Journal articles on the topic 'Gateway entry medical steudents'

"Sepsis occurs especially in people with a compromised immune system. Hosts become immunocompromised by chronic conditions, HIV, neoplasms, diabetes, as well as immunosuppressive and cytotoxic treatments. This first research direction aims at conducting an etiopathogenic study on a representative group of patients diagnosed with severe sepsis with oral gateway, following the prevalence and incidence of each clinical entity in the corroborative context of a range of factors influencing the final results, outlining with the real image of a complex pathology on the territory of Moldova is very accurate, aspects with a profound impact in the therapeutic approach both for severe sepsis and for the prophylactic methods of oral pathology. For the clinical study, a representative group of patients was studied: 94 patients hospitalized in the Galați Infectious Diseases Clinic between 2018 and 2019. Patients included in the study group, anchored in the territory of immunosuppression, have a general condition affected by: diabetes mellitus, chronic hepatitis, liver cirrhosis, alcoholism, neoplasms, chronic renal failure, anemia. Age is an important factor in the evolution of sepsis. This study also highlighted a phenomenon described in the literature, namely that there is an increased incidence of sepsis in patients of extreme age."

The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.

Background: Aggressive marketing has resulted in exponential growth of energy drink sales in recent years. Despite growing concerns about the negative health effects of energy drinks, they are increasingly popular among young people. Little is known about temporal associations between energy drink consumption and other drug use, though some researchers have suggested that energy drink consumption reflects an entry into a drug-using lifestyle. Aims: The purpose of this study was to evaluate whether energy drink use among adolescents who have never tried substances is associated with a risk of initiating tobacco (i.e. cigarettes, e-cigarettes, and hookah) and alcohol use. Methods: A school-based longitudinal study of 3071 adolescents ages 9–17 years was conducted in six federal states of Germany. Data analyses involved two assessment waves that took place approximately 12 months apart: baseline (fall-winter of school year 2016–2017), and 12-month follow-up (fall-winter of school year 2017–2018). Results: Multilevel models revealed that energy drink use at baseline was associated with cigarette (odds ratio for energy drink ever use, 3.15 (95% confidence interval, 2.07–4.78 )), e-cigarette (odds ratio, 4.32 (95% confidence interval, 2.87–6.51)), hookah smoking (odds ratio, 3.15 (95% confidence interval, 2.06–4.82)), and alcohol use (odds ratio, 2.26 (95% confidence interval, 1.75–2.93)) initiation within 12 months. Conclusions: These results raise the possibility that energy drinks may potentially act as a gateway drug to other substances. However, inferences regarding whether this association is or is not causal cannot yet be made.

Background: Innervation of larynx is much more complicated than previously been thought. Laryngopharynx is the common gateway for many specialists like oral surgeons, ENT surgeons, anaesthetists, UGI endoscopists and bronchoscopists. The sub-mucosal neural network can be anaesthetised by topical application or injection of local anaesthetics. In this study destination of the internal laryngeal nerve and its penetration into the intrinsic muscles of larynx are analysed.Methods: A total of 40 en bloc cadaveric specimens were investigated in the department of anatomy, Madras Medical College, Chennai and from Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Kanchipuram. Conventional anatomy dissection method was used in the identification of internal laryngeal branch of superior laryngeal nerve and its branches.Results: Irrespective of the number of divisions at the point of entry into thyrohyoid membrane, 4 branches were constantly traceable. The branches were traced by 2 approaches- (A) those supplying the mucus membrane- (i) to the junction of aryepiglottic fold and lateral border of epiglottis; (ii) to the posterior surface of interarytenoideus; (iii) to the posterior surface of posterior arytenoideus; and (iv) descending to apex of the pyriform fossa behind cricothyroid junction; (B) penetration into intrinsic muscles- (i) a branch terminated after entering interaryteoideus; and (ii) another terminated after entering the posterior cricoarytenoideus muscle.Conclusions: The knowledge of variation into branches and area of supply of internal laryngeal nerve is essential for anatomists and clinicians. It is not a nerve to be neglected as the knowledge of its branches is very much essential for the surgeons operating in this area of air and food passage.

Abstract In the scientific field, data acquisition using commercial or self-developed sensors is a necessity for many research activities. Data security and data privacy are important requirements in all types of IoT applications, especially in the medical context. IoTree42 is a powerful, OpenSource platform that closes the gap between cost-efficiency, the ease of use and digital sovereignty. The flexible and user-friendly design makes the platform ideal for the originally conceived research context. Nevertheless, it can be used for smaller budget-oriented setups and industrial applications with thousands of sensors and actuators likewise. The platform was developed with security in mind by minimizing interfaces and the use of stable software components and transport protocols. IoTree42 utilizes lightweight OpenSource software cast into a flexible backend, allowing the deployment not only on full-fledged servers but also on single board computers like the Raspberry Pi. Data is transmitted with low overhead via MQTT, a robust protocol optimized for machine to machine communication. The transmission technology between all components is freely selectable. Besides data acquisition, IoTree42 enables control of actuators and automation through interfaces with visual programming tools. This allows for remote interventions without requiring prior programming experience. The incoming data can conveniently be visualized in dashboards or easily be exported for further analysis. The network consists of a central server and satellites (gateways) arranged in a star topology. Sensors and actuators connect to the gateway. The initial setup of the server and the gateways is automated, well documented, and can be done within minutes. Thanks to the increasing usage and the contribution of the community, the pool of code examples for sensors is growing and lowers the entry hurdle for users without programming background. IoTree42 is a fast-growing, multi-user, hardware and cloud agnostic, easy to deploy, privacy compliant and competitive solution compared to commercial IoT alternatives.

Abstract Background Gateway courses are increasingly popular widening participation routes into medicine. These six year courses provide a more accessible entry route into medical school and aim to support under-represented students’ progress and graduation as doctors. There is little evidence on the performance of gateway students and this study compares attainment and aptitude on entry, and outcomes at graduation of students on the UK’s three longest running gateway courses with students studying on a standard entry medical degree (SEMED) course at the same institutions. Methods Data were obtained from the UK Medical Education Database for students starting between 2007 and 2012 at three UK institutions. These data included A-levels and Universities Clinical Aptitude Test scores on entry to medical school and the Educational Performance Measure (EPM) decile, Situational Judgement Test (SJT) and Prescribing Safety Assessment (PSA) scores as outcomes measures. Multiple regression models were used to test for difference in outcomes between the two types of course, controlling for attainment and aptitude on entry. Results Four thounsand three hundred forty students were included in the analysis, 560 on gateway courses and 3785 on SEMED courses. Students on SEMED courses had higher attainment (Cohen’s d = 1.338) and aptitude (Cohen’s d = 1.078) on entry. On exit SEMED students had higher EPM scores (Cohen’s d = 0.616) and PSA scores (Cohen’s d = 0.653). When accounting for attainment and aptitude on entry course type is still a significant predictor of EPM and PSA, but the proportion of the variation in outcome explained by course type drops from 6.4 to 1.6% for EPM Decile and from 5.3% to less than 1% for the PSA score. There is a smaller significant difference in SJT scores, with SEMED having higher scores (Cohen’s d = 0.114). However, when measures of performance on entry are accounted for, course type is no longer a significant predictor of SJT scores. Conclusions This study shows the differences of the available measures between gateway students and SEMED students on entry to their medical degrees are greater than the differences on exit. This provides modest evidence that gateway courses allow students from under-represented groups to achieve greater academic potential.

Abstract Background Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. ‘Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.’ This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities. Methods Data from 2007–13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school. Results Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%). Conclusions Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.

We study the impacts of telehealth adoption on geographic competition among urban and rural healthcare providers. We consider a quasinatural experiment: states’ entry into the Interstate Medical Licensure Compact, wherein the entry events facilitate healthcare providers to adopt telehealth technology. By analyzing a representative sample of providers, we first establish the Compact entry shock’s validity and its positive effect on the supply of medical services. We then report evidence that there are service and payment shifts from rural providers to urban providers (i.e., urban providers are more likely to benefit from the Compact entry financially). Relying on patients’ telehealth reimbursement claim data, we observe two mechanisms contributing to the revenue redistribution: the substitution and gateway effects of telehealth. Finally, we show that telehealth readiness and service quality moderate the impact of telehealth adoption. These findings speak to both potentially positive and negative consequences for welfare.

Abstract Background UK medical schools vary in terms of factors such as mission, specific curricula and pedagogy. As relatively little is understood about the impact of these differences at a post-graduate level, we examined the relationship between medical school and MRCS success. Method Using the UKMED database we analysed data on UK medical graduates who attempted MRCS Part A (n = 9729) and MRCS Part B (n = 4644) between 2007-2017. Univariate analysis characterised the relationship between medical school and first attempt MRCS success. Logistic regression modelling identified independent predictors of MRCS success. Results MRCS pass rates differed significantly between medical schools (P &lt; 0.001). Trainees from standard-entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses ((Part A (Odds Ratio (OR) 3.72 [95% Confidence Interval (CI) 2.69-5.15]); Part B (OR 1.67 [1.02-2.76])). Non-graduates were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]). Russell Group graduates were more likely to pass MRCS Part A (OR 1.79 [1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])). Conclusions Medical programme and medical school are associated with MRCS success. Further research is needed to tease out the relationship between individual factors, medical school and MRCS performance.

Introduction: Older patients with chronic disease such as hypertension (HTN) may benefit from utilizing home based technology (tech) to monitor and improve disease control, but may forgo these opportunities due to concerns and/or fears over lack of tech skills. Reducing these concerns by providing a free service where use of newer technologies can be introduced and taught may provide opportunities for better HTN management and patient engagement. Purpose: To evaluate whether tech impaired patients with uncontrolled HTN could actively participate and achieve BP control similar to those without tech limitations as part of a digital HTN program. Methods: We created a free health tech “genius bar” called the “O Bar” where patients could be taught how to use a wireless BP unit that transmitted data automatically to the electronic medical record. Patients were assessed at entry as to their tech “savviness” based on capability to email, shop on-line, and use text. All patients were instructed how to take their BP using a smartphone app as well as use of a basic patient portal app. The O Bar was available to all patients for free instruction on the use of health apps and home based monitoring. Results: Of the 247 patients enrolled into the digital HTN program, 18% (44) were labeled as tech impaired. Patients were asked to submit 3-5 BP readings per week from home and intervention consisted of lifestyle and medication management by a clinical pharmacist and a health coach. Conclusions: 1. Tech impaired patients were older and had lower health literacy but were able to successfully submit weekly BP measurements and achieve BP control, similar to tech savvy patients. 2. Older patients with poor tech skills should not be dissuaded from enrolling into a digital tech management program provided health systems are willing to provide basic tech education.

Abstract Aims UK medical schools vary in their mission, curricula and pedagogy, but little is known of the effect of this on postgraduate examination performance. We explored differences in outcomes at the Membership of the Royal College of Surgeons examination (MRCS) between medical schools, course types, national ranking and candidate sociodemographic factors. Methods A retrospective longitudinal study of all UK medical graduates who attempted MRCS Part A (n = 9730) and MRCS Part B (n = 4645) between 2007 and 2017, utilising the UK Medical Education Database (https://www.ukmed.ac.uk). We examined the relationship between medical school and success at first attempt of the MRCS using univariate analysis. Logistic regression modelling was used to identify independent predictors of MRCS success. Results MRCS pass rates differed significantly between medical schools (P &lt; 0.001). Russell Group graduates were more likely to pass MRCS Part A (Odds Ratio (OR) 1.79 [95% Confidence Interval (CI) 1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])). Trainees from Standard-Entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses, Part A OR 3.72 [2.69-5.15]; Part B (OR 1.67 [1.02-2.76]. Non-graduates entering medical school were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]) than graduate-entrants. Conclusion Medical school, course type and socio-demographic factors are associated with success on the MRCS. This information will help to identify surgical trainees at risk of failing the MRCS in order for schools of surgery to redistribute resources to those in need.

Background: COVID-19 is a life threatening novel corona viral infection to our civilization and spreading rapidly. Terrific efforts are generous by the researchers to search for a drug to control SARS-CoV-2. Methods: Here, a series of arsenical derivatives were optimized and analyzed with in silico study to search the inhibitor of RNA dependent RNA polymerase (RdRp), the major replication factor of SARS-CoV-2. All the optimized derivatives were blindly docked with RdRp of SARS-CoV-2 using iGEMDOCK v2.1. Results: Based on the lower idock score in the catalytic pocket of RdRp, darinaparsin (-82.52 kcal/mol) revealed most effective among them. Darinaparsin strongly binds with both Nsp9 replicase protein (-8.77 kcal/mol) and Nsp15 endoribonuclease (-8.3 kcal/mol) of SARS-CoV-2 as confirmed from the AutoDock analysis. During infection, the ssRNA of SARS-CoV2 is translated into large polyproteins forming viral replication complex by specific proteases like 3CL protease and papain protease. This is also another target to control the virus infection where darinaparsin also perform the inhibitory role to proteases of 3CL protease (-7.69 kcal/mol) and papain protease (-8.43 kcal/mol). Conclusion: In host cell, the furin protease serves as a gateway to the viral entry and darinaparsin docked with furin protease which revealed a strong binding affinity. Thus, screening of potential arsenic drugs would help in providing the fast invitro to in-vivo analysis towards development of therapeutics against SARS-CoV-2.

Abstract Youth pathways are significant for studying the reconfigurations that happen in the contemporary world, in its various social spheres. Youth is the social contingent most directly exposed to the dilemmas of our society, and nowadays unemployment rates among young people in the country are expressive. In addition to the barriers to entering and keeping a first job, the difficulties they face to remain in a decent and protected job are even greater. The data also show that informality is higher in this group when compared to the group of the adults. Regarding the condition of formal employment, the presence of young people in occupations with greater turnover and temporary entries is notorious. In this sense, aiming at unveiling the pathways of work built up by part of the Brazilian working youth, this study intends, by using singular paths and jointly triangulating with national databases, to analyze two forms of entry in the job market: the first job through the youth apprenticeship law and employment in the telemarketing sector. The young people pathways analyzed contributed to the flexible forms of employment being a gateway to the exercise of a paid activity. However, the great transformation that has occurred in recent years lies in the fact that both precarious jobs and new forms of underemployment – apprentices and telemarketing operators – assume less and less the form of a bridge leading to job stability. For many young people, this type of job stopped being a particular biographical event to become a way of life.

Abstract Objectives To determine whether the reform of the first year of medical studies implemented in September 2020 in France met its objective of diversifying the profiles of students admitted to second year at the faculty of medicine at the University of Tours. Methods Single-centered, retrospective study, covering students who passed the first year of medical studies between 2018 and 2022. Student profiles originating from three different entry gateways (PACES, PASS and L.AS) to the second year of medical studies were compared. Results One thousand four hundred and seventy-nine students over five promotions were included (806 in PACES, 329 in PASS, 198 in L.AS). The ratio of students who had obtained a baccalaureate with high or highest honors was significantly higher in PACES (85%) and PASS (96%) compared to L.AS (66%; p < 0.001). These differences were related to increased student intake via a standard pass in L.AS (21% compared to 3.2% in PACES and 0.9% in PASS) (p < 0.001). In terms of geographical origin, the proportion of students residing in regions outside the University City area increased significantly in L.AS (11%) compared to PACES (1.7%) and PASS (3.3%) (p < 0.001). The mean number of parents from the white-collar and knowledge professional category was significantly higher in PACES (0.91) and PASS (1.06) compared to L.AS (0.80; p < 0.001). Conclusion Students with a scientific background and who obtained highest honors in their high school diploma, remain the standard in PACES and PASS. Diversification of student profiles was achieved only within the L.AS gateway, which represented 42% of total second year admissions during the post-reform year. Student profile diversification was therefore a partially achieved objective and follow up studies of future promotions is needed to assess the medium and long-term impact of the reform. Particular attention should be paid to the future of these students who have different profiles between L.AS and PASS to determine whether these changes will have any impact in the quality of healthcare for the French population.

Abstract: Tooth and mouth is the entry gateway of bacteria that can damage the health of other organs. Indonesian dentists in order to improve the health of society is have to act as motivators, educators, and providers of health services (preventive, promotive, curative, and rehabilitative). National Dental Health Month (BKGN) is a social activity that is expected to motivate the citizens of Manado and surrounding communities in order to be aware of the importance of prevention and early dentalcare. This was a descriptive retrospective study. Since the data of 2012 were incomplete, we only used data of 2013. There were 1964 patients in 2013; all medical records were filed completely. Dental and oral cares were the highest in the age group ≤ 20 years. There were more women (63.14%) than men (36.86%). Based on the type of jobs, the majority of patients (59.98%) were students. Based on the type of maintenance carried out most of them (34.88%) were scaling.Keywords: BKGN, oral health, scalingAbstrak: Gigi dan mulut merupakan pintu gerbang masuknya bakteri sehingga dapat mengganggu kesehatan organ tubuh lainnya. Dokter gigi di Indonesia dalam rangka meningkatkan derajat kesehatan masyarakat, wajib bertindak sebagai motivator, pendidik, dan pemberi pelayanan kesehatan (preventif, promotif, kuratif, dan rehabilitatif). Bulan kesehatan Gigi Nasional (BKGN) merupakan kegiatan bakti sosial yang diharapkan dapat memotivasi warga masyarakat Kota Manado dan sekitarnya agar kembali sadar akan pentingnya upaya pencegahan dan perawatan gigi sejak dini. Jenis penelitian ini bersifat deskriptif dengan pendekatan retrospektif. Populasi yang digunakan yaitu seluruh rekam medik pasien pada BKGN periode tahun 2012 dan 2013. Data rekam medik tahun 2012 tidak lengkap sehingga tidak digunakan. Data rekam medik tahun 2013 terdapat 1964 pasien yang diisi dengan lengkap. Hasil penelitian BKGN pada periode tahun 2013 berdasarkan kelompok umur menunjukkan perawatan gigi dan mulut lebih banyak pada kelompok umur ≤20 tahun. Berdasarkan jenis kelamin didapatkan perempuan (63,14%) lebih banyak dibandingkan laki-laki (36,86%). Berdasarkan jenis pekerjaan mayoritas pasien yang berkunjung ialah pelajar/mahasiswa dengan persentase 59,98%. Berdasarkan jenis perawatan yang dilakukan paling banyak ialah skeling sebesar 34,88%.Kata kunci: BKGN, perawatan gigi dan mulut, skeling

Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circumstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. (2021). Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA, 326(7), 597–598. https://doi.org/10.1001/jama.2021.11997 [3] Association of American Medical Colleges. (2023). Who is eligible to participate in the fee assistance program? https://students-residents.aamc.org/fee-assistance-program/who-eligble-participate-fee-assistance-mprogram [4] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [5] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm; Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf; Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [6] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm [7] Center for Disease Control and Prevention. (2021, October). Estimated HIV incidence and prevalence in the United States 2015–2019. https://www.cdc.gov/hiv/pdf/group/racialethnic/hispanic-latino/cdc-hiv-group-hispanic-latino-factsheet.pdf [8] Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [9] CDC. (2020). [10] CDC. (2020). [11] Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [12] Office of the Assistant Secretary for Planning and Evaluation. (2021, October). Issue Brief No. HP-2021-2. Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos [13] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [14] Alsan, M., Garrick, O., & Graziani, G. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446 [15] Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.24583 [16] Alsan, et. al. (2019). [17] Marrast, L., Zallman, L., Woolhandler, S., Bor, D. H., & McCormick, D. (2014). Minority physicians’ role in the care of underserved patients. JAMA Internal Medicine, 174(2), 289. https://doi.org/10.1001/jamainternmed.2013.12756 (“Nonwhite physicians cared for 53.5% of minority and 70.4% of non-English speaking patients.” Increasing the number of Latino doctors could lead to more nonwhite physicians to care for the underserved populations as they serve those populations at disproportionate rates. This may lead to better care for the patients.) [18] Cersosimo, E., & Musi, N. (2011). Improving Treatment in Hispanic/Latino Patients. The American Journal of Medicine, 124(10), S16–S21. https://doi.org/10.1016/j.amjmed.2011.07.019 [19] Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/s0022-3476(00)90043-x [20] Cersosimo & Musi. (2011). [21] Flores. (2000). [22] Torres, D. (2019). Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. The Permanente Journal. https://doi.org/10.7812/tpp/18-258 [23] The Princeton Review. (n.d.). Score 513+ on the MCAT, Guaranteed! | The Princeton Review. [24] 2021 FACTS: Applicants and Matriculants Data. (2022). AAMC. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data [25] The Princeton Review. (n.d.). How Many Med Schools Should You Apply To? https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to [26] Association of American Medical Colleges. (n.d.). Fee Assistance Program (FAP). 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Percentage of all active physicians by race/ethnicity, 2018 | AAMC. (2018). AAMC. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [32] Ramirez, et al. (2021). [33] Passel, et al. (2022). [34] Census Reporter. (n.d.). Census profile: Manhattan borough, New York County, NY. https://censusreporter.org/profiles/06000US3606144919-manhattan-borough-new-york-county-ny/ [35] MD Student Diversity Recruitment. (2022). NYU Langone Health. https://med.nyu.edu/our-community/why-nyu-grossman-school-medicine/diversity-inclusion/recruiting-diversity/md-student-diversity-recruitment [36] NYU. (n.d.). STEP Pre-College Program. New York University. https://www.nyu.edu/admissions/undergraduate-admissions/how-to-apply/all-freshmen-applicants/opportunity-programs/pre-college-programs.html [37] Association of American Medical Colleges. (2022). NYU Grossman School of Medicine. 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Introduction The current social climate of Western societies understands fatness as the self-inflicted disease ‘obesity’; a chronic illness of epidemic proportions that carries accompanying risks of additional disease and that will eventually lead to death. In recent years, the stigmatisation and general negative societal evaluation of fatness and thus fat identities has increased (Sobal). Primarily, fatness has become a sign of medical deviance in that it is perceived to be a product of unhealthy eating behaviours and physical inactivity (Rothman). As a result, to be fat has become a barrier to entry in terms of employment opportunities, and has restricted the availability of health and insurance services for many (Sobal). Recently there has been a drastic increase in the availability of radical weight-loss solutions that strictly regulate and police fat-bodied deviants, namely in the form of surgery. Bariatric surgery, or weight-loss surgery, physically enforces the achievement of ‘health’ by curing obesity by reducing the size and functionality of the stomachs of the morbidly obese. However, bariatric ‘post-ops’ (short for post-operative) often encounter harmful consequences following their surgery in the form of increased self-surveillance, regulation and control in order to maintain their health through thinness. This article seeks to examine these consequences of surgery as a way to problematise the achievement of health through thinness overall. In order to address this issue, this article first establishes a framework of obesity discourse which enables us to understand how obesity is perceived as a self-inflicted disease in need of medical intervention within modern Western societies. From this position, we can begin to understand the purpose of interventions such as bariatric surgery. While it is acknowledged that surgery provides the morbidly obese with a gateway to health through the achievement of thinness and an escape from a heavily stigmatised identity, it is argued that this is done at the expense of placing increased regulations and surveillance upon individuals. Finally, in drawing on post-op experiences collected for research examining the life impacts of bariatric surgery, this article will examine how post-ops are subjected to intense policing, monitoring and regulating from themselves and others as a result of achieving and maintaining ‘health’ through body size. Obesity Discourse: Establishing a FrameworkScholars Evans, Rich, Davies and Allwood argue that contemporary Western responses to obesity can be conceptualised as operating within an ‘obesity discourse’ which provides a framework of “thought, talk and action concerning the body in which ‘weight’ is privileged not only as a primary determinant but as a manifest index of well-being” (13). Predominantly, this framework draws upon two key assumptions; that obesity is a legitimate and measurable disease that poses significant medical risks to populations, and that both the cause of and solution to obesity are individual lifestyle choices (Rich, Monaghan and Aphramor). More specifically, the obesity discourse is the result of the combined efforts of an extensive process of medicalisation in conjunction with an increasingly neoliberal approach to healthcare. Since the 1950s, fatness has been widely regarded as the disease ‘obesity’. Sobal argues that this occurred through an extensive process of medicalisation, which can be defined as when non-medical issues and behaviour are redefined and understood as medical problems through the use of medical jargon and medical solutions (Conrad). In particular, fat was portrayed as pathological and requiring medical intervention through “frequent, powerful and persuasive claims that [medicine] should exercise social control over fatness” (Sobal 69). In particular this has been exercised through the widespread implementation of the body mass index [BMI] into healthcare settings, as it is seen as an accessible, practical and affordable measure of ‘health’ (Ministry of Health). Unlike other markers of health, body weight is highly visible, and thus using it as an overall indicator of health increases surveillance of the self and others within populations. In this way we can see how the medicalisation of fatness works to produce what Bordo refers to as:one of the most powerful normalizing mechanisms of our century, insuring the production of self-monitoring and self-disciplining ‘docile bodies’ sensitive to any departure from social norms and habituated to self-improvement and self-transformation in the service of these norms. (186)Primarily, this is created through a construction of a ‘normal’ body shape or an ‘ideal’ weight, which can be specified using the BMI, and acts as a health imperative for individuals to achieve and maintain (Rich and Evans). However, these constructions do not factor in individual variations in body composition and thus represent a medically defined ‘thin ideal’, in that they are unobtainable and unrealistic for most people (Metzl 5). Consequently, the idea of a ‘normal weight’ strengthens contemporary body ideals (Burns and Gavey).The recent move in contemporary Western societies towards a neoliberal model of healthcare has significantly impacted societal attitudes towards fatness. The neoliberal healthcare model emphasises an individual’s choice and responsibility with respect to their health, and the privatisation of healthcare systems overall (Fries). While there is a general belief that this change gives patients more autonomy and input within the medical encounter (Lupton), the move towards a ‘democratisation’ of healthcare in reality further entrenches self-surveillance behaviours within populations by asserting that the responsibility for achieving and maintaining ‘health’ lies at the feet of the individual (Fox, Ward and O’Rourke). In particular, there is an assumption that ‘health’ can be ‘unproblematically’ achieved through individual efforts to discipline and regulate body size (Crawford) and thus individuals are obliged to engage in acts of self-discipline as both a personal and public service (Throsby, War). In this way, those who are labelled as ‘obese’ are not only questioned on their ability to appropriately care for themselves, but also their ability to be a good citizen (Throsby, War). Overall, the obesity discourse has intensified the stigmatisation of the obese in that they are portrayed as morally bad and weak-willed (Sobal) and ultimately reinforced the need for external regulatory bodies such as the weight-loss industry to monitor and control the obese. The combined efforts of the medical and weight-loss industry have produced a single message which suggests that if individuals want to maintain ‘health’ and prevent disease, there must be an enduring commitment to a ‘lifestyle change’. A ‘lifestyle change’ implies that in order to achieve successful weight loss and thus ‘health’, there needs to be enduring amendments to diet and exercise that are perceived as a ‘way of life’ rather than the ‘means to an end’ message marketed by other diet regimes (Fullagar). These changes are necessitated through an assumption that excess body weight is a sign of laziness and poor personal habits (Evans and Colls). Similar to the causes of obesity, there is a definitive notion that individual choices predicate the outcomes of weight loss endeavours. Thus, weight-loss successes and failures directly reflect how well individuals adhered to their ‘lifestyle change’ rather than the reliability and validity of the weight-loss regimes themselves (Saguy and Riley).Addressing Bariatric Surgery: The Solution to Morbid ObesityOver the past decade there has been a drastic increase in the availability of radical weight-loss solutions that strictly regulate and police fat-bodied deviants, namely in the form of surgery. While there appears to be support from the medical community for the effectiveness of a ‘lifestyle change’ as the primary solution to obesity, it should be highlighted that a ‘lifestyle change’ is only seen as a realistic option for certain obesity cohorts. In particular, surgery is reserved for the very highest of obesity cohorts – the morbidly obese – and is presented as their only viable option. ‘Morbid obesity’ is defined as having a BMI of 40 or higher and is associated with the most risk of comorbid diseases such as type II diabetes, cardiovascular disease and hypertension (Foo et al.). According to the Ministry of Health, for individuals classified as morbidly obese, clinicians in New Zealand should strongly recommend bariatric surgery. Bariatric surgery describes a group of surgical procedures that physically restrict and redesign the stomachs of morbidly obese patients to achieve weight-loss as most procedures are permanent, and are associated with the greatest long-term weight loss in patients (Ministry of Health). Bariatric surgical procedures became popular due to their long-term effectiveness in weight-loss, and cost-effectiveness particularly for countries with public healthcare, through the drastic reduction in public health expenditure for co-morbid diseases such as diabetes and cardiovascular disease (Sampalis et al.). These procedures are considered the only effective treatment option for morbid obesity or a ‘last resort’ (Cranwell and Seymour-Smith; Ogden, Clementi and Aylwin), and consequently the amount of surgeries performed annually within Australasia has increased at an exponential rate (Buchwald and Williams).What makes bariatric surgery so important as a weight-loss method is that it offers the ‘morbidly obese’, who are seen as persistently deviating from idealised body norms and unable or unwilling to conform to standardised forms of self-regulation, a reprieve from their stigmatising identity. Indeed, many morbidly obese individuals who are seeking weight loss state that bariatric surgery is their only ‘hope’ or choice, or the ‘right’ choice for them (Morgan; Ogden, Clementi and Aylwin). In particular, the fear of, or the onset of, illnesses associated with obesity can be a major factor in their decision to undergo surgery (Ogden, Clementi and Aylwin). In this way, motivations to have surgery are heavily reflective of obesity discourse in that the presence of body fat is a marker of ‘impending doom’ (Rich, Monaghan and Aphramor). Indeed as Wann highlights:I really do understand why someone would consider this extreme option. The stigma attached to even the slightest amount of body fat can be daunting, and the surgeon’s sales pitch can be very slick. (41)However, as Morgan argues, more must be done to critique bariatric surgery as it largely exemplifies the social forces that control and regulate modern societies. Bariatric surgery physically enforces weight-loss and adherence to acceptable eating practices, and makes dissent both punishable and difficult (203). The removal of a large portion of the stomach means that, bariatric surgery imposes “corporeal order and discipline” (Morgan 203) upon individuals. The stomach not only enforces strict self-surveillance protocols but also an unyielding control over the individual through the “forceful prohibition or ejection” (Morgan 202) of substances. Thus, if individuals fail to regulate and govern their intake, the surgical intervention does it for them. The side-effects of vomiting and dumping syndrome act as a regulation failsafe and a form of punishment – an ‘internal policeman’ (Morgan) – that rejects deviant behaviour and punishes the individual through unpleasant and often painful experience. In this way, bariatric surgery can be viewed as the ‘ultimate weapon’ in the war against obesity as it is a means through which deviant individuals and bodies can be controlled and normalised (Glenn, McGannon and Spence).Bariatric Surgery: For Better or for Worse?In order to interrogate the dominant notion perpetuated through obesity discourse that fatness is a disease and body weight more generally is a legitimate way of measuring ‘health’ overall, this article will now draw on key findings generated from recent research examining the life impacts of bariatric surgery conducted with a support group for bariatric surgery in Auckland, New Zealand. While bariatric surgery is portrayed as a gateway to health, Throsby (Re-Birthday) argues that ultimately it is constructed as a ‘tool’ for weight-loss, rather than a cure-all ‘magic pill’ (130). This means that users are required to engage in normative dieting practices in the midst of developing new techniques of discipline that are specific to the post-surgery experience. In this way bariatric surgery creates new levels of self-surveillance that are unique to post-surgery life (Throsby, Re-Birthday 120). Self-surveillance and policing are methods in which bariatric post-ops are subjected to critique, monitoring and maintenance by both themselves and others. A key aspect of this involves the moral construction of ‘good’ and ‘bad’ foods, which often influenced eating behaviours and narratives whereby bariatric post-ops adhere to normalised understandings of diet, nutrition and health (Simpson 84). This dichotomy of good and bad foods reflects dominant understandings of the causal relationship between food, health and body size. Researchers have noted that there is a significant change in the relationship individuals have with food following surgery, and that often this comes with a serious fear of weight regain, and thus an intense policing of food (Cranwell & Seymour-Smith; Ogden, Clementi and Aylwin). Often, further restrictions are placed on an already restricted diet in order to achieve thinness, which emphasises the importance of achieving and maintaining thinness through the micromanagement of food intake (Simpson). In part, this reflects the way that the rhetoric that equates obesity with individual responsibility can equally ascribe blame to patients for any subsequent weight gain following surgery (Throsby, Re-Birthday 130) and indeed previous research has highlighted extensive fear of weight regain, particularly when users encounter fluctuations in their weight (Cranwell and Seymour-Smith). This is arguably what makes discussions around the concept of ‘maintenance’ so important. Maintenance refers to the monitoring process post-ops enter into after losing a significant portion of their weight and reaching a ‘plateau’, or a point where they stop losing weight; in essence it involves discussions around how to maintain and manage a ‘healthy’ weight (Simpson 79). Largely this draws on the assumption that despite being treated for obesity through a surgical intervention, one can never be recovered or truly ‘cured’ of obesity and thus individuals must engage in consistent monitoring as a preventative measure through ‘maintenance’ (Throsby, Re-Birthday). Maintenance is a complex process for bariatric post-ops; it is inextricably linked to weight management and is therefore a visible and moral indicator as to how ‘well’ post-ops are doing in their weight loss endeavours (Simpson). In this way maintenance is heavily couched in obesity discourse as individuals are expected to integrate self-surveillance and regulation practices into a ‘lifestyle change’ in order to prevent future weight gain (Cranwell and Seymour-Smith). For most, maintenance is difficult, and is understood to require a consistent consciousness of food related behaviours in order to be successful. In the observed support group, participants discussed the observations that they had made about their difficulties with resisting ‘crave’ or ‘bad’ foods (primarily those associated with high calories) that they enjoy, as well as revealing the ways in which they had altered their behaviour to address maintenance concerns (Simpson 79). One participant revealed that recent weight gain was making maintenance ‘very hard’, and it was clear that they attributed this weight gain to personal failings despite admitting that there had been no change to their ‘healthy’ eating behaviour (80). In order to address this issue, the participant admitted that they had resorted to traditional dieting rhetoric and removed dairy from their diet (83). Other support group members encouraged the participant to also remove carbohydrates from their diet (83), which further reinforced the notion that weight is a product of personal choice and individual responsibility (Crawford; Donaghue and Clemitshaw). As a result of the rapid weight loss achieved through bariatric surgery, many post-ops struggle to adjust to their ‘new’ bodies. This makes maintenance increasingly difficult as many individuals continue to see themselves as ‘fat’ despite having achieved a ‘normal’ weight (Simpson). Arguably a key factor in their misinterpretation of their body size and composition is the abundance of excess skin that is left over after rapid weight-loss. Excess skin, which has to be surgically removed and cannot be lost through diet or exercise, is a sore issue for bariatric post-ops, as it is a reminder of their former ‘fat’ selves, and thus a source of continuous dissatisfaction and lowered self-esteem (Groven, Råheim and Engelsrud). This is a common problem for many bariatric post-ops, with many citing that their low-hanging stomach or ‘apron’ is a primary source of anguish. Indeed, one post-op admitted that it was “even harder now because … it doesn’t seem to be going anywhere” (Simpson 63), and another revealed that while they consciously understood that their ‘apron’ was excess skin and not fat, they still used it as a sign that they must continue to lose weight. In this way, the reduction of the ‘apron’ has become a dangerous fixation for this post-op and the way in which they measure their success (Simpson 63). Further, post-ops were monitored by family and friends, primarily through concerns over their small portion sizes, which led them to develop techniques to escape the scrutiny of others (Simpson 78). One technique that was particularly popular was the use of a smaller side plate during dinner time (Simpson 78). A smaller plate was both an easy way for post-ops to monitor and regulate their portions, and a method of avoiding criticism and monitoring from others as it effectively masked their reduced portions from the gaze of others. Indeed many post-ops lamented over the consistent external pressures from friends and family to increase their intake and discussed further masking techniques such as moving food around the plate to convince others that they were eating (Simpson 78). These behaviours are troubling as they mimic many primarily observed within the eating disorder community (Prestwood) and indeed Rich and Evans highlight that the level of stigmatisation surrounding fat and body size may push obese individuals into disordered relationships with food, exercise and the body (354). This would suggest that the discourses surrounding the bariatric and the eating disorder communities have lines of similarity in that weight and in particular, thinness is privileged as the primary method in which health and overall personal success is measured (Burns and Gavey; Rich and Evans). Concluding RemarksThe existence of behaviours such as maintenance, food policing and body fixation forces us to question the extent to which bariatric surgery is a gateway at all to ‘health’. 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