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Black premedical student retention: exploring campus support programming through the eyes of the student

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Black premedical student retention: exploring campus support programming through the eyes of the student

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Black Premedical Student Retention: Exploring Campus Support Programming Through
the Eyes of the Student
by
Kamau Jamal Abercrombia

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

December 2021

© Copyright by Kamau Jamal Abercrombia 2021
All Rights Reserved

The Committee for Kamau Jamal Abercromia certifies the approval of this Dissertation

Alan Green
Patricia Tobey
Paula M. Carbone, Committee Chair

Rossier School of Education
University of Southern California
2021

iv
Abstract
In the United States, there is a disproportionately low number of Black physicians in comparison
to the demographic composition of Black people in the nation. This underrepresentation gap is
result of historic systemic racism that led to Black people being abused and left out of healthcare
and medical education. Despite improvement in healthcare and educational since the Civil Rights
era, the underrepresentation gap amongst physicians persists. While the causes and solutions for
the underrepresentation gap are multifactorial, one avenue of exploration is in how universities
support Black student persistence in premedical education. Under the framework of Critical Race
Theory, this study addresses the research question “what are Black premed students’ experiences
and perceptions of support programming at public universities in the state of California”. The
purpose of this study was to identify opportunities to enhance support for Black premedical
students by utilizing their voice in literature and practice. This study features semi-structured
interviews with seven Black premed students from four public universities in California who
were in the process of applying to medical school. Findings show that the participants were
overall dissatisfied with their universities’ efforts to support Black premed students, citing
concerns about a lack of awareness of programs, effectiveness, availability, and a need for
community amongst Black students and faculty. These findings provide insight into how to
address the high rates of attrition amongst Black premed students at primarily White institutions
(PWIs) and produce the physician workforce needed to address health disparities in
underrepresented communities.

v
Acknowledgements
I would like to humbly thank everyone who has helped me complete this program. Thank
you to my advisor, Dr. Paula Carbone, who made the dissertation process smoother than I could
ever imagine. I am appreciative of her wisdom and encouragement, along with her
recommendation of Drs. Alan Green and Patricia Tobey to join my dissertation committee Their
insights and conversations in my defenses have been invaluable. Thank you to my editor, Katie,
who took the time out of her busy schedule to work on the final edits in such short time. Thank
you to all my friends (too many to mention) that have been supportive of me and good people to
everyone else around them. Thank you to my in-laws. You all have been nothing but supportive
and understanding of my interests, and sometimes odd working hours, since I’ve known you.
You’ve always made me feel welcome. I can’t say enough to provide the proper appreciation for
my family, both immediate and extended. My sisters have always looked out for me and helped
me grow, whether I knew it or not. My parents gave me the opportunity to explore and think
deep, all while providing the perfect example of what hard, selfless work looks like. I could
never repay all you have done to position me to be able to maneuver through the world in the
way that I do.
My wife means a great deal to me, and her support is what has gotten me through some
tough times on a long road. I appreciate you always picking up the pieces and filling in the gaps
where you can. You’ve had to put up with a lot of long impromptu rants, lectures, and diatribes
about philosophy, society, and critical thinking (and of course we can’t forget about music).
You’ve spent more than enough time entertaining my role as Devil’s advocate and dissector of
things that probably don’t need to be dissected. You are the one person who has experienced the

vi
full scope of my interests in music, organizational, and now medicine. Thank you for always
being enthusiastic for me.
To my participants: Thank you for opening up and sharing your stories. I wish much of
what you told me was not the case; but unfortunately, it is for you, me, and many other Black
students just trying to make something of themselves. Let’s move forward and do good in the
world together.
When I first started working on this dissertation, I had no idea Critical Race Theory
would soon be thrusted into the spotlight of national media shrouded in misconception,
misunderstanding, and mistruths. Hopefully my work helps to clear the air and display this
framework as the tool for change it is meant to be. Dr. Derrick Bell is right, America was built
on racism and is consequently engrained in our culture; there is no way to escape what happened
in history. However, American culture is a social construct. To start over is not to destroy people,
but to change our collective consciousness.

vii
Table of Contents
Abstract iv
Acknowledgments v
List of Tables iv
List of Figures x
Chapter One: Introduction 1
Context and Background of the Problem 2
Purpose of the Project and Research Question 3
Importance of the Study 4
Overview of Theoretical Framework and Methodology 5
Definitions 6
Organization of the Dissertation 8
Chapter Two: Literature Review 9
Health Implications 9
The History of the Underrepresentation Gap 11
Contemporary Challenges 17
Conceptual Framework 33
Conclusion 37
Chapter Three: Methodology 39
Overview of Design 39
Research Setting 40
The Researcher 41
Data Sources 42

viii
Credibility and Trustworthiness 50
Ethics 52
Limitations and Delimitations 53
Chapter Four: Findings 56
Campus Capacity for Support 57
Low Sense of Belonging 78
Summary 86
Chapter Five: Discussion and Recommendations 87
Discussion 87
Future Research and Recommendations 91
Conclusion 95
References 97

ix
List of Tables

Table 1: Participant Information 57

x
List of Figures
Figure 1: Conceptual Framework 34
Figure 2: Coding Model 47
Figure 3: Coding Grid Example with Participant Identification Numbers 48
Figure 4: Data Organization Sheet Example 49

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Chapter One: Introduction
Throughout the history of organized medicine in the United States, Black Americans
have been denied care, provided limited access to services, left out of education, or suffered
medical abuse at the hands of the predominantly White male culture of physicians (Baker, et al.,
2008; Gartland et al., 2009). These atrocities have greatly contributed to health disparities within
Black communities. While there have been significant strides in increasing access to medical
education necessary to train more Black physicians, data demonstrates there is still a significant
gap in representation, as Black Americans make up only 5% of practicing physicians in the U.S.
(AAMC, 2019a) despite Black Americans accounting for 13% of the demographic makeup of the
country (U.S. Census Bureau, 2020). While there are many factors that contribute to the
underrepresentation of Black physicians, one area of study that deserves considerable attention is
retention of Black students in premedical programs.
The percentage of Black Americans obtaining college degrees has grown significantly in
recent years (U.S. Census Bureau, 2017); however, the pool of medical school applicants has not
seen the same growth, as only 8% of medical school applicants were Black as of 2019 (AAMC,
2019b). According to the National Center for Education Statistics (Chen & Soldner, 2013),
between 2003 and 2009, Black undergraduate students in STEM majors had attrition rates due to
leaving post-secondary education or switching to non-STEM majors of 29.3% and 36%,
respectively. In comparison, the attrition rates of White students for these categories were 19.8%
and 28.1%, respectively (Chen & Soldner, 2013). Studies have shown that socioeconomic,
academic, and racial struggles act as barriers to premedical education for Black students (Barr et
al., 2008; Lovicchio & Dundes, 2002; St. John et al., 2005; Tucker & Wilson, 2013), thus
contributing to the low number of students participating in medical education. However, research
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also has showcased the success that Historic Black Colleges and Universities (HBCUs) have had
in producing qualified Black medical school candidates (Carmichael, Jr. et al., 1988; Gasman et
al., 2017), meaning these issues can be overcome. Evidence demonstrating that this success has
not been shared equally among U.S. colleges, including institutions in the state of California,
which produces a high percentage of medical school applicants (AAMC, 2021) warrants
examination and raises questions about the support programming institutions offer to address a
well-documented retention issue. The purpose of the research presented in this work will address
the problem of low rates of retention amongst Black premedical students in the United States.
Context and Background of the Problem
There has been a well-established link between success in higher education and support
programming for Black students (Thomas et al., 2011). Premedical students across races have
had similar academic struggles and concerns about performing well enough in their
undergraduate years to enter medical school (Lovicchio & Dundes, 2002); however, Black
students are a demographic predicted to be most negatively impacted by these challenges (Barr et
al., 2008). Research has demonstrated that premedical attrition can be combated with proper
support programming, especially for Black students who may be particularly vulnerable because
they are first generation college students, come from low socioeconomic backgrounds, or
matriculate from low performing and underfunded high schools (Cohen, 2003; Gushue &
Whitson, 2006). Despite the number of studies that confirm these findings, as stated in a study by
Karp (2011), which reviewed 128 publications on non-academic support programming, minimal
research has been undertaken to explore Black students’ perceptions of support programming or
their specific needs.
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Karp’s work has provided an avenue to continue the conversation of support
programming as it relates to perceptions of Black students. This relationship is important to
examine when considering the success of campus support programming, especially in states such
as California where the elimination of affirmative action in college admissions caused a
substantial long-term drop in the number of Black applicants to medical school (Cohen, 2003).
As recruiting and retention efforts via support programing exist to ease the blow of many
colleges losing affirmative action to legal action such as Proposition 209 (Kidder & Gándara,
2016), the data demonstrate that there are improvement opportunities for states like California in
recovering the number of Black students who have been left out of medical education.
Purpose of the Project and Research Question
The purpose of this study is to explore Black students’ experiences with and perceptions
of support programs at California colleges to identify opportunities to enhance support for Black
premedical students. In addressing this purpose, the following research question is proposed:
What are the perceptions and experiences of Black premedical students utilizing support
programming at primarily White institutions?
This research question was created in consideration with review of literature which finds
that much of the discussion around campus support programming generalizes the importance of
assisting Black students, while missing the opportunity to speak through their perspectives and
experiences on a given college campus. This research has the potential to advance the topic of
equitable support programming for underrepresented minority (URM) students by interjecting
the voice of Black students, speaking of their lived experiences, into the conversation.
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Importance of the Study
Studying the perceptions and experiences of Black premedical students remains
significant in many ways. Speaking directly to the problem of high attrition of Black premedical
students, research on campus support programming conducted through the lens of Black
students’ perspectives can produce data that can be utilized to develop the best practices
necessary to retain Black students in the premedical pipeline. In addressing the larger societal
issue of underrepresentation of Black physicians in the U.S., increasing retention of Black
students on the premedical education path will increase the pool of Black medical school
applicants who may then become practicing physicians. To reach the number of physicians
required to meet the United States’ physician diversity need requires roughly double the current
number of Black physicians, as expressed by the National Institute of Health (Kington et al.,
2001). These efforts are significant because research has shown that that increasing racial and
ethnic concordance between physicians and minority communities will improve health outcomes
in said communities (Saha et al., 1999). Additionally, the findings and subsequently developed
best practices from this work have the potential to act as scaffolding colleges can use to support
students of other underrepresented demographics in medicine, thus arguably providing similar
opportunities for increasing health outcomes in other underrepresented communities. However, it
should be noted that increasing the number of URM physicians does not only impact the racial
group in which the physician identifies. Research shows that URM physicians are more likely to
practice in economically underserved communities as well as communities with physician
shortages (Gartland et al., 2003; Xierali & Nivet, 2018) and not just the ones in which they
identify. Increasing the number of Black, indigenous people of color (BIPOC) physicians in the
U.S. willing to practice in these underserved communities will help to promote good health in
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the public and address the nation’s overall physician shortage, which is currently trending toward
large-scale growth (Zhang et al., 2020).
Overview of Theoretical Framework and Methodology
In exploring the high rates of attrition amongst Black premedical students, Critical Race
Theory (CRT) can be used to examine the role race plays in impacting societal structures, such
as higher education institutions (Ladson-Billings, 1998). CRT has four central tenets: race is
normalized, not an exception, in U.S. society; storytelling of and from the perspective of the
oppressed is required to positively change dominant racial narratives through counternarratives;
the limitations of liberalism should be scrutinized for the inability of legal paradigms to cause the
fast-sweeping change needed to address racism; and Whites have been the primary beneficiaries
of affirmative action (Delgado, 1995; Delgado & Stefancic, 2017; Ladson-Billings, 1998). Of
direct relevance for this study are CRT tenets one and two. Because the faculty and leadership on
California public college and university campuses (not including private schools, which have not
been analyzed in this research) has been overwhelmingly comprised of White males (Bustillos et
al., 2018), it can be argued using a CRT perspective that race and subconscious racism/bias may
impact the development of support programs that are intended to address the needs of Black
students. Allowing Black students to tell the story of their experiences and needs can be argued
under the lens of CRT as an important component of the equitable program development process
needed to retain Black students in the premedical pipeline. In keeping with the CRT framework,
a qualitative study will be conducted using interviews of Black premedical students’ experiences
and perceptions of the support programming offered by California colleges in which they are
matriculated.
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Definitions
The following definitions are to provide understanding to loosely defined terms within
the context of the problem addressed in this dissertation:
Underrepresented Minority (URM)
Underrepresented minorities are defined as students from racial demographics that are
not represented in higher education or profession equal to their population in the United States.
This study will focus on the URM group of Black Americans.
Primarily White Institution (PWI)
Institution refers to a college and all of its organizational components utilized to govern
the education of matriculated students. In this study, institution may also be used to refer to the
collective thoughts and values of a college based on the perceptions of Black students.
Institutions are referred in this study as primarily White due to demographic makeup of the
institution.
Historically Black Colleges and Universities (HBCU)
Historically Black Colleges and Universities is used to describe a system of higher
education institutions in the U.S. South and Southeast that were primarily responsible for
educating Black communities before the post-civil rights era. Many HBCUs continue to operate
and cater to Black students. There are currently four HBCU medical schools operating in the
U.S: Howard, Meharry, Morehouse, and Charles R. Drew (Campbell et al., 2020).
Unconscious Bias
Also known as implicit bias, unconscious bias refers to stereotypes and prejudice
unconsciously acquired through social learning (Byrd, 2019). While unconscious bias can refer
to a variety of cultures and positionalities, such as gender, sexual orientation, and age,
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unconscious bias in this work will refer to Black students’ perceptions and experiences regarding
how their institutions support their education.
Student Experience
Student experience is in reference to the lived experience of Black students at a college.
Student experience will be framed as positive or negative in this study’s conceptual framework
based on student’s experiences at and perceptions of the institution.
Campus Support Programming (CSP)
Campus Support programming in this work is defined as the institutional efforts, aside
from typical coursework, designed and implemented by the college to assist students in
educational success. Campus Support Programming will be used to refer to programs created
from the college purview and is not limited to programs that physically take place on college
grounds.
Premedical Education
Premedical education is defined as the path core coursework and efforts to prepare for
medical school. Premedical education does not need to be defined as a specific major but is often
associated with degree programs related to biological sciences.
Medical School Pipeline
The medical school pipeline is the process of student and institutional efforts leading to
matriculation into medical school by a student who declares their intentions to pursue a career as
a physician. The medical school pipeline will be used in this study as a positive end result to
effective support programming.
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Organization of the Dissertation
In examining Black premedical students’ experiences with and perceptions about campus
support programming, this study is organized into five chapters. This chapter introduces the topic
and familiarizes the reader with the context of the problem, key concepts, and Critical Race
Theory as the theoretical framework used in this study. Chapter two is a review of literature in
topic areas related to this study and the conceptual framework in use. Chapter three explains the
research methodology used in this study, including information on participants, selection criteria,
and data collection practices. Chapter Four provides analysis of data collected, while Chapter
Five provides recommendations for increasing the retention of Black premedical students with
consideration of current literature and data collected in this study.

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Chapter Two: Literature Review
Conducted through the lens of Critical Race Theory, this literature review brings to the
forefront the historic and current issues of normalized institutional racism in medicine and
medical education, while covering topics related to the underrepresentation of Black premedical
students in the United States. This literature review begins by discussing health issues common
in Black communities and their relation to the underrepresentation of Black physicians in the
United States. The literature review discusses the historic causes of the underrepresentation gap
by examining past injustices that prevented the development of Black physicians in the U.S.
Following the historical causes, the contemporary challenges to retention faced by Black
premedical students at primarily White institutions is explored. The contemporary challenges
section also addresses some of the ways Historic Black College and Universities have found
success in retaining Black students in the medical school pipeline. The review then addresses the
gaps in support program literature before introducing the conceptual framework utilized in this
study. This literature review is formatted to help the reader understand the impact that history has
on the underrepresentation of Black physicians in the United States and how that history, if not
addressed, may impact the effectiveness of campus-based support programing at primarily White
institutions. It is of important note that although the literature presented here has been applied to
a variety of context, this review focuses primarily on the literature’s application to the problem
of the disproportionately high rate of attrition of Black premedical students in the United States.
Health Implications
Research documents that Black communities in the United States have had
disproportionately high rates of morbidity and mortality from preventable illnesses
(Airhihenbuwa & Liburd, 2006), such as hypertension, cardiovascular disease (Mozaffarian et
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al., 2016), and type two diabetes (Office of Minority Health, 2019; Signorello et al., 2007).
According to the American Heart Association, Black American adults are among the highest
level of prevalence of hypertension (high blood pressure) in the world at 44.9% for men and
46.1% for women (Mozaffarian et al., 2016). These rates are critical because hypertension often
presents no symptoms while leading to stroke and cardiovascular disease, which are leading
causes of death in the U.S. (CDC, 2020; Kochanek et al., 2019). It has been reported that in 2013
the overall deaths attributable to cardiovascular disease was 222.9 per 100,000 Americans.
Among Black males and females, the death rate was 356.7 and 246.6, respectively, per 100,000
Americans (Mozaffarian et al., 2016). In comparison, non-Hispanic White males and females
had rates of 270.6 and 183.8, respectively, per 100,000 Americans (Mozaffarian et al., 2016).
The same concerns are echoed in consideration of diabetes, as Black American adults are 60%
more likely to have been diagnosed with diabetes than non-Hispanic White Americans (Office of
Minority Health, 2019). Furthermore, in 2016, Black Americans were 2.3 times more likely to be
hospitalized for limb amputation, 3.5 times more likely to be diagnosed with end stage renal
(kidney) disease, and twice as likely to die because of diabetes than non- Hispanic White people
in the U.S. (Office of Minority Health, 2019). Furthermore, cardiovascular disease and diabetes
are closely related, as their causes are linked to a group of risk factors, called metabolic
syndrome, that tend to occur simultaneously and lead to heart attack, stroke, and diabetes
(National Heart, Lung, and Blood Institute, 2019). This means that Black people who have one
of the previously mentioned diseases are also likely to have a comorbidity (Opara et al., 2013).
The prevention and treatment of metabolic syndrome can be achieved with lifestyle
intervention and regular health screenings (National Heart, Lung, and Blood Institute, 2019).
However, the risk factors of metabolic syndrome are often correlated to environmental and
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behavioral factors that are related to low socioeconomic status (Signorello et al., 2007; Williams,
1997). As has historically been their burden, Black communities tend to have lower
socioeconomic status than predominantly White communities (Signorello et al., 2007; Williams,
1997). This often leaves many Black communities in a double bind as racism’s role in medicine
has bred mistrust that demotivates individuals to utilize healthcare services (Arnett et al., 2016),
while Black people with low socioeconomic status often live in communities that are medically
underserved (Health Workforce, 2021) and lack the financial resources to pay for care (Becker &
Newsom, 2003). As previously mentioned in the literature review, research has shown that
increasing racial concordance increases trust (Arnett et al., 2016; Musa et al., 2009) and creates a
workforce more likely to practice in underserved populations (Saha et al., 1999); however, racial
concordance is not simply solved for due to a deeply rooted history of racism in medical care and
education in the United States.
The History of the Underrepresentation Gap
The history of Black communities and medicine in the United States is deeply rooted in
what Critical Race Theorist would describe as normalized racism (Delgado, 1995; Delgado &
Stefancic, 2012; Ladson-Billings, 1998) and arguably sets the framework for the
underrepresentation gap of Black physicians in the U.S. As stated by Byrd & Clayton (2001),
racism in medicine has manifested as abuse, indifference to health concerns, bias, unequal
treatment, and exclusionary practices toward Black communities (Smedley et al., 2003; Thomas
& Casper, 2019). Racism is responsible for beliefs held by some scientists, prominent until
relatively recently in American history, that Black people are biologically and intellectually
inferior to White people and justified chattel slavery (Baker, 1970; Magnis, 1999). The pseudo-
scientist backed sentiments that Black people are less than human allowed for high-profile
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instances of racism such as the Tuskegee Study, where Black men in the south were intentionally
injected with syphilis and purposely denied treatment without informed consent to study its
effects (Scharff et al., 2015). The controversy over HeLa cells, which were taken from a Black
woman cancer patient named Henrietta Lacks and widely distributed along with her medical
record without consent, is another example of abuse in the name of science (Callaway, 2013;
Wolinetz & Collins, 2020). But in addition to these large profile occurrences of mistreatment,
there are several everyday instances of health inequity toward Black communities.
Literature on medicine in the U.S. tells a history of Black people being seen as less
favorable than Whites when seeking medical care, which has resulted in Black people often
receiving lower quality care (Bulatao & Anderson, 2004) or even being denied care (Chandler,
2010; Obermeyer et al., 2019). The scar of this history is mistrust of physicians, healthcare, and
research institutions by the Black community (Thomas & Casper, 2019), which has led to its
underutilization of healthcare services (LaVeist et al., 2009). While the topic of underutilization
of healthcare services in minority communities is more complex than can be analyzed under a
singular cause, addressing mistrust speaks to the underrepresentation of Black physicians in the
U.S. Studies have found that patient utilization of important health services such preventative
care may increase with physician trust (Arnett et al., 2016; Musa, et al., 2009) and racial
concordance (Saha et al., 1999). However, institutional racism in medical education has limited
the number of Black physicians available to care for their communities.
Racism in Medical Education
For most of the United States history, Black people were excluded from participation in
medical education. This exclusion started from the onset of K-12 education, as Black Americans
historically lived in communities with underperforming schools that were financially neglected
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(Cohen, 2003; Gushue & Whitson, 2006; Rothstein, 2015), thus making it difficult for students
in said communities to become qualified candidates for medical education. When these barriers
were breached, many Black students were often denied entry at the nation’s White male
dominated medical schools and were limited to being educated at medical schools affiliated with
what we know today as Historic Black Colleges and Universities (HBCUs) (Butler, 2011).
Before 1910, out of 160 medical schools, only 12 were dedicated to educating the Black
population (Butler, 2011) that made up 9.8% of the U.S. population (Bennett et al., 1993).
However, social stressors fueled changes that would further limit Black students’ options for
medical education.
Economic depression beginning in 1893 caused financial troubles for the nation,
including White physicians who became disgruntled about competition amongst themselves and
Black peers (Butler; 2011; Thomas, 2003). In 1904, The American Medical Association gained
momentum as the major influential authority on medical education (Butler, 2011) and
established The Council on Medical Education (AMA, 2020). The council sought to limit the
number of both Black and White medical schools in the U.S., and ultimately physician
competition, by implementing training and admissions standards, which most Black schools
could not meet (Butler, 2011; Ward, 2003). In 1910, the AMA was aided in this effort by the
release of education reformist Abraham Flexner’s national review of medical schools called the
Flexner report (Butler, 2011). Flexner’s review discredited the practices of many medical
schools, including those dedicated to educating Black physicians, based on teaching practices
and resources. His findings were used by the AMA to justify calls to close several medical
schools, thus making it more difficult for aspiring Black physicians to receive training (Butler,
2011). By 1930, the number of medical schools in the U.S. dropped from 160 to 75 due to the
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Flexner Report’s influence, leaving just two schools, Howard University and Meharry Medical
College, to serve the Black population (Butler, 2011). In addition, the Flexner Report stated that
Black medical schools were best to focus on public health education, further discrediting the
qualifications of Black graduates as physicians (Butler, 2011). Come 1928, Black students were
placed at an even greater disadvantage after the AMA implemented the Medical College
Admissions Test (MCAT), which assessed applicants on science subjects that many Black
students struggled with due to poor K-12 science education in segregated schools (Butler, 2011).
The result of these changes saw the number of Black physicians in the United States drop from
4,400 in 1910 to 100 in 1940 (Butler, 2011; Ward, 2003), which greatly contributed to the
representation gap of the coming decades.
Post-Civil Rights Era
Despite the many challenges of overt racism as previously described, there has been
positive change in medical school admissions since the Civil Rights Act of 1964 outlawed race-
based discrimination at all medical schools in the U.S. (Gasman et al., 2017). For example, the
percentage of Black medical school students grew from 2% in 1968 to 7% in 1997 in part due to
efforts by the American Association of Medical College (AAMC) to increase the number of
Black physicians (Campbell et al., 2020). These efforts include Project 3000 by 2000, which was
an effort to increase the number of enrolled, underrepresented minority (URM) student in
medicals school to 3000 by the year 2000 (Campbell et al., 2020). However, changes to policies
used in education to include groups who have historically been excluded, known as affirmative
action (Fullinwider, 2018), contributed to the AAMC falling short of this goal and continues to
shape the story of underrepresentation in the modern era by impacting the number of Black
students participating in premedical and medical education.
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Affirmative Action
Affirmative action is a set of laws, policies, and practices implemented to address the
historic discrimination and exclusion of women and minorities from education, employment, and
social contribution (Fullinwider, 2018). Affirmative action is put into practice by increasing the
available opportunities to a specific demographic group (Garces, 2012). In education, this is
achieved by allowing race to be considered in the admissions process, but not assessed with a
point value (Fischer and Massey, 2006). From 1996 to 2006, several states, including California,
instituted a law that would ban public colleges from considering race in college admissions
(Bleemer, 2020; Long, 2004). As a result, the number of URM students accepted into selective
colleges in these states dropped (Hinrichs, 2012). In 1997 at the University of California
Berkley, one year after affirmative action was banned in California under the passage of
Proposition 209, the probability for acceptance of competitive Black high school students
dropped from 48.5% to 15.6%, which included those planning to pursue premedical education
(Long, 2004). California, along with other newly anti-affirmative action states, attempted to
recover the percentage of Black students lost after the affirmative action ban using top percent
programs (Long, 2004). These programs granted high school students amongst the top ranks of
their class guaranteed admissions to specified public universities in their state (Bleemer, 2020;
Long, 2004).
However, research shows that top percent programs have not yielded the intended results,
especially at highly competitive UC Berkley and UC Los Angeles (Bleemer, 2020), which are
among the top five producers of medical school applicants in the U.S. (AAMC, 2021). Long
(2004) found that the Top 4% program in California guaranteed access to only one public college
within the University of California system and did not guarantee admission to a top-tier school.
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Instead, students may have gained acceptance to a less selective campus they would have been
admitted to without the Top 4% program and rejected by a prestigious campus such as UC
Berkeley. The UC system moved to a program that only offers acceptance to a UC campus to
high school students in the top 9% of their class when the applicant has been rejected by the UC
campuses in which they applied and space is available at another UC (University of California,
2021).
Furthermore, Prop 209 has led to URM students being funneled into significantly less
competitive schools and has been correlated to a decline in STEM persistence rates among this
group (Bleemer, 2020). While the drop in admittance of Black students arguably has limited the
number of undergraduate students who could potentially progress into medical school, the results
of anti-affirmative action legislation have been directly and significantly tangible at the medical
school level.
Cohen (2003) found that there was an 11.8 % drop in URM medical school matriculants
overall between 1995 and 2001. In California, the percentage change was -29.6% (Cohen, 2003).
From 1996 (the year Prop 209 was passed) to 1997, the decline in Black matriculants declined by
38% (Garces, 2012). Contradictory to these results, Cohen (2003) adds that medical school
admissions committees in states without affirmative action bans have done a better job of being
race-conscious in applicant consideration. Additionally, the AAMC (2020) has officially
expressed support for holistic candidate review that takes into consideration an applicant’s
personal attributes experiences, in addition to academic metrics, to promote greater diversity
amongst matriculated students. Despite these statements of support, the percentage of Black
students who have matriculated into U.S. medical schools has only grown 0.4% from 6.7% in
1995 (AAMC, 2007) to 7.1% in 2019 (AAMC, 2019c).
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The literature on racism in pre-civil rights era medicine and affirmative action bans of the
mid 1990s have informed the URM gap in medicine today. Using Critical Race Theory as a
theoretical lens, it is important to see this gap because of beliefs, policies, and actions of those in
power, as the first tenant of CRT states racism is a U.S. cultural norm. It is essential to keep this
history in mind when examining contemporary challenges to retention of Black premedical
students that will be discussed in the following section of this literature review.
Contemporary Challenges
For the purposes of this literature review, contemporary challenges refer to challenges to
Black students receiving premedical education that have persisted beyond the Civil Rights era
and the affirmative action ban in the state of California.
Although this section of the literature review primarily focuses on challenges Black
premedical students may have faced while matriculated in undergraduate education, this portion
of the literature review begins by discussing the financial considerations that may prevent a
student from beginning their path to medical education. This review then discusses literature
related to student sense of belonging and academic challenges. Following the previously
mentioned topics, the review explores student self-efficacy at HBCUs, followed by discussion on
faculty and support programming before transitioning to the conceptual framework. Each topic
relates back to the problem of high attrition rates among Black premedical students and modern
education.
Financial Burden
Research shows that financial cost is a key motivational factor in when, where, and how
Black students choose to pursue higher education. St. John et al. (2005) state that the persistence
of Black students to complete college applications is significantly influenced by the availability
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of financial aid, such as grants, more so than compared to White students, who on average were
at a financial advantage. Perna (2006) adds a dimension to this argument by citing that while
there is an abundance of cost information and financial aid for undergraduate students, many
Black students and their families are not properly introduced to these resources until senior year
of high school or only after they have been accepted into a college. Receiving late information
about the financial aid process is a detriment to Black students because without having said
information before applying to colleges, Black students may not adequately prepare in high
school (taking university specific required classes, entrance exams, etc.) to apply to universities,
thinking that they would not be able to afford tuition (Tucker & Winsor, 2013), thus motivating
them to pursue other career opportunities. In addition to obtaining information later than White
students, receiving inadequate financial information contributes to Black students and their
families making the decision to forgo applying for financial aid and declining necessary loans
(Perna, 2004; Perna, 2006). It is reasonable to assess that a contributing factor in the decision to
decline applying for financial aid is due to the extraneous mental effort created by applying for
financial aid. In a report for The Advisory Committee on Student Financial Aid, Stone (2005)
has described this experience as “daunting and onerous for many individuals” (Perna, 2006).
Premedical students who have managed to navigate the finances associated with applying to and
completing undergraduate programs have then been faced with the financial burden of applying
to medical school.
Medical School Cost
The process of matriculating into medical school contains several costs. In addition to
tuition, students and their families must also spend money preparing for and taking the MCAT
exam, application fees, and traveling for in person interviews (Knight, 2018). Due to the low
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acceptance rate of medical schools, potential students often apply to several schools per
application cycle. As reported by the Princeton Review (2020), a well-known college admission
services company, in the 2018-2019 cycle, the AAMC reported that the average number of
schools applied to by applicants was 16. This number increased to 18 schools in the 2021
admissions cycle (AAMC, 2021). It is reported by the AMA (Murphy, 2019) that during this
same application cycle, the application fee charged by the American Medical College
Application Service (AMCAS) was $170 for the first school a student applies to and $39 for
every school thereafter. Because of these costs, students who have financial means are at a
significant competitive advantage in increasing acceptance chances by applying to more schools.
The income disparity in applying to medical school has been demonstrated by data from
the AAMC that has shown that half of medical school students come from the richest 20% of the
population (Jolly, 2008). It is often this group of students who can afford the opportunity for
application boosting activities such as physician shadowing and other prestigious opportunities
(Kahn & Sneed, 2015). Furthermore, the six-figure debt often associated with medical school
may demotivate underrepresented minority applicants, many of which who have loans from
undergraduate education (AAMC 2012; Kahn & Sneed, 2015). Kahn and Sneed (2015) stated
that financial messaging to medical school applicants that emphasizes cost of attendance, without
adequate information on career earnings and stability of the profession, works to dissuade UMR
applicants from applying to medical school. Kahn and Sneed (2105) also stated that educating
applicants on the financial outcomes of a career as a physician can counter cost messaging;
however, Kahn’s work has not addressed a solution to the immediate financial needs that may
prevent Black students from persisting to medical school. In contrast, Smedley et al. (2001) has
suggested increasing available financial aid and guaranteeing support for a minimum of five
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years as a tool for keeping UMR students in the medical school pipeline. Research has stated that
intrinsic and extrinsic motivation for persistence and academic performance has increased when
guaranteed financial assistance is presented to Black students (St. john, 1990; St. John et al.,
2005). For Black students who can overcome the financial burden associated with premedical
education, more challenges, including finding their sense of belonging, await them on their
premedical journeys.
Sense of Belonging
Low sense of belonging in education and the professional field have been common
themes in the struggle for persistence of Black students interested in careers in medicine. In a
research study conducted by Rao and Flores (2007), Black high school students expressed their
perceptions of not belonging in medicine by citing limited exposure to the field (personally
knowing a physician); unequal educational opportunities (specifically in comparison to their
White suburban counterparts); limited representation (perceptions of a physician being a tall
White male); and perceived racism in health care. As demonstrated by Rao and Flores (2007), it
is reasonable to argue that the impact of historical racial bias in medicine, proven through
extensive literature on the subject, has manifested as a lack of motivation for some Black
students to pursue careers in medicine. A respondent from the interviews of Rao and Flores
(2007) provided the following statement in said regard:
The only thing, being an African American, is I couldn’t be in the medical field because
[of] the little racial comments and stuff that might come by, even if it’s from one of my
coworkers or somebody that just walked in the hospital needing help. I couldn’t take it.
(Rao and Flores, 2007, p. 990)
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This quote has demonstrated the early reticence of young Black students to pursue careers in
medicine out of avoidance of racist confrontations, thus limiting the pool of qualified Black
applicants for medical school.
Research has been conducted on the impact racial sense of belonging has on the success
of Black students in STEM. Literature consistently has shown that when Black students cannot
establish a sense of belonging at primarily White institutions, they are increasingly likely to lose
motivation to persist in STEM majors (Strayhorn, 2011). Black students who have experienced a
low sense of belonging are more likely to have negatively impacted self-esteem (Hope et al.,
2013), which has negatively impacted intellectual achievement (Walton & Cohen, 2011) and
ultimately their efforts at persisting through their education (Booker, 2016). Furthermore, lacking
a sense of belonging has negatively impacted the behavior (Strayhorn, 2012) and health of URM
students (Booker, 2016; Walton & Cohen, 2011) A significant contributor to creating a sense of
belonging amongst Black and other UMR students has been having faculty of the same race
provide a sense of academic and professional validation on campus (Meza, 2017); however, data
has demonstrated a consistent lack of diversity in faculty at universities (Bustillos, 2018; Hunn,
2014). In addition to a lack of diversity amongst faculty, and amongst their student body (Hunn,
2014), Black students have struggled to find sense of racial belonging at primarily White
institutions (PWI) because of racially hostile campus climates (Van Dyke & Tester, 2014).
Research has shown that URM student sense of belonging can be increased through
encouragement to participate in organized campus activities such as student government, student
groups, and sports (Kim & Irwin, 2013; Strayhorn, 2012). Freeman et al. (2007) found that sense
of belonging in the classroom can also be fostered by encouraging participation, but also has
contributed that a warm and open environment, consistently messaging about students’ abilities
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for success, and keeping students aware of their academic standing in class also add to sense of
belonging for URM students.
The work of Walton and Cohen (2011) demonstrated that URM sense of belonging can
be improved, and ultimately their academic performance, by reframing the adversity they may
face on campus as a common component of the college experience that will improve over time.
However, the result of this research highlighted a change in psychological perception as opposed
to having the participants provide a deep reflection as to whether they felt more accepted by their
non-URM peers. Additionally, while Walton and Cohen’s intervention demonstrated a boost in
academic performance, the study only examined Black freshmen in their first semester at a
selective college. The study was not designed to address the level of belonging for students who
have had more exposure to hostility on campus nor did it consider the confidence comparison
against students who were not accepted to a selective university. Furthermore, Walton and
Cohen’s intervention did not address the cause of URM students’ low sense of belonging, which
is largely derived from the hostility they may face on campus (Booker, 2016; Hope et al., 2013).
As racism in the United States has shifted away from overt acts to subtlety (Coates, 2008), a
significant contributor to this hostility are microaggressions Black students face in everyday
campus life.
Microaggressions and Stereotype Threat
Sue et al. (2007) have defined microaggressions as verbal and behavioral insults and
invalidations cast upon a person unconsciously by a perpetrator. These microaggressions, which
are often made toward racial heritage, send messages of insensitivity and devaluation of an
individual or ethnic group (Sue et al. 2008). Common microaggressions against Black students
on college campuses often have enforced stereotypes of inferiority (Beasly & Fischer, 2012).
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The example provided by Sue et al. (2008) is of the college professor who is surprised by the
articulateness of a Black student, proposing the message that Black people are generally less
intelligent and that a Black student meeting basic competency of everyday speech is exceptional.
A study by Williams et al. (2020) found that Black students on college campuses experienced
other forms of microaggressions including being ignored, being considered dangerous, or having
their racial identity invalidated by casting a net of sameness across all Black people. These
experiences, which have been consistent features of college education for Black students at PWIs
(Griffith, et al. 2017; Harwood et al., 2010) have revealed a direct link to Franklin (2016), whose
work has demonstrated significant psychological and behavioral stress for Black students under
constant threat of microaggression.
This experience of microaggressions against Black students at PWIs may have triggered
stereotype threat, which is defined as the constant apprehension to affirm harmful stereotypes
about an individual’s group identity (National Institutes of Health, 2017; Steele & Aronson,
1995). In addition to health related problems, such as depression, post-traumatic stress disorder,
and high anxiety (Huynh, 2012; Nadal et al., 2014; Williams et al., 2017; Williams et al., 2018),
suffering under stereotype threat has resulted in academic performance issues such as diminished
working memory and executive functioning skills (Johns et al., 2008; Inzlitch et al., 2006), thus
reasonably contributing to subpar grades and contributing to a Black student’s diminished sense
of belonging in STEM.
Johns et al. (2008) illustrated that reduced intellectual performance and working memory
is the result of three responses to stereotype threat: a physiological stress response; self-
monitoring of performance by the person under threat; and emotional regulation in the form of
working to repress thoughts of inferiority. As Black students have struggled not to be seen as
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inferior and to justify their existence on campus (Franklin, 2016; Kane, 2019), the result of
education in a racially hostile climate often has left Black students feeling isolated (Kane, 2019;
Johnston-Guerrero, 2016). Additionally, stereotype threat can have significant impact on the self-
efficacy of Black students in terms of both education and career choice.
Self- efficacy Concerns
A theoretical construct developed by Albert Bandura, self-efficacy has been defined as an
individuals’ perceptions of their abilities to perform and impact the outcomes of the events that
impact their lives (Bandura, 2010). Bandura (2010) has stated that individuals with high-self
efficacy tend to approach tasks and obstacles as an opportunity for mastery while those with low
self-efficacy may quickly give up when faced with difficulty due to perceiving said difficulty as
a personal threat. Self-efficacy impacts cognitive ability and can be increased through mastery of
experience or task; having vicarious experiences through social models familiar to the individual;
strengthening the individual’s belief that they can succeed; and reducing stress and negative
emotions associated with the individual’s beliefs about their self-efficacy (Bandura, 2010). These
methods are of important note because, as demonstrated in the literature presented in this review
thus far, Black students have not equally received the support outlined by Bandura. Systemic
racism has not only prevented Black students from having models of similar positionality or
opportunities for task mastery related to medicine, as Black people have been left out of medical
education, but also demonstrates a lack of social persuasion that speaks to Black student’s
abilities to succeed. Instead, literature on microaggressions and stereotype threat point to
experiences that increase the stress that must be reduced to increase self-efficacy. Without proper
support, the motivation and selection processes have been impacted (Bandura, 2010), veering
Black students away from careers in medicine.
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Rao and Flores (2007) stated that when considering the extrinsic motivation of financial
success associated with higher education, Black students recognize motivation towards career
options they perceive as easier opportunities towards financial security than careers in medicine.
It is reasonable to argue that the data found by Rao and Flores confirms Black students’ sense of
self-efficacy towards careers in medicine through avoidance of failure. Gushue and Whiston
(2006) have offered that high school counselors can combat low career self- efficacy of high
school students in a number of ways, such as teaching them how to recognize environmental
support, making mentorship connections, working with teachers to make career- related
programs, and teaching them how to anticipate career choice barriers such as racial stereotypes.
In some cases, however, Tucker and Winsor (2008) found that Black high school students often
lack the interventional support discussed by Gushue and Whiston. Without this support, Black
premedical students may be left to learn how to cope with stereotype threat and their racial
existence in a rigorous program of study without adequate support. This is significant because
research has demonstrated that the stereotype threat in which Black students believe they will
underperform in comparison to classmates of other races leads to lower exam scores (Beasly &
Fischer, 2012). Lower exam scores lead to lower course grades, which can make an individual
less competitive in the highly competitive medical school application process. In return, lower
performance arguably perpetuates a cycle of low-self efficacy while adding validity to the
coursework concerns of Black premedical students as discussed by Lovichhio and Dundes
(2002) and Barr et al. (2008). However, at HBCUs, which make up only 3% of degree granting
institutions in the U.S. but comprise 17% of the colleges that produce the most Black medical
school applicants (Gasman et al., 2017), students tend to struggle less with similar concerns.

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Self-Efficacy at the HBCU
Gasman et al. (2017) have depicted HBCUs, such as Xavier University and Prairie View
A&M University, as campuses where Black premedical students have had a high rate of success
and sense of belonging. This is result of students being immersed in a culture of Black
achievement in STEM starting with messaging about generational success, community support,
and encouragement of their academic abilities having been selected to study at Xavier (Gasman
et al., 2017). Additionally, Gasman et al. (2017) stated that the availability of same-race role
models and representative presence of Black faculty are contributing factors of the high sense of
belonging for Black premedical students at Xavier and the campuses success in retention. When
sense of belonging is high, Black premedical students have been more likely to persist through
the rigorous academic challenges they face as premedical students and have been challenged less
by self-efficacy issues (Gasman et al., 2017).
Aside from perpetuating a culture of alumni success, HBCUs have combatted self-
efficacy concerns in their Black premedical student population by acclimating them to support
programming as soon as possible (Gasman et al., 2017). This often will include early MCAT
prep and tutors for all first- and second-year students, in addition to offering clearly defined
premedical core curriculum tracks as opposed to course selection models at other universities
(Gasman et al., 2017). Xavier has credited two specific programs to much of its Black
premedical student success: the peer and instructor led drill system and the peer- led student
tutoring centers. Xavier’s Drill system utilized one two-hour drill class per week to provide
constant reinforcement of material while monitoring student success (Gasman et al., 2017). The
peer- led tutoring center was staffed by faculty selected students who are available on campus
throughout the day (Gasman et al., 2017). Each of these programs was specifically designed to
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assist students with general and organic chemistry courses where Black students tend to have
high attrition rates (Barr et al., 2008; Gasman et al., 2017). While peer tutoring is not unique to
HBCUs, it must be considered based on research discussing the impact of representation on
college campuses (Bean & Eaton, 2016; Gasman et al., 2017; Thomas et al., 2011) that has
shown the availability of same-race models that HBCUs offer Black premedical students in
college environments, where stereotype threat may be minimal due to like-identity, has
contributed to the success of these programs at Xavier. Research has also shown that student
success at Xavier and other HBCU campuses has been in part due to having faculty who are
representative of the student body (Gasman et al., 2017). However, the success that HBCUs have
seen in student persistence are not shared equally across colleges in the U.S., as academic
challenges have been a barrier to success for Black students at PWIs.
Academic Challenges
Research indicates that academic challenges have contributed to the unproportioned
number of Black undergraduate students who have abandoned the pursuit of premedical
education. Among those challenges are premedical coursework. In a research article discussing
interviews with Black pre-health and graduate students, Tucker and Winsor (2013) recalled the
research of Lovicchio and Dundes (2002) which states 90 percent of all Black and non-Black
pre- med students have worried about the rigors of medical education, thus contributing to their
rate of attrition. Lovichhio and Dundes (2002) also found that 88% of pre- med students were
concerned about their ability to earn the grades necessary to enter a medical program. Organic
chemistry courses were of the highest concern and success in said courses was often an indicator
of persistence to continue on the premedical path (Lin et al., 2013).
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While this research shows commonality amongst all students, Barr et al. (2008) have
drawn a distinction that the largest decline in pre-med persistence due to chemistry courses was
amongst Black and Latino students. These findings echo sentiments of Black high school juniors
who stated that the stress from the perceived difficulty of premedical education has been a
considerable factor in the lack of motivation for Black students to persist in medical education
(Rao & Flores, 2007). Black students’ perceived and experienced difficulty of premedical
coursework bare a significant link to the pre-college education of many Black premedical
students.
Underfunding
A substantial amount of literature has been produced on the STEM achievement gap
between schools in primarily Black underrepresented neighborhoods and predominantly White
neighborhoods at the K-12 level. Research shows that a key reason for the achievement gap is
underfunding in often racially segregated schools, which has resulted in faculty shortages that
have lead to hiring of underexperienced teachers, lack of enrichment programs, classroom
resource shortages, and a lack of guidance counselors (Darling-Hammond, 2001; Hall &
Ushomirsky, 2010; Morgan et al., 2016).
Additionally, a U.S. Department of Education report (2018) found that Black students
enrolled in and passing preparatory courses, such as Algebra I, at significantly lower rates than
White students. The report also found that high schools with majority Black and Latinx
enrollment consistently offered fewer STEM preparatory courses than the overall population of
all high schools (U.S. Department of Education report, 2018). As a result of these gaps, Black
students who come from underserved high schools may start college at a disadvantage that is
highlighted by how they perform in rigorous, college level STEM courses. These same Black
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students may face additional hurdles related to their racial identities at primarily White
institutions when considering the literature on sense of belonging and self-efficacy. Furthermore,
outside of the HBCU system, Black students have not experienced the same rate of same- race
role model reinforcement, or “existence proof” as that is shown to help with their persistence in
STEM (Meza, 2017) because, along with Black students, Black faculty have also been
underrepresented at U.S. universities.
Faculty
Research has demonstrated that Black faculty are underrepresented at college campuses
in the United States (U.S. Department of Education, 2020). In California, Black faculty across
disciplines comprise no more than 6% of tenured faculty and 5% of non-tenured faculty across
the UC, CSU, and community college systems, with the UC system having the lowest
percentages at 3% and 2%, respectively (Bustillos, 2018). These data were highlighted by a
study that finds Black faculty only accounted for 1% of biology professors and 1% of chemistry
professors nationwide (Li & Koedel, 2017). Along with previously discussed systemic racism
that denied equal opportunity to Black students, prominent reasons for the gap in Black STEM
professorship has included concerns of unequal financial compensation (Startz, 2017), racially
hostile work environments and Black faculty’s trauma of experiencing racism throughout their
own college education (Truong & Museus, 2012).
Other avenues of research have provided insight on the representation gap through
examining the percentage of the Black population with qualifying degrees to teach STEM
subjects at the university level. In 2017, Black citizens and permanent residents (green card
holders) comprised only 4.9% of biological and biomedical doctorate recipients in the U.S.
(National Science Foundation, 2017a). In the same year, Black citizens and permanent residents
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accounted for 3.3% of chemistry doctorate recipients in the U.S. (National Science Foundation,
2017). Additional data from the same study showed that these low percentages have been an
existing trend dating back to 1997 at the least (National Science Foundation, 2017b). Black
medical school faculty have cited similar concerns of hostile working environments as
demotivating factors to persist in academic medicine (Page et al., 2011).
Underrepresentation of Black faculty means that Black premedical students may not have
received the same-race mentorship experiences needed to persist through the premedical pipeline
(Bean & Eaton, 2016; Gasman et al., 2017; Thomas et al., 2011). An underrepresentation of
Black faculty in leadership roles on college campuses suggests that campus leadership charged
with development and oversight of support programs catering to Black premedical students may
lack similarities in life experience necessary to best address student needs.
Support Programming
Recent studies demonstrated that research into Black students’ perceptions about campus
support programming is of emerging interest, as little research has been done in this area (Karp,
2011; Uwaezuoke, 2018). Furthermore, much of the research that has occurred in Black student
success in higher education has been written using deficit language. Student inadequacies have
been the central focus of this research, while the institutional structures of racism that have
created obstacles for underrepresented minorities to succeed in higher education have been
deemphasized or unmentioned altogether (Harper, 2012). This has been evident in prominent
support models such as Tinto’s Model of Student Retention (National Academy of Sciences,
National Academy of Engineering, and Institute of Medicine Committee on Underrepresented
Groups and the Expansion of the Science and Engineering Workforce Pipeline, 2011).
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Tinto’s theory, which has been purported as foundational in student experience and
retention (Braxton, 2019; Karp, 2011), discussed the importance of sense of belonging for URM
students and suggested social and academic interactions are means to increase said sense of
belonging (Tinto, 1993). However, Tito’s model has not sufficiently addressed the racial context
surrounding URM sense of belonging (Karp, 2011). Instead, this component of Tinto’s model
has implied Black students’ assimilation to the university as opposed to the university’s
acceptance of Black students. Conversely, HBCUs have successfully retained Black premedical
students by making them feel welcome for who they are (Gasman et al., 2017). Tinto’s model
also has not addressed to stigma URMs might feel while utilizing URM specific support
programs at PWI, as they may be viewed by their peers as inadequate (National Academy of
Sciences, National Academy of Engineering, and Institute of Medicine Committee on
Underrepresented Groups and the Expansion of the Science and Engineering Workforce
Pipeline, 2011). Additionally, a study conducted by Karp, O’Gara, and Hughes (2008) on the
specific needs of community college students found that student support service at many colleges
operate under the assumption that URM already have the social skills and knowledge to utilize
support programs. This assumption is supported by data that showed the large majority of
California based university faculty and leadership are not from URM backgrounds (Bustillos et
al., 2018); therefore, those tasked with developing and delivering support programs may do so
without these concerns in mind. This idea is supported by a report from National Academy of
Sciences, National Academy of Engineering, and Institute of Medicine Committee on
Underrepresented Groups and the Expansion of the Science and Engineering Workforce Pipeline
(2011), which implied that retention strategies alone will not lead to retention of URM students
in STEM education, but that institutions who have been successful in reversing attrition trends
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have undertaken substantial institutional transformation efforts. These efforts included making
diversity and inclusion paramount within the institution and building capacity for educational
and social interactions across racial groups (National Academy of Sciences et al., 2011).
In considering the literature previously discussed, positive support programming through
the lens of CRT has the following components in mind: support is based on validating personal
experiences of Black premedical students; Black premedical students are made to feel valued for
who they are; Black premedical students are actively involved in dialogue about program
development and involved in its delivery; Black students receive validation about their academic
abilities and qualifications; and Black students are made to feel like they belong at the institution
and are deserving of their spot. Negative support programming does not consider CRT and
instead displays characteristics currently expressed as themes in the reviewed literature: support
programming is generalized, or colorblind, foregoing the diversity of Black student experience;
Black premedical students are not involved in program development; support for Black
premedical students is focused on changing student attitudes and behaviors to match the
institution; support programs focus on deficiency as opposed to being asset-based; Black
students academic abilities and qualifications are not validated, thus Black students feel alienated
from the rest of the student body.
While the problem of high attrition of Black premedical students is one of complex
nuance, campus-based support programming, such as the peer tutoring and early MCAT prep
seen at Xavier University (Gasman et al., 2017), can act as a means to address this issue and
ultimately address the underrepresentation of Black physicians in the United States. However,
the struggles PWIs have in retaining Black premedical students (Chen & Soldner, 2013; Rodgers
& Summers, 2008) demonstrated that support programing alone does not resolve the issue. The
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literature in this review has demonstrated the impact racism’s history has had on Black
premedical student retention and offers the opportunity for exploration of best practices by
listening to the underutilized voices of the oppressed. The conceptual framework to be discussed
in the following section provides explanation and visual representation of how support
programming that addresses the historic racism discussed in previous sections through hearing
and utilizing the student voice, can help PWIs retain Black premedical students.
Conceptual Framework
The conceptual framework of this research provides visualization of the paths a Black
premedical student may encounter within the medical school pipeline. These paths have been
established using Critical Race Theory (CRT). A term coined by Kimberlé Crenshaw, CRT was
developed by activist and legal scholars as an offshoot framework of critical law theory as a
means of better understanding the lack of progress around race in society during the post-civil
rights era (Delgado & Stefancic, 2017). For the key developers of the framework, CRT was a
response to colorblind ideology that looks to homogenize the racial experiences of individuals
and communities in the United States by considering everyone as the same and ignoring White
privilege that has been established and maintained through the structures that support systemic
racism (Delgado & Stefancic, 2017). As previously stated in Chapter One, CRT has four key
tenets: racism is the normal of U.S. society and not an exception; storytelling telling from the
oppressed is necessary to positively change racial narratives; the limitations of liberalism should
be scrutinized for the inability of legal paradigms to cause the fast-sweeping change needed to
address racism; and Whites have been the primary beneficiaries of affirmative action (Delgado,
1995; Delgado & Stefancic, 2017; Ladson-Billings, 1998), with tenets one and two being the
focus of this study. Tenet one helps to explain racial blind spots that exist in PWIs approach to
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34
supporting their Black students that result from a normalized history of racism that may cause
these institutions to perpetuate stereotypes that imply the inferiority and otherness of Black
students. Tenet two helps to provide a means of addressing these blind spots and creating
equitable support that ultimately reduces the representation gap amongst the Black population in
the U.S. and the number of practicing physicians. Figure 1 provides a graphic representation of
the conceptual framework used in this study.

Figure 1
Conceptual Framework

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Starting with the Black premedical student in the medical school pipeline, Figure 1
illustrates how the conceptual framework’s two paths are split based on how an institution
addresses tenets one and two of Critical Race Theory in the creation of campus-based support
programming. The conceptual framework is designed to demonstrate how support program
experiences may impact Black premedical students’ persistence in the medical school pipeline by
motivating or demotivating them to continue their premedical education when faced with
education related challenges typical of Black students.
The top pathway in the conceptual framework is the positive path in which the
institution addresses tenets one and two of CRT by understanding and acknowledging racism’s
historic impact on Black students and in response, offers support programming that is inclusive,
non-biased, and focuses on the individual’s ability to act and be accepted for their authentic self.
The flow of the “support programming” box points to the “positive student experience,” where
the previously mentioned characteristics of positive support programming, as derived from the
literature, are listed. On this path, the previously mentioned positive support characteristics, as
seen at HBCUs (Gasman, et al., 2017), are interwoven with the types of support programming
that the literature previously reviewed mentions as crucial to the retention of Black premedical
students (Thomas et al., 2011).
The bottom pathway in the conceptual framework shows the negative path where, like
the top path, the institution offers support programming for their Black premedical student
stakeholders. Unlike the positive path, the “support programming” box in the negative pathway
reinforces CRT tenet one through non-inclusive, biased based support programming that
emphasizes assimilation as opposed to value congruence. The characteristics of this path are
represented in the “negative student experience box” do not consider blind spots caused by
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normalized societal racism and do not engage students as a means of addressing these blind
spots, as supported by CRT tenets one and two, respectively.
In the negative pathway, institutions do not adequately address biases created by
historic racism, as demonstrated by the literature previously presented. Furthermore, institutions
on the negative pathway do not engage students in changing the narrative of support programing
by telling the story from the perspective of Black premedical students. As a result, students
remain at risk of leaking out of the medical school pipeline at high rates. This attrition leads to a
continued low number of Black applicants to medical schools and ultimately a continued
shortage of Black physicians in the United States, which may have grave implications on the
health of the nation’s Black population. As CRT states, racism in the form of bias and
marginalization are normalized fixtures in U.S. society; therefore, the oppressed must be in a
position to tell their story in order to begin to address the issue (Delgado & Stefancic, 2017;
Ladson-Billings, 1998). This also means that to address the health disparities in Black
communities, there needs to be more Black physicians to start the process of healing.
As demonstrated by this conceptual framework, PWIs can make important gains when
considering CRT tenets one and two. When PWIs understand and acknowledge the history of
racism in the U.S. and work to address their racial blind spots through understanding the
experience of their Black premedical students, positive outcomes of Black student persistence in
premedical education like HBCUs, such as Xavier and Prairie View A&M, and may be achieved.
If CRT tenets one and two are not addressed, the cycle of high rates of attrition amongst Black
premedical students at PWIs will persist.

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Conclusion
The history of racism in the U.S. and its relation to the problem of high attrition rates for
Black premedical students is long and complex. Though the literature in this review cannot cover
every nuance on this topic, it provides an outline of the historical context, contemporary issues,
and the associated health implications related to the problem. In considering the significant
amount of scholarship undertaken in Black college student success, there is significant evidence
of the barriers that prevent Black students from becoming physicians. However, the success
HBCUs have had in guiding students through the premedical pipeline demonstrates that Black
students are fully capable of success in premedical education despite the obstacles that they may
face in their journey. What this means for primarily White institutions is that a lack of their own
success in Black student retention may be result of systemic issues that prevent Black premedical
students from being fully supported by the institution, thus contributing to the high rates of
attrition of Black premedical students.
The lack of success PWIs, especially in the state of California, which is a top producer of
the nation’s medical school applicants (AAMC, 2020), paired with the gap in literature on Black
premedical student perceptions and experiences utilizing support programs at PWIs, sets the
groundwork for research that adheres with the tenets of Critical Race Theory by telling the story
of need from the perspective of the oppressed (Delgado & Stefancic, 2017; Ladson-Billings,
1998). This emerging perspective of research can contribute a much-needed change in the
demographic makeup of physicians in the U.S. by best supporting Black premedical students
through the challenges specific to their identity, as society works towards removing the long-
lasting racial injustices that have inhibited the success of underrepresented minorities. In doing
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so, the next generation of physicians may be a diverse cohort who are trained and willing to
address the serious health concerns of underrepresented minority communities.
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Chapter Three: Methodology
As discussed in the previous chapters of this dissertation, there are many factors that
contribute to the underrepresentation of Black physicians in the United States. While the larger
societal issue cannot be solved with just one area of examination, the literature presented in
Chapter Two demonstrates the need for significant study of Black premedical students’
undergraduate experience. Starting with the overview of the research design, this chapter will
detail the methodology used to conduct this study, which explored Black premedical students’
experiences and perceptions of campus-based support programming at public universities in the
state of California through the lens of Critical Race Theory. Following the design overview, this
chapter will also address the research setting as well as the researcher’s background and
positionality. This text will then go on to discuss the data sources, including participants, survey
instrumentation, and data collection procedures. The chapter will conclude by discussing validity
and reliability in this work, along with the ethical considerations involved with conducting the
study.
Overview of Design
This study was conducted with a qualitative research design that utilized semi-structured
interviews for data collection. Semi-structured interview format was chosen to keep in alignment
with Critical Race Theory by allowing participants, who have typically had a limited voice in
student support research (Uwaezuoke, 2018), the opportunity to tell the story of their experiences
in undergraduate premedical education at PWIs. The semi-structured interview format
appropriately allowed for the development of an interview protocol that was used to guide the
interview process, while providing the freedom to explore participant responses and establishing
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a sense of partnership in creation of new knowledge amongst participants (Marriam & Tisdell,
2015).
Research Setting
As this study was conducted during the midst of the COVID-19 pandemic, all interviews
used in this research were conducted over the web-based teleconferencing platform, Zoom.
Participants were not provided the opportunity to be interviewed in person out of an abundance
of caution for transmitting the disease and out of convenience, as students participating in this
study were partaking in distance education away from their college campus. Zoom was deemed
as an appropriate medium for conducting interviews because of its video and audio recording
capabilities, as well as its audio transcription functionality. Furthermore, Zoom’s increased
utilization and popularity during the pandemic meant there was greater chance that participants
were familiar with the platform prior to their interview, thus decreasing the chance of a potential
technological barrier to successful data collection. Lastly, as the purpose of this study is to
understand the experiences and perceptions of Black premedical students to give them a voice in
this topic of study, it was important to cater the data collection process to their needs in order to
create a sense of community and collaboration. Participants who did not use Zoom as their
primary teleconferencing platform were given the option to have their interview conducted using
the platform of their choice, with the researcher responsible for acquiring said platform.
Demonstrating a willingness to use tools in which the participants are familiar, and on their
schedule, was a gesture to demonstrate their importance to this study.

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The Researcher
Professional Background
During the time of this study, I as the researcher, was employed as the Director of
Student Diversity and Inclusion Pipeline Programming at a medical school located in Northern
California, as well as being the lead coordinator for student affairs. In my role I was involved
with many areas related to this study including the admissions committee, outreach,
undergraduate support programming, and diversity and inclusion committees. In my role, there
was the possibility that study participants were familiar with me prior to being asked to
participate in this study; however, no participants were asked to be in the study because I was
familiar with them, nor did I know or recognize anyone who was asked to be in the study.
Positionality
Many aspects of my positionality are closely related to the subjects in the study. As a
Black male who has gone through multiple stages of education in the state of California and who
has engaged with prerequisite coursework for application to medical school at the time of writing
this dissertation, I have many experiences and opinions in regard to how institutions support
Black students. I also recognize that my level of education allows me to be situated in a place of
privilege and understanding of university processes that may in some ways be very different
from the participants. It is also of note that I was 7 years removed from undergraduate education
at the time participant interviews took place. This was an important detail to consider when
conducting this study because generational nuances may have shaped my perceptions of the
college experience differently than those of the participants, which if not considered could
unduly bias the data analysis process. Furthermore, as a student affairs professional at a medical
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school, I needed to be aware that I am in a position of power to where participants may perceive
that I can negatively or positively impact their application into medical school.
As to not mislead any participants, I practiced transparency by letting them know the
capacity in which I worked for a university, but also reassured them that I was conducting this
survey as a fellow student researching ways to make a positive change. In the invitation to the
survey, I emphasized that this project was about only their experiences and perceptions. I used
my positionality as a tool to be relatable for the sake of getting the most detailed answers
possible from my participants, but I did not make it a focal point of participant interactions.
Furthermore, I made minimal reference to my own educational or other experiences unless it was
called upon by the participants to facilitate discussion.
Data Sources
As the purpose of this study was to explore Black premedical students’ experiences and
perceptions of support programming at public universities in the state of California, this study
relied on interviews as the method used for gathering data.
The following section will provide details into the participants, criteria, instrumentation,
data collection, and analysis procedures used to conduct this study.
Participants
This study featured interviews from self-identifying Black premedical students who
attended public universities in the state of California within four years of the study date and were
in the process of applying to medical school during the time of the study. The aforementioned
college class status was selected for this study because Black students in the medical school
admissions process would have had the opportunity to complete a significant portion of their
basic science coursework, including participating in chemistry courses which have been
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identified as a major attrition point for underrepresented minority students (Barr et al., 2008;
Gasman et al., 2017), thus having the ability to speak to the many challenges of premedical
education and their strategies for addressing them. Furthermore, due to the limited sample size of
participants, it was of benefit to the study to limit class status to gather data on a concentrated
group of students.
Participant Selection
Purposeful sampling was used to select four female and four male students who self-
identify as Black premedical students in the University of California and California State
University systems. Participants were recruited through contact to premedical student groups at
identified campuses, as well as through recommendations from student affairs colleagues.
Student group advisors and student affairs staff were asked to send out a recruitment email to
their students with instructions stating for students to contact the researcher directly if interested
in participating in the study. The study sought to choose eight participants, equally divided
amongst male and female, to gather meaningful insight from a sample size large enough to
provide diverse perspectives across multiple college campuses in the state of California while
still being a small enough sample size to reasonably accommodate an interview period of two
months. Recruitment efforts yielded seven participants within the one-month recruitment period
due to a lack of recruitment responses, one disqualification of a candidate who did not meet
study criteria, and one non-response from a candidate who replied to the call for participants.
Five of the seven participants were female, while the other two identified as male. All
participants were contacted and selected in the order in which they responded to the recruitment
email. Upon replying to the recruitment email, participants were asked to confirm their premed
status and university. The lack of responses to recruitment and the gender composition of the
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participants is in alignment with data that shows there were a limited number of Black premed
students at public universities in the state of California (AAMC, 2019) that skews female
(AAMC, 2019). The participants came from four universities, with one university (referred to as
University Four in Chapter Four), providing four students, while the other three campuses
provided one participant each.
Although the goal of this study was not to investigate intersectionality between race, sex,
and Black premedical experience, the study participants were split evenly amongst male and
female to gain insight from both sexes. Purposeful participant selection was utilized for this
study because, in keeping with the Critical Race Theory framework, Black voices are needed to
change racial narratives surrounding institutions such as education, yet those same voices are
often missing from the conversation. Therefore, it was of utmost importance to hear from only
Black premedical students in this study. While there is significant research on the need for
support programming to ensure the success of Black premedical students (Thomas et al., 2011)
and the factors that lead to their attrition from STEM programs, Black student experience is an
emerging area of study (Karp, 2011; Uwaezuoke, 2018).
Instrumentation
The semi-structured interview format selected for this study was accompanied by a 13-
question interview protocol. As the study’s focus was student experience and perceptions, the
questions included in the study’s interview protocol were opinion, feeling, and experience based,
in reference to Patton’s question types (Marriam & Tisdell, 2016). Semi-structured interviews
provided the needed flexibility to ask participant responses with probing questions, as needed,
that helped to expand on participants’ thoughts and create new knowledge based on their
storytelling. Utilizing a completely structured protocol may have given the participants the
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impression that the researcher wanted only short answers to affirm their own world view
(Marriam & Tisdell, 2016) or that they are not equals in the knowledge creation process, thus
reinforcing the negative support programming path illustrated in the conceptual framework.
Furthermore, highly structured interviews in this context would not allow participants the
opportunity to elaborate on their responses as a part of the effort to extract their worldviews
(Marriam & Tisdell, 2016), which is a key component of addressing tenet two, the need of
storytelling from the perspective of the oppressed to positively change racial narratives, of CRT.
The questions asked of participants focused on their familiarity and experiences
accessing and utilizing campus support programs, their racial sense of belonging on campus, and
their perceptions of effectiveness of support programs offered by their university. The intended
outcome for the questioning was to gain information on ways in which institutions can be more
impactful and inclusive when addressing Black premedical students’ needs to address high rates
of attrition from Black premedical students, as is well documented in literature. The questions
asked of study participants can be found in Appendix A.
Data Collection Procedures
Data collection for this study was conducted via Zoom audio and video recording. To
ensure the privacy of all participants, all recordings were made directly to a computer hard drive,
transferred to an external hard drive, and deleted after the study was published.
Interviews were conducted in the late summer 2021. Each interview was approximately
50 to 75 minutes, with time varying based on depth of responses and opportunities for probing
questions. All participants received a brief summary of the study in clear, succinct language and
a consent form via email and verbally on camera before beginning interviews.
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Video and audio recording, accompanied by the auto-generated text transcript, was
selected as the means of capturing data to allow the researcher to dedicate their attention to
participant responses in order to formulate the best follow-up questions in the semi-structured
interviews and to signal to participants the researcher’s willingness to engage in dialogue. In
addition, audio visual recording provided the opportunity to capture participants’ physical and
verbal responses verbatim to be analyzed at a later time (Marriam & Tisdale, 2016). The physical
cues captured on camera were used to provide additional context, such as discomfort or agitation,
to the participants’ speech. Handwritten notes were taken during analysis to synthesize
understanding from participant responses and to keep track of areas of specific interest in the
data.
Data Analysis
Data collected from interview participants via Zoom audio/video recording, subsequent
transcripts, and handwritten notes were coded using a hybrid of coding approaches to best make
meaning of data and to keep in line with the CRT framework. Emergent coding was selected to
allow the data analysis process to begin by investigating reoccurring themes provided by the
study participants as opposed to the researcher’s own world view (Creswell & Creswell, 2017;
Elliott, 2018; Eskolta, 2013). This process was aligned with CRT tenet two, which states that
story telling of the oppressed is necessary for positive change (Delgado & Stefancic, 2017;
Ladson-Billings, 1998). This was an important point of emphasis in design of this study, as much
of the literature on support programming does not speak from the experiences and perceptions of
Black premedical students, therefore they were able to tell their own stories or counter stories
during the interview process (Karp, 2011; Uwaezuoke, 2018). Established coding, the process of
reviewing and organizing data with specific themes in mind (Creswell & Creswell, 2017), was
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used to investigate and organize fine details in the subsequent reviews of the data collected from
participants.
Coding Process
Coding was performed by reviewing data collected from each interview participant and
appropriately categorizing said data on a spreadsheet with columns that identified themes and
rows for topics established during data analysis. The creation of the themes used in this study
were derived from modifying Saldaña’s Code-to-Theory Model (2008), where data is used to
generate codes, which are then used to generate categories that are used to create themes or
concepts that lead to theory. In this study’s modified model, data was used to generate codes,
which then was used to create categories referred to as topics. Topics were then categorized into
themes found throughout the study data, as shown in Figure 2.

Figure 2
Coding Model

Note. Left- Saldaña’s streamlined codes-to-theory model for qualitative enquiry. Right- derived coding model
for this study.

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The spreadsheet grid created by the themes and topics, referred to in this study as the Coding
Grid, house the codes that were generated in data analysis. Accompanied with each code is an
identifier, based on participant numbers assigned by a random number generator web
application, that linked a participant’s statement that was pulled from study data. Each identifier
included a numeric value that acts as a tally to signify how many times each participant made a
distinct comment or return to a topic identified on the spreadsheet. The following system was
used to connect codes and participant identifiers: code, underscore, participant identification
number, followed by an underscore and numeric value (ex. Belonging_P1_1). Topics that were
associated with multiple themes were represented on the spreadsheet appropriately, as seen in
Figure 3.

Figure 3
Coding Grid example with participant identification numbers

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In addition to the Coding Grid, a data organizing sheet was used to provide quick
reference to participant responses after themes and topics have been determined and counted for
reference of occurrence. As seen in Figure 4, the Data Organization Sheet is organized in
columns to show theme, topic, description or analysis of data, and the data itself as verbatim text
from the participant with their unique identifier. Each topic has its own row organized next to the
row entry for the corresponding theme.

Figure 4
Data Organization Sheet example

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This coding system was created to provide an effective means for organizing data for
meaning making, as well as to provide an efficient way to recall examples to be provided in the
study results. Additionally, this coding system provided an easy means to keep track of how
many times a topic appeared throughout the study data and how many entries fell under each
theme. This information was important in establishing commonalities between participants to
demonstrate that the participant’s concerns were not isolated incidents but instead symptoms of
systemic issues.
Credibility and Trustworthiness
To ensure credibility and trustworthiness in the findings of this study, three strategies
were adopted from the work of Merriam and Tisdell (2016): member checking, peer
examination, and reflexivity. The following section will outline how each of these three
strategies were utilized in this study.
Member Checking
In keeping with the tenets of Critical Race Theory, the process of study participant
review of researcher interpretation, known as member checking, was an essential component of
this study. Member checking was an important method for establishing credibility in this study
because it provided the opportunity for study participants to be directly involved with the
creation of their own narrative (Merriam & Tisdell, 2016), as is associated with tenet two of
Critical Race Theory. Furthermore, member checking was needed to support this study’s intent
of speaking to the lack of research into the experiences and perspectives of Black premedical
students, as identified by existing literature reviewed in Chapter two.
During the data analysis period of this study, participants were contacted to confirm
summarizations of their thoughts and ideas when there was ambiguity found in their response, to
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avoid misinterpretation of data. Each participant was assigned a participant number which
referenced their contributions in Chapter Four of this dissertation.
Peer Examination
As described in Merriam and Tisdell (2016), peer examination was utilized to explore the
study’s data and findings based on the knowledge and experiences of the researcher’s peers in
the study subject matter. This study utilized two peer examiners, each of whom at the time of the
study worked in undergraduate education and studied issues of underrepresented minority
students. Peer examination focused on examining the researcher’s interpretations for
sophisticated understanding of participant responses and researcher biases. While plausibility of
participant responses was a consideration of peer examination, it was important that this study
strived to accept the testimony of Black premedical students as it was given. As opposed to
scrutinizing the validity of participant responses, peer examiners explored the technical details
related to university structure, administration, and faculty, as told by the participants. The peer
examiners were instructed to note inconsistencies in these areas that may require follow-up
member checking with the study participants. All participants were presented to the peer
examiners using the identification numbers assigned to the participants to preserve
confidentiality.
Reflexivity
Another method used to establish credibility and trustworthiness in this study was to
divulge the researcher’s positionality to discover and disclose any biases held by the researcher
which had the potential to impact the interpretation of data (Merriam & Tisdell, 2016). The
researcher section of Chapter Three provides valuable insight into the researcher’s positionality
and worldviews; however, the researcher provided additional clarification to comments made in
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the recommendations for change found in chapters four and five of this dissertation, as
necessary, to guide the reader in understanding the researcher’s interpretations of data (Merriam
& Tisdell, 2016).
Ethics
The nature of this study required participants to reflect on potentially upsetting and
traumatizing experiences they may have had throughout their time in institutional education. It
was the researcher’s privilege to be provided with such data to be used for analysis and
interpretation. In realizing this privilege and responsibility, all participants were involved in
ongoing consent throughout the process of this study. Prior to their interview, participants were
emailed a written consent form to e-sign and provide to the researcher prior to beginning the
interview session. The consent form asked permission to record both video and audio from the
interview session, as well as to utilize the participant’s responses as collected data. In the period
of time before the start of an interview, the participants also received a verbal request to record
video and audio for the duration of the interview process. The participant was given complete
power to request the stoppage of the interview and all associated video and audio recording upon
immediate request. The participants also had the right to ask to see any handwritten notes or
video transcripts. Additionally, the researcher was prepared to ask the participant if they would
like to stop interviewing if the research noticed the participant was under significant and visually
apparent emotional distress. All recorded data from interview sessions were saved to a private
computer and immediately transferred to an external hard drive immediately following the
interview session. The desktop versions of all recordings were then permanently deleted after
transfer to external hard drive was complete. For data safety, backup copies of recorded
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interviews were stored on a second external hard drive. All interview data was destroyed within
one month after completion of the research project and approval of this dissertation.
Confidentiality
All participants’ identities were kept confidential throughout any reporting of this study.
Assurance of this confidentiality was imperative because study participants may have chosen not
to answer the researcher’s questions truthfully and fully if under the impression that participation
in the study could negatively impact their chances of matriculation into the medical school. This
includes the medical school which employs the researcher or any other medical schools in the
United States. To the regard of participation in this study, reasonable concerns participants may
have held were the risk of falling out of favor with faculty in which the participants relied on for
letters of recommendation at their undergraduate institution; being regarded as a troublesome
student; or receiving additional scrutiny from medical school admissions committees for
revealed academic weakness. For these reasons, faculty were not informed of student
participation.
To establish confidence in the confidentiality of the study, the researcher assigned a
number to each participant and used said number system to refer to participants throughout the
study. Each participant was notified of their unique participant number upon receiving the
confidentiality agreement via email prior to the date of their interview.
Limitations and Delimitations
Delimitations
As mentioned throughout this dissertation, it is of important note that the subject of the
experiences and perceptions of students from underrepresented minority groups is one of
significant nuance and intersectionality. The goal of this study was to provide a general overview
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of the experiences and perceptions of Black premedical students and support programming at
public universities in the state of California while providing basic exposure to the considerations
of the diversity within said demographic to generate further avenues of research. With that in
mind, this study was conducted with delimitations, or boundaries of exploration (Theofanidis &
Fountouki, 2018) to guide the research.
This study did not specifically ask about differences in experience and perceptions related
to gender, sexual orientation, first generation status, subculture within the Black community,
immigration status, colorism, multi-racial identity, socioeconomic background, or K-12
education experience. However, though this study did not ask about these intersectional topics,
participants were encouraged to elaborate on them provided the participant introduced the topic,
it was of significance to them in telling their story, and it provided relevant data to the study.
Intersectional topics introduced in data collection and investigated in data analysis were
discussed in the suggestions for additional research.
Limitations
As previously mentioned, this study was conducted during the COVID-19 pandemic in a
time when the state in which the study took place was particularly hard hit by the disease. As a
result, most of typical university life in the state was disrupted, including student’s access to on
campus resources. It should be noted that the perceptions of the students in this study may have
been shaped by the trauma and irregularity of COVID- era distance learning. It is suggested that
additional research be done in this area by conducting a similar study with Black premedical
students when they have the opportunity to return to a more typical university lifestyle where
campus faculty, staff, and support resources are functioning at or close to full capacity. In
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addition to considerations regarding COVID-19, this study was limited by the willingness and
truthfulness of its participants.
After reviewing the literature regarding Black students in U.S. universities and the history
of the Black community and medicine, it is reasonable that study participants choose to withhold
their true feelings along with other important information, even if the researcher is of a similar
positionality. Students applying to medical school understand the extremely competitive nature
of the application process and may not have wanted to appear inadequate in any way, especially
when knowing the researcher is associated with medical school admissions. For this reason, it
was imperative that the researcher build trust and rapport with the study participants; ultimately,
the accuracy of this study is at the mercy of the participants’ willingness, as it should be so in
order to continue on a new path of support with enhanced equity and substantial results.

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Chapter Four: Findings
In addressing the medical school pipeline component of the representation gap amongst
Black physicians in the United States by investigating Black premed students experiences and
perceptions of support programming at public universities in California, two key themes were
identified in this research. The first theme was that participants’ dissatisfaction with support
programming related to campus capacity for support; the second theme found that participants
lack a sense of belonging in their premed experiences. These findings were determined based on
the experiences and perceptions of the study participants and in consideration to the literature
presented in Chapter Two.
This portion of the dissertation will present the findings related to the identified themes in
two sections. The first section will cover the participants’ dissatisfaction related to campus
capacity for support by covering four topic areas: awareness of programs, advisement and
guidance, availability and usefulness, and relationships with faculty. The second section will
cover the theme of belonging while covering the topics of isolation and the need for community.
To protect confidentiality in this study, all participant quotes will be attributed to their randomly
assigned participant number. All names of universities and support programs that can identify a
specific campus have also been removed from quotes to protect confidentiality.
The participants in this study identified themselves as Black and premed. All participants
attended public universities in the state of California within four years of the date this study and
were actively in the process of applying to medical school. The students were recruited from four
public universities. Four of the seven participants attended the same university. Table 1 provides
a visual representation of the participants, including their pseudonym, gender, and their de-
identified campus.
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Table 1
Participant Information
Identification Gender Campus Graduation Year
Participant One Female University 1 2017
Participant Two Female University 2 2018
Participant Three Female University 3 2019
Participant Four Male University 4 2022
Participant Five Male University 4 2021
Participant Six Female University 4 2021
Participant Seven Female University 4 2020

Campus Capacity for Support
Data show that each of the seven participants in this study expressed overall
dissatisfaction in how their campuses supported Black premed students, as illustrated by
Participant Two’s blunt statement “my undergrad school is not the best example of a support
system.” This dissatisfaction was linked to experiences and perceptions about campus capacity,
or ability, to support Black premed students. But while participants expressed their overall
dissatisfaction, data analysis reveals nuance, as all seven participants were also able to speak to
some positive aspect of support programming on their campus. This leads to the understanding
that campuses have mechanisms in place to support Black premed students, but with
opportunities for improvement.
As it was important to start each interview by understanding what support programs the
participants were familiar with on their campuses, the first category presented findings related to
participants’ inconsistent awareness of support programming on their campuses.

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Awareness
Data show that all seven participants in the study expressed lacking a consistent and
reliable means of awareness of support programs made available to them by their college
campus. The participants expressed varying ways in which they learned about support
programming, including word of mouth amongst peers, reference by advisors or faculty, self-
directed internet searches, informal classroom presentations, and by chance encounters on
campus. Participant Six described how they learned about a program they perceived as valuable
through a chance encounter when trying to locate a classroom:
I think it was the first week of school, they have like the tables out, you know… these
[program representatives] were very forward. They were like “hey if you need help, we
got you.” So I went to the booth, and I just wrote down my [information] and since then
they were emailing me. They even have new job opportunity as well…they look out for
you in every way.
When asked if there were other means for students to find out about this program, the participant
replied that the social media application Instagram, which was operated under a student managed
account, was the primary method in which she was able to stay updated on their activities,
alluding to uncertainty about formal modes of awareness. Furthermore, the program’s social
media coordinator was a peer in the participant’s major and served as a visual reminder for the
participant to keep up with the program. As stated in the following quote, Participant Six
described how she and other students could be made aware of the program’s activities:
… they [DEGREES program] keep up with their Instagram a lot, so every time I would
see their posts, it would always be something I never knew about…their social media
person was actually in the same major as me, so every time I would see her I was like
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“oh, DEGREES!” [program name]. And then they would [post] “coming into your class”
talking about what they do…I remember one time they came into my math class [and]
gave us little fun questions and whoever answered them right [would] get a pop socket
that said DEGREES on it. Or they’d give you like a Starbucks gift card as long as you
come into the DEGREES office and tell them how you're doing that day; that's all you
[needed] to do.
This quote demonstrates that though the program did perform outreach to the student body, such
as visiting classes, their primary level of awareness, as told by the participant, was related to
students having knowledge of the program’s social media presence as opposed to an official
communication strategy put forth by the university. This is highlighted by the fact that of the
four participants from same university (Participants Four, Five, Six, and Seven), only Participant
Six made any mention of said program when asked about the programs they were aware of or
utilized on their campus. Of the programs mentioned by participants from this campus, no
programs were universally known by all four of the participants. There were only three programs
that were mentioned by more than one participant, with two participants being the highest
number of participants familiar with a single program. Participant Four spoke to the
inconsistencies of program awareness by describing how he learned of a premed support
program through a search on the school’s website as opposed to communication from a pre-
health advisor:
they [the pre-health program] didn't tell [about] it [the support program]. We [students]
didn't receive an email or anything like that. What I continuously do is I googled
[university name] premed and that [program] popped up…I actually found that [program]
out like three or four months ago, maybe not even that. And so I joined “like what is
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this?”…I clicked on the CANVAS [learning management platform], I was like, “oh this
is all new to me”... that would be pretty cool to receive that my freshman year.
Participant Four’s response shows similarity to Participant One’s experience of not learning
about their campuses support programs specific to Black, indigenous, and people of color
(BIPOC) students until halfway through their undergraduate degree:
Maybe my second or my third year I learned about a program that [university name] had
for students of color for premed…where it gave you that one-on-one mentorship for
premed students. It was very selective and it's only accessible for first years...by the time
I found out about it, I was passed the [point] where I could apply.
These quotes highlight how important support programming may go unutilized by Black
premedical students due to lack of awareness. As participants report missing out on valuable
support programs early in their premed careers, it is important to consider these data because
literature states that many Black students discontinue premedical education early in their first
and second years of college (Barr et al., 2008; Lin et al., 2013). The literature is supported by
data from this study, as none of the participants mentioned a centralized means for learning about
support programs, yet six of the seven participants stated they knew of another Black student
who discontinued as a premed major. The participant who did not know a Black student who
discontinued as premed, Participant Four, stated that they were not familiar with other Black
premed students at their campus, but did express how important they felt knowledge of support
programming was for the persistence of Black premed students:
…as I said before, if they [Black premed students] don't have the resources and they don't
already come with a strong set of skills or strong knowledge of chemistry, bio physics,
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they may feel like they don't have the cognitive ability to progress forward. They might
just end their [premed] career there.
In addition to his quote discussing the importance of support programming, Participant Four’s
unfamiliarity with other Black premeds also speaks to concerns regarding the effectiveness of
word-of-mouth awareness of support programming amongst Black premed students.
It was the perception of all participants in the study that Black premed students were a
small minority on their campuses, with three participants estimating Black premeds accounting
for less than two percent of their campus. Additionally, all participants stated that they were
often the only or one of few Black students in their classes or participating in premed activities
on their campus. These perceptions are in alignment with data stating Black students only
account for 6% of students in California’s public higher education system (Bustillos et al., 2018).
This may mean that Black premed students, who are seemingly disconnected with one another
on campus, do not have adequate opportunities to share their knowledge about and experiences
with support programming amongst peers of the same race. This idea is articulated in Participant
Six’s quote regarding her thoughts on sharing information with other Black premed students:
… When we find each other, we kind of stick together. And so that information, it
spreads to the group like wildfire. So, when one person doesn't know, everybody doesn't
know; but if one person does know, I’m going to tell everybody…basically we're all
going to eat together, because if I find help for me, I'm going to give it to everybody else
too. But if I don't know it, then who will.
This quote demonstrates the important role student networks have in the dissemination of
information related to available support for premed students. But as all participants have stated,
Black premeds often do not have the chance to engage with other Black premed. These
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participant comments seem to indicate that universities may not be able to adequately reach
Black premed students and provide the support they may need. Furthermore, in considering how
participants became aware of support programming on their campuses, no participants mentioned
receiving information from the university’s formal guidance channels, such as advisors or
counselors, as their primary means of learning about support programs. No participants
expressed a strong awareness of all the support programs available to them at their university.
Instead, all participants expressed some level of concern regarding their experience with
advisement and guidance from their campus.
Advisement and Guidance
Data regarding participants’ experiences and perceptions of premed guidance on their
campus produced mixed opinions. While all participants reported at least one positive experience
receiving guidance on their campus, all participants also expressed negative experiences,
including advisement providing inaccurate or outdated information, or having limited capacity to
serve students. Participant One stated that an advisor intentionally withheld important
information about available support because of their race:
When I got to [university] I was not aware of any support programs whatsoever…we
have the [building name], which was a special building for housing counselors and
resources for minority students. I saw a counselor there and told them “I’m a premed
student, I need all your resources.” Initially I did not get access to all resources. I happen
to have a roommate, who was a Latina and she happened to have a packet …with like a
roadmap for premed students and I said “how did you get that packet?” She said, “oh my
counselor gave it to me!” I happen to have the same counselor as she did but [the]
counselor didn't give me the same resources she gave her. I had to really advocate for
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myself to get those resources. I had to dig deep… How can I put this; my roommate was
[Latinx], her counselor was [Latinx]. I did hear [the counselor] say on many occasions
that she feels like her role is to, as a Latinx women in a predominately White space,
advocate for her people. So to me that's kind of how it came off; I didn't get that resource
just because that's how the cards were dealt. And that kind of kind of became the theme
for my experience at [university].
Participant One’s response describes a perception of unfair treatment from counselors at their
campus, even amongst counselors from underrepresented minority backgrounds, and perhaps
speaks to larger issues of Black student isolation (to be further discussed later). Though only
Participant One discussed a situation where they perceived counseling services were withheld in
direct relation to their race, Participant Six told of two instances of how she was indirectly
denied the same advisement resources as her peers. In one scenario, Participant Six discussed
how a program for underserved students was designed to offer advisement based on racial parity,
yet there was often no one available to serve them.
…I went in there [program specific counseling center] to get an appointment with an
advisor and they [the staff] were like “um, hold on, let me go get somebody for
you”…they like keeping it Black with Black, just in case there are some similarities that
somebody else can help you with…they're like “well right now we don't have anybody,
but we can help you maybe tomorrow?” And so I'm like okay I just have to go because
tomorrow [there’s] going to be a whole different problem [I need help with]. My trust
[with them] is very low.
This quote describes an instance where Participant Six perceived that they were not connected
with counseling service because the center preferred to match students based on racial parity but
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there were no Black counselors available on that day. Participant Six went on to describe how
they perceived the program to be disorganized when assisting Black students:
It was so disorganized; you couldn’t even go in there and ask somebody for help. They
were like “okay hold on, let me go find somebody”, and I'm like wait; if I were anybody
else (another race) asking for help you guys have a line, you have a pick a number
system, something. But when I go in there for help, it's so disorganized every single time
and nobody cares to [address that issue]…How can I trust that you guys have my best
[interest] at heart when I come in here and you guys can’t even help me. So, I have zero
trust in it [counseling from that program] just based off of that, because every time I try
and go there's nothing there for me to get help. I leave like five minutes later.
In another scenario regarding a separate aspect of the same program, Participant Six recalled that
she was placed in a cohort of students meant to act as a learning community where students of
similar racial background and academic interests could network and share resources amongst
themselves while receiving mentorship from a faculty advisor. Participant Six stated that her
cohort was comprised of all Black students but of different majors, making it difficult to discuss
similar academic experiences. It was Participant Six’s perception that her cohort did not receive
the same level of attention from the program administrators as other cohorts in the program.
Participant Six shared that her faculty advisor, who she stated was the only Black professor
involved with the program, openly acknowledged that he also felt the cohort of Black students
did not receive the same level of attention as other cohorts. Participant Six recalled that her
faculty advisor told her that he was often dismissed when attempting to bring up their equity
concerns to the program administrators. These concerns were put into example by Participant Six
in the following quote regarding their experience at a ceremony for the program:
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I think it was our Crossing Bridge ceremony; it was in person, and we had four guest
speakers. All of them were [Latinx], none of them were Black. There were at least 20
Black [program participants] in there and we were all at one table, again. We were all like
“okay, I wonder who's going to come tell us that we're doing good, who are these guest
speakers?” No Black representation came out, so I was pretty mad. I went up to him
[Participant Six’s faculty advisor], I was like “why didn't we get any representation?”
He's like “yeah I'm trying to do that, too”…So now, I feel like I'm at the bottom. I feel
like I should just quit, like I should just give up because nobody's trying to help me.
Participant Six’s experience demonstrates perceived instances of inequity in student
support along with frustrations Black premeds may experience when seeking support on their
campuses. This is idea is supported by study data showing in addition to Participant Six, all
participants except Participant Four acknowledged experiencing frustration when looking for
guidance from their campus. Participant Four, who did not discuss experiencing frustration,
instead acknowledged the justification for other Black premed students to have feelings of
frustration that may lead to premed attrition. Participant Four, who was the only participant in
which both parents graduated from college, acknowledged that having prior exposure to the
higher education experience through his parents helped him to be more resilient to the challenges
of seeking advisement; however, Participant Four agreed with other participants that their
campus needed to do more to support Black premed students. In addition to these concerns that
primarily focus on career and premed experiential advisement, participants also expressed issues
with guidance in completing their major coursework.

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Coursework Guidance
Five of the seven participants in the study expressed concern about the guidance they or
others have received regarding meeting the requirements to earn a bachelor’s degree in their
major. Amongst these participants, four (Participants One, Four, Six, and Seven) mentioned
concerns about receiving inaccurate advisement leading to taking the wrong classes, with
Participants One, Six, and Seven personally receiving conflicting advice, and Participant Four
having heard of similar experiences on their campus but not experiencing these issues firsthand.
Participant Six described their experience with academic advising as follows:
…I don’t go into advising and ask questions, I just go into advising for clarification
because the very first year I went there I would be like “so do I need to take this, Do I
need to take this” and they're like “oh yeah you take all of this”…From day one I was
already taking the wrong classes. I took multiple nursing classes, and they were wrong. I
took two classes, they were both wrong, and they were my hardest classes I ever had.
And I'm like “so nobody wanted to tell me this before I even enrolled?” … I took that fat
binder [with course information], that I made during the summer before I even went to
college, [to the advisors and said] “this is all the information I know I need, but I just
want to ask you am I doing it right, am I going in the right direction?” They [were] like
“yeah”. Two years later, I’m in the wrong major. I had literally I think 25 units from
[finishing] my psychology major and then I [had to add] another year to get into the bio
track. I was in a lot of first year classes, with a lot of first year students as a junior…I'm
still scrambling now today...Everybody tells me, yes [I am on taking the right classes],
and then I end up in the wrong class.
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Participant Seven also expressed a lack of confidence that academic advisors at their
undergraduate university had the knowledge to guide premedical students through their course
scheduling:
I don't feel like [the counselors had] the guidance and or the resources they probably
needed to direct the students where they needed to go. They [would] be like “oh take
your GEs, you know, take your general ed. first”. When I got to [community college
where the participant supplemented some classes] it was a totally different thing. I talked
to a professor and [they said] as STEM major you should get [as many of] your science
classes as you can done first. [Not doing that first was] a pivotal thing that added more
time to my overall experience… this is a student's time, it's their future, it’s their present,
as their money.
The previous two quotes demonstrate that though advisement may have been willing to work
with students, they may not have understood premedical course work needed to effectively guide
Black premed students, in some cases which they perceived as hindering their success. As was
the case with Participant Seven’s quote, the advisors at their university appeared not to have an
understanding of the amount of STEM courses required, and the difficulty in obtaining said
courses, to complete an undergraduate degree in the projected four-year timespan.
These data on participant experiences with and perceptions of advisement show that
though campuses have resources in place to provide advisement services, the services may not be
able to meet the needs of Black premed students who may not have the same awareness of the
steps necessary to become a competitive medical school applicant as their peers from other racial
groups with greater representation in the medicine. This was a similar consideration when
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analyzing data on regarding the participants’ experiences and perceptions of the active programs
offered at their campuses.
Availability and Usefulness
Data show that despite the participants’ inability to describe a centralized source for
learning about support programming on their campus, each participant was able to name at least
three support programs and options available to them at their university. This demonstrates that
there are mechanisms in place for student support. But despite knowledge of programming, each
participant cited concerns about the availability and usefulness of one or more programs in
addition to the previously mentioned concerns about advisement. Participant Three described
how they chose to sign up for a class designed to pair undergrads with graduate psychology
students to provide the grad students practice with their counseling abilities. The participant
chose to participant in this course because they were not able to utilize the campuses official
counseling and psychology services
At [university] we had CAPS which is counseling and psychology services; but the thing
with that is that it filled up really fast, and so, not a lot of students are able to utilize that
service. It's kind of like a first come, first serve to people who have already utilized it
before, so to get like an appointment is actually really, really hard. I didn't really utilize it
until spring semester of my [senior] year. There was a class [where] you help students
that are in their master's program basically learn how to be a psychologist or a
therapist…Because I couldn't get into CAPS, I was like “okay like I'll just use that
instead”. It worked out; it actually really helped a lot. I miss my mentor that I had.
Though Participant Three enjoyed utilizing the course alternative to counseling services, their
experience demonstrated the difficulty Black premed students may face in accessing this avenue
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of support. This is an important concern because access to counseling and psychological services
may be crucial to their success in overcoming the mental stressors, such microaggressions and
stereotype threat, that literature points out as being common in the experiences of Black premed
students (Griffith et al. 2007; Harwood et al., 2010). This participant’s experience bears
similarity to Participant Six’s experience of not being able to receive academic advisement
services at a particular program on campus because of the common unavailability of staff
members. When availability of services was not the concern regarding support programing,
participants cite scheduling difficulties that did not allow them to best utilize programs offered
by their campus.
Time Conflicts
Four of seven participants (Participants Two, Three, Five, and Seven) stated that they had
difficulty utilizing support programs on campus because of time limitations. Each of those four
participants cited being employed while in school to meet their basic needs. Of that subset of
participants, Participants Three, Five, and Seven cited needing to lighten the burden of expenses
for their families, with Participants Five and Seven citing that their families had multiple
children and only one parent as the primary income earner. The following quote provides
example of how Participant Seven described their reasoning for working while being a premed:
I have a total of three sisters, [there’s] four of us, and just my parents not being able to
supply the extra [financial support] that was needed, especially with [college education].
There was [always] three of us in some type of schooling at the same time. One parent is
the breadwinner in the family so it's definitely difficult.

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Participant Five provided similar remarks as to how they could not participate in programs that
both they and their faculty mentor perceived were helpful to the participants academic and career
success:
…my dad is really the only one in the family that works full time. I can’t expect my dad
give me what I need, so I have to work to pay my own bills, car insurance, car notes and
all [those] kinds of thing; I have to work to keep up to my own needs… There was no
way I was going to be a MAPS [Minority Association of Premed Students] Member or
board member and be able to do what they ask me to do while I still have to work and I'm
picking up 17 units a semester. If I do [join MAPS], then I have to sacrifice something. I
mean that's what happened at the end of the day, which affected my GPA…
Participant Five continued to explain how a professor consistently suggested joining a support
program which the participant could not utilize because of their scheduling conflicts:
…every time I wanted to get something done, she would always tell me, “you know if
you're part of this program they could help you with this” and I'm like “well, I'm not”. I
just can't go join. She always told me that if I was part of the SEE [spell out name]
program it'd be easier for me to be part of the PAL (support program), and they have
other organizations, other things that I could have been involved in if I was a part of the
SEE program. But the SEE program also requires time from me, and it's not going to
work out…it really made me feel left out.
Participant Five’s response highlights how an inability to engage in support programming due to
time constraints not only acts as a barrier to immediate opportunities, but also subsequent
opportunities students may learn about through campus engagement. The professor’s consistent
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mention of joining the same program also may indicate their limited knowledge of the support
programs available to students.
In addition to support program utilization troubles related employment conflicts, six out
of seven participants (Participant One, Two, Four, Five, Six, and Seven) mentioned class
scheduling concerns on their campus as barriers to support program utilization. Of those
participants, each participant mentioned taking a heavy course load, with Participants Two, Five,
and Six mentioning the need to prioritize taking several units a semester to avoid spending extra
time in school. Participant Two described their experience with classes on their campus as
follows:
It was kind of hard being at [university] and being in a science program for biology, or
even physics and chemistry, because [the class] schedules were so close and intertwined
that for your core electives, those classes staggered on each other as far as the days and
times that they will be available each quarter. We're really working hard to get all of
these classes taken in time. And sometimes you will be running, hiking across campus
trying to go from one class to another; so it didn't really leave the opportunity to join
those groups [support programs], at least for me personally. I went to school full time, I
was working part time, I was also caring for family who were sick. I didn't really have the
opportunity to do a lot of extracurricular activities that I wish I could have joined, it was
just too hard. And for the students who did do it, they were like walking zombies. I can't
devote my time, my attention, and my money towards something that can make me more
tired, depleted, and freak out during exams because I'm so exhausted. It's just not worth it
for me.
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Along with how scheduling impacted Participant Two’s ability to engage in support
programming, Participant One mentioned that they took on too many classes in their first two
years because of a lack of guidance. This relates to a statement by Participant Four, who did not
cite their own personal class scheduling issues but mentioned that it was their opinion that
support programming for Black premed students should include guidance on how to space out
class leading up to the MCAT examination for med school. This spoke to not only the previously
mentioned issues regarding the participants’ perceptions of the effectiveness of counseling and
guidance programs, but also perceptions about the importance of these programs and how Black
premed students may be impacted without them or if they are ineffective.
Effectiveness of Programs
Though each participant spoke positively about at least one support program, each
participant also questioned the effectiveness of the programs being offered. A shared concern
regarding program effectiveness was related to a perceived lack of personnel needed for proper
execution, a subject that also surfaced when discussing the counseling and advisement support.
Participant One stated that tutoring was often too overcrowded to be useful for their needs:
The programs are kind of treated- at least the tutoring programs- like a free for all.
Whoever comes can come, you can come when you want to come. In our chemistry or
[other] major science courses there could be 30 people in a tutoring session, so it's not
really that effective…and it’s only an hour
Participant Seven voiced similar concerns to Participant One, but added that it became
increasingly difficult to find tutors for higher level coursework:
The tutoring services were limited…and the teachers were busy, so you’re forced to try
and find a tutor [if you need help], [but] they don’t have a lot of tutors in the STEM
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field…[and] once you got to a certain level- I don’t know where [the tutors were] but
weren’t there.
In addition to concerns about tutor availability, Participants One and Six expressed concern
about tutors being peers who may be limited in their help due to having to navigate their own
academic careers. In contrast, Participants Five and Seven, who found peer tutoring useful, did
not mention concerns about their tutors being limited by their own academic responsibilities.
Participant One elaborated on their perception of peer tutoring with the following quote, which
also discusses how they perceive that administration measured the success of tutoring based on a
select few who excelled and often themselves became tutors:
…the person teaching is another student. They have their own life, they have their own
classes, they can't sit there and help every single person. And that kind of brings me back
into my other point; I feel like they [program directors] kind of got a little tunnel vision
and not really looking at the big picture in the success of all their students. They seem to
kind of capitalize or focus in on the successful few students who were excelling…I think,
to me it felt like 10% of people in our tutoring sessions were actually excelling and doing
well, and then they would graduate to be a tutoring [instructor] themselves…and [admin]
seemed to really put their focus on those students like “oh they're doing so well, they're
going to be awesome doctors”, but you're not looking at the other students who are really
kind of just drowning.
Participant One’s perception that administration is misguided in measuring program
success is important because it is consistent with each of the other study participants’ perceptions
about their own campus’ effectiveness in addressing the support needs of Black premed students.
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Each of the seven participants stated that their campus did not effectively address the
needs of Black premed students even in efforts that specifically target their success. Participants
perceived their universities to be misguided in thinking that the support offered was adequate.
This is highlighted by the fact that zero of the seven participants could recall any requests from
their universities soliciting the opinions or collaboration of Black premed students in developing
and measuring the success of support programming. Only Participant Six made mention of
receiving general feedback surveys that were sent out from their university. Additionally,
Participant One stated that it was her perception that on her campus there was no tracking of
Black premed students who used support programming to assess the success of any interventions
put forth. Furthermore, Participants One, Five, Six, and Seven stated that they perceived their
campuses effectiveness in helping Black premed students was diluted by efforts to help students
from other racial and ethnic backgrounds. Participant Five described how they were unaware that
a particular support program was targeted towards minority students because of the demographic
composition of the program:
…I'm not saying you shouldn't help other people, because I want to see [everybody]
helped, but the thing I didn't like about [the Minority Association of Premed Students
program] is you go there, because I guess it's meant to be for minorities, but once you
appear on scene, to me it doesn't really feel like it’s for Black people [or minorities]
only. You just see everybody participating. Everyone's on the board membership and
whatsoever. So it just feels like an everyday program on campus… I didn't even know
MAPS stood for minorities until after somebody told me.
Participant Five highlights a potential blind spot that campuses may have in supporting
Black premed students by creating spaces that are intended for Black and other minority students
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but not being intentional in their inclusion. Additionally, these data also speak to the collective
importance that participants place on Black spaces within college campuses, which is in
alignment with literature that speaks to the impact of Black spaces in higher education (Bentley-
Edwards & Chapman-Hillard, 2015; Brooms et al., 2015). This idea is supported by data that
shows while no participants expressed wanting any group of students to receive less help or
attention, they all expressed the need for support that is explicit in its attempt to help Black
students because of the specific challenges they face in their premed journeys. Participant Two
spoke about the need for Black spaces as a means of fellowship with peers who share racial
identity:
There should be a Black premed [organization] on every campus…there needs to be one
for all [ethnicities]- there needs to be something a little bit more [available] for everyone.
I understand there is an importance in people coming together, but there’s also
importance in people’s [racial identity] and that connection there.
Participant Three also spoke of their desire to have a Black “safe space” on campus:
One of the things I would have appreciated- and I feel like for Black students
specifically- is just having a safe space to talk or a place to go. We [University 3] had the
Hub, which is an area for the LGTBQ+ community, [I’d want] something like that. They
[the Hub] is inclusive to everyone, but at a certain point you need something more
specific.
These data from the previous three quotes speak to Black premed students’ need for racial sense
of belonging through community on college campuses, as discussed in the literature reviewed for
this study (Hope et al., 2013; Lin et al. 2013; Walton & Cohen, 2011) and to be further explored
later in this chapter.
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Relationships
Though all participants expressed some concern over being isolated and out of place in
their premed experience, all participants also cited having some form of positive relationship on
campus with peers and faculty. Participant Four explained that it was their perception that faculty
was always willing to help if approached: “[the professors] are really helpful in answering
questions and they are not hard to walk up to. They are approachable and I feel like they are
really helpful.” Participant Two became visibly emotional when recalling how much effort
he/she perceived his/her faculty put into supporting their STEM students despite having to take
on several responsibilities on campus:
… I get emotional with this- to be so close with the staff that you see how they're
struggling. We had teachers who couldn't go see family who [were] in emergencies
because they knew that they had to help their students, because we weren't getting help
[from elsewhere]. We had some teachers who were part of so many different committees
that going to see them you see all these papers all over the desk, and not even student
homework assignments past due because they're just slacking. They're stretched thin. The
same way that our school put a lot of heavy weight on us [students] and made us really
self-reliant, our teachers are going through the same thing, which is why they had so
much passion towards their career to the point where a lot of them got burned [out] and
they left. And they gave emails, they gave phone numbers, they gave Linkedin so that we
can still reach out for help.
Participant Six described the impact that a faculty member had on their persistence in premed
from early on in their undergraduate career:
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…my very first hard bio class I ever took, I was like “I don’t even know how to study for
this”. Then my professor looked at us [and said] “you're okay, calm down, just go
through the first day”. And after the first day, I understood so much and I thought it was
just because of my professor. He gave me a foot in the door and he told me “don't”
[participant sighs and smiles]; I cried in class. He was like “don't cry. I know this is hard,
this seems hard”. And [with] the amount of positivity he gave me every single time I
went in [to class], I would get As on my test… everybody in [the class] who was [a
minority] were all trying to be nurses and I was the only one trying to be a doctor. And as
soon as I told him that [I wanted to be a physician], he gave me extra work. He would
give me extra help to really tell me “you can do this, do that. You have the motivation,
and you have the drive.
The importance of faculty relationships was again cited by Participant Five, who stated that a
faculty member’s support for his dream of being a physician motivated them to persist in
premed:
… my sophomore year I had a Nigerian professor, she's Black, just like me. I told her my
dream is to become a doctor…I can never forget that time I went to pick up my lab
[exam] results from her, and then we started going and going [talking]. Then she told me
“go become a doctor it's definitely possible, you can do it.” I will never forget that.
These experiences highlight that the participants’ universities have stakeholders who are willing
and capable of offering the type of support that Black premed students’ value and, in some case,
need for their persistence into medicine. But while these positive experiences were important to
participants and demonstrate campus personnel’s willingness and ability to provide meaningful
support to Black students, participants still expressed a need for more targeted support. This is
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demonstrated through participants’ perceptions and experiences with their sense of belonging on
their campuses.
Low Sense of Belonging
As predictive based on the literature, each of the seven participants in this study
expressed being alienated from their peers at some point in their premed experience. In addition
to microaggressions and in some cases overtly racist encounters, alienation often took the form
of the participants being the only Black premed student in their classes and not being connected
with other Black premed students on campus. Participant One described her perceptions of
isolation through experiences approaching peers about premed advice, where she received little
help from one group of students while being overwhelmed with how much another group knew
about becoming a competitive medical school applicant:
… some of the White students I've talked to weren't very forthcoming with what they
knew. They were actually more gate keeping with their information. I learned that a lot of
their information came from their fraternities [and sororities]. They pass down
information; they share answers to test; they get each other job positions; they get each
other volunteer positions; they kind of really chem it up [network build]. Talking to
Asian students it kind of felt like an overwhelming flood of information from them
because they're like “you need to be doing this, this, this, and that.” They kind of came in
the gate already knowing all the steps that they needed to accomplish. Their advice kind
of felt overwhelming and felt like they kind of were starting from a different point than I
was starting…I came in not even knowing what classes to take. They knew what classes
to take, what professors to go with. They knew what kind of research they should have
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been doing. They were talking about publishing research. I was a freshman and I didn't
know the importance of publishing research, that sounded foreign to me.
Participant One’s quote demonstrates that isolation can occur for Black premed students as result
of being out of the know about the premed process, especially when they compare their
knowledge to other racial groups who are more prominent at their university. Additionally, sense
of belonging may be tested amongst Black premed when confronted by stereotypes regarding
their academic abilities.
Just as is shown in the literature on Black STEM student sense of belonging discussed in
Chapter Two, each of the seven participants discussed the need to prove their academic fitness in
their coursework. When asked about the challenges he faces as a premed student, Participant
Four acknowledge that though he had confidence in his academic abilities, there may be others
who do hold prejudice that could impact the opportunities available to him:
As I said before, my work ethic will show for itself, but there’s certain opportunities that
you’ll [Black premed students] be shut out of just due to prejudice and so you won’t even
be able to showcase your work ethic or knowledge. I’ve heard many stories where people
[Black premed students] will get into medical school but then many students will
question if they had the stats [grades and MCAT score] necessary to get in. They’ll say
“oh you got in because you’re Black or because of this.” Taking that into account going
forward, I’m going to just continue to keep the same mind [that I have]. My work ethic
will show for itself. I am not going to let people dictate who I am as a person…people
may count me out from the start, but I am going to continue to work hard whether they
notice or not.

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While Participant Four’s quote showed hardened determination in the face of stereotype,
Participant Three provides contrast, as she pondered how stereotype threat impacted her
academic performance:
It took a long time (to feel like I belonged in my major) and I did constantly feel like I
had to prove myself. I felt like there was a lot of stigma towards me being a Black person
and like Black people being “uneducated” [participant gestured air quotes], for lack of a
better words… I feel like that was also a reason as to why like I struggled so much in
classes. If I didn't get a good grade or something, I'd be like oh like “am I falling into the
stigma?” I would be really hard on myself because I want to prove the stigma wrong but
because my grades [weren’t] correlating [to] what I want to do [her personal standards],
[I had an internal struggle].
Participant Three demonstrates how the burden of proving herself as a STEM major impacted
her performance and self-perception. Participant Two adds to this discussion by describing how
stereotypes about the academic abilities of Black women impacted her ability to work in groups
with non-Black students:
I think one thing that was kind of hard was doing group work or study groups
because…there were some individuals who were treating [Black students as] inferior. I
think for me it was harder because I’m both Black and female, so it’s “oh, [Participant 2],
just sit back, go to Starbucks and just listen” or “[Participant 2], I don’t think that’s going
to be covered in lecture when I’m looking at the objectives” [Participant alluding to her
thoughts being invalidated]. And so I’m like, “okay, you guys go do your thing, I’m just
going to sit here and use this room because it’s quieter than the rest of campus and just do
my own personal thing and just cheer you on.” And then there are other times where it’s
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like “for you to give me so much focus on my looks, my appearance, my race, my family,
my background where I come from, you sure are very eager to ride on the minority’s
coattails when it comes to this exam and getting ready [for it].
Participant Two’s experience showed a willingness to withdraw from interactions when
confronted by stereotypical attitudes amongst her peers, further increasing perceptions of
isolation and lowering sense of belonging.
These data presented in the previous four quotes demonstrate the challenges participants
face in establishing sense of belonging as premed students at primarily White institutions. It is
reasonable to consider that the pressure to avoid validating any stereotypes about Black premed
students being less qualified than their peers may lead to Black premed students’ underutilization
of needed support programs, resulting in their falling behind in coursework thus leading to
attrition. Additional research is needed to investigate the link between stereotype threat and
underutilization of support programs amongst Black premed students. The experiences and
perceptions expressed by the participants regarding their sense of belonging as premed students
spoke to a need for community building amongst Black premed students.
The Need for Community
Upon being asked about their idea of equitable support programming for Black premed
students, each of the seven participants described the development of a premed community.
Participant Five highlighted the importance of community amongst Black premed students by
stating “we [Black premeds] are not united at the same place…if we could all be together at one
place, working together to achieve one goal…that would make a very, very big difference.” The
participants’ collective idea of community included consistent and centralized awareness of all
opportunities and resources available to Black premed students. Participant Four stated that his
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idea of a premed support program would aggregate Black premed students together starting in
their first year to ensure they are not “lost” in learning how to craft their educational experience
around applying to medical school. Participant Four’s perfect scenario of support would also
extend to providing Black premeds with extracurricular opportunities that are valuable to their
applications and personal growth:
[…the perfect thing for me] would be if we could collab [students and support programs]
and have MCAT prep groups; have [students] talk to admissions committees about what
they are looking for in premed students; talk about their admissions [metrics]; tour
medical schools; tour hospitals…get them to network with active physicians; just overall
try to get their feet wet…I don’t want [Black premed students], especially coming from a
low socioeconomic [background], in a completely different city, don’t know where
anything is, [to be] completely lost and have to find things on their own. I just want to
provide [these] things to them and give them the [choice] of whether or not they want to
take advantage of it.
Participant Five metaphorizes the importance of Participant Four’s ideal Black premed
community by equating the nurturing of the limited number of Black premed students to trying
to manage a small amount of savings:
You know let's say you don't have too much money; you're going to make sure to protect
your little money so you don't lose it. There's not a lot of Black premeds, so you can’t just
leave them running randomly around; they can fall off very easily.
Participant Five’s quote comparing Black premed students to money illustrates the value and
protectiveness PWIs could place on Black premed students just as one may be protective of their
money if they only had a small number of funds. As an individual may track their funds if they
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are working on a limited budget, Participant Five stated that PWIs should have an interest in
tracking their limited number of Black premed students to ensure they are succeeding.
Participant Five followed up his comment by recalling a Black premed student who, to the
participant’s knowledge, derailed on the premed track because they did not have guidance.
Participant Five went on to emphasize how this type of community would be important for the
development of relationships that can combat the feeling of isolation Black premeds may
experience on their campus and should be included in the idea support scenario:
from day one, the program is there to help them all the way to senior year when they
graduate, all the way to when they take the MCAT. From day one! So they don’t feel
alone and left out…[It wasn’t] until my third year when I met this other [Black] guy who
wanted to become a doctor.
Participant Six added to the subject of community amongst Black premeds by emphasizing the
importance of surrounding Black premed students with peers who are going through similar
academic journeys as a means to utilize each other as resources. Participant Six expressed her
thoughts on this point through describing frustration with a particular support program for what
was perceived as grouping their cohort of students together only because they were Black:
…there's like eight Black people in there, they put us all in one group, but I was the only
premed. There was a business major, a communications major, theater major, a music
major and…we don't have anything in common [except] that we're Black. So, we're
sitting [there] and we're all talking about how are we all put in one group…that just put it
all in perspective for us...How are we supposed to get the help that we need? All we're
talking about is the fact that we're all Black and we all don't get help, but we can even ask
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each other for help because we don't even [have the same majors]. That was kind of
hurtful.
Similarly to Participant Six, Participant Three spoke of wanting community based on Black
identity, including amongst faculty, as a means of sharing experiences when faced with
challenges:
It was always something I thought about [having Black representation on campus], even
[with] professors. I never had a professor that was Black person; but I had other minority
professors, so I was like “oh, at least there is some minority representation here”. But at
the end of the day, [they can’t really understand what I am going through…yeah, it was
always something that I thought about. When things get hard, you’re like can [I] actually
succeed in this major because there isn’t enough representation of my kind. There’s all
these other racial entities that are here in this college, but I don’t see anyone like me or
studying the same thing as me, so I don’t know if I can make it in this career.”
Participant Three spoke to how premed persistence may be jeopardized in the face of challenges
when there are no similar models for Black premed students to share experiences with. These
data give credence to the literature that describes the success some HBCUs have had in premed
retention by creating STEM learning communities dedicated to student indoctrination into a
culture of Black representation and success in the sciences (Gasman et al., 2017).
When prompted, Participants One and Three enthusiastically expressed their familiarity
with the support programming HBCU Xavier offers its Black premed students. When the
participants were asked if they would consider going to an HBCU if they had the opportunity to
redo their undergrad experience, Participant Three stated she had recently thought a lot about
what it would have been like at an HBCU and said “my experiences at University Three, I
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wouldn’t trade for anything; but if there was a way for me to keep my memories and go to
another school, I’d probably try that out.” While Participant Three was the only participant who
made mention of developing close friendships during her college experience, explaining her
willingness to hold on to her memories of her time in undergrad, an important consideration in
her choosing a university was proximity. Participant Three wanted to be separated from her
hometown yet close enough for easy travel home, meaning an HBCU like Xavier would have
been out of her comfort zone. Participant One expressed how going to an HBCU would have
changed her academic trajectory, but that there were benefits in personal growth that came from
her undergrad experience:
I think that [going to an HBCU] would have [made] all the difference. I was accepted
into Xavier and into their premed program. When I was deciding between schools it's like
“do I want to get this [world class] [participant’s university] education or do [I] want to
go somewhere where I'm going to be really steered into my profession. I assumed,
[participant’s university], this top school, I'm pretty sure they're going to have something
similar…I think that [going to Xavier] would have made all the difference… I believe I'm
a very exceptional student with high standards, and I shoot for the stars to do my best and
put my best foot forward. I think [by going to Xavier] I would have had a better academic
profile. I think I would have already graduated from medical school… But in hindsight, I
think my journey helped me…so I do think that’s the blessing in disguise in [my
decision].
Participant One and Three both demonstrated their perception of the value the community
and support that an HBCU could offer a Black premed student, but also showed resistance to part
from the idea of going to school in California, where all the participants are residents. This points
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to one reason why encouraging all Black students to go to an HBCU may not be the ultimate
answer to premed persistence, as there may be unwillingness to leave or preference to attend
college in California. The participant’s quote represents a need to address campus support
outside of the HBCU system for those students who choose not to attend.
Summary
These data demonstrated that though the participants were all aware of at least three
support programs and could recall positive experiences, their overall perception was that their
campuses did not adequately address the needs of Black premed students. Participants expressed
mixed satisfaction with the quality and effectiveness of the support programs they were offered.
In addition to concerns about minimal Black representation of faculty and other students on
campus that were in concert with previously existing literature, participants had a low sense of
belonging as premed majors and inclusion in support programming offered on their campuses.
Participants expressed a desire for community amongst other Black premed students to overcome
the challenges they faced in being Black premed students at institutions where they were a
substantially small minority of the student population.

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Chapter Five: Discussion and Recommendations
The fifth and final chapter of this dissertation will provide discussion related to the
findings presented in Chapter Four. This discussion will focus on the relationship of the findings
to the literature reviewed in Chapter Two, the study’s theoretical framework, and the conceptual
framework.
Following the discussion section of this chapter, recommendations based on the findings
will be presented. This section will begin by discussing recommendations related to further
research needed to best understand the current state of support programming at public
universities in the state of California. The section will then discuss practice related
recommendations based on the current findings discussed in chapter four.
Discussion
Upon analysis, it was determined that the findings in this study are closely aligned with
the literature reviewed in Chapter Two of this dissertation. At the forefront of this alignment is
data showing that participants experience isolation from their peers due not only to salient cases
of microaggressions and perceived racism, but also due to concerns of being viewed as
academically weaker students in the eyes of classmates and faculty. Isolation appears in support
programming as a perceived lack of inclusion, as data cited programs to be of lower quality
when targeted towards Black students, resources were withheld or unavailable, and scheduling
issues that prevented Black premed students from utilizing support programming. These
concerns ultimately lead Black premed students to perceive that their universities are not paying
attention to or adequately addressing their needs related to premed persistent, as was perceived
by all seven participants and highlighted in Participant One’s insights about her university’s
tutoring programs. It is reasonable to argue that a perceived lack of care and quality combined
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with a stigma of being viewed as an academically weak student may lead to underutilization of
support programming for Black premed students as a symptom of stereotype threat, thus
perpetuating a cycle of Black premed attrition; however, it is recommended that more research
be done to investigate this argument.
Underutilization may be further exacerbated by findings that show students across
campuses lack a centralized means of learning about the support programming available to them.
This means that Black premed students may utilize less programming simply from lack of
awareness. There is also a reasonable threat that a program underutilized, yet valuable to Black
premed students, may be at risk of being cut to provide resources to programs with higher
utilization amongst other groups. As the literature states that Black students are amongst the
highest risk for premed attrition (Chen & Soldner, 2013), the discontinuation of a support
program may have the biggest impact on their demographic.
Though participants from this study discussed concerns about how their academic
competitiveness was viewed by peers and faculty, this was not their main focus in interviews.
Instead, emphasis was continuously placed on the poor quality of programming, availability, and
awareness, as all seven participants expressed overall dissatisfaction with the support
programming at their universities. The participants in this study each expressed an awareness of
the stereotypes Black premed students face regarding how they are viewed academically in
predominantly White campus environments yet, with few exceptions, still chose to seek out
support programming. This demonstrates that Black premed students may be accepting of the
vulnerabilities they may expose in asking for help in exchange of receiving the knowledge they
need to reach their goals. Furthermore, despite stereotype threat, the participants all wanted more
options in support programming on their college campus, demonstrating their determination to
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become competitive applicants for medical school in the face of inferiority stereotypes. Each of
the participants also expressed at least one positive support experiences, such as interactions with
faculty, that may have helped mitigate the impact of poor support experiences and stereotype
threat. Each of the participants expressed the desire to be included in the development of support
programming, meaning that Black students may be willing to work as partners in the creation of
a positive student support experience. However, as mentioned in Chapter Four, no participant
could recall being given the opportunity to provide their voice in the development of support
programming. These findings are in close alignment with the conceptual framework created for
this study.
Conceptual Framework Alignment
As discussed in Chapter Two, this study’s conceptual framework features a positive and negative
path for student support. The positive support path showed that an institution addresses the
academic, financial, and racial sense of belonging challenged Black premed students may face
through offering support that was inclusive, non-biased, and non-deficit focused. The negative
track outlined support opposite of the positive track where support was non-inclusive, biased,
deficit focused, and emphasizes student assimilation. The positive support experiences expressed
by the participants were classified under three out of five of the categories of Positive Student
Experience provided in the conceptual framework: support is based on validating personal
experiences; students were made to feel valued for who they are; and validation of academic
abilities. These positive experiences were often the result of faculty support interactions, as was
demonstrated by quotes from Participants Five and Six about the positive impact an interaction
with their professors had on their persistence. Negative participant experiences aligned with
three out of five of the Negative Student Experience categories on the negative path when
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support participants perceived support as generalized; students were not involved in program
development; and academic abilities and qualifications were not validated. It is also important to
consider that the categories of assimilation and deficit theories focus on the conceptual
framework, and prominent fixtures in the literature of Black STEM student experience cited
were not major discussion topics throughout participant interviews, but were instead inferred in
the data, except for one explicit item mentioned by Participant Five.
Importance of the Findings
The findings in this research are important in solving the underrepresentation gap
amongst Black physicians in the United States because they demonstrate how a lack of the Black
premed student voice in support programming perpetuates a cycle of primarily White institutions
falling short of meeting the needs of this demographic group. As stated in the literature review,
support programming is essential to STEM persistence, especially amongst Black students. But
support may not meet its intended purpose of combatting STEM attrition (Estrada et al., 2016) if
it is designed without direct input from the students it is supposed to help. This study has shown
that there is a correlation between participants overall dissatisfaction with support programming
on their campuses, perceptions that their campuses are misguided in meeting the needs of Black
students, and a lack of their inclusion in the planning process. Furthermore, in some cases, the
current state of support programming further establishes feelings of isolation amongst students,
as stated by Participant Five, who felt “left out” when his work schedule would not allow him to
participate in programs. In addressing these concerns, universities must re-evaluate the
effectiveness of support programming for Black premed students. The road to improvement must
start with the inclusion of the Black premed student voice.

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Future Research and Recommendations
To best understand and address the support programming needs of Black premed
students, additional research must be performed. As discussed in the limitations section of
Chapter Three, this study does not specifically ask about differences in experience and
perceptions related to gender, sexual orientation, first generation status, subculture within the
Black community, immigration status, colorism, multi-racial identity, socioeconomic
background, or K-12 education experience. It is recommended that additional research be done
to investigate how these intersectionalities impact the Black premed student support experience.
Additional research is also recommended to investigate the student support practices of public
universities in the state of California from the campus perspective, including tracking of program
effectiveness, student utilization, demographics of student and staff stakeholders, and the
perceptions and experiences of the staff and faculty charged with developing and implementing
support programs. Lastly, additional research is also needed to explore how perceived lack of
quality of programs stereotype threat related to perceptions of academic vulnerability may
impact Black premed students’ usage of support programs.
Though additional research is needed to provide deeper understanding of how to improve
the support programming experience of Black premed students, suggestions of practice can be
made based on the findings from this study.
Recommendation One: Implementation of a Task Force
An overarching strategy that universities can put in place to address the findings related
to Black premed students’ overall dissatisfaction with their universities support programming is
for campuses to establish a diversity, equity, and inclusion (DEI) best-practice trained task force
for holistic examination of student support. This task force would be responsible for examining
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the current effectiveness of the support programs offered by the university to establish a baseline
to measure progress against. The task force should then compare the current state of support
programming against established best practices such as those put forth by HBCUs like Xavier
University, which has been successful in retaining Black STEM students and graduating
premeds. The task force must also actively seek to break the current norms of support
programming, where the study participants perceive Black premed students to not have a voice
and seek the opinions and collaboration of Black premed students, as is in alignment with tenet
two of Critical Race Theory. Tent two, which states that storytelling of and from the perspective
of the oppressed is required to positively change dominant racial narratives through
counternarratives, is essential to reframing support programming to best meet the needs of Black
students. Clark and Estes (2008) Gap Analysis can be utilized to best understand any gaps in the
knowledge and motivation of stakeholders tasked with developing and executing support
programming, as well as organizational barriers preventing the successful implementation of
support programming. The task force must also be responsible for the implementation of a
system for periodic review of support programs and personnel in conjunction with the consistent
collection of feedback from Black premed students.
In addressing perceptions of isolation amongst Black premed students, the task force
should also be charged with investigating ways to implement and improve campus DEI training
amongst all stakeholders. DEI training on how to contribute to a welcoming campus environment
can be included as a part of the onboarding process for new students, faculty, and staff through
the campuses learning management platforms, such as CANVAS. This portion of the task force
recommendation is important because it is in direct alignment with tenet one of Critical Race
Theory by acknowledging the history of institutional racism and anti-Black culture in the United
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States and providing a means for changing the culture around inclusion as opposed to
assimilating Black premed students. A goal setting and monitoring system, such as the New
World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016; Liao & Hsu, 2019), should be put in
place to ensure the task force has detailed milestones in place for reaching specific, measurable,
attainable, relevant, and timely goals, also known as SMART goals (Lawlor & Hornyak, 2012).
All necessary revamping of support programming should take place during campus downtime
such as summer session, as to provide minimal disruption to essential services.
Recommendation Two: Create a Centralized Means of Support Awareness
Based on data from this study showing that none of the participants could recall a
centralized means of learning about support programming, an office of premed support should be
established on campuses that currently lack this mechanism for support. Campuses who do have
dedicated premed programs, tracks, or offices for support, should be re-evaluated under the guise
of the previously mentioned task force for student support practices. The office of premed
support, in partnership with the student support programming task force, should put forth a
strategy to insure centralized and consistent awareness campaigns for all support programs
available to Black premed students. This will ensure that there is equity in how students may
learn about support programming, addressing Participant One’s perception that support program
information was withheld from them based on race. Success of this effort can be measured by
student satisfaction survey data that shows that the majority Black students recognize the office
of premed support as a centralized place for learning about the campus supports available to
them. A division of this office should be dedicated to the support needs of Black premed
students. In the case that campuses do not have enough Black premed students for this endeavor
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to be financially feasible, it may be considered to establish a university system-sponsored
support office to fill any gaps in campus support.
Recommendation Three: Create Black Premed Learning Communities
As was found successful by HBCUs such as Xavier and Prairie View A&M, and desired
by the participants in this study, Black premed learning communities should be established on
campuses to help aggregate Black premed students and to act as a buffer against the feelings of
isolation that are common in the Black premed student experience.
These learning communities should be modeled after the success of universities like
Xavier and seek to incorporate Black premed students starting from their first year on campus.
Within these learning communities, Black students can have fellowship amongst each other
while also being provided opportunities and experiences that are often missing from their premed
experiences.
Recommendation Four: Adjust Support Program Scheduling
A relatively immediate recommendation to impact the practices of campus-based support
programming is to adjust the scheduling of support programs on campuses by extending hours
and offering services on weekends. This adjustment would allow for Black premed students to
have more opportunities to engage in support programming and perceive themselves as being a
part of the campus’ premed experience.
Time adjustments should be made in consideration with data that looks at the scheduling
habits of Black premed students. It is also important for campuses to consider the scheduling of
classes when discussing support program schedules. Though concerns about tight class schedules
were brought up as concerns by participants Five and Two, separate research would need to be
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conducted into the best practices of class scheduling before a definitive recommendation could
be put forth in that regard.
Conclusion
The representation gap amongst Black physicians in the United States is a complex
problem that will require attention across multiple issues if there is to be any chance at correcting
the course laid out by a long history of systemic racism and anti-Black sentiment. As research
states, support programming is crucial in the success of aspiring Black physicians, as it helps to
mitigate the historic injustices seen in U.S. society and the education system (Gasman et al.,
2017; Thomas et al., 2011). This study seeks to understand that impact by exploring the
experiences and perceptions of Black premed students utilizing support programing at public
universities in the state of California as a means of examining premed attrition, which is a
contributing factor to the Black physician representation gap in the United States. Though
limited in size, this research finds that Black premeds shared that they were overall dissatisfied
with the support programming their campuses offered and often perceived themselves as being
isolated from the premed experience that was shared by their peers. The participants in this study
are successful at persisting in premed because they have the support of faculty and, despite
overall dissatisfaction, they are able to make the most of the support programs that they were
aware of when possible. Without changes to support programming, Black premed students, who
based on the participants’ perceptions may not have an efficient means of learning about support
programming, may not receive equitable treatment, or may not have equitable opportunity to
utilize programming, will continue the trend of attrition. If attrition persists amongst the ranks of
Black premed students, the physician workforce will remain underdeveloped and health
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disparities related to preventative illnesses will continue as a threat to the health and wellbeing of
the nation.
The participants in this study proved themselves to be resilient and resourceful, as
demonstrated by Participant Four’s constant searching for opportunities, or Participant Three’s
utilization of alternative counseling services. But as the data demonstrate, their efforts alone are
not enough to address this serious problem. Despite the participants’ success, there are too many
Black students falling through the cracks of the medical school pipeline. If support programming
can be the difference between a brilliant Black student with the potential to be an excellent
physician continuing to medical school or a choosing the path of least resistance simply because
they do not have the same resources and support as their peers, then the education system owes it
to itself to examine the practices of support that data in this study show have room for
improvement. The alternative is preventable morbidity and mortality of countless people caught
in the wrath of the darkest parts of our nation’s history.

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Creator Abercrombia, Kamau Jamal (author)

Core Title Black premedical student retention: exploring campus support programming through the eyes of the student

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2021-12

Publication Date 12/13/2021

Defense Date 11/17/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Black premed support,Black student experience,Black student support,critical race theory,OAI-PMH Harvest,premed,premedical education,support programming

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Carbone, Paula M. (committee chair), Green, Alan (committee member), Tobey, Patricia (committee member)

Creator Email kabercro@usc.edu,kjabercrombia@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC18367064

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Rights Abercrombia, Kamau Jamal

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