Diversity in osteopathic medical school admissions and the COMPASS program: an update

The COMPASS program

In a previous article, we reported the formation of the COMPASS program by an alumnus [15]. Jemima Akinsanya, DO, was a first-year medical student in 2013 who thought that starting a program to help future minority students might also help those already enrolled at TouroCOM-NY by providing a stronger support system. With this in mind, the seeds of COMPASS were planted. Between the years 2015 and 2016, COMPASS began an energetic peer-to-peer program with specific goals and strategies. Working collaboratively with the Dean of Student Affairs office, the COMPASS welcoming program brought minority student prospect candidates from the application cycle together with current TouroCOM-NY URiM medical students. This updated communication presents the impact of the COMPASS program on admissions and enrollment between the years 2015 and 2022.

Utilizing the American Association of Colleges of Osteopathic Medicine’s Application Service (AACOMAS), an invitation was sent to students who self-identified as URiM applicants to the COM on behalf of the COMPASS program. Prior to the COVID-19 global pandemic [16], COMPASS student leaders organized an agenda for a single in-person welcoming program specifically for invited applicants. The Office of Student Affairs provided funding for refreshments through a specific budgeted allocation for student activities. The program was student-led and did not include administration or admissions officers. Student leaders were instructed to refer specific questions related to a candidate’s academic/admissions standing to admissions officers, which kept the focus of events on providing a social, supportive, and welcoming atmosphere. TouroCOM-NY admissions materials were also distributed; these included information about admissions requirements, processes, and procedures, and the principles of osteopathic manipulative medicine (OMM), as well as TouroCOM-NY branded admissions promotional materials (e.g., t-shirts, pens, bags, etc.) typically distributed during recruitment. COMPASS leaders also invited other TouroCOM-NY student leaders representing the Student National Medical Association, Latino Student Medical Association, and the Student Diversity Committee to participate in the welcoming event on campus. Again, the event focused primarily on answering questions about student life and providing applicants with direct exposure to URiM students currently attending TouroCOM-NY. The rationale for this approach was that by fostering a positive social atmosphere with current minority medical students with whom they could relate, prospective minority students could envision themselves as potential members of TouroCOM-NY. From an admissions perspective, this was an important strategy in reassuring URiM students that they could “accept” us.

Table 1 demonstrates the organizational structure of the COMPASS welcoming event. Beginning with the year 2015, invitations were sent via the WebAdmit application system. Before the year 2019, an average of 23 candidates would attend the in-person event each year, typically candidates already living in the New York, New Jersey, and Connecticut tristate area. Between 2020 and 2022, we saw a significant increase in the total number of participants due to a conversion to the virtual format and the social impact of the COVID-19 pandemic [16]. Notably, the virtual format facilitated participation from candidates outside of the New York/New Jersey area.

A global pandemic, student engagement, and technology

The COVID-19 pandemic [16] altered the lives of students across the country [17]. Students were forced to quickly adapt to utilizing remote instruction. The use of remote instruction provided students who resided in a remote or underserved area the opportunity to attend lectures and classes from any site. Through remote instruction and the use of technology programs like Zoom [17, 18], students were not required to travel to class and could complete their course work in any location [17]. Not only was there an increase in accessibility to completing schoolwork, but also the aspect of students being closer to support systems was significant. The ability for increased accessibility to educational materials aided in more students to manage their academics remotely. The pandemic not only presented as a difficult time for students, but also created a need to stay on top of coursework while also keeping connected to critical family and friend support necessary for success [17]. The flexibility provided through remote instruction presented the opportunity for students to effectively and efficiently balance personal and professional obligations. A more fluid system gave students the freedom to engage in their classes and lectures from anywhere in the world [17]. This fluidity crossed over into participation in the COMPASS program as well, facilitating increased participation and broadening the discussion to include participants from across the United States. As such, Table 2 demonstrates the exact increase in URiM group participation in the COMPASS program.

The COMPASS program is beneficial to prospective candidates because it exposes them to the TouroCOM-NY experience, with a special focus on the Harlem campus. Prospective students are given the chance to lead breakout rooms by asking any question about TouroCOM-NY, being a medical student, and living in Harlem. This was done to break the imaginary wall that can exist between premedical and medical students. Chosen osteopathic medical student I (OMS-I) and II (OMS-II) students were given the opportunity to serve as virtual moderators for the prospective students. After preliminary introductions, approximately 10–12 students were assigned to one moderator (a current OMS student of TouroCOM-NY); the purpose of this was to establish an environment of trust and transparency.

The contribution of the URiM TouroCOM-NY student leader is that they have a unique perspective to share. They can relate to the unique challenges faced pursuing a medical education. The breakout rooms provided candidates with varying perspectives of the TouroCOM-NY experience, based on the moderator’s view. Moderators answered queries about the grading system, interactions with peers and faculty, school-life balance, housing and commuting, and the quality of the overall experience of the current medical students. Attendees were left with an honest insight into the rigors of medical school, an understanding of the TouroCOM-NY experience, and a complete sense of what is important to them as applicants entering the realm of medicine.

Feedback from prospective candidates who attended the program indicated feelings of ease about the program, adding that the program facilitated networking with their peers without the presence of faculty or staff and void of the pressure associated with a formal interview process. Additional feedback from prospective candidates highlighted candidates who chose to enroll after engaging with the COMPASS program. They also articulated a lack of formal guidance from their academic communities about how to successfully matriculate into medical school.

Tables 3 and 4 demonstrate COMPASS participation in relation to being offered a Doctor of Osteopathic Medicine (DO) interview, enrollment, and graduation status at the osteopathic medical school. The issue of matriculation in medical school is a complex, multifactorial process. The addition of the COMPASS program has not only added a sense of belonging on campus but also expanded the opportunities for mentorship.

All medical schools have their own criteria for selecting which students are interviewed. At TouroCOM-NY, a primary filter is implemented that selects candidates for a secondary application invitation based on a minimum MCAT score (498) and GPA criteria (3.0). If a candidate submits the secondary application, the candidate is considered for an interview. Annually, TouroCOM-NY receives approximately 3,500 secondary applications, and each campus interviews approximately 525 candidates.

In the year 2017, all of the COMPASS attendees met our criteria to be invited for an interview. If a candidate was not qualified for an interview, they received email communication about alternate pathways into medical school or other healthcare options. One of the options offered as an alternate pathway into medical school is applying for the Master of Science (MS) in Biological Sciences program. Students who successfully completed the one-year MS program at TouroCOM-NY are offered promotion into the DO program, upon meeting promotion criteria. The details of the MS to DO program are outlined in Table 5.

To determine whether there was an increasing trend in enrollment of URiM students over time in Table 4, the Man-Kendall test of trend was applied to enrolled students and the percentage of attendees who enrolled. The results for both columns for n=6 was s=3, alpha=0.36. Although numerically there appears to be an upward trend, statistically the trend was not significant.

Mentorship

Mentoring URiM students is of paramount importance because it can support successful matriculation, graduation, and contentment with one’s chosen field of medicine. It can also add diversity to the medical workplace that is sorely lacking in that regard. According to the AAMC, only 5.7 % of physicians in the United States are African American and/or Black [19]. Furthermore, 51 % of first-generation undergraduate students are URiM [20]. After reviewing these numbers, one quickly recognizes that URiM students may be disadvantaged when seeking social support and networking groups within their families and/or communities who would be equipped to guide and advise them.

As it pertains to the impact that effective mentorship can have on academic achievement, at-risk students who participate in co-curricular activities and feel socially integrated drop out of school less frequently [21]. Students who have trusting relationships with mentors are better able to take advantage of critical feedback and other opportunities to learn [22, 23]. Medical students are happier and academically stronger when they feel that they are not alone and are supported. Therefore, mentors can play an important role in assisting students to recognize their imposter syndrome and provide empowerment strategies on managing and overcoming them [24].

Belonging

Belonging uncertainty theory provides needed context through heightened levels of the imposter syndrome when a student subconsciously forms the impression that they are not meant to be there [25]. In addition, smaller numbers of URiM student representation on medical school campuses further exacerbates feelings of imposter syndrome as they wrestle with general feelings of not belonging. For example, Black medical students at predominantly White institutions “may experience greater everyday discrimination relative to their Historically Black Colleges and University (HBCU) peers that leads to reduced perceptions of their ability to succeed within medical school [26].”

It should be noted that many students, and adults experience imposter syndrome, especially those who are high achieving, perfectionistic, and have high expectations and standards that are difficult if not impossible to achieve [27]. In addition to some of these personality traits or tendencies, implicit and explicit bias also contributes to imposter syndrome [28]. URiM students are at risk for imposter syndrome for all the same reasons, and are at greater risk because they chronically encounter explicit, implicit, and institutional racism both within and beyond the institutions they attend [29]. Because of these factors – no matter how confident, intelligent, and successful they may be in school or in life – they must constantly wrestle with imposter syndrome. These factors further affect their ability to form the necessary relationships with other students, faculty, and administration in medical school – the very relationships that are critical to success [21]. Mentors play the critical role of modeling and framing for students that their own imposter syndrome can be managed and that they can consistently achieve success. Through mentorship, students will realize that imposter syndrome is normal and does not exclude one from success. Further, mentorship can act as a motivator for URiM students to overcome their struggles and celebrate their triumphs.

Discussion

The dearth of Black and Latino physicians continues not only to negatively affect diversity in the field of medicine, but also to contribute to health disparities in minority populations [30]. To increase the number of URiM physicians, initiatives in recruiting diverse and minority student cohorts are sorely needed as part of the admissions process in our medical schools and postbaccalaureate medical programs [31]. TouroCOM-NY has successfully integrated the COMPASS program into its recruitment and admission programs. COMPASS works to make sure applicants feel that they belong and can see themselves in medical school. Although COMPASS in its essence is a social program associated with the admissions process, many COMPASS student leader volunteers become peer mentors the following year to help fellow students appropriately adjust to medical school matriculation.

Lessons learned

The most valuable lesson learned is that it is not enough to simply recruit diverse candidates – the environment on campus must also mirror that diversity and provide opportunities to connect with faculty who can provide necessary mentorship. Although medical school leadership desires to increase the diversity of the student body [31], the best strategies for successfully recruiting and retaining URiM candidates must be both intentional and thoughtful [31].

Conclusions

Successful recruitment of URiM applicants requires a variety of approaches, such as ensuring that prospective medical school students have opportunities to interact with current URiM students, faculty, and administration who reflect diversity. Pathway programs also serve as a way to enhance the opportunities for prospective medical students. These programs help students recognize their academic capacity and provide the college with an assessment of their potential for success. With over 40 [7] DO schools and 157 [9] MD schools in the United States, competition for qualified URiM candidates has only increased the pressure to be attractive to medical school candidates.

The strength of a student-led program like COMPASS is in facilitating a welcoming environment to support applicants, allowing them to socialize with URiM medical students. Although social in nature, these activities also provide a greater understanding of the medical school’s culture and student life on campus. The most noticeable impact of the COMPASS program is on the URiM candidate’s increased comfortability with the admissions process as they elect to confirm their secondary invitation and participate in our interview process.

As a result of COMPASS’s efforts, along with the contribution of medical school mentorship after matriculation, URiM faculty representation, the MS-to-DO pathway program, and ongoing student support through student organizations, TouroCOM-NY has facilitated a winning strategy for guiding students on their path to academic success. This winning strategy also incorporates the important support provided by the Learning Specialist and Social Worker as well as a 24-7 confidential and free counseling program offered by the college.

We recommend that all colleges of osteopathic medicine explore their current efforts to recruit prospective URiM students and consider additional efforts that would be effective in their local community.