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Non-traditional Military Enlisted Students – Impacts to Medical School Cohorts
Althea Green, Ph.D.Command Sergeant Major, US Army (Retired)Assistant Professor, Military & Emergency Medicine
DISCLAIMER: I (and all immediate family members or partners) have NO financial or non-financial arrangement or affiliation with a commercial interest as defined by the ACCME.
Learning Objectives
• Understand the concept, design, and
implementation of the EMDP2
• Discuss the diversity outcomes of
the EMDP2
• Understand the lessons learned from
the EMDP2
• Discuss EMDP2 benefits to medical
school cohorts
Enlisted to Medical Degree Preparatory Program (EMDP2):
What is it?
• Partnership between the Uniformed Services University (USU) and the
Military Services to provide a new opportunity for highly-motivated,
academically promising enlisted service members to complete the
necessary coursework to qualify for medical school application
USU funds tuition and associated academic costs
Military services funds training billets
• Supports USU’s strategic objective to increase matriculation from the
enlisted force as a significant initiative for student diversity
• Service members PCS to USU and remain on active duty for duration
of program; commissioned after completion/medical school
acceptance
Solid Science & Humanistic Foundation
USUMentoring Program
(Medical Students, Physician Staff/Faculty)
*Cla
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*Pre
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visi
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Clin
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ad
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Embedded Service Values, Culture and Traditions
EMDP2 Program Outline
* Civilian Partner Institution
EMDP2 Selection Process
• Enlisted on Active Duty (open to Air Reserve
personnel) No restrictions on Military Occupational Specialty
• Baccalaureate degree from an accredited academic
institution 3.2 on a 4.0 scale
No restrictions on major or academic discipline
• Meet Service requirements for commission US citizen
Moral character
• Each Service has specific qualification
requirements
Selection Process
Military Service
• Determine eligibility criteria
• Determine application process
• Collect candidate packets
• Screen candidates
• Select best qualified
Uniformed Services University
• Conduct secondary screening
• Make final selections from among best qualified
• Selection begins with the candidate’s respective military service
• USU conducts final vetting
• Annual selection cycle
Program Outline
Year 1
Pre-Medical Post-baccalaureate Coursework
Medical College Admissions Test Preparation
Clinical Shadowing
Pre-health Advising
USU Mentoring
Summer –End of Year One
Pre-Medical Post-baccalaureate CourseworkMedical College Admissions Test
Apply to Medical Schools
Clinical Shadowing
Pre-health Advising
USU Mentoring
Year Two
Advanced Coursework
Clinical Shadowing
Pre-health Advising
USU Mentoring
Medical School Interviews
Curriculum (1st Year)• Fall Semester (12-16 credits)
BIOL 213 - Cell Structure and Function Credits: 4
CHEM 211 - General Chemistry Credits: 4
PHYS 243 - College Physics Credits: 3
PHYS 244 - College Physics Lab Credits: 1
MATH 105 – Pre-calculus Mathematics: 4 (depending on Math Placement Test score)
• Spring Semester (16 credits)
BIOL 311 - General Genetics Credits: 4
CHEM 212 - General Chemistry Credits: 4
PHYS 245 - College Physics Credits: 3
PHYS 246 - College Physics Lab Credits: 1
MATH 113 - Analytic Geometry and Calculus I Credits: 4
Medical College Admissions Test (MCAT) Prep Credits: 0
• Summer Session (10 credits)
CHEM 313 - Organic Chemistry Credits: 3
CHEM 314 - Organic Chemistry II Credits: 3
CHEM 315 - Organic Chemistry Lab I Credits: 2
CHEM 318 - Organic Chemistry Lab II Credits: 2
Curriculum (2nd Year)
• Fall Semester BIOL 508 Human Anatomy : 3
BIOL 691 Medical Biostatistics: 3
BIOL 516 Mammalian Neurobiology: 3
CHEM 563 Biochemistry: 4
• Spring Semester BMED 604 Human Physiology: 5
BIOL 506 Medical Microbiology: 3
BIOL 553 Advanced Topics in Immunology: 3
Total: 24 Credits• May take 6 additional credits for MS in Biology
Matriculations/Graduations/Medical School Acceptances
Year Matriculated Graduated Accepted USUHS
Cohort 1 2014 10 10 9
Cohort 2 2015 12 12 10
Cohort 3 2016 19 15 14
Cohort 4 2017 24 N/A N/A
Cohort 5 2018 23 N/A N/A
Total 88 37 33
Developing Diversity Outcomes
Compare diversity of EMDP2 students to two other groups of
medical students
Students attending F. SOM at USUHS
National sample of medical students (National Group)
Goal: To examine whether the EMDP2 Group
reflected a significant increase in the diversity of
medical students
Identify specific demographic categories
Identify nature of the differences
11
Study Sample/Data Collection
EMDP2 Group, N = 33 medical students
USUHS’ Admissions Data File
USUHS Group, N = 325 medical students
USUHS’ Admissions Data File
National Group, N = 13,868 medical students
Association of American Medical Colleges –
Matriculating Student Questionnaire
Public website
12
Organization of Data/Data Processing
Considerable differences in sample sizes (N=33, N=325,
and N=13,868) precluded direct comparisons of three
databases in their original form
Two-step process used to generate modified samples of N = 33
Calculated proportions of students per level of each
demographic variable for each sample
Demographic variables: ethnicity, age, marital status,
number of dependents (children), and socio-economic (SES)
background
Demographic variables collapsed into dichotomies
13
Data Processing
14
EMDP2 Group USUHS Group National Group
Gender
Male 26 18 16
Female 7 15 17
Ethnicity
Non-URM 25 27 28
URM 8 6 5
Age Category
20-25 Years Old 0 20 27
26-28+ Years Old 33 13 6
Marital Status
Married 28 7 3
Single 5 26 30
Number of Dependents
0 Dependents 11 30 30
1+ Dependents 22 3 3
SES Background
Less than $49,999 17 6 5
$50,000-$200,000+ 16 27 28
Data entered into SPSS
Analysis
2x2 Chi-square tests of independence (X2) examined type of
medical student and demographic variable by comparing
expected to observed frequencies
H0 : There is no systematic association between medical student
group and [demographic variable]. Type of medical student and
[demographic variable] are independent.
Adjusted residuals ± 1.96 revealed statistically significant O-E
pairs
Effect size from Φ correlations
Significance set at alpha = .050
15
0
5
10
15
20
25
30
URMS NON-URMS
EthnicityNE University
PBPM Group
16
RQ2: Ethnicity in EMDP2 vs USUHS
No systematic association,
X2(1, 66) = 0.09, p = .763;
null retained
Effect of medical student
group on ethnicity small
and non-significant, Φ = -
.07, p = .547
0
5
10
15
20
25
30
35
20-25 YEARS OLD 26+ YEARS OLD
AgeNE University Group
PBPM Group
17
RQ4: Age in EMDP2 vs USUHS
Statistically significant
association, X2(1, 66) = 25.90,
p < .001; null rejected
Effect of medical student
group on age large and
significant, Φ = .66, p < .001
0
5
10
15
20
25
30
MARRIED SINGLE
Marital StatusNE University
PBPM Group
18
RQ4: Marital Status in EMDP2 vs USUHS
Statistically significant
association, X2(1, 66) = 24.33,
p < .001; null rejected
Effect of medical student
group on marital status large
and statistically significant, Φ
= .64, p < .001
0
5
10
15
20
25
30
35
0 DEPENDENTS 1+ DEPENDENTS
DependencyNE University
PBPM Group
19
RQ4: Dependency in EMDP2 vs USUHS
Statistically significant
association, X2(1, 66) = 20.86,
p < .001; null rejected
Effect of medical student
group on dependency very
large and statistically
significant, Φ = .59, p < .001
0
5
10
15
20
25
30
INCOME < $50,000 INCOME $50,000+
SES Background NE University Group
PBPM Group
20
RQ5: SES Background in USUHS vs USUHS
Statistically significant
association, X2(1, 66) = 25.90,
p < .001; null rejected
Effect of medical student
group on age large and
significant, Φ = .66, p < .001
0
5
10
15
20
25
30
URMS NON-URMS
Ethnicity National Group
PBPM Group
21
No systematic association, X2(1, 66) = 0.86, p = .350; null retained
Effect of medical student group on ethnicity small and non-significant, Φ = -.11, p = .350
RQ1: Ethnicity in EMDP2 vs National
0
5
10
15
20
25
30
35
20-25 YEARS OLD 26+ YEARS OLD
AgeNational
PBPM Group
22
RQ3: Age in EMDP2 vs National
Statistically significant
association, X2(1, 66) = 42.37,
p < .001; null rejected
Effect of medical student
group on age very large and
significant, Φ = .88, p < .001
0
5
10
15
20
25
30
35
MARRIED SINGLE
Marital StatusNational Group
PBPM Group
23
RQ3: Marital Status in EMDP2 vs National
Statistically significant
association, X2(1, 66) = 35.04,
p < .001; null rejected
Effect of medical student
group on marital status very
large and significant, Φ = .76, p
< .001
0
5
10
15
20
25
30
35
0 DEPENDENTS 1+ DEPENDENTS
DependencyNational Group
PBPM Group
24
RQ3: Dependency in EMDP2 vs National
Statistically significant
association, X2(1, 66) = 35.04,
p < .001; null rejected
Effect of medical student
group on marital status very
large and significant, Φ = .76, p
< .001
0
5
10
15
20
25
30
INCOME < $50,000 INCOME $50,000+
SES BackgroundNational Group
PBPM Group
25
RQ5: SES Background in USUHS vs National
Statistically significant
association, X2(1, 66) = 8.25,
p = .004; null rejected
Effect of SES background on
medical student group
moderate and statistically
significant, Φ = .39, p = .002
Summary
26
Overarching question: Does the Post-Baccalaureate Premedical
Program for military enlisted students at the Northeast United
States medical school increase diversity in medical school cohorts?
Answer: Yes
Military (EMDP2 Group) students were older, married, had
dependents, and more of them grew up in households in which
annual income was less than $50,000 compared to the USUHS
Group and the National Group students.
Military (EMDP2 Group) did not differ from the USUHS Group and
National Group in ethnic diversity and therefore did not increase
diversity in that variable.
Lessons Learned
27
Racial/Ethnic Demographics
Results consistent with previous studies that show the medical school
population lacks racial and ethnic diversity.
Support previous findings that medical school programs use mission-driven
goals to develop plans to recruit a diverse student body (Addams et al.,
2010).
Support defining diversity measures based on organizations’ missions - not
simply by race and ethnicity (Betancourt et al., 2013; Figueroa, 2014),
Harris et al., 2012).
Lessons Learned
28
Age, marital status, and dependency
Entire EMDP2 Group was at least 26 years old, almost all married with
children.
Almost all USUHS and National Group were > 26, and single with no children.
Health school advisors recommend students wait at least a year after finishing
undergraduate work before medical school.
Use time to experience life, and develop interpersonal and scientific skills.
EMDP2 Group did not fit national norms; this is an advantage.
Could all claim at least 3 years of life experience outside of school.
Diverse military and life experiences often enhance their medical school
applications.
Lessons Learned
29
Socioeconomic status
Over half of the EMDP2 Group students came from low-income families.
Nationally, over two-thirds of medical school matriculants came from
families in the top income quartile.
Leaky pipeline loses many disadvantaged aspiring medical students.
Programs specifically designed to provide opportunities for students from
disadvantaged backgrounds can yield success.
Results reinforce Meroe’s (2012) assertion that meritocracy in American
education is an ideal not yet realized.
30
Student support leads to student persistence (Tinto, 1986, 1993).
Economic: USUHS funds all academic costs; students continue to receive all
military pay and benefits.
Organizational: Each group (≤ 25) of EMDP2 students are in an exclusive
cohort; with dedicated faculty, tutors, and administrators; military unit
provides oversight, leadership, and administrative support.
Psychological: Every candidate volunteers, then undergoes a rigorous
screening and selection process.
Sociological: Military team culture, family support network, and integrated
mentoring.
Lessons Learned
Benefits to Medical School Cohorts
31
Educational leaders who are seeking to recruit a diverse medical student
body.
Not limit diversity to simply race and ethnicity.
Recruit from within a desirable population.
Military students inculcated and trained on a values-based foundation.
Develops the character, commitment, and competence of a soldier, sailor,
airman, or marine.
Instills the discipline that leads service members to think and act in ways that are
congruent with the values of their respective service.
Diverse, yet linked by their culture and ethos of military service.
Enlisted members a desirable population from which to recruit medical
students.
Benefits to Medical School Cohorts
32
Traditional medical students are young and single
Over 80% are ≤ 25 years old; almost all are single.
Can suffer from high levels of stress, depression, burnout, and low life-satisfaction.
Issues can lead to poor academic performance and become part of a vicious circle,
including developing similar problems as physicians.
Military culture has a strong focus on fitness, to include psychological fitness
and resilience.
Military learners may have greater self-discipline, leadership abilities, time-
management skills, maturity and focus because of military training and experiences.
Attributes often engrained through military socialization; can mitigate some of
inherent challenges of medical school.
Benefits to Medical School Cohorts
33
Blend of traditional and non-traditional aged, and married
students in the same classroom. Older, married students tend to bring a measure of maturity and steadiness to
the student body.
As the occasion permits, educational leaders should take advantage of the
experience these students bring, especially during group exercises.
Make efforts to assign more experienced students as peer mentors
based on their interests and abilities.
34
Almost half of EMDP2 students raised in low-income families.
Over two-thirds of medical students nationally came from families
earning six-figure incomes.
Educational leaders develop and implement pipeline programs to increase
opportunities for economically disadvantaged students.
Ensure medical school curriculum provides opportunities for students to
deal with issues of income inequality.
Role-playing exercises and standardized patients challenge medical students to
interact with patients from different socioeconomic backgrounds.
Provide training venues to discuss stereotypes, concerns, and mitigating
strategies.
35
Lack of racial and ethnic diversity in medical school classrooms
remains a challenge.
Educational leaders as well as those of the military services review
recruiting strategies to determine where changes are needed to impact
candidate pool.
Educational leaders ensure curriculum encompasses situations that
challenge medical students to examine their own biases and how those
might impact their attitudes toward patient-centered care.
Education programs must also train medical students on how to provide
culturally competent healthcare.
Benefits to Medical School Cohorts
Benefits to the Military Health System
• Supports retention of highly-qualified, experienced, often battle-tested
service members in support of military readiness needs
• Provides the services with a pool of high-quality future clinicians,
scholars and health care leaders
• Supports better care by contributing to a cadre of culturally competent
healthcare professionals
• Contributes to a capable medical workforce that is ready to deliver
health care anytime, anywhere, in support of the full range of military
operations
Web page: www.usuhs.edu/emdp2
Facebook: . https://www.facebook.com/USUEMDP2
Email: [email protected]
Information
Questions?
38
