![]() OnlineMedEd is an asynchronous learning platform, purposefully built to support self-regulated learning. UAB students were given access to OnlineMedEd to support their experiential learning on clinical rotations. To address the need for additional support, in 2017 UAB sought an educational technology partner to support its students during the clinical phase (Year 3 and 4) in preparation for the USMLE Step 2 CK exam. Consequently, providing additional support for rural students becomes an urgent and necessary move to ensure student success. Students with a USMLE exam failure may not match to a residency program at all- leading to expensive gap years, re-application fees, and even abandoning the pursuit of medicine altogether. In this new environment, students at risk for poor standardized test performance face the possibility of limited choices for post-graduate residency training. The weight of the USMLE Step 2 CK score is set to further increase for initial residency applicant screening, individual competitiveness for certain specialties, and interview selection across all disciplines, as the previous number-one factor cited by program directors in 2020, the USMLE Step 1 score, is now only reported as pass/fail. Why are standardized test scores so important? In the 2020 National Residency Matching Program Director survey, a candidate’s USMLE Step 2 CK score was highlighted as a highly influential factor for program directors’ selection of candidates for interviews (12). Students from rural backgrounds were entering UAB with an academic disadvantage that, despite having access to the same core curriculum as the rest of the student body, seemed to be persisting through clinical rotations. However, a pre-matriculation gap of approximately thirteen percentile points existed between the mean MCAT score of UAB’s students from rural backgrounds compared to students from non-rural backgrounds. Research demonstrates that Medical College Admission Test (MCAT) scores predict future performance on standardized tests in medical school (10,11), and indeed, internal data at UAB revealed that for every percentile increase in pre-matriculation MCAT score, there was an associated increase in mean USMLE Step 2 CK performance during the 3rd year of medical school. As such, the school aims to recruit students from diverse socioeconomic backgrounds, including from rural and underserved areas. The University of Alabama Heersink School of Medicine (UAB) is a mission-driven, state-funded medical school with a primary institutional goal to improve health disparities across the state by adding more physicians to its areas of greatest need. ![]() Rural Students and the University of Alabama Heersink School of Medicine Schools need practical tools to support the development of rural and other non-traditional applicants. Due to the academic challenges facing these students, medical schools in the United States must build up academic support systems to ensure rural students are successful through medical school and beyond. Once matriculated, a student’s race, socioeconomic status, and rural student background are known to be associated with poor academic and standardized test performance (4-9). However rural students remain underrepresented in medical school (2) and challenges persist for many who do enroll. ![]() As the strongest predictor for medical students eventually returning to practice in a rural area is to have themselves grown up in a rural area (2, 3), many schools of medicine in the United States are working to increase enrollment of students from rural areas. There is a well-documented need for more physicians practicing in rural areas. This geographic maldistribution of physicians within the US is thought to be one of the drivers of disparities in health outcomes for residents of rural areas. While 15-20% of the population in the US lives in rural areas, only 11% of physicians practice in rural or underserved counties (1). A 2017 study from the Centers for Disease Control showed that Americans living in rural areas have a significantly high risk of death from chronic diseases such as heart disease, cancer, chronic lower respiratory disease, and stroke (1). ![]()
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