Approximately one-fifth of U.S. medical schools offer combined baccalaureate-M.D. programs that guarantee high school seniors admission to medical school if they meet the program's requirements at a designated undergraduate institution (Olson, 1992). The benefits of such programs to both students and the undergraduate and medical institutions are significant. For students, the main benefit is that they know as high school seniors that they have a guaranteed spot in a medical school's entering class, thus saving them from the typical premed anxieties concerning whether they will have the credentials necessary to be admitted to medical school after they graduate from their undergraduate institutions. Medical schools and their affiliated undergraduate institutions use these guaranteed programs as a tool to reduce educational expenses, to attract students to primary care in underserved areas, and/or to improve education in the humanities (Norman & Calkins, 1992). In addition, some schools use such programs as a way to attract the best and brightest high school students to their undergraduate institution. The purpose of this article is to discuss how the medical school at the University of Louisville seeks to serve the unique needs of the undergraduate students enrolled in their Guaranteed Entrance to Medical School (GEMS) program.
ach institution administers its combined baccalaureate-M.D. program a little differently. For instance, some schools have accelerated programs in which students complete their undergraduate and medical coursework in six years, whereas other programs require students to complete a traditional undergraduate degree in four years and then matriculate in medical school for an additional four years. The University of Louisville's GEMS program follows the latter option with students pursuing both their undergraduate and medical school degrees at the University of Louisville. The GEMS program was established in 1988 with the main objective of persuading academically talented high school students from the state of Kentucky to attend the University of Louisville's undergraduate program.
Students participating in the GEMS program have a number of advantages over traditional track premed students. They are free to major in anything, as long as they take the required premedical prerequisite classes. Many traditional premedical students feel obligated to major in biology or chemistry in order to position themselves to be attractive candidates for medical school, despite the fact that medical schools encourage students to major in whatever they desire to pursue. Additionally, GEMS students feel freer to take more difficult courses than typical premed students do because they know that as long as they meet the minimum cumulative GPA of a 3.3 upon graduating they will be admitted to the U of L's medical school. Therefore, “with the conditional acceptance, the student is relieved of some of the competition that traditional premedical students endure in order to be accepted to medical school” (Daubney, Wagner, & Rogers, 1981, p. 499). They also feel more comfortable studying abroad and becoming more involved in campus activities that traditional premedical students might not pursue due to their perceived need to earn the highest grades possible at all costs.
The GEMS program provides a comprehensive set of advising and programmatic initiatives to ensure student success and to help students confirm that their true calling is a career in medicine. One of the primary concerns about guaranteed admissions programs is that many people believe it is really difficult to know as a high school senior exactly what you want to do for the rest of your life. One of the most important aspects of the traditional undergraduate experience is that it allows students to explore many different courses and majors before deciding on their ultimate career goal. According to research done by Penn State, “over 50 percent of first-year students change their majors at least once before graduation” (Leonard, 2003, p. 1). As a result, being locked into medicine is an appropriate concern.
Another concern is that GEMS students may receive pressure from their families to remain in the program even if they decide midway through their education that medicine is not their true passion. In some cultures, when a child decides to become a doctor, this decision is a source of pride for the student's family. Therefore, parents may exert pressure on students to remain in the program even if they have decided to pursue alternate career paths.
The University of Louisville's GEMS program strives to address some of these concerns of the combined baccalaureate-M.D. students via a series of programmatic and advising initiatives. The four-year mission for GEMS students is to participate in a broad array of undergraduate experiences and to have extensive exposure to medical options and opportunities so that by the time they graduate they have had ample occasions to confirm that they indeed want to pursue a career in medicine.
The first GEMS-sponsored event of the school year is a welcome reception. Students are introduced to the GEMS faculty, composed of physicians, directors, and counselors at the University of Louisville School of Medicine. Student advising is also available from the program director, who is a physician as well. The program coordinator and staff work together along with the Health Sciences Campus to set up medical observations and presentations by physicians. In addition, the program coordinator is available to advise students on personal, academic, and career matters.
Midway through the school year, GEMS students attend a holiday social at which they present the group volunteer projects they completed during the prior month. The students are put into three groups of ten to twelve students. They select among themselves what type of volunteer project they will participate in and set up the activity so they all work on the project at the same time. Through participation in this activity, students develop communication, teamwork, and professionalism skills—traits that patients desire in a physician. Furthermore, the project allows students and faculty to intermingle and learn about each other's passions. If students are questioning whether or not they want to be physicians, they have ideally developed some relationships with other students in the same situation and can dialogue with them if they are hesitant to talk to university officials.
The program also sponsors an end-of-the-year retreat. The emphasis at this event is facilitating teamwork among the students. For example, one year the students went to a rock-climbing wall where they had to work together to help their partners successfully scale the wall. The retreat is also an opportunity for students to let the administration know through surveys and group discussions about the highlights of the year and to make suggestions for improving the program.
To increase student interaction and facilitate communication between the GEMS program administrators throughout the year, a Blackboard classroom has been established. This online site allows the GEMS students to conveniently access information about certain policies, contact information for faculty and students, information about where and when activities are being held, etc. Also, administrators communicate with students via e-mail to notify them of important information. The coordinator phones students who have not responded to e-mails to set up appointments to discuss any problems that may have arisen.
A new requirement that has been implemented this year is that each student must compile a GEMS Outcome Portfolio. This portfolio is loosely based on the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project for medical residents. The competencies were adjusted for undergraduate students so that the GEMS students would be able to give an explanation of patient care based on observations of patients instead of actually taking histories and treating the patients. Students submit portfolio entries for each activity in which they engage (examples include observing a surgery, participating in a volunteer project, or attending a Grand Rounds presentation). The entry describes the activity, relates that event to one or more of the core competencies, and then offers students the opportunity to reflect on what the experience has meant to them. At the end of the school year, when they have completed approximately ten portfolio entries, they can see how they have grown and matured as a result of participating in these activities, and they have a little more insight into what it takes to become a physician. By using the portfolio, the program addresses students' need for reflection on whether or not becoming a physician is their true calling. After each activity is completed, students turn in their portfolio entry, and the program coordinator reviews their entries. If it appears that a particular student is having some difficulties, the coordinator contacts the student to offer some feedback and to begin a dialogue aimed at addressing the student's issues. This year each GEMS student will review his or her completed portfolios at the end-of-the-year retreat. Students will share with the group at least one of their most meaningful experiences of the year.
The distinctive needs of GEMS students require that unique experiences be created for them to explore the field of medicine and that a comprehensive set of advising services be available to them. The GEMS program provides students an opportunity to participate in group activities, university course work, and volunteer projects. In addition, they network with fellow students and faculty, compile a portfolio, and have multiple opportunities to confirm their decision to become a physician.