Academic Support Services in U.S. and Canadian Medical Schools

^*Assistant Dean for Educational Programs
UMDNJ-Robert Wood Johnson Medical School

^†Director, Office of Academic Development
UMDNJ - New Jersey Medical School

Abstract: Background: Academic support services play a critical but largely undocumented role in helping medical students meet the challenges of the curriculum.
Purpose: To determine the prevalence of academic support programs in medical schools,
and to find out how these are conceptualized and implemented.
Methods: Questionnaires were sent to medical schools in the US and Canada. Questions addressed specific services, providers, and funding.
Results: The survey was returned by 86 of the 135 (67.7%) schools. Almost all (95.3%) provide academic support in the first two years, and a large majority in third (82.6%) and fourth (79%) year. Great variability exists in the infrastructure and funding of the programs, and in the training of the providers.
Conclusions: Academic support is common, but has broad interpretation; services are varied. Programs are conceptualized differently, some to provide specific assistance to pass courses, and others for skill development, to enhance self-directed, life-long learning.

Keywords: academic support, medical students, student counseling, medical education

     Academic support services within medical schools play a critical but largely undocumented role in helping medical students meet the challenges of the undergraduate medical curriculum and in helping institutions accomplish their educational mission. Approximately sixty-two percent of the students surveyed in the 2003 Association of American Medical College’s (AAMC) Graduation Questionnaire indicated they were satisfied or very satisfied with the “academic counseling” available to them, and 56% were satisfied or very satisfied with the “tutorial help.” The specific role and impact of academic support services on academic achievement and on quality of life remains unclear. Medical schools have an immediate interest in fostering student academic success to facilitate timely progression through courses, clerkships and licensure examinations, to increase graduation rates, and to educate medical students as future physicians to become effective self-directed learners. It is important that we begin to better understand the role academic support services play in promoting effective learning.

     Some aspects related to academic support have been discussed in the literature. Several studies addressed the importance of academic support in matriculating and retaining underrepresented minority students.^1,2,3 In 1989, a survey of student-directed services at AAMC member schools found that 75.8% of those who responded offered peer tutoring programs. ⁴ A survey conducted in 1997 asked about the prevalence of services provided for students with learning disabilities. Formal support programs for learning disabled students were reported in 71 schools (67.6%) and tutoring was listed as an accommodation in 98 (93.3%).⁵ In 1999, a specific program for medical students at risk for academic failure at the University of Michigan was described.⁶ However, we found that national data about the role of academic support services in medical education are lacking.

     As direct providers of academic support to medical students, and as experienced administrators of these programs, we wondered how academic support services were conceptualized at other medical schools. We anticipated that the focus and structure of academic support services at different schools would vary according to institutional needs, priorities, and available resources. Our goal was to determine the prevalence of academic support programs in medical schools, and to find out how these programs are conceptualized and implemented.

Methods

     In October, 2000, an author designed survey was mailed to 39 medical schools in the Northeast Region of the Association of American Medical Colleges (AAMC). The survey asked questions about what academic support services were provided, the qualifications of those who provide services, and about funding. Several types of questions were asked: those with short checklists, e.g., “Check all that apply,” questions that required a “yes” or “no” response, questions which required open-ended responses, e.g., “What is the total yearly cost for your tutoring program?”, and those that asked for descriptive answers, e.g., “Please describe…”, “Please explain…”, “What training do you offer?”, etc. In February, 2001, we wished to expand the sample and decided to revise the survey, deleting items that did not seem to offer interpretable responses, and adding four additional questions regarding specific services for students diagnosed with learning disabilities, degree status and training of providers, student access, and confidentiality. (Both versions of the survey can be viewed in the Appendix of this article.) The revised survey was sent to an additional 96 AAMC member schools in the United States and Canada, for a total of 135 surveys distributed. All surveys were sent to the attention of the Dean of Student Affairs at each medical school listed in the May, 2000 AAMC Group on Student Affairs (GSA) Directory of School Representatives United States and Canada. We maximized the response rate by first contacting school representatives by email and re-sending the survey to those who had not responded. Follow-up phone calls were then made to non-respondents after the second mailing.

Results

     Eighty-six surveys (63.7%) were returned. The surveys were completed by the Dean of Student Affairs at each school or a designee. Responses were received from 31 of 39 medical schools in the Northeast region (79.5%); 55 of 96 responses (57.3%) were received from schools outside the region. Results are summarized in Table 1. (Since the revised February, 2001 survey was not sent to the original Northeast region schools, the answers to the additional questions are unfortunately missing from the 31 respondents as indicated.)

     Prevalence: Academic support is a widespread and sustained intervention for medical students in all four years, not just a means of providing short-term transition services to beginning medical students. Almost all (95.3%) medical schools report providing academic support to students in both the first and second years. A large majority of schools provide academic support to students in the third (82.6%) and fourth years (79.0%) as well.

     Specific Services and Providers: The term academic support is interpreted broadly, and the types and range of services provided are varied. Seventy-nine percent of the respondents reported that academic support was offered by academic departments, and consisted primarily of content review sessions and 1:1 faculty/student tutoring. Special preparation programs for the United States Medical Licensure Examination (USMLE) were offered in 52.3% of the schools. Services for students with learning disabilities (LD) were reported by 56.4% of the respondents.

     Although it is difficult to identify the importance placed on the provision of academic support services within an institution, the presence of a recognized and designated office, with secretarial/administrative staff, is likely significant. Although 68.6% of the schools offered academic support through the Office of Student Affairs, 45.3% reported that there was a specific designated office that provided academic support services to students. Many names were reported for these offices, as shown in Table 2. Secretarial/administrative staff specifically designated to manage academic support services was employed in 45.3% of the schools.

     Another likely indicator of the emphasis placed on academic support is the presence of trained, knowledgeable providers. Of the 55 schools responding, 67.3% employ designated individuals to provide academic support. Of those providers, 36.4% have degrees in education at the masters level, while 14.5% hold doctorates in education. Ph.D. degrees were held by 43.6%, and 25.5% have M.D. degrees. However, only 21.8% of all the providers are trained in adult learning principles, and only 32.7% were described as having previous experience with college students. Of those schools that offered tutoring services, 74.4% employed medical students and 59.3% employed graduate students to provide the service. Although some respondents indicated that training was provided for tutors, this was not a widespread occurrence.

    How available are the academic support services to students and how comfortable do students feel about reaching out for support? Forty-four of 55 (80.0%) schools responding indicated that students are able to access academic support services directly, without a referral. Confidentiality for students seeking academic support was maintained in 30 (54.5%) of the 55 schools responding to this question.

     Funding: The costs of academic support programs were reported from no [separate line item] cost, to more than $100,000 per year. Funding came from three sources: the Dean’s Office, individual academic departments, and from grant support. Although some schools used volunteer tutors, one school reported paying tutors $80 per hour; most offered remuneration of between $10 and $15 per hour for tutoring. As a way to reduce costs, some schools require eligibility for tutoring, such as, low exam grades or a recommendation by a course director; others allow students to request a tutor on an as-needed basis. Only 24.4% of those responding limited the number of tutoring sessions available to students.

Discussion

     In sum, most medical schools profess to provide academic support to students. It is a common and seemingly acceptable intervention. However, academic support is defined in many different ways, and a range of services is offered. There is great variability in the administration of the offices that provide academic support services, the expertise of those providing services, and the extent of institutional support.

     There is difficulty in gauging the degree to which academic support services stress long term skill development (life-long self-directed learning) versus content boosting (tutoring), since both are often discussed in an intertwined manner. It might be assumed that academic support provided within an academic department would focus mainly on immediate academic success rather than on more generalized skills. Students may reach out for remedial academic support when academic difficulty is feared or realized. But the variability of the academic support services documented in the results of this survey suggest that some programs are perceived less as remedial and more as programs leading to professional enhancement. All medical schools must continue to retain and graduate students, and also to meet the current LCME Accreditation Standard that states: “The faculty should foster in students the ability to learn through self-directed, independent study throughout their professional lives.” It is increasingly important, therefore, that each school examine whether its faculty who provide academic support are prepared to meet this directive.

     We believe that comprehensive programs that provide both assistance with specific content (tutoring) and training in specific learning strategies (for life-long self-directed learning) should be promoted. Perhaps as more physicians receive formal training as educators, and more educators are trained in the area of medical education, this will become more the reality. Further study is needed to determine how different paradigms of providing academic support influence student success. Comprehensive academic support programs are likely to continue to play an important role in student retention and in promoting lifelong learning. It behooves us to learn more about these prevalent but loosely defined programs.

Acknowledgements

     The authors would like to acknowledge Robert Lebeau, Ed.D. for his critical review of this manuscript.

References

1. Tekian A. Attrition rates of underrepresented minority students at the University of Illinois at Chicago College of Medicine. Academic Medicine. 1998;73:336-8.
2. Shields PH. A survey and analysis of student academic support programs in medical schools focus: underrepresented minority students. Journal of the National Medical Association. 1994;86(5):373-7.
3. Wellington JS, Montero P. Equal educational opportunity programs in American medical schools. Journal of Medical Education. 1978;53(8):633-9.
4. Moore-West M, Hennessy A, Meilman PW, O’Donnell JF. The presence of student-based peer advising, peer tutoring, and performance evaluation programs among U.S. medical schools. Academic Medicine. 1990;65:660-1.
5. Faigel, HC. Changes in services for students with learning disabilities in U.S. and Canadian medical schools, 1991-1997. Academic Medicine. 1998;73:1290-1293.
6. Segal SS, Giordani B, Gillum LH, Johnson N. The academic support program at the University of Michigan School of Medicine. Academic Medicine. 1999;74:383-5.

Reference

Saks NS, Karl S. Academic support services in U.S. and Canadian medical schools. Med Educ Online [serial online] 2004;9:6. Available from medical schools. http://www.med-ed-online.org

Correspondence

Norma S. Saks, Ed.D.
Assistant Dean for Educational Programs &
Director, Cognitive Skills Program
Associate Professor, Department of Psychiatry
UMDNJ-Robert Wood Johnson Medical School
675 Hoes Lane
Piscataway, NJ 08854-5635

Voice 732-235-4129
Fax 732-235-5280
Email: saks@umdnj.edu