Annslee Lowe1, Amy Clithero-Eridon2, Cameron Crandall3, and Marlene Ballejos4
1BA, Medical student, University of New Mexico School of Medicine, Albuquerque, United States
2PhD, MBA, Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque, United States
3MD, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, United States
4PhD, MPA, Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque, United States
Abstract
BACKGROUND: The social mission of health professional schools is to train a diverse group of providers to care for all populations. Community college students encounter more challenges than traditional students in accessing the resources and support, including mentorship, needed to prepare for graduate health professions programs. This project aimed to identify community college students’ challenges. METHODS: We expanded an existing mentorship program, initially designed for medical and community college students, to include other specialties such as nursing, occupational therapy, physical therapy, and physician assistant programs. RESULTS: Mentees indicated that barriers to participating in extracurricular activities included work, opportunities for shadowing a healthcare provider, lack of time, financial barriers, and living far away from volunteer opportunities. CONCLUSION: By addressing resource challenges and establishing intentional pathways for community college students through effective mentorship, we may enhance diversity in healthcare and alleviate the shortage of primary care providers.
Key Words: Medical students, Community Colleges, Mentorship
Date submitted: 19-September-2024
Email: Amy Clithero-Eridon (aclithero@salud.unm.edu)
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Citation: Lowe A, Clithero-Eridon A, Crandall C, and Ballejos M. Recruiting community college students into health professions programs. Educ Health 2025;38:68-76
Online access: www.educationforhealthjournal.org
DOI: 10.62694/efh.2025.191
Published by The Network: Towards Unity for Health
Training a well-suited health workforce is essential for improving healthcare access.1 This is the driving principle behind a social accountability (SA) mandate that seeks to transform health professional education to produce a workforce meeting population and health system needs.2 The World Health Organization (WHO) defines SA as “the obligation to orient education, research, and service activities towards priority health concerns of the local community, the region and/or nation (schools) one has a mandate to serve. These priorities are jointly defined by government, health service organizations, and the public.”3 The social mission of a school drives social accountability activities. The social mission is generally to ensure a diverse cadre of providers trained to care for populations, with particular attention paid to the delivery of primary care in underserved areas.4
The University of New Mexico Health Sciences Center (UNM HSC) expresses its social mission through its curriculum. From selecting students from diverse backgrounds to emphasizing population health and primary care throughout training, the UNM HSC prepares a workforce to meet the needs of the communities served. Health inequities can result from a mismatch between education strategies, health systems, and population needs. Health inequities extend to people’s ability to access timely, cost-effective, and quality healthcare services delivered by skilled practitioners.5 This is compounded by difficulties recruiting health workers to rural, remote, and underserved areas. Most efforts to address health workforce shortages focus on producing more health workers and providing incentives towards recruitment and retention in underserved areas, with little or no attention paid to the effects of the institutional context and students’ educational experiences.1
Like other states, New Mexico has a shortage of physicians and healthcare providers.6 The educational experience of students includes where they study. In the United States, a community college is considered a place of higher education. Still, the highest degree one can earn is a two-year associate degree rather than a Bachelor’s, Master’s, or Doctorate degree.7 Community college students typically represent their communities regarding age, socioeconomic background, and other demographics.8 Attending a community college may be a disadvantage for medical students due to less competitive applications, which arise from limited mentorship, research opportunities, and potential biases of admissions committee members who may believe a community college is “lesser than” a four-year institution.9 In 2019, Our medical students partnered with a local community college, Central New Mexico (CNM), to strengthen the mentorship aspect and formalized a peer mentorship program.10 Program details have been published previously.10 The program’s success led us to extend the mentorship program in 2021 to other specialties, including nursing, physical therapy, physician assistant, and occupational therapy. The objectives of the mentorship program are to pair current health professional students with community college students to assist them in preparing competitive applications and gaining the experiences needed to be competitive applicants. We hypothesized that fear of negative associations, resource challenges, and the positive effects of mentorship would be consistent for CC students pursuing any health professional career.
We recruited UNM HSC health professional students via email. Interested students subsequently attended an informational meeting led by the program lead (PL) and confirmed their participation. Recruitment for CC students was more extensive. The PL spoke at various CNM science, technology, engineering, and math (STEM) classes, placed flyers in the tutoring center, and asked CNM professors to send program information by email. A Zoom meeting was held to explain the mentorship opportunity and confirm participation. Prospective mentees provided their names, email addresses, and fields of interest within healthcare. We then randomized mentor-mentee matches within their areas of interest/study.
We asked mentees to complete a survey on their beliefs and experiences as CC students interested in health professional careers. We asked mentors to complete a survey on their beliefs and experiences as prior CC students and compared them with mentors who were not CC students. (See Appendix 1 for mentor survey questions and Appendix 2 for mentor survey questions) Both surveys were summative evaluations. Where questions were similar to those on the survey, we presented combined results for comparison. Surveys were administered through Qualtrics, where data was stored, and initial data summaries were collected. For Likert Scale responses, the scale was: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree. To assess statistical significance where appropriate, we used the Wilcoxon Rank Sum Test and a two-tailed Type I error of less than 5%.
We collected the demographic characteristics of the mentees to assess potential social determinants of health risk. For education, we used the education level of CC parents as a proxy for socioeconomic status. If a student has two fathers or two mothers, we asked them to select the parent with the highest degree for their response. We defined first-generation students as those whose parents did not attend a 4-year degree-granting institution.
We asked mentors and mentees whether attending a community college was advantageous in pursuing a health career and if they were concerned about admissions committee perceptions.
We asked mentees and mentors about their experiences in a community college setting, including their ability to participate in volunteer activities and their need to work while in school.
We asked mentors if they attended a community college, how many programs they applied to and interviewed with, and how many schools they were accepted to. We compared responses to mentors who did not attend a CC. The findings depended on each other: The number of programs interviewed depends on the number of programs applied to, and the number of programs accepted depends on the number of programs applied to.
The University of New Mexico Human Research and Review Committee exempted this study (HRRC # 22-239).
We recruited 41 UNM HSC mentors and 36 CC mentees for the expanded program. Five mentees were paired with two mentors as they reported interest in two fields of study. We received responses from 29 (71%) mentors and eight mentee responses (22%).
The mentee demographic responses were consistent with New Mexico minority/majority demographics. More than half, 63% (5/8), were Latino, Spanish, or Hispanic. Social determinants of health demographics reflect the potential difficulty of CC students entering a university setting to pursue a career as a health professional. Seventy-five percent of the respondents (6/8) identified as female, and 75% (6/8) indicated they were first-generation college students. Sixty-three percent of respondents (5/8) indicated their mothers’ highest level of education was predominantly high school, and 75% (6/8) indicated their fathers’ highest level of education was high school.
Barriers to mentees participating in extracurricular activities included work, opportunities for shadowing a healthcare provider, lack of time, financial barriers, and living far away from volunteer opportunities. Of those currently working, 25% (2/8) work more than 40 hours a week, and 50% (4/8) work less than 40 hours a week. There were two no-responses to the mentee experience questions.
Barriers for mentors who attended a CC were having to work, opportunities for shadowing a healthcare provider, lack of time, financial barriers, and living far away from volunteer opportunities.
We asked mentors to rate their agreement with the following statement: I think Admissions Committees for Health Professions have a negative perception of completing prerequisites at a community college. We analyzed results for this question and the number of programs they applied to, interviewed with, and were accepted to based on whether they had attended a CC. See Table 1: Mentorship Program: Mentors who attended a Community College compared to mentors who did not participate in a Community College
Table 1 Mentorship Program: Mentors who attended a Community College compared to mentors who did not participate in a Community College
We asked both mentors and mentees Why they chose to attend a CC. See Table 2: Mentorship Program: Mentee/Mentor Experience
Table 2 Mentorship Program: Mentee/Mentor Experience
While a majority of mentees in our program indicated neutrality in whether community college attendance provided an advantage in applying for graduate school (42.9%), a roughly equivalent percentage of students either agreed (14.3%) or strongly agreed (28.6%) with this statement. Additionally, most graduate-level mentors in our program agreed (60%) or strongly agreed (20%) that their CC educational background provided an advantage in pursuing a health career. Slightly less than one-third (28.6%) of mentees agreed that they had enough time to participate in extracurricular activities to enhance their pre-health applications, with 14.3% showing strong agreement with this statement. Other mentees indicated neutrality (28.6%) or disagreement (28.6%) with this statement. All of our participants agreed that our mentorship program was a success, with 100% of mentors who attended CC agreeing that a mentorship program would have benefitted them while attending CC.
Limitations of this study include the low response rate from CC mentees.
Previous studies have shown that applicants who attend CC often lack the financial and social capital to matriculate into a 4-year university.11 When graduate health students reflect on their application process, our results suggest that their CC educational background was viewed as a positive component of their application, contributing to matriculation. However, previous studies have shown a difference in matriculation rates between traditional students and those who attended CC, despite differences in GPA and MCAT scores, further demonstrating that applicants with a CC background were less likely to achieve acceptance into medical school. Our results suggest that this discrepancy may be perpetuated by macro-level systems and institutional practices that prevent CC students from achieving success in a university setting rather than CC students lacking confidence in themselves. Most medical schools in the United States explicitly report a dedication to increasing diversity in their students. However, the continuous uncertainty or ambivalence of students with a CC background leaves a large pool of applicants suited to caring for diverse populations out of the healthcare workforce.
Mentees in our study reported a need to work a job for financial security (42.9%) while attending college, with 87% reporting their choice to attend CC was financially influenced. No mentee or mentor reported that they attended a CC because it was closer to home or because they did not feel ready to attend a 4-year university, even though these are often thought to be indications of CC attendance. The findings on extracurricular activities suggest that CC students face mixed time barriers in completing volunteer and shadowing activities. This is likely due to the need to balance school with work for financial security. Medical schools and other health profession programs are shifting to a holistic application process involving a balanced and individualized review of applicants’ experiences, attributes, and metrics. Thus, an emphasis on extracurricular participation should be controlled for the financial obligations that CC students often face.12
Among the mentors in our program, we found a significant difference in perceptions of admissions committees, the number of programs applied to, and the proportion of programs interviewed when comparing graduate students who had previously attended a CC and those who had not. Students who had attended CC were more concerned with admissions committees’ perceptions compared to those who did not attend a CC. These results suggest that students who attend CC on the journey into a health professions program are more distressed with the perception of that education than students who have never attended a CC. As Talamentes’ study indicated, there may be an external perception that CC students are not as academically prepared as those who only attended a 4-year university.13 Those who did not attend CC were interviewed at more programs than those who did attend CC, though there was no significant difference in the proportion of programs to which they were accepted. Because the surveyed mentors were all University of New Mexico students, this may represent a greater familiarity with local CCs and, thus, a better understanding of CC students’ preparedness for graduate school.14
Our results support the hypothesis that CC students pursuing any health professional career consistently experience fear of negative associations, resource challenges, and the benefits of mentorship. The ongoing expansion of programs that support CC students pursuing health careers is likely to aid underrepresented minorities and help dismantle barriers to their entry into graduate health programs. Schools that establish intentional pathways for CC students may enhance the retention of health professionals who more accurately reflect the populations they serve.
We thank the community college mentees for participating in this partnership and the UNM HSC students for mentoring.
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