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.
1 Elam CJ, Wilson JF, Johnson R, Wiggs JS, Goodman N. Challenging the system: admissions issues for at-risk students, admissions committees. Acad Med. 1999;74 (10 suppl):S58–S61.
2 Henry P. Toward a career development model for postbaccalaureate premedical program from theory to practice. Psychol Rep. 2003;93:335–342.
3 McGaghie WC. Qualitative variables in medical school admissions. The Advisor. 1990;10:2–7.
4 McGlinn S, Jackson EW, Bardo HR. Postbaccalaureate medical/dental education preparatory program (MEDPREP) at Southern Illinois University School of Medicine. Acad Med. 1999;74:380–382.
5 Judd NL, Sing PM. Imi Ho’ola post-baccalaureate program: recruitment, retention, and graduation of Asian American and Pacific Islander students in medicine. Pac Health Dialog. 2001;8:446–449.
6 Giordani B, Edwards AS, Segal SS, Gillum LH, Lindsay A, Johnson N. Effectiveness of a formal post-baccalaureate pre-medicine program for underrepresented minority students. Acad Med. 2001;76:844–848.
© 2008 Association of American Medical Colleges
7 Association of American Medical Colleges. AAMC Statement on the Physician Workforce. Washington, DC: Association of American Medical Colleges; 2006.