Building a bridge to medical school success: An analysis of the acculturation process of eight minority students in a post-baccalaureate, pre-medical program.

Abstract

In this dissertation I investigated a group of underrepresented minority students enrolled in a compensatory program designed to support their attempts to become acculturated into a community of traditional medical students and eventually to enroll in medical school. These students had previously been unsuccessful in their attempts at admission to medical school, due to underpreparedness suggested by low MCAT scores and undergraduate grade point averages. I was particularly interested in the students' own identification of their underpreparedness, as well as the meanings they constructed about this underpreparedness. Given that the program provided a rich array of opportunities for students to remedy their lack of preparation, I was also interested in the extent and nature of the students' engagement with those opportunities. Finally, I wanted to determine whether students' preparedness, sociocultural identities, and use of program opportunities could be grouped together to characterize identifiable trajectories that students such as these might follow in their quest to become physicians. I followed all eight students enrolled in this compensatory program during the academic year 1996-1997. I collected the personalized study plans they composed as a response to reflection on their learning histories and preferences, conducted an observational study in one of their winter semester classes and collected the notes they took in that class, and interviewed each student twice during the year. Students varied in their ability to discuss the nature of their underpreparedness. Two were not willing to label themselves underprepared at all, two were so acutely aware of their lack of preparation that they felt inferior to their peers in the compensatory program, and four were able to frankly discuss their lack of preparation, provide rationales for it, and discuss how they intended to go about remedying that lack of preparation. Students also showed differential motivation and interest in using the opportunities provided by the program. Half of the eight students engaged with the program opportunities in thoughtful ways, motivated by metacognition of their own particular needs as potential medical students and strengths as learners. The other half were less consistent in their use of opportunities; for instance, some completed the requirements without engagement, while others rejected the opportunities without trying them. Three trajectories were identified that characterize students' movement toward preparation for and enrollment in medical school. The trajectories were based on the distance students had to traverse between the discourse of their home and family and that of the medical school culture, their ability to identify this distance and engage with opportunities to compensate for it, and their motivation and interest in becoming physicians. These findings suggest that compensatory programs provide valuable opportunities for students who are willing to seize these opportunities and use them judiciously. Medical schools may find that these opportunities can be provided for all medical students. Furthermore, my findings indicate that students who are not traditionally prepared can be successful in their quest to enter medical school, given time and support from the medical school, as well as their own motivation and desire to become physicians.