Premed Research Program: Impact on Physician Recruitment and Retention in an Underserved Community

Premed Research Program: Impact on Physician Recruitment and Retention in an Underserved Community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Premed Research Program: Impact on Physician Recruitment and Retention in an Underserved Community Lily Johnson, Kirra Borrello, Justin Abe, Andrea Siu, Chieko Kimata, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6159478/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Oct, 2025 Read the published version in BMC Medical Education → Version 1 posted 9 You are reading this latest preprint version Abstract Background Physician shortages are prevalent in medically underserved areas, where healthcare disparities hinder physician recruitment and retention. The Hawai’i Pacific Health (HPH) Summer Student Research Program (SSRP) provides early clinical and research experiences to pre-med students from Hawai’i, enhancing their qualifications, improving medical school acceptance rates, and expanding the pool of local students committed to practicing in Hawai’i. Objective To evaluate SSRP's impact on medical school admissions, career trajectories, and retention of healthcare professionals in Hawai'i, a medically underserved region. Methods A 38-year retrospective analysis examined 393 SSRP alumni (1986–2023), tracking educational and career outcomes, such as medical school admission, residency, and practice location, through surveys and internet research. Data compared early (1986–2002) and recent (2003–2023) cohorts. Results The program achieved a 73% medical school admission rate. Of 393 alumni, 221 became physicians, with 74 practicing in Hawai'i. Among those in training, 81% plan to practice locally. The program produced 57 abstracts, 43 posters, 53 oral presentations, and 37 peer-reviewed publications while providing students with clinical exposure and physician mentorship. Conclusion HPH SSRP successfully guides local students toward medical careers, with alumni medical school admission rates exceeding the national average by 30%. By increasing the number of local medical professionals committed to practicing in Hawai'i, the program helps address regional physician shortages. This community-based model may serve as a valuable framework for other underserved regions aiming to build a sustainable healthcare workforce. Physician retention physician recruitment pre-medical education student summer research program medically underserved healthcare disparities. Figures Figure 1 Figure 2 Introduction Training and retaining qualified healthcare providers in communities with significant healthcare disparities or remote geographical locations is challenging. 1 These distinct practice settings require a broad range of provider expertise but often have limited financial incentives for qualified providers with appropriate training. 2 Moreover, subspecialized medical care, an essential component of medical training, tends to centralize in dense urban areas, where there is higher quality and volume of medical training and easier access to academic centers. 3 As a result of this educational cycle, many young physicians build both personal and clinical relationships in urbanized areas and never return to their home communities. 4 This cycle inevitably leads to a deficit of qualified physicians in rural, resource-limited communities, which ultimately contributes to worsening healthcare disparities within those same underserved areas. If we hope to improve healthcare disparities in rural communities, we must diversify the outreach and impact of medical education by specifically recruiting students from within the same underserved communities. 5 Many promising physician candidates from rural and underserved areas hope to return to practice in those areas. 6,7,8,9 In order to gain the clinical and research experience required for medical school admission, many of these students benefit from summer educational or research programs. 10 Summer Student Research Programs (SSRPs) are immersive research programs designed for undergraduate students interested in pursuing a career in medicine. These programs are offered by large universities, many of which have strong academic affiliations with major medical institutions, which potentially contributes to the perpetual and problematic educational cycle. In contrast to the larger academic SSRPs, SSRPs have also been established in smaller communities with the stated goal of educating and retaining talented pre-med students from their own, often rural, communities. One of the most long-standing SSRPs is the program in Hawai‘i, which was established in 1986, 38 years ago. These community SSRPs differ from larger academic programs in two significant ways. First, they tend to lack the academic funding and mechanisms often associated with the success of such programs. Second, they enable undergraduates to engage with research in their home community during the summers of their undergraduate years. However, it is not known how much these SSRPs in smaller community-based health centers may contribute to physician retention in their rural areas. Given the differences in design and location between community and larger academically funded SSRPs, we were interested in assessing the impact of a longstanding community SSRP on the physician workforce distribution in an isolated community. In order to assess the impact of a long-standing community SSRP on long-term physician retention in our community, we conducted a review of the outcomes of this pre-med clinical immersion and research program. Herein, we review the outcomes over the 38-year period of the SSRP in Hawai‘i. We report the downstream impact of a community SSRP on medical education, residency training, and eventual physician recruitment and retention back into a community with significant healthcare disparities. Methods Description of the student immersion program The Summer Student Research Program (SSRP) at Hawai‘i Pacific Health (HPH) is an 8-week-long program that exposes undergraduate students to clinical medicine and research through a structured curriculum. The program is centered at a four-hospital system on the islands of O‘ahu and Kaua‘i and has academic affiliations with the John A. Burns School of Medicine at the University of Hawai‘i. Each year, the program selects a cohort of 8–14 undergraduate students originally from Hawai‘i. While several of these students are pursuing their degrees at universities on the continental United States, many are selected from the in-state universities to recruit those who are more likely to establish roots within the community. Selected students are then paired with a research mentor, who leads them to the completion of a clinical research project. While the projects and experience are focused on providing a framework for the students to develop their skills in designing, conducting, analyzing, and summarizing clinical research studies, there are additional benefits that may attract promising students back to both the local community and healthcare leadership. Through the clinical experiences in this program, students get opportunities to familiarize themselves with rural medicine, community-based primary practice, subspecialty practice, interventions, and surgeries. In addition, they get to discuss career choices with over 50 physicians of various specialties and meet executive leaders of the medical system to discuss healthcare delivery and community health. Most physicians who volunteer as SSRP mentors in this program do not have a formal affiliation or compensated teaching appointment at the medical school. These physicians design and execute research projects based on hospital-based quality improvement initiatives, or more specifically, on patient care within their field. Study design This is a 38-year retrospective review of the HPH SSRP. The study was reviewed by the Hawai‘i Pacific Health Research Institute and was deemed exempt from further Institutional Review Board review and participant consent. All processes were blinded and anonymous. We evaluated the outcomes of the program, specifically the trajectory of SSRP graduates, including admission to medical school or other education in healthcare or biotechnology. If SSRP students were not accepted into medical school, we tracked their alternative education choices where possible. We looked to see if these promising students were retained in the community in other capacities. From there, we traced students’ residency and subspecialty training to see if post-graduate training was done locally or out of state. Finally, we tracked the long-term placement and professional practice choices of SSRP graduates (when available) and whether they did return or planned to return to Hawai‘i to practice medicine, or if they stayed on the continental United States. Data Collection and Analysis Data was collected through internet searches and a survey. The anonymous survey included questions about the SSRP students’ education and career choices and their involvement in scholarly activities. The survey was sent out to SSRP alumni via email and mail, and the results were accumulated and tabulated into a database. The summarized survey results were then analyzed for frequency and proportion of answers. The analysis was split to assess the first half of SSRP history (1984–2002) separately from the latter decades (2003–2023), not only because there was more data available in the last two decades, but also because there was a slight shift and adjustment of career choices of SSRP students in the latter years of the research training program. Statistical analysis was performed using Excel (Microsoft, Redmond, WA). Results The HPH SSRP has been ongoing since 1986, with 393 alumni during the 38 years of existence (1986–2023). Cohort size has ranged between 6–14 students, but in the last 14 years (2010–2023) the program had an annual average of 12 students (Fig. 1 ). The program successfully aligned students with physician mentors on specific projects. Once the 8-week long program was over, students worked to further develop their projects into abstracts, poster presentations, oral presentations, and journal publications. Participants were successful in publishing and presenting many of their efforts both locally and nationally. Thus far, there have been 57 abstracts, 43 poster presentations, 53 oral presentations, and 37 journal publications completed after/through SSRP. Peer-reviewed publications have appeared in reputable journals with a national audience. By extension, this seems to have had a helpful downstream impact on opportunities in future medical training. The program has a high rate of success in aligning undergraduate students with programs of higher medical education. Since 2010, 123 SSRP participants (73%) have been accepted to medical school (Fig. 2 ). Since some of these students participated in the program during their sophomore and junior college years, and many of these students are still actively applying for medical school, the percentage may under-represent the SSRP students’ acceptance rate to medical school. Overall, the SSRP program was helpful in bolstering student applications for other graduate schools as well. Among the 393 alumni, 23 students did not choose to pursue medical school, but continued with their interest in healthcare and became a dentist, nurse, public health expert, physician assistant, clinical psychologist, or biomedical engineer. In terms of the downstream impact on direct medical school admission and education, of the 393 SSRP alumni, 52 are currently in medical school, the majority of which attend John A. Burns School of Medicine in Hawai‘i. Another 42 alumni are in residency, 20 of which are in Hawai‘i. With regards to long-term retention and recruitment back to the state of Hawai‘i, a total of 221 alumni are practicing physicians, of which 74 are practicing in Hawai‘i. Thirty of the 74 physicians who practice in Hawai‘i work at HPH. When surveyed SSRP alumni still in training were asked about their long-term plans and practice outcomes, 66 (81%) medical students, residents, fellows, and other alumni in training planned to return to practice in Hawai‘i. Discussion Our retrospective analysis of 38 years of existence of a summer student research program in the state of Hawai‘i demonstrated that a community hospital based pre-med program can be highly successful in engaging and preparing the next generation of physicians. More than 70% of the students from the HPH SSRP were admitted to medical school, and more than 80% of the students and medical trainees from the program felt committed to return to Hawai‘i as a medical professional. In contrast, the national overall acceptance rate for medical school between 2022–2023 was 43.1%. 12 We found an excellent correlation between SSRP graduation and later entry into medical school. Specifically, the SSRP was very successful in retaining local students for local medical education. Most SSRP graduates from the HPH system, while likely to leave Hawai‘i for some part of their training, have either chosen to or indicated that they plan to return to Hawai‘i for their careers. Our results show an excellent correlation between the success of the HPH SSRP and the retention of physicians in the community. Noting and correlating such outcomes is an important finding in a community with significant disparities in healthcare outcomes. Overall, the SSRP program was helpful in bolstering student applications for other graduate schools as well, which may impact the local economy and ‘brain drain’ within the community. That noted, the program has also helped to improve healthcare in an area with significant disparities by engaging local physicians in projects that elevate their own quality of practice or address challenges regarding the local delivery of healthcare. , Limitations Over the course of the study, 103 (39.2%) students were lost to follow-up. It is unknown whether these students were able to leverage their Summer Student Research Program (SSRP) experience into some kind of medical practice or whether they were even retained locally in the community. The ongoing nature of HPH’s SSRP also limits the accuracy of the evaluation of the long-term impact of the program. Because students of the more recent cohorts are still applying to medical school or working through residency, the long-term impact or outcomes of the program is incomplete. Overall, looking back over a decade, it seems hopeful to assume that the trend will continue favorably to retain students and physicians in the community. Additional factors, such as Hawai’i’s unique culture and geography, may positively impact Hawai‘i in a way that might not be observed in other community SSRPs. 11 Conclusion This review of a 38-year history of a community SSRP contributes to the growing body of literature that describes the impact of SSRPs nationally. This review highlights how community SSRPs support local students to help them attain their goals in graduate medical education. The program has proven particularly successful, as its participants had high rates of medical school admission and commitment to return to practice in Hawai‘i. Thereafter, the relationships established through the SSRP experience positively impact local physician recruitment and retention of subspecialist physicians within the community where they had their SSRP experience. Abbreviations HPH: Hawai‘i Pacific Health; SSRP: Summer Student Research Program Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. It was reviewed by the Hawai‘i Pacific Health Research Institute and deemed exempt under the WCG Institutional Review Board protocols from further Institutional Review Board review and participant consent. All processes were blinded and anonymous. Consent for publication: Not applicable. Availability of data and materials: Data described in the manuscript and survey materials used will be made available upon request. Competing interests: The authors have no financial or proprietary interests in any material discussed in this article. Funding: No funding was received for the conduct of this study or the preparation of this manuscript. Authors’ contributions: The author’s responsibilities were as follows: A.B. led the study and conceptualized the analysis, K.B. and J.A. conducted the data collection, A.S. and C.K. performed the data analysis, L.J., S.J., A.B., and K.B. drafted the manuscript, and all authors provided input on the manuscript throughout the revision process. Acknowledgements: The authors extend their gratitude to those who have contributed to the ongoing success of the Hawai‘i Pacific Health Summer Student Research Program, including Raymond Vara, David Andrew, MD, Robert Kistner, MD, and James Penoff, MD. Clinical trial number: not applicable. References 1Arredondo K, Touchett HN, Khan S, Vincenti M, Watts BV. Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review. J Gen Intern Med. 2023;38(Suppl 3):916–922. 10.1007/s11606-023-08122-6 . Epub 2023 Jun 20. PMID: 37340266; PMCID: PMC10356718. 2Chen C, Xierali I, Piwnica-Worms K, Phillips R. The redistribution of graduate medical education positions in 2005 failed to boost primary care or rural training. Health Aff (Millwood). 2013;32(1):102 – 10. 10.1377/hlthaff.2012.0032 . PMID: 23297277. 3Meit M, Knudson A, Gilbert T et al. The 2014 update of the rural-urban Chartbook. 2014. https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf 4Vazzana CM, Rudi-Polloshka J. Appalachia Has Got Talent, But Why Does It Flow Away? A Study on the Determinants of Brain Drain from Rural USA. 2019; 33(3). 10.1177/0891242419844320 5Arredondo K, Touchett HN, Khan S, Vincenti M, Watts BV. Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review. J Gen Intern Med. 2023;38(Suppl 3):916–922. 10.1007/s11606-023-08122-6 . Epub 2023 Jun 20. PMID: 37340266; PMCID: PMC10356718. 6Johnson GE, Wright FC, Foster K. The impact of rural outreach programs on medical students' future rural intentions and working locations: a systematic review. BMC Med Educ. 2018;18(1):196. 10.1186/s12909-018-1287-y . PMID: 30107795; PMCID: PMC6092777. 7 Shipman SA, Wendling A, Jones KC, Kovar-Gough I, Orlowski JM, Phillips J. The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce. Health Aff (Millwood). 2019;38(12):2011–2018. doi: 10.1377/hlthaff.2019.00924. PMID: 31794312. 8Pretorius RW, Lichter MI, Okazaki G, Sellick JA Jr.. Where do they come from and where do they go: implications of geographic origins of medical students. Acad Med. 2010;85(10 Suppl):S17-20. 10.1097/ACM.0b013e3181ed3e78 . PMID: 20881695. 9Wendling AL, Phillips J, Short W, Fahey C, Mavis B. Thirty Years Training Rural Physicians: Outcomes From the Michigan State University College of Human Medicine Rural Physician Program. Acad Med. 2016;91(1):113-9. 10.1097/ACM.0000000000000885 . PMID: 26332428. 10Pacifici LB, Thomson N. Undergraduate science research: a comparison of influences and experiences between premed and non-premed students. CBE Life Sci Educ. 2011 Summer;10(2):199–208. 10.1187/cbe.11-01-0005 . PMID: 21633068; PMCID: PMC3105926. 11Villinger ND. In Search of Paradise: Why People Choose to Live and Work in Hawaii. Journal of Global Business Issues. 2011: 5(2): 85–88. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. AAMC. 2021. Accessed February 10, 2025. https://www.aamc.org/media/9576/download Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Oct, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 02 Jun, 2025 Reviews received at journal 22 May, 2025 Reviews received at journal 15 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 05 May, 2025 Reviewers invited by journal 29 Apr, 2025 Editor assigned by journal 18 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 16 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6159478","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":450694310,"identity":"eace9937-033e-4142-a35b-ec0b7cdc8d5f","order_by":0,"name":"Lily Johnson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACPmbmBoYPBhL1/RIgrgGITMCvhY2ZsYFxRoUF48wZRGthYGxg5jlTwbjhBlyMkBZ2xjYJ3jYJZuPbzc8kfhRYMPCz5xgQclibhGSbBJvZnWNmkj1Ah0n2vCFCi2GbBI/ZjQSzGzxALQY3iLElsU1CwnhG+rebf4Ba7InScuCMhIGBRI7ZbbAtEoS1NFs2VEgkSNzIKf8tYyDBI3HmWQFeLfz8hw/e/mNQl8A/I32z4Zs/dXL87ckb8GoBAhYJZB4PIeUgwPyBGFWjYBSMglEwggEAiw49/SG5/foAAAAASUVORK5CYII=","orcid":"","institution":"John A. 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1","display":"","copyAsset":false,"role":"figure","size":136223,"visible":true,"origin":"","legend":"\u003cp\u003eCompleted surveys relative to number of SSRP students between 1986-2020\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6159478/v1/9f341814dccd8bda0db28cb1.png"},{"id":81954223,"identity":"d8025c1e-1d7b-4397-b03f-20ebb85744be","added_by":"auto","created_at":"2025-05-05 09:41:50","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":281231,"visible":true,"origin":"","legend":"\u003cp\u003eAcceptance to medical school among Summer Student Research Program participants between 2010-2022\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6159478/v1/3559166272fbc8f8ec5b16fc.jpeg"},{"id":93955981,"identity":"f9b487aa-bcde-423a-92b4-a8e0af1cc410","added_by":"auto","created_at":"2025-10-20 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component of medical training, tends to centralize in dense urban areas, where there is higher quality and volume of medical training and easier access to academic centers.\u003csup\u003e3\u003c/sup\u003e As a result of this educational cycle, many young physicians build both personal and clinical relationships in urbanized areas and never return to their home communities.\u003csup\u003e4\u003c/sup\u003e This cycle inevitably leads to a deficit of qualified physicians in rural, resource-limited communities, which ultimately contributes to worsening healthcare disparities within those same underserved areas.\u003c/p\u003e \u003cp\u003eIf we hope to improve healthcare disparities in rural communities, we must diversify the outreach and impact of medical education by specifically recruiting students from within the same underserved communities.\u003csup\u003e5\u003c/sup\u003e Many promising physician candidates from rural and underserved areas hope to return to practice in those areas.\u003csup\u003e6,7,8,9\u003c/sup\u003e In order to gain the clinical and research experience required for medical school admission, many of these students benefit from summer educational or research programs.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSummer Student Research Programs (SSRPs) are immersive research programs designed for undergraduate students interested in pursuing a career in medicine. These programs are offered by large universities, many of which have strong academic affiliations with major medical institutions, which potentially contributes to the perpetual and problematic educational cycle.\u003c/p\u003e \u003cp\u003eIn contrast to the larger academic SSRPs, SSRPs have also been established in smaller communities with the stated goal of educating and retaining talented pre-med students from their own, often rural, communities. One of the most long-standing SSRPs is the program in Hawai‘i, which was established in 1986, 38 years ago.\u003c/p\u003e \u003cp\u003eThese community SSRPs differ from larger academic programs in two significant ways. First, they tend to lack the academic funding and mechanisms often associated with the success of such programs. Second, they enable undergraduates to engage with research in their home community during the summers of their undergraduate years. However, it is not known how much these SSRPs in smaller community-based health centers may contribute to physician retention in their rural areas.\u003c/p\u003e \u003cp\u003eGiven the differences in design and location between community and larger academically funded SSRPs, we were interested in assessing the impact of a longstanding community SSRP on the physician workforce distribution in an isolated community. In order to assess the impact of a long-standing community SSRP on long-term physician retention in our community, we conducted a review of the outcomes of this pre-med clinical immersion and research program. Herein, we review the outcomes over the 38-year period of the SSRP in Hawai‘i. We report the downstream impact of a community SSRP on medical education, residency training, and eventual physician recruitment and retention back into a community with significant healthcare disparities.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eDescription of the student immersion program\u003c/p\u003e\u003cp\u003eThe Summer Student Research Program (SSRP) at Hawai‘i Pacific Health (HPH) is an 8-week-long program that exposes undergraduate students to clinical medicine and research through a structured curriculum. The program is centered at a four-hospital system on the islands of O‘ahu and Kaua‘i and has academic affiliations with the John A. Burns School of Medicine at the University of Hawai‘i.\u003c/p\u003e\u003cp\u003eEach year, the program selects a cohort of 8–14 undergraduate students originally from Hawai‘i. While several of these students are pursuing their degrees at universities on the continental United States, many are selected from the in-state universities to recruit those who are more likely to establish roots within the community. Selected students are then paired with a research mentor, who leads them to the completion of a clinical research project.\u003c/p\u003e\u003cp\u003eWhile the projects and experience are focused on providing a framework for the students to develop their skills in designing, conducting, analyzing, and summarizing clinical research studies, there are additional benefits that may attract promising students back to both the local community and healthcare leadership. Through the clinical experiences in this program, students get opportunities to familiarize themselves with rural medicine, community-based primary practice, subspecialty practice, interventions, and surgeries. In addition, they get to discuss career choices with over 50 physicians of various specialties and meet executive leaders of the medical system to discuss healthcare delivery and community health. Most physicians who volunteer as SSRP mentors in this program do not have a formal affiliation or compensated teaching appointment at the medical school. These physicians design and execute research projects based on hospital-based quality improvement initiatives, or more specifically, on patient care within their field.\u003c/p\u003e\u003cp\u003eStudy design\u003c/p\u003e\u003cp\u003eThis is a 38-year retrospective review of the HPH SSRP. The study was reviewed by the Hawai‘i Pacific Health Research Institute and was deemed exempt from further Institutional Review Board review and participant consent. All processes were blinded and anonymous.\u003c/p\u003e\u003cp\u003eWe evaluated the outcomes of the program, specifically the trajectory of SSRP graduates, including admission to medical school or other education in healthcare or biotechnology. If SSRP students were not accepted into medical school, we tracked their alternative education choices where possible. We looked to see if these promising students were retained in the community in other capacities.\u003c/p\u003e\u003cp\u003eFrom there, we traced students’ residency and subspecialty training to see if post-graduate training was done locally or out of state. Finally, we tracked the long-term placement and professional practice choices of SSRP graduates (when available) and whether they did return or planned to return to Hawai‘i to practice medicine, or if they stayed on the continental United States.\u003c/p\u003e\u003cp\u003eData Collection and Analysis\u003c/p\u003e\u003cp\u003eData was collected through internet searches and a survey. The anonymous survey included questions about the SSRP students’ education and career choices and their involvement in scholarly activities. The survey was sent out to SSRP alumni via email and mail, and the results were accumulated and tabulated into a database. The summarized survey results were then analyzed for frequency and proportion of answers. The analysis was split to assess the first half of SSRP history (1984–2002) separately from the latter decades (2003–2023), not only because there was more data available in the last two decades, but also because there was a slight shift and adjustment of career choices of SSRP students in the latter years of the research training program. Statistical analysis was performed using Excel (Microsoft, Redmond, WA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe HPH SSRP has been ongoing since 1986, with 393 alumni during the 38 years of existence (1986\u0026ndash;2023). Cohort size has ranged between 6\u0026ndash;14 students, but in the last 14 years (2010\u0026ndash;2023) the program had an annual average of 12 students (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe program successfully aligned students with physician mentors on specific projects. Once the 8-week long program was over, students worked to further develop their projects into abstracts, poster presentations, oral presentations, and journal publications. Participants were successful in publishing and presenting many of their efforts both locally and nationally. Thus far, there have been 57 abstracts, 43 poster presentations, 53 oral presentations, and 37 journal publications completed after/through SSRP. Peer-reviewed publications have appeared in reputable journals with a national audience. By extension, this seems to have had a helpful downstream impact on opportunities in future medical training.\u003c/p\u003e \u003cp\u003eThe program has a high rate of success in aligning undergraduate students with programs of higher medical education. Since 2010, 123 SSRP participants (73%) have been accepted to medical school (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Since some of these students participated in the program during their sophomore and junior college years, and many of these students are still actively applying for medical school, the percentage may under-represent the SSRP students\u0026rsquo; acceptance rate to medical school.\u003c/p\u003e \u003cp\u003eOverall, the SSRP program was helpful in bolstering student applications for other graduate schools as well. Among the 393 alumni, 23 students did not choose to pursue medical school, but continued with their interest in healthcare and became a dentist, nurse, public health expert, physician assistant, clinical psychologist, or biomedical engineer.\u003c/p\u003e \u003cp\u003eIn terms of the downstream impact on direct medical school admission and education, of the 393 SSRP alumni, 52 are currently in medical school, the majority of which attend John A. Burns School of Medicine in Hawai\u0026lsquo;i. Another 42 alumni are in residency, 20 of which are in Hawai\u0026lsquo;i.\u003c/p\u003e \u003cp\u003eWith regards to long-term retention and recruitment back to the state of Hawai\u0026lsquo;i, a total of 221 alumni are practicing physicians, of which 74 are practicing in Hawai\u0026lsquo;i. Thirty of the 74 physicians who practice in Hawai\u0026lsquo;i work at HPH. When surveyed SSRP alumni still in training were asked about their long-term plans and practice outcomes, 66 (81%) medical students, residents, fellows, and other alumni in training planned to return to practice in Hawai\u0026lsquo;i.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur retrospective analysis of 38 years of existence of a summer student research program in the state of Hawai\u0026lsquo;i demonstrated that a community hospital based pre-med program can be highly successful in engaging and preparing the next generation of physicians. More than 70% of the students from the HPH SSRP were admitted to medical school, and more than 80% of the students and medical trainees from the program felt committed to return to Hawai\u0026lsquo;i as a medical professional. In contrast, the national overall acceptance rate for medical school between 2022\u0026ndash;2023 was 43.1%.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe found an excellent correlation between SSRP graduation and later entry into medical school. Specifically, the SSRP was very successful in retaining local students for local medical education. Most SSRP graduates from the HPH system, while likely to leave Hawai\u0026lsquo;i for some part of their training, have either chosen to or indicated that they plan to return to Hawai\u0026lsquo;i for their careers. Our results show an excellent correlation between the success of the HPH SSRP and the retention of physicians in the community. Noting and correlating such outcomes is an important finding in a community with significant disparities in healthcare outcomes.\u003c/p\u003e \u003cp\u003eOverall, the SSRP program was helpful in bolstering student applications for other graduate schools as well, which may impact the local economy and \u0026lsquo;brain drain\u0026rsquo; within the community. That noted, the program has also helped to improve healthcare in an area with significant disparities by engaging local physicians in projects that elevate their own quality of practice or address challenges regarding the local delivery of healthcare.\u003csup\u003e,\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eOver the course of the study, 103 (39.2%) students were lost to follow-up. It is unknown whether these students were able to leverage their Summer Student Research Program (SSRP) experience into some kind of medical practice or whether they were even retained locally in the community.\u003c/p\u003e \u003cp\u003eThe ongoing nature of HPH\u0026rsquo;s SSRP also limits the accuracy of the evaluation of the long-term impact of the program. Because students of the more recent cohorts are still applying to medical school or working through residency, the long-term impact or outcomes of the program is incomplete. Overall, looking back over a decade, it seems hopeful to assume that the trend will continue favorably to retain students and physicians in the community. Additional factors, such as Hawai\u0026rsquo;i\u0026rsquo;s unique culture and geography, may positively impact Hawai\u0026lsquo;i in a way that might not be observed in other community SSRPs.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review of a 38-year history of a community SSRP contributes to the growing body of literature that describes the impact of SSRPs nationally. This review highlights how community SSRPs support local students to help them attain their goals in graduate medical education. The program has proven particularly successful, as its participants had high rates of medical school admission and commitment to return to practice in Hawai\u0026lsquo;i. Thereafter, the relationships established through the SSRP experience positively impact local physician recruitment and retention of subspecialist physicians within the community where they had their SSRP experience.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eHPH: Hawai‘i Pacific Health; SSRP: Summer Student Research Program\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. It was reviewed by the Hawai\u0026lsquo;i Pacific Health Research Institute and deemed exempt under the WCG Institutional Review Board protocols from further Institutional Review Board review and participant consent. All processes were blinded and anonymous.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Data described in the manuscript and survey materials used will be made available upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors have no financial or proprietary interests in any material discussed in this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding: No funding was received for the conduct of this study or the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: The author\u0026rsquo;s responsibilities were as follows: A.B. led the study and conceptualized the analysis, K.B. and J.A. conducted the data collection, A.S. and C.K. performed the data analysis, L.J., S.J., A.B., and K.B. drafted the manuscript, and all authors provided input on the manuscript throughout the revision process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors extend their gratitude to those who have contributed to the ongoing success of the Hawai\u0026lsquo;i Pacific Health Summer Student Research Program, including Raymond Vara, David Andrew, MD, Robert Kistner, MD, and James Penoff, MD.\u003c/p\u003e\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e1Arredondo K, Touchett HN, Khan S, Vincenti M, Watts BV. Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review. J Gen Intern Med. 2023;38(Suppl 3):916\u0026ndash;922. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11606-023-08122-6\u003c/span\u003e\u003cspan address=\"10.1007/s11606-023-08122-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2023 Jun 20. PMID: 37340266; PMCID: PMC10356718.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2Chen C, Xierali I, Piwnica-Worms K, Phillips R. The redistribution of graduate medical education positions in 2005 failed to boost primary care or rural training. 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The impact of rural outreach programs on medical students' future rural intentions and working locations: a systematic review. BMC Med Educ. 2018;18(1):196. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-018-1287-y\u003c/span\u003e\u003cspan address=\"10.1186/s12909-018-1287-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30107795; PMCID: PMC6092777. \u003csup\u003e7\u003c/sup\u003e Shipman SA, Wendling A, Jones KC, Kovar-Gough I, Orlowski JM, Phillips J. The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce. Health Aff (Millwood). 2019;38(12):2011\u0026ndash;2018. doi: 10.1377/hlthaff.2019.00924. PMID: 31794312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e8Pretorius RW, Lichter MI, Okazaki G, Sellick JA Jr.. Where do they come from and where do they go: implications of geographic origins of medical students. 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Undergraduate science research: a comparison of influences and experiences between premed and non-premed students. CBE Life Sci Educ. 2011 Summer;10(2):199\u0026ndash;208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1187/cbe.11-01-0005\u003c/span\u003e\u003cspan address=\"10.1187/cbe.11-01-0005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 21633068; PMCID: PMC3105926.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e11Villinger ND. In Search of Paradise: Why People Choose to Live and Work in Hawaii. Journal of Global Business Issues. 2011: 5(2): 85\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. AAMC. 2021. Accessed February 10, 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aamc.org/media/9576/download\u003c/span\u003e\u003cspan address=\"https://www.aamc.org/media/9576/download\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physician retention, physician recruitment, pre-medical education, student summer research program, medically underserved, healthcare disparities.","lastPublishedDoi":"10.21203/rs.3.rs-6159478/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6159478/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysician shortages are prevalent in medically underserved areas, where healthcare disparities hinder physician recruitment and retention. The Hawai\u0026rsquo;i Pacific Health (HPH) Summer Student Research Program (SSRP) provides early clinical and research experiences to pre-med students from Hawai\u0026rsquo;i, enhancing their qualifications, improving medical school acceptance rates, and expanding the pool of local students committed to practicing in Hawai\u0026rsquo;i.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate SSRP's impact on medical school admissions, career trajectories, and retention of healthcare professionals in Hawai'i, a medically underserved region.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 38-year retrospective analysis examined 393 SSRP alumni (1986\u0026ndash;2023), tracking educational and career outcomes, such as medical school admission, residency, and practice location, through surveys and internet research. Data compared early (1986\u0026ndash;2002) and recent (2003\u0026ndash;2023) cohorts.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe program achieved a 73% medical school admission rate. Of 393 alumni, 221 became physicians, with 74 practicing in Hawai'i. Among those in training, 81% plan to practice locally. The program produced 57 abstracts, 43 posters, 53 oral presentations, and 37 peer-reviewed publications while providing students with clinical exposure and physician mentorship.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHPH SSRP successfully guides local students toward medical careers, with alumni medical school admission rates exceeding the national average by 30%. By increasing the number of local medical professionals committed to practicing in Hawai'i, the program helps address regional physician shortages. This community-based model may serve as a valuable framework for other underserved regions aiming to build a sustainable healthcare workforce.\u003c/p\u003e","manuscriptTitle":"Premed Research Program: Impact on Physician Recruitment and Retention in an Underserved Community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 09:41:45","doi":"10.21203/rs.3.rs-6159478/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-02T15:00:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-22T05:38:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T17:32:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140538539180686458500038619770700356520","date":"2025-05-08T04:38:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244753706434321181167130204212713671958","date":"2025-05-05T11:17:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T03:45:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-18T05:45:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-16T16:27:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-16T16:26:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63bd868a-f852-451b-9309-e0c3f734d91a","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:01:30+00:00","versionOfRecord":{"articleIdentity":"rs-6159478","link":"https://doi.org/10.1186/s12909-025-08007-8","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-10-17 15:57:03","publishedOnDateReadable":"October 17th, 2025"},"versionCreatedAt":"2025-05-05 09:41:45","video":"","vorDoi":"10.1186/s12909-025-08007-8","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08007-8","workflowStages":[]},"version":"v1","identity":"rs-6159478","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6159478","identity":"rs-6159478","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}