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The Social and Learning Environments Experienced by Underrepresented Minority Medical Students: A Narrative Review

Orom, Heather PhD; Semalulu, Teresa MPH; Underwood, Willie III MD, MS, MPH

doi: 10.1097/ACM.0b013e3182a7a3af

Purpose To review the literature on the social and learning environments experienced by underrepresented minority (URM) medical students to determine what type of interventions are needed to eliminate potential barriers to enrolling and retaining URM students.

Method The authors searched MEDLINE, PubMed, Ovid HealthStar, and Web of Science, and the reference lists of included studies, published between January 1, 1980, and September 15, 2012. Studies of the learning and social environments and of students’ satisfaction, experiences with discrimination or unfair practices, and academic performance or progress, as well as assessments of programs or interventions to improve URM students’ academic performance, were eligible for inclusion.

Results The authors identified 28 studies (27 unique data sets) meeting the inclusion criteria. The results of the included studies indicated that URM students experienced less supportive social and less positive learning environments, were subjected to discrimination and racial harassment, and were more likely to see their race as having a negative impact on their medical school experiences than non-URM students. Academic performance on standardized exams was worse, progress less timely, and attrition higher for URM students as well.

Conclusions For URM students, an adverse climate may be decreasing the attractiveness of careers in medicine, impairing their academic performance, and increasing attrition. Improvements to the social and learning environments experienced by URM students are needed to make medicine a more inclusive profession. The current environment of health care reform creates an opportunity for institutions to implement strategies to achieve this goal.

Dr. Orom is assistant professor, Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York.

Ms. Semalulu is practice facilitator, Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York.

Dr. Underwood is associate professor, Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

Previous presentations: Poster presented at the 140th annual meeting of the American Public Health Association, San Francisco, California, October 2012.

Correspondence should be addressed to Dr. Orom, State University of New York at Buffalo, Community Health and Health Behavior, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14214; telephone: (716) 829-6682; e-mail:

© 2013 by the Association of American Medical Colleges