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Latinos in medicine: A study of traditional and non-traditional predictors of success
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Latinos in medicine: A study of traditional and non-traditional predictors of success
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LATINOS IN M EDICINE: A STUDY O F TRADITIONAL AND NON-TRADITIONAL PREDICTORS O F SU C C E SS by E rin A n n Q u in n A D isse rta tio n P re se n te d to th e FACULTY O F TH E GRADUATE SCH O O L UNIVERSITY O F SOUTHERN CALIFORNIA In P a rtia l F u lfillm en t of th e R e q u ire m e n ts for th e D egree D O CTO R O F PHILOSOPHY (Public Administration) M ay 1990 C o p y rig h t 1990 E rin A n n Q u in n UMI Number: DP31267 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. D ia & w W o n W K IisM ng UMI DP31267 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 - 1346 UNIVERSITY OF SOUTHERN CALIFORNIA THE GRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES, CALIFORNIA 90089-4015 Ph.D. P u This dissertation, w ritten by Erin Ann Quinn under the direction of h.^x:....... Dissertation Committee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fulfillm ent of re quirements for the degree of D O C TO R OF PHILOSOPH Y Dean of Graduate Studies Date April 17, 1990 DISSERTATION COMMITTEE Chairperson A pril 1990 T his d issertatio n is dedicated to two veiy special people. Brian A n d res Mico Q uinn (b.5-22-82) A n n a Camila Mico Q uinn (b.2-19-86) My M asters' b ab y an d D octoral baby, respectively. T here are m a n y people w ho helped m e an d encou rag ed m e to accom plish th is dream . My g ra titu d e a n d love for th e m is endless. T hey are m y p a re n ts, Noel a n d H elen Q uinn, m y siste rs T ara K. Q u in n D avidson an d Sheila G. Q u in n Kelley, J u a n A ndres Mico, T eresa G arcia (loyal friend a n d chief babysitter), th e Mico P erales fam ily, J u a n F. Mico, M aria P erales a n d M aricel Mico, th e Kolb fam ily, m y "girls' a k a m y staff (C arm en Colon, Celia Cedillo, A g ath a M orales a n d J o la n d a M acadang), W in Bock, Clyde W. D en t, Ph.D .(for h is sta tistic a l exp ertise a n d Infinite patience), J u lie Solis, Ph.D .(w ho encouraged m e in th e first place), an d J a n e t A rribas, B a rb a ra B. T alavan, L au ra Pendorf, M argaret B. M artinez a n d L orraine C. G utierrez for th e y ears of loyal frien d sh ip a n d su p p o rt. I w ould also like to th a n k C h ris a n d S u zan n e H aik er a n d R ichard an d K athy T. Y ates for th e ir help during th e p a st two years. T he tw o p ro fe sso rs w ho have b e e n th e h ig h lig h t of m y g ra d u a te e d u c a tio n are P rofessor Alex M cE ach em an d Dr. D avid Lopez-Lee. I w ould like to th a n k b o th of th e m for encouraging m y curio sity a n d intellect. 1 w ould also like to ex p ress m y g ratitu d e to P eter V. Lee. M.D., w ho h a s provided m e w ith co n sta n t su p p o rt durin g th is p a st year. The U niversity of S o u th e rn C alifornia, th ro u g h its g en ero u s tu itio n rem issio n policy, h a s e n ab led m e to p u rs u e g ra d u a te w ork w hile w orking full-tim e a n d raisin g two children. USC h a s certain ly b een a fam ily to m e. 1 am grateful to th e U niversity for th e opportu n ity to have stu d ied a n d w orked w ith m a n y special people. I w ould like to acknow ledge th e cooperation of D ario Prieto an d J u d ith F ro st of th e A sso ciatio n of A m erican M edical Colleges in facilitatin g th e stu d y . T he w ork of W illiam S e d la c e k a t th e U n iv ersity of M ary lan d h a s b e e n in v a lu a b le in th e d e v elo p m en t of th e c o n c e p tu a l fram e w o rk fo r th e d is s e rta tio n . 1 g ra te fu lly acknow ledge th e encouragem ent 1 received from Dr. Sedlacek a n d D ario Prieto. II TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS ............................................................................................................. i i U S T OF TABLES ................................................................................................................... v CHAPTER I. Introduction B ackground of th e Problem .................................................................................................. 1 P urpose of th is R esearch ..................................................................................................... 4 R ationale a n d C onceptual Fram ew ork ......................................................................... 5 O utline of th e R em ainder of D issertation ............................ ..................................... 7 CHAPTER II. R eview o f the Literature M inorities in M edicine - H istorical B ackground ................................................... 8 Predictors of S uccess ........................................................................................................... 11 M exican-A m erican A ttitu d es tow ard E d u ca tio n ..................................................... 15 Social S tru c tu ra l C o n strain ts in C areer O ptions ..................................................... 17 S tatem en t of H ypotheses ................................................................................................... 17 D efinition of T erm s ............................................................................................................. 18 Scope an d D elim itations of th e Study ........................................................................... 19 S u m m ary ................................................................................................................................... 20 CHAPTER III. M ethodology Overview of S tu d y ................................................................................................................ 22 R esearch D esign .................................................................................................................... 22 Subjects ...................................................................................................................................... 26 In stru m e n t D escription ....................................................................................................... 26 D a ta Collection P rocedures ................................................................................................ 27 D a ta A nalysis .......................................................................................................................... 27 .lU CHAPTER IV. R esults a n d A n a lyses 30 In tro d u ctio n ............................ T he D escriptive Stage .......... E xploratoiy Stage of A nalysis M ultivariate S tage of A nalysis 30 35 43 CHAPTER V. D iscussion, Im plications a n d Policy R ecom m endations 54 D iscussion .......................................................... Policy Im plications a n d R ecom m endations F u tu re Studies ................................................... C oncluding R em arks .................................... 57 59 60 REFERENCES 61 A P P E N D IX MCAT Pre-M edical Q uestio n n aire 65 LIST OF TABLES PAGE 1. LATINO APPLICANT POOL DESCRIPTION ......................................................................32 2. TRADITIONAL VARIABLES - PERCENT OF LATINO APPLICANTS WITH HIGH OR LOW SCORES ...............................................................................................................36 3. NON-TRADITIONAL VARIABLES - PERCENT OF LATINOS WITH HIGH OR LOW SCORES .........................................................................................................................37 4. TRADITIONAL PREDICTORS OF SUCCESS ....................................................................40 i 5. NON-TRADITIONAL PREDICTORS OF SUCCESS ............................................................41 6. BACKGROUND VARIABLES ................................................................................................... 44 7. VARIABLES THAT ARE EQUALLY PREDICTIVE FOR LATINOS AND WHITES ...........................................................................................................................................45 8. VARIABLES THAT ARE DIFFERENTIALLY PREDICTIVE FOR LATINOS AND WHITES ............................................................................................................................... 46 9. PREDICTORS OF SUCCESS FOR LAHNOS- STEPWISE REGRESSION MODEL ...........................................................................................................................................48 10. PREDICTORS OF SUCCESS FOR WHITES- STEPWISE REGRESSION MODEL ............................................................................. 49 11. DISCRIMINATE ANALYSIS OF ERROR CLASSIFICATION RATES ........................52 12. PREDICTORS OF SUCCESS - LOGISTIC REGRESSION MODEL ................................ 53 CHAPTER I INTRODUCTION BACKGROUND OF THE PROBLEM T he co n tin u e d u n d e rre p re se n ta tio n of m inority s tu d e n ts in th e field of m edicine c re a te s a m a jo r p u b lic h e a lth policy p ro b lem . M in o rities a re n o t equitably! re p re se n te d in th e v ario u s h e a lth professions, w hich h a s re su lte d in m a n y negative effects, in c lu d in g th e m a ld istrib u tio n of h e a lth m an p o w er. M inority co m m u n ities c o n tin u e to be m edically u n d e rse rv e d (C alifornia H ealth M anpow er P lan , 1979; DHHS T ask Force on B lack a n d M inority H ealth, 1985). A lthough g reat strid e s have b e e n ta k e n to b rin g into b alan ce th e provision of h e a lth services in all com m unities, a n in e q u ity re m a in s a n d m in o rity co m m u n ities co n tin u e to be poorly served. The m a jo rity of n o n -m in o rity p h y sic ia n s u p o n g ra d u a tio n cho o se n o t to p ractice in m inority com m unities, u n le ss th ey are fulfilling a c o n tra c tu a l agreem ent, su c h a s th e N ational H ealth Service C orps S ch o la rsh ip . U pon co m pletion of th e c o n tra c tu a l ag reem en t th e n o n m in o rity p h y sician re tu rn s to a m o re tra d itio n a l co m m u n ity to s ta rt a p ra c tic e o r ta k e a p o sitio n at a h ig h e r salary . It h a s b e e n sh o w n th a t a s u b sta n tia l n u m b e r of m inority p h y sician s practice in m inority com m unities. Of th e to tal n u m b e r of L atino p h y sician s th a t g ra d u a te d from m edical schools in C ahfom ia b etw een 1971 a n d 1975, 75% p ractice in o r n e a r a d esig n ated h e a lth m a n p o w er shortage a re a s (DHHS Publication 1986). T his inform ation lead s u s to th e conclusion th a t if m o re m in o rity p h y s ic ia n s co u ld b e re c ru ite d a n d tra in e d th e m ed ical m a ld istrib u tio n problem could be reduced. D uring th e p a s t tw enty y ears a concerted effort h a s been m ad e on th e p a rt of th e F ed eral g o vernm ent, th e sta te governm ent, p rivate fo u n d a tio n s a n d m a n y m edical schools to in crease th e n u m b e r of m inority m edical school g rad u ates. D uring th e late sixties an d early seventies F ederal an d S tate p ro g ram s w ere developed to a d d re ss th e iss u e of re c ru itin g m in o rities in to th e h e a lth p ro fessio n s. L ead ers in th e field ofj h ealth care b ro u g h t th is issu e to th e forefront. Legislation w as p a sse d w hich providedj m oney to develop p ro g ram s for m inority re c ru itm e n t. P ro g ram s developed at th is| I tim e in c lu d e d th e H e a lth P ro fessio n s C a re e r O p p o rtu n ity P ro g ram , O ffices ofj I M inority A ffairs, an d th e A rea H ealth E d u catio n C en ters (Strelnich a n d Young, 1984).j I S ch o larsh ip m oney w as m ade available a n d allocated specifically for th e p u rp o se of 1 providing m in o rity a n d d isad v an tag ed s tu d e n ts w ith th e o p p o rtu n ity to p u rs u e a ; c a re e r in m edicine. At th e sam e tim e, m edical sch o o ls w ere reserv in g "slots" for! qualified m in o rity a p p lic a n ts a n d sch o o ls w ere w orking in c o n ju n c tio n w ith the; F ed eral a n d S ta te p ro g ra m s to develop o u tre a c h p ro g ra m s to colleges a n d high schools in re tu rn for fu n d in g a ssista n c e (Burke, 1977). C oncurrently, local g rassro o t o rgan izatio n s on college c a m p u se s, su c h a s C hicanos for C reative M edicine an d La R aza M edical O rganization, provided a m ech an ism for p eer su p p o rt. T he re s u lt of th is co n ce rted effort w as a d ra m a tic in c re a se in th e n u m b e r o f m inority s tu d e n ts recru ited into a n d accepted by m edical schools. D uring th e m id- 1 9 7 0 's th e n u m b e r of m in o rity m ed ical s tu d e n ts re a c h e d a n all tim e h igh. T he m in o rity e n ro llm en t re a c h e d its p eak w ith th e c la ss of 1974 -1 9 7 5 w h en 8.2% of m e d ic a l s tu d e n ts w ere fro m u n d e r-re p re s e n te d m in o ritie s, w h ich are B lack, C h ican o /L atin o , m a in la n d P uerto R ican or A m erican Indian. (Sidel a n d Sidel, 1984). W ith th is co n certed effort th e n u m b e r of m in o rity m edical g ra d u a te s did increase; how ever, even a t th e h ig h e st p o in t, th is re p re s e n ta tio n n ev er achieved a level in p arity to m in o rity re p re se n ta tio n in th e g en eral p o p u la tio n (16%) n o r did it achieve th e objective se t in 1970 by th e A ssociation of A m erican M edical C olleges w hich called for 12 p ercen t m inority enrollm ent by 1975 (B urke, 1977). T he im p e tu s b e h in d th e in crease in m inority m edical school ad m issio n s w as th e issu e of affirm ative actio n a t th e n atio n al policy level. F u n d s w ere m ade available th ro u g h v a rio u s p ro g ram s to im plem en t affirm ative actio n p ro g ra m s in g ra d u a te level education. M edical schools, in ad d itio n to reserving slo ts for qualified m inority c a n d id a te s, w ere u sin g n o n -tra d itio n a l criteria, in ad d itio n to th e tra d itio n a l MCAT score a n d GPA, to determ ine m edical school adm ission req u ire m en ts. T his change in ad m issio n criteria w as a m a jo r b reak th ro u g h . However, th is b re a k th ro u g h an d th e concept of "slots" a n d "quotas" did not rem ain in practice long before being b ro u g h t to litigation. The infam ous B akke case, w hich w as h e a rd before th e F ederal S uprem e C ourt, q u estio n ed th e legality of slo ts reserved for m in o rity s tu d e n ts if th e re w ere a m ore qualified (by tra d itio n a l criteria) n o n -m in o rity a p p lic a n t. In 1973 a n d th e n again in 1974, A llan B akke, a w hite m iddle class m ale, applied to th e U niversity of C alifornia a t D avis School of M edicine. He w as denied ad m issio n b o th tim es. He b ro u g h t s u it in th e C alifornia sta te c o u rt claim ing th a t he w as being d iscrim in ated ag a in st by th e fact th a t he w a s n o t allow ed to com pete for th e 16 slo ts reserved fo r disadvantaged a n d m inority app lican ts. The Suprem e C ourt w as divided on th is issue w hich led to tw o se p a ra te five to fo u r m ajorities. The first o rd ered th a t A llan B akke b e ad m itted to th e m ed ical school a t th e U niversity of C alifornia a t D avis a n d found' th a t th e affirm ative actio n pro g ram w as in effect illegal. The seco n d m ajority stated| I th a t th e C o u rt h eld som e form s of ra c e -c o n sc io u s a d m issio n s p ro c e d u re s to b e c o n stitu tio n a l. T he issu e q u e stio n e d by th e ca se w as w h e th e r o r n o t v o lu n ta iy m e a su re s should be u se d to rem edy th e p resen t effects of p a s t discrim ination. T he fa llo u t from th e B ak k e d ecisio n w as th e e lim in a tio n of sp e c ia l "slots" d esig n ated for m inority m edical s tu d e n ts a t m o st schools of m edicine. Schools w ith a n in stitu tio n alized co m m itm en t to affirm ative actio n co n tin u e d to ad m it m inority s tu d e n ts u sin g n o n -trad itio n a l ad m issio n s criteria; th o se schools w hich did n o t have a n in stitu tio n alized com m itm en t re tu rn e d to th e ir pre-affirm ative actio n adm issio n p a tte rn s. The g reat strid es ta k e n d uring th e 1970s b egan to level off in the 1980s an d m inority ad m issio n s dropped (DHHS Publication, 1984). T he n u m b e rs of u n d e rre p re s e n te d m in o ritie s in th e h e a lth fields hav e n o t in c re a se d sin ce th e 1970s. T he n u m b e rs h av e re m a in e d fairly c o n s ta n t. W ith re c ru itm e n t re m a in in g c o n s ta n t a fo cu s n e e d s to be p la ced o n a d m issio n a n d re te n tio n of m in o rity s tu d e n ts th ro u g h th e u s e of n o n -tra d itio n a l a d m issio n s criteria. T hese s tu d e n ts m ay n o t score a s well o n th e trad itio n a l a d m issio n s criteria b u t are capable of com pleting a h ealth field career. PURPOSE OF THIS RESEARCH T he p u rp o se of th is re se a rc h is to d eterm in e w hich fa c to rs p red ic t su c c e s s for L atino m ed ical s tu d e n ts. S u ccess, for th e p u rp o se of th is stu d y , is d eterm in e d by su ccessfu l g ra d u a tio n from m edical school. The fo u r m ajo r q u estio n s to b e answ ered by th is stu d y are a s follows. 1) How well do trad itio n al v ariables (MCAT a n d GPA) p redict su c c e ss for L atinos? 2) H ow w ell do n o n -tra d itio n a l v a ria b le s (S ed lac ek 's n o n -co g n itiv e v aria b les) p red ict su ccess for Latinos? 3) How well w ould a com bined tra d itio n a l a n d n o n -tra d itio n a l ad m issio n s criteria p red ict su ccess for L atinos? 4) Is th e re a difference in predictors of su ccess betw een Latino m edical g ra d u a te s an d W hite m edical g ra d u a te s? D eterm in in g w hich fa c to rs p re d ic t su ccessfu l com pletion of m ed ical school for L atino s tu d e n ts is valuable b eca u se it w ould provide u sefu l inform atio n for m edical schools to u se in determ ining ad m issio n s criteria for Latino stu d e n ts. S tu d e n ts could be ad m itted u sin g n o n -trad itio n a l criteria a n d w ou ld be capable of perform ing well. S tu d en ts w ho do not score a s well could be th e focus of program s w hich are designed to provide th e m su p p o rt th ro u g h o u t th e ir academ ic career. RATIONALE AND CONCEPTUAL FRAMEWORK A m a jo r o b sta c le to re c ru itin g m in o ritie s in to m ed icin e, a s w ell a s o th e r j professional o ccupations, is th e "social s tru c tu ra l constrain t" placed u p o n a p erso n by h is o r h e r p o sitio n in so ciety a s w ell a s by o c c u p a tio n a l b a rrie rs c re a te d by t o rg an iz atio n al s tr u c tu re s (B ucher, 1980). T he so cial le a rn in g th e o ry of c a re e r d e c isio n m a k in g (B u ch er, 1980) in c lu d e s in th e m o d el th e c o n c e p t of so cial c o n stra in ts a n d th e ir effects on care er decision m ak in g processes. Social co n straints! are placed on a p erso n by h is or h e r position in society. A p erso n 's p o sition in society! is d eterm in ed by th e following variables: age, sex, ed u catio n , socioeconom ic s ta tu s , ethnicity, ru ra l, su b u rb a n .in n e rc ity , fam ily p osition, etc. A ccording to th is m odel a p e rso n b o rn in to a low incom e, in n e r city, m in o rity fam ily w ould have a lim ited ac c e ss to c a re e r o p p o rtu n itie s. T he "o p p o rtu n ity stru c tu re " available to different people d ep en d s u p o n w here a p e rso n is lo cated in th e social stru c tu re . A ffirm ative actio n p ro g ram s, in clu d in g th o se developed for m ed ical school re c ru itm e n t, have m ade a n a tte m p t to elim inate th e "occupational b a rrie rs " a n d ex p an d th e o p p o rtu n ity s tru c tu re s of m inority groups. A n ex am p le of a n o c c u p a tio n a l b a rrie r for m e d ical s tu d e n ts is th e u s e ofj stan d ard ized te s ts like th e MCAT exam . S tan d ard ized te sts have b een a m ajor p a rt of th e trad itio n a l fo rm at of m e asu rin g intelligence for g ra d u a te w ork in th is country. It h a s b e e n sh o w n th a t m inority s tu d e n ts do n o t do a s well on trad itio n a l intelligence te sts (Sternberg, 1986). S te rn b e rg p ro v id es^ a~ th e o re fic â l“ffârn ëw o rir“ fôr~lôôltirig at~different~ w ays tb^ m e asu re intelligence (Sternberg, 1985, 1986). He d escrib es com ponential intelligence a s th e ability to in te rp re t in fo rm atio n in a h ie ra rch ica l a n d taxonom ic fash io n in a well defined a n d u n ch an g in g context. People w ho are able to m em orize facts an d w ho perform well on sta n d a rd iz e d te sts, su c h a s th e MCAT, have th is type of intelligence. They trad itio n ally do well in a didactic learning setting. T he n ex t type of intelligence described by S tern b erg is experien tial intelligence. T h is type of in tellig en ce is n o t m e a su re d by s ta n d a rd iz e d te s ts . E x p e rie n tia l intelligence involves th e ability to be creative, to be able to in te rp re t Inform ation in a ch an g in g context. A ccording to S tern b erg th is type of intelligence, for a m edical c a re e r, w ould be im p o rta n t for in te g ra tin g a n d sy n th e siz in g th e in fo rm atio n in clinical an d p ro fessio n al w ork. T he th ird type of in tellig en ce is called c o n te x tu a l in tellig en ce . S te rn b e rg d escrib es th is type of intelligence a s th e ability to h a n d le a ch an g in g environm ent. T his type of p erso n w ould have th e ability to handle a n d negotiate th e system . S ed lacek a n d Prieto (1989) feel th a t experiential a n d c o n te x tu a l intelligence, a s w ell a s co m p o n en tia l intelligence, n eed to b e m e a su re d in o rd e r to b e s t select a c a n d id a te for m ed ical school. T h eir w ork w ith non-cognitive m in o rity ad m issio n s v aria b les h a s c o n c e n tra te d o n m e a su rin g ex p erien tial a n d c o n te x tu a l intelligence. S edlacek a n d P rieto say th a t b e c a u se of th e lack of a tte n tio n given to m inorities in th e society a n d ed u catio n sy stem s an d b ecau se of o th e r form s of in stitu tio n al racism , m inorities have h a d to develop th e ir intelligence a n d abilities w ith in th e experiential a n d co n tex tu al realm . T his stu d y acknow ledges th a t L atinos in th e S o u th w est have trad itio n ally b e e n lim ited in th e ir c a re e r o p tio n s by th e "social s tru c tu ra l c o n stra in ts" d escrib ed by B u ch er. T h ro u g h affirm ative actio n p ro g ram s a n u m b e r of th e se c o n s tra in ts have 6 b e e n so m ew h at elim inated. However th is a u th o r believes th a t it is still n ece ssary to p red ic t c a re e r o u tco m es by u sin g n o n -tra d itio n a l criteria in o rd er to c o n tin u e to rem ove th e social b a rrie rs th a t exist. A dm issions policies th a t do n o t ta k e th e non- tra d itio n a l c rite ria in to a c c o u n t a re d isc rim in a to ry . T h is s tu d y w ill provide ad d itio n al inform atio n to su p p o rt th e u se of n o n -trad itio n a l ad m issio n s criteria. OUTLINE FOR THE REMAINDER OF THE DISSERTATION T h is d isse rta tio n is divided into fo u r rem ain in g C h ap ters. C h a p te r II is a reviewi I of th e lite ra tu re . T he n ex t section, C h a p te r III d escrib es th e m ethodology u se d to com plete th e study. C h ap ter IV is th e description of the resu lts a n d an aly ses conducted o n th e d ata. The la st ch ap ter. C h ap ter V, is th e S u m m ary of th e stu d y in w hich th e im plications are d iscu ssed a n d th e policy recom m endations are given. CHAPTER II REVIEW OF THE LITERATURE MINORITIES IN MEDICINE: A HISTORICAL PROFILE "... stro n g efforts by th e ed u c a tio n a l in s titu tio n s , th e h e a lth p ro fe ssio n s a n d th e 1 governm ent m u s t be u n d e rta k e n to reverse th e losses of th e p a s t decade a n d to assurej p arity of o p p o rtu n itie s for m inorities in m edicine by th e y ear 2000... T here is a crisisj in m ed ical ed u c a tio n in reg ard to m in o rity p articip a tio n ." --E d u c a tio n a l T e stin g S ervice j T he lite ra tu re o n m in o rities in m ed icin e h a s fo cu sed m a in ly o n th e im p act ofj affirm ative actio n on opening th e career p ath w ay for m in o rities a n d th e im p act th a t th is ch an g e w ould have on im proving th e h e a lth s ta tu s of m in o rity com m unities.j J a m e s L. C u rtis in h is article, "Civil R ights in M edicine," acc u rately d escrib es thisj effort a s tw o fro n ts: 1) equalizing m in o rity acc e ss to h e a lth c a re e r e d u c a tio n andj train in g o p p o rtu n ity a n d 2) equalizing m inority access to h ealth care. In h is p a p e r he' describes th e n eed for specific race-conscious policies w hich w ould serve to change th e in stitu tio n alized racial in ju stice (C urtis, 1980). C u rtis describ es a m eth o d by w hich to d eterm in e inequity. F irst a c o u n t of a n in s titu tio n 's w ork force is co n d u cted . If few er p e rs o n s of a given g ro u p (i.e.. B lack, L atino, etc.) th a n are available in th e qualified m a n p o w er pool are re p re se n te d in th e d esirab le, lu crativ e a n d d ecisio n m ak in g levels of th e organization th a n a n inequity exists. If a n inequity ex ists th e n specific efforts m u s t be m ade a n d d o cu m en ted to ch an g e th e n u m b e rs rep resen ted . T hese specific efforts n eed to show th a t a tte m p ts are being m ade to co rrect w h a t is p resu m ed to be u n fa ir im pact. T his is a definition of affirm ative action. He say s th a t given th e fact th a t g ro ss u n d e rre p re se n ta tio n of m in o rities in th e h e a lth pro fessio n s schools is still a problem th e re is u rg e n t n eed for affirm ative action correction. 8 Y vonne B ra th w a ite B u rk e in h e r a rtic le , "M inority A d m issio n s to M edical Schools: P ro b lem s a n d O p p o rtu n ities," n o te d th a t n a tio n a lly th e re is one w h ite p h y sician for eveiy 600 w hite p e rso n s an d one b la ck p h y sician for every 5,000 b lack p e rso n s (B urke, 1977). S he noted th a t of all u n d e rre p re se n te d m inorities, b la ck s are p robably th e b e st m edically served m inority in th is country. It w as once believed th a t M edicare a n d M edicaid w ould b rin g ab o u t ch an g es in th e provision of h e a lth care in th e in n e r cities a n d p o o r ru ra l area s. The reality how ever, sh e w rites, is th a t only w ith th e tra in in g of ad d itio n al p h y sician s from m inority g ro u p s will a step be m ade to solve th is problem . P rior to 1970 th e delivery of h e a lth care in m inority c o m m u n ities w as providedj by h e a lth p ro fessio n als of th e sam e m inority b ack g ro u n d (B urke, 1975). However,I m inority p h y sician s w ere vastly u n d e rre p re se n te d co m p ared w ith th e ir p roportion in th e population (DHEW, 1975). According to th e 1970 cen su s. B lacks accounted for 11.1 p e rc e n t of th e p o p u la tio n b u t only acc o u n te d for 2.1 p e rc e n t of U.S. p h y sic ia n s' (DHEW, 1975). B lacks w ere th e one ethnic g roup to have th e o p p o rtu n ity to stu d y ' m edicine by v irtu e of th e existence of B lack m edical sch o o ls a n d m ore th a n three-1 fifths of all B lacks stu d ie d at th e pred o m in an tly B lack schools, su c h as H ow ard andj M eharry (AAMC, 1976; H aynes, 1969). In 1970 only 2.8 p ercen t of th e to tal n u m b e r of| s tu d e n ts enrolled in U.S. M edical Schools w ere B lack (DHEW, 1975). In th e 1970 c e n su s only 175 A m erican In d ian p h y sician s w ere listed, w hich rep resen ted less th a n j 0.1 p e rc e n t of th e to ta l n u m b e r of p h y sician s. M exican-A m erican a n d m a in la n d P uerto R ican phy sician s w ere not listed in th e cen su s. A s tu d y b y th e A sso ciatio n of M inority H ealth P ro fe ssio n s S chools in 1983 entitled. B lacks a n d th e H ealth Professions in th e 80s: A N ational C risis a n d a Time fo r A ctio n , p ro v id es th e b a c k g ro u n d in fo rm a tio n on B la c k a n d o th e r m in o rity p h y s ic ia n s in th e U n ited S ta te s. The s tu d y d o c u m e n ts th a t th e n u m b e r a n d 9 p erce n tag e of B lack a n d o th e r m in o rity p h y sician s re m a in s low, n o tw ith sta n d in g p ro jectio n s th a t th e re w ill b e a s u rp lu s of p h y sician s by 1990, a n d th a t th e h ealth s ta tu s of m in o rity A m ericans is significantly poo rer th a t th a t of W hite A m ericans. Louis W. Sullivan, M.D. rep o rted in 1983 th a t th e percen tag e of U .S. p h y sician s w ho are b la ck in creased by only 0.5% betw een 1950 an d 1980. D uring th a t tim e th e to tal n u m b e r of U.S. p h y sician s in c re a se d from 191,947 to 4 4 9 ,5 0 0 w hile th e n u m b e r of B lack p h y sician s only in creased from 4 ,0 2 6 to 11,700 (Sullivan, 1983). D u rin g th e la te sixties efforts b eg an on th e p a rt of th e m ed ical sch o o ls a n d th e F ederal governm ent to in c re ase th e enrollm ent of b la ck a n d o th e r m in o rity s tu d e n ts (Sullivan, 1983). Up to th a t p o in t, th e a n n u a l p e rc e n ta g e of m in o rity fre sh m a n s tu d e n ts h a d b e e n less th a n 3% w ith b la c k s com prising th e la rg e st m in o rity group (Sullivan, 1983). K eith et al. in th e ir 1987 p u b lic a tio n "A ssessin g th e O u tco m e of A ffirm ative A ction in M edical Schools: A S tu d v of th e C lass of 1975" w rote th a t affirm ative action in m edical schools h a d b een ju stified by th e arg u m en t th a t, b eca u se m inority stu d e n ts hav e h isto rically b e e n excluded u n fairly on racial g ro u n d s, it w as m orally rig h t to adm it th e m in large n u m b e rs to m ake u p for p a st injustices. In 1970, th e A ssociation of A m eric an M edical C olleges c re a te d a ta s k force for E x p a n d in g E d u c a tio n a l O p p o rtu n ities In M edicine for B lacks an d O th er M inorities. T his ta s k force proposed a stra te g y for in creasin g th e re p re se n ta tio n of m inorities in th e m edical profession. The long te rm goal w as to "achieve equality of o p p o rtu n ity by relieving or elim inating in e q u itab le b a rrie rs an d c o n stra in ts to access to th e m ed ical profession." The sh o rt te rm goal w as to in c re a se th e p ro p o rtio n 'o f m in o rity s tu d e n ts in U .S. m edical schools from 2.8% to 12 percen t by 1975 (Keith, 1985). A s Keith et al. note progress w as m ad e b u t th e goal proposed b y th e AAMC w as not m e t (Keith et al., 1987). In 1976, th e to tal enrollm ent of u n d e rre p re se n te d m inorities . 10. in th e m edical schools w a s a t 8.2 p erce n t (AAMC, 1985). T here h a s b e e n alm o st no in crease in th a t proportion since 1976. I j PREDICTORS OF SUCCESS FOR MINORITIES I I T ra d itio n a l P red icto rs I W illiam E. S ed lacek a n d D ario Prieto p re se n te d th e following in fo rm atio n in a I p a p e r given a t th e A m erican E d u c a tio n a l R esearch A sso ciatio n m e etin g in 1989 (S edlacek a n d Prieto, 1989). T hey fo u n d th a t d a ta o n p re d ic tin g th e su c c e ss of m in o rity m e d ic a l s tu d e n ts w a s sc a rc e . T h u rm o n d a n d L ew is (1986) fo u n d statistic a lly significant b u t relatively low co rrelatio n s (range .18 to .57) betw een SAT] sc o re s a n d MCAT sco res for 131 B lack s tu d e n ts enrolled in a sp ecial en ric h m e n t p ro g ram a t th e M edical College of G eorgia over th e period 1978-1984. S edlacek an d Prieto (1989) believe th a t sta n d a rd iz e d te s ts m ay n o t have th e predictive u tility for m in o rity s tu d e n ts a s th e y do for m ajo rity s tu d e n ts b e c a u se th e y do n o t m easure, ex p erien tial o r co n tex tu al intelligence. j M cG linn a n d J a c k s o n re p o rte d o n a s tu d y w hich p red ic ted th e re te n tio n a n d p ro g re ssio n of 75 m in o rity s tu d e n ts w ho a tte n d e d a M edical S chool p re p a ra to ry p ro g ram a t th e S o u th e rn Illinois School of M edicine from 1976 to 1986. T hey found th a t MCAT scores a n d college GPA’s did n o t predict s tu d e n t reten tio n , alth o u g h th ey did find th a t th e MCAT R eading score w as h igher for s tu d e n ts w ho prog ressed th ro u g h m edical school on th e norm al sch ed u le (M cGlinn an d Ja c k so n , 1989). M cG linn a n d J a c k s o n fo u n d th a t a ra tin g , b a s e d in p a rt o n n o n -co g n itiv e v a ria b le s, did sig n ifican tly d iffere n tiate (0.05 level) s tu d e n ts w ho re m a in e d in m ed ical school v e rsu s s tu d e n ts w ho d ropped out. T hey co n clu d ed th a t th e stu d y 11 d e m o n s tra te d th e lim ita tio n s of only u s in g tra d itio n a l a p p lic a tio n c rite ria for predicting m inority s tu d e n t su ccess in m edical school. N o n -tra d itio n a l P red icto rs I A n u m b e r of e d u c a to rs hav e sp o k e n of th e n e e d to u s e n o n tra d itio n a l or ! noncognitive p red ic to rs for m edical s tu d e n ts, especially m inority s tu d e n ts (Sedlacek I i j an d Prieto, 1980). R om an et al (1979) found th a t college selectivity, self-evaluation of sk ills a n d m o th e r's level o f e d u c a tio n p re d ic te d m in o rity s tu d e n t p erfo rm a n ce. E v an s et al (1975) also found th a t th e selection of u n d e rg ra d u a te in stitu tio n served as a valid p red ic to r of su c c e ss for m inority stu d e n ts. In sh arin g th a t co n clu sio n . S h ea a n d Fullilove (1985) fo u n d th a t failu re c o u ld be tra c e d to p o o r ex p erien ces for m in o rity s tu d e n ts a t p red o m in an tly all-w hite univ ersities. T he article "The R elationship of N oncognitive v ariab les to A cadem ic S u ccess: A L o n g itu d in a l C o m p a riso n b y R ace " (Tracy a n d S ed lacek , 1984) e x a m in e d th e rela tio n sh ip of SAT sco res a n d noncognitive v ariab les to academ ic su c c e ss (GPA a n d persisten ce) over fo u r y e a rs for B lack un iv ersity s tu d e n ts a n d co m p ared it to th a t of W hite s tu d e n ts. S ed lacek a n d B rooks (1976) h y p o th esized th a t th e se noncognitive v a ria b le s are m ore im p o rta n t th a n tra d itio n a l academ ic m e a su re s to th e acad em ic su c c e ss of m in o rity stu d e n ts. They p roposed th a t th e seven non-cognitive v aria b les rela ted to academ ic su c c e ss are 1) positive self-concept, 2) realistic self-ap p raisal, 3) u n d e rsta n d in g of a n d a n ability to deal w ith racism , 4) preference for long-term goals over m ore im m ed iate-sh o rt te rm n eed s, 5) availability of a stro n g s u p p o rt p erso n , 6) su c c e ssfu l le a d e rsh ip experience, a n d 7) d e m o n stra te d co m m u n ity service. T racey a n d S ed lacek (1984) developed a n in s tru m e n t to m e a su re th e se v ariab les, th e N on cognitive Q u estio n n aire (NCQ). They fo u n d th a t th e NCQ w as m ore predictive of first a n d th ird s e m e ste r g rad e p o in t av erag es (GPAs) th a n w ere th e SAT sco res. T he d im en sio n s a sse sse d by th e NCQ w ere predictive of GPAs for b o th B lacks a n d W hites. 12 It w as also predictive of B làclT studiëht~âttïïtion afte r th ree, six and~ëïgHt sem esters. The a u th o rs n o te d th a t th e NCQ could be u sefu l in ad m issio n s a n d in identiiying stu d e n ts w ho are n o t likely to do well academ ically. T hese stu d e n ts could th e n b e th e focus of p rogram s designed to increase th e ir academ ic success. T he m o st extensive sy stem of organizing noncognitive ad m issio n s v aria b les for j m in o rity s tu d e n ts h a s b een developed by W illiam S ed lacek a n d is d escrib ed in h is article "Predicting M inority S tu d e n t A ccess in M edical School" (Sedlacek a n d Prieto,! 1989). A b rief d escrip tio n of each of th e v ariab les follows. T hese profiles are of high sco rers on th e non-cognitive variables. Positive S elf-C oncept T he s tu d e n t feels confident of m aking it th ro u g h g rad u atio n . T he s tu d e n t m a k es positive s ta te m e n ts a b o u t h im /h e rse lf. T he s tu d e n t ex p ec ts to do well in academ icj a n d non-academ ic areas. A ssum es th a t he or she c a n h an d le new situ atio n s. | I I I R ealistic S elf-A ppraisal The s tu d e n t a p p re c ia te s a n d acc ep ts rew ard s a s w ell a s c o n se q u e n c e s of poor| perform ances. The s tu d e n t u n d e rsta n d s th a t reinforcem ent is im perfect, a n d does notj overreact to positive or negative feedback. T he s tu d e n t h a s developed a sy stem of u sin g feedback to a lter behavior. U n d e rsta n d s a n d D eals w ith R acism T he s tu d e n t u n d e rs ta n d s th e role of th e "system" in h is o r h e r life a n d how it tre a ts m in o rity p e rso n s, often u n in ten tio n ally . The s tu d e n t h a s developed a m e th o d of a sse ssin g th e c u ltu ra l a n d racial d em an d s of th e sy stem a n d re sp o n d s accordingly: assertively, if th e sy stem is w orth it, passively if th e g ain is sm all or th e situ a tio n is 13 am biguous. The stu d e n t does n o t blam e o th ers for h is or h e r problem s o r ap p ea r as a "PoUyanna" w ho does n o t see racism . Prefers long-range goals to sh o rt-te rm o r im m ediate n eed s The s tu d e n t c a n set goals a n d proceed for som e tim e w ith o u t reinforcem ent. The s tu d e n t show s patience. The s tu d e n t c a n see p artial fulfillm ent of longer te rm goal. T he s tu d e n t is fu tu re a n d p a s t oriented, a n d does n o t ju s t see Im m ediate issu e s o r I ! problem s. The s tu d e n t show s evidence of p la n n in g in acad em ic a n d non-academ icj areas. A vailability of a stro n g s u p p o rt p e rso n T he s tu d e n t h a s identified a n d received help, su p p o rt a n d e n co u ra g em en t from one or m ore specific individuals. The s tu d e n t does n o t rely solely on h is o r h e r ownj reso u rces to solve problem s. He or she is not a loner. The s tu d e n t is w illing to adm it' th a t he or she n eed s help w h en appropriate. j S uccessfu l lead ersh ip experience T he s tu d e n t h a s sh o w n evidence of in flu en cin g o th e rs in aca d em ic o r non- acad em ic are a s. T he s tu d e n t is com fortable in providing advice a n d d irectio n to I o th e rs. T he s tu d e n t h a s served a s m e d ia to r in d isp u te s o r d isa g re e m e n ts among! colleagues. C om fortable tak in g actio n w here called for. | 14 D e m o n stra te d C om m unity Service T h e s tu d e n t h a s id e n tified w ith a g ro u p w h ich is c u ltu ra l, ra c ia l a n d or geographic. The s tu d e n t h a s specific a n d long te rm re la tio n sh ip s in a com m unity. The s tu d e n t h a s b een active in com m unity activities over a period of tim e. Knowledge acq u ired in a Field The s tu d e n t know s ab o u t a field o r a re a th a t he or sh e h a s n o t form ally stu d ie d in school. The s tu d e n t h a s a n o n -trad itio n a l possibly c u ltu ra lly o r racially -b ased view of m edicine. T he s tu d e n t h a s developed innovative w ays to acq u ire in fo rm atio n ab o u t a given su bject or field. MEXICAN-AMERICAN ATTITUDES TOWARD EDUCATION I i I In th e c h a p te r 'W hite E th n ic an d C hicano Fam ilies: C o n tin u ity a n d A d ap tatio n in' th e New W orld " th e a u th o r, A n d rei S im ic, p o in ts o u t th a t a t a tim e w henj in d iv id u alism , self-realizatio n a n d sex u al lib eratio n loom large in A m erican socialj th o u g h t, th e im age of th e ethnic fam ily s ta n d s o u t in sh a rp co n trast. C hicanos, by an d large, a re th e p ro d u c ts of a p e a s a n t, econom ic em ig ratio n from a n o n -E n g lish speaking. C atholic c u ltu re (Simic, 1979). C. B. M cC lintock n o te s th a t th e M exican-A m erican fam ily's stro n g av ersio n to o ste n ta tio u sn e ss a n d overt com petition does n o t equip th e ch ild ren to a d ju st easily to an y highly com petitive A m erican group. T he ch ild ren b rin g a c u ltu ra l b ack g ro u n d to school w hich, in m a n y w ays, is in sh a rp c o n tra st to th e m id d le-class c u ltu re of th e A m eric an school. M exican c u ltu re e n c o u ra g e s fam ily so lid a rity a n d d isc o u ra g e s 15 co m p etitio n . T he c u ltu re of th e A m erican sch o o l e n c o u ra g e s co m p e titio n a n d in d e p en d en t w ork (M cClintock, 1974). E d u c a tio n in th e M exican tra d itio n h a s b een lim ited to a select few, prim arily th e u p p e r class. F u rth e r, ed u catio n w as never com petitive o r ap p ro ach ed w ith aggression a n d h a s m a in ly b e e n co n ce rn ed w ith p h ilo so p h y , lite ra tu re a n d religion. In th e U n ited S ta te s e d u c a tio n is co m p u lso ry a n d com petitive. S tu d e n ts u su a lly have definite goals (C abrera, 1973). The low er-class M exican A m erican child is th e n often p u t a t a d isad v an tag e w h en it com es to utilizing w h a t a n A m erican school sy stem h a s to offer. He com es from a n a u th o rita ria n , fa th e r-d o m in a te d h o u seh o ld to a fem ale-d o m in ated classro o m . H is c u ltu re is offended by co m petition an d th e A m erican school d e m a n d s it. E n g lish skills are often poor, an d reading ca n be very difficult ( Gomez, 1972). . In a stu d y done o n a ttitu d e s tow ard e d u ca tio n held by ad o lescen ts D em os fo u n d th a t th e re w ere considerable differences in a ttitu d e s ex p ressed by M exican-A m erican s tu d e n ts a n d A nglo s tu d e n ts . T he M exican-A m erican s tu d e n ts e x p re sse d a le ss positive a ttitu d e . Specifically, th e M exican-A m erican s tu d e n ts h eld th e following attitu d es. 1) T eachers did n o t u n d e rsta n d them . 2) T hey did n o t feel th a t th e staff of th e school w a s concerned ab o u t them . 3) T hey felt it w as n o t im p o rtan t to m a in ta in a good atten d an c e record. 4) They th o u g h t it desirable to drop o u t of school before g rad u atio n . D em os n o te s th a t th e v alu es th a t th e M exican-A m erican child com es to accept are in d ire c t conflict w ith th o s e of th e A nglo m id d le c la ss a d m in is tra to rs th a t are respo n sib le for th e school in stitu tio n s (Demos, 1962). 16 SOCIAL STRUCTURAL CONSTRAINTS IN CAREER OPTIONS "Social S tru c tu ra l C o n stra in ts in C areer D ecision M aking O ccu p atio n al H urdles" 1 is a concept described by R ue B u ch er in th e book. Social L earning an d C areer D ecision j M aking. B u ch er's th e sis is th a t th e re are social c o n stra in ts w hich are pervasive an d I are capab le of sh ap in g a n d m olding a p erso n 's developm ent w ith o u t th a t p erso n being j aw are of th e se in flu en ces. T he pervasive social c o n s tra in ts c a n be sum m arized! w ith in th e co n ce p t of th e p e rs o n 's p o sitio n in society. T he p o sitio n is b a se d on fam iliar dem ographic variables: age, sex, education, socio-econom ic s ta tu s (or social class), eth n icity , u rb a n , s u b u rb a n , o r ru ra l location, fam ily com position, a n d so forth. All of th e se c h a ra c te ristic s com bine to crea te a p e rs o n 's perspective on th e w orld- a p e rsp e c tiv e w h ich re fle c ts th e p e rs o n 's p o sitio n . In a d d itio n to th e p e rsp e c tiv e s w h ich people a c q u ire b a s e d on th e ir p o sitio n in so ciety th e y face different o p p o rtu n ity stru c tu re s. O pportunity s tru c tu re s m ay b e defined a s th e range of life ch a n g in g o p tio n s w h ich are available to th e in d iv id u al. T he o p p o rtu n ity s tru c tu re in clu d es n o t ju s t th e op p o rtu n ities to gain access to v ario u s options, b u t th e probability of successfully p u rsu in g th e m (Bucher, 1979). STATEMENT OF HYPOTHESES T he prin cip al th e sis of th is stu d y is th a t su ccessfu l com pletion of a m edical school c a re e r for a L atino c a n be p red icted by v ario u s non-cognitive v aria b les in ad d itio n to th e trad itio n al v ariab les u se d in th e m edical school ad m issio n s p rocess. H ypotheses related to th e principal th e sis are a s follows. 1) N o n -traditional v ariab les will b e a m ore acc u rate p red icto r of su c c e ss for L atinos th a n traditional variables, (see Page 4, Q uestions 1,2,& 3) 17 2) N o n -tra d itio n a l v a ria b le s w ill be m ore stro n g ly co rrelated w ith su c c e s s am ong L atin o m ed ical sch o o l g ra d u a te s th a n s u c c e s s am o n g W hite m e d ical sch o o l g rad u ates. (See question 4 on Page 4) DEFINITION OF TERMS F or th e p u rp o se of th is stu d y th e following are th e definitions of te rm s used : SU CCESS is defined a s rec ru itm e n t into a n d g rad u atio n from m edical school. LATINOS are s tu d e n ts of M exican-A m erican d escen t w ho self-identified a s M exican- A m erican u p o n ta k in g th e MCAT exam . MAJORITY o r W hite is defined a s self-identified C a u c a sia n s tu d e n ts w ho to o k th e MCAT exam . MCAT is th e stan d ard ized exam u se d by m edical schools a s one of th e ir criteria for a d m issio n s. GPA is th e g rade point average from u n d e rg ra d u a te academ ic w ork. TRADITIONAL VARIABLES are th e scores from the MCAT exam a n d th e GPA. NON-TRADITIONAL VARIABLES a re th e n o n -co g n itiv e m in o rity a d m is sio n s v ariab les developed by W illiam E. Sedlacek, listed below. 1. Positive self-concept o r confidence. 18 2. R ealistic self-ap p raisal. 3. U n d e rsta n d s a n d d eals w ith racism . 4. P refers long-range goals to sh o rt te rm or im m ediate needs. 5. A vailability of stro n g su p p o rt p erso n 6. S u ccessfu l lead ersh ip experience. 7. D em o n stra te d co m m u n ity service. 8. D em o n strated m ed ical in terests. A n in th n o n -tra d itio n a l v a ria b le is a lso e x am in ed . T h is v a ria b le is c a lle d "M otivation for C areer in M edicine." T his variable is a Q u in n ad d itio n to th e study. 9. M otivation for C areer in M edicine SCOPE AND DELIMITATIONS OF THE STUDY T he stu d y is lim ited to providing inform ation only o n L atinos from th e S o u th w est (California, A rizona, T exas, C olorado an d New Mexico). The concept could be u s e d to ex am in e o th e r u n d e r-re p re s e n te d m in o ritie s, i.e., A m e ric a n -In d ia n s, m a in la n d P u erto -R ican s, etc. Dr. W illiam Sedlacek developed a n d h a s u se d th e non-cognitive m inority ad m issio n s variab les to m e asu re a n d p red ict su c c e ss in h ig h er ed u ca tio n for B lack stu d e n ts. 19 T H ë ~ ln fo im a tiô n ^ b tâ in ë ’ d~from tH ë~stïïdy is lim ited toTth e y e a rs following th e m a jo r p u s h for affirm ative actio n in th e early 7 0 s. T herefore s tu d e n ts w ho w ere accepted into "slots" du rin g th e pre-B akke era are n o t represented. SUMMARY T he foregoing review of th e lite ra tu re d e sc rib e s th e in e q u ity th a t e x ists for m inority s tu d e n ts in th e field of m edicine. T his inequity, in tu rn , is a p rim aiy c a u se for th e m a ld istrib u tio n of h e a lth m an p o w er in m in o rity a re a s. T h is review of th e lite ra tu re p o in ts to th e n eed for m ore re se a rc h to d eterm in e th e m e th o d s for b e st selectin g a n d re c ru itin g m in o rity s tu d e n ts in o rd er to m a k e a co n ce rted effort to ch an g e th e m a ld istrib u tio n problem . The d escrip tio n of tra d itio n a l p re d ic to rs and' n o n -tra d itio n a l p re d ic to rs of su c c e ss in m edicine provides a n innovative m eth o d by; w h ich to in c re a se th e ap p lic a n t pool of m in o rity a p p lic a n ts. D evelopm ent of new a d m issio n s c rite ria for L atino a p p lic a n ts, w hich are p red ictiv e of su c c e ss , wouldl I in crease th e n u m b e rs of L atinos rep resen ted in th e field of m edicine. A co m bination of tra d itio n a l a n d n o n -tra d itio n a l a d m issio n s v a ria b le s m ig h t b e a m ore accu ratej reflection of th e ability of a m in o rity app lican t. M exican-A m erican a ttitu d e s tow ard! ed u ca tio n are c u ltu ra l facto rs w hich need to be consid ered in developing p ro g ram s as' w ell a s th e c h a n g e s th a t o ccu r w ith acc u ltu ratio n . R esearc h th a t provides u s w ith m ore know ledge o n L atinos w ho su cceed in m edical school will provide u s w ith th e in fo rm atio n to develop m ore effective ed u ca tio n a l in te rv e n tio n p ro g ram s a s well a s a sc e rta in w hich v a ria b le s c o n trib u te to n o n -su c c e ss. T he p rin c ip a l th e sis of th is stu d y is th a t su c c e ssfu l com pletion of a m edical school c a re e r for a L atino c a n be p re d ic te d by v a rio u s n o n -tra d itio n a l v a ria b le s in a d d itio n to th e tra d itio n a l v a ria b le s u s e d in th e m ed ical sch o o l a d m issio n s p ro c e ss. O n th e b a s is of th e foregoing review of th e lite ra tu re it seem ed re a so n a b le to h y p o th esize th a t no n - tra d itio n a l p red icto rs of su c c e ss w ould have a m e a su ra b le stre n g th of p red ictio n for L atinos. T he h y p o th e se s th a t w ill b e te ste d by th is s tu d y are 1) N o n -trad itio n al 20 v aria b les will be a m ore a c c u ra te p red ic to r of su c c e ss for L atin o s th a n tra d itio n a l v a ria b le s a n d 2) N o n -tra d itio n a l v a ria b le s will b e m ore stro n g ly c o rre la te d w ith su c c e ss am ong L atino m edical school g ra d u a te s th a n su c c e ss am ong W hite m edical sch o o l g ra d u a te s . T he re a d e r w ill re c a ll th e re a re fo u r m a jo r q u e stio n s to be; a d d re sse d b y th is d is s e rta tio n (see page 4). The first h y p o th e sis is a d d re sse d in q u estio n s one, tw o a n d three; th e second h y p o th esis is ad d re sse d in q u estio n n u m b e r four. The n ex t c h a p te r d escrib es th e m e th o d s w hich are u s e d to te s t th e foregoing h y p o th eses a n d questions. 21 CHAPTER III METHODOLOGY OVERVIEW OF STUDY T h is stu d y u s e s a retro sp ectiv e, c a u sal-co m p ara tiv e re s e a rc h design. A rchival d a ta collected in 1978 an d 1983 by th e A ssociation of A m erican M edical Colleges arej ex am in ed to d eterm in e w h e th e r tra d itio n a l or n o n -tra d itio n a l p re d ic to rs of su ccess' are m o re closely co rrelated to su c c e ssfu l com pletion of m ed ical sch o o l for Latinoj s tu d e n ts. D ifferences betw een L atino m edical school s tu d e n ts a n d a m a tch in g set of! n o n -L atin o m ed ical s tu d e n ts are also ex am ined. Tw o-w ay ta b le s a n d re g re ssio n m odels are u sed to predict su ccess using different se ts of predictors. RESEARCH DESIGN T he design for th is stu d y is retrospective, reviewing th e d a ta collected d u rin g 1978 a n d 1983 on s tu d e n ts w ho took th e MCAT exam . It is a cau sal-co m p arativ e research d esig n in w hich possible c a u se a n d effect rela tio n sh ip s are in vestigated b y observing so m e e x istin g co n se q u e n c e (in th is s tu d y g ra d u a tio n fro m m e d ic a l school) a n d analyzing th ro u g h th e archival d a ta for plau sib le c a u sa l factors. D ep en d en t V ariable T he d e p e n d e n t variable is m ed ical school o utcom e s ta tu s , i.e., su c c e ss eq u als g ra d u a tio n from m edical school a n d no n - su c c e ss eq u als no n -co m p letio n of m edical school. T h is outcom e w as d eterm in e d fro m th e d a ta show ing la st s ta tu s change. G rad u atio n w as coded a s equ al to or g reater th a n 62 an d Non- su c c e ss w as coded as 22 less th a n 62. A code of g reater th a n 62 indicated th a t th e s tu d e n t h a d g ra d u a te d from! m edical school. Less th a n 62 in d icated th a t th e s tu d e n t h a d n o t fin ish ed m edical school. I T ra d itio n a l V ariab les T he p red ic tiv e v a ria b le s w h ich are la b eled th e tra d itio n a l v a ria b le s fo r th e i p u rp o se of th is stu d y are MCAT sco res an d GPAs {Grade Point Averages). T he MCAT su b ject categories are Biology, C hem istry, P hysics, R eading, Science P roblem s, andj Q u an titativ e. T h ese w ere collapsed into high or low MCAT sco res (>7) or (<=7) andj I high GPA (>3.5) a n d low GPA (<=3.5). The m e d ian of th e ap p lican t pool sco res w as u se d to d eterm ine th e c u t off score of high or low o n MCAT sco res a n d on GPA for th e p urpose of th e study. N o n -tra d itio n a l V ariab les T he predictive v aria b les w h ich are th e n o n -tra d itio n a l v aria b les for th e p u rp o se of th is stu d y are th e following. 1. Positive self co n cep t T h is variable w as m e a su re d b a se d on self rep o rte d ev alu atio n of skill in w riting, re a d in g , m a th (acad em ic sk ills) a n d c re a tiv ity , s y m p a th y a n d in d iv id u a l re la tio n s (life skills). T he stu d e n t ra te d h is or h e r level of ability in th e se areas. A verage o r below w as co n sid ered a low self co n cep t a n d b e tte r th a n average or g re a te r w as considered a high self concept. 2. R ealistic S elf-A ppraisal T h is v ariab le w a s m e a su re d b y com paring th e s tu d e n t's self a p p ra isa l w ith th e MCAT score in th e sam e area. The MCAT q u an titativ e score w as m a tc h e d to self 23 re p o rt on M ath skills. T he MCAT score in read in g w as m a tc h e d to self rep o rt of skill in reading. A high self ra tin g m atch in g a high score on th e m a th MCAT wasj co n sid ered a realistic self ap p raisal, if th e MCAT score w as low a n d th e self ratingi 1 w a s high th a t w as considered n o t realistic. ! 3. U n d e rsta n d in g R acism T his variable w as m e a su re d u sin g p a re n ta l incom e (<=$15,000 p e r year) a n d th e ed u c a tio n a l level of fa th e r (<= high school g rad u ate) to in d ic a te a low socio econom ic b a c k g ro u n d . T he s tu d e n t’s ability to le a m to u s e th e "system " a s in d icate d by h is o r h e r skills in arriving a t th e poin t to apply to m edical school is a n in d icato r th a t h e o r she u n d e rs ta n d s th e system , u n d e rs ta n d s h is or h e r role in th e system a n d developed th e "sm arts" to use th e system . Low SES for th e purpose of th is stu d y is equal to u n d e rsta n d in g racism . 4. Prefers Long Range G oals T h is variable w as m e a su re d u sin g th e n u m b e r of p ro cessed ap p licatio n s (> 2) and! w h e th e r or n o t they h a d sta te d a preference in a m edical c are er area. 5. A vailability of A S tro n g S u p p o rt P erson T his variable could n o t be m e a su re d w ith th e available d ata. 6. L eadership E xperience T h is v a ria b le w as m e a su re d by self-rep o rt on d ecisio n m a k in g skills. If th e s tu d e n t reported a b e tte r th a n average or above ability in decision m ak in g skills it w as considered a stre n g th for le ad ersh ip skills. A verage or below w as considered no le ad ersh ip skills. 24 7. D e m o n stra te d C om m unity Service T h is v ariab le w as m e a su re d by th e n u m b e r of v o lu n teer h o u rs th e s tu d e n t h a d accom plished. If th e s tu d e n t in d icate d th a t th e y h a d done v o lu n teer w o rk for a period of tim e in th e p a st it w as coded a s d em o n strated com m unity in terest. 8. D em o n strated M edical In tere st T h is variable w as m e a su re d u sin g th re e item s: 1) a t w h at poin t th e y first th o u g h t of a c a re e r in m edicine, 2) w h en th e y decided u p o n a care er in m edicine a n d 3) if i th e y h a d a lre a d y decid ed u p o n a m e d ical sp ecialty . D e m o n stra te d m e d ical j in te re st w as show n by a n early decision to s tu d y m edicine an d b y th e ir capability I to describe a m edical speciality th a t w as of in te re st to them . 9. M o tiv atio n fo r a C a re e r in M edicine (Q u in n 's a d d itio n to S e d la c e k 's non- i tra d itio n a l criteria) : T h is variable w as m e a su re d u sin g tw o item s. T his first w as th e s tu d e n t's re a so n fo r choo sin g to go in to m edicine (MEDFACTOR). T his w as divided in to altru istic m o tiv e s a n d n o n -a ltru is tic m o tiv es. T he se c o n d ite m w a s th e a p p lic a n t’s d e sc rip tio n of th e in flu en ces th a t c a u se d h im or h e r to ch o o se m ed icin e a s a care er. T his w as divided into tw o ty p e s of influence: 1) experience, or 2) people. E x p erien ce w a s a h e a lth re la te d w o rk exp erien ce a n d people w a s c o u n selo r, te ach er, p a re n t, physician, etc. In fo rm atio n al B ack g ro u n d V ariables B a c k g ro u n d in fo rm a tio n w h ich w ere also ex am in ed for th e ir re la tio n sh ip to outcom e in clu d ed th e following, age sex h o m eto w n size L . 25 S tate of residence N um ber of d ep en d en ts F a th e rs e d u ca tio n F a th e rs em ploym ent M others e d u c a tio n I M o th er em ploym ent I P a re n ta l Incom e I F in an cial Aid s ta tu s [ W illingness to C om m it to Service (in exchange for F in an cial Aid) SU BJECTS S u b je c ts in th is stu d y a re self d escrib ed "M exican A m ericans" w ho are m edical school ap p lican ts. T h eir resp o n se at th e tim e of te stin g on th e MCAT exam is u se d as th e d e sc rip to r of ethnicity. T hey are referred to a s L atino in th is stu d y . S tu d e n ts resp o n d in g a s "C aucasian" are referred to a s W hite or m ajority s tu d e n ts w ith in th is I study. T he su b jects inclu d ed in th is stu d y are from th e following so u th w estern states:, C alifornia, A rizona, T exas, New Mexico, an d C olorado. In 1978 th e re w ere 364 Latino m edical school ap p lican ts. In 1983 th e re w ere 4 1 5 L atino a p p lican ts. W hites w ere m atch ed by state of residence, sex and age. INSTRUMENT DESCRIPTION The q u estio n n aire is a five page d o cu m en t co n sistin g of 3 9 item s an d six sections. T he se c tio n s a re I) P a re n ta l In fo rm atio n , II) M a rita l S ta tu s In fo rm a tio n , III) B ack g ro u n d Inform ation, IV) C areer Inform ation, V) E d u c a tio n Inform ation, a n d VI) F in an cial Inform ation. A copy of th e q u estio n n aire is in th e A ppendix. 26 DATA COLLECTION PROCEDURES T he d a ta for th is stu d y w ere collected by th e A sso ciatio n of A m erican M edical Colleges a t th e tim e of th e MCAT exam . T his is a p ro cto red exam w h ich is given a t v ario u s sites acro ss th e n atio n on specific dates. D uring th e exam p rocess, w hich is J tra d itio n a l, s ta n d a rd iz e d te s t, th e a p p lic a n ts a re given a P re m e d ic a l S tu d e n t I I Q u estio n n aire. The s tu d e n ts are told th a t th e q u e stio n s w ill b e u se d to stu d y th e c h a ra c te ristic s, experiences, a n d ed u ca tio n a l c a re e r p la n s of p e rso n s contem p latin g a p p lic a tio n to M.D. d e g ree -g ra n tin g p ro g ram s in th e AAMC m e m b e r in stitu tio n s.! A nonym ity is g u aran teed . T he d a ta u se d to com plete th is stu d y w as req u este d from! th e A sso ciatio n of A m erican M edical Colleges. T he AAMC’s S tu d e n t a n d A pplicant ! In fo rm atio n M an ag em en t S y stem (SAIMS) is a co m p reh en siv e b a n k of d a ta on all in d iv id u a ls ap p ly in g to a n A m erican M edical School. I review ed th e listin g of available d a ta in form ation a n d req u este d th a t a d a ta ta p e b e developed of th e itemsj w h ich w ere a p p licab le to m y stu d y . I re q u e ste d in fo rm a tio n o n all M exican-! A m erican ap p lican ts for th e y ears 1978 an d 1983. The y e a r 1978 w as ch o sen b ecau se it w as th e first y e a r th a t th e y h a d com plete d a ta for th e inform atio n I w as requesting.^ 1983 w as ch o sen b eca u se it w as th e m o st recen t y ear in w hich we could verify w h eth er o r n o t th e s tu d e n t h a d com pleted m edical school. A m a tc h e d g ro u p s of W hites w as re q u e ste d for th e sa m e y e a rs. T he W hites w ere m a tc h e d by S ta te , age a n d sex. T elephone co n v ersatio n s a n d le tte rs w ere w ritten betw een th e R esearch A ssociate at- th e AAMC a n d m yself over a period of four m o n th s to d eterm in e a n d clarify th e data! to be u sed. The req u est for th e d a ta tap e took approxim ately six m o n th s to com plete. DATA ANALYSIS T here are th re e sta g e s to th e an aly sis of th is stu d y . The first stag e of an aly sis is| descriptive. In th is stage descriptive inform ation a b o u t each of th e v ariab les is given.| i F requencies in each category are show n. F or exam ple, th e frequency of th e percentage 27 of L atin o s w ith a p a re n ta l incom e below $ 1 5 ,0 0 0 is given. T he freq u en cy of th e su c c e ss ra te for L atinos is given a s well a s th e frequency for th e su c c e ss ra te of w hite m e d ical g ra d u a te s . B a c k g ro u n d in fo rm atio n is also p re s e n te d in th is section. D escrip tio n s of th e L atino ap p lic a n ts, s u c h a s p a re n ta l e d u ca tio n , incom e, etc. are given in th is section. T he ta b le of freq u en cies in c lu d e s in fo rm atio n on W hites for reference. T he s e c o n d sta g e of a n a ly sis is th e ex p lo ra to ry sta g e . In th is sta g e th e re la tio n s h ip s b etw ee n th e d e p e n d e n t v ariab le, su c c e ss fu l co m p letio n of m ed ical school, a n d each v ariab le are explored. F or exam ple, th e re la tio n sh ip b etw een the; 1 MCAT sco res a n d th e su ccess ra te is exam ined. T his inform ation w as exam ined using! I j tw o w ay tab les. C h i-sq u are te s t of in d ep en d en ce is th e s ta tistic a l te c h n iq u e u se d in th is stag e of an aly sis to d eterm in e if th e relatio n sh ip betw een predictive variable an d th e d e p e n d e n t variable is significant. T his inform ation is p re se n te d in ta b le s giving th e su c c e ss ra te o f L atinos scoring high or low on th e variable (or equivalent) a n d Chi- sq u a re v alue a n d probability value are given. T he th ird stag e of an aly sis is m u lti-v a riate analy sis. In th is sta g e co m b in atio n s of th e different facto rs a re exam ined to d eterm ine w hich are m o st strongly correlated to su ccess. The relative im p o rtan ce of th e different factors is d eterm ined. B ecause of th e in te re st in th e relatio n sh ip betw een pred icto rs of su c c e ss for L atino s tu d e n ts a n d n o n -L atin o s tu d e n ts re g re ssio n s are r u n w ith d ep e n d e n t v ariab le c o rresp o n d in g to g ra d u a tio n from m edical school an d non-com pletion of m edical school. Logistic an d step w ise re g re ssio n s are c o n d u c te d b e c a u se of th e categ o rica l n a tu re of su c c e ss outcom e. L ogistic re g re ssio n s are c o n d u c te d for each o f th e p red ic tiv e v a ria b le s. The logistic a n d reg ressio n m odel p a ra m e te rs are estim ated u sin g th e SAS PROC CATMOD { a n d PROC REG program s (SAS S tatistic U ser's Guide, 1985). 28 To a d d re s s q u estio n one, "how well do tra d itio n a l v a ria b le s p re d ic t s u c c e ss for Latinos?", th e set of trad itio n al variab les are u se d a s pred icto rs of su c c e ss in tw o-w ay ta b le s a n d b i-v ariate logistic reg ressio n s. T he c h i-sq u a re overall fit is a s se sse d a n d com pared to th e first m odel. To a d d re s s q u e stio n tw o, "how well do n o n -tra d itio n a l v aria b les p red ic t su c c e ss for L atinos?" th e se t of n o n -tra d itio n a l predictive v ariab les are u s e d a s p re d ic to rs of su c c e ss in tw o-w ay ta b le s a n d b i-v ariate logistic reg ressio n s. The c h i-sq u a re overall fit is a sse sse d a n d com pared to th e first m odel. To a d d re s s th e th ird q u e stio n , "how w ell do tra d itio n a l a n d n o n -tra d itio n a l a d m issio n s c rite ria (com bined) p red ic t su c c e ssfu l com p letio n of m ed ical school by] i Latinos?", stepw ise a n d logistic reg ressio n s are ru n . i To a n sw e r th e fo u rth q u estio n , "is th e re a difference in p re d ic to rs of success! b etw een L atino m edical g ra d u a te s a n d non-L atino m edical g rad u ates?" th e stepw ise; a n d logistic reg ressio n s for L atinos an d W hites are ru n an d com pared. A m odel is also c o n s tru c te d w h ich in c lu d e s in te ra c tio n te rm s betw een p red ic to rs a n d e th n ic s ta tu s. Follow ing th is th e b p a ra m e te rs are exam in ed for zero, w ith n o n -zero in te ra c tio n in d icatin g differences betw een L atinos an d W hites. T he following c h a p te r d escribes th e re s u lts of th e analyses. 29 CHAPTER IV RESULTS AND ANALYSES INTRODUCTION T here are th re e levels of an aly sis u se d to exam ine th e d ata. T hese levels are th e 1), I th e descriptive stage, 2) th e exploratory stage a n d 3) th e m u ltiv ariate stage. D ifferent statistic al te c h n iq u e s are u se d w ithin each stag e to an sw er th e fo u r q u estio n s posed in th is stu d y . The th re e sta g e s are d escrib ed w ith a n a rra tiv e sectio n a n d ta b le s to ( p resen t th e resu lts. I 1. THE DESCRIPTIVE STAGE T h is sta g e of a n a ly sis w a s d o n e u s in g fre q u e n c ie s for e a c h category. T he d e s c rip tiv e in fo rm a tio n fro m th e fre q u e n c ie s s e rv e s to d e s c rib e th e ; c h a ra c te ris tic s of m ed ical school a p p lic a n ts a n d is u s e d a s th e b a s is for th e i re m a in d e r of th e analysis. B ack g ro u n d In fo rm atio n D u rin g 1978 th re e h u n d re d sixty fo u r L atin o s (M exican-A m ericans) from th e S o u th w e st to o k th e MCAT ex am s a n d ap p lied for a d m issio n to a n A m erican M edical School. Seventy fo u r p erce n t (74%) w ere m a les a n d tw en ty six p erce n t (26%) w ere fem ales. Fifty nine percen t of th e ap p lican ts w ere age 23 or above. The sta te of resid en ce b reak d o w n w as a s follows: A rizona 15 (4.1%), C alifornia 159 (44%), Colorado 15 (4.1%), New Mexico 31 (8.5%) a n d T exas 155 (39.6%). T he range o f p ro c e ss e d a p p lic a tio n s for m ed ical sch o o l w a s from one to 70 p ro c e sse d ap p licatio n s for one applicant. O ne h u n d re d sixty one L atino ap p lican ts w ere not accep ted into an y m edical school. T his re p re se n ts 44.2% of all a p p lican ts for th a t year. O f th e 3 6 4 L atinos w ho w ere in th e ap p lican t pool for m edical school in 1978 I one h u n d re d fifteen g ra d u a te d from m edical school. The en terin g cla ss of 1978 30 w ere fro m fam ilies in w h ich 61% of th e ir fa th e rs w ere em ployed in n o n p ro fessio n al fields (i.e. no college degree). T h ese in c lu d e d th e o c c u p a tio n s of c le ric a l o r s a le s w o rk er, fa rm e r, fa rm la b o re r, sk ille d w o rk er, c ra ftsm a n , u n sk ille d w o rk er a n d lab o rer. T h irty n in e p e rc e n t (39%) re p o rte d th a t th e ir f a th e rs w o rk e d in p ro fe ssio n a l o c c u p a tio n s. T h ese o c c u p a tio n s included! P h y s ic ia n (6% ), h e a lth p ro fe s s io n a l (i.e., d e n tis t, n u r s e p h a rm a c is t) (3%),o w n e r/m a n a g e r of sm all b u s in e s s (9%), a d m in istra to r, m a n a g e r (9%), a n d clergym an, te a c h e r, law yer (13%). The ed u ca tio n a l level of th e fa th e rs show ed th a t 33% h a d only a n eig h th g rad e e d u c a tio n o r le ss, th irte e n p e rc e n t of th e I t fa th e rs h a d som e hig h school, te n p erce n t h a d gone to som e college, nine p ercen t j j h a d g ra d u a te d from college, fifteen p erce n t h a d som e g ra d u a te w o rk o r beyond. F orty one p erce n t h a d m o th e rs w ho w ere full tim e h o m em ak ers. The ed u catio n al level of th e m o th ers w as com parable to th e fath e rs, except at th e doctoral level 7% of th e fa th e rs h a d a doctoral degree a n d less th a n one p e rc e n t of th e m o th ers h a d a doctoral degree. F o rty fo u r p e rc e n t of th e a p p lic a n ts re p o rte d a p a re n ta l incom e of le ss th a n $ 1 0 ,0 0 0 p er year. L ess th a n 10% reported a n incom e of over $30,000. Eighty one p e rc e n t sta te d th a t th e y w ould n eed fin an cial aid. E ighty tw o p e rc e n t said th a t th e y w o u ld b e w illing to m a k e a c o m m itm e n t to p ra c tic e u n d e r specified co n d itio n s in o rd er to o b ta in financial su p p o rt. S eventy seven p e rc e n t said th a t th e y w ould be in te re s te d in serving in th e P ublic H ealth Service C orps or th e N ational H ealth Service C orps. F o u rteen p ercen t rep o rted having dep en d en ts. T hirty p erce n t of th e ap p lican ts w ere from a m o d erate sized city (50,000-500,000). F o u rte e n p e rc e n t w ere from a sm all city (10,000 - 50,000) a n d th irte e n p e rc e n t ^ i w ere from th e in n e r city. Ten p ercen t w ere from a large city (>500,000) a n d eleven ' p e rc e n t w ere from s u b u rb a n areas. The rem a in d er (19%) w ere from sm all tow ns i or ru ra l areas. 31 TABLE 1 LATINO APPLICANT POOL DESCRIPTION SEX M ale I F em a le 1978 (N=364) LATINOS % WHITES % 1 9 8 3 (N=415) LATINOS % WHITES % 74 26 74 26 72 28 72 28 AGE <23 41 >=23 59 STATE OF RESIDENCE A Z 4 CA 44 CO 4 NM 8 TX 40 PARENT EDUCATION FATHER <H igh School >= High School PARENT INCOME ! <$15,000 >=$15,000 NEED FINANCIAL AID Yes No D on’ t Know WILL COMMIT Yes No D on’ t Know HAS DEPENDENTS Yes N o 45 55 57 43 81 6 13 82 4 14 14 86 GRADUATION SUCCESS Yes 63 N o 37 38 62 4 44 4 8 40 8 92 19 81 47 29 24 65 6 28 12 88 62 38 30 70 3 47 3 8 39 41 59 39 61 85 6 8 78 3 19 14 86 57 43 34 66 3 47 3 8 39 6 94 9 91 55 27 18 63 8 29 7 93 61 39 32 T he ap p lican t pool of 1983 h a d fo u r h u n d re d fifteen L atinos (M exican A m ericans). S eventy tw o p e rc e n t w ere m ale a n d tw en ty eight p e rc e n t w ere fem ale. Seventy p ercen t of th e ap p lican ts w ere age 23 or above. The state of residence breakdow n is a s follows: A rizona 12 (2.9%), C alifornia 194 (46.7% ), C olorado 12 (2.9%), New i Mexico 3 4 (8.2%) an d Texas 163 (39.3%). O f th e fo u r h u n d re d fifteen ap p lican ts th e d a ta sh o w s th a t one h u n d re d a n d forty n in e n ev er m a tric u la te d . Two h u n d re d a n d th irty seven (57%) of th e a p p lican t pool e n te re d a n d com pleted m edical school. T he ran g e of p ro cessed ap p licatio n I ra n g e d fro m one p ro c e sse d a p p lic a tio n to a h ig h of 76 a p p lic a tio n s for one; I a p p lic a n t. O ver fifty p e rc e n t h a d le ss th a n te n p ro cessed a p p licatio n s. O ne h u n d re d n in e ty n in e of th e a p p lic a n ts w ere n ev er accep ted in to m edical school. Two h u n d re d th irty seven (57%) su ccessfully en tered a n d finished m edical school. O ne h u n d re d n in e ty eig h t (56%) re p o rte d th a t th e ir fa th e rs w o rk ed in n o n p ro fessio n al o c c u p a tio n s a n d one h u n d re d a n d fifty th re e (44%) re p o rte d th a t I th e ir fa th e rs w orked in professio n al po sitio n s. T h irty one p e rc e n t of th e fa th e rs j h a d a n eig h th g rad e ed u ca tio n or less. T en p e rc e n t of th e fa th e rs h a d a tte n d e d ; som e high school. S ixteen p ercen t h ad g ra d u a te d from high school. Five p erce n t | h a d som e form of te c h n ic a l train in g . T en p e rc e n t h a d a tte n d e d som e college, j E ight p e rc e n t h a d a college degree. T en p erce n t h a d done g ra d u a te w o rk or h a d a M aster's degree. T en p ercen t of th e fath e rs held a doctoral degree. Forty p ercen t of th e m o th e rs w ere full tim e h o m em ak ers, th e n ex t la rg e st p erce n tag e (14%) w ere I u n sk ille d la b o re rs a n d (12%) h eld p ro fessio n al p o sitio n s, s u c h a s te a c h e r. T en I p e rc e n t of th e m o th e rs held clerical or sale s w orker positions. T hirty one p ercen t of th e m o th e rs h a d a n eighth grad e level or low er edu catio n . E ight p e rc e n t h a d a tte n d e d som e h ig h school a n d tw en ty eight p e rc e n t h a d g ra d u a te d from high school. E leven p e rc e n t h a d a tte n d e d som e college. E ight p e rc e n t h a d a college degree. Seven percen t h a d attended g rad u ate school or held a M aster's degree. 33 F o rty p e rc e n t re p o rte d a p a re n ta l incom e of le ss th a n $ 1 5 ,0 0 0 p e r year. T h irty eight p ercen t rep o rted a p aren tal incom e of betw een $15 ,0 0 0 a n d $ 3 0 ,0 0 0 p er year. T w enty tw o p e rc e n t rep o rte d a n incom e of over $ 3 0 ,0 0 0 p e r y ear. E ig h ty five p e rc e n t sa id th a t th e y w ould n eed fin an cial aid. S eventy eight p e rc e n t in d icate d th a t th ey w ould b e w illing to m ak e a com m itm en t to p ractice for a period of tim e u n d e r a specified co n d itio n s to o b ta in fin an cial su p p o rt. Sixty n in e p erce n t said th a t th e y w o u ld be w illing to serve in th e P ublic H ealth Service C o rp s o r th e N ational H ealth Service C orps a s p a rt of a fin an cial su p p o rt agreem ent. Tw enty one p e rc e n t sa id th a t th e y w ould serve in th e m ilitary in exchange for fin an cial su p p o rt for m ed ical school. In 1983 fo u rte e n p e rc e n t of th e ap p lic a n t pool h a d d ep en d en ts. T h irty p erce n t of th e 1983 ap p lican t pool w ere from a m od erate sized city (50,000- 1 I 500,000). Eleven p ercen t w ere from a sm all tow n or ru ra l area. E ight percen t w ere from a large city (>500,000) a n d fifteen p erce n t w ere from th e in n e r city. Sixteen p erce n t w ere from s u b u rb a n areas. S eventeen p erce n t w ere from sm all cities. T able one su m m a rizes th e key b a ck g ro u n d in fo rm atio n for 1978 a n d 1983. D ata on w h ite a p p lic a n ts for 1978 a n d 1983 is in c lu d ed in th is ta b le p rim arily for c o m p a riso n o n fin an c ial in fo rm atio n s ta tu s . T he d a ta w as c o llap sed fo r th e p u rp o se of analysis. T ra d itio n a l V ariab les T able 2 sh o w s th e p e rc e n t of L atinos sco rin g h ig h o n th e MCAT exam a n d th e p e rc e n t sc o rin g low. T he six MCAT te s t categ o ries are: Biology, C h em istry , Physics, R eading, Science Problem s, a n d Q uantitative. T hese scores ran g e from O to 15. A h ig h MCAT sco re w a s c o n sid ere d to b e >=to 7 a n d a low score w as considered <7. The G rade Point A verages (GPA) are also show n. F or th e p u rp o se of th e stu d y <3.5 w as considered a low score a n d >=3.5 w as considered a high score. 34 N o n -T rad itio n al V ariab les T able 3 sh o w s th e n in e categ o ries of n o n -tra d itio n a l v aria b les. T hey are: 1) Positive Self C oncept, 2) R ealistic Self-A ppraisal, 3) U n d e rs ta n d s R acism , 4) P refers Long R ange G oals, 5) A vailability of S trong S u p p o rt Person, 6) L eadership E x p erien ce, 7) D e m o n stra te d C om m unity Service, 8) D e m o n stra te d M edical In te re s t a n d 9) M otivation for C areer in M edicine. T he d etail on how th e se v aria b les w ere in te rp re te d a n d coded from th e SAIMS d a ta is given in C h ap ter III, i in th e sectio n o n D ata A nalysis. Table 3 gives th e b reak d o w n of how th e L atino ap p lican ts responded in 1978 an d 1983 on th ese variables. EXPLORATORY STAGE OF ANALYSIS A t th is sta g e of a n a ly s is e a c h v a ria b le (tra d itio n a l, n o n -tra d itio n a l a n d b a c k g ro u n d in fo rm a tio n a l) w a s a n a ly z e d to d e te rm in e w h ic h sh o w e d a rela tio n sh ip to outcom e. Two-way ta b le s w ith frequency a n d p erce n t for success! I a n d n o n su c c e ss by facto r w ere u se d to d eterm in e th e stre n g th of rela tio n sh ip . ; S tre n g th of p red ic tio n w as d eterm in ed u sin g th e s ta n d a rd iz e d m e a su re of C hi' S q u a re w h ere a v alu e over 4 .0 w as c o n sid e re d sig n ifican t w ith p ro b a b ilitie s significant a t a <0.05 level. 35 TABLE 2 TRADITIONAL VARIABLES % OF LATINO APPLICANTS WITH HIGH OR LOW SCORES 1978 1983 MCAT BIO <7 >=7 59 41 4 6 54 MCAT CHEM <7 >=7 65 35 60 4 0 MCAT PHYSICS <7 >=7 65 35 57 43 MCAT READING <7 >=7 55 45 57 43 MCAT SCIENCE PROBLEMS <7 >=7 65 35 59 41 MCAT QUANT <7 >=7 68 32 73 27 GPA TOTAL <3.5 >=3.5 15 85 25 75 36 TABLE 3 NON-TRADITIONAL VARIABLES % OF LATINOS WITH HIGH OR LOW SCORES 1978 ( N = 3 6 4 ) 1983 ( N = 4 1 5 ) 1. POSITIVE SELF CONCEPT W ritin g % <=A verage 30 33 > B etter th a n Average 70 67 R eading <= A verage 26 31 > B etter th a n A verage 74 69 M a th <=A verage 28 31 > B etter th a n Average 72 69 C re a tiv ity <=A verage 22 15 > B etter th a n Average 78 85 S y m p a th y <=A yerage 4 6 > B etter th a n Average 96 94 In d iv id u al R elatio n s <=A verage 6 5 > B etter th a n Average 94 95 2. REALISTIC SELF-APPRAISAL R eading - N on realistic 50 51 R e alistic 50 49 M ath - N ot realistic 56 57 R ealistic 44 43 3. UNDERSTANDS RACISM Low SES 62 73 H igh SES 38 27 37 Table 3 (cont.) 1978 C N = 3 6 4 ) 1983 C N = 4 1 5 ) 4. PREFERS LONG RANGE GOALS No 27 22 Yes 73 78 5. AVAILABILITY OF STRONG SUPPORT PERSON Not A vailable Not A vailable 6. LEADERSHIP EXPERIENCE N o 13 11 Yes 87 89 7. DEMONSTRATED COMMUNITY SERVICE N o 38 28 Yes 62 72 8. DEMONSTRATED MEDICAL IN TEREST F irst T hought of - A fter J r . Y ear 16 12 Before J r. Y ear 83 88 Decided - A fter J r . Y ear 33 28 Before J r. Y ear 67 72 9. MOTIVATION FOR CAREER IN MEDICINE N ot A ltru istic 6 7 A ltru is tic 93 93 Influence F acto r P eople 34 32 E xperience 66 68 38 T ra d itio n a l V ariab les A s sh o w n in T able 4 MCAT sco res are strongly predictive of su c c e ss in m edical school for L atinos. All of th e MCAT categories h a d c h i-sq u a re s g reater th a n 4.00.1 E a c h MCAT category h a d a p value of less th a n 0.05. GPA w as also predictive in 1978 b u t w as n o t predictive in 1983. In 1978 th e p value for GPA w as <0.05 b u t in^ ! 1983 it w as 0 .1 1 , T h ese re s u lts in d icate th a t tra d itio n a l v a ria b le s do p red ict su c c e ss in m ed ical school for Latinos. T his an sw ers q u e stio n n u m b e r one of th e s tu d y w hich a s k s if trad itio n a l v ariables are predictive of su c c e ss for Latinos. A p erce n tag e of s tu d e n ts w ho scored le ss th a n 7 on th e MCATs did su ccee d in en terin g an d g ra d u a tin g from m edical school. It th erefo re becom es im p o rta n t to' d e te rm in e w h ich n o n -tra d itio n a l v a ria b le s in c o n ju n c tio n w ith trad itio n al! v aria b les cre a te a predictive a d m issio n criteria for a n a p p lic a n t w ho h a s scored i low on MCATs b u t ap p ea rs to be a cand id ate due to GPA or o th er criteria. N o n -tra d itio n a l V ariab les Table 5 gives th e percen tag e of su ccess by n o n -trad itio n a l variable a n d th e p value is given to in d icate w h e th e r o r n o t th e variable is significant. T he non-traditional] v a ria b le s w h ich are sta tistic a lly sig n ifican t are R ealistic S elf A p p raisal in both' 1978 a n d 1983 a n d Positive Self C oncept in 1978. T he o th e r v aria b les w ere not] s ta tistic a lly significant. Q u estio n n u m b e r tw o of th e stu d y a s k s how w ell n o n - tra d itio n a l v aria b les p red ic t su c c e ss for L atinos. T h is d a ta in d ic a te s th a t no n - tra d itio n a l v a ria b le s do n o t p re d ic t s u c c e ss for L atin o s a s w ell a s tra d itio n a l v a ria b le s. 39 i 1 TABLE 4 TRADITIONAL PREDICTORS OF SUCCESS 19 7 8 CN=364) % CHI P SU C C ESS SQUARE VALUE O verall S uccess 63% <0.05* 19 8 3 (N=415) % CHI P SU C C ESS SQUARE VALUE 57% <0.05* I MCAT BIOLOGY I <7 ' >=7 52 79 28.59 33 77 82.06 j MCAT CHEMISTRY : <7 51 >=7 85 MCAT PHYSICS <7 54 >=7 79 MCAT READING <7 51 >=7 78 MCAT SCIENCE PROBLEMS <7 53 >=7 86 41.89 21.68 29.02 29.27 MCAT QUANT <7 >=7 GPA TOTAL <3.5 >=3.5 54 82 45 66 27.14 8.75 40 82 40 80 44 76 41 80 48 82 50 59 70.34 68.00 43.01 64.12 41.22 2.45 0.11 40 TABLE 5 NON-TRADITIONAL PREDICTORS OF SUCCESS 1978 (N=364) 1983 (N=415) % cm p % C H I p SUC C ESS SQUARE VALUE SU C C ESS SQUARE VALUE <0.05* <0.05* 1. PO Sm V E SELF CONCEPT W ritin g <=A verage 55 54 > B etter th a n A verage 67 4.84 0.02* 60 1.24 .26 R eading <= A verage 59 55 >B etter th a n A verage 65 1.05 .30 59 .39 .52 M a th <=A verage 56 54 > B etter th a n Average 67 3.49 0.06 59 .74 .38 C re a tiv ity <=A verage 58 48 > B etter th a n Average 65 1.20 .27 60 2.55 .11 S y m p a th y j <=Average 50 55 > B e tte r th a n A yerage 64 1.16 .28 58 .11 .74 In d iy id u al R elatio n s <=A verage 33 42 > B e tte r th a n A yerage 65 7.54 .00* 59 2.02 .15 2. REALISTIC SELF-APPRAISAL R eading - Not realistic 58 48 R e a listic 69 4.38 .03* 69 15.57 0.00* M ath - Not realistic 58 53 R e a listic 70 5.32 .02* 63 4.36 0.03* 3. UNDERSTANDS RACISM Low SES 61 59 High SES 67 1.33 .24 52 1.74 .18 * sig n ifican t 41 Table 5 (Cont.) 1978 (N=364) 1983 (N=415) % cm P % cm P SU C C ESS SQUARE VALUE SUC C ESS SQUARE VALUE <0.05* 4. PREFERS LONG RANGE GOALS No Yes 5. AVAILABLE STRONG SUPPORT PERSON 59 65 1.11 Not A vailable .29 52 56 1.40 Not A vailable .23 6. LEADERSHIP N o 55 Yes 65 7. COMMUNITY SERVICE Yes No 8. MEDICAL INTEREST F irst T h o u g h t of - A fter J r . Y ear Before J r . Year D ecided - A fter J r . Y ear Before J r . Year 62 38 62 64 64 64 1.62 .77 .08 .01 .20 .38 .77 .91 54 58 72 28 62 57 59 57 .34 .31 .43 .06 .55 .57 .50 .80 9. MOTIVATION FOR CAREER IN MEDICINE Not A ltru istic 66 A ltru is tic 64 .04 .83 46 59 1.54 .21 Influence F a c to r P eople 65 E xperien ce 64 .00 .94 57 58 .02 .87 42 B ack g ro u n d V ariables T able 6 show s b a c k g ro u n d v aria b les w hich are significant in th e ir re la tio n sh ip to outcom e. The d a ta show s th a t if a s tu d e n t h a s d e p e n d e n ts h is o r h e r ch an c e in; succeed in g d ro p s to 36% a s v e rsu s a 61% chance of g ra d u a tin g if h e o r sh e did n o t have d ep en d en ts. The p value w a s <0.05. Age also strongly p red ic ts su ccess. The y o u n g er s tu d e n ts (less th a n age 23) are m u c h m ore likely to su ccessfu lly e n te r an d g ra d u a te from m edical school th a n are th e s tu d e n ts th a t are age 23 o r older. T he y o u n g er stu d e n ts succeeded at th e rate of 74% in 1978 a s co m p ared to 56% for the! o ld er s tu d e n ts. In 1983 th e y o u n g er s tu d e n ts su ccee d ed a t a ra te of 76% as! co m p ared to 49% for th e older stu d e n ts. In 1983 th e su c c e ss ra te for fem ales was! sig n ifican tly h ig h e r th a n th a t of th e m ale s tu d e n ts . 67% of all th e fem ale a p p lic a n ts g ra d u a te d from m edical school a s v e rsu s 53% of th e m ale ap plicants. 3. MULTIVARIATE STAGE OF ANALYSIS L ogistic re g re ssio n s w ere c o n d u c te d to te s t in te ra c tio n w ith e th n ic ity a n d thcj variable. T hese an aly se s of m ax im u m likelihood estim a te s tell u s th re e things: 1) w h e th e r or n o t th e variable is significant, 2) w h e th e r th e re is a difference betw een L atin o s a n d W hites for th is variable a n d 3) w h e th e r being L atino o r W hite is a positive in d ic a to r fo r th is v aria b le. F o r exam ple if th e e stim a te is positive it! m e a n s th a t if a W hite a n d L atino have th e sam e score th e L atino is m ore likely to su c c e e d . If th e e stim a te figure is negative th e W hite a p p lic a n t h a s a h ig h e r p ro b ab ility of success. 43 TABLE 6 BACKGROUND VARIABLES THAT PREDICT SUCCESS SEX, AGE AND DEPENDENT STATUS DEPENDENT STATUS 1978 % SUCCESS P VALUE No D ep en d en ts 65 S tu d e n t h a s D ependents 56 .25 AGE <23 >=23 1978 % SUCCESS P VALUE 74 .00* 56 1983 % SUCCESS P VALUE <0.05* 61 36 0.00* 1983 % SUCCESS P VALUE 76 .00* 49 SEX F em a le M ale 1978 % SUCCESS P VALUE 59 .27 63 1983 % SUCCESS P VALUE 67 0.01* 53 (63% overall) (57% overall) * S ignificant U n iv aria te re la tio n to o u tco m e n o t u s e d in m u ltiv a ria te a n a ly sis b e c a u s e thesej v a ria b le s c a n n o t b e u s e d a s a n e n tra n c e c rite ria . H ow ever, th e y do provide! in fo rm atio n o n w here to provide ad d itio n al ed u ca tio n a l su p p o rt. | 4 4 TABLE 7 VARIABLES THAT ARE EQUALLY PREDICTIVE FO R LATINOS & WHITES STANDARD CHI- VARIABLES ESTIM ATE ERROR SQUARE PROBABILITY P=<0.005* I I AGE GE 23 : DEPEN DENT STATUS SEX PARENTAL INCOME I FATHERS EDUCATION LOW SES READING RLSTC SELF-APPRSL MATH RLSTC SELF-APPRSL SYMPATHY SKILLS CREATIVITY MOTIVATION-ALTRUISM MOTIVATIONAL EXP LEADERSHIP SKILLS CAREER PREFERENCE NO. OF PROCESSED APP 0.17 LONG RANGE GOALS MCAT BIOLOGY MCAT CHEMISTRY MCAT PHYSICS MCAT SCI PROBLEMS MCAT QUANTITATIVE 0.50 .059 73.77 0.00 * -0.34 .090 14.84 0.00 * -0.01 .058 0.10 0.75 -0.10 .074 2.16 0.14 -0.11 .067 2.66 0.10 -0.03 .095 0.11 0.73 0.30 .054 31.68 0.00 * 0.28 .053 27.71 0.00 * 0.12 .111 1.22 0.26 0.21 .078 7.42 0.00 * 0.15 .114 1.80 0.17 -0.10 .060 3.34 0.06 0.20 .094 4.63 0.03 * -0.15 .110 1.88 0.17 0.17 .088 3.83 0.05 0.08 .058 2.33 0.12 0.76 .064 140.78 0.00 * 0.86 .064 181.31 0.00 * 0.76 .062 148.90 0.00 * 0.76 .063 142.66 0.00 * 0.65 .063 104.34 0.00 * 45 TABLE 8 I VARIABLE VARIABLES THAT ARE DIFFERENTIALLY PREDICTIVE FOR LATINOS AND WHITES STANDARD CHI- ESTIM ATE ERROR SQUARE PROBABILITY P=<0.05* WHEN DECIDED W hite . 11 L atino D ifference . 13 L a tin o .24 .059 .059 3.48 4.93 0.06 0.02 INDIVIDUAL RELATIONS W hite .28 L atino D ifference -.21 L a tin o .07 MATH SELF-REPORT W hite .34 L atino D ifference .18 L a tin o .52 READING SELF-REPORT W hite .32 L atino D ifference .21 L a tin o .53 WRITING SELF-REPORT W hite .35 L atino D ifference .15 L a tin o .50 MCAT READING W hite .52 L atino D ifference -.13 L a tin o .39 GPAS W hite .09 L atino D ifference -.20 L a tin o -.11 121 121 .071 .071 .068 .068 .068 .068 .061 .061 .065 .065 5.60 3.03 24.25 6.49 22.18 10.22 27.52 5.30 73.65 4.90 2.28 9.98 0.01 0.08 0.00 0.01 0.00 0.00 0.00 0.02 0.00 0.02 0.13 0.00 46 T ab le 7 lists th e v a ria b le s th a t are eq u ally pred ictiv e for L atin o s a n d W hites. T h ese are Age, D ep en d en t S ta tu s, Sex, F a th e r E d u ca tio n a l level. Socio-econom ic s ta tu s . R ealistic Self- A p praisal in R eading a n d M ath, S y m p ath y skills, creativity sk ills. M otivation, L ea d ersh ip sk ills. C a re e r P referen ce, N u m b er of P ro c e sse d A p p lic atio n s, Long R ange G oals, a n d th e MCAT sc o re s in Biology, C h em istry , P hysics, Science Problem s, a n d Q uan titativ e. T he v ariab les w hich a re significant in pred ictin g su c c e ss for b o th L atinos a n d W hites are Age, D ep en d en t s ta tu s , th e I MCAT sc o re s in all categ o ries, a n d in n o n -tra d itio n a l v aria b les, re a listic self-j a p p ra isa l in read in g a n d creativity skills. Of th e v aria b les th a t are significant inj p re d ic tin g su c c e s s th e re are seven w hich have a n estim ate w hich in d ic a te s th a t b ein g L atino p red ic ts a h ig h er su c c e ss ra te th a n th e ir W hite c o u n te rp a rts. T hese a re realistic self a p p ra isa l in reading, realistic self a p p ra isa l in m a th , leadershipj sk ills, MCAT S cien ce P ro b lem s, MCAT P h y sics, MCAT C h e m istry ,a n d MCATj Biology. T he estim ate figure in d icate s th a t L atinos scoring equally w ith W h ites o n th e se v ariab les will succeed a t a hig h er ra te th a n W hites. | T he v a ria b le s th a t do differ b etw een L atin o s a n d W h ites are th e tim e perio d in sch o o l a t w h ich decided on c a re e r in m edicine, in d iv id u al re la tio n s, m a th self-, ev alu atio n , read in g self- evalu atio n , w riting self-evaluation, MCAT R eading scorej a n d GPAs. T he v a ria b le s w h ich a re sig n ific a n t in p re d ic tin g s u c c e s s for, a p p lic a n ts are In d iv id u al R elation sk ills, self-ev alu atio n in m a th , re a d in g a n d w riting, a n d th e MCAT read in g score. L atinos are m o re likely to su ccee d if theyj sco re w ell in self ev alu atio n in m a th , read in g , a n d w riting, a n d on th e ir MCAT] I read in g sco res. W hites are m ore likely to su cceed if th e y score well in individual; relatio n s, if th e y decided early to p u rs u e m edicine a n d if th e y have a h ig h e r GPA. T hese v aria b les are listed in T able 8. S tepw ise reg ressio n s w ere u s e d to d eterm in e th e series of v aria b les m o st likely to p re d ic t s u c c e s s for L atin o s a n d th e s e rie s of v a ria b le s m o st likely to p re d ic t 47 I 1 s u c c e s s for W hites. T he se rie s of v a ria b le s th a t to g e th e r are m o st u s e fu l in pred ictin g su c c e ss for L atinos are show n in Table 9. T he m odel of v ariab les m o st likely to p red ic t su c c e ss for L atinos in c lu d e s th e following tra d itio n a l variables;! MCAT biology, MCAT C hem istry, MCAT R eading, a n d MCAT Q u an titativ e a n d th e n o n -tra d itio n a l v ariab le of positive self co n ce p t. (V ariables in th e m o d el are significant a t th e 0.0 5 level.) A stepw ise reg ressio n w a s also r u n w ith b a ck g ro u n d v a ria b le s in clu d ed . T his m odel is in te re stin g in th a t age (< 23) sh o w s a s being I stro n g ly c o rre la te d to su c c e ss. S ince age c a n n o t be u s e d a s a c rite ria for determ in in g ad m issio n to m edical school th is variable c a n n o t b e u se d in a m odel] I how ever it p ro v id es im p e tu s for m ed ical sch o o ls to provide a g re a te r level of su p p o rt to th e ir older s tu d e n ts w ho ap p aren tly have m ore p re ssu re s cau sin g th e m to n o t g ra d u a te from m e d ical school. T he m o d el of v a ria b le s for p re d ic tin g su c c e ss for W hites is show n in Table 10. T h e m odel sh o w n in T able 9 an sw ers q u e stio n n u m b e r th re e of th e stu d y "How w ell d o es a co m b in ed tra d itio n a l a n d n o n -tra d itio n a l v a ria b le s a d m issio n s c rite ria p re d ic t s u c c e ss in m ed ical school for L atinos?" A com bined m odel c a n I w o rk to p re d ic t s u c c e ss a n d provides in fo rm atio n in ad d itio n to th e tra d itio n a l c rite ria . E rro r cla ssific a tio n s ra te s are sh o w n in T able 11. T h is d isc rim in a te a n a ly sis allow s th e c o m p a riso n b e tw e e n th e e rro r of p re d ic te d failu re, th e e rro r of p re d ic te d s u c c e s s a n d th e to ta l e rro r ra te . F o r L atin o s th e e rro r in predicted! su c c e ss in c re a se s by one p ercen t, over a tra d itio n a l m odel, u sin g th e tra d itio n a l p lu s n o n -tra d itio n a l m odel for ad m issio n s. F o r th e W hites th e tra d itio n a l p lu s n o n -tra d itio n a l m odel actu ally d ecreases th e erro r ra te for pred icted failure by sixj p e rc e n t. T he e rro r fo r p re d ic te d su c c e ss in c re a se s by one p e rc e n t. U sing a! tra d itio n a l p lu s n o n -trad itio n a l m odel actu ally favors th e W hite ap p lican ts. 48 J TABLE 9 PREDICTORS OF SUCCESS FOR LATINOS STEPWISE REGRESSION MODEL I VARIABLE I P ositive Self-C oncept ! Individual R elations ! MCAT Biology I MCAT C h em istry MCAT R eading ESTIMATE .21 16 .20 16 STANDARD ERROR .087 6.22 .046 12.61 .048 17.79 PVALUE .042 14.63 0.01 0.00 0.00 0.00 MCAT Q u an titativ e .09 .047 4.20 0.04 L. 49 VARIABLE TABLE 10 PREDICTORS OF SUCCESS FOR WHITES STEPWISE REGRESSION MODEL STANDARD ESTIMATE ERROR F PVALUE M otivation for M edicine C areer -.08 .038 4.51 0.03 W hen D ecided 0.09 R ealistic S elf-A ppraisal in M ath -0.13 Positive Self C oncept - W riting 0.11 Positive Self C oncept - R eading 0.17 .038 6.38 0.01 .053 6.01 0.01 .057 3.89 0.04 .056 9.67 0.00 Positive Self C oncept - M ath MCAT Biology MCAT C h em istry MCAT P h y sics MCAT Q u a n tita tiv e GPA 0.16 0.10 0.15 0.18 0.17 -0.13 .054 9.26 0.00 .059 2.93 0.08 .055 7.71 0.00 .059 9.32 0.00 .058 8.68 0.00 .043 8.83 0.00 50 T he fin al a n a ly sis to b e c o n d u c te d w as a logistic re g re ssio n u sin g all of th e pred ictiv e v a ria b le s except age an d sex. T he logistic re g re ssio n confirm ed th e re s u lts of th e stepw ise reg ressio n for b o th th e L atinos a n d th e W hites. The m odel of tra d itio n a l a n d n o n -tra d itio n a l v a ria b le s m o st predictive for L atinos w as th e MCAT sc o re s in Biology, C h em istry , R eading a n d P ositive S elf-concept. T he m o d el of tra d itio n a l a n d n o n -tra d itio n a l v a ria b le s m o st p red ictiv e fo r W hites w a s MCAT sco res in Biology, C hem istry, P hysics, Q u a n tita tiv e a n d Positive Self C oncept (reading, a n d M ath), GPAs, a n d R ealistic Self-A ppraisal in M ath. A n on- tra d itio n a l v a ria b le th a t w a s sig n ifican t in th is re g re ssio n , w h ic h w a s n o t significant in th e S tepw ise regression, w as M otivational Influence. T he re su lts of th e an aly sis are show n in Table 12. T he d ifferen ces b e tw e e n th e m o d els fo r L atin o s a n d W h ites p ro v id es u se fu l in fo rm a tio n . MCAT c a te g o rie s th a t p re d ic t s u c c e s s in m e d ic a l sch o o l are different for L atinos th a n th e y a re for W hites. T he n o n -tra d itio n a l v ariab le of a positive self concept in life skills is included o n th e L atino m odel b u t in th e W hite m odel th e n o n -tra d itio n a l v ariab le of a positive self co n cep t is in academ ic skills. F o r W h ite s a n ea rly d e c isio n (coded a s th e n o n - tra d itio n a l v a ria b le of d em o n stra te d m edical interest) is included in th e m odel. T he stepw ise a n d logistic reg ressio n s provide th e a n sw e r to q u e stio n n u m b e r 4. The q u estio n a sk ed w h e th e r th e re is a difference in p red ic to rs of su c c e ss betw een L atino m edical g ra d u a te s an d w hite m edical g ra d u a te s. T here is a difference, a n d th is difference is u se fu l in a ss e ssin g a d m issio n c rite ria th a t are p red ictiv e of su ccess for Latinos. T he n e x t C h a p te r is a d is c u s s io n of th e r e s u lts a n d d e s c rib e s th e policy im plications a s w ell a s reco m m en d atio n s for fu tu re stu d ie s. L - . _ _ _ _ _ _ _ _ _ _ _ _ _ _ — TABLE 11 DISCRIMINATE ANALYSIS OF ERROR CLASSIFICATION RATES ERRORIN ERROR IN TOTAL PREDICTED FAILURE % PREDICTED SUCCESS % ERROR RATE % LATINOS T r a d itio n a l 36 26 27 T ra d itio n a l + N on T rad itio n a l 37 25 30 W HITES T ra d itio n a l 58 12 29 T ra d itio n a l + N on T rad itio n a l 52 13 28 TABLE 12 PREDICTORS OF SUCCESS LOGISTIC REGRESSION MODEL VARIABLE L A T IN O S ESTIM A TE STD ERROR SQUARE P VALUE IN TERCEPT -0.4673 0.3755 1.55 0.2133 WRITING 0.0999 0.1350 0.55 0.4594 READING -0.1026 0.1519 0.46 0.4995 MATH -0.0482 0.1714 0.08 0.7787 CREATIV 0.0743 0.1502 0.24 0.6207 SYM PATH -0.3442 0.3026 1.29 0.2554 INDIVRE 0.8362 0.3185 6.89 0.0086* MCAT-BIO 0.3551 0.1266 7.87 0.0050* M CAT-CHE 0.4774 0.1585 9.07 0.0026* MCAT-PHY 0.1535 0.1469 1.09 0.2962 M CAT-REA 0.4058 0.1342 9.14 0.0025* MCAT-PRO -0.00895 0.1728 0.00 0.9587 MCAT-QUA 0.2752 0.1809 2.31 0.1283 GPAS 0.1191 0.1240 0.92 0.3365 REALREAD 0.0577 0.1280 0.20 0.6521 REALMATH -0.0159 0.1691 0.01 0.9251 LOWSES 0.1451 0.1063 1.86 0.1722 LONGGOAL 0.0532 0.1465 0.13 0.7167 LEADER -0.1370 0.2005 0.47 0.4945 FRSTTHO -0.3440 0.1770 3.78 0.0519* DECIDED 0.1924 0.1345 2.05 0.1527 MOTIVE-REASON 0.1943 0.2050 0.90 0.3432 MOTIVE-INFL -0.0825 0.1093 0.57 0.4503 VOLHRS 0.0475 0.1091 0.19 0.6631 W H I T E S IN TERCEPT 1.1670 0.4350 7.20 0.0073 WRITING 0.3010 0.1614 3.48 0.0622 READING 0.6314 0.1801 12.29 0.0005* MATH 0.6648 0.2051 10.50 0.0012* CREATIV -0.1100 0.1947 0.32 0.5722 SYM PATH -0.3247 0.2337 1.93 0.1648 INDIVRE 0.4019 0.2756 2.13 0.1448 MCAT-BIO 0.3346 0.1674 3.99 0.0457* MCAT-CHE 0.4760 0.1571 9.18 0.0024* M CAT-PHY 0.5124 0.1655 9.58 0.0020* M CAT-REA -0.0238 0.1693 0.02 0.8882 MCAT-PRO -0.1487 0.1815 0.67 0.4125 M CAT-QUA 0.6885 0.2169 10.07 0.0015* GPAS -0.4335 0.1367 10.06 0.0015* REALREAD -0.1950 0.1634 1.42 0.2327 REALMATH -0.6056 0.2080 8.48 0.0036* LOWSES -0.0167 0.2542 0.00 0.9475 LONGGOAL -0.0190 0.1321 0.02 0.8857 LEADER 0.1226 0.2178 0.32 0.5735 FRSTTHO -0.1121 0.1510 0.55 0.4581 DECIDED 0.3020 0.1195 6.38 0.0115* MOTIVE-REASON 0.1359 0.2183 0.39 0.5337 MOTIVE-INFL -0.2399 0.1119 4.60 0.0320* VOLHRS 0.1210 0.1127 1.15 0.2832 53 r CHAPTER FIVE DISCUSSION. IMPLICATIONS AND POLICY RECOMMENDATIONS i , DISCUSSION D eterm in in g w h ich fa c to rs p red ic t su c c e ssfu l co m p letio n of m ed ical school for| L atin o s tu d e n ts is v a lu a b le b e c a u se it p ro v id es u s e fu l in fo rm a tio n for m e d ic a l I schools to u se in d eterm in in g ad m issio n s criteria for L atino m edical stu d e n ts. O n a policy level th is in fo rm a tio n p ro v id es g o v e rn m e n ta l a g e n c ie s w ith in fo rm a tio n w h ic h c a n be u s e d to develop p ro g ra m s to in c re a s e th e n u m b e r of m inorityj p h y sician s. R eversing th e in eq u ity th a t ex ists for m in o rity s tu d e n ts in th e field of m edicine w ould have a positive influence on th e d is trib u tio n of h e a lth m an p o w er. T h is s tu d y h a s id e n tified th e tra d itio n a l c rite ria w h ic h a re m o st sig n ifican t in d eterm ining su c c e ss for L atinos a s well as th e m o st u sefu l n o n -trad itio n a l variables. T h ere a re fo u r p rim a ry fin d in g s w hich c a n be su m m a rized from th e d a ta . T he first is th a t L atinos, w ith equivalent sco res on MCAT a n d GPA, a re a s su c c e ssfu l a s W hite s tu d e n ts in com p letin g m ed ical school. T he seco n d is th a t n o n -tra d itio n a l I v a ria b le s are c a p a b le of providing u se fu l in fo rm atio n fo r d e te rm in in g ad m issio n ' criteria. The th ird is th a t th e re are identifiable v ariab les w hich indicate th a t specific s tu d e n ts are a t-risk for n o t com pleting m edical school. A fo u rth finding of in te re st is th e difference betw een th e pred icto rs of su ccess m odel for L atinos an d W hites. 54 T he first finding w hich is im p o rtan t is th a t L atinos are a s su ccessfu l a s W hites in com pleting a m ed ical c a re e r if th e y have eq u al sco res o n th e ir MCAT exam s. Latino stu d e n ts succeed a t a h ig h er rate th a n W hite m edical s tu d e n ts w ith equal sco res in th e MCAT on Biology, C hem istry, Physics, an d Science P roblem s. A positive self concept, a n d le a d e rs h ip sk ills a re th e n o n -tra d itio n a l v a ria b le s w h ic h a re sig n ific a n t to] g ra d u a tio n su c c e ss. L atin o s su ccee d a t a h ig h e r ra te th a n do W hite s tu d e n ts w ith sim ilar sco res in th e se tra d itio n a l a n d n o n -tra d itio n a l a re a s. T h e seco n d finding is th a t n o n -tra d itio n a l v a ria b le s give u se fu l in fo rm atio n on s tu d e n t su c c e ss ra te s w hich c a n be u se d in c o n ju n ctio n w ith tra d itio n a l adm issions] criteria. N o n -trad itio n al v ariab les, like le a d e rsh ip sk ills, positive self con cep t, a n d crea tiv ity , a re a d d itio n a l c rite ria to fa c to r in to th e m o d e l w h e n d e te rm in in g a d m issio n . T he sc o re s on n o n -tra d itio n a l v a ria b le s c o u ld b e u s e d to determ ine^ ad m issio n s ta tu s for tw o s tu d e n ts w ith eq u al MCAT sc o re s b u t differing sc o re s on n o n -tra d itio n a l v a ria b le s. T he s tu d e n t w ho sc o re s h ig h in le a d e rsh ip sk ills a n d positive self-concept w ould be a b e tte r can d id ate for th e slot a n d su cceed at a higher rate . T he th ird p rim a ry finding from th e d a ta is th e know ledge th a t c e rta in v ariab les p red ict failure. T he in fo rm atio n reg ard in g v aria b les th a t p red ic t failure c a n be used ' to ta rg e t m ed ical s tu d e n ts a t ris k for failure. T h ese s tu d e n ts could b e th e focus of specific su p p o rt th ro u g h school in o rd er to in crease th e ir su c c e ss rate . O lder stu d e n ts a n d s tu d e n ts w ith c h ild re n face a m u c h h ig h e r ris k of n o t fin ish in g school. T hese s tu d e n ts sh o u ld b e fu rn is h e d w ith ad d itio n a l s u p p o rt th ro u g h o u t th e ir m ed ical school career. Specific s u p p o rt could be reg ularly sc h e d u le d m e etin g s w ith a faculty m e n to r, for exam ple, a y o u n g facu lty p erso n w ho also h a s ch ild ren a n d u n d e rs ta n d s th e difficu lties of b ein g u p all n ig h t w ith a sick ch ild . H aving a m e n to r w ho is supportive, a n d n o n -ju d g m en tal, w ho is able to see th e s tu d e n t th ro u g h "tough tim es" could m ak e a difference in su c c e ss ra te for th e older stu d e n t. 55 T he fo u rth fin d in g of In te re st is th e difference fo u n d b e tw e e n th e m o d e ls of ; p red ic to rs of s u c c e ss for L atinos a n d W hites. In answ ering th e q u e stio n s posed in th J 1 ' s tu d y it b ecam e clear th a t tra d itio n a l v aria b les do p red ict s u c c e ss for L atinos a s wellj a s W hites. L atinos w ho score well on th e MCAT exam in Biology, C hem istry, R eading a n d Q u an titativ e are th e m o st su ccessfu l. The GPA w as n o t significant in pred ictin g s u c c e s s for L atin o s. T he m o d el for W hite s tu d e n ts in c lu d e s th e MCAT sco res of I Biology, C hem istry, Q u an titativ e a n d Physics. GPA is a p red icto r of s u c c e ss for White^ s tu d e n ts . T he q u e stio n of w hy R eading is sig n ifican t for L atin o s a n d P h y sics for, ! ; W hites n e e d s to be answ ered. A possible h y p o th e sis m ig h t b e th a t L atino stu d e n ts, in j o rd e r to su ccee d to th e g ra d u a te level of e d u ca tio n , m u s t be ex ce p tio n a l in theirj I re a d in g a n d co m p re h e n sio n ab ilities in E nglish. It is v alu ab le to n o te th a t positive' self co n ce p t w a s th e n o n -tra d itio n a l v ariab le th a t w as sig n ifican t for b o th L atinos a n d W hites. The difference is th a t for L atin o s it w as positive self co n ce p t in life skills a s v e rs u s positive self-concept in academ ic skills for W hites. T he co n c e p t of n o n -tra d itio n a l v a ria b le s is im p o rta n t a n d sh o u ld b e u se d , in a d d itio n to tra d itio n a l v aria b les, a s a m e a n s for d eterm in in g c rite ria for adm ission' I to m ed ical school. The in fo rm atio n th a t is c u rre n tly available w ith in th e MCAT pre-j M edical q u e s tio n n a ire is n o t th o ro u g h e n o u g h to m e a s u re th e n o n -tra d itio n a l v aria b les a s describ ed by S edlacek. It w ould be u sefu l to develop a n in s tru m e n t th a t co u ld m e a su re th e n o n -tra d itio n a l v a ria b le s a s d escrib ed by S edlacek. A review of m in o rity adm issioiK p ro g ram s th a t are fu n ctio n in g in som e m ed ical sch o o ls to adapt; for u se in ad d itio n al m ed ical sch o o ls w ould be beneficial. It w ould b e im p o rta n t for| i m e d ical sc h o o ls to in c o rp o ra te th e n o n -tra d itio n a l v a ria b le s in th e ir a p p lic a tio n p ro cess in a form at w hich could be m e a su re d objectively. 56 POLICY IMPLICATIONS AND RECOMMENDATIONS ! T he d em o g rap h ics of th e S o uthw est, especially a s d o cu m en ted in C alifornia, show j th a t th e n u m b e rs of M exican A m eric an c itiz e n s a n d M exican im m ig ra n ts a re in c re a s in g d ra m a tic a lly . T h e fertility ra te of L a tin o s is h ig h e r th a n a n y o th e r ] m in o rity o r m ajo rity group. T he L atino p o p u latio n is a young p o p u latio n . In a recent' su rv ey co m p lete d b y th e T o m as R ivera C e n te r in C larem o n t (Los A ngeles C ountyj L atino A sse ssm e n t S tudy, 1989) it w as sh o w n th a t th e average age of L atinos is 34' I j y e a rs (as co m p ared to 42 y e a rs of age for th e Anglo resp o n d en ts), 57% w ere m arried,j 55% are n o t U.S. citizens a n d alm o st 60 % m ak e le ss th a n $ 2 0 ,0 0 0 p e r year. Almost! 60% p referred being interview ed in S p an ish . By th e y e a r 2 0 1 0 L atinos will com prisej i 35% of th e p o p u la tio n in C alifornia. T h is is th e p o p u la tio n for w h o m we w ill be I 1 providing h e a lth care. P h y sician s, a n d o th e r h e a lth care p ro fessio n als a s w ell, will need to b e tra in e d to m eet th e n eed of th is grow ing p o p ulation. T he nex t g en eratio n of h e a lth c a re p ro v id e rs s h o u ld in c lu d e a n e q u ita b le r e p r e s e n ta tio n of L atino| C a lifo rn ia n s . j I T he h e a lth m an p o w er m a ld istrib u tio n problem n e e d s to b e m e t h e a d on. O ne w ay I to solve th is p ro b lem is to tra in m o re m in o rity p h y sic ia n s. S lots, like th e ty p e in' ex iste n c e p rio r to th e B ak k e ca se , c a n w o rk to in c re a se th e n u m b e r of Latino^ p h y sician s. In creasin g th e n u m b e r of L atino p h y sic ia n s tra in e d w ould in c re a se the] n u m b e r of p h y sician s w orking in c u rre n tly u n d erserv ed a re a s of th e S ou th w est. State! fu n d e d sc h o o ls a re in a b e tte r p o sitio n , financially, to reserv e slo ts for m inorityj s tu d e n ts. In ad d itio n to tu itio n co sts, how ever, are th e co sts of living for fo u r o r five y e a rs. H o u sin g , food, tra n s p o rta tio n , c h ild c a re , etc. all h av e to b e ta k e n in to co n sid eratio n . L oans are n o t a perfect solution. M edical s tu d e n ts p la n n in g to go in to p rim a ry c a re (Fam ily M edicine, P e d ia tric s a n d In te rn a l M edicine), w h ich are th e I ; fields in w h ich m in o rity s tu d e n ts are especially need ed , c a n n o t realistically p la n on 57 m a k in g th e level of s a la ry n e c e ssa ry to p ay b a c k ap p ro x im ately $ 8 0 ,0 0 0 in loans. T he one su ccessfu l so lu tio n h a s b een th e N ational H ealth Service C orps. T h e N atio n al H ealth Service C o rp s p ro g ra m w a s su c c e ss fu l in in c re a sin g thej n u m b e r of m in o rity s tu d e n ts w ho could afford to a tte n d m edical school in ex ch an g e ; for a tim e co m m itm en t to p ractice in a n u n d e rse rv e d area. O ver 82% of th e Latino j , 1 m e d ical sch o o l a p p lic a n ts sa id th a t th e y w ere w illing to com m it to th e N atio n al H ealth C orps (NHSC) in exchange for F in an cial Aid. L atino s tu d e n ts n eed fin an cial I aid a t a m u c h h ig h e r ra te th a n do w hite stu d e n ts. P ro g ram s like th e NHSC a d d re ss I I ! th is p roblem a n d solve it w hile providing m u c h n eed ed h e a lth care services in h a rd to i serve a re a s. U n fo rtu n ately , th e N ational H ealth Service C orps p ro g ram h a s all b u t : i b e e n d ism a n tle d in th e p a s t few years. A priority for le ad ers in th e h ealth field sh o u ld b e th e stre n g th e n in g of th is program . A re co m m en d atio n for policy a t th e F ed eral I j level w ould b e to fu n d th e N ational H ealth Service C orps a t a level c o n siste n t w ith I m eeting th e n eed to tra in m inority p h y sician s to w ork in h a rd to serve area s. i : i It is clear from th e d a ta th a t a m ajo rity of th e L atino s tu d e n ts m a k e a decision a b o u t p u rsu in g a c a re e r in m edicine before th e ir J u n io r y e a r in college. A m ajority of th e s tu d e n ts first c o n sid e r m e d icin e w hile th e y a re in h ig h school. T herefore,' p ro g ram s to en co u ra g e m in o rity s tu d e n ts w hile th e y a re in h ig h school, w ould b e effective in in c re a sin g th e n u m b e rs of L atino s tu d e n ts qualified to p u rs u e a college e d u c a tio n a n d , th e re fo re, a c a re e r in th e h e a lth field. H igh S chool h e a lth careerj p ro g ram s, like th e H ealth P rofessions C areer O p p o rtu n ity P rogram (HPCOP), are a n exam ple of th e type of p ro g ram th a t c a n b e im plem ented. A lm ost 70% of th e Latino! s tu d e n ts sta te d th a t it w as a h e a lth related w ork experience th a t m ad e th e m decide to go in to m e d icin e . H igh sch o o l s tu d e n ts involved in th e s e p ro g ra m s h av e the! ; o p p o rtu n ity to h e a r m in o rity h e a lth p ro fe ssio n a ls ta lk a b o u t th e ir jo b s , to visit; h o sp ita ls, la b s, etc., a n d a re provided w ith th e o p p o rtu n ity to do "in tern sh ip s" (i.e. su m m e r jobs) in h e a lth care rela ted settings. A p rim ary outcom e of th e se p ro g ram s is 58 j th e o p p o rtu n ity for m inority y o u th to realize w h a t is available in th e w orld o u tsid e of th e ir im m ed iate neig h b o rh o o d . T he policy im plicatio n d raw n from th e d a ta is th a t j th e e a rlie r y o u th are re a c h e d , th e g re a te r th e c h a n c e for in c re a sin g th e n u m b e r of m in o rity p h y sician s. A re co m m en d atio n is to in c re a se th e level of fu n d in g at b o th I th e S tate a n d F ederal level for p ro g ram s aim ed at m inority y o u th . I ^ M edical sch o o ls n eed to develop p ro g ram s w hich en co u rag e a n d su p p o rt stu d e n ts I th ro u g h m ed ical school. A s n o te d previously th e re are som e b a c k g ro u n d v ariab les I th a t place a s tu d e n t a t risk for failu re in th e m ed ical school p ro cess. The n u m b e r of ! L atino s tu d e n ts is so sm all it is im p o rtan t to in su re th a t a s m a n y s tu d e n ts a s possible su c c e s sfu lly co m p lete m e d ical school. T u to rin g p ro g ra m s a n d a fa c u lty m e n to r pro g ram , or a sim ilar type of p rogram , could be a fairly sim ple, c o st effective program i to h elp s tu d e n ts com plete th e ir m edical school career. FUTURE STUDIES | I T he p rim ary w e a k n e ss of th is s tu d y h a s b e e n th e u se of seco n d ary d a ta to a sse ss th e n o n -tra d itio n a l v aria b les developed b y W illiam E. S edlacek. T he a u th o r w ould like to ta k e th is s tu d y to a n ex t level by collecting p rim ary d a ta from L atino m edical g ra d u a te s u s in g ite m s developed specifically for th e p u rp o s e of m e a s u rin g non-| cognitive v a ria b le s. T h is level of s tu d y w o u ld provide a d d itio n a l in fo rm a tio n oii L atino m ed ical school g ra d u a te s w h ich to d a te h a s n o t b een collected. A collection of p rim ary d a ta to a s s e s s n o n -tra d itio n a l p red icto rs of su c c e ss co u ld effectively a d d re ss th e n eed to explore th e feasibility of u sin g n o n -tra d itio n a l ad m issio n s criteria. ' A n o th e r s tu d y w hich w ould d eterm in e th e validity of ta rg e tin g h ig h school age s tu d e n ts w ould be a longitudinal stu d y of th e m inority s tu d e n ts w ho have atten d ed th e I Los A ngeles U nified School D istrict M agnet H ealth P rogram s. A s tu d y to determ in e 59 a n d e v a lu a te th e aca d em ic o u tco m e of th e se s tu d e n ts w o u ld provide a d d itio n a l in fo rm atio n fo r u se in th e developm ent of high school level acad em ic p ro g ra m s for m in o rity s tu d e n ts . CONCLUDING REMARKS T h is s tu d y p ro v id es in fo rm atio n w h ich is u se fu l a n d ap p licab le fo r u s e in th e acad em ic a d m issio n s p ro cess. T he issu e of u n d e rre p re se n ta tio n of m in o rities in th e h e a lth fields will c o n tin u e to re m a in a public h e a lth p roblem u n til a co n ce rted effort is m a d e to e d u c a te m in o rity y o u th a n d provide th e o p p o rtu n itie s of g ra d u a te level| I ed u catio n . T he "browning" of A m erica is a reality. T he b e a u ty of a "young" society is th a t th e fu tu re is full of possibilities. C u rren tly , L atino c h ild re n m a k e u p forty fivej p ercen t of th e public school s tu d e n ts in Los A ngeles. By th e y e a r 2000, m ore th a n half] of th e Los A ngeles C o u n ty w orkforce will b e "m inority", th e la rg e st g ro u p being Latino! t (Los A ngeles C o u n ty L atino A sse ssm e n t stu d y , 1989). O u r y o u th are o u r fu tu re . 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J o u rn a l of th e A m erican M edical A ssociation, 218(12): 1814-1815, Dec 20, 1971. O degaard, C.E. M inorities in M edicine: F rom R eceptive P assivity to Positivity A ction 1966-76. (New York: The J o sia h Macy, J r . F oundation), 1977. Office of S tatew ide H ealth P lan n in g a n d D evelopm ent. 1979 C alifornia H ealth M anpow er P lan B iennial U pdate. (Los Angeles: H ealth Professions R esource Center), 1979. Perry, R.R., Philips, B.U., & M ahan, M. A follow -up ev alu atio n of a s u m m e r h e a lth c a re e r p ro g ram for m in o rity stu d e n ts. J o u rn a l of M edical E ducation, 51: 175-180, M arch 1976. P h y sician a n d h e a lth care statistic s: A h a n d b o o k of b asic dem ographic an d socioeconom ic d a ta concern in g p h y sic ia n s a n d h e a lth care delivery in C a lifo rn ia a n d th e U nited S tates. (S an F rancisco: C alifornia M edical A ssociation) A ug 1981. P inn, V.W. H ie u n d e rre p re se n te d in g ra d u a te m edical ed u catio n an d m edical research . J o u rn a l of th e N ational M edical A ssociation, 76(9): 858-862, 1984. R evitalizing h e a lth p ro fessio n s ed u ca tio n for m in o rities a n d th e d isad v an tag ed : A h e a lth pro fessio n s D eans' forum on issu e s a n d strategies. F inal R eport. D ep artm en t of H ealth & H u m an Services, M arch 1986. R om an, S.A., S orenson, J.R ., D avis, W.I., & E rickson, R. Predicting m inority s tu d e n t perfo rm an ce in th e first m edical school year. J o u rn a l of th e N ational M edical A ssociation., 71, 661 -664. 1979. Roybal, E.R. M inorities in M edicine: T he n ex t decade. J o u rn a l of M edical E ducation, 54: 652-655, Aug 1979. SAS P ro ced u res G uide for P ersonal C om puters. V ersion 6. SAS In stitu te Inc. Cary, N orth C arolina. 1985 Sedlacek, W .E., & Brooks, G.C., Jr. R acism in A m erican education: A m odel for change. Chicago: N elson-H all. 1976. Sedlacek, W .E. & Prieto, D. P redicting M inority S tu d e n t S u ccess in M edical School. P ap er p re se n te d at A m erican E d u c a tio n a l R esearch A ssociation. S a n F rancisco, 1989. 63 Sim lc, A. W hite eth n ic a n d C hicano fam ilies: co n tin u ity a n d a d a p ta tio n in th e new w orld. C h a p te r in C hanging Im ages of th e Fam ily (Meyerhoff, B. & T ufte, V. Editors). Yale U niversity P ress, 1979. S h ea, S., & Fullilove, M.T. E n try of m in o rity s tu d e n ts in to U.S. M edical Schools: H istorical perspective a n d recent tren d s. New E ngland J o u rn a l of Medicine, 313, 933-940. 1985. Spencer, S.S. & O utcalt, D. C om m itm ent to U n derserved People (C.U.P.) P ro g ram a t th e U niversity of A riz o n a . Public H ealth R eports, 95(1): 26-28, Jan -F eb 1980. S ternberg, R .J. B eyond I.Q. London, E ngland, Cam bridge. 1985. S ternberg, R .J. W h at w ould b e tte r Intelligence te s ts look like? In M easu res in th e college ad m issio n p ro cess (pp. 146-150). New York : College E n tra n c e E xam in atio n B oard. 1986. Strelnick, H. & Younge, R A ffirm ative A ction in m edicine: M oney b ecom es th e a d m issio n s c riterio n of th e 1980’ s. In: Reform ing M edicine: L essons of th e Last Q u arter C en tu ry (V.W. Sidel & R Sidel, Eds.) P an th eo n Books: New York, 1984, pp. 150-175. S trelnick, H. & Y ounge, R D ouble Indem nity: T he poverty a n d m ythology of affirm ative actio n in th e h e a lth p ro fessio n al schools. (New York: Health-PAC), 13-26, 1980. S ullivan, L.W. T he re p re se n ta tio n of B lacks a n d o th er m in o rities in m edicine. P ap er p resen te d to th e A m erican M edical A ssociation. Los A ngeles, C alifornia. 1983 T hom as, A.L. Project 75: A pro g ram to in crease th e n u m b e r of m in o rity m edical s tu d e n ts in US m ed ical schools. J o u rn a l of th e A m erican M edical A ssociation, 218(12): 1816-1818, Dec 20, 1971. Tracey, T .J., & Sedlacek, W.E. T he re la tio n sh ip of noncognitive v ariab les to academ ic su ccess: A lo n g itu d in al com pariso n by race. J o u rn a l of College S tu d e n t Personnel, 26, 405-410. 1985. W eym outh, R .J., & W ergin, J.F . Pilot p ro g ram s for m inority stu d e n ts: O ne school's experience. J o u rn a l of M edical E ducation, 51: 668-670, Aug 1976. 64 Premedical Student Questionnaire Y our VOLUNTARY re s p o n s e s to th e follow ing q u e s tio n s a re u s e d on ly b y th e A sso ciatio n of A m erican M edical Colleges to stu d y th e c h a ra c te ristic s, experiences, a n d ed u ca tio n a l c a re e r p la n s of p e rso n s co n tem p la tin g ap p lic a tio n to M.D. degree- g ra n tin g p ro g ra m s in AAMC m e m b e r in s titu tio n s . In fo rm a tio n is e x a m in e d in aggregate fo r m fo r all exa m in ees a n d a n o n ym ity is guara n teed . In d iv id u al re sp o n se s a re not forw arded to m ed ical sch o o l a d m issio n com m ittees. T his in fo rm atio n is a u n iq u e a n d v alu ab le so u rce of re s e a rc h d a ta a n d p ro v id es th e b a s is for a b e tte r u n d e rsta n d in g of s tu d e n ts a n d of th e ad m issio n process. A nsw er e ac h q u e stio n a s a c c u ra te ly a s possible. Y our re sp o n se sh o u ld b e carefully g rid d ed (the ovals darkened) on p ag es 2 a n d 3 of th e C an d id ate In fo rm atio n Folder. T here m a y b e q u estio n s to w hich you c a n n o t or choose n o t to resp o n d , b u t y o u r effort to an sw er a s m a n y a s possible is sincerely appreciated. Part I. P arental Inform ation 1. P a rts a a n d b refer to y o u r fa th e r’s occu p atio n . P lease in d ic a te in p a rt b y o u r fa th e r’s o cc u p a tio n d u rin g th e m a jo r p o rtio n of th e p a s t y ear. NOTE: If y o u r fa th e r is unem ployed, retired , o r deceased, please in d icate th is in p a rt “a ” below. T h e n in d icate in p a rt “b ” h is o ccu p a tio n p rio r to u n em p lo y m en t, retirem e n t, or death. a. 1. U nem ployed or seeking em ploym ent 2. Retired 3. D eceased b. O ccupation (Use O ccu pations L ist on page 28) 2. P a rts a a n d b refer to y o u r m o th e r’s occupation. P lease in d ic a te in p a rt b y o u r m o th e r’s o c cu p a tio n d u rin g th e m a jo r p o rtio n of th e p a s t y ear. NOTE: If y o u r m o th e r is unem ployed, retired , or d eceased, p lease in d icate th is in p a rt “a ” below. T h e n in d icate in p a rt “b ” h e r o ccu p a tio n p rio r to u n em p lo y m en t, re tire m e n t, or death. a. 1. U nem ployed o r seeking em ploym ent 2. Retired 3. D eceased b. O ccu p atio n (Use O ccu pations L ist on page 28) 3. P lease in d icate th e h ig h e st ed u ca tio n a l level attain e d b y y o u r father. 1. E ighth g rad e o r less 2. Som e high school 3. High school g rad u ate 4. Specialized b u s in e ss or te ch n ica l train in g (beyond high school) 65 5. Som e college (inc. asso ciate degree) 6. C om pleted college (e.g., B.A. o r B.S.) 7. S om e g ra d u a te o r p ro fe ssio n a l sc h o o l (re q u irin g w o rk b e y o n d college g raduation) 8 w M aster's (e.g., M.A. o r M.S.) a M.D., D .O ., or M .D ./Ph.D . 10. Ph.D . o r o th e r equivalent 4. Please in d icate th e h ig h e st ed u catio n al level a tta in e d by y o u r m other. 1. E ighth grade or less 2. Som e high school 3. High school g rad u ate 4. Specialized b u s in e s s o r tech n ical train in g (beyond high school) 5. Som e college (inc. asso ciate degree) 6. C om pleted college (e.g., B.A. o r B.S.) 7. S om e g ra d u a te o r p ro fe s sio n a l sc h o o l (re q u irin g w o rk b e y o n d college graduation) & M aster’ s (e.g., M.A. or M.S.) a M.D., D.O., or M .D ./Ph.D . 10. Ph.D . o r o th e r equivalent 5. P lease e stim a te y o u r p a re n ts ’ g ro ss incom e (before taxes) for th e la st year. P rin t th e a m o u n t in th e boxes above th e grid area. T hen, in th e co lu m n below each box, b la c k e n th e oval c o n ta in in g th e sam e n u m b e r a s th e box. Fill all sev en boxes, u sin g zeros at th e beginning, if necessary. For exam ple, $ 4 0 ,0 0 0 w ould b e p rin ted a n d gridded a s 0040000. Part II. M arital S ta tu s In form ation 6 . P lease in d icate y o u r c u rre n t m a rita l sta tu s. 1. Never m a rrie d (Go to Q u estio n 12) 2 . S e p a ra te d (Go to Q u estio n 12) 3 . D ivorced (Go to Q u estio n 12) 4 . W idowed (Go to Q u estio n 12) 5 . E ngaged (Go to Q u estio n 7) 6 . M arried (Go to Q u estio n 7) 7 . Y ear of m arriag e or expected y e a r of m arriage: 19____. P rin t th e y e a r in th e boxes above th e grid area. T hen, in th e co lu m n below each box, b la c k e n th e oval co n tain in g th e sam e n u m b e r a s th e box. Fill b o th boxes. F or exam ple, 1985 w ould be p rin te d a n d gridded 85. 8 . Please in d icate th e h ig h est level of ed u catio n y o u r sp o u se o r sp o u se-to -b e h a s com pleted. 1. E ighth grade o r less 2. Som e hig h school 3. High school g rad u ate 4 . Specialized b u s in e s s or tech n ical train in g (beyond high school) 5. Som e college (inc. asso ciate degree) 6 . C om pleted college (e.g., B.A. or B.S.) 7. Som e g ra d u a te or professional school (requiring w ork beyond college graduation) .66 8. M aster’s (e.g., M.A. o r M.S.) 9 . M .D., D.O., o r M .D ./P h.D . 10. Ph.D . or o th e r equivalent 9 . P lease indicate th e c u rre n t o ccu p atio n of y o u r sp o u se or sp o u se-to -b e. (Use O ccu p a tio n s L ist o n page 28.) 10. P lease in d icate th e type of ed u catio n al program in w hich y o u r sp o u se o r spouse- to -b e is cu rre n tly enrolled. 1. D oes n o t apply 2 . M .D ./D .G . in resid en cy tra in in g 3 . M edical s tu d e n t 4 . Full-tim e s tu d e n t in o th e r h e a lth field 5 . Full-tim e s tu d e n t in n o n h e a lth field 6 . P art-tim e s tu d e n t in o th e r h e a lth field 7 . p a rt-tim e s tu d e n t in o th e r n o n h e a lth field 11. P lease in d icate w here y o u r sp o u se or sp o u se-to -b e sp e n t th e m a jo r p o rtio n of h is o r h e r h ig h school years. 1. Large city (population 5 0 0 ,0 0 0 o r m ore) 2 . S u b u rb of a large city 3 . City o f m o d erate size )p o p u latio n 5 0 ,0 0 0 to 500,000) 4 . S u b u rb of m o d erate size city 5 . Sm all city (population 10,000 to 5 0 ,0 0 0 --other th a n su b u rb ) 6 . Tow n (population 2 ,5 0 0 to 10,000— o th e r th a n su b u rb ) 7 . S m all tow n (population le ss th a n 2,500) 8. R u ra l/u n in c o rp o ra te d a re a 9 . D on’ t know Part in. B ackground Inform ation 12. P lease in d icate th e n u m b e r of d ep en d e n ts you have. Do n o t in clu d e y o u rse lf or y o u r sp o u se (if n one, p lease in d icate w ith zeros). P rin t th e n u m b e r in th e boxes above th e grid area. T hen, in th e co lu m n below each box, b la c k e n th e oval co n tain in g th e sam e n u m b e r a s th e box. Fill b o th boxes, u sin g zeros a t th e beginning. F or exam ple, tw o d e p e n d e n ts w ould be p rin te d a n d grid d ed “02." 13. P lease in d icate w here you sp e n t th e m ajor portion of y o u r hig h school years. 1. Large city (population 5 0 0 ,0 0 0 o r more) 2 . S u b u rb of a large city 3. City of m o d erate size (population 5 0 ,0 0 0 to 500,000) 4 . S u b u rb o m o d erate size city 5. Sm all city (population 10,000 to 5 0 ,0 0 0 --o th er th a n su b u rb ) 6 . Tow n (population 2 ,5 0 0 to 1 0,000--o th er th a n su b u rb ) 7. Sm all tow n (population le ss th a n 2,500) 8. R u ra l/ u n in c o rp o ra ted a re a 14. If you are now em ployed o r have recently b een em ployed, please an sw er p a rts a a n d b below. In p a rt a, please in d icate th e sta te m e n t th a t b e s t d escrib e s th e ex ten t of y o u r p aid w ork p articip atio n . In p a rt b, in d icate th e s ta te m e n t th a t b e st d escrib e s th e d u ra tio n of y o u r p aid w ork p articipation. 67 a. 1. Not em ployed 2. W ork only occasionally o n a n in te rm itte n t b a s is 3. W ork o n su m m e r v acatio n s a n d /o r school b re a k s 4. W ork le ss th a n 10 h o u rs p er w eek 5. W ork 10 to 19 h o u rs p e r w eek 6 . W ork 2 0 to 3 4 h o u rs p e r w eek 7. W ork 3 5 o r m ore h o u rs p e r w eek b. 1. None 2. Less th a n 1 y e a r 3. 1 y e a r 4. 2 y ears 5. 3 y e a rs 6 . 4 y e a rs o r m ore 15. If y o u are doing v o lu n teer w ork o r have recen tly done v o lu n teer w ork, an sw er p a rts a a n d b below. In p a rt a, p lease in d icate th e sta te m e n t th a t b e st d escrib es th e ex ten t of y o u r v o lu n teer w ork. In p a rt b, Indicate th e sta te m e n t th a t b e st d escrib es th e d u ra tio n of y o u r v o lu n teer w ork. a. 1. D oes n o t apply 2. W ork only occasionally o n a n In term itten t b a sis 3. W ork o n su m m e r v aca tio n s a n d /o r school b re a k s 4 . W ork le ss th a n 10 h o u rs p e r w eek 5. W ork 10 to 19 h o u rs p e r w eek 6 . W ork 20 to 3 4 h o u rs p e r w eek 7. W ork 35 or m ore h o u rs p e r w eek b. 1. None 2 . L ess th a n 1 y e a r 3. 1 y e a r 4 . 2 y ears 5 . 3 y e a rs 6 . 4 y ears o r m ore 16. Please in d icate y o u r religious b ackground. 1. C atholic 2. P ro te sta n t 3. Je w ish 4. O th er 5. None 17. Please d escrib e y o u r political orientation. 1. F a r left 2. Liberal 3. M iddle-of-the-road 4. C onservative 5. F a r rig h t 6 . None 68 18. P lease in d icate w h en you definitely decided you w an ted to stu d y m edicine. 1. H ave n o t yet m ad e a firm decision 2 . Before high school 3 . D uring hig h school 4 . D uring first tw o y e a rs in college 5 . D uring ju n io r y e a r in college 6 . D uring sen io r y e a r in college 7. A fter receiving b ach e lo r’ s degree 8. A fter receiving advan ced degree Part IV. Career Inform ation 19. A ssu m in g you e n te r m edical school, please indicate w h eth er y o u h av e a preference for a p a rtic u la r m edical specialty. 1. Yes, definitely. (Go to Q u estio n 20) 2. Yes, 1 do have som e in clin atio n s, b u t I have n o t finally decided. (Go to Q u estio n 20) 3. No, b u t I have decided a g ain st som e specialties. (Go to Q u estio n 21) 4 . No, I am undecided. (Go to Q u estio n 21) 2 0 . P lease in d icate y o u r p re s e n t c a re e r preference concern in g specialization by choosing one of th e following. (M ark only one.) 1. A nesthesiology 2 . D erm atology 3. E m ergency M edicine 4 . Fam ily practice 5. G eneral in te rn a l m edicine 6 . In tern a l m edicine subspecialty--e.g., endocrinology, hem atology, etc. 7 . Neurology 8. G eneral obstetrics-gynecology 9 . O bstetric-gynecology su b sp e cialty — e.g., reproductive endocrinology 10. O phthalm ology 11. O tolaryngology 12. Pathology 13. G eneral p ed iatrics 14. P ediatric su b sp e cialty — e.g., p ed iatric cardiology, etc. 15. Physical m edicine a n d reh ab ilitatio n 16. Public h e a lth /p re v e n tiv e m edicine 17. P sychiatry 18. Radiology 19. S u rgery— general 2 0 . S urgical su b sp e cialty — e.g ., orthopedic, plastic, etc. 2 1 . O ther, specify 69 2 1 . P lease in d icate y o u r preference for one of th e specific care er activities below even if you have n o t definitely decided on a specific preference. (M ark only one.) Full-time academ ic fa c u lty appointm ent: 1. B asic science teach in g a n d re se a rc h (e.g., an ato m y , bio-chem istry) 2 . C linical science teach in g an d research , inclu d in g p a tie n t care (e.g., in te rn a l m edicine, surgery) Salaried research scientist (e.g., in in d u stiy , federal agency, sta te agency): 3 . B asic m ed ical sciences 4 . Clinic E l l scien ces Private clinical practice (e.g., in a private office, p aid by fee-for-service): 5 . A lone 6 . In p a rtn e rsh ip w ith one o th e r p h y sician 7 . In a gro u p of th re e or m ore p h y sician s 8. U ndecided am ong resp o n ses 5, 6, a n d 7 Salaried clinical practice, em ployed by: 9 . H ospital 10.PrepEdd p ractice (e.g., HMO, IPA) 11. S tate or federal agency (e.g., VA, A rm ed Forces, Public H ealth Service) Other: 12. A dm inistration-N o practice (e.g., h o sp ita l a d m in istrato r, sta te or federal agency a d m in istra to r, asso ciatio n or academ ic executive, b u s in e s s executive) 13. O th er 2 2 . P lease in d icate th e settin g in w hich you th in k you w ould m o st like to practice following m edical training. 1. LEirge city (population 5 0 0 ,0 0 0 or m ore) 2 . S u b u rb of a large city 3 . City of m o d erate size (population 5 0 ,0 0 0 to 500,000) 4 . S u b u rb of m o d erate size city 5. S m all city (population 10,000 to 5 0 ,0 0 0 — o th e r th a n su b u rb ) 6 . Tow n (population 2 ,5 0 0 to 10,000--o th e r th a n su b u rb ) 7. S m all tow n (population le ss th a n 2,500) 8. R u ra l/u n in c o rp o ra te d a re a 9 . U ndecided or no preference 2 3 . W ould y o u b e w illing to practice in a socioeconom ically deprived a re a ? 1. Yes 2 . No 3 . D on’ t know 2 4 . F rom th e list of facto rs below, please indicate th e first, second, a n d th ird m o st im p o rta n t facto rs in y o u r choice of m edicine a s a c are er goal. a. F irst (row 2 4 a on C an d id ate Inform ation Folder) b. S econd (row 2 4 b on C an d id ate Inform ation Folder) c. T h ird (row 24c o n C an d id ate Inform ation Folder) 70 1. D esire for au th o rity 2 . O pp o rtu n ity to lead 3 . High incom e possibilities 4 . Independence 5 . Intellectual challenge 6 . In te re st in helping people 7 . In tere st in re se a rc h 8 . J o b secu rity 9. O p p o rtu n ity to m ak e u se of special ta le n ts a n d abilities 10. S ta tu s a n d prestige 11. E n co u rag em en t o r influence of o th ers 12. O ther, specify 2 5 . P lease in d icate th e one a re a below in w hich you are m o st in terested . 1. Public h e a lth a sp e c ts of d isease 2 . Psychological a sp e c ts of disease 3. D irect p a tie n t care 4 . B iom edical research 2 6 . P lease in d icate th e one a re a below in w hich you are le a st in terested . 1. Public h e a lth a sp e c ts of d isease 2. Psychological a sp e c ts of disease 3 . D irect p a tie n t care 4 . B iom edical re se a rc h 2 7 . F rom th e list of in flu en ces below, please indicate th e first, second, a n d th ird m o st im p o rta n t in flu en ces in y o u r decision to stu d y m edicine. a. F irst (row 2 7 a on C an d id ate Inform ation Folder) b. S econd (row 2 7 b on C an d id ate Inform ation Folder) c. T hird (row 27c o n C andidate Inform ation Folder) 1. Allied h e a lth pro fessio n s advisor 2. P rofessor o r te a c h e r 3 . P aren t 4 . A n o th er relative or friend 5 . P hysician 6 . Science co u rse 7. P a rtic u la r book, article, film, television program 8. H ealth -related w o rk experience 9 . E xperience w ith illn e ss/a c c id e n t 10. O ther, specify 11. H ave n o t decided 2 8 . Please in d icate w h e th e r you agree or disagree w ith th e following p ercep tio n s of m edicine a n d m edical p ractice by coding th e ap p ro p riate n u m b e r for y o u r resp o n se: 1. Agree strongly 2 . Agree som ew hat 3. D isagree som ew hat 4 . D isagree strongly 5. D on’ t know o r no opinion 71 a. M edicine will be a s financially rew arding in th e fu tu re a s in th e p a st. b. P hysician s will n o t receive th e sam e resp ect from society in th e fu tu re a s th ey have in th e p ast. c. C h an g es in th e h e a lth care sy stem are im pairing p h y sician s’ indepen d en ce. d. P h y sician s’ legal liabilities an d th e high cost of m alp ractice in s u ra n c e are not m a jo r problem s. e . T he d em an d s of a p h y sician ’s w ork do n o t interfere w ith fam ily relatio n s. f. P rim ary care p h y sician s are a s im p o rtan t a s specialists. g. O p p o rtu n ities to b u ild a su ccessfu l p ractice are alw ays available to p h y sician s w ho w ork h ard . h . H aving in terestin g a n d intelligent colleagues is a m ajo r b enefit of being a physician. i. U nequal access to m edical care is no longer a problem in th e U nited S tates. j. T he d em an d s of a p h y sician ’s w ork interfere too m u c h w ith o th e r in te re sts an d p u rs u its. k. E veiyone is en titled to receive a d eq u a te m edical care reg ard less of h is o r h e r sta tio n in life. 1. A dvances in th e biom edical sciences an d th e ir applicatio n to th e care of p a tie n ts will m ak e being a doctor m ore stim u latin g , challenging, a n d fulfilling in th e fu tu re. 2 9 . P lease indicate below y o u r preferences (first, second, a n d th ird choices) am ong th e p o stb a c c a la u re a te p rogram s to w hich y o u have applied o r p la n to apply. a. F irst (row 2 9 a on C an d id ate Inform ation Folder) b. S econd (row 2 9 b o n C an d id ate Inform ation Folder) c . T hird (row 29c o n C an d id ate Inform ation Folder) 1. A llopathic m edicine (M.D.) 2 . O steo p ath ic m edicine (D.O.) 3 . P odiatric m edicine (D.P.M.) 4 . V eterinary m edicine (D.V.M.) 5. D en tistry (D.D.S.) 6 . O th er h ealth p ro fessions (optom etry, p h arm acy, etc.) 7. N ursing 8 . S o cial/b eh av io ral sciences 9 . B u sin e ss 10. E d u ca tio n 11. E ngineering 12. Law 13. P hysical/biological sciences 14. Fine a rts 15. O th er 16. None 3 0 . P lease indicate below y o u r p referen ces (first, second, a n d third) am ong th e o ccu p a tio n s you will seek if you are n o t accepted in to an y of th e p o stb a c c a la u re a te p ro g ram s no ted in Q u estio n 29. (Use th e O ccu p ation s L ist o n page 28.) a. F irst (row 3 0 a on C an d id ate Inform ation Folder) b. S econd (row 3 0 b o n C an d id ate Inform ation Folder) c. T hird (row 30c o n C an d id ate Inform ation Folder) 72 Part V. Educational Information 3 1 . U sing th e a p p ro p ria te code from th e tab le of h o u rs below , please in d icate th e n u m b e r of co u rse h o u rs you will have com pleted (or n early com pleted) in each a re a listed a t th e tim e you ta k e th e MCAT. CODES AREAS S e m e ste r H ours Q uarter Hours a. Biology 1. 0 0 b. C hem istry 2 . 1-4 1-6 c. B iochem istry 3 . 5-8 7-12 d. Physics 4 . 9-16 13-24 e. C alcu lu s 5 . 17-24 25-36 f. M athem atics, o th e r th a n c a lc u lu s 6 . M ore th a n 24 More th a n 36 g. P sychology/B ehavioral scien ces h. Social sciences, o th e r th a n above i. E nglish j. H u m an ities, o th e r th a n above k. C o m p u ter science 3 2 . A s of th e en d o f th e la st q u a rte r o r se m e ste r in w h ich you a tte n d e d school, please , in d icate y o u r cum ulative, overall g rad e-p o in t average. 1. Below 1.00 2. 1.00-1.50 3. 1.51-2.00 4 . 2 .0 1 -2 .5 0 5. 2 .5 1 -3 .0 0 6 . 3 .0 1 -3 .2 5 7. 3 .2 6 -3 .5 0 8 . 3 .5 1 -3 .7 5 9 . 3 .7 6 -4 .0 0 lO . D on’ t know 3 3 . F o r eac h of th e a re a s listed below , please indicate th e level th a t you th in k b e st d escrib e s y o u r ability in th a t a re a co m p ared w ith o th e r college s tu d e n ts. (This m a y be h a rd to do, b u t p lease give y o u r m o st objective estim ate.) LEVEL OF ABILITY 1. Poor 2 . F air 3 . Good 4 . E xcellent AREAS a. Physical sciences b. Biological sciences c. M ath em atics a n d sta tistic s d. E nglish com position a n d literatu re e. Fine a rts f. Pi^chology/Sociology g. H isto ry /g o v ern m en t, c u ltu ra l stu d ie s 73 Part VI. Financial Information 3 4 . Do you have a n y o u tsta n d in g ed u catio n al lo an s for y o u r u n d e rg ra d u a te ed u catio n w h ich y ou are legally req u ired to repay? (M ark one) 1. No (Go to Q u estio n 37) 2. Yes (Go to Q u estio n 35) 3 5 . If yes, p lease estim ate th e am o u n t of y o u r ed u catio n al in d e b te d n e ss a s of th e day you p la n to e n te r m edical school. P rint th e am o u n t in th e boxes above th e grid area. T hen, in th e co lu m n below each box, b la ck en th e oval co n tain in g th e sam e n u m b e r a s th e box. Fill all six boxes, u sin g zeros a t th e beginning, if necessary. F or exam ple, $ 5 ,0 0 0 w ould be p rin ted a n d gridded 005 0 0 0 . 3 6 . P lease indicate th e so u rc e s of y o u r loans. M ark all th a t apply. 1. G u aran te ed S tu d e n t L oan (GSL) 2 . P erkins L oan (formerly. N ational D irect S tu d e n t L oan— NDSL) 3 . PLU S/SLS 4 . S tate 5. College or univ ersity 6 . Fam ily o r frien d s 7 . O ther, specify 3 7 . A ssum ing you e n te r m edical school, please ia d icate w h e th e r y ou will need som e form of ex tern al fin an cial a ssista n c e to com plete y o u r m ed ical edu catio n . (This refers to lo a n s from so u rc e s o th e r th a n fam ily, s u c h a s b a n k s , ed u catio n al in stitu tio n s, o r sim ilar sources.) a. 1. Yes (Go to p a rt b) 2. No (Go to Q u estio n 38) 3. D on’ t know (Go to Q u estio n 38) b. If y o u r an sw er to p a rt a is yes, please estim ate th e ap p ro x im ate a m o u n t of fin an cial a ssista n c e you will n eed to ob tain from so u rc e s o th e r th a n fam ily to com plete y o u r m edical ed u catio n . P rin t th e am o u n t in th e b o x es above th e grid area. T hen, in th e co lu m n below each box, b la ck en th e oval co n tain in g th e sam e n u m b e r a s th e box. Fill all six boxes, u sin g zeros a t th e beginning. F or exam ple, $ 2 0 ,0 0 0 w ould b e p rin ted a n d gridded 020000. 3 8 . a. Please estim ate th e ap p ro x im ate am o u n t you c a n provide (ap art from loans, g ra n ts, etc.) to com plete y o u r m edical education. P rin t th e a m o u n t in th e boxes above th e grid area. T hen, in th e colum n below e ac h box, b la ck en th e oval co n tain in g th e sam e n u m b e r a s th e box. Fill all six b oxes, u sin g zeros a t th e beginning. F or exam ple, $ 2 0 ,0 0 0 w ould be p rin ted a n d g rid d ed 020000. 74 b. P lease in d icate th e m ajo r so u rce of y o u r co n trib u tio n . C hoose only one. 1. P erso n al savings 2 . E m ploym ent d u rin g academ ic y ears w hile in m edical school 3 . E m ploym ent d u rin g su m m e rs w hile in m edical school 4 . P a re n ts’ savings 5 . P a re n ts’ incom e 6 . S p o u se’s sav in g s/ incom e 3 9 . If you a tte n d m edical school, p lease indicate in p a rt a if y o u w ould be w illing to m a k e a co m m itm en t to practice for a tim e u n d e r specified con d itio n s in o rd er to o b ta in financial su p p o rt. a. 1. Yes (Go to p a rt b) 2 . No 3 . D on’ t know b. If yes, p lease indicate in w hich of th e following you w ould be willing to p ractice for a period of service a s a p a rt of a financial su p p o rt agreem ent. 1. Public H ealth S ervice/N ational H ealth Service C orps 2. M ilitary Service 3 . None of th e above O ccu p ation s L ist H ealth P rofessional 1. P hysician (M.D. or D.O.) 2 . D en tist 3 . V eterin arian 4 . O ptom etrist 5. P odiatrist 6 . P h arm ac ist 7 . R egistered n u rse 8. H ealth technologist 9 . O th er licen sed h e a lth professional 10. H ealth w orker o th e r th a n above B u sin e ss a n d O th er P rofessional 11. A rchitect 12. Clergy 13. E ng in eer 14. G overnm ent official (also com m issioned officers of th e m ilitary) 15. Law yer o r ju d g e 16. M ath em atician or co m p u ter scien tist 17. N atu ral scien tist 18. Social scien tist or u rb a n p la n n e r 19. T eacher- - college / university 75 2 0 . T each er--o th er th a n colleg e/u n iv ersity 2 1 . O w ner, executive, m a n a g e r— co rporate b u sin e ss 2 2 . O w n e r/m a n a g e r— sm all b u sin e ss 2 3 . T ech n ician o r sem i-professional n o t listed elsew here 2 4 . B u sin e ss or professional n o t listed elsew here C le rical/S ale s 2 5 . S ecretary 2 6 . O th er clerical w orker (file clerk, bookkeeper, receptionist, etc.) 2 7 . S ales— su p erv iso r 2 8 . S ales rep resen tativ e 2 9 . S ales w orker, retail a n d p e rso n a l services Service O ccu p atio n a n d T rad es 3 0 . A rm ed F orces (enlisted only) 3 1 . Service w orker (police officer, firefighter, o th e r service) 3 2 . Skilled w orker o r c ra ftsm a n 3 3 . T ran sp o rt or eq u ip m en t o p erato r 3 4 . U nskilled w orker, laborer, or private h o u seh o ld w o rk er A griculture 3 5 . F arm er, farm m an ag er, farm forem an 3 6 . F arm lab o rer O th er 3 7 . H om em aker 3 8 . F ull-tim e s tu d e n t 3 9 . D on’ t know 76
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Quinn, Erin Ann
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Core Title
Latinos in medicine: A study of traditional and non-traditional predictors of success
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Doctor of Philosophy
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University of Southern California
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