Monday, April 13, 2015

CHM Assistant Dean for Admissions Discusses DACA in "DREAMers of Medicine" Post

The following was written by Dr. Joel Maurer, College of Human Medicine Assistant Dean for Admissions, and was originally posted in March 2015 as part of the "Bioethics in the News" series by The Center for Ethics and Humanities in the Life Sciences

In February 2013 while visiting the University of California-Riverside, I presented a program on how to best prepare for medical school. As Assistant Dean for Admissions, I’d given this talk numerous times, and as such felt comfortable addressing questions from premed audiences. It was at that point I encountered a moment of awkwardness….

“Dr. Maurer, does your medical school consider applications from undocumented students?”

I’d previously addressed questions about citizenship on many occasions, but never quite in the context of the question at hand. Thoughts began to race through my head… “Undocumented, as in illegal alien? Attending our colleges and universities? Really?” I suddenly suspected that the response that [the College of Human Medicine] will only consider US citizens, Canadians, and permanent residents wasn’t the answer this student (and perhaps a few others) was looking for. It then hit me that there is something going on in American higher education that I was not aware of. I needed an education about this, and quick!

Throughout the early 21st century, Congress attempted numerous times to pass the DREAM Act (Development, Relief, and Education for Alien Minors). Its intent was to provide protection from deportation of individuals who had come to the US  illegally as children (under the age of 15), graduated from a US high school or received their GED, and had lived here continuously for at least 5 years.

On August 15, 2012, US Citizenship and Immigration Services started accepting applications under executive order of the President for his new Deferred Action for Childhood Arrivals (DACA) program, in which qualifying individuals are given legal renewable protection from deportation every two years. To qualify, applicants must: arrive to the US before age 16; live here continuously since July 15, 2007; be under age 31 in June 2012; demonstrate completion of high school or a GED; and be without conviction of a felony or serious misdemeanor.

Most DACA enrollees come from Mexico and other Latin American countries. Approximately 2 million people qualify or potentially qualify for DACA, most living in California and Texas. In Michigan, approximately 15,000 people would potentially qualify or have enrolled for DACA. DACA enrollees can get a driver’s license, work permits, and social security numbers (meaning that they can pursue medical residency and become employed). They can take the MCAT and all US medical licensing exams. In states with the highest numbers of undocumented DACA potentials, there are no laws prohibiting their medical licensure.

Up to 65,000 undocumented students graduate from high school annually. The right to this education was granted in 1982 when the Supreme Court ruled that undocumented children could not be denied a K-12 education. It is less clear how many undocumented students attend college. Estimates in California suggest that 10-20% of undocumented students who graduate from high school enroll in college. With a national graduation rate of 59%, this would translate into roughly 3,800—7,600 undocumented college graduates nationally.

In many states, immigrant youth have worked hard to pass in-state tuition bills at their respective public colleges and universities. California and Texas have been able to pass bills granting access to state financial aid. And Illinois has passed a bill creating a state-run private scholarship fund. Federal loans, though, are not available.

According to the Undocumented Student Guide to College, the following schools are considered DACA-friendly: Western Michigan University, Michigan Technological University, Hope College, University of Detroit, Eastern Michigan University, Olivet College, Marygrove College, and Grand Valley State University. Eastern Michigan University, Wayne State University, and the University of Michigan recently began offering in-state tuition to undocumented students meeting Michigan residency requirements. Michigan State University does not offer in-state tuition to undocumented or DACA enrolled matriculants.

Let’s now take this a step further and think about DACA in the context of the mission of our College:
Michigan State University’s College of Human Medicine is committed to educating exemplary physicians and scholars, discovering and disseminating new knowledge, and providing service at home and abroad. We enhance our communities by providing outstanding primary and specialty care, promoting the dignity and inclusion of all people, and responding to the needs of the medically underserved.
I believe it is no mistake that “responding to the needs of the medically underserved” is the last component of our mission—it leaves a lasting impression. Undocumented students are civically engaged and give back to their communities. Coming from underrepresented backgrounds in medicine, they are likely to return to their communities—low income, doctor shortage areas—and serve as primary care physicians.

Immigration remains highly problematic and politicized. And my point is not to initiate commentary about how to solve the problem of illegal immigration by those who were brought to our country as children beyond their own will, raised in American society, speak the dominant language, and educated in our public schools. My personal ethics, though, compel me to want to help these people if for no other reason than their personal merits and potential to our society (or even for what I believe is our profession’s duty of beneficence and the value of social justice).

I have since received a handful in inquiries from DACA students in Michigan asking us to accept their application to medical school. If we believe that DACA enrollees possess value in our society, giving them the opportunity to apply to medical school is the first step in recognizing this potential. If we continue the status quo, we risk trying to defend a mission statement in light of an admissions policy that is selective and rejects inclusiveness. If we change our current policy, we risk scrutiny and support from certain aspects of the public. The issues are complex to say the least.

Shouldn’t we, though, as a college and institution be grappling with this? It appears that others in Michigan have (and are moving onward). At a minimum, this is an issue that we can no longer ignore. I hope that our institution is having this conversation. If asked, I know what position I and my conscious would take.

  • Balderas-Medina Anaya Y, del Rosario M, Doyle LH, Hayes-Bautista DE. Undocumented students pursuing medical education: The implications of Deferred Action for Childhood Arrivals (DACA).  Academic Medicine. 2014 Dec; 89(12):1599-602.


Several weeks later, Dr. Maurer also spoke at a Steering Committee meeting to begin looking for ways to engage the issue at an institutional level. Please see "Steering Committee begins dialogue on undocumented student concerns" via The State News.

Joel Maurer, MD, is Assistant Dean for Admissions in the College of Human Medicine and Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Biology at Michigan State University.

Thursday, April 2, 2015

New MCAT Reflective of Changes To Medicine, Medical School

Starting in just a few short weeks, a much different MCAT will be administered across the nation. These revisions are some of the most extensive changes to the test in its 80-plus year history. The new test will identify specific competencies whereas previous versions relied heavily on one's grasp of prescribed material.

The question for many is...why?

All of these changes to the MCAT are spurred on by a domino-effect that begins with the fact that health care is changing. Advancements in medicine and technology are consistently coming at a rapid pace. This is especially true today in the information age.

Since the last version of the MCAT was first implemented, medical research and scientific knowledge have taken great strides. Thus, the foundation that tomorrow's doctors need to have is also evolving. Future physicians will need enhanced critical reasoning skills and must also have the ability to apply an even broader set of knowledge to more diverse populations. What makes a good doctor is being redefined.

For instance, we now know how big a role behavioral and sociocultural factors play in determining health. Future physicians need to comprehend how behaviors, biological factors, physical environments and even social inequities all influence a patient and, on a larger scale, the communities in which they come from.

For this reason, medical schools are adopting more competency-based curricula, including the Michigan State University College of Human Medicine (CHM). Here at CHM, we will be transitioning into our Shared Discovery curriculum next year to better prepare students for residency and beyond.

The typical medical school curriculum has required a lot of book learning and memorizing facts. But medical schools like our own will implement clinical exposure much earlier to augment competency-based learning beyond lectures and reading materials.

Broader bodies of knowledge that include interprofessional training, communication, and the social determinants of health will be emphasized to ensure future doctors are able to deliver better patient care and solve the complex problems facing the future of medicine.

This philosophical change directly affects what incoming students need to be prepared for, which in turn affects how medical school applicants are reviewed in the first place. While CHM was the first medical school in Michigan to use the Multiple Mini-Interview format (MMI), others across the U.S. are switching to interview methods like the MMI as they transition into a more holistic review process.

Potential students must be more well-rounded than they were in the past. Meaningful social and volunteer experiences paired with clinical exposure are just two more things CHM considers when reviewing an applicant. The personal statement, secondary essays and letters of recommendation are also important factors beyond metrics when determining one's fit with our program. Lastly, one must do well on the MCAT.

The MCAT's purpose is to examine "the skills and knowledge medical educators and physicians have identified as key prerequisites for success in medical school and the practice of medicine," per the MCAT Essentials guide.

Since the skills and knowledge that will be required of medical school students have changed, the MCAT must adapt so that it may properly assess those key prerequisites.

As discussed in detail on our previous post, the test will still be heavy in natural sciences. But the new revisions will also require some competency with social and behavioral sciences. In addition, the Critical Analysis and Reasoning Skills section will test just that—the analysis and reasoning skills needed for success in medical school.

The hope is that this combination of testing will help diversify the workforce by making the exam and medical school application process more attractive to individuals from a variety of academic and demographic backgrounds.

Per the MCAT Essentials guide, "Increasing diversity within the study of medicine is something the AAMC and our members actively promote and endeavor to advance. It is hoped that the new content and skills tested on the exam will encourage people from broad educational backgrounds to apply to medical school."

The general consensus from medical educators and physicians alike is that the new MCAT will produce stronger, better equipped medical students. It's about more than science and preparation is always important. Here are some tips.

It is a very interesting time to enter the field of medicine. The release of the new MCAT is a milestone reflective not only of where medicine is, but also where it is headed.

Note: This is the second of a two-piece installment regarding the most recent set of revisions being made to the MCAT in April 2015. To read the first piece, please see "What You Need To Know About MCAT 2015: Details and Prep Info."