Aspiring physicians program: description and characterization of the support processes for an undergraduate pathway program to medicine

Figures & data

Table 1. APP pillars, components within that pillar, description of each component, and the literature and evidence utilized in the design and/or implementation of each component. UCSF.

Component of Pillar	Description of Component	Literature and Evidence Utilized to Design and/or Implement Component (If Relevant)
Program Pillar: Medical School Preparation
Medical school readiness	This component builds students’ knowledge about the medical school application process, provides information about resources and on creating a competitive application, and mock interviews with feedback.	Hadinger MA. Underrepresented Minorities in Medical School Admissions: A Qualitative Study. Teach Learn Med. 2017;29(1):31–41.
Structure of medical training	APP educates students about the format of medical training starting with pre-clinical years and into residency with the aim of preparing students for what to expect and how to work through the implicit rules of medical education to succeed.	Billett S. Learning in the Workplace: Strategies for Effective Practice. Allen and Unwin; 200127.Hafferty FW. Academic Medicine and Medical an Evolving Field of Educational Scholarship. Academic Medicine. 2018;93(4):532–536.
Preparation for the MCAT	Building on evidence supporting the effectiveness of near peer teaching, MCAT preparation takes place with near-peer facilitators (students with teaching experience and successful MCAT performance).	Chou CL, Teherani A. A foundation for vital academic and social support in Clerkships: Learning through peer continuity. Academic Medicine. 2017;92(7).
Career exploration	Students learn about varied career choices by engaging with guest speakers, including introduction to academic medicine.
Customizing a personal pathway to medical school	APP informs students about the multiple pathways into medical school often informed by personal choices, financial and psychosocial constraints, family needs, and other cultural factors.
Program Pillar: Personal and Professional Development
Articulation of the personal narrative	These sessions increase students’ abilities to articulate (for the medical school application) their lived experiences and contributions through an asset-based lens.	O’Connor C. 2019 Wallace Foundation Distinguished Lecture: Education Research and the Disruption of Racialized Distortions: Establishing a Wide-Angle View. Educational Researcher. 2020;49(7):470–481
Underscoring the importance of mentorship	Considering decades-long research showing the importance of mentorship to UIM student success, APP addresses what a successful mentoring relationship is and how to engage mentors. Students are matched with a program mentor.	Farkas AH, Allenbaugh J, Bonifacino E, Turner R, Corbelli JA. Mentorship of US Medical Students: a Systematic Review. J Gen Intern Med. 2019;34(11):2602–2609 Harris TM, Lee CN. Advocate-mentoring: a communicative response to diversity in higher education. Commun Educ. 2019;68(1):103–113
Recognition of sociocultural barriers in the professional environment	These sessions, grounded in the evidence on UIM learner experiences, equip students with the tools necessary to identify structural and non-structural barriers to success and provide tools for overcoming barriers. These sessions address topics such as overcoming stereotype threat, imposter syndrome, and unconscious bias, and working through microaggressions.	Odom KL, Roberts LM, Johnson RL, Cooper LA. Exploring Obstacles to and Opportunities for Professional Success Among Ethnic Minority Medical Students. Academic Medicine. 2007;82(2):146–153 Orom H, Semalulu T, Underwood W. The social and learning environments experienced by underrepresented minority medical students: A narrative review. Academic Medicine. 2013;88(11):1765–1777 Bullock JL, Lockspeiser TM, del Pino-Jones A, Richards R, Teherani A, Hauer KE. They don’t see a lot of people my color: a mixed-methods study of racial/ethnic stereotype threat among medical students on core clerkships. Academic Medicine. 2020; 95 (11), S58–66. Sukhera J, Gonzalez C, Watling CJ. Implicit Bias in Health Professions:From Recognition to Transformation. Academic Medicine. 2020;95(5):717–723
Importance of self-care	In response to heightened awareness of physician burnout APP prepares students to meet the challenges of future medical education and provide them with effective stress management tools.	Thomas LR, Ripp JA, West CP. Charter on Physician well-being. JAMA – Journal of the American Medical Association. 2018;319(15):1541–1542.
Leadership Development	As leadership training is key to the success of underrepresented learners, a key component of APP is to empower students to see themselves as leaders within their communities.	Leblanc C, Sonnenberg LK, King S, Busari J. Medical education leadership: from diversity to inclusivity. GMS J Med Educ. 2020; 37(2):Doc18
Program Pillar: Health Policy and Advocacy
Fundamentals of public health and health policy	Students are introduced to foundational public health concepts including health disparities, social determinants of health, population health data measurements, and health disparities.	Dawes DE. Perspective: The future of health equity in America: Addressing the multiple, intersecting determinants of health. Ethn Dis. 2019; 29:343–344
Policy advocacy	Sessions provide an overview of health policy development, data collection and needs assessments, policy communication, and advocacy. Adapted from an existing learning approach students engage with a writing activity and mock debate on the topic of universal healthcare.	Hubinette M, Dobson S, Scott I, Sherbino J. Health advocacy*. Med Teach. 2017;39(2):128–135 Payán DD. Cultivating Health Policy Analysis and Communication Skills in Undergraduate Public Health Education: An Active Learning Approach. Pedagogy Health Promot. 2021;7(3):235–241
Policy fact sheets	Students learn about community engagement, meet with community-based organizations (CBOs), and learn how to create a policy fact sheet using the key principles for policy fact sheet development. To date, more than half of CBOs report using these factsheets for their organizations.	American Public Health Association. Fact Sheets. American Public Health Association
Empowerment and community advocacy	Students are taught to recognize their role as community advocates and envision ways to make a difference even prior to starting their careers as physicians.

Table 2. Student participant focus group guide utilized for data collection about the program components of the APP between 2019 and 2022.

Focus Group Questions and Probes
To start us off, briefly, reflect back on your experiences during the APP. Tell us more about your overall experience.
(2) Could you describe the key lessons you learned about health professions careers/medicine during your time in APP? About other careers? Any other key lessons learned during your time in APP?
(3) Did the program make you aware of how to become a successful pre-medical student and medical student applicant? Please elaborate.
(4) How would you describe your interest in medicine prior to participating in the program? (a) Probe: How would you describe your interest in health professions/medicine after participating in the program?
(5) How would you describe your understanding and interest in health policy and working with communities prior to participating in the APP? (a) Probe: Did participation in the program impact your interest in health policy? Working with communities? If so, please describe how? How do you see being involved health policy efforts moving forward? (b) Probe: In the future, will you engage in health policy efforts relating to the topic/in the area you worked on during the program? Communities? Why or why not?
(6) Let’s focus now on the activities (e.g., workshops, mentoring, project work, group meeting, fact sheet development, provided to you as part of program. Overall, how valuable were those activities to your learning? You may discuss individual activities or activities a whole. (a) Probe: Were there activities that were more or less helpful and why?
(7) How would you describe your interest in a career in medicine after participating in the program? (a) Probe: Did participation in the program impact your interest in medicine? If so, how? Please describe. (b) Probe: Which program activities do you think were most important in impacting your career decisions?
(8) Is there anything about the program that we have not asked about that you think is important to know?

Table 3. Demographic characteristics of student participants in the APP at the UCSF between 2019 and 2022 (N = 81).

	APP N=81
	Race/ethnicity				Gender			Undergraduate Institution
Year	Latinx N (%)	African American N (%)	Bi-Racial N (%)	Other UIM N (%)	Female N (%)	Male N (%)	Nonbinary N (%)	California State University, Fresno N (%)	California State University, San Francisco N (%)	University of California, Merced N (%)
2022	16 (19.8)	2 (2.5)	2 (2.5)	1 (1.2)	15 (18.5)	6 (7.4)	0	10 (12.4)	10 (12.4)	1 (1.2)
2021	18 (22.2)	1 (1.2)	1^a (1.2)	0	16 (19.8)	4 (5)	0	8 (9.9)	10 (12.4)	2 (2.5)
2020	18 (22.2)	0	0	2 (2.5)	14 (17.3)	5 (6.2)	1 (1.2)	9 (11.1)	10 (12.4)	1 (1.2)
2019	16 (19.8)	2 (2.5)	0	2 (2.5)	14 (17.3)	6 (7.4)	0	9 (11.1)	11 (13.5)	0
All years	68 (84)	5 (6.2)	3 (3.7)	5 (6.2)	59 (72.8)	21 (25.9)	1 (1.2)	36 (44.4)	41 (50.6)	4 (5)

^aLatinx and African American.

Table 4. Themes and quotes by theme characterizing supportive processes of the APP pillars described by participating students in four focus groups between 2019 through 2022.

Theme	Quote (participant focus group year)
Medical School Preparation	The MCAT prep was the bread and butter for me. As an aspiring physician … going to medical school, there is a standardized test that you have to do well on in order to get in. That was … the highlight of the program … Because … if you don’t … get how to do it, then that cannot serve you best” (2019) We should do more MCAT prep exercises because those are really hard and you need to practice … instead of just an hour, maybe two … we need to practice and practice for the MCAT. So … more time for that will be better. (2021) I would definitely love to see more clinical skills demonstrated and practiced … and … being able to possibly check out some … clinics … that we are affiliated with … would be a welcome addition to the program.” (2019) The program should implement more … problem-based learning because … that was very helpful … on how to help future patients as well as more like suturing or like more hands-on activities like anatomy, physiology because we learn more from those activities I believe as future doctors.” (2021) Something that I really enjoy about the program is that it … reemphasizes the idea that you could be a physician but … you can also be a policy maker … an educator. You can wear different hats … that’s something … I really enjoyed hearing and learning about because … to revolutionize healthcare, we do have to take a different approach … So, the program reenergizing the idea that that’s possible was really refreshing.” (2019) Knowing … what else I can do. Hearing about I can get a Masters. I could take a stop in med school or follow some other degree I want … It definitely changed my perspective [of] … you just have to solely be in medicine … there’s … other aspects you could pick up … like a post-bac and stuff like that to solidify.” (2021) I know the focus was physicians, but there was a sprinkle of just different career opportunities; PhD research and health policy and things like that within healthcare.(2022)
Personal and Professional Development	… had a lot of self-reflecting … There were a lot of exercises that … had us look back on our experiences or on ourselves as a person … and that was … very helpful to understand who you are and build yourself up from there. (2019) My experience … has been really positive overall. I feel like we worked a lot on personal development and being able to tell our story and represent ourselves, our identity when we’re applying for medical school, and have that safe space to be able to talk to the different teachers and mentors about our story. (2020) How helpful and impactful it is for me to have been able to interact with some Black doctors because … I’ve never had a Black doctor until I was 19 and I’m 20 now and I’ve only met one Black nurse and that’s my dad. So, like having the experience to speak with Black physicians and Black med students was so emotional for me, but also so powerful for me as well. (2021) Overall … the sense of community … in this program … it’s good to be surrounded by people of color that are also on the same path. It’s like, ‘Okay, we can all do this.’ We all uplifted each other. (2019) I hope that the program can continue to have more interactions between the San Francisco cohort and the Fresno cohort, because this is really great to be able to get to open up the experience toward a lot of people and get to hear other perspectives in other communities. (2020) I found very valuable the networking … I didn’t know that there’s so many people that want to help us into our journey into medical school. (2021) There’s definitely an emphasis on finding and building your networks. Every physician we talked to in the program emphasized how important it is to have those connections and networks, especially those of us who are first generation whose parents aren’t necessarily very affluent. We need those to get off the ground. (2022) Mentorship … that one hit really deep because before this I was … going through the motions by yourself and trying to figure it out. Because … I don’t really trust other people to help me but now I reach out to … people … [to] mentor me … because they know that we’re going to make an impact or we’re what’s needed in the future … So, it was really good. (2021) The microaggression, micro-affirmation block … was awesome. I had no real knowledge of that topic, let alone the ramifications that come with it … it kind of illuminated a lot of … examples in my own life that…I didn’t know what to call … [Dr T] gave perfect examples for us to follow … that to this day, I’m still moving forward with. I loved that. (2019)
Health Policy and Advocacy	We’re doing policy … I had no idea that that was going to be the focus … So, this program is really good in showing us how physicians have a voice that can reach congress, or the president, or our local board of supervisors. Especially as undergrads, we have a lot of power given the fact that this is an opportunity where we can reach up to those people. Those would be your congressmen, senators, whatever. (2019) I definitely want to make pushes to better help the community with a lot of the policies that physicians and people with that kind of status, power, wealth are able to make just in a day because it’s important. I feel like, especially for the XX community in a lot of the XX, the underserved community, definitely want to push for better healthcare access and options for everybody. I think I definitely want to pursue that in the future. (2022) Before [the program] I thought it was strictly like just medicine, you’re a doctor, that’s it … I’ve learned now that it’s medicine and also with advocacy, and really needing to know all the health policies, and how you play a role in changing them. (2020) Overall … I … took away that the health policy does intertwine with medicine. I thought they were completely separate … and … now … I get it … [and] understand why they are together and why people speak from public health officials. This course taught me that and I’m very grateful for that. (2021) The talk … today … was helpful to our policies, but … began at the government level and … state level where … I don’t think we would have been able to get our policy all the way up there. So … maybe implementing it … at the local level, community-wise where … we’re actually doing with our policies even at just a local level, and having … the same information … but in a … way that applies to what we can do and what we have the power to do. (2019) The content was a little … broad or general … trying to cover everything on surface level … I would rather we had focused in on a certain area that maybe pertain to what we could do as doctors or … with students or … learning how to create a policy ourselves … might have been … more useful for me because … I enjoyed going to class and the conversations but I didn’t feel really engaged in it. (2021) It was very broad … trying to teach … everything that goes on into making a policy and a bill, and … it would have been nice to have it centered on one specific aspect of that. (2021) A lot of [students] struggled with their CBO’s … if the CBO’s had a better understanding … those sessions would have gone a lot better. (2021) if there was maybe something we could do … to say, “These are certain physicians and some subspecialties or fields that are affiliated with our schools in your areas that are willing or want a medical translator for English, Spanish, Hmong, Punjabi or they’re looking for someone to actively shadow or to actively mentor under (2022)