by Timothy P. Ready
The initial push to make medical education accessible to students from all segments of our society was widely known as Project 75. Until the late 1960s, medical schools were highly segregated, with the vast majority of physicians in training being white men. Only about three percent of students were minorities, threefourths of whom attended the two predominantly black medical schools Howard and Meharry. On average, all other medical schools admitted only one minority student every two years. To address the injustice of this situation and to increase the number of minority physicians who would be motivated to address the severe health care needs of many minority communities, the federal government and private foundations provided financial support to medical schools to create minority affairs offices, hire personnel to recruit minority students, develop educational enrichment programs for minority college students, implement affirmative action policies and provide academic support services for minority students once they were enrolled.
Although Project 75 did not reach its goal of enrolling minority students in numbers proportional to their representation in the population at large, the percentage of minorities among beginning medical school students in 1975 rose to nine percent.1 Even though most of the programs established in the early 1970s remained in place, minority enrollment would not advance beyond this level for more than fifteen years. During that period, the country's minority population continued to grow, resulting in more severe under representation in 1990 than in 1975.
By 1978, it already had become clear that medical schools' continuing efforts to increase minority enrollment were no longer working, so a blueribbon task force of medical educators was convened to analyze the problem and make recommendations. The task force found that the primary cause of stagnation in minority enrollment was an inadequate supply of well prepared minority applicants. Although medical school efforts begun during Project 75 were helpful and necessary, they were far from adequate. The task force recommended that medical schools form partnerships with the high schools and colleges that are primarily responsible for the academic preparation of minority medical school applicants of the future. Although this recommendation was not widely adopted at the time, it is the fundamental tenet of Project 3000 by 2000.
The goal of Project 3000 by 2000 is that 3,000 underrepresented minority students should enter the nation's 126 medical schools each year by the start of the next decade. This goal simply updates to the demographics of the 1990s what medical educators had sought to accomplish through Project 75. Before Project 3000 by 2000 was officially launched in the fall of 1991, research conducted on the actual and potential minority applicant pool confirmed the primary conclusion of the 1978 Task Force. If medical schools are to substantially increase their minority enrollment, the size and degree of academic preparation of the minority applicant pool must be dramatically increased. To illustrate, approximately seventy percent of medical students have earned bachelor's degrees in either the life sciences or physical sciences.2 In 1991, only 3,666 blacks, Hispanics and American Indians earned bachelor's degrees in these fields. That same year, 4,363 blacks, Hispanics and American Indians applied to medical school. To reach the goal of 3,000 minority students entering medical school each year, it is immediately clear that two points must be addressed: (1) the number of minority applicants needs to be much larger; and (2) the number of minority students earning bachelor's degrees from the primary feeder disciplines is insufficient to meet the needs of medical schools, let alone the many other science and health related fields in which minorities are equally underrepresented and needed.
Moving further back in the educational continuum, we examined data on the science skills of white, black, and Hispanic 17yearold high school seniors from the National Assessment of Education Progress (NAEP). Specifically, we looked at the percentage from each of these groups who could use specialized scientific data in problem solving (NAEP level 350)a skill level considered to be prerequisite for doing collegelevel science work. In 1990, only 1.5 percent of a representative sample of black 17yearolds and 2.1 percent of Hispanic 17yearolds had developed these skills, compared to 11.4 percent of whites of the same age. Combining this information with census data on the number of white, black and Hispanic 17yearolds in the general population, we estimated that there are approximately 354,000 white 17yearolds with the skills needed to study science in college, compared to fewer than 9,000 blacks and about 7,000 Hispanics. In fact, the numbers may actually be lower than this, since these estimates do not take into account the fact that many 17year olds (especially Hispanic and black) drop out of school.
Admittedly, these are rough estimates. But these data convinced us that any credible effort to significantly increase the number of minority applicants to medical school had to begin no later than the start of high school. Some studies have shown that summer academic enrichment programs sponsored by medical schools can be helpful, as evidenced by the fact that a relatively large number of former participants eventually enrolled in medical schools. Many programs reinforce the motivation of already well prepared students by providing them with experiential learning opportunities in medical settings. Although they make an important contribution, no short term enrichment program can take the place of a strong academic high school curriculum and access to a good college. Far too few minority students have access to either.
While the primary goal of Project 3000 by 2000 is to increase minority enrollment in medical schools, the means to achieving that goalharnessing the resources of the academic health centers to improve learning opportunities for minority precollege and college studentsis no less important than the goal itself. Project 3000 by 2000 calls on medical schools and affiliated teaching hospitals to be catalysts in their communities' efforts to improve the quality of education especially in the sciences. The academic health centers in which medical schools are based are often the largest enterprises in their communities and the largest employers. Usually, they also are the institutions with the largest concentration of scientific resources human and materialin their communities. As such, they have both the means and the responsibility to enhance the quality of education available to the young people of surrounding communities. Nowhere is the need greater than in predominantly minority school districts in the vicinity of many of the nation's major medical centers.
Since Project 3000 by 2000 officially began three years ago, many more medical schools are involved in a variety of educational partnerships that include local school systems, predominantly minority communitybased organizations, and undergraduate colleges, many of which are affiliated with the same universities in which the medical schools are based. What does each institution have to gain from participating in these minority studentfocussed partnerships?
As already described, medical schools are committed to the goal of increasing the number of minority physicians they train. However, history has shown that they cannot solve the problem of minority underrepresentation by acting alone. Medical schools are dependent upon undergraduate colleges and K12 school systems to supply them with a sufficient number of well prepared applicants. An increasing number of medical schools are proving through their actions that they are willing to collaborate to increase the number of minority students who will be prepared not only for medical school, but for many other scienceintensive fields, as well.
While the name, Project 3000 by 2000, reflects a goal primarily of interest to medical schools, other participants in these community partnerships have their own goals that are congruent with those of the medical school. Other health professions' schools and postgraduate programs training scientific researchers are strongly encouraged to join in. Virtually all science and health related fields face a common problem of minority underrepresentation, and all have important resources that they can contribute to minority focussed community partnerships. The same is true for undergraduate colleges. For example, relatively few undergraduate colleges can be satisfied with the degree to which they now serve minority students and minority communities, especially when it comes to education in the sciences. If it were not for a small number of historically black colleges graduating a disproportionate number of students with degrees in science, the already alarming scarcity of black and other minority bachelor's degree recipients in the sciences would be much worse. Producing minority graduates who go on to medical school can be one measure of an undergraduate college's success but, of course, it is by no means the only measure, or the most important measure. However, if a college agrees to participate in the partnership and resolves to take steps to better serve minority students, not only will that college likely produce more graduates who become physicians, but also research scientists, teachers, dentists, etc. Local school systems also have much to gain by participating in health science partnerships. High school educators also want to see their graduates become successful in fields such as medicine. Not only would more "success stories" among their graduates reflect well on the school system and the teachers working in it, but the success of graduates from a community's elementary and secondary schools is crucial to the longterm prosperity and wellbeing of the community, itself. No single partnernot the medical school, college, or school systemshould be in a position to dictate the goals or structure of a health science partnership. All need to hear each other's concerns and interests, and then agree to work together to achieve a series of related student achievement goals.
For example, a public college in a partnership may wish to set a goal of doubling the number of minority students that it graduates with degrees in biology. However, even after taking steps to improve its own curriculum and learning environment, it may find that reaching this goal would be impossible if feeder school systems do not provide more minority students who are well prepared in the sciences. One or more school systems might then agree to set a goal of graduating X number of additional minority students who have completed a specific set of rigorous courses, and who will achieve a certain performance level on one or more standardized tests. With encouragement and assistance from the medical school, a school district may wish to pursue its goal by establishing a rigorous magnet or focus school for the health sciences. The school district might also propose to work with its college and medical school partners to improve the quality of science education at all of the middle schools and high schools. The college would agree to assist the school system in the areas of teacher inservice training and curriculum development. The medical school also would agree to assist in these areas, as well as by providing high school biology students interested in medicine with experiential learning opportunities in medical settings. A collaborating dental school might agree to do the same thing for students interested in dentistry.
Although a comprehensive partnership such as the hypothetical case just described does not yet exist, many of the components already are in place. Every medical school in the country has appointed a Project 3000 by 2000 coordinator, whose job it is to develop educational partnerships that eventually should lead to increased minority enrollment in the medical school. Over fifty medical schools have established partnerships with magnet health science high schools. Some leading examples include the Gateway to Higher Education Program, a partnership of the Sophie Davis School of Biomedical Education and the New York City Public Schools, the Baylor High Schools for Health Professions in Houston and Mercedes, Texas, and the Hopkins/Dunbar Program in Baltimore. Even more are working with school systems in science education partnerships in which medical schools collaborate with school districts on basic issues such as providing laboratory supplies, or by working on issues such as curriculum development or providing teachers with laboratory research opportunities during the summer. Medical schools with some of the more extensive science education partnerships with K12 school systems include Baylor College of Medicine, the University of California at San Francisco, the University of Kentucky and Boston University School of Medicine. Through such partnerships medical schools are helping to improve the quality of science education available to students of all racial and ethnic backgrounds.
Partly as a result of the support given to Project 3000 by 2000 by medical school leadership, the number of underrepresented minority students entering medical schools has increased 27 percent in three years. This enrollment gain was facilitated by a 40 percent increase in minority applicants, a rate of growth that slightly exceeded that of the applicant pool as a whole. Where are the additional minority applicants coming from? Since many of the partnerships developed under Project 3000 by 2000 are new, one has to point to other reasons for the increase in wellprepared applicants. It is likely that some of the educational reforms of the 1980s, such as encouraging all high school students to take high level mathematics and science courses, are beginning to show results. Also, major investments made during the past decade by the National Science Foundation in minorityfocussed science education programs like the Alliances for Minority Participation are probably helping, as are programs from the National Institutes of Health (e.g., the Science Education Partnership Awards), ongoing programs of the Bureau of Health Professions of the Public Health Service, and the Eisenhower grants of the Department of Education.
For a variety of reasons, the number of bachelor's degrees awarded to minorities in the sciences has risen sharply in the past few years. Through Project 3000 by 2000, medical schools intend to contribute to the continued improvement in minority student achievement in the sciences and health. Medical schools and teaching hospitals will offer handson learning opportunities to more minority students, work to ensure that students from all backgrounds know what opportunities exist in medicine, and endeavor to provide students from diverse backgrounds with access to those opportunities whenever possible. In conjunction with similar activities sponsored by other professions, medical educators will demonstrate to students who might otherwise be discouraged that the difficult academic lessons of school are important and relevant to their one day entering a satisfying professional career.
2. Most medical schools strongly encourage applicants with broad educational backgrounds in the arts and humanities. However, because of the extensive science content in the medical school curriculum and many medical schools' prerequisite course requirements, most medical school applicants and matriculants have earned bachelors degrees in the sciences.