**PROMOTING RESEARCH CAREERS AMONG MINORITY STUDENTS -**

**A POST-BACCALAUREATE PROGRAM IN PATIENT-ORIENTED RESEARCH**

Richard McGee, PhD, and Gregory A. Poland, MD, Mayo Medical and Graduate
Schools, Mayo Clinic, Rochester, MN (507-284-0339 \-- rmcgee@mayo.edu)

**ABSTRACT**

**Purpose:** Many minority students find it difficult to decide between
research and clinical medicine by the time they graduate from college.
They often have not done enough research to know if this is the correct
career choice, and often want to see practical applications of research.

**The Program:** To address these issues a new postbaccalaureate
research program was created by Mayo Graduate School. Recent college
graduates spend 75% of their time doing research in basic or
patient-oriented laboratory research. The remaining time is spent in a
non-degree curriculum customized to each student\'s needs.

**Results:** All students grow substantially in the program. Of the
first 27 students, 4 entered PhD programs, 2 entered MD/PhD programs, 12
entered MD programs, 1 entered a DDS program, and 8 are applying to PhD,
MD/PhD, or MD now or in the future. Many who enter MD programs develop
strong interests in research and appear likely to do more in the future.
Although planned as a 1-year program, some students require a year to
refine career decisions, and a second year for applying to graduate or
medical schools. A formal course \"Design of Clinical Research
Protocols\" has emerged as the key to teaching analytical thinking,
research design and scientific writing.

**Conclusions:** The program is achieving its goal of building interest
in basic and clinical research careers among minority students. Only a
few, however, sustain interest in PhD programs.

*Supported in part by R25 GM 55252, NIGMS/NIH, "Initiative for Minority
Student Development"*

**Context - The Need**

Many underrepresented minority (URM) students are affected by
educational disadvantages that slow their academic and professional
development. Although they may make impressive gains while in college, a
significant number approach graduation without having achieved the
requisite skills and/or clarity of purpose needed to excel in medical
and graduate schools.

The vast majority of postbaccalaureate programs are designed for
students in need of academic enrichment or remediation. These programs
are very successful in this mission, and are responsible for placing
many minority students in medical schools each year. We have identified
another group of students, however, for whom these programs are not
appropriate. **These** **students often**:

-   are unsure if they want a career in research or clinical medicine

-   like research process but want to provide care too

-   have not acquired the maturity needed to [excel]{.underline} in
    graduate schools

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-   appear on the surface to have adequate academic preparation, but may
    have underdeveloped learning, analytical and critical thinking
    skills

It is this group of students for which the new, experimental, Mayo
Clinic postbaccalaureate research program has been designed. Without
programs like this these students attempt to keep developing outside of
any \"pipeline\" to guide their progression toward a successful career.
Students in the postbaccalaureate program are part of the **Mayo Clinic
Initiative for Minority Student Development (IMSD): \"Training in
Translational Research - Bench to Bedside\".**

**Formal and Informal Hypotheses Being Tested by the Program**

1.  A semi-structured, non-degree postbaccalaureate experience which
    primarily emphasizes research will aid students toward basic science
    and clinical research careers

2.  Introducing students to patient-oriented and clinical research will
    motivate some of them to choose laboratory and clinical research
    careers

3.  A structured group process which requires students, among other
    things, to evaluate and challenge their career choices will promote
    ultimate success of these students

4.  Development of learning, analytical and critical reasoning skills is
    fostered by a semi-structured research experience when it is
    individualized for each student\'s needs

# The Program - Selection of Students

-   Eligibility -- Undergraduates apply during their senior year, or
    open to recent graduates

-   MUST demonstrate, by actions not just words, curiosity and an
    interest in \"discovery\"

-   Above average academic background - often showing growth after a
    slow start

-   Emphasis on recommendations from faculty who know the student well

**The Program Elements**

-   Research Assistant with a skilled faculty mentor for 1 or 2 years

-   Participation in summer activities with Mayo Summer Undergraduate
    Research Fellowship (SURF) students

-   Group-mentoring in a weekly meeting with the program directors

-   Curriculum:

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-   Design of Clinical Research Protocols (2 credits)

-   Biostatistics in Research (2 credits)

-   

-   Responsible Conduct of Research (1 credit)

-   Introduction to Clinical Epidemiology (1 credit - optional)

-   Up to 1 graduate basic science course per quarter

-   Molecular biology techniques course (optional)

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-   Attendance/presentation at national research meeting

-   Guidance on applying to PhD, MD/PhD and MD programs

**Financial Support of Students**

-   Students are paid \$21,000/year \~ 75% of a starting Lab Tech

-   No tuition for courses

-   Mayo Clinic institutional support for students beyond those
    supported by IMSD

**Program Evaluation**

The effectiveness of the program in continuing students toward basic or
clinical research careers is evaluated by tracking student admission
into graduate programs and future activities.

Formative evaluation of the program is carried out largely by extensive
semi-structured interviews.

**Four Year Results**

**Applications**

+--------+----------+------------+----------+-----------+------------+
| **     | **Appli  | Average    | **Ac     | **        | *          |
| Year** | cation** |            | cepted** | Average** | *Funding** |
|        |          | **GPA**    |          |           |            |
|        | **       |            | **New/Yr | **GPA**   | **I        |
|        | Number** |            | 2**      |           | MSD/Mayo** |
+--------+----------+------------+----------+-----------+------------+
| 1      | 20       | 3.33       | 8/0      | 3.36      | 7/1        |
| 997/98 |          |            |          |           |            |
+--------+----------+------------+----------+-----------+------------+
| 1      | 23       | 3.39       | 6/1      | 3.57      | 4/3        |
| 998/99 |          |            |          |           |            |
+--------+----------+------------+----------+-----------+------------+
| 1      | 41       | 3.34       | 8/3      | 3.32      | 7/4        |
| 999/00 |          |            |          |           |            |
+--------+----------+------------+----------+-----------+------------+
| 2      | 26       | 3.41       | 6/3      | 3.44      | 7/2        |
| 000/01 |          |            |          |           |            |
+--------+----------+------------+----------+-----------+------------+
| 2      | 34       | 3.34       | 10/1     | 3.62      | 11/0       |
| 001/02 |          |            |          |           |            |
+--------+----------+------------+----------+-----------+------------+

**Student Outcomes -- Year 1**

+---+-------+-------------+----+-----+--------+-------------+---------+
|   | **E   | **Un        | *  | **Y | **Gr   | **School**  | **Res   |
|   | thnic | dergraduate | *G | ear | aduate |             | earch** |
|   | ity** | School**    | PA | s** | Pro    |             |         |
|   |       |             | ** |     | gram** |             | **Inte  |
|   |       |             |    |     |        |             | rest?** |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 1 | Al    | U of Alaska | 3. | 1   | MD     | U of        | U       |
|   | askan |             | 83 |     |        | Washington  | nlikely |
|   | N     |             |    |     |        |             |         |
|   | ative |             |    |     |        |             |         |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 2 | Black | San Jose    | 3. | 1   | MD/PhD | Mayo        | Yes     |
|   |       | St. U       | 02 |     |        |             |         |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 3 | His   | U of MN,    | 3. | 1   | MD/    | Mayo        | Yes,    |
|   | panic | Morris      | 82 |     | PhD^1^ |             | C       |
|   |       |             |    |     |        |             | linical |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 4 | Black | Florida     | 3. | 1   | MD     | Johns       | Yes     |
|   |       | Int. U      | 86 |     |        | Hopkins     |         |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 5 | Black | Truman St.  | 3. | 1   | MD     | N           | Yes     |
|   |       | U           | 34 |     |        | orthwestern |         |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 6 | Black | U of Kansas | 2. | 1   | MD     | Kansas U^2^ | Un      |
|   |       |             | 75 |     |        |             | decided |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 7 | Black | U of        | 3. | 2   | MD     | U of        | Yes     |
|   |       | Minnesota   | 83 |     |        | Minnesota   |         |
+---+-------+-------------+----+-----+--------+-------------+---------+
| 8 | Black | Notre Dame  | 2. | 1   | DDS    | Meharry     | No      |
|   |       | U           | 29 |     |        |             |         |
+---+-------+-------------+----+-----+--------+-------------+---------+

^1^ Changed to MD/Masters in Clinical Research

^2^ Accepted to medical school prior to beginning the program

**Student Outcomes -- Year 2**

+---+-------+------------+----+-----+--------+-------------+---------+
|   | **E   | **Und      | *  | **Y | **Gr   | **School**  | **Res   |
|   | thnic | ergraduate | *G | ear | aduate |             | earch** |
|   | ity** | School**   | PA | s** | Pro    |             |         |
|   |       |            | ** |     | gram** |             | **Inte  |
|   |       |            |    |     |        |             | rest?** |
+---+-------+------------+----+-----+--------+-------------+---------+
| 9 | His   | Baylor U,  | 3. | 1   | A      | Lost        | No      |
|   | panic | TX         | 29 |     | pplied | Contact -   |         |
|   |       |            |    |     | MD     | unknown     |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 1 | His   | U of New   | 3. | 2   | PhD    | Mayo        | Yes     |
| 0 | panic | Mex.       | 42 |     |        |             |         |
|   |       |            |    |     |        | Immunology  |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 1 | Black | Hood       | 3. | 2   | MD     | U of        | Yes,    |
| 1 |       | College,   | 74 |     |        | Wisconsin   | C       |
|   |       | MD         |    |     |        |             | linical |
+---+-------+------------+----+-----+--------+-------------+---------+
| 1 | His   | U of CA,   | 3. | 1   | MD     | Yale        | Yes,    |
| 2 | panic | San Diego  | 47 |     |        |             | C       |
|   |       |            |    |     |        |             | linical |
+---+-------+------------+----+-----+--------+-------------+---------+
| 1 | Asian | San        | 3. | 1   | MD     | UCLA        | No      |
| 3 |       | Francisco  | 91 |     |        |             |         |
|   |       | State U    |    |     |        |             |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 1 | His   | U of PR,   | 3. | 2   | PhD    | UCSD        | Yes     |
| 4 | panic | Rio        | 77 |     |        |             |         |
|   |       | Piedras    |    |     |        | B           |         |
|   |       |            |    |     |        | iochemistry |         |
+---+-------+------------+----+-----+--------+-------------+---------+

**Student Outcomes -- Year 3**

+---+-------+------------+----+-----+--------+------------+----------+
|   | **E   | **Und      | *  | **Y | **Gr   | **School** | **Re     |
|   | thnic | ergraduate | *G | ear | aduate |            | search** |
|   | ity** | School**   | PA | s** | Pro    |            |          |
|   |       |            | ** |     | gram** |            | **Int    |
|   |       |            |    |     |        |            | erest?** |
+---+-------+------------+----+-----+--------+------------+----------+
| 1 | His   | CA. St. U, | 2. | 1   | MD     | UC Irvine  | Yes,     |
| 5 | panic | Fullerton  | 86 |     |        |            | applying |
|   |       |            |    |     |        |            | MD/PhD   |
|   |       |            |    |     |        |            | at       |
|   |       |            |    |     |        |            | Irvine   |
+---+-------+------------+----+-----+--------+------------+----------+
| 1 | Black | Bryn Mawr  | 3. | 1   | MD     | Mayo       | Yes      |
| 6 |       |            | 42 |     |        |            |          |
+---+-------+------------+----+-----+--------+------------+----------+
| 1 | His   | U of CA,   | 3  | 1   | MD/PhD | A          | Yes      |
| 7 | panic | Santa Cruz | .4 |     |        | pplying^1^ |          |
+---+-------+------------+----+-----+--------+------------+----------+
| 1 | Black | U of       | 2. | 2   | MD     | U of       | Yes -    |
| 8 |       | Michigan   | 72 |     |        | Michigan   | PhD?     |
+---+-------+------------+----+-----+--------+------------+----------+
| 1 | His   | Wellesley  | 3. | 1   | MD     | St. Louis  | Yes,     |
| 9 | panic |            | 36 |     |        | U.         | Clinical |
+---+-------+------------+----+-----+--------+------------+----------+
| 2 | Black | Morehouse  | 3. | 2   | MD     | Applying   | U        |
| 0 |       | U          | 53 |     |        |            | ndecided |
+---+-------+------------+----+-----+--------+------------+----------+
| 2 | Black | Alabama St | 3. | 1   | MD     | Mayo       | U        |
| 1 |       | U          | 92 |     |        |            | ndecided |
+---+-------+------------+----+-----+--------+------------+----------+
| 2 | N     | Arizona St | 3. | 1   | MD/PhD | Applying   | Yes      |
| 2 | ative | U          | 42 |     |        | 2002       |          |
|   | Ame   |            |    |     |        |            |          |
|   | rican |            |    |     |        |            |          |
+---+-------+------------+----+-----+--------+------------+----------+

^1^ Initially began second year but left for personal reasons - doing
research near home

**Student Outcomes -- Year 4**

+---+-------+------------+----+-----+--------+-------------+---------+
|   | **E   | **Und      | *  | **Y | **Gr   | **School**  | **Res   |
|   | thnic | ergraduate | *G | ear | aduate |             | earch** |
|   | ity** | School**   | PA | s** | Pro    |             |         |
|   |       |            | ** |     | gram** |             | **Inte  |
|   |       |            |    |     |        |             | rest?** |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | His   | U of       | 3. | 1   | PhD    | U of Iowa,  | Yes     |
| 3 | panic | Puerto     | 67 |     |        | Env.        |         |
|   |       | Rico,      |    |     |        | M           |         |
|   |       | Humacao    |    |     |        | icrobiology |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | His   | Trinity    | 3. | 2   | PhD    | Applying    | Yes     |
| 4 | panic | College    | 37 |     |        | 2002        |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | His   | Arizona    | 3. | 0.1 |        | Working in  | Yes     |
| 5 | panic | State U    | 31 | ^1^ |        | lab         |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | His   | U of       | 3  | 1   | MD     | Applying    | Yes     |
| 6 | panic | Puerto     | .1 |     |        | 2002        |         |
|   |       | Rico,      |    |     |        |             |         |
|   |       | Mayaguez   |    |     |        |             |         |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | Black | Morehouse  | 3. | 1   | MD     | Applying    | Un      |
| 7 |       | College    | 37 |     |        | 2002        | decided |
+---+-------+------------+----+-----+--------+-------------+---------+
| 2 | Black | Tuskegee   | 3  | 1   | PhD    | UCLA,       | Yes     |
| 8 |       | University | .8 |     |        | Molecular   |         |
|   |       |            |    |     |        | Biology     |         |
+---+-------+------------+----+-----+--------+-------------+---------+

^1^ Left after 2 months for personal reasons - doing research near home

**New Students -- 2001/2002**

  ---- ---------------- -------------------------- --------- ----------------
       **Ethnicity**    **Undergraduate School**   **GPA**   **Initial Career
                                                             Goal**

  29   Black            Clark Atlanta University   3.48      PhD or MD/PhD

  30   Black            New York University        3.67      MD/PhD

  31   Hispanic         Arizona State University   3.54      MD/PhD

  32   Native American  Wilmington College         3.55      PhD

  33   Black            University of Arizona      3.25      PhD

  34   Black            Arizona State University   3.6       MD/PhD

  35   Hispanic         University of Puerto Rico, 3.63      PhD
                        Rio Piedras Campus                   

  36   Hispanic         UCLA                       3.61      MD/PhD

  37   Hispanic         Arizona State University   3.88      MD/PhD

  38   Hispanic         University of Texas,       3.97      MD/PhD or MD
                        Austin                               
  ---- ---------------- -------------------------- --------- ----------------

**Program Evolution Years 1-4 - Lessons Learned**

-   Topics of weekly meetings have crystallized:

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-   Seminars on practical topics such as:

-   "Preparing a Poster Presentation"

-   "Preparing an Oral Presentation"

-   "NIH Grant Processes"

-   "Funding Processes with Biotech and Industry"

-   Discussions of myths and realities of various career options

-   Student presentations on their research

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-   "Design of Clinical Research Protocols" has become one of the most
    important parts of the program. Students can also write a laboratory
    research proposal. Although research process and grant writing is
    usually "learned by doing" with a mentor, a great deal can be
    achieved in a course format preparing a theoretical protocol even
    for recent college graduates.

-   Drs. McGee and Poland engage students in active critique and
    evaluation. This is extremely important for students to develop
    critical thinking and analytical reasoning.

-   Major deficiencies in learning skills were identified in a fraction
    of the students. Excellent progress can be achieved in developing
    these skills without the constant demands of formal courses, but it
    takes a lot of time and hard work for both students and the Program
    Director.

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-   \"Group Mentoring\" is a powerful activity that occurs during the
    weekly meetings. Co-facilitation by a basic scientist and clinical
    investigator provides students different perspectives which opens
    their eyes to options and possibilities.

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-   Each student needs a formal, individualized program plan as no two
    students are the same.

-   

-   

-   One year is not enough for some students. For many their decision
    between PhD, MD and MD/PhD directions are still evolving during the
    first year and not formed in time to apply for graduate schools
    until the following year. Some students also need the year for
    growth and development. For those students who performed well, a
    second year turns out to be very beneficial in keeping them on track
    toward success.

-   Qualitative research using semi-structured interviews can be very
    effective in examining both program effectiveness and common
    characteristics among students who succeed and don\'t succeed, and
    those who go toward clinical versus research careers.

-   For the first 4 years, few students have persisted in or were able
    to gain admission into MD/PhD programs. Time will tell if this can
    be improved.

-   Overall, most students seemed extremely pleased with the program and
    it appears to be meeting the needs and the goals established.