Letteratura scientifica selezionata sul tema "Representative government and representation – Scotland – Study and teaching"

Abstract Introduction Additional Cost of Teaching for Pharmacy (ACTp) funding from Scottish Government supports the development of experiential learning (EL) placements for student pharmacists [1]. Interprofessional learning (IPL) has been built into initial education for many healthcare professionals [2]. In 2019, a National Pharmacy EL Stakeholder event recommended exploring the further development of IPL within EL for the MPharm. Aim To scope existing IPL in EL and explore the feasibility for further development within the MPharm in Scotland Methods Online qualitative interviews were conducted with key stakeholders from Schools of Pharmacy, NHS Education for Scotland, EL sites, and Scottish health boards. All were involved in the development/delivery of these activities. The interview schedule was developed by the research team, reviewed for face and content validity, piloted prior to use, and modified based on early interviews. All interviews were audio-recorded, transcribed, and independently thematically analysed by two researchers. Interviews continued until data saturation and good representation from all settings were achieved. All ethical approvals were sought prior to the interviews. Results Twenty interviews were conducted with three key themes emerging; (1)current IPL within EL activities, (2)future developments, and (3)perceptions of enablers and barriers to developing/delivering IPL within EL. There were limited examples of existing IPL within EL activities including: a pilot pharmacy longitudinal clerkship and hospital-based pharmacy/medical student IPL week. Some stakeholders indicated that current IPL involves mainly campus-based activities but other EL based initiatives were planned but not yet implemented. Respondents indicated that future developments should be carefully planned in collaboration with other stakeholders and tailored to students’ stage of study to ensure their success. There was significant support for incorporating IPL within EL initiatives as part of the MPharm course to complement traditional ways of teaching. “I think if we don't do it, we're missing a big trick… Doing something in a classroom or doing something within a small tutorial is a very false way of learning, whereas in practice, where they're going to end up working together, it seems ideal.” Many enablers were highlighted mainly relating to the expected benefits of such activities on students, facilitators, patients, and the healthcare system. Logistics and planning difficulties were perceived to be barriers to implementation of IPL within EL. “We've tried to do it, it was with the medical school and they were receptive to it, but the logistics just didn't work out… when you've got two very different timetables to try and bring together, it is very, very difficult to do.” Conclusion Pharmacy stakeholders highlighted that the majority of IPL currently undertaken in Scotland is not based in EL settings but they supported developing it. Enablers and barriers articulated highlight the need for careful planning of these activities. A strength of this study is it involved a broad range of key stakeholders from across Scotland ensuring representativeness of views and ideas. A limitation may be that, given the Scottish focus, findings may lack direct transferability to other countries. Future research should focus on designing a framework for developing and implementing IPL within EL in Scotland. References 1. NHS Education for Scotland, 2020. Experiential learning for student pharmacists in Scotland. [online]. Edinburgh: NHS Education for Scotland. Available from: https://www.nes.scot.nhs.uk/our-work/experiential-learning-for-student-pharmacists-in-scotland/ [Accessed 07/10/2020]. 2. Barr H. Interprofessional Education-The Genesis of Global Movement. 2015. https://www.caipe.org/resources/publications/barr-h-2015-interprofessional-education-genesis-global-movement. [Accessed 4 Aug 2020]

The problems of formation and activity of supervisory boards at vocational education institutions in Ukraine is insufficiently disclosed in the theoretical and practical aspects. The government's initiatives to establish supervisory boards in the Lviv region of Ukraine update the study of existing practices with the identification of problematic aspects for further improvement. The legal support for the functioning of supervisory boards in the education system of Ukraine in the article is analysed. The main focus is on the drafts of the Strategy for the Development of Vocational Education 2023, as well as the Standard Regulations on the Supervisory Board of Vocational Education. The essence of supervisory boards is determined – as advisory-consulting, controlling and coordination-communication formations at educational institutions (including vocational), which operate on a permanent basis and unite stakeholders in the field of strategic development of this institution. The main disadvantagesof the current supervisory boards at vocational education institutions in Ukraine are summarized. There are the lack of information about their results, the uncertain practice of institutional representation. In this regard, it is proposed to vary the inclusion of representatives of the internal and external environment of the institution in the supervisory board. The internal environment should be formed by a representative of the teaching staff who do not hold a managerial position, a representative of the student government, a representative of the trade union organization. The external environment of the supervisory board should be maximally represented by different spheres. It is recommended that the supervisory board include representatives of the central and regional authorities, a representative of the local government, a representative of the educational and methodological center of vocational education of the region, representatives of a public organization, employer or its supervisory board, higher education institution with related specialization, foreign organization, as well as the scientific environment. The recommendations emphasize the need to form the legal basis for the activities of supervisory boards in the system of strategic development of vocational education in Ukraine.

IntroductionDespite claims that the importance of distance has been reduced due to technological and communications improvements (Cairncross; Friedman; O’Brien), the ‘power of place’ still resonates, often intensifying the role of geography (Christopherson et al.; Morgan; Pratt; Scott and Storper). Within the film industry, there has been a decentralisation of production from Hollywood, but there remains a spatial logic which has preferenced particular centres, such as Toronto, Vancouver, Sydney and Prague often led by a combination of incentives (Christopherson and Storper; Goldsmith and O’Regan; Goldsmith et al.; Miller et al.; Mould). The emergence of high end television, television programming for which the production budget is more than £1 million per television hour, has presented new opportunities for screen hubs sharing a very similar value chain to the film industry (OlsbergSPI with Nordicity).In recent years, interventions have proliferated with the aim of capitalising on the decentralisation of certain activities in order to attract international screen industries production and embed it within local hubs. Tools for building capacity and expertise have proliferated, including support for studio complex facilities, infrastructural investments, tax breaks and other economic incentives (Cucco; Goldsmith and O’Regan; Jensen; Goldsmith et al.; McDonald; Miller et al.; Mould). Yet experience tells us that these will not succeed everywhere. There is a need for a better understanding of both the capacity for places to build a distinctive and competitive advantage within a highly globalised landscape and the relative merits of alternative interventions designed to generate a sustainable production base.This article first sets out the rationale for the appetite identified in the screen industries for co-location, or clustering and concentration in a tightly drawn physical area, in global hubs of production. It goes on to explore the latest trends of decentralisation and examines the upturn in interventions aimed at attracting mobile screen industries capital and labour. Finally it introduces the Scottish screen industries and explores some of the ways in which Scotland has sought to position itself as a recipient of screen industries activity. The paper identifies some key gaps in infrastructure, most notably a studio, and calls for closer examination of the essential ingredients of, and possible interventions needed for, a vibrant and sustainable industry.A Compulsion for ProximityIt has been argued that particular spatial and place-based factors are central to the development and organisation of the screen industries. The film and television sector, the particular focus of this article, exhibit an extraordinarily high degree of spatial agglomeration, especially favouring centres with global status. It is worth noting that the computer games sector, not explored in this article, slightly diverges from this trend displaying more spatial patterns of decentralisation (Vallance), although key physical hubs of activity have been identified (Champion). Creative products often possess a cachet that is directly associated with their point of origin, for example fashion from Paris, films from Hollywood and country music from Nashville – although it can also be acknowledged that these are often strategic commercial constructions (Pecknold). The place of production represents a unique component of the final product as well as an authentication of substantive and symbolic quality (Scott, “Creative cities”). Place can act as part of a brand or image for creative industries, often reinforcing the advantage of being based in particular centres of production.Very localised historical, cultural, social and physical factors may also influence the success of creative production in particular places. Place-based factors relating to the built environment, including cheap space, public-sector support framework, connectivity, local identity, institutional environment and availability of amenities, are seen as possible influences in the locational choices of creative industry firms (see, for example, Drake; Helbrecht; Hutton; Leadbeater and Oakley; Markusen).Employment trends are notoriously difficult to measure in the screen industries (Christopherson, “Hollywood in decline?”), but the sector does contain large numbers of very small firms and freelancers. This allows them to be flexible but poses certain problems that can be somewhat offset by co-location. The findings of Antcliff et al.’s study of workers in the audiovisual industry in the UK suggested that individuals sought to reconstruct stable employment relations through their involvement in and use of networks. The trust and reciprocity engendered by stable networks, built up over time, were used to offset the risk associated with the erosion of stable employment. These findings are echoed by a study of TV content production in two media regions in Germany by Sydow and Staber who found that, although firms come together to work on particular projects, typically their business relations extend for a much longer period than this. Commonly, firms and individuals who have worked together previously will reassemble for further project work aided by their past experiences and expectations.Co-location allows the development of shared structures: language, technical attitudes, interpretative schemes and ‘communities of practice’ (Bathelt, et al.). Grabher describes this process as ‘hanging out’. Deep local pools of creative and skilled labour are advantageous both to firms and employees (Reimer et al.) by allowing flexibility, developing networks and offsetting risk (Banks et al.; Scott, “Global City Regions”). For example in Cook and Pandit’s study comparing the broadcasting industry in three city-regions, London was found to be hugely advantaged by its unrivalled talent pool, high financial rewards and prestigious projects. As Barnes and Hutton assert in relation to the wider creative industries, “if place matters, it matters most to them” (1251). This is certainly true for the screen industries and their spatial logic points towards a compulsion for proximity in large global hubs.Decentralisation and ‘Sticky’ PlacesDespite the attraction of global production hubs, there has been a decentralisation of screen industries from key centres, starting with the film industry and the vertical disintegration of Hollywood studios (Christopherson and Storper). There are instances of ‘runaway production’ from the 1920s onwards with around 40 per cent of all features being accounted for by offshore production in 1960 (Miller et al., 133). This trend has been increasing significantly in the last 20 years, leading to the genesis of new hubs of screen activity such as Toronto, Vancouver, Sydney and Prague (Christopherson, “Project work in context”; Goldsmith et al.; Mould; Miller et al.; Szczepanik). This development has been prompted by a multiplicity of reasons including favourable currency value differentials and economic incentives. Subsidies and tax breaks have been offered to secure international productions with most countries demanding that, in order to qualify for tax relief, productions have to spend a certain amount of their budget within the local economy, employ local crew and use domestic creative talent (Hill). Extensive infrastructure has been developed including studio complexes to attempt to lure productions with the advantage of a full service offering (Goldsmith and O’Regan).Internationally, Canada has been the greatest beneficiary of ‘runaway production’ with a state-led enactment of generous film incentives since the late 1990s (McDonald). Vancouver and Toronto are the busiest locations for North American Screen production after Los Angeles and New York, due to exchange rates and tax rebates on labour costs (Miller et al., 141). 80% of Vancouver’s production is attributable to runaway production (Jensen, 27) and the city is considered by some to have crossed a threshold as:It now possesses sufficient depth and breadth of talent to undertake the full array of pre-production, production and post-production services for the delivery of major motion pictures and TV programmes. (Barnes and Coe, 19)Similarly, Toronto is considered to have established a “comprehensive set of horizontal and vertical media capabilities” to ensure its status as a “full function media centre” (Davis, 98). These cities have successfully engaged in entrepreneurial activity to attract production (Christopherson, “Project Work in Context”) and in Vancouver the proactive role of provincial government and labour unions are, in part, credited with its success (Barnes and Coe). Studio-complex infrastructure has also been used to lure global productions, with Toronto, Melbourne and Sydney all being seen as key examples of where such developments have been used as a strategic priority to take local production capacity to the next level (Goldsmith and O’Regan).Studies which provide a historiography of the development of screen-industry hubs emphasise a complex interplay of social, cultural and physical conditions. In the complex and global flows of the screen industries, ‘sticky’ hubs have emerged with the ability to attract and retain capital and skilled labour. Despite being principally organised to attract international production, most studio complexes, especially those outside of global centres need to have a strong relationship to local or national film and television production to ensure the sustainability and depth of the labour pool (Goldsmith and O’Regan, 2003). Many have a broadcaster on site as well as a range of companies with a media orientation and training facilities (Goldsmith and O’Regan, 2003; Picard, 2008). The emergence of film studio complexes in the Australian Gold Coast and Vancouver was accompanied by an increasing role for television production and this multi-purpose nature was important for the continuity of production.Fostering a strong community of below the line workers, such as set designers, locations managers, make-up artists and props manufacturers, can also be a clear advantage in attracting international productions. For example at Cinecitta in Italy, the expertise of set designers and experienced crews in the Barrandov Studios of Prague are regarded as major selling points of the studio complexes there (Goldsmith and O’Regan; Miller et al.; Szczepanik). Natural and built environments are also considered very important for film and television firms and it is a useful advantage for capturing international production when cities can double for other locations as in the cases of Toronto, Vancouver, Prague for example (Evans; Goldsmith and O’Regan; Szczepanik). Toronto, for instance, has doubled for New York in over 100 films and with regard to television Due South’s (1994-1998) use of Toronto as Chicago was estimated to have saved 40 per cent in costs (Miller et al., 141).The Scottish Screen Industries Within mobile flows of capital and labour, Scotland has sought to position itself as a recipient of screen industries activity through multiple interventions, including investment in institutional frameworks, direct and indirect economic subsidies and the development of physical infrastructure. Traditionally creative industry activity in the UK has been concentrated in London and the South East which together account for 43% of the creative economy workforce (Bakhshi et al.). In order, in part to redress this imbalance and more generally to encourage the attraction and retention of international production a range of policies have been introduced focused on the screen industries. A revised Film Tax Relief was introduced in 2007 to encourage inward investment and prevent offshoring of indigenous production, and this has since been extended to high-end television, animation and children’s programming. Broadcasting has also experienced a push for decentralisation led by public funding with a responsibility to be regionally representative. The BBC (“BBC Annual Report and Accounts 2014/15”) is currently exceeding its target of 50% network spend outside London by 2016, with 17% spent in Scotland, Wales and Northern Ireland. Channel 4 has similarly committed to commission at least 9% of its original spend from the nations by 2020. Studios have been also developed across the UK including at Roath Lock (Cardiff), Titanic Studios (Belfast), MedicaCity (Salford) and The Sharp Project (Manchester).The creative industries have been identified as one of seven growth sectors for Scotland by the government (Scottish Government). In 2010, the film and video sector employed 3,500 people and contributed £120 million GVA and £120 million adjusted GVA to the economy and the radio and TV sector employed 3,500 people and contributed £50 million GVA and £400 million adjusted GVA (The Scottish Parliament). Beyond the direct economic benefits of sectors, the on-screen representation of Scotland has been claimed to boost visitor numbers to the country (EKOS) and high profile international film productions have been attracted including Skyfall (2012) and WWZ (2013).Scotland has historically attracted international film and TV productions due to its natural locations (VisitScotland) and on average, between 2009-2014, six big budget films a year used Scottish locations both urban and rural (BOP Consulting, 2014). In all, a total of £20 million was generated by film-making in Glasgow during 2011 (Balkind) with WWZ (2013) and Cloud Atlas (2013), representing Philadelphia and San Francisco respectively, as well as doubling for Edinburgh for the recent acclaimed Scottish films Filth (2013) and Sunshine on Leith (2013). Sanson (80) asserts that the use of the city as a site for international productions not only brings in direct revenue from production money but also promotes the city as a “fashionable place to live, work and visit. Creativity makes the city both profitable and ‘cool’”.Nonetheless, issues persist and it has been suggested that Scotland lacks a stable and sustainable film industry, with low indigenous production levels and variable success from year to year in attracting inward investment (BOP Consulting). With regard to crew, problems with an insufficient production base have been identified as an issue in maintaining a pipeline of skills (BOP Consulting). Developing ‘talent’ is a central aspect of the Scottish Government’s Strategy for the Creative Industries, yet there remains the core challenge of retaining skills and encouraging new talent into the industry (BOP Consulting).With regard to film, a lack of substantial funding incentives and the absence of a studio have been identified as a key concern for the sector. For example, within the film industry the majority of inward investment filming in Scotland is location work as it lacks the studio facilities that would enable it to sustain a big-budget production in its entirety (BOP Consulting). The absence of such infrastructure has been seen as contributing to a drain of Scottish talent from these industries to other areas and countries where there is a more vibrant sector (BOP Consulting). The loss of Scottish talent to Northern Ireland was attributed to the longevity of the work being provided by Games of Thrones (2011-) now having completed its six series at the Titanic Studios in Belfast (EKOS) although this may have been stemmed somewhat recently with the attraction of US high-end TV series Outlander (2014-) which has been based at Wardpark in Cumbernauld since 2013.Television, both high-end production and local broadcasting, appears crucial to the sustainability of screen production in Scotland. Outlander has been estimated to contribute to Scotland’s production spend figures reaching a historic high of £45.8 million in 2014 (Creative Scotland ”Creative Scotland Screen Strategy Update”). The arrival of the program has almost doubled production spend in Scotland, offering the chance for increased stability for screen industries workers. Qualifying for UK High-End Television Tax Relief, Outlander has engaged a crew of approximately 300 across props, filming and set build, and cast over 2,000 supporting artist roles from within Scotland and the UK.Long running drama, in particular, offers key opportunities for both those cutting their teeth in the screen industries and also by providing more consistent and longer-term employment to existing workers. BBC television soap River City (2002-) has been identified as a key example of such an opportunity and the programme has been credited with providing a springboard for developing the skills of local actors, writers and production crew (Hibberd). This kind of pipeline of production is critical given the work patterns of the sector. According to Creative Skillset, of the 4,000 people in Scotland are employed in the film and television industries, 40% of television workers are freelance and 90% of film production work in freelance (EKOS).In an attempt to address skills gaps, the Outlander Trainee Placement Scheme has been devised in collaboration with Creative Scotland and Creative Skillset. During filming of Season One, thirty-eight trainees were supported across a range of production and craft roles, followed by a further twenty-five in Season Two. Encouragingly Outlander, and the books it is based on, is set in Scotland so the authenticity of place has played a strong component in the decision to locate production there. Producer David Brown began his career on Bill Forsyth films Gregory’s Girl (1981), Local Hero (1983) and Comfort and Joy (1984) and has a strong existing relationship to Scotland. He has been very vocal in his support for the trainee program, contending that “training is the future of our industry and we at Outlander see the growth of talent and opportunities as part of our mission here in Scotland” (“Outlander fast tracks next generation of skilled screen talent”).ConclusionsThis article has aimed to explore the relationship between place and the screen industries and, taking Scotland as its focus, has outlined a need to more closely examine the ways in which the sector can be supported. Despite the possible gains in terms of building a sustainable industry, the state-led funding of the global screen industries is contested. The use of tax breaks and incentives has been problematised and critiques range from use of public funding to attract footloose media industries to the increasingly zero sum game of competition between competing places (Morawetz; McDonald). In relation to broadcasting, there have been critiques of a ‘lift and shift’ approach to policy in the UK, with TV production companies moving to the nations and regions temporarily to meet the quota and leaving once a production has finished (House of Commons). Further to this, issues have been raised regarding how far such interventions can seed and develop a rich production ecology that offers opportunities for indigenous talent (Christopherson and Rightor).Nonetheless recent success for the screen industries in Scotland can, at least in part, be attributed to interventions including increased decentralisation of broadcasting and the high-end television tax incentives. This article has identified gaps in infrastructure which continue to stymie growth and have led to production drain to other centres. Important gaps in knowledge can also be acknowledged that warrant further investigation and unpacking including the relationship between film, high-end television and broadcasting, especially in terms of the opportunities they offer for screen industries workers to build a career in Scotland and notable gaps in infrastructure and the impact they have on the loss of production.ReferencesAntcliff, Valerie, Richard Saundry, and Mark Stuart. Freelance Worker Networks in Audio-Visual Industries. University of Central Lancashire, 2004.Bakhshi, Hasan, John Davies, Alan Freeman, and Peter Higgs. "The Geography of the UK’s Creative and High–Tech Economies." 2015.Balkind, Nicola. World Film Locations: Glasgow. Intellect Books, 2013.Banks, Mark, Andy Lovatt, Justin O’Connor, and Carlo Raffo. "Risk and Trust in the Cultural Industries." Geoforum 31.4 (2000): 453-464.Barnes, Trevor, and Neil M. Coe. “Vancouver as Media Cluster: The Cases of Video Games and Film/TV." 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Introduction The exhibition of an artist’s work is traditionally accepted as representing the final stage of the creative process (Staniszewski). This article asks, however, whether this traditional view can be reassessed so that the curatorial practice of mounting an exhibition becomes, itself, a creative outcome feeding into work that may still be in progress, and that simultaneously operates as a learning and teaching tool. To provide a preliminary examination of the issue, we use a single case study approach, taking an example of practice currently used at an Australian university. In this program, internal and external students work together to develop and deliver an exhibition of their own work in progress. The exhibition space has a professional website (‘CQUniversity Noosa Exhibition Space’), many community members and the local media attend exhibition openings, and the exhibition (which runs for three to four weeks) becomes an outcome students can include in their curriculum vitae. This article reflects on the experiences, challenges, and outcomes that have been gained through this process over the past twelve months. Due to this time frame, the case study is exploratory and its findings are provisional. The case study is an appropriate method to explore a small sample of events (in this case exhibitions) as, following Merriam, it allows the construction of a richer picture of an under-examined phenomenon to be constructed. Although it is clear that this approach will not offer results which can be generalised, it can, nevertheless, assist in opening up a field for investigation and constructing a holistic account of a phenomenon (in this case, the exhibition space as authentic learning experience and productive teaching tool), for, as Merriam states, “much can be learned from a particular case” (51). Jennings adds that even the smallest case study is useful as it includes an “in-depth examination of the subject with which to confirm or contest received generalizations” (14). Donmoyer extends thoughts on this, suggesting that the single case study is extremely useful as the “restricted conception of generalizability … solely in terms of sampling and statistical significance is no longer defensible or functional” (45). Using the available student course feedback, anonymous end-of-term course evaluations, and other available information, this case study account offers an example of what Merriam terms a “narrative description” (51), which seeks to offer readers the opportunity to engage and “learn vicariously from an encounter with the case” (Merriam 51) in question. This may, we propose, be particularly productive for other educators since what is “learn[ed] in a particular case can be transferred to similar situations” (Merriam 51). Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Background The Graduate Certificate of Creative Industries (Creative Practice) (CQU ‘CB82’) was developed in 2011 to meet the national Australian Quality Framework agency’s Level 8 (Graduate Certificate) standards in terms of what is called in their policies, the “level” of learning. This states that, following the program, graduates from this level of program “will have advanced knowledge and skills for professional or highly skilled work and/or further learning … [and] will apply knowledge and skills to demonstrate autonomy, well-developed judgment, adaptability and responsibility as a practitioner or learner” (AQF). The program was first delivered in 2012 and, since then, has been offered both two and three terms a year, attracting small numbers of students each term, with an average of 8 to 12 students a term. To meet these requirements, such programs are sometimes developed to provide professional and work-integrated learning tasks and learning outcomes for students (Patrick et al., Smith et al.). In this case, professionally relevant and related tasks and outcomes formed the basis for the program, its learning tasks, and its assessment regime. To this end, each student enrolled in this program works on an individual, self-determined (but developed in association with the teaching team and with feedback from peers) creative/professional project that is planned, developed, and delivered across one term of study for full- time students and two terms for part- timers. In order to ensure the AQF-required professional-level outcomes, many projects are designed and/or developed in partnership with professional arts institutions and community bodies. Partnerships mobilised utilised in this way have included those with local, state, and national bodies, including the local arts community, festivals, and educational support programs, as well as private business and community organisations. Student interaction with curation occurs regularly at art schools, where graduate and other student shows are scheduled as a regular events on the calendar of most tertiary art schools (Al-Amri), and the curated exhibition as an outcome has a longstanding tradition in tertiary fine arts education (Webb, Brien, and Burr). Yet in these cases, it is ultimately the creative work on show that is the focus of the learning experience and assessment process, rather than any focus on engagement with the curatorial process itself (Dally et al.). When art schools do involve students in the curatorial process, the focus usually still remains on the students' creative work (Sullivan). Another interaction with curation is when students undertaking a tertiary-level course or program in museum, and/or curatorial practice are engaged in the process of developing, mounting, and/or critiquing curated activities. These programs are, however, very small in number in Australia, where they are only offered at postgraduate level, with the exception of an undergraduate program at the University of Canberra (‘215JA.2’). By adopting “the exhibition” as a component of the learning process rather than its end product, including documentation of students’ work in progress as exhibition pieces, and incorporating it into a more general creative industries focused program, we argue that the curatorial experience can become an interactive learning platform for students ranging from diverse creative disciplines. The Student Experience Students in the program under consideration in this case study come from a wide spectrum of the creative industries, including creative writing, film, multimedia, music, and visual arts. Each term, at least half of the enrolments are distance students. The decision to establish an on-campus exhibition space was an experimental strategy that sought to bring together students from different creative disciplines and diverse locations, and actively involve them in the exhibition development and curatorial process. As well as their individual project work, the students also bring differing levels of prior professional experience to the program, and exhibit a wide range of learning styles and approaches when developing and completing their creative works and exegetical reflections. To cater for the variations listed above, but still meet the program milestones and learning outcomes that must (under the program rules) remain consistent for each student, we employed a multi-disciplinary approach to teaching that included strategies informed by Gardner’s theory of multiple intelligences (Gardner, Frames of Mind), which proposed and defined seven intelligences, and repeatedly criticised what he identified as an over-reliance on linguistic and logical indices as identifiers of intelligence. He asserted that these were traditional indicators of high scores on most IQ measures or tests of achievement but were not representative of overall levels of intelligence. Gardner later reinforced that, “unless individuals take a very active role in what it is that they’re studying, unless they learn to ask questions, to do things hands on, to essentially re-create things in their own mind and transform them as is needed, the ideas just disappear” (Edutopia). In alignment with Gardner’s views, we have noted that students enrolled in the program demonstrate strengths in several key intelligence areas, particularly interpersonal, musical, body-kinaesthetic, and spacial/visual intelligences (see Gardner, ‘Multiple Intelligences’, 8–18). To cater for, and further develop, these strengths, and also for the external students who were unable to attend university-based workshop sessions, we developed a range of resources with various approaches to hands-on creative tasks that related to the projects students were completing that term. These resources included the usual scholarly articles, books, and textbooks but were also sourced from the print and online media, guest speaker presentations, and digital sites such as You Tube and TED Talks, and through student input into group discussions. The positive reception of these individual project-relevant resources is evidenced in the class online discussion forums, where consecutive groups of students have consistently reflected on the positive impact these resources have had on their individual creative projects: This has been a difficult week with many issues presenting. As part of our Free Writing exercise in class, we explored ‘brain dumping’ and wrote anything (no matter how ridiculous) down. The great thing I discovered after completing this task was that by allowing myself to not censor my thoughts by compiling a writing masterpiece, I was indeed “free” to express everything. …. … I understand that this may not have been the original intended goal of Free Writing – but it is something I would highly recommend external students to try and see if it works for you (Student 'A', week 5, term 1 2015, Moodle reflection point). I found our discussion about crowdfunding particularly interesting. ... I intend to look at this model for future exhibitions. I think it could be a great way for me to look into developing an exhibition of paintings alongside some more commercial collateral such as prints and cards (Student 'B', week 6, term 1 2015, Moodle reflection point). In class I specifically enjoyed the black out activity and found the online videos exceptional, inspiring and innovating. I really enjoyed this activity and it was something that I can take away and use within the classroom when educating (Student 'C', week 8, term 1 2015, Moodle reflection point). The application of Gardner’s principles and strategies dovetailed with our framework for assessing learning outcomes, where we were guided by Boud’s seven propositions for assessment reform in higher education, which aim to “set directions for change, designed to enhance learning achievements for all students and improve the quality of their experience” (26). Boud asserts that assessment has most effect when: it is used to engage students in productive learning; feedback is used to improve student learning; students and teachers become partners in learning and assessment; students are inducted into the assessment practices of higher education; assessment and learning are placed at the centre of subject and program design; assessment and learning is a focus for staff and institutional development; and, assessment provides inclusive and trustworthy representation of student achievement. These propositions were integral to the design of learning outcomes for the exhibition. Teachers worked with students, individually and as a group, to build their capacity to curate the exhibition, and this included such things as the design and administration of invitations, and also the physical placement of works within the exhibition space. In this way, teachers and students became partners in the process of assessment. The final exhibition, as a learning outcome, meant that students were engaged in productive learning that placed both assessment and knowledge at the centre of subject and project design. It is a collation of creative pieces that embodies the class, as a whole; however, each piece also represents the skills and creativity of individual students and, in this way, are is a trustworthy representations of student achievement. While we aimed to employ all seven recommendations, our main focus was on ensuring that the exhibition, as an authentic learning experience, was productive and that the students were engaged as responsible and accountable co-facilitators of it. These factors are particularly relevant as almost all the students were either currently working, or planning to work, in their chosen creative field, where the work would necessarily involve both publication, performance, and/or exhibition of their artwork plus collaborative practice across disciplinary boundaries to make this happen (Brien). For this reason, we provided exhibition-related coursework tasks that we hoped were engaging and that also represented an authentic learning outcome for the students. Student Curatorship In this context, the opportunity to exhibit their own works-in-progress provided an authentic reason, with a deadline, for students to both work, and reflect, on their creative projects. The documentation of each student’s creative process was showcased as a stand-alone exhibition piece within the display. These exhibits not only served not only to highlight the different learning styles of each student, but also proved to inspire creativity and skill development. They also provided a working model whereby students (and potential enrollees) could view other students’ work and creative processes from inception to fully-realised project outcomes. The sample online reflections quoted above not only highlight the effectiveness of the online content delivery, but this engagement with the online forum also allowed remote students to comment on each other’s projects as well as to and respond to issues they were encountering in their project planning and development and creative practice. It was essential that this level of peer engagement was fostered for the curatorial project to be viable, as both internal and external students are involved in designing the invitation, catalogue, labels, and design of the space, while on-campus students hang and label work according to the group’s directions. Distance students send in items. This is a key point of this experiment: the process of curating an exhibition of work from diverse creative fields, and from students located thousands of kilometres apart, as a way of bringing cohesion to a diverse cohort of students. That cohesiveness provided an opportunity for authentic learning to occur because it was in relation to a task that each student apparently understood as personally, academically, and professionally relevant. This was supported by the anonymous course evaluation comments, which were overwhelmingly positive about the exhibition process – there were no negative comments regarding this aspect of the program, and over 60 per cent of the class supplied these evaluations. This also met a considerable point of anxiety in the current university environment whereby actively engaging students in online learning interactions is a continuing issue (Dixon, Dixon, and Axmann). A key question is: what relevance does this curatorial process have for a student whose field is not visual art, but, for instance, music, film, or writing? By displaying documentation of work in progress, this process connects students of all disciplines with an audience. For example, one student in 2014 who was a singer/songwriter, had her song available to be played on a laptop, alongside photographs of the studio when she was recording her song with her band. In conjunction with this, the cover artwork for her CD, together with the actual CD and CD cover, were framed and exhibited. Another student, who was also a musician but who was completing a music history project, sent in pages of the music transcriptions he had been working on during the course. This manuscript was bound and exhibited in a way that prompted some audience members to commented that it was like an artist’s book as well as a collection of data. Both of these students lived over 1,000 kilometres from the campus where the exhibition was held, but they were able to share with us as teaching staff, as well as with other students who were involved in the physical setting up of the exhibition, exactly how they envisaged their work being displayed. The feedback from both of these students was that this experience gave them a strong connection to the program. They described how, despite the issue of distance, they had had the opportunity to participate in a professional event that they were very keen to include on their curricula vitae. Another aspect of students actively participating in the curation of an exhibition which features work from diverse disciplines is that these students get a true sense of the collaborative interconnectedness of the disciplines of the creative industries (Brien). By way of example, the exhibit of the singer/songwriter referred to above involved not only the student and her band, but also the photographer who took the photographs, and the artist who designed the CD cover. Students collaboratively decided how this material was handled in the exhibition catalogue – all these names were included and their roles described. Breaking Ground exhibition, CQUniversity Noosa Exhibition Space, 2014. Photo by Ulrike Sturm. Outcomes and Conclusion We believe that the curation of an exhibition and the delivery of its constituent components raises student awareness that they are, as creatives, part of a network of industries, developing in them a genuine understanding of the way the creating industries works as a profession outside the academic setting. It is in this sense that this curatorial task is an authentic learning experience. In fact, what was initially perceived as a significant challenge—, that is, exhibiting work in progress from diverse creative fields—, has become a strength of the curatorial project. In reflecting on the experiences and outcomes that have occurred through the implementation of this example of curatorial practice, both as a learning tool and as a creative outcome in its own right, a key positive indicator for this approach is the high level of student satisfaction with the course, as recorded in the formal, anonymous university student evaluations (with 60–100 per cent of these completed for each term, when the university benchmark is 50 per cent completion), and the high level of professional outcomes achieved post-completion. The university evaluation scores have been in the top (4.5–5/.5) range for satisfaction over the program’s eight terms of delivery since 2012. Particularly in relation to subsequent professional outcomes, anecdotal feedback has been that the curatorial process served as an authentic and engaged learning experience because it equipped the students, now graduates, of the program with not only knowledge about how exhibitions work, but also a genuine understanding of the web of connections between the diverse creative arts and industries. Indeed, a number of students have submitted proposals to exhibit professionally in the space after graduation, again providing anecdotal feedback that the experience they gained through our model has had a sustaining impact on their creative practice. While the focus of this activity has been on creative learning for the students, it has also provided an interesting and engaging teaching experience for us as the program’s staff. We will continue to gather evidence relating to our model, and, with the next iteration of the exhibition project, a more detailed comparative analysis will be attempted. At this stage, with ethics approval, we plan to run an anonymous survey with all students involved in this activity, to develop questions for a focus group discussion with graduates. We are also in the process of contacting alumni of the program regarding professional outcomes to map these one, two, and five years after graduation. We will also keep a record of what percentage of students apply to exhibit in the space after graduation, as this will also be an additional marker of how professional and useful they perceive the experience to be. In conclusion, it can be stated that the 100 per cent pass rate and 0 per cent attrition rate from the program since its inception, coupled with a high level (over 60 per cent) of student progression to further post-graduate study in the creative industries, has not been detrimentally affected by this curatorial experiment, and has encouraged staff to continue with this approach. References Al-Amri, Mohammed. “Assessment Techniques Practiced in Teaching Art at Sultan Qaboos University in Oman.” International Journal of Education through Art 7.3 (2011): 267–282. AQF Levels. Australian Qualifications Framework website. 18 June 2015 ‹http://www.aqf.edu.au/aqf/in-detail/aqf-levels/›. Boud, D. Student Assessment for Learning in and after Courses: Final Report for Senior Fellowship. Sydney: Australian Learning and Teaching Council, 2010. Brien, Donna Lee, “Higher Education in the Corporate Century: Choosing Collaborative rather than Entrepreneurial or Competitive Models.” New Writing: The International Journal for the Practice and Theory of Creative Writing 4.2 (2007): 157–170. Brien, Donna Lee, and Axel Bruns, eds. “Collaborate.” M/C Journal 9.2 (2006). 18 June 2015 ‹http://journal.media-culture.org.au/0605›. Burton, D. Exhibiting Student Art: The Essential Guide for Teachers. New York: Teachers College Press, Columbia University, New York, 2006. CQUniversity. CB82 Graduate Certificate in Creative Industries. 18 July 2015 ‹https://handbook.cqu.edu.au/programs/index?programCode=CB82›. CQUniversity Noosa Exhibition Space. 20 July 2015 ‹http://www.cqunes.org›. Dally, Kerry, Allyson Holbrook, Miranda Lawry and Anne Graham. “Assessing the Exhibition and the Exegesis in Visual Arts Higher Degrees: Perspectives of Examiners.” Working Papers in Art & Design 3 (2004). 27 June 2015 ‹http://sitem.herts.ac.uk/artdes_research/papers/wpades/vol3/kdabs.html›. Degree Shows, Sydney College of the Arts. 2014. 18 June 2015 ‹http://sydney.edu.au/sca/galleries-events/degree-shows/index.shtml› Dixon, Robert, Kathryn Dixon, and Mandi Axmann. “Online Student Centred Discussion: Creating a Collaborative Learning Environment.” Hello! Where Are You in the Landscape of Educational Technology? Proceedings ASCILITE, Melbourne 2008. 256–264. Donmoyer, Robert. “Generalizability and the Single-Case Study.” Case Study Method: Key Issues, Key Texts. Eds. Roger Gomm, Martyn Hammersley, and Peter Foster. 2000. 45–68. Falk, J.H. “Assessing the Impact of Exhibit Arrangement on Visitor Behavior and Learning.” Curator: The Museum Journal 36.2 (1993): 133–146. Flyvbjerg, Bent. “Five Misunderstandings about Case-Study Research.” Qualitative Inquiry 12.2 (2006): 219–245. Gardner, H. Frames of Mind: The Theory of Multiple Intelligences, New York: Basic Books, 1983. ———. Multiple Intelligences: New Horizons in Theory and Practice, New York: Basic Books, 2006. George Lucas Education Foundation. 2015 Edutopia – What Works in Education. 16 June 2015 ‹http://www.edutopia.org/multiple-intelligences-howard-gardner-video#graph3›. Gerring, John. “What Is a Case Study and What Is It Good For?” American Political Science Review 98.02 (2004): 341–354. Hooper-Greenhill, Eilean. “Museums and Communication: An Introductory Essay.” Museum, Media, Message 1 (1995): 1. Jennings, Paul. The Public House in Bradford, 1770-1970. Keele: Keele University Press, 1995. Levy, Jack S. “Case Studies: Types, Designs, and Logics of Inference.” Conflict Management and Peace Science 25.1 (2008): 1–18. Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation: Revised and Expanded from Qualitative Research and Case Study Applications in Education. Jossey-Bass, 2009. Miles, M., and S. Rainbird. From Critical Distance to Engaged Proximity: Rethinking Assessment Methods to Enhance Interdisciplinary Collaborative Learning in the Creative Arts and Humanities. Final Report to the Australian Government Office for Learning and Teaching, Sydney. 2013. Monash University. Rethinking Assessment to Enhance Interdisciplinary Collaborative Learning in the Creative Arts and Humanities. Sydney: Office of Learning and Teaching, 2013. Muller, L. Reflective Curatorial Practice. 17 June 2015 ‹http://research.it.uts.edu.au/creative/linda/CCSBook/Jan%2021%20web%20pdfs/Muller.pdf›. O’Neill, Paul. Curating Subjects. London: Open Editions, 2007. Patrick, Carol-Joy, Deborah Peach, Catherine Pocknee, Fleur Webb, Marty Fletcher, and Gabriella Pretto. The WIL (Work Integrated Learning) Report: A National Scoping Study [Final Report]. Brisbane: Queensland University of Technology, 2008. Rule, A.C. “Editorial: The Components of Authentic Learning.” Journal of Authentic Learning 3.1 (2006): 1–10. Seawright, Jason, and John Gerring. “Case Selection Techniques in Case Study Research: A Menu of Qualitative and Quantitative Options.” Political Research Quarterly 61.2 (2008): 294–308. Smith, Martin, Sally Brooks, Anna Lichtenberg, Peter McIlveen, Peter Torjul, and Joanne Tyler. Career Development Learning: Maximising the Contribution of Work-Integrated Learning to the Student Experience. Final project report, June 2009. Wollongong: University of Wollongong, 2009. Sousa, D.A. How the Brain Learns: A Teacher’s Guide. 2nd ed. Thousand Oaks, CA: Corwin Press, 2001. Stake, R. “Qualitative Case Studies”. The Sage Handbook of Qualitative Research. 3rd ed. Eds. N.K. Denzin and Y.S. Lincoln. Thousand Oaks, CA: Sage, 2005. 433-466. Staniszewski, Mary Anne. The Power of Display: A History of Exhibition Installations at the Museum of Modern Art. Cambridge, MA: MIT Press, 1998. Sullivan, Graeme. Art Practice as Research: Inquiry in Visual Arts. Thousand Oaks, CA: Sage, 2010. University of Canberra. “Bachelor of Heritage, Museums and Conservation (215JA.2)”. Web. 27 July 2015. Ventzislavov, R. “Idle Arts: Reconsidering the Curator.” The Journal of Aesthetics and Art Criticism 72.1 (2014): 83–93. Verschuren, P. “Case Study as a Research Strategy: Some Ambiguities and Opportunities.” International Journal of Social Research Methodology 6.2 (2003): 121–139. Webb, Jen, and Donna Lee Brien. “Preparing Graduates for Creative Futures: Australian Creative Arts Programs in a Globalising Society.” Partnerships for World Graduates, AIC (Academia, Industry and Community) 2007 Conference, RMIT, Melbourne, 28–30 Nov. 2007. Webb, Jen, Donna Lee Brien, and Sandra Burr. “Doctoral Examination in the Creative Arts: Process, Practices and Standards.” Final Report. Canberra: Office of Learning and Teaching, 2013. Yin, Robert K. Case Study Research: Design and Methods. Thousand Oaks, CA: Sage, 2013.

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). 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[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). AAMC. https://students-residents.aamc.org/fee-assistance-program/fee-assistance-program-fap [27] Nguyen, M., Desai, M. M., Fancher, T. L., Chaudhry, S. I., Mason, H. R. C., & Boatright, D. (2023). Temporal trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income, 2014-2019. JAMA. https://doi.org/10.1001/jama.2023.5654 [28] Ramirez, et al. (2021). [29] Ko, M. J., Henderson, M. C., Fancher, T. L., London, M., Simon, M., & Hardeman, R. R. (2023). US medical school admissions leaders’ experiences with barriers to and advancements in diversity, equity, and inclusion. JAMA Network Open, 6(2), e2254928. https://doi.org/10.1001/jamanetworkopen.2022.54928 [30] Johns Hopkins University School of Medicine. (n.d.). JHU CSM SIP. Johns Hopkins Initiative for Careers in Science and Medicine - the Summer Internship Program. https://csmsip.cellbio.jhmi.edu/ [31] Figure 18. 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The Scots MPs of the eighteenth century have traditionally been portrayed in a negative light. In a century once noted for electoral corruption and the abuses of patronage, they were seen by contemporaries and later writers as among the worst examples of their kind: greedy, self-seeking, unprincipled ‘tools of administration’ whose votes could be bought with the offer of places and pensions. Lewis Namier’s seminal work exposing the cynical approach to politics of MPs generally, sparked a backlash which has produced a more balanced evaluation of English politics. Strangely, although Namier exonerated the Scots MPs from the worst of the charges against them, his less judgmental verdicts are found only sporadically in more recent writing, while the older viewpoint is still repeated by some historians. There is no modern study of the eighteenth-century Scots MPs, a situation which this research proposes to remedy, by examining the group of MPs who represented Scotland at Westminster between 1754 and 1784. It re-assesses the extent to which the original criticisms are merited, but also widens the scope by examining the contribution made by Scotland’s MPs, to British and Scottish political life in the later part of the eighteenth century. A study of the social make-up and the careers of this particular cohort provides the backdrop for the two main themes: the participation of Scots MPs in the legislative process, and their effectiveness as representatives of Scottish interests at Westminster. Existing biographical information has been supplemented by an examination of Parliamentary Papers, debates, and personal correspondence to enable further analysis of attitudes, in particular with regard to politics and political mores. The research explores issues of motivation, asking questions about allegiance, identity, perceptions of government, and how conflicts of interest were resolved, before presenting a conclusion which aims to offer a revised, broader, but more nuanced, assessment of this much-criticised group, based on more recent approaches to interpretation of the period.