Black male enrollment in med schools worrisome

The cost of medical degree is one key factor in the decline in Black male medical students.

WASHINGTON (NNPA) –The number of Black males applying to medical school is lower than it was three decades ago, raising concerns about the United States’ future ability to have health care providers be as diverse as the patients they serve, according to a new report by the Association of American Medical Colleges (AAMC).

“No other minority group has experienced such declines,” wrote Marc Nivet, the chief diversity officer for AAMC, in a foreword for the report. “The inability to find, engage, and develop candidates for careers in medicine from all members of our society limits our ability to improve health care for all.”

The AAMC report titled, “Altering the Course: Black Males in Medicine,” paints a stark image of the current science, technology, engineering and math (STEM) pipeline and specifically how ineffective it has been with motivating young Black males to pursue medical careers.

In 1978, there were 1,410 Black male applicants to medical school. By 2014, however, that number had declined to 1,337, according to the report.

“A similar trend is observed for first-time matriculants: in 1978, there were 542 [b]lack male matriculants to MD-granting institutions, and in 2014, there were 515,” the report said. “In addition, of all racial and ethnic groups, the proportion of applicants to medical school who were male compared with female is lowest for African-Americans – despite an overall increase in the number of Black male college graduates.”

The AAMC represents 144 accredited medical schools in the United States, 17 accredited Canadian medical schools and nearly 400 major teaching hospitals and health systems.

The push to get more young minorities to embrace STEM careers comes at time when researchers are predicting a shortage of 46,000 to 90,000 physicians by 2025 and studies have shown that increasing diversity in medical schools and in health care professions can boost civic engagement, expand exposure to different educational approaches and make it easier to recognize racism, the report said.

In 2006, more incoming Black male freshman (37.5 percent) than Black females (31.9 percent) reported that they intended to major in a STEM field, but four years later, “female African-American students received the majority of overall science and engineering degrees, totaling 100,435, while male African-American students received 51,969 science and engineering degrees,” the AAMC report said citing a study by the National Science Foundation.

A limited pool of scholarships and the staggering cost associated with earning a medical degree were identified as key challenges to getting more Black males into the medical school pipeline.

More than 30 percent of all 2014 medical school graduates reported that they accumulated a total education debt amount that eclipsed $200,000; meanwhile nearly 42 percent of Black male medical school graduates amassed that much debt.

Entering the labor market with a heavy debt burden can often contribute to a sense of lasting economic strain for health professionals and can also act as another deterrent for Black male college students weighing the value of a medical degree.

In 2006, just 26 percent of Black male physicians stated that they had “excellent” or “very good” financial status compared to 33 percent of Black female physicians, 54 percent of White female physicians and 53 percent of White male physicians, who reported the same financial status.

“Talent is universal, but opportunity is not,” exlained Nivet. “Not only are there several programs to address the issue, such as the White House initiative My Brother’s Keeper, but academic medicine is working within the community and partnering with minority-serving institutions – the largest feeder schools to medical school – to help develop the next generation of physicians.”

According to the report, Morehouse College in Atlanta was the undergraduate institution that provided the most Black male applicants to medical schools with 148 between 2010 and 2014. The University of Florida in Gainesville (129), Howard University in Washington, D.C. (92), Xavier University in New Orleans, Louisiana, (90) and the University of Maryland in College Park rounded out the top five over the same time period. Four of the top 10 schools that provided Black male applicants to medical schools were HBCUs.

Virtual classrooms foster medical education and research in Bangladesh

Prof. Laila Banu (Left) and Next Generation Sequencer in her laboratory

Bangabandhu Sheikh Mujib Medical University (BSMMU) is the only medical university in Bangladesh. It is also the leading post-graduate medical institute in the country. It has a supreme role in raising the quality of medical study and research. BSMMU is one of the largest beneficiaries of the Academic Innovation Fund (AIF) under the Higher Education Quality Enhancement Project (HEQEP) which has brought about significant improvements in the quality of medical education and research.

The university is now launching the first-ever virtual classroom for medical education in Bangladesh. The World Bank blog cited a story in this regard.

Teaching quality in medical education and training is increasingly a troublesome issue in Bangladesh. Teachers in medical colleges are inadequate both in quantity and quality. Currently there are only around 120 pharmacology teachers across 86 medical colleges in Bangladesh.

To address the challenge, the AIF supported the Department of Pharmacology of BSMMU to establish the first-ever virtual classroom system for medical college students in Bangladesh. The system has a great potential of changing the landscape of medical education and training in Bangladesh.

The “Virtual Teaching-Learning Program on Pharmacology” sub-project was launched to pilot innovative use of information technology in medical education by establishing a virtual classroom environment. Under the pilot, medical college institutions across Bangladesh are connected to the virtual classroom. It allows senior medical professors in Dhaka and even international experts from abroad to deliver their lectures to students in medical colleges in different regions. Students can attend real-time online classes, download teaching materials, and assess their competence in self-administered test.

“So far 36 topics are available to the students for free. An online question bank has been uploaded containing about 4,000 questions. We also established a synchronous teaching system that is so far connected with 32 medical colleges. Professors in Dhaka now remotely teach classes to students outside of Dhaka, and sometimes international guest lecturers also give lectures via the synchronous system. It is an exceptional experience for students in remote areas to listen and ask questions to renowned medical professionals. The bandwidth of internet connectivity is the only challenge. BSMMU is connected to high-speed Bangladesh Research and Education Network (BdREN), whereas colleges in remote areas have only narrow-band connectivity and cannot receive our synchronous broadcasting. It is now essential for the colleges to get broad-band internet connectivity.” says Professor Mir Misbahuddin, the sub-project manager at Department of Pharmacology, BSMMU.

Establishing a world-class genetic research environment 
The “Modernization of Genetic Research Facilities and Patient Care Services” sub-project by the Faculty of Basic Medical Sciences is another success at the BSMMU. The sub-project installed a Next Generation DNA Sequencer, the only one of its kind in the country, and established a modern fully equipped genetic research laboratory. The sub-project aims to promote research on human genetic diseases in Bangladesh, which have never been addressed due to the lack of proper facilities, and invites international experts in genetics and molecular biology to train medical researchers in Bangladesh.

“With this Next Generation Sequencer, we can now analyze the DNA sequence of Bangladeshi citizens and explore the genetic data of most prevalent genetic diseases in Bangladesh.’ explains Dr. Laila Anjuman Banu, sub-project manager and professor of Genetics & Molecular Biology. “Currently, we are developing a database of patients suffering from breast cancer and hypertrophic cardiomyopathy in Bangladesh. The database is useful for researchers in Bangladesh for further researches on developing molecular diagnostics and designing targeted therapeutics in the near future. This is a cutting-edge arena for medical research worldwide. We have published two papers already using this new sequencer.” she added.

AIF sub-projects awarded to other departments such as Anatomy, Urology, and Palliative Care have been equally successful

source: newshour.com.bd

Oversupply of doctor graduates leads to questions on new medical school


ELEANOR HALL: Now to the furore over the Federal Government's allocation of $20 million for another undergraduate medical school in Perth.

The Australian Medical Association and other health lobbies argue there's an oversupply of graduates and that the money should be going towards intern and postgraduate training.

The Rural Doctors Association is also concerned.

It says there are still not enough doctors in regional areas but that a new school in Perth won't solve the problem.

Bridget Brennan has our report.

BRIDGET BRENNAN: Cardiologist Professor Gerard Carroll trains graduate doctors in Wagga Wagga in New South Wales.

He believes Australia has plenty of medical graduates so he was surprised to hear that there'll be another medical school opened at Curtin University in Perth.

GERARD CARROLL: I was surprised. I was surprised that there was another medical school that was based in a capital city.

There are certainly concerns throughout Australia and throughout medical education circles that the number of medical students in training now has saturated resources and capacities to train them. 

In fact, we've probably got too many graduates in relation to the number of training positions following graduation.

So it is extremely difficult now to find intern positions and training positions in various fields for the huge number of graduates that are coming through each year.

BRIDGET BRENNAN: Professor Carroll has seen increasing pressure on hospitals and clinics where graduates need to do two years of junior medical training.

GERARD CARROLL: So for example you might have 10 or 12 or 15 medical students seeing a sick patient and then another group come in, and another group come in, because there's so many students to see relatively few numbers of patients.

BRIDGET BRENNAN: The Australian Medical Association is angry the Federal Government will spend $20 million on the new school, instead of on training.

The Rural Doctors Association has also expressed concern.

The association's president is Dr Dennis Pashen.

DENNIS PASHEN: We've had a rapid increase in the number of doctors produced in Australia.

It's gone from about, it's actually doubled in the last 10 years, but you've got this very large bulge that's there and you have to fund training places, and if you don't have enough intern and second year training places in hospitals, you get a backlog.

BRIDGET BRENNAN: Given that bulge, as you describe it, would you like to have seen that $20 million on this new undergraduate school spent on training instead?

DENNIS PASHEN: Well, I think you need to have a measured approach and you have to look at how you're going to provide that pathway into rural practice.

It's going to take five to seven years before these people are going to go out there.

BRIDGET BRENNAN: This morning the Federal Health Minister Sussan Ley defended the decision.

SUSSAN LEY: One of the things that has really come home to me on my visits to the West is the high number of overseas trained doctors, particularly in rural and remote WA, and there are no dollars in our forward budget attributed to this little.

So WA Government has stepped, the Curtin University has stepped up, and yes, there will be new Commonwealth funded places into the future and I look forward to those students servicing the communities of Western Australia.

BRIDGET BRENNAN: The former WA Health Department boss Neale Fong did a feasibility study on the new Perth medical school.

NEALE FONG: Well, the main premise for the medical school from Curtin was that there is a shortage of doctors in Western Australia and an overreliance on overseas trained doctors coming into Western Australia and filling those positions.

So this is a long term plan to prime that pipeline because it takes between five and 10 years for medical graduates to get into the system.

BRIDGET BRENNAN: But, Dr Dennis Pashen says a shortage of rural doctors is not an issue of under supply - the problem is that graduates aren't going bush.

DENNIS PASHEN: If Curtin's going to produce 25 per cent with a rural focus, that's good, but the other 75 per cent probably won't and we'll probably end up in the, you know, in the south-west quarter.

There are a number of doctors already being produced in Australia that will end up in sort of metropolitan, out of metropolitan areas.

BRIDGET BRENNAN: The Federal Government says it's getting a guarantee that training places will be provided by the West Australian Government.

Cardiologist Professor Gerard Carroll would rather get an assurance that more medical schools will be built in regional areas.

GERARD CARROLL: We did have a shortage, a substantial shortage 15, 20 years ago and that has certainly been more than compensated for.

There should be rural medical schools where the entire training or nearly the entire training is done out of regional centres.

ELEANOR HALL: That's cardiologist Gerard Carroll, ending Bridget Brennan's report.

Source : http://www.abc.net.au/worldtoday/content/2015/s4237584.htm

Medical education risks becoming two-tiered unless strong research focus is preserved


For more than 100 years, exposing students to basic and clinical research has been an essential component of a medical school education in the United States. However, today, new models of medical education in which research plays a minimal role are likely to create a two-tiered system of education, decrease the physician-scientist pipeline and diminish the application of scientific advances to patient care.

Those are the concerns outlined in "American Medical Education at a Crossroads" - a position paper published April 29 by Science Translational Medicine and co-authored by Arthur Feldman, MD, PhD, Executive Dean of Temple University School of Medicine and Chief Academic Officer for the Temple University Health System, Arthur H. Rubenstein, MBBCh, Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, and colleagues. The abstract explores the reasons why research is being deemphasized, particularly at some of the nation's newer medical schools, and at those which are not affiliated with a major research university. The authors argue that the U.S. is headed for a two-tiered system, one that exposes students to research and physician-scientists, and another that trains students with exclusively practitioners as role models.

"Research at our nation's medical schools has led to discoveries that have changed the face of American medicine," says Dr. Feldman. "Unfortunately, many of the nation's newer medical schools do not prioritize research or are unable to compete for scarce research funding. The result is an increased proportion of U.S. medical school graduates matriculating from programs where the faculty members pursue little to no clinical or translational research."

According to the authors, many of the new U.S. medical schools share other features beyond just the absence of a research portfolio: they are not partnered with major research universities; they have a small basic science faculty; and, in many cases, their students take clerkships solely in community hospitals rather than in research-oriented quaternary care hospitals.

Proponents of this model argue that empiric instruction (i.e., exposure to clinical settings) is sufficient and students who intend to pursue a career in primary care do not require hands-on exposure to laboratory-based translational research, to clinical research that is focused on the complex array of disease found in research-oriented hospitals, or to outcomes research, comparative effectiveness research and investigations centered on health care delivery systems.

The authors find this argument problematic. Just as it is axiomatic that clinical medicine is best taught at the bedside, the authors believe that the most effective means by which a student can learn the complexities of clinical and translational science is through exposure to actual research studies and to the physician scientists who pursue translational research.

Students must learn to amass, synthesize, critique and apply new scientific data to the care of an individual patient. How we provide our students with the skills to amass this data both in the short term and over a lifetime of learning will have a major impact on their clinical capabilities, they write.

"Research is just as important for the student who plans to pursue primary care as it for the physician-scientists in training," said Dr. Rubenstein, who also served as dean of Penn's Perelman School of Medicine from 2001 to 2011. "It is becoming increasingly important for all students to be in an environment where both attending physicians and trainees take the opportunity to explore at the bedside how the bi-directional highway of translational science can be taken advantage of to inform clinical decision making."

Dr. Feldman, Dr. Rubenstein and the authors write that it is not surprising that many new medical schools do not, or cannot, support basic or clinical research. The 2013 National Institutes of Health (NIH) budget was 21.9 percent below its 2003 level when adjusted for inflation, pharmaceutical support for research has diminished, changes in reimbursement policies make it problematic to support research with clinical revenues, and proposed cuts to direct and indirect medical education payments threaten funding for residents and teaching faculty. In addition, due to the high cost of maintaining research programs, many schools find it more advantageous to shrink or eliminate these programs.

"Without question, omitting research improves the finances of a school of medicine," write the authors. "Indeed, a 2011 report from the Association of American Osteopathic Colleges demonstrated that a medical school achieves a positive margin when it does not have to support basic or translational research or a research-oriented clinical program. There is the very real threat that at a time of decreased NIH funding, some medical schools and/or their parent universities will meet their budgetary goals by decreasing their support for medical research, shrinking the size of the medical school faculty and divesting their research-oriented hospitals."

The authors suggest several steps to ensure that the changes taking place in medical education do not have unintended consequences.

These include objective evaluation of these new models by academic organizations and regulatory bodies; a commitment from universities to bear the significant cost of maintaining basic science faculty members and a quality medical education; public education about the value inherent in a scientifically based education; and enhanced support from the NIH for new physician-scientists in order to ensure that there will be an adequate supply of instructors and mentors to train the next generation of medical students.

"We need to continue to educate highly competent physicians and assiduously avoid the creation of a group of physicians who will be unable to apply the scientific advances of medicine for the benefit of their patients," the authors say.


Funding key to growth of medical education

Ilustration: Medical Education (source: invisioncam.com)The politics of establishing a second medical school shouldn’t impede efforts to ramp up medical education in Spokane this year. The University of Washington and Washington State University both agree that many more students are needed. The state can’t wait.

The Legislature passed a bill that allows WSU Spokane to seek accreditation for its medical school, and the governor signed it. However, that process will take time, and the first graduates of the new school won’t materialize for at least a decade. In the meantime, the Legislature shouldn’t back away from its commitment to the WWAMI program run by the University of Washington.

WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) wants funding for 60 students, up from the 40 now enrolled for each of the first two years. But the House and Senate budgets diverge dramatically in funding medical school slots.

Over the next biennium, the Senate budget allots $2.5 million to WSU to pursue accreditation and the same amount to the University of Washington. But as UW leaders note, that isn’t enough to fund the current 40-student load, let alone a desired increase. The university can’t simply shift the students over to Seattle. If medical education in Washington is going to expand, it’s going to expand in Spokane.

That’s heartening, and the House budgets $9.4 million for UW in Spokane, which would fund the 20-student increase for two years.

WWAMI’s goal is to reach 120 medical students in Spokane, but if the Senate proposal stands UW officials say the number of slots would actually decline.

Not to worry, say Senate leaders. The lowball amount is merely a prod to force the schools back into a relationship. This will all get worked out during final budget negotiations.

That’s somewhat encouraging, but if this attempt at marriage counseling fails, the state will still need the slots. The two schools initially talked about teaming up on a request to dramatically increase medical education funding, but that alliance broke apart when WSU decided to seek its own school.

UW officials told the editorial board recently that they don’t want to monopolize medical education, and they point out that they did not try to block the bill that allowed for a second school. They reiterated that Spokane is important to WWAMI’s future plans.

The need for more students, wherever they train, has been well-documented.

By 2030, the state will need 4,000 more doctors, including 1,700 in primary care. WWAMI rejects about 85 percent of Washington applicants. Twice as many Washingtonians study out of state than in-state. The paucity of slots, along with a shortage of post-graduate internships, makes it difficult for rural counties to draw physicians.

UW officials worry that a rivalry narrative will damage the overall cause of medical school expansion. Apple Cup partisanship is fine for football, but not medical education.

We agree, and hope lawmakers don’t use the “divorce” as an excuse to shortchange an urgent need.

source: spokesman

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