chuckstaben CollegeAccess, Diversity, Uncategorized

4H College Pipeline and Diversity

  • Broadening the concept of the land grant university and its programs

4H was founded in 1902 to instruct rural youth in improved farming and homemaking practices.  In the 1960s and 1970s, 4H broadened its mission to serve urban youth and life experiences unrelated to agriculture that encourage positive youth development.  4H is housed in the Division of Youth and 4H in the National Institute of Food and Agriculture within the USDA. State programs have extensive ties to, and are usually administered by, extension offices at land grant universities. Can 4H programs serve universities as pipeline programs, especially for diverse or disadvantaged youth?

The University of Idaho initiated a college pipeline program oriented towards LatinX youth via an internal mechanism, but has realized the value of associating that program with 4H in a way that may benefit other college pipeline programs. Perhaps a more intentional approach to using 4H to enhance college-going and youth development, on either a state or national basis, could address today’s college educated workforce and social mobility challenges.

The most extensive recent study of 4H’s effects on youth is that of Lerner and colleagues. The study clearly demonstrates many positive youth outcomes of 4H participation, including higher rates of academic achievement as well as lower frequency of negative behavior, but the study does not directly address college going outcomes and diversity issues.  

Finding national participation rate data for 4H programs proved challenging (and my queries were never answered by the USDA 4H office), but the Lerner study included survey data of this sort.  Comparing the survey data to census data is a bit challenging as the data definitions and survey differed. Nevertheless, as one might expect, rural students are currently overrepresented in the sample; over 46% of respondents of known living environment were rural while only 14% of the US population is rural.  4H also has significant underrepresentation of Asian American, African American, and LatinX youth. Regionally, the Midwest is overrepresented and the South underrepresented. 4H also engages over 60% young women. College-going rates generally follow similar trends with some exceptions. LatinX and African American students are underrepresented in US colleges as they are in 4H; the Midwest has a generally high college attendance rate.

Idaho has one of the lowest per capita incomes in the nation and this is directly correlated with low educational attainment of the adult population. The state hopes to radically increase education attainment to support an emerging high technology economy. Idaho has one of the lowest rates of college attendance in the nation. That rate is particularly low among its LatinX and rural populations (which overlap significantly).  In fact, Idaho has the lowest postsecondary attainment of any LatinX population, only 10.7% of LatinX adults in Idaho hold a postsecondary degree.

As a model program, the University’s Latino Advisory Council and Office of Equity and Diversity in 2017 developed a deep engagement model in which programs were embedded in a rural, heavily Latino high school in Jerome, Idaho.  The program engaged 8th grade students and their families, and was named by the families “Caminos al Futuro.” This Road to the Future already seems to have changed student perception of career options and brought the students experiences well beyond those offered by the school, but, nonetheless, a challenge emerged concerning the sustainability of the program..

Our Extension Office stepped forward to write a USDA CYFAR grant that will allow us to not only sustain the program but to double it in size. In addition to this support, the engagement with Extension opened our eyes to the Youth Development Curriculum already developed by 4H, Juntos.  Juntos programs are operating across the country; I note that Oregon State University’s program engages over 30,000 students. The success of the first grant encouraged us to successfully apply for a second, allowing another program doubling. Additionally, students and some family members from Caminos participated in the on-campus summer meeting program; again opening eyes to new possibilities and engaging students and families in seeing the potential of college-going in general, and especially at the state’s land grant, research university.

How can 4H be leveraged even farther?  The cultural relevancy of materials and programs must be increased.  To address the cultural gaps, materials should be available in Spanish, for example, so that families who may be less bilingual than the students understand the value and nature of the programs.  Volunteers play an important role in 4H; 4H alumni are a rich source of volunteers. Bicultural volunteers must be recruited, many of whom may not have traditionally participated in 4H themselves (4H alumni are the richest current source of volunteers).  Addressing the gender gap in 4H participation may also require a much broader approach to activities and intentional engagement of male students and volunteers.

The 4H and Extension programs of our universities have extensive infrastructure and capacity to address some of the central issues facing postsecondary education in rural and other communities.  Just as land grant universities helped the United States economic transformation to an industrial society and a world leader in agricultural productivity, we can use this same system to ensure that our underserved communities are not left behind in the knowledge economy.

chuckstaben CollegeAccess, Higher Education Policy, Uncategorized

Medical School Application

Let’s level the field!

Medical schools have made great efforts and important strides in becoming more inclusive.  Nevertheless, the physician workforce of the United States does not yet reflect the racial/ethnic composition of our country.  Many factors undoubtedly contribute to the underrepresentation of black, Hispanic, and American Indian physicians.  Ethnic underrepresentation may in part be a proxy for low income status; ethnicity, income, and parental education all correlate in the US.  A recent “Analysis in Brief” by the AAMC shows that 3/4 of all medical school matriculates come from the top two household-income quintiles and that this distribution has been unchanged for 3 decades.  As income stratifies even more in the US and our population becomes more diverse, we must consider approaches beyond those employed and contemplated in the last 30 years.

As medical schools consider how to increase representation, they may partially have overlooked the process and expense involved in the application and matriculation to medical school.   In addition to discouraging successful application to medical school by low income students, an expensive or unclear process may especially discourage lower income students from seeking placement at very selective medical schools, leading to what is termed “undermatching” in undergraduate education.

There are simple steps that universities preparing medical students and medical schools themselves could take that could address some of this unintended financial bias.  My perspective on this issue arises from years as a Biology faculty member, advising hundreds of premedical students, as a university leader, and as the father of 3 recent (successful) applicants to medical school.  Let’s examine the application process stepwise to identify potential improvements.  I will focus on the schools that use the AMCAS application system, the majority of US medical schools.

              According to AAMC (https://www.aamc.org/data/facts/applicantmatriculant/) data, non-white applicants and matriculants to US medical schools have lower GPAs and lower MCAT scores than white (and generally wealthier)  applicants.  A large percentage of wealthier students are using MCAT prep services, financially inaccessible to lower income families.  Universities should consider whether test preparation is something that they should do at reduced cost in a more extensive and intentional way.  Additionally, if such courses were offered for credit within a degree program, financial aid could be applicable.  Test prep materials could be a target of OER (open educational resource) development, as well.  The financial playing field may never be level, but it need not be quite so steep a hill.

              The MCAT test itself costs $315 for a single administration, but the AMCAS Fee Assistance program reduces that and the costs of application significantly.  To qualify for Fee Assistance, a family of 4 in the contiguous US would need an income below $73,800; fortunately many applicants would be eligible for this assistance as it aligns with the upper end of the third economic quintile.  In such cases, cost is reduced to $125 and students receive access to preparation materials and other support.

The cost of application can also be a barrier.  Again, the Fee Assistance program is a major help.

AMCAS supports free application in the case of need for up to 20 medical schools, a $930 value.  AMCAS estimates that 15 is the average number of schools to which students apply, so Fee Assistance provides good support for the average student.  But, applicants are applying to many more schools if they hope for a selective placement, often 30 or more.  An application costs about $100 for each school…so a marginal cost of $1000 would be a big bite for low income families, many of whom have an EFC (Expected Family Contribution) of $0 per year.  AMCAS and schools could support more applications, or free applications, for low income students or perhaps offer more free applications to applicants with higher GPA or MCAT scores that might be more competitive at selective schools.  Additionally, medical school application costs could become eligible for aid or loans from the federal government.

The next step in medical school application is secondary screening.  Typically, medical schools charge $0-200 to submit a secondary application that provide some supplementary information about the student.  A common charge would be $75.  Surprisingly, few medical schools screen primary applicants very stringently before collecting secondary applications.  Therefore, most students must pay the secondary to have their application considered in any detail.  Though many schools will waive the secondary fees for those who qualify for Fee Assistance, this could be a barrier, particularly if seeking a selective placement.  Medical schools could simply be more selective based on primary applications, or consider adding the information they feel they need from secondary applications to the standard AMCAS primary application to eliminate this step and associated charges.

Our student has now reached the most exciting and potentially most expensive stage of the process:  the interview.  Students generally get short notice of interviews, meaning they must schedule travel immediately, often expensively.  Though many students will interview and attend in-state medical schools that pose lower travel costs, some students-perhaps especially those seeking placement in very selective schools- will need to travel.  Many schools support the visit by offering that students can stay with a host student, but airfare, hotel and meals could be prohibitive for many students.  Interviews would be more convenient and much less expensive if conducted as video interviews.  This stage could probably replace the evaluative portion of the interview, though a visit for an admitted student who is choosing placement is likely to remain valuable to the applicant.

If the process continues with in-person interviews, a problem for some students  is the expected dress-suit and tie for men and women’s business suit.  Though professional appearance is important, cost could readily be reduced by asking that everyone dress in a business casual fashion (such as khakis and a polo).

Some aspects of the application and interview process could incorporate real or implicit biases based partly in applicant financial situation.  For example, many essays and applications ask for medically-relevant experiences like volunteering.  Many lower income students work while enrolled and do not have the luxury of volunteer time.  Some students lack the health insurance or personal contacts that have become more important in securing shadowing experiences to demonstrate a motivation for medicine.  Essays on applications often speak to experiences like a parent being a physician, a sibling… a preference for which could perpetuate the profession from “legacies” rather than drawing our new physicians from the general population of intellectually and emotionally qualified students.  Many lower income, first-generation families and their students are simply daunted by processes unfamiliar to them, such as college application or completion of FAFSA forms, that are central to success for lower income students.

Liz Bryant, the University of Idaho’s Premedical Advisor directed me to a more personal perspective.  Liz was immediately familiar with each of these difficulties and said that numerous students contacted her each year for advice and help.  I spoke with Megan Schlusser, a recent University of Idaho student, Pell Grant eligible, who will matriculate into our WWAMI program in summer 2019.  Megan is a first generation student, who received fee assistance.  Megan enrolled in a $900 MCAT prep course; multiple family members chipped in to make this happen.  Fee assistance enabled her to apply to the 10 medical schools she felt would offer her the best chance of acceptance.  Megan received multiple interviews, but travel was a very difficult barrier for her.  She laughed when I asked about a business suit-saying she is the first in her family to own one, and that she had to ask Liz what to buy and where to shop.  Megan felt very conscious of clothing and status on her interviews.  And, like many students, Megan worked throughout college and had limited time to shadow or volunteer.  Fortunately, she landed a job as a medical scribe in her senior year.  As our conversation evolved, Megan had clearly just accepted these difficulties and surmounted them, not considering how barriers could be lowered.  But, as we discussed alternatives, such as video interviews or business casual dress, she quickly realized that the world does not have to accommodate the wealthy at the expense of the poor.  Megan, of course, is a lucky and plucky survivor, but how many other students don’t succeed or persist?

Medical schools, prospective medical students, and the public of the United States share the goal of ensuring access to the medical profession for the best doctors.  Let’s examine each step of that pathway to ensure success depends on those qualifications rather than the financial resources of the applicants.