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    Pre-Premed: Pipeline Efforts Steer Elementary School Students Into Medicine

    Children as young as six are being encouraged to consider medical school. Learn why getting kids interested early could help medically underserved communities in the future.

    elementary school students
    The Junior STEM Academy held by the University of Arkansas for Medical Sciences (UAMS) introduces elementary school students to professions in the health care field.
    UAMS Center for Diversity Affairs

    The student is told that the patient can't breathe. He must insert the laryngoscope into the patient’s mouth and slide the plastic tube past the vocal cords and into the trachea. His peers are watching, the clock is ticking, and he’s feeling pretty anxious.

    But it’s really fine after all, because the student is only in fifth grade and the patient is a mannequin at a Dell Medical School Health Sciences Summer Camp in Austin, Tex.

    Across the country, children as young as six are participating in programs—often called pipeline efforts—designed to inspire and prepare them for health care professions. Without such programs, experts say, students from underrepresented and low-income communities often lack the role models to spark dreams of such careers and the robust education, resources, and mentoring necessary to achieve them. In 2016, for example, blacks or African Americans represented 7.1% of medical school matriculants, and Hispanics or Latinos totaled 6.3%, according to a recent AAMC Analysis in Brief.

    “Interventions that start in high school and college are still important, but if we wait until then, unfortunately, we have already lost some students.”

    Norma Poll-Hunter, PhD
    AAMC senior director of Human Capital Initiatives

    And while intended to help individual children meet their potential, these pipeline programs also aim to fill wide gaps in medically underserved communities. Practitioners who come from racial and ethnic minority backgrounds are more likely to choose to work in underserved communities, studies show. Research also suggests that, without intervention in elementary school, underrepresented students may lose interest in science and math by their teens and discount their abilities in those subjects before finishing high school.

    “There’s a greater awareness that if we are going to really increase the pool of diverse talent in medicine, we need to start young,” says Norma Poll-Hunter, PhD, AAMC senior director of Human Capital Initiatives. “The foundations of math and science are built early in elementary school. Also, some research shows that children from disadvantaged communities start to foreclose their career choices as young as first grade.”

    “Interventions that start in high school and college are still important,” Poll-Hunter says, “but if we wait until then, unfortunately, we have already lost some students.”

    Bridging science gaps

    Cooper Medical School of Rowan University in Camden, N.J., had a pipeline program even before it had medical students.

    “Part of our mission as an institution from the start was to make sure that the children in this city could one day realize becoming a physician themselves [and] to create physicians who can meet the needs of this city and others like it,” explains Jocelyn Mitchell-Williams, MD, PhD, Cooper associate dean for diversity and community affairs. In Camden, she says, the population is approximately 95% African American and Latino, and schools are often hamstrung by tight budgets.

    Cooper provides some support to younger students—a visit to the medical school for third graders designed to demystify the institution, for example—but its main pipeline focus is fifth graders at two local schools who had been receiving minimal science education, says Mitchell-Williams.

    Students listening to presentation
    Malika Fair, MD, AAMC senior director of health equity partnerships and programs, and Sherese Johnson, lead specialist for public health initiatives, discuss health careers with Kelly Miller Middle School students in Washington, D.C.

    Now, thanks to medical school students who teach hourly lessons each week, youngsters apply the scientific method, get up close and personal with human brains, and participate in an array of experiments. In one class, for example, they drew their vision of hearts on their instructors’ T-shirts, then compared their renditions against the actual organ viewed on an ultrasound machine.

    Such hands-on experiences are among the components of an effective program, according to a 2012 review. Other recommendations include being attuned to students’ cultural backgrounds and emphasizing the connection between science and everyday life.

    Cooper leaders also hope to bolster a sense of possibility for students. “This program helps dismantle some preconceived beliefs,” notes Luke Stanice, a Cooper student who has helped run the program. “We’ve had kids say to us, ‘I’d love to be a doctor,’” but fear they can’t do it. “We want to reinforce that … you absolutely could be a doctor, that we’ve had students in our school from your exact situation.”

    Creating Native scientists

    In Minnesota, nearly 40% of Native American fifth graders did not meet state science standards in 2016, compared with 9.5% of white fifth graders, according to state data. Added to that, Native Americans can expect to live 11 fewer years than whites in the state, says Anna Wirta-Kosobuski, PhD, an assistant professor of biomedical sciences at the University of Minnesota Medical School, Duluth campus (UMMSD).

    “We so desperately need our Native kids to graduate,” Wirta-Kosobuski adds. “We need our kids to be able to [pursue health careers to] take care of our own people, and that’s just not happening enough.”

    This past year, Wirta-Kosobuski’s department created a science program for K–6 schools at two reservations where students previously had insufficient science instruction and few opportunities for enrichment.

    “These communities are very geographically isolated,” explains Wirta-Kosobuski. “To participate in an enrichment program, students would need to go to another location, and in a lot of cases that just isn’t possible.”

    The Community-based Science Program takes multifold approaches, including lessons in nearby woods, content added to existing classes, visits from medical school faculty, and elements from Native culture. And the program recently added a remote component: “lab partners” at the elementary schools and on the Duluth campus can now see each other while working on shared experiments.

    Program leaders hope that some of the Native youngsters will ultimately wind up at a research bench. “Researchers tend to research topics that are of interest to them,” says Wirta-Kosobuski. “With a homogeneous research workforce, the issues concerning Native people … are not addressed enough.”

    Wirta-Kosobuski also hopes she’ll be able to procure sufficient grant money to continue the program beyond next year. Funding issues affect other pipeline programs as well.

    “Over the past 10 years, from my observation, the number of elementary and middle school pipeline programs have not been growing to meet the undeniable need,” says Lynne Holden, MD, president of Mentoring in Medicine. “One of the main issues is funding. The timeline to reach a measurable outcome—an educational milestone, for example—can be long,” she says. “Many funders want to see an impact in a shorter time frame.”

    Programs have gathered some data on intermediate outcomes. At the Dell Med  program, for example, pre- and posttests of content taught at the camp showed a 105% increase in biology knowledge for students, reports Reginald Baptiste, MD, Dell Medical School director of prehealth professions. And 65% of middle school participants said they were more likely to pursue a health science career. Such results are particularly exciting, says Baptiste, given that nearly half of the participants have parents who did not graduate from college.

    Wirta-Kosobuski also reports positive—albeit anecdotal—results. After a recent program at the UMMSD campus, for example, one young participant wrote: “I decided I want to go there. I want to learn more about science. I want to come right now!”

    Community connections

    At the Junior STEM Academy in Little Rock, youngsters don white coats at the University of Arkansas for Medical Sciences (UAMS) for a two-week camp that covers biology, chemistry, physics, and more. The students—broken into groups of kindergarteners through third graders and fourth through sixth graders—may hear guest lectures from a neonatologist or a psychiatrist, but instruction generally takes a problem-solving approach.

    Students have had to figure out how to build a cardboard “heart” with valves that allow “blood” (represented by marbles) to flow in only one direction, for example. And they’ve had to do so as part of a team. Camp leaders want participants to learn to collaborate and support each other, explains Amber N. Booth, UAMS senior diversity specialist.

    They also want the youngsters to know that adults are available to provide support.

    “We want them to see that there is a network that can mentor them and connect them to resources in the community,” Booth notes.

    And ultimately, she says, the program hopes to instill in participants a sense of responsibility to their communities and a connection to Arkansas. This summer, for example, students made get well cards for hospitalized children and sent thank you notes to veterans.

    “We want participants to think about their futures,” says Booth, “but we also want them to start thinking about other people as well.”