Successfully Training and Educating Pre-medical Students (STEPS)

Evidence-level

Promising (About evidence-level criteria)

Description

In northeast Kentucky, almost half of the counties are considered Health Professional Shortage Areas (HPSAs) for primary medical care. In addition to low numbers of its students applying to medical school, the region has seen less than 30% of its applicants accepted into an in-state medical program.

In order to encourage local students to pursue medicine at Kentucky's three medical schools, the Northeast Kentucky Area Health Education Center (NE KY AHEC) created the Successfully Training and Educating Pre-medical Students (STEPS) program in 2013. STEPS supports pre-medical students in the Appalachian region as they apply for medical school.

Through STEPS, the NE KY AHEC partners with the three medical schools in Kentucky, which provide annual county-level data on applicants and matriculants. From 2013 to 2017, STEPS was almost entirely self-funded by the NE KY AHEC.

Services offered

Pre-medical students attending college in northeast Kentucky or with a permanent address in the region are encouraged to apply for the STEPS program. Interested students must complete the following:

• Be enrolled in certain math and science courses
• Complete an online application
• Write a personal essay no longer than 500 words
• Submit a letter of recommendation from a professor
• Complete an in-person or virtual interview
• Have a GPA of at least 3.0

From 2013 to 2022, an average of 13 applicants were selected each year. After the NE KY AHEC received a state contract to expand and replicate STEPS, the number of participants per year was increased to 15 beginning in 2018 and the number of applicants was 21 for the 2019-20 cohort and 20 for the 2020-21 cohort. Once accepted into the STEPS program, participants attend about six meetings, take an online Medical College Admission Test (MCAT) preparatory course, and receive:

• Medical school application process tutorials
• Weekly MCAT reviews
• MCAT practice exam(s)
• Mock interviews
• Personal statement writing workshops
• Physician shadowing in multiple specialties
• Other activities that will help pre-medical students prepare for medical school

Results

From 2013 to 2015, a total of 28 students participated in STEPS, 25 of whom met all program requirements. Of these 25 participants, 22 were accepted by a medical school (21 to schools in Kentucky and one to West Virginia); this success rate of 88% exceeded the program's original goal of 70%.

On average, students' MCAT scores were 4.6 points higher than their practice scores. In 2015 and most subsequent years, average MCAT scores have been approximately 7.6 points higher than practice scores.

There have been 72 participants in the STEPS program from the 2017-18 cohort to the 2021-22 cohort. Of these 72 students, 43 have matriculated to medical school, with only two going out of state. Program organizers attribute part of the lowered success rate during this timeframe to COVID-19, which limited the ability to hold in-person meetings. Additionally, since many of the students' college classes were transitioned online, there could have been some fatigue that reduced the impact of the online MCAT prep trainings.

As further evidence of the STEPS program's success, the NE KY AHEC is now administering its third two-year contract (July 2022-June 2024) from the Kentucky Primary Care Office to replicate various aspects of the program among the state's seven other regional AHECs, most of which had no prior pre-medicine preparation programming. After participating in 2018-19, the Northwest AHEC started its own pre-medicine prep program for the 2019-20 academic year and still operates the program. After an increase in state funding of the Kentucky AHEC Program during the 2022 legislative session, the Southeast Kentucky AHEC initiated its own pre-med prep program, bringing the total of regional center pre-med prep programs in Kentucky to six.

Continuation of the statewide MCAT Project allows Kentucky's regional AHECs to track the results of previous years' pre-medicine prep participants. Most students participate as college juniors, so obtaining 2020-23 in-state medical school matriculation data has allowed the AHECs to assess the results of the 2019-22 pre-medicine prep cohorts:

• 120 of 219 pre-medicine prep participants (55%) supported by the Kentucky Primary Care Office during 2019-22 matriculated to medical school in fall 2020-23.
• 104 of these 120 matriculants (87%) are attending a medical school in Kentucky.

Program coordinators presented STEPS and their county-level medical school data tracking initiative at the 2015 and 2017 National Rural Health Association (NRHA) annual conferences, the 2016 National AHEC Organization biennial conference, and a 2018 HRSA Region IV Workforce Forum. An abstract titled “Development of a Statewide, AHEC-administered Pre-med Prep Project” was accepted for presentation at the May 2022 NRHA annual conference, in which NE KY AHEC Director David A. Gross was joined by the directors of the Northwest and South Central AHECs.

Due to the success of STEPS, the NE KY AHEC was presented with the Center of Excellence for Distribution Award at the National AHEC Organization's 2018 conference. The award recognizes an AHEC program that is improving healthcare workforce distribution throughout the nation, particularly among rural and underserved areas and populations.

For more information:

Gross, D.A., Mattox, L.C., & Winkleman, N. (2016). Priming the Physician Pipeline: A Regional AHEC's Use of In-State Medical School Data to Guide Its Health Careers Programming. Journal of Health Care for the Poor and Underserved, 27(4A), 8-18. Article Abstract

Challenges

STEPS coordinators continue to have difficulty filling the slots each year with students only from northeast Kentucky, so they have accepted multiple students from the nearby regional university (Morehead State) who live in other areas. In November 2021, the NE KY AHEC formed a Medical Student Matriculation Working Group in an effort to further increase the number of students from the region who pursue medical school.

In addition to NE KY AHEC staff, members include representatives from Morehead State, regional hospitals, medical schools (including current medical students), and the Kentucky Primary Care Association. After an initial meeting, the group is making plans to host a forum with high school guidance counselors and science teachers from the NE KY AHEC's 17-county service region in order to solidify the physician preparatory pipeline at that level.

The online MCAT preparatory course costs $2,300 per student. While the NE KY AHEC receives a discount that reduces this figure to $1,300 per student, the remaining cost is still a significant barrier for many. For the 2022-23 STEPS participants, the NE KY AHEC covered the full cost for each student.

Replication

In addition to rolling out the program content, the NE KY AHEC is assisting the other Kentucky AHECs with tracking applicant and matriculant data by county or medical school. This type of data collection can help AHECs determine which counties have the fewest applicants and, in response, target their efforts to encourage more students from underrepresented counties to pursue medical careers.

The NE KY AHEC also offers the Summer Health Internship Program (SHIP), which places students in six-week paid internships in local health organizations. This program helps students gain experience in the healthcare field and encourages them to work in the region after graduation.

This 3-minute video features a student's testimonial of the program:

Contact Information

David A. Gross, Director
Northeast Kentucky Area Health Education Center
david.gross@st-claire.org