an MS degree in clinical research management, or a traditional PhD in biomedical sciences, or they may apply to and be accepted into other medical school programs.
Program enrollment and medical school entrance data for 2000–2006
The postbac program began at UNTHSC in the fall of 2000. A total of seven students applied to, were accepted into, and completed the program during that academic year (2000–2001). Of the seven original students, one was accepted into TCOM for the fall of 2001, and three students from this class were accepted into other medical schools. In contrast, 107 applications were received for the 2005–2006 academic year. Of those, 35 were accepted as postbacs, and 31 postbacs completed the program during that year (2005–2006). Thirteen from this class began medical school at TCOM in fall 2006 as the Class of 2010. Eight of their fellow classmates were accepted into programs at other medical schools. At the end of the spring semester of 2006, a total of 101 postbac students had completed the program. Furthermore, with 115 applicants for the fall of 2006, there has been more than a 16-fold increase in the number of students applying to the program during the past six years. During 2000–2006, 282 applicants for the program were reviewed, and 112 of those students were accepted into the program. See Tables 1 and 2 for information about applicants to the program and postbac admissions into medical schools.
As shown in Table 2, of the 101 postbacs completing the program, 48 have been accepted into TCOM and 22 have been accepted into other medical schools. For the purposes of this manuscript, all students referred to as accepted into TCOM or accepted into another medical school means they matriculated into that school. Consequently, we have achieved an overall acceptance (matriculation) rate of 69% for postbacs completing the program. Of the 48 postbacs accepted into TCOM, 90% (43) stated they had applied to medical school at least once before entering the postbac program when surveyed. In surveys from the current class of 40 postbacs (2006–2007 academic year), 93% (37) stated they had applied to medical school at least once before entering the program. Of those, 12 stated that they had applied three or four times. Additional information given by these students indicated that their major reason for not getting into medical school was low GPA or MCAT scores. From both groups surveyed, fewer than 10% of the postbacs had never applied to medical school. From this small percentage, most expressed a lack of confidence in getting accepted into medical school, because of low GPA or MCAT scores, as their reason for not applying.
Other program data
During the first six years, 23% of those students accepted into the postbac program were minorities. Minority populations considered for this study included African Americans, Hispanics, Native Americans, and Pacific Islanders. Three of the seven students completing the first year of the program were minorities (Table 1). Two of these three were accepted into medical school (Tables 1 and 2). Of the 19 minorities completing the program during the first six years, eight were African American, eight were Hispanic, two were Native American, and one was a Pacific Islander (Table 1). Of those minorities, 7 were males and 12 were females. The gender of all students accepted into the program shows a male-to-female ratio of approximately 1:1; however, the ratio for those completing the program and those meeting criteria for acceptance into TCOM leans slightly toward the males (Table 1 and 2). In addition to the postbacs who completed the program, 21 postbacs completed other graduate programs at UNTHSC. Nineteen postbacs completed the MS in clinical research management program, and two completed other master-degree programs within the Graduate School of Biomedical Sciences at UNTHSC.
Comparison of undergraduate GPA and MCAT scores for postbacs and regular TCOM medical students
In general, postbacs accepted into TCOM have an average MCAT score that is slightly lower than their classmates admitted to medical school through the traditional process. However, postbacs’ overall undergraduate GPA (four-point scale) was significantly lower than their medical school classmates (Table 3). As a reminder, the postbacs used in these data were those accepted and matriculated into TCOM, and they represent about 48% of all postbacs who completed the program. MCAT scores and undergraduate GPA of postbacs accepted into other medical schools, as well as postbacs who were not accepted into medical school after completing the program, are not calculated in these data. The postbac students who are denied enrollment in medical school (31% of those completing the program) are some of the weaker students academically, and it would lower these figures significantly if their numbers had been used in the calculations. However, with more qualified applicants being accepted to the program, we have seen a shift in this trend. For example, the 13 postbacs accepted into the TCOM Class of 2010 had a higher average MCAT score than did their fellow medical school classmates (Table 3). However, their undergraduate GPA was still slightly lower than that of the medical students within their class who were accepted through the traditional route of admission. In Table 3, the first-year TCOM students’ scores for MCAT and overall undergraduate GPA reflect averages from only TCOM students who did not come through the postbac program. Averages for postbac students who were part of the represented TCOM classes were calculated separately. They are listed separately.
Medical school performance for postbacs accepted into TCOM compared with regular TCOM medical students
The average GPA (grade scale: 0–100) after the first-year medical school curriculum for all postbacs accepted into TCOM is slightly higher than the regular TCOM medical students who were accepted through the traditional medical school admissions process (Table 4). Analysis of overall performance in medical school reveals that the TCOM Class of 2008 postbacs did very well compared with their nonpostbac classmates. Their average class rank and GPA were 12.4 and 93, respectively (Table 4). Additionally, the postbacs have performed well on the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 that is taken at the end of their second year of medical school. The average COMLEX Level 1 score for all postbacs accepted to TCOM in the classes of 2005–2008 was 542.3 compared with 529.3 for their medical school classmates (Table 4).
Postbac Postprogram Surveys
To monitor the background and progress of our students, each year we invite postbacs to participate in a survey on completion of the program. From postprogram surveys from 2000 to 2005, 32 postbacs indicated they had taken an average of 4.6 additional upper-level science courses beyond the required medical school prerequisites as undergraduates. In addition, we asked participants to determine deficiencies in their preprogram medical school application portfolios. Respondents were asked to list multiple deficiencies if applicable. Of the 32 postbacs returning the postprogram surveys from 2000–2005, 17 listed MCAT scores, 7 listed undergraduate science GPA, and 16 indicated overall undergraduate GPA as a deficiency in their application to medical school. We surveyed the class of postbacs enrolled in 2006–2007 with the same question. All 40 participants enrolled in the program responded to the survey, and 24 stated that their MCAT scores were deficient when they had previously applied to medical school. An additional 13 stated that low undergraduate GPA was a cause of them not being admitted to medical school, and 6 specifically stated undergraduate science GPA as the reason.
As shown in Table 5, a postprogram questionnaire was given to postbacs to ascertain their overall assessment of the program. A summary measure, the strength index (SI), was calculated for each of the 13 questions from the percentage responding: 5 = strongly agree (SA), 4 = agree (A), 3 = neutral (N), 2 = disagree (D), and 1 = strongly disagree (SD) to each statement. The formula for calculating SI is ((SA × 5) + (A × 4) + (N × 3) + (D × 2) + (SD × 1)/SA + A + N + D + SD) × 20. The SI has a range of 20 to 100, where 100 is maximum satisfaction (strength). The surveyed postbacs strongly agreed that the program positively affected their career goals and opportunities, and they reconfirmed their desire to enter the medical profession, with both questions scoring an SI of 93.8 (Table 5). Registering a high SI of 87.5, postbacs believed the program enhanced their chances to get into medical school. Postbacs strongly agreed (SI of 99.4) that the Structural Anatomy course gave them a good background in anatomy and histology. In addition, they highly valued the cadaver dissection experience. Overall, they enjoyed the interaction with medical students and would recommend the program to anyone trying to enhance their admissions qualifications when applying to medical school (Table 5).
Postbac Programs: A Potential Solution for Students, Schools, and Medicine
In the 1980s and 1990s, most public policy makers predicted the United States would have a sizeable excess of physicians by the beginning of the 21st century.7 During the past five years, this prediction has been reversed, and in June 2006, the Association of American Medical Colleges’ Statement on the Physician Workforce recommended that medical school enrollment should be increased by 30% from 2002 levels during the next decade.7 With the call for enrollment increases, this type of program that brings more qualified students into the pipeline would be very beneficial to U.S. medical schools seeking to fulfill this recommendation.
The postbac program at UNTHSC has proven very successful in preparing students for the rigors of a medical school curriculum by allowing these students the opportunity to develop the skills and confidence necessary to compete. This means competing not only in the medical school classroom but also at the admissions committee level, where previous reviews of their qualifications were a hindrance for entry into medical school. These students have performed very well because of their high level of motivation to pursue a career in medicine, and from a thorough training received in the UNTHSC premedical, postbac program. Consequently, postbacs have stated that the training in human anatomy with first-year medical students was a key factor in their success on matriculation into medical school. Classes in ethics, health disparities, epidemiology, and evidence-based medicine help round out their academic studies, giving them a broader view of health issues than many medical school applicants. In addition to the rigorous coursework, postbacs participate in a “medical school interview workshop” to prepare them for interviews with graduate and clinical faculty at TCOM, as well as at other medical schools. Coupled with the clinical practice preceptorship offered the first month in the program, these added activities for the postbacs boost their noncognitive value to medical school admission committees.
The strength of the program has been its ability to enhance the credentials of students for application to medical school; however, some students take this year to decide whether medicine is truly their career goal, and some decide not to pursue medicine. Postbacs who have matriculated at TCOM have taken leadership positions in their classes, served as tutors and mentors for their classmates, and served as school ambassadors to medical school applicants. In the past six years, not one of the 48 postbacs admitted into TCOM has reported to the student performance committee with academic difficulties or failures in any course.
In addition to a large increase in the number of applications to the program, the quality of applicants has improved. Higher GPA and MCAT scores, coupled with more upper-level, undergraduate science courses, seem to be the norm for many of the applicants during the past few years. For example, the graduate students accepted as postbacs for the 2006–2007 academic year had an average MCAT score of 26 and an overall undergraduate GPA of 3.3 (n = 45 students). Consequently, during the past few years the number of acceptable minority applicants has increased, which should reflect a larger number of minority students graduating from the program in the future. It is our intention to use this program as a recruitment tool for qualified minority students who can fill shortages in rural communities and urban neighborhoods in dire need of family physicians.
Overall, the postbacs have performed very well in the first year of medical school. For example, all five of the postbacs who completed their first year of medical school in the spring of 2005 finished ranked in the top 25 of their class, three finished ranked in the top 10, and one finished first out of 130 medical students. These were individuals who had been rejected at least once through the traditional medical school admissions process but were motivated enough to investigate, enroll, and participate in an alternative path for entry into medical school. During the past five years, the postbacs on average have consistently performed at the same level as or ahead of their medical school classmates.
Another comparison of the postbacs and their medical school classmates is demonstrated in the average scores of the Mechanisms of Disease (MOD) course (Table 4). The MOD course is the most difficult course in the first-year medical curriculum at UNTHSC. During the last five years, the postbacs’ average score in MOD has been almost equal to, and in some cases higher, than their classmates’ in a course that contains material that neither group has been exposed to previously.
These results indicate that biomedical science coursework offered in a premedical postbac program can neutralize cognitive differences of participants when compared with their medical school classmates. The strong academic performance by the postbacs in their first year of medical school reflects the quality of the postbac students and program. After the second year of medical school, average COMLEX scores for postbac students who experienced difficulty entering medical school through the traditional route (i.e., normal medical school admissions process) were higher than their colleagues’ (Table 4). These facts give proponents a strong incentive to advocate the acceptance of graduates of the program to medical school admissions staff, committees, and the dean of TCOM.
One complaint of the program perceived by a few students is that participation in the program has set them back a year in their pursuit of a medical career. Although not a strong complaint, some feel they should have been admitted to medical school when they first applied. On the basis of their performance in the postbac program, this could be viewed as a legitimate argument. However, one could argue that some of the postbacs might not have performed as well as they did without this additional year of premedical coursework. It is probable that the program increases a student’s class rank, thus enhancing the possibility that a student will secure a choice residency program on graduation from medical school.
At TCOM, overall COMLEX Level 1 scores have increased during the past few years. Several factors have contributed to this success. One factor suggested was the change to an integrated, systems-based medical curriculum eight years ago that is currently taught by a dedicated clinical and basic science faculty at TCOM. Another plausible factor is the steady supply of highly motivated, well-prepared former postbac students who have assimilated into the medical school student body during the past six years (48 in all). The successful track record of this endeavor can only benefit the medical school, and in turn, should ensure the long-term survival of the Post-Baccalaureate Premedical Certification Program at the UNTHSC at Fort Worth.
The data presented in this manuscript were previously presented in part in an abstract by Jamboor K. Vishwanatha at the Graduate Research, Education, and Training Group Conference of the AAMC that met in Fort Meyers, Florida in October 2005.
The authors would like to recognize Dr. Victoria Rudick, associate dean (retired) of the Graduate School of Biomedical Sciences at the University of North Texas Health Science Center (UNTHSC) for her expertise and dedication to the success of the postbac program from 1999 to 2004. In addition, they would like to thank Carla Lee and Amanda Griffith in the Graduate School of Biomedical Sciences, UNTHSC, and Lynn Scott in the Office of Admissions and Outreach, Texas College of Osteopathic Medicine, for their assistance with data provided in this manuscript.