COVID-19 Pandemic Negatively Affected Medical Education Pathway Funding, Diversity Recruitment

Sonal Batra, MD, MST

Diversity pathway programs for medical schools were significantly disrupted by the COVID-19 pandemic, recent research suggests.

While some changes have been positive for medical school pathway programs during the pandemic, such as cost-cutting and increased engagement due to expanded reach through remote learning, certain programs have faced disruption.

The benefits of a diverse medical workforce demonstrate the importance of these educational pathway programs, and the programs’ disruption was analyzed in a study led by Sonal Batra, MD, MST, for George Washington University’s Department of Emergency Medicine.

“Student body diversity produces educational benefits such as racial and cultural awareness to care for racial and ethnic minority populations and strong attitudes toward equitable access to care,” Batra and colleagues wrote. “A physician workforce that is not only adequate in size and specialty mix but that also reflects the increasing racial and ethnic diversity of the nation is a necessary element to the advancement of health equity in the US.”

For these reasons, Batra and colleagues felt the analysis was an important step in demonstrating the pandemic’s potentially negative effects on the future medical workforce representation.

Research and Methods

The principal aims of the investigation were to identify changes in medical school diversity pathways since the outset of the pandemic, in order to analyze the ways in which these changes might have been variably associated with different medical schools, and to highlight the ways in which support can be given to these types of programs.

An exploratory sequential design, surveys, and several interviews were used by investigators to question 12 medical school diversity pathway administrators and leaders on changes that have occurred with these programs since the pandemic’s beginning, compared to the previous year. The interviews were conducted from January 4 to August 3, 2021.

The study involved purposive sampling, with selection including medical schools of varying affiliations, sizes, geographic locations, urban and rural populations, and public versus private ownership.

Batra and colleagues used a guide to conduct the interviews beginning in January, with the guide including questions on program goals and measures, operational characteristics, outcomes of the pandemic, and future recommendations. A rapid thematic content approach was used as a means to analyze patterns in the data received from transcribing the recorded interviews, the content of which was coded inductively into a matrix of themes.

An online survey was then used, involving 13 questions gathered from the major themes analyzed in the interview process. Investigators surveyed participants working in leadership roles of the institutions’ offices of diversity, equity, and inclusion, or similar roles at the schools.

The investigators’ questions involved respondent characteristics, alterations in the scope of program pathways, funding comparisons, and the opinions of respondents on the potential future needs for pathway programs. The survey also employed 2 open-ended questions designed to learn about unexpected outcomes associated with the pandemic, as well as additional comments by participants.

Study Results

Of the 29 individuals asked to participate in the interviews, 12 participated. This met the a priori estimated needs threshold of 10 - 15 participants. Of the 198 schools asked to participate, about half agreed, with no significant response rate differences among all of the schools.

The investigators identified 7 primary themes gathered from the interview responses, including:

• Programmatic changes
• Engagement of participants
• Technological barriers
• Increased psychosocial support for students
• Partnerships in the community
• Financial factors
• The possibility of future hybrid programming

Most of the schools that responded to surveys ran at least 1 pathway program both before and during the pandemic. Forty-two of the respondents reported canceling some or all of their programs due to the pandemic.

Investigators found that both elementary and middle school programs were less common than high school and undergraduate programs prior to COVID-19, and both also had significant decreases in programming during the pandemic (50.0% decrease for elementary schools; P = .01; 32.6% decrease for middle schools; P = .02). This contrasted with high school (4.3% decrease; P = .22), undergraduate (2.2% decrease; P = .35), and postgraduate schools (4.9% decrease; P = .34) students.

About 80% of schools surveyed received funding for their programs both prior to and during the pandemic. Of the 106 schools that used pathway programs, 23 reported decreases in funding during COVID-19. Investigators found only 9 reported increases in funding, and 71 reported no changes. While funding, participant retention, and availability of staff were largely unaffected, most respondents reported that COVID-19 changes had negative effects on engagement and learning effectiveness. 38 of the 106 respondents reported negative effects on recruitment for pathway programs as well.

Generally, across all pathway program functions, schools tended to report more negative or neutral outcomes as opposed to positive. While most respondents did not report substantial funding decreases, the interviews and open-ended questions resulted in concerns over future funding measures for pathway programs.

The investigators added in their research that the uncertainty reported around future funding reflects larger economic concerns in the healthcare industry. They stated that the reported negative effects of these program changes will take decades to be felt, given that the pathways affect primarily young people.

“The need for a robust physician workforce representative of the diversity of the US is critical to improving health outcomes and eliminating health disparities,” they wrote. “Active support for pathway programs and other policy and programmatic opportunities to enhance the diversity of the health professions may be needed to achieve this goal.”

The study, “Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs,” was published online in JAMA Network Open.