Representation matters: shaping future medical enrichment and pipeline programs for students in a post-pandemic world

The COVID-19 pandemic significantly limited access to Science, Technology, Engineering, and Mathematics (STEM) pipeline and enrichment opportunities for all students, but the impact was particularly profound for those historically underrepresented in these fields. These students often face structural barriers such as limited prior exposure to STEM, fewer mentorship opportunities, and socioeconomic challenges that restrict entry into STEM pathways. Given these barriers, securing continued access to pipeline programs during the pandemic was especially critical to maintain equity in STEM education. To contribute to the growing research base focused on evaluating the effectiveness of virtual and/or hybrid STEM enrichment programs, our team conducted a retrospective cohort study of a hybrid program led by the senior author, and hosted by the University of California Los Angeles (UCLA) Department of Urology and the Ernest Everett Just Youth Science Program by the Bridge Builders Foundation in February 2022. In this program, twenty-four middle school and high school students participated in three separate 45-min interactive virtual lectures focused on general anatomy, the cardiovascular system, and the gastrointestinal system, along with an in-person dissection lab. Pre- and post-program surveys were completed by the students to assess their confidence in their abilities, their attitudes toward medical careers, and if they felt the medical field had a place for people of their background. Of the 24 participants, 63% identified as Black or African American and 16% identified as Latinx or Hispanic. Following the program, there were no statistically significant differences in students perceptions of their academic abilities or connectivity with physicians and medical students. However, there were noticeable differences in students’ survey responses, as well as in their excitement during the program. In the post-COVID-19 era, medical school programs and STEM programs focused on medicine should consider fully virtual and hybrid medical enrichment initiatives as a medium of positively encouraging middle school and high school students to pursue careers in medicine.

Introduction

Black, Indigenous, and People of Color (BIPOC) communities are growing rapidly and are projected to make up a 32% of the population by the year 2060 (Vespa et al., 2018). Yet, only 5.8% of physicians identify as Hispanic, 5.0% identify as Black or African American, and 0.3% identify as American Indian or Alaskan Native (Association of American Medical Colleges, 2019, 2021; Ortman and Guarneri, 2009). A key driver of this disparity may be the systemic inequity in educational opportunities that BIPOC students can encounter as early as childhood (Hill et al., 2021; Murray-García and García, 2002). Pipeline and early-enrichment programs serve as one approach to addressing these inequities by providing students with exposure to the field of medicine, expanding access to mentorship, and providing insight into the academic journey of becoming a physician.

Significant strides have been made to create STEM enrichment programs targeted specifically toward middle and high school students. One of the most prominent examples of this effort is University of Arizona’s iSTEM (Innovative Hybrid Program for Diversifying and Building Capacity in the STEM and ICT Workforce) program, which combined in-school mentoring with informal, out-of-school learning experiences for Native American and Hispanic students in grades 3–8 (iSTEM (University of Arizona Sirow), n.d.). iSTEM leveraged community members, local college students and STEM professionals to deliver learning sessions. Although this program did not contain a virtual component, it demonstrated how the integration of health-related STEM themes can build confidence and sustain interest among BIPOC youth to potentially increase their chances of joining the STEM workforce. Finally, it shined a light on culturally relevant exposure and mentorship amongst BIPOC communities.

In the wake of the COVID-19 pandemic, fully virtual and hybrid STEM enrichment and pipeline programs have emerged as vital tools for engaging students, especially in medicine related career pathways. One prominent example is Case Western Reserve University School of Medicine’s creation of a fully virtual biomedical research immersion program for high school students in the peak of the 2020 COVID-19 pandemic (Qua et al., 2021). Although previously an in-person program, the virtual adaptation demonstrated that despite the absence of hands-on lab experience, students could gain significant knowledge of laboratory techniques and feel newfound connections to medical professionals. High levels of satisfaction were reported from both sides of participation, with 90% of students noting the program met their expectations and 97% of faculty reporting improvements in students’ scientific knowledge.

Moreover, because BIPOC students are disproportionately affected by socioeconomic disadvantages compared to their White peers, adapting STEM programs into hybrid or fully virtual formats offers a mechanism to reduce potential geographical barriers that impede access to STEM exposure (National Center for Education Statistics, 2019; NYU Metro Center, n.d.). With this in mind, we created a hybrid STEM enrichment program for middle school and high school students living in Los Angeles, California.

The cohort of participants in this hybrid program were evaluated to assess the program’s effectiveness in improving students’ self-perceptions and academic capabilities. By assessing the effectiveness of this program, we aimed to contribute to the growing knowledge base that supports virtual and hybrid STEM programs for students.

Materials and methods

Participants

The participants of this initiative included students enrolled at nine middle schools and high schools across seven school districts in Los Angeles County. Inclusion criterion was enrollment in middle school or high school during the program period.

Program logistics

The program was led by three fourth-year medical students (MR, PD, RT) and two urologists from communities historically underrepresented in medicine. Each medical student developed and delivered an interactive lecture. One of the urologists (KS) reviewed the content of these lectures, while both were virtually present during the lectures. All program leaders were involved in developing a 1-day curriculum that consisted of three separate virtual 45-min interactive lectures on basic anatomy, the cardiovascular system, and the gastrointestinal system. After each lecture, participants were asked to work as a team to answer post-lecture knowledge check questions. Upon completion of the lectures, participants then attended a separately scheduled 2-h in-person anatomy dissection lab. A retrospective cohort study was conducted in February 2022 to assess the results of the hybrid program. Our team implemented the Four-Level Kirkpatrick Training Evaluation Model to evaluate the program’s usefulness, ability to educate the participants, and success in encouraging participants to consider medicine as a future career (Figure 1; Kirkpatrick, 1994). Our study focused on the “Reaction” and “Learning” levels.

FIGURE 1

Figure 1. The Kirkpatrick Evaluation Model (Churavy, 2025).

Analysis of outcomes

Participants were asked to complete a pre- and post-program survey. The pre-program survey included questions (Figure 2) about the students’ demographics, attitudes toward pursuing a career in medicine, and whether they felt a sense of belonging in the medical field. Excluding demographic questions, the post-program survey asked the same questions as the pre-program survey to participants, in addition to asking if the students enjoyed the hands-on dissection lab. The Likert Rating Scale was employed to quantify the participants’ responses.

FIGURE 2

Figure 2. Survey question asked to the students before (1, 2, 3 and 5) and after the hybrid program.

All statistical analyses were performed using Microsoft Excel Version 16.60’s data analysis ToolPak tool. The Wilcoxon signed-rank test was used to compare pre-program and post-program survey results. P < 0.05 signifies statistical significance. Mean Likert ratings were also collected for pre-program and post-program survey results. Data analysis and manuscript writing was undertaken by an additional two medical students (MM, NF). Manuscript editing undertaken by the study lead (KS).

IRB statement

This study fulfills criteria for exemption by the Institutional Review Board of the University of California, Los Angeles. No informed consent was required for completion of this study.

Results

A total of 24 students participated in the hybrid STEM enrichment program with an 87.5% (21/24) post-program survey response rate. Three-fourths of the participants were middle schoolers (18/24), and the remainder were high-school students (6/24) (Figure 3). Approximately 63% of students identified as Black/African American (15/24) and 17% identified as Latinx/Hispanic (4/24). Women represented 38% of all participants (9/24).

FIGURE 3

Figure 3. Demographics of Bridge Builders program participants (n = 24). 21/24 students completed the survey. 1/24 students did not identify their gender.

Immediately following program participation there was a noticeable increase in participant’s belief that they could pursue a career in medicine if they decided to, with a pre-program and post-program mean Likert rating of 2.33 and 3.10, respectively (p = 0.04) (Figure 4). In addition, participants reported that they had gained physicians they could reach out to for advice, reflected by an increased mean Likert rating of 2.16 pre-program to 2.90, (Figure 4). Although there were differences in the pre-program and post-program mean Likert ratings, overall, there were no statistically significant changes in students’ beliefs.

FIGURE 4

Figure 4. Post-program Likert survey results.

Discussion

This retrospective cohort study demonstrated that participation in a hybrid STEM enrichment program was beneficial in BIPOC middle school and high school students’ belief that they could pursue a profession in medicine. Moreover, the program increased their belief that they had built relationships with medical professionals whom they could approach for guidance. Although modest, these discoveries highlight the necessity of such STEM enrichment programs which act as an apparatus to both demystify STEM careers, such as being a urologist, and introducing students to mentors from similar backgrounds who have traversed the STEM pathway.

Long-standing structural inequities in the U.S. health system continue to drive persistent poor health outcomes for Black and Brown communities. Zhao et al. (2024) reported that Black patients receive inferior care compared to their White counterparts in domains such as heart disease, cancer, maternal health, pain management, and surgery. Additionally, Zhao et al. (2024) as well as Artiga et al. (2024) reported that Black infants experience more than twice the infant mortality rate of White infants.

Moreover, these inequities are present both intrinsically and extrinsically. Extrinsic inequities are more readily visible and include factors such as chronic underfunding of safety-net institutions, geographic barriers to care, and institutional policies that can perpetuate unequal access (Artiga et al., 2024; Zhao et al., 2024). In contrast, intrinsic inequities are more insidious, they are entrenched within the culture and daily practices of medicine, ranging from implicit biases and stereotyping to cultural insensitivity which stymies the patient provider relationship (FitzGerald and Hurst, 2017; Gonzalez et al., 2024). Diversifying the physician workforce may be among the most effective solutions. Greater representation increases cultural competence and helps shift the dominant culture of medicine toward one that more equitably serves the most vulnerable (Stanford, 2020; Gomez and Bernet, 2019). Pipeline programs serve as one of the most promising avenues to achieve this diversification by fostering early exposure, mentorship, and sustained support for BIPOC students interested in medicine. Not only has previous research called attention to the need for the creation and expansion of STEM enrichment and pipeline programs, but it has also emphasized that mentorship and community involvement from individuals of a similar background can act as a shield against institutional barriers. Houston et al. (2020) highlights that institutional barriers, ranging from decreased access to college preparatory classes, to underrepresentation in more rigorous courses, pose important risks to the long-term achievements of BIPOC students and is successfully countered by ardent support from community members. Our retrospective cohort study findings show that even a brief hybrid STEM enrichment program can strengthen students’ self-perceptions, and foster meaningful relationships with professionals from similar ethnocultural backgrounds.

However, the research findings of this initiative were not found to be significant. By the conclusion of the program, students’ perceptions of their capacity to succeed in difficult science classes, their interest in becoming medical professionals, and their access to college or medical student mentors remained statistically unchanged (Figure 5). Due to the short duration of our initiative, our null findings align with the broader literature which suggests that STEM pipeline programs geared toward BIPOC individuals find more pronounced success when the programs are long-term and provide continuous positive reinforcement (Valla and Williams, 2012). Additionally, program duration acts synergistically with other critical components such as peer-to-peer support, cultural attunement, increased academic vigor, and access to mentorship (Valla and Williams, 2012).

FIGURE 5

Figure 5. Wilcoxon signed-rank test of student attitudes before and after completion of the hybrid enrichment program.

Moreover, the COVID-19 pandemic was a paradigm-shifting event that normalized meaningful interactions in virtual spaces–a medium that had previously been underutilized in education. Hence, in the wake of the COVID-19 pandemic, virtual educational mediums became a highly valuable resource in minimizing geographical and scheduling barriers often faced when attempting to connect students with professional mentors. Regarding medicine-related mentorship specifically, research by Winderbaum et al. (2024) highlighted that busy clinical schedules and limited protected time constrain a physicians ability to mentor others, even if they are eager to do so. Thus, by lowering geographical and logistical barriers, virtual events enable increased physician participation, which in turn increases the benefit that students receive.

However, the use of virtual events must be weighed against persistent inequities in digital access. Although broadband and device availability improved during the COVID-19 era, continued access remains uneven, with students from low-income and rural backgrounds more likely to experience unstable connections or limited devices (ACT, 2024; Hampton et al., 2022; Schachner et al., 2025). Without deliberate attention to these disparities, fully virtual programs risk reproducing the very inequities they aim to address.

Furthermore, research by Satyam and Fulk (2024), revealed that by exposing students to medical education via preparatory coursework and simultaneously placing medical students to foster conversation about how to navigate difficult coursework, a foundation of self-assurance and confidence to consider pursuing medicine builds in the program participants. These findings align with other research studies that call attention to the importance of who delivers mentorship, and not just how it is delivered. Specifically, the Equity Ethic emphasizes that affirming students’ racial identities can cultivate a commitment to use STEM careers as means of uplifting their communities (McGee et al., 2021). Thus, by integrating BIPOC mentors and role models into STEM enrichment programs, as well as sessions about the importance of representation in such fields, students may come to recognize medicine as a means of advancing equity and contributing to the betterment of their community. Our team theorizes that embedding these types of discussion within future program designs will significantly motivate students to pursue STEM careers.

While our study findings open a gateway to further opportunities for BIPOC students, the study’s limitations must be considered.

Limitations

This retrospective cohort study was severely limited by its small sample size, lack of a control group, reliance on immediate post-intervention survey outcomes, lack of longitudinal follow-up, and potential participant self-selection bias. Participant self-selection bias likely influenced results, as students who chose to participate may already have been more inclined to pursue STEM or medical, in comparison to their peers who did not attend. Prior research has acknowledged that students who gravitate toward STEM enrichment and pipeline programs have a higher baseline and familiarity with the field (Miller and Sonnert, 2018; Stake and Mares, 2005).

Due to this potential self-selection bias, the generalizability of this study’s findings is limited. Additionally, the sample size decreases the statistical power. Finally, students may have experienced social desirability bias given the hierarchical dynamics of working with physicians and medical students. Prior research shows that individuals often adjust their responses in the presence of authority figures to align with perceived expectations (Adams et al., 1999; van de Mortel, 2008). Therefore, it cannot be dismissed that a percentage of student survey responses, such as those reflecting motivation to engage in mentorship or the belief that they can pursue medicine, may have been skewed toward affirmative responses to present themselves more favorably to program facilitators. Future research should include examining long-term outcomes in larger cohorts to enhance the reliability and generalizability of our study’s findings. Studies are needed to evaluate the long-term impact of hybrid STEM enrichment programs led by BIPOC physicians and medical students on participants’ attitudes and their sustained pursuit of STEM and medical careers.

Conclusion

This initiative illustrates the promise of hybrid STEM enrichment programs for BIPOC middle school and high school age students. Participation was associated with increased confidence in pursuing medicine and improved access to mentorship, underscoring the value of culturally attuned role models in shaping student attitudes. As STEM education and community outreach evolve in the post–COVID-19 era, hybrid formats should not be viewed as temporary substitutes but as enduring opportunities to expand access, foster identity development, and connect students with mentors who might otherwise be inaccessible. Future research should evaluate larger cohorts, utilize prospective and longitudinal designs, and examine how mentorship led by BIPOC physicians and medical students influences students’ long-term pursuit of medical careers.

Data availability statement

The original contributions presented in this study are included in this article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by UCLA Institutional Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. Informed consent was not required, however written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

Author contributions

MM: Writing – review & editing, Data curation, Visualization. MR: Writing – original draft, Writing – review & editing. NF: Writing – review & editing. RT: Writing – review & editing, Data curation, Conceptualization. KS: Writing – review & editing, Writing – original draft.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Acknowledgments

We wish to thank Stanley Frencher for his work in the teaching of the educational information.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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