Mandatory Microcomputers: Potential Effects on  Medical School Recruitment and Admissions*

Brian E. Mavis, Ph.D^*. and Jane M. Smith, M.A⁺

Abstract: To inform discussions about a proposal that required incoming medical students own a microcomputer, applicants accepted for admission to the College of Human Medicine at Michigan State University were mailed a survey which focused on microcomputer literacy, ownership and perceptions of a mandatory microcomputer proposal. The response rate was 79%. Two-thirds of respondents had access to a microcomputer at home; more had access at school. Microcomputer ownership ranged from 95% for respondents with graduate education to 28% for underrepresented minorities. Reactions to the proposal were mixed: male and graduate-educated respondents were most in favor whereas underrepresented minority respondents reported that such a policy would negatively influence their decision to attend our medical school. Cost was a concern for respondents independent of their support for the proposal. The results suggest that despite increased computer literacy, this proposal could undermine efforts to recruit a diverse matriculating class. Other computer-based innovations in medical school admissions will favor computer literate students.

    The GPEP Subgroup Report on Medical Information Science Skills¹ concluded that "the use of computer systems to help physicians retrieve information from the literature and analyze and correlate data about patients can be expected to grow." (p.13) A dozen years later, Smith’s review of the information needs of physicians found that experienced physicians used approximately two million pieces of information to manage patients, and that with the current doubling time of the biomedical knowledge base of 19 years, a physician can expect a fourfold increase in available medical knowledge during a typical professional lifetime.² Such estimates imply that effective and competent medical practice require physicians to continually update and reevaluate their own medical knowledge. Although historically this has been facilitated through textbooks, journals and conferences, in daily practice these modes of information transfer are far from ideal: textbooks quickly become dated and journals often have a low yield of information of immediate interest.² Physicians of all specialties have been exhorted to become more knowledgeable about electronic resources available to them.^3,4,5,6,7 While health care administrators and financial managers have been quick to adopt computer technology, physicians in clinical practice have made comparably little use of computers to manage information.⁸

    The GPEP report challenged educators to provide opportunities for both students and faculty to acquire the technical skills necessary to effectively use electronic resources in medical practice. The response to this challenge has been variable. A 1990 survey of medical schools found rapid growth in the number of microcomputers available for student use in the five years since the prior survey.⁹ Most medical schools reported at least one microcomputer for every 20 students, although student-to-computer ratios ranged from 4 to 150 medical students per microcomputer. PC-type microcomputers accounted for about 70% of those available to medical students, with Macintosh computers accounting for most of the rest.

    The increased availability of microcomputers in medical schools runs parallel to the increased computer literacy of medical students. A 1985 survey of medical students at one medical school revealed that students experienced with microcomputers prior to medical school were much more likely to use them while in medical school.¹⁰ Medical students valued computers for telecommunications and word processing, though few were interested in their use for office management or database purposes. However, at that time at least one-in-three students reported no computer experience prior to medical school, comparable to the findings reported for another medical school.¹¹ A more recent survey of first, fourth and sixth year medical students at one Australian medical school documented an increased exposure to computers. Ninety-two percent of first year medical students reported previous exposure to computers compared to 81% of sixth year students. First year medical students had greater computer skills than sixth year students: men were found to be more computer literate than women.¹² These studies highlight the changing role of computers in the education and lives of medical school matriculants.

    This increase in computer literacy among students entering medical school and increased computer resources within medical schools has evolved against a back drop of increasingly sophisticated computers and associated technology. From an infrastructure perspective, this has created a fundamental dilemma for organizations investing in computer-based technologies: the speed of technological advances has accelerated the obsolescence of existing microcomputer hardware and software.⁹ While on one hand recognizing the curricular potential of microcomputer technology and their role in educating physicians prepared for life-long learning, the costs of maintaining computer hardware, software and other necessary support has significantly increased. For this and other reasons some medical schools have considered policies requiring incoming medical students own a microcomputer.

    Issues regarding mandatory computers in medical school mirror those faced by undergraduate institutions.¹³ Requiring matriculating students to own microcomputers shifts hardware costs from the medical school to the student; if the microcomputer is a requirement the expense can be included within the financial aid package. A microcomputer requirement could be used as a means to dictate a uniformity in computer system configurations as well as signal to students the importance of computer technology in medical education and practice. Facilitating the use of microcomputers by medical students also serves as an incentive for faculty to maintain current computer skills as well as to consider computer-based resources and innovations to supplement the curriculum. For community programs, access to computer networks can provide a means of helping students maintain contact with both faculty and other students, as well as provide a link with electronic resources not readily available in some community settings.

    In an effort to inform faculty deliberations at our medical school, the Office of Admissions sponsored a survey to determine how student recruitment might be affected by a computer requirement. Additional issues related to student experience with microcomputers and current computer ownership were examined.

Method

    Survey Development - Survey items were developed by the first author for each of four main areas of interest: frequency of microcomputer use (4 items), microcomputer ownership (2 items), perceptions regarding the proposal for a microcomputer requirement (4 items), and respondent characteristics (5 items). The draft survey then was reviewed by a university-affiliated computer consultant and a physician knowledgeable about computers. Afterwards, the revised survey was pilot tested by three second-year medical students. Their comments were used to create the final survey form, which was printed in a four page booklet format.

   Respondent Sample - As is common in medical school admissions, more students were admitted than were expected to matriculate. Students accepted for admission (N=143) received a mail survey during spring semester, three months prior to the beginning of the academic year. A self-addressed postage-paid envelope was included for respondents to return the survey. Non-respondents received a follow-up mailing approximately 30 days after the initial mailing. Participation was voluntary: 113 surveys were received (79%). Approximately 20% of the survey respondents did not subsequently matriculate at this medical school.

Results

    Respondent Characteristics - The mean age of the respondents was 24.8 years; they were divided equally between men and women. Underrepresented minority (African American, American Indian, and Hispanic) respondents comprised 25% of the sample. This profile of respondents was similar to the demographic characteristics for the subset of students who subsequently matriculated: they had a mean age of 25.3 years, 51% were female, and 31% were underrepresented minority. Eighteen percent of the respondents accepted to medical school had a graduate or professional degree. Respondents reported using microcomputers for an average of 7.4 years, with a range of 2 to 16 years (Table 1).

    Microcomputer Use - Approximately 70% of respondents had access to a microcomputer at home: a slightly larger proportion had access through their academic institution. Only 5% of respondents had not used a microcomputer in the last month. Underrepresented minority respondents were least likely to report frequent microcomputer use whereas two-thirds of respondents with a graduate degree reported daily microcomputer use. Respondents were divided in half regarding their preference for IBM compatible (PC) versus Macintosh systems, although differences for various subgroups of respondents (Table 1) were evident. Almost all respondents (>95%) indicated that they used microcomputers for word processing. Over half of the respondents used microcomputers for electronic mail (68%), bibliographic searching (52%) and games or entertainment (52%). Computer use for word processing, electronic mail and bibliographic searching was the same for both owners and non-owners of microcomputers, however computer owners were more likely to report using microcomputers for games and entertainment (70%) than were non-owners (38%).

    Microcomputer Ownership - Microcomputer ownership ranged from 95% for respondents with a graduate education to 28% for underrepresented minority respondents. Having microcomputer access elsewhere (48%) and not being able to afford one (48%) were the two reasons most often given by non-owners. Among respondents who did not own a microcomputer, most (60%) would purchase a PC system over a Macintosh system.

    Proposed Microcomputer Requirement - Almost half (44%) of the respondents indicated that a mandatory microcomputer policy would not influence their opinion of the medical school: 36% indicated that it would be a positive influence and 20% a negative influence. Male and graduate-educated respondents were most likely to see the requirement as a positive influence whereas underrepresented minority students more often viewed the proposed policy as a negative influence. Underrepresented students also were most likely to report that the requirement would negatively influence their decision to attend this medical school.

    When asked if the proposed microcomputer requirement was reasonable, almost two-thirds rated it reasonable or very reasonable. Again, male and graduate-degree respondents were most likely to view it as reasonable while over half of underrepresented minority students thought it unreasonable. Among respondents who provided additional written comments on their surveys (N=51), 53% indicated that cost issues were a concern regardless of whether or not they supported the microcomputer requirement.

Conclusions

    Clearly we have witnessed a dramatic increase in computer literacy among incoming medical students in the past ten years.¹⁰ While Bresnitz and colleagues found that 42% of medical students had no experience with computers prior to starting their medical education, all of the current respondents reported some prior level of computer experience; only 2% had not used a computer in the past year. A comparable rate of computer use has been reported in another recent survey.¹⁴ Not only has the likelihood of computer use increased dramatically, the ways in which computers are used has changed. A decade ago, Bresnitz et al. found that most experienced computer users (46%) encountered computers for programming in FORTRAN or some other language, as well as research (25%) or word processing (30%). Among current respondents, 97% reported using computers for word processing whereas only 6% used them for programming purposes. Ten years ago, medical students anticipated greater use of computers for word processing and telecommunications, the two main uses reported by current respondents. Despite this increased literacy, there remains a continued need for computer-based educational experiences specific to medical education and medical practice. Medical students, while quick to adopt computers for literature searching and word processing, have been less interested in computer applications for office management and practice enhancement, perhaps in part due to the relative lack of computer training physician faculty have received. Most faculty were trained in the era of computers described by Bresnitz et. al., if not earlier. Given that most medical students have some mastery of basic microcomputer applications prior to entering medical school, they might now be more receptive to learning applications that more specifically enhance their practice of medicine. The question remains as to whether requiring in-coming medical students to own microcomputers will facilitate this process.

    There are a number of possible motivations underlying the adoption of a computer requirement for medical students. If the requirement is enacted with the hope of improving the academic performance of medical students, other studies provide evidence to suggest that any gains in achievement are more likely associated with socioeconomic factors than computer ownership specifically.^15,16 Such a policy will likely do little to help medical schools offset the costs of maintaining computer labs, since the variable experiences and resources reported by students implies that medical schools will continue to be faced with demands for instructional, software, hardware and network support. In addition, students required to purchase and maintain a microcomputer will likely be dissatisfied if appropriate educational and clinical goals supporting the implementation of a technology requirement have not been well articulated. For these reasons, the value of a mandatory microcomputer ownership policy as an end in itself is questionable.

    Among underrepresented minority respondents, the negative perceptions and relative inexperience with microcomputers challenge medical schools engaged in efforts to increase minority enrollment and/or committed to increasing the degree of computer literacy among medical students. Underrepresented minority respondents had access to microcomputers comparable to that of other respondent groups, but reported a lower rate of computer ownership. This suggests that with adequate access to microcomputer resources ownership was less a concern for these respondents. As medical schools consider requiring microcomputer ownership, this may differentially impact underrepresented minority students, as supported by the negative opinions expressed by underrepresented minority students regarding possible ownership policies. The increased debt load associated with microcomputer ownership was a prevalent concern for all respondent subgroups independent of support they voiced for the policy. The salience of the cost concern might be reduced if computer ownership is made mandatory, since the cost could then be included as part of students’ financial aid package.

    These findings have obvious implications for medical school recruitment. Applicants will need specific information about how the costs can be incorporated into their financial aid package to reduce their negative perceptions of the policy. Some students do not see obvious benefits associated with the policy and due to their limited experience will need more than an ownership requirement to motivate them to make significant use of the technology. Special efforts might be needed to maintain non-computer users in the medical school applicant pool, lest they be scared away by the mandatory microcomputer policy itself. As more medical schools move towards paperless admissions procedures and the use of the World Wide Web for recruitment and public relations, these innovations will favor computer literate students and could act to undermine efforts to recruit diverse applicants. One solution might be to require incoming students to have their own computer. Alternatively, it is very likely that medical schools will consider expanding their admission requirements to assure some baseline level of computer proficiency prior to matriculation.

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Dr. Mavis is an assistant professor in the Office of Medical Education Research and Development. Ms. Smith is the Director for Admissions/Alumni.

Address all correspondence to:

mavis@pilot.msu.edu

Reference:

Mavis BE, Smith JM. Mandatory microcomputers: Potential effects on medical school recruitment and admissions. Med Educ Online [serial online] 1997;2,5. Available from: URL http://www.Med-Ed-Online.org.