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HELP-SEEKING ATTITUDES, PREFERENCES, AND BEHAVIOR
OF BLACK AND HISPANIC MEDICAL STUDENTS IN MICHIGAN
By
Denise Maybank Shepard

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirement
for the degree of
DOCTOR OF PHILOSOPHY

Department of Counseling, Educational
Psychology and Special Education
1994

UMI N u m b e r:

9537263

UMI Microform 9537263
Copyright 1995, by UMI Company. All rights reserved.
This microform edition is protected against unauthorized
copying under Title 17, United States Code.

UMI
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ABSTRACT
HELP-SEEKING ATTITUDES, PREFERENCES, AND BEHAVIOR
OF BLACK AND HISPANIC MEDICAL STUDENTS IN MICHIGAN
By
Denise Maybank Shepard

There is substantial evidence that indicates an imbalance between the number o f
heath care professionals and the number o f people most in need o f health care services.
For underrepresented ethnic/racial groups designated as minority (i.e., Blacks, Hispanics
and Native Americans), who are underserved by the health care community, increased
access to medical care is closely linked to the number of minority group physicians
available. In the wake o f demographic and educational preparation trends which impede
significantly increased numbers o f underrepresented minority group students, efforts to
maximize the potential o f those students admitted to medical school must be considered.
The retention o f minority group medical students becomes an essential factor in providing
care to underserved populations.

The purpose o f this study was to examine the help-seeking attitudes, preferences
and behavior o f Black and Hispanic medical students in Michigan, and to determine the
relationship o f these factors to the academic performance o f the students.

A self report questionnaire was used to assess each o f the dependent variables and
to collect associated demographic and academic data from respondents attending the four
colleges o f medicine in Michigan. The questionnaire included five measures: Part I:

Attitudes Toward Seeking Psychological Help; Part II: Preferences for Potential Help
Sources Index; Part III: Problem Experiences and Help Sought; Part IV: Reasons for Not
Using Help Resources; and Part V: Academic Performance and Demographics. Statistical
procedures used to test hypotheses included both parametric and nonparametic methods.

It was found that Black and Hispanic students did not differ significantly in their in the
problems they experienced nor in their attitudes toward seeking psychological help. For
Black students more than for Hispanic students an unfavorable assessment o f providers is
a key reason for not using help resources, while Hispanic students indicate more than
Black students having no concern to address. Students reporting greater problem severity
were found to use more help resources than were students expressing lesser severity.

The findings o f this exploratory study have highlighted some relationships between help
seeking attitudes, preferences, and behavior, and student characteristics, problems
experienced and academic difficulty. A complex o f factors related to who seeks which
services to address what concerns have been raised in drawing conclusions from the
finding.

Dedicated to my parents Andrew Marion Maybank and Lottie B. Davis Maybank now in
memory, but forever in love, for "training me up in the way that I should go" and for
encouraging me to be all that I could be, which is boundless in God.

ACKNOWLEDGMENTS

TABLE OF CONTENTS

LIST O F

JA B L E S..................................................................................................................... viii

L IST O F F IG U R E S .....................................................................................................................x
C H A PTER
I.

IN TROD U CTIO N
B ackground........................................................................................................................ 2
R a tio n a le ............................................................................................................................7
Purpose o f the S t u d y ....................................................................................................... 8
Research Q u estio n s.......................................................................................................... 9
Scope and Limitations..................................................................................................... 10
Overview o f the D is se rta tio n ....................................................................................... 11

II.

REV IEW O F TH E LITERA TU RE
Medical Student R e te n tio n ...........................................................................................12
Attrition and R e te n tio n ..................................................................................................17
Medical Student Needs for Non-Academic Help R eso u rces................................... 22
Help-seeking B e h a v io r ................................................................................................. 27
S u m m a ry ......................................................................................................................... 31

III.

STUDY DESIGN AND PROCEDU RES
Description o f the P o p u latio n ....................................................................................... 37
Description o f the Sam ple..............................................................................................39
In stru m en ts...................................................................................................................... 39
Operational D efin itio n s................................................................................................. 49
Procedures for Collecting D a t a ....................................................................................52
Research H y p o th e ses.....................................................................................................54
Design................................................................................................................................ 56
Data A nalysis...................................................................................................................57
Potential Limitations........................................................................................................ 61

IV.

ANALYSIS OF THE DATA
Demographic C h aracteristics....................................................................................... 62
Problems Experienced and Help Sources U s e d ........................................................ 89
Academic D ifficulty........................................................................................................ 95

V.

SUMMARY, CONCLUSIONS, AND IMPLICATIONS
S u m m a ry ........................................................................................................................100
R e s u l t s .........................................................................................................................102
Conclusions and D iscussion...................................................................................... 106
L im ita tio n s.................................................................................................................... 115
Implications for Future R e s e a r c h ...............................................................................116
APPENDIX.................................................................................................................... 119
REFERENCES............................................................................................................. 126

V ll

LIST OF TABLES

Table 1

1990 Enrollment o f Black and Hispanic Students in Michigan
Medical Schools by Year of S tudy.................................................................. 38

Table 2

Demographic Data o f S a m p le .......................................................................... 40

Table 3

Distribution o f Sample on Academic Background V ariables...................... 41

Table 4

Scale Construction and Reliability o f Reasons for Not Using
Help Resources M easure................................................................................ 46

Table 5

Definition of S c a le s ........................................................................................... 47

Table 6

Mean Scores and t-Tests for Differences Between Black and Hispanic
Medical Students' Problems Experienced.....................................................64

Table 7

Mean Scores and t-Tests for Differences Between Black and Hispanic
Medical Students' Use o f Formal and Informal Help Sources by
Category o f C o n cern.......................................................................................65

Table 8

Mean Scores and t-Tests for Differences Between Black and Hispanic
Medical Students' Attitudes Toward Seeking Psychological Help . . .67

Table 9

Mean Scores and t-Tests for Black and Hispanic Medical Students
on Scales o f Reasons for Not Using Help Resources................................68

Table 10

Mann-Whitney est o f Preference for Potential Help S o u rces...................... 70

Table 11

Analysis o f Variance on Preferences for Informal and Formal
Help Sources by College and R ace............................................................... 72

Table 12

Mean Scores and t-Tests for Female and Male Medical Students
on Scales o f Attitudes Toward Seeking Psychological H e l p .................. 74

Table 13

Analysis o f Variance on Scales o f Attitudes Toward Seeking
Psychological Help by Gender and R a c e .....................................................75

Table 14

Mean Scores and t-Tests for Female and Male Medical Students
on Scales o f Reasons for Not Using Help Resources................................ 76

Table 15

Analysis o f Variance on Scales o f Reasons for Not Using
Help Resources by Gender and R a c e ............................................................78

Table 16

Mean Scores and t-Tests for Medical Students by Age Groups
on Attitudes Toward Seeking Psychological Help by A g e ......................79

Table 17

Analysis o f Variance on Scales o f Attitudes Toward Seeking
Psychological Help by Age and Race............................................................80

Table 18

Mean Scores and t-Tests for Medical Students by Age Groups
on Scales o f Reasons for Not Using Help Resources................................ 82

Table 19

Analysis o f Variance on Scales o f Reasons for Not Using
Help Resources by Gender and Race............................................................83

Table 20

Mean Scores and t-Tests for Medical Students by Class Standing
on Attitudes Toward Seeking Psychological Help by A g e ..................... 84

Table 21

Analysis o f Variance on Scales o f Attitudes Toward Seeking
Psychological Help by Class and R a c e ........................................................ 85

Table 22

Mean Scores and t-Tests for Medical Students by Class Standing
on Scales o f Reasons for Not Using Help Resources................................ 87

Table 23

Analysis o f Variance on Scales o f Reasons for Not Using
Help Resources by Class and R ace............................................................... 88

Table 24

Spearman Correlation Coefficients for Concern Categories
with Informal and Formal Help Sources U s e d .......................................... 91

Table 25

Analysis o f Variance for Formal Sources o f Help Used for
Emotional Concerns by C o lle g e .................................................................. 94

Table 26

Mean Scores and t-Tests for Differences Between Students with
Committee and Committee/Dismissal on Problems Experienced . . . . 96

Table 27

Analysis o f Variance by Academic Risk on Informal
Sources o f H e l p .............................................................................................. 98

ix

LIST OF FIGURES

Figure 1

Tinto's Model o f A ttritio n ..................................................................................20

Figure 2

Cell Configuration for A n aly ses....................................................................... 57

Figure 3

Cell Configuration for 4x2 Factorial D e s ig n ...................................................57

x

CHAPTER I
INTRODUCTION

It has been well documented and acknowledged that there are substantial inequities
in the delivery o f and access to health care services for ethnic/racial minority and
disadvantaged populations when compared to the general population. The problem has been
a chronic one, and reports clearly highlight the continued imbalance between the number of
health care professionals—particularly from underserved and underrepresented populations—
and the number o f people who need their services, despite growing concern about a surplus
o f physicians (Hanfl & White, 1987).
Although a variety o f factors contribute to ethnic/racial minority groups not having
adequate access to health care this circumstance may exist, in part, because o f a shortage of
physicians practicing in high need rural and urban areas where populations are
disproportionately low income and minority. An examination o f Census Bureau population
projections indicates there are expected to be 36 million Blacks and 25 million Hispanics by
the year 2000 as compared to 29 million and 17 million, respectively estimated for 1985
(Simpson & Aronoff, 1988).

Combining this data with that o f the Bureau o f Health

Professions regarding physician supply projections for the same period, Simpson and Aronoff
(1988) report physician to population ratios of 79.7 per 100,000 for Blacks and 94.0 per
100,000 for Hispanics by the year 2000. These figures indicate an increase in Black physician

1

2
supply as compared to Black population, and a decrease in Hispanic physician supply as
compared to Hispanic population, when 1985 physician to population ratios (53.7 Blacks,
101.8 Hispanics) are the basis for comparison.

It is important to note, in view o f the

projected decrease in the rates for Hispanics and despite the increase for Blacks, these figures
do not approach that o f the overall physicians to population ratio for the United States, which
is estimated to increase from the 1985 ratio o f 218.2 per 100,000 to a ratio o f 260.0 per
100,000 by the year 2000.
In order to influence statistics which suggest ethnic/racial minority populations will
continue to be underserved by, and underrepresented in the medical community, efforts must
be targeted toward attracting, providing access for, retaining, and graduating minority and
disadvantaged students to become the physicians that change these numbers and ratios and
the quality o f health care available to the American population as a whole.

Background
In an effort to determine the success o f affirmative action programs implemented in
the early 1970s to increase the supply o f minority physicians and improve the health care of
the poor, Keith et al. (1985) conducted a study o f the Association o f American Medical
Colleges' (AAMC) graduating class o f 1975. The study examined differences between
minority (Blacks, Native Americans, Mexican Americans, mainland Puerto Ricans, and Puerto
Ricans from the Commonwealth o f Puerto Rico) and non-minority (Caucasians and Asian
Americans) graduates based on specialty choice, practice locations, patient population served,
and board certification rates.
Consistent with earlier studies, Keith et al. (1985) found that the minority graduates

3
in their study tended to "serve disproportionately more patients o f their own racial or ethnic
group," but "did not serve significantly more persons from other racial or ethnic groups than
did nonminority physicians" in the study (p. 1519). Specifically, fifty-six percent (56%) o f the
total patient population of Black physicians were Black patients and 30 percent of the patients
served by Hispanic physicians were Hispanic. Additionally, Black and Hispanic physicians
"cared for a significantly higher percentage o f Medicaid patients than did graduates from
other ethnic groups," and minority physicians were "practicing in the federally designated
health-manpower shortage areas in almost twice the proportion of nonminority graduates."
In a national survey comparing the use o f health services by Black and White
Americans, Blendon et al. (1989) found significant deficits in the access to health care among
Black respondents; additionally, they found a significant underuse of medical services by
blacks. The researchers point to the undersupply of physicians and a contributing factor to
this problem;
The undersupply o f black physicians and o f physicians in general in minority
communities also may result in reduced opportunities for medical care. Studies by the
Public Health Service on the availability o f physicians in minority communities
showed that many counties with dense populations have substantially lower ratios of
health professionals than similar communities with primarily white populations.
(p.280)

The findings presented by Keith et al. (1985) and Blendon et al. (1989) support the
need for increasing the numbers o f Black and Hispanic physicians in an attempt to increase
access to medical care for ethnic/racial minority and low socioeconomic populations

Efforts to establish parity in the health professions for Black and other
underrepresented minority groups have largely focused on increasing the numbers of
ethnic/racial minority group students enrolling in medical school. Since the early 1970s,
colleges o f medicine, along with various public and private agencies, have developed
strategies to increase access to medical education for underrepresented ethnic/racial group
students. An example o f these strategies is the federal initiative under the Health Careers
Opportunity Program (HCOP) which has focused on improving access to health careers for
minority and otherwise disadvantaged students since 1977. Programs funded under HCOP
include a broad array o f services along a continuum beginning with preliminary education
activities and spanning the education pathway through retention activities which support
disadvantaged students through to graduation.
The Association o f American Medical Colleges (AAMC) Task Force on Expanding
Educational Opportunities in Medicine for Black and Other Minorities proposed in 1970 to
increase the proportion o f minority students enrolled in schools o f allopathic medicine from
the existing 2.8 percent for Black Americans to 12 percent by 1975 or 1976, with the long
range goal o f eliminating barriers to access to the medical profession (Keith et al., 1985). By
1976 the enrollment o f all underrepresented ethnic/racial minority group students (Black
Americans, Native Americans, Mexican Americans, and mainland Puerto Ricans) in AAMC
schools had risen to only 8.2 percent o f the total enrollment, with Black Americans
representing 6.1 percent o f the total enrollment. Statistics presented in the 1990 edition of
Minorities & Women in the Health Field, prepared by the U.S. Department o f Health and
Human Services, indicate that 1988 Census Bureau estimates determined underrepresented
minorities to constitute 21.2 percent of the population. Total enrollment figures at AAMC

schools for the same period indicate underrepresented minorities to comprise 10.5 percent of
all students enrolled, with Blacks at 6.1 percent, still far short o f the goal set for 1976.
These statistics emphasize the complexity of trying to achieve parity for minority
physicians when the rate o f growth o f the underrepresented minority population exceeds the
available pool o f potential minority physicians.
The past and current efforts to increase the numbers o f underrepresented minority
group students having access to the medical profession are certainly commendable. The
creation of mechanisms which facilitate access aid in insuring a means to the end o f increasing
the needed supply o f minority group physicians. Unfortunately, the additional issues of
quantity (i.e., a relatively small number of minority group students in the applicant pool) and
quality (i.e., the academic credentials o f minority group applicants on average tend to be
lower than those o f their white counterparts) affect the ability of medical schools to admit
sufficient numbers o f underrepresented minority group students.
The Second Report o f the Council on Graduate Medical Education [COGME] (1990)
examines some o f the major factors associated with the "deteriorating state o f minority
representation in medicine." The factors identified as having the most profound impact and
therefore requiring "special and immediate attention and action" are:
the deteriorating pool o f minority applicants to medical schools;
the growing debt burden o f minority students pursuing health careers; and
the persistent shortage o f minority faculty in medical schools, (p.21)
With regard to the deteriorating minority applicant pool the COGME report presents
and substantiates two conclusions:
Conclusion F-l: The minority applicant pool for medical education continues to

deteriorate.
Conclusion F-2:

Available data indicate that the problem o f recruiting minority

students to medical school is directly linked to poor early academic preparation and
insufficient encouragement.

There is both a high dropout rate among minority

students and evidence that those who remain in the educational pipeline are often
inadequately prepared for study in the health sciences, (p. 21)

Clearly the size and quality o f the applicant pool are factors which will affect the
future admission o f minority students to medical school, but these factors are further
complicated by a growing minority population and concern about the ability o f educational
programs to meet their need for appropriate preliminary education (COGME, 1990).
Recommendations resulting from the COGME analysis are:
Recommendation No. 6: Emphasis should be placed on the development and support
o f programs which improve the size and quality o f the minority applicant pool by
focusing on early intervention (e.g., consortia o f medical schools, public schools, and
community organizations which work together to improve the educational pipeline).
Recommendation No. 7: Priority for Federal funding should be given to medical
schools and teaching hospitals that have demonstrated success in the recruitment,
enrollment, retention and graduation o f underrepresented minority students, (p. 24)
These recommendations acknowledge the need for medical schools to take an active role in
cultivating a future pool o f minority applicants through partnerships and offer incentives for
the schools to be successful in increasing the number o f minority physicians.

7
Rationale
The aforementioned concerns about a shrinking minority applicant pool are certainly
important and require the attention o f educators at all levels. O f equal, and possibly more
immediate, concern is the need to provide an atmosphere conducive to supporting the success
of current and incoming minority group medical students. Efforts to increase the supply of
minority physicians cannot be limited to "opening the gate"; those efforts must include
strategies for insuring success in the process such that completion o f medical school is a
realistic and attainable conclusion. Attention must be given to maximizing the potential at
hand until demographic trends and educational initiatives result in an overall improvement in
applicant pool quantity and quality.
Affirmative action programs have focused on equity o f opportunity for disenfranchised
groups. The recent emphasis on diversity, with a move toward pluralism, at many institutions
requires a more conscious examination of what happens to students o f diverse backgrounds
once they have gained access to the educational system, as well as an examination o f the
impact on the educational system: if the barriers and constraints to access are diminished,
then what is the nature o f the environment into which minority group students are ushered,
what supports are provided for participation in the educational process, and what effect does
an increasingly diverse student population have on the environment?
Educational institutions are faced with the challenge o f educating and responding to
the needs o f a multiethnic and multicultural student population with diverse approaches to
learning and diverse needs for successful completion o f the educational requirements
Compounding this challenge are the additional demands placed on the institution to create an
environment which will maximize the potential o f each student to whom it makes a

8
commitment for education. For the ethnic/racial minority group student at a predominately
white institution, consideration must be given to the diversity o f needs across different groups
and the impact o f minority status on educational performance.

Institutions o f higher

education must not only make a commitment to admitting students from underrepresented
ethnic/racial groups, but they must simultaneously commit to retaining and graduating these
students.

Purpose of the Study
The research presented herein was designed to examine an aspect o f what happens to
designated minority students admitted to the medical school environment.

The study

concentrates on student-centered nonacademic concerns and the means by which students
chose to address those concerns. Black and Hispanic students have been selected as the focus
for this investigation because, of the groups underrepresented in the field o f medicine (Blacks,
Hispanics, and Native Americans), these groups have the greatest minority representation in
medical schools currently. (It should be noted that Asians are not underrepresented in that
they represent over 10% o f total medical school enrollment while being 2% o f the total
United States population.) Additionally, the target groups are expected to show the greatest
population growth over the next two decades, creating an even greater need for health care
services for these populations. If Black and Hispanic physicians are most likely to meet the
critical need for health care services of Black and Hispanic populations and lower
socioeconomic populations, then medical schools must consider what factors will aid in
producing a maximum number o f physician from these groups.
The concerns examined in this study are believed to influence student performance and

attainment o f the goal o f becoming a physician; therefore, these are not simply individual
student concerns, but are also institutional concerns which will require institutional responses
to increase the probability o f student success. Studies have shown that medical students often
report concerns about interpersonal relationships and stress related health problems
(Dickstein, Stephenson & Hinz, 1990; Parkerson, Broadhead & Tse, 1990). In a study of
psychosocial assets and mental health status o f Black, White and Hispanic medical students,
Pyskoty, Richman and Flaherty (1990) found that minority students entered medical school
with some distinct advantages over nonminority students; however, they further found that
some o f those advantages diminished after one year of medical school. The research reported
in this study looks at the health, interpersonal, familial and emotional concerns o f the subjects
and their means for gaining assistance in addressing those concerns as medical students.
Results o f this study are expected to aid in identifying additional tools to be employed
in the retention and graduation o f ethnic/racial minority group students attending non­
minority medical schools. The emphasis is on examining nonacademic factors which may
negatively impact Black and Hispanic students' performance in medical school resulting in
attrition. The attitudes, preferences, use o f help sources, and reasons for not using help
sources, which relate to students accessing assistance in addressing these concerns, are more
closely examined in an attempt to identify appropriate interventions which may aid in
improving minority medical student retention.

Research Questions
Under investigation in this study are three broad research questions each having
specific hypotheses which are tested through the data analysis. The research questions are:

10
1.

What is the relationship between students' personal characteristics and their
attitudes toward seeking help, uses of help resources and reasons for not using
help resources?

2.

How does problem severity relate to the number and type of help sources used
by students to address the categories o f nonacademic problems?

3.

How do preference for sources o f help, problem severity, and help sources
used by students to address nonacademic concerns relate to academic
difficulty experienced by students?

These questions have been chosen to explore means by which medical schools, having
made the commitment to increasing the number o f minority group students admitted, can
insure providing the necessary supports for the retention and graduation o f a population o f
physicians seen as crucial to the health care delivery system. By examining the nature o f the
concerns o f this group o f students and the combinations o f support services they seek
hopefully, institutional resources will be targeted toward programmatic efforts consistent with
the identified needs.

Scope and Limitations
In order to limit the scope of this study, the population of investigation was
established as those groups both underrepresented in the health care profession and
determined to have the greatest impact on services to populations determined to be most
limited in their access to health care. Black and Hispanic students were targeted because,
although they are underrepresented among physicians and medical students, they represent

11
a more substantial number o f students enrolled and therefore are more accessible when
compared with the only other underrepresented minority group, which is Native Americans.
The colleges o f medicine in the state o f Michigan were selected because they provided a
reasonable and convenient population from which to draw a sample.
The sparsity of literature available on the nonacademic concerns of medical students
and their use o f support services aided in establishing the research variables for the study.
The investigator recognized the potential for including additional variables (e.g. personality
measures, locus o f control, racial identification) but also recognized the importance of
designing the questionnaire which could be responded to early requiring a limited amount of
time, given the observed time pressures experienced by medical students. Limitations more
specific to the data and findings are described in Chapters 3 and 5.

Overview of the Dissertation
A review of the literature regarding medical school retention, medical student attrition
and retention, and help-seeking behavior is provided in the next chapter providing support for
the rationale o f this study. The methodological design and procedures for the study are
presented in Chapter III, followed by a presentation of the results from the proposed analysis
in Chapter IV. A discussion o f the findings, emphasizing implications for medical education
is provided in the concluding Chapter V.
The final Chapter V provides summative information including conclusions, limitations
o f the findings, and implications for practice and future research.

CHAPTER II
REVIEW OF THE LITERATURE

Medical Student Retention
Studies examining factors which influence success in medical school date back to a
report titled "What Becomes o f Medical Students?" published by Paget in 1869, in which he
presents results of a ten year longitudinal study o f 1,000 students trained at St. Bartholomew's
Hospital (Gough & Hall, 1975). Gough and Hall (1975) estimate there was a 10 percent
attrition rate among the group during their studies, and the loss o f an additional 18 percent
out o f medical practice during the period o f the study.

Johnson and Huchins (1966)

responded to the call for a national study o f the reasons underlying failure to graduate from
medical school in a monograph on the dropout problem. This ten year longitudinal study of
75,453 medical students entering American colleges from 1949 through 1958 identified 3,857
students (5.1%) who dropped out for academic reasons and 2,699 (3.6%) who dropped out
for nonacademic reasons. A 1972 report issued by the American Medical Association's
Division o f Medical Education indicated that during the nine year period from 1963 to 1971,
322,864 students were enrolled in medical schools; 3,666 dropped out because o f academic
difficulties and 3,318 withdrew for nonacademic reasons (American Medical Association,
1972).
Summarizing the trends and findings o f dropout data Gough and Hall (1975) present

12

13
five conclusions:

From 50 years o f record-keeping in American medical education and from parallel
data from Britain and Canada, it appears that dropout rates have varied from a high
figure o f about 25 percent to a low o f perhaps 1.5 percent; (b) an attrition rate of
from 5 to 10 percent would appear to be "normal" with higher rates reflecting
correctable difficulties in selection and evaluation and lower rates reflecting unusually
favorable practices in both regards; (c) although the presumed normal wasting of 5
to 10 percent is appreciable, it is lower than that observed among most other graduate
and professional training programs; and (d) even today when the dropout rate is the
lowest it has ever been, over 500 students can be expected to withdraw from medical
school during the current academic year. (p.942-943)

Much o f the research regarding attrition and retention o f medical students focuses on
developing predictive equations. Reid and Blain (1977) report "conventional measures such
as science grade point average (GPA) and Medical College Admission Test (MCAT) scores
have not had high correlations with student success or failure in medical school" (p. 66). In
response the researchers began to administer a battery o f tests to incoming medical students
in an attempt to more accurately identify students who could experience academic difficulty
in medical school. Reid and Blain (1977) found that the addition o f a reading test and
problem-solving test to conventional measures allowed then to identify about three times
more students who experience academic difficulty than did conventional measures alone.
Henderson (1988) sought to identify student characteristics which correlated with

14
future success or failure among students at risk o f dismissal while attending the George
Washington University School of Medicine and Health Science. Students in his investigation
included 20 Caucasians, 19 Blacks, 1 Hispanic and 1 Asian; 25 o f the students were male and
16 female. Examining four groups o f students, based on the primary problem which placed
them at risk for dismissal (i.e., academic problems, intrapersonal problems, interpersonal
problems, intrapersonal and academic problems), Henderson (1988) found that o f the fourteen
students (9 Caucasian, 5 Black) experiencing intrapersonal problems (i.e., problems related
to anxiety or personal conflicts), 10 graduated and four withdrew. The second highest
concentration o f students were in the interpersonal problem group (i.e., difficult social and
working relationships with other students and medical school staff), o f which 8 were
Caucasian, 4 Black and one Asian. O f this group one graduated, 3 withdrew, and 9 were
dismissed. The academic problems group consisted of 3 Caucasian, and 4 Black students,
resulting in 4 graduations, 1 withdrawal and 2 dismissals. The combined intrapersonal and
academic problems group consisted of 6 Black and one Hispanic students.

For these

students, 5 graduated, one withdrew and one was dismissed.
Henderson (1988) concludes that students for whom the primary problem is related
to academic ability are least likely to complete medical school. Students for whom the
primary problem is intrapersonal are most likely to complete medical school, especially when
help is provided. He recommends early identification of students whose primary problem is
interpersonal, indicating this group is very unlikely to complete medical school. With regard
to those students expressing academic and intrapersonal problems Henderson (1988) suggests
the following:
For the minority students, who predominate in the academic problems and

15
intrapersonal/academic problems group, improved social supports have been shown
to increase graduation rates and are likely to account for the high graduation rate (71
percent) in the study reported here. (p. 601)
Supportive of Henderson's (1988) conclusions regarding minority students are the studies of
Johnson (1978) and Strayhorn (1980).
Johnson (1978) examined differences between minority and non-minority student
perceptions o f the Rutgers Medical School environment. He found that minority student
attitudes tended to be more positive than those o f non-minority students toward the concept
o f the administration and remedial programs, while their attitudes toward faculty were more
negative than those o f non-minority students. The groups did not differ in their perceptions
o f tutorial assistance. Johnson (1978) suggests special programs may serve as a positive
source of identification for all medical students and that "improved faculty-student interaction
may do much to indicate to minority students that they are accepted and to alleviate much of
the uncertainty they feel" (p. 136).
Strayhorn (1980) examined differences in the degree o f perceived stresses and social
supports among Black and White medical students at the University o f North Carolina School
o f Medicine at Chapel Hill. The research found that Black medical students perceived more
stresses than did White medical students, with the Black students having the perception that
the faculty made them feel unimportant. No differences were found in perception o f social
support for the two groups with both turning to fellow students more frequently than to other
sources, and with Black students perceiving interaction with students in general as being
stressful. Strayhom (1980) suggests that the "ability o f black students to find adequate social

16
support may offset some o f the effects o f their higher perception o f sources o f stress" (p.
619).
In an examination o f the reasons for interruption o f medical school studies for
minority and non-minority medical school graduates from 1978-79 through 1982-83, the
Association o f American Medical Colleges, Section o f Minority Affairs (1988) indicates that
over the five academic years considered, personal and/or family difficulties has been the
primary category identified as the reason minority students interrupt their studies. During the
1978-79 academic year, o f the 32 minority students indicating reasons for interrupting studies
25 percent designated personal/family difficulties as the reason, followed by health reasons
and academic difficulties (both at 22.7 percent). By the 1982-83 year o f the 80 minority
students indicating reasons, 40 percent identified personal/family difficulties and 32.5 percent
identified academic difficulties. The highest number of minority students responding occurred
during the 1981-82 academic year. O f the 83 students responding that year, 41 percent
indicated personal/family difficulties, followed by academic difficulties identified by 38.6
percent.
Given the aforementioned literature and data regarding reasons for interruption of
medical school studies among ethnic/racial group students, the need for further investigation
in this area is evident. Programming and services which will assist ethnic/racial group
students in addressing intrapersonal and interpersonal problems that impact their academic
performance must be identified in order to insure increased retention rates and ultimately
increased representation o f ethnic/racial groups among the numbers o f American physicians.

17
Attrition and Retention
Research regarding student persistence in college has over time primarily focused on
student characteristics related to attrition, with a lesser and more recent emphasis on
institutional characteristics which affect student retention (Lenning, Beal & Sauer, 1980; Lea,
Sedlacek & Stewart, 1979).
D ropout and attrition research often examines demographic factors (i.e., age, sex,
socioeconomic status, ethnicity, residence, etc.), student aspiration and motivation factors
(e.g., commitment, peer group influence, satisfaction versus dissatisfaction), and financial
factors which result in an individual's leaving college before graduation or program
completion. Two important problems associated with research on students who dropout are
those o f not "distinguishing dropout resulting from academic failure from that which is the
outcome o f voluntary withdrawal," and not differentiating those students who dropout
permanently from those who transfer to other institutions to complete their studies (Tinto,
1975, p. 89-90).

Without these distinctions findings will tend to be contradictory and

confusing and offer little assistance in the effort to identify appropriate interventions for
alleviating the problem o f student attrition.
Consistent with the focus o f attrition research on student characteristics is the
tendency to "blame the victim." Institutions examining the academic preparedness and ability
o f the student, along with other intervening individual characteristics o f the student who drops
out, will likely respond to student attrition concerns through the selection process and
avoidance o f the types of students who have not successfully completed the course o f study.
Efforts consistent with this view o f attrition tend to focus on identification of predictive
factors for admissions decisions, with those factors most heavily weighted toward academic

18
capability.
Research examining student retention has tended to incorporate information about the
college environment, which Pantages and Creedon (1978) identify as a fairly recent inclusion
in the research considerations. Lenning, Beal and Sauer (1980) present three categories of
institutional influences on retention. The first, the "objective environment," includes the
institution's image, costs o f attending, size and type, residential conditions, and services
available to students. The environment as associated with student involvement is the second
category and includes extracurricular activities, development o f close friendships, the quality
o f student -faculty relationships, and involvement in academic programs. Third is the policies
and procedures o f the institution. Lenning, Beal and Sauer (1980) indicate this category to
be lacking in sufficient research and suggest that policies and procedures need to be
supportive and "not impede matriculation or re-enrollment at an institution" (p. 21).
Certainly a response to any o f the factors included in the aforementioned categories
o f college environment will require the institution to do some self examination in considering
the fate o f its students. However, many of these factors are the characteristics that distinguish
institutions which, if altered, change the very nature o f the institution; therefore, intervention
poses a dilemma which often extends beyond the institution itself.
The interaction between student characteristics and institutional characteristics is an
area which requires examination in order to insure the development o f an optimal response
to the issues o f attrition and retention. Lenning, Beal, and Sauer (1980) make this statement:
The characteristics o f the interaction, not the student or institution alone, affect a
student's decision to stay or drop out. Students remaining in school and attaining
goals or completing a program represent a fit between a variety of factors relating to

19
both the student and the environment. Conversely, the cause o f attrition is a lack of
fit between a student and the institution; this lack o f fit can involve a wide range of
factors, which vary with the student, the institutional program and the situation, (p.
43)

Researchers examining this interaction have in various ways, and to varying degrees of
complexity, communicated the intricacies o f this interaction.
Tinto (1975) presents a theoretical model o f dropout behavior, based on Durkheim's
theory of suicide, which incorporates individual and institution interaction and distinguishes
between the processes that result in different forms o f student attrition. He emphasizes that
his is a model that seeks to explain dropout behavior from the level o f the institution rather
that from the level o f the higher education system. He presents his model as based on the
argument below:
The process o f dropout from college can be viewed as a longitudinal process of
interactions between the individual and the academic and social systems o f the college
during which a person's experiences in those systems (as measured by his normative
and structural integration) continually modify his goals and institutional commitments
in ways which lead to persistence and/or to varying forms o f dropout, (p. 94)
A schematic diagram o f Tinto's model is presented in Figure 1.
Tinto's model o f attrition acknowledges the individual characteristics associated with
personal attributes, family background, and pre-college experiences and their influences on
college performance and the development o f educational expectations and commitments.
Integration o f the individual into the academic and social systems of the institution has a direct
relationship to that individual's commitment to the specific institution and to the goal of

C om m itm ents

Academic System

Comm itments

1------------ 1
|
\

Family
Background

1I II
Goal
Commitment

i\

Grade
Performance

I

Intellectual
Development

|
|

Academic
Integration

Goal
Commitment

I
Individual
Attributes

1

J!
't

I

Institutional
Commitment

i i—
|s.^ |

Pre-College
Sihuulillg
I
I

------ 1

Faculty
Interactions

Dropout
Decisions

-*1

Jk

Peer-Group
Interactions

■I

r

Social
I---- ► Integration

Institutional
Commitment

L

|
|

I____________ I
Social System

Figure 1. Tinto's model of attrition. From "Dropout from Higher Education: A Theoretical Synthesis of Recent Research"
by V. Tinto, 1975, Review of Educational Research. 45.

21
completion. The "interplay between varying levels o f goal and institutional commitment and
the characteristics for the institution (e.g., level, quality, and size) may also be utilized to
explain the occurrences o f differing patterns o f transfer between institutions o f higher
education." The model also acknowledges the potential impact o f factors in the social system
external to the college and suggests this impact is evidenced in the person's "changing
evaluation o f his commitment to the goal o f college completion and to the institution in which
he is registered" (Tinto, 1975, p. 97).
Tinto (1975) offers a concise explanation o f the complex interrelatedness o f individual
and environmental factors which impact student attrition and retention while also providing
a comprehensive model for considering these factors.
A study conducted by Tracey and Sedlacek (1987) addressed some of the
methodological problems evident in retention research raised by Lea, Sedlacek and Stewart
(1979), and focused on Black/White differences related to prediction o f graduation. In a
longitudinal study which sampled freshmen entering a predominately white institution in 1979
and 1980, the researchers attempted to determine the validity o f the Noncognitive
Questionnaire in predicting graduation by race after five and six years (Tracey and Sedlacek,
1987). The questionnaire was designed to assess seven noncognitive factors associated with
the academic success o f racial and ethnic minority group students. Following are the seven
factors: "(a) global positive self-concept as related to expectations for the coming years, (b)
realistic self-appraisal, especially with respect to academic abilities, (c) an understanding of
racism and an ability to deal with it, (d) an ability to work toward long-term goals rather than
more immediate, short-term ones, (e) availability o f people supportive o f one’s academic
goals, (f) successful leadership experiences in either organized or informal groups, and (g)

22
demonstrated community service as indicated by involvement in local community and church
activities before college" (Tracey and Sedlacek, 1987, p. 179). Results o f this study indicate
that the noncognitive dimensions assessed by the questionnaire were significantly related to
graduation, while traditional measures of academic ability such as SAT scores were not
Additionally, most subscales o f the questionnaire were found to be more related to graduation
for Black students than for White students.
Research regarding the factors which affect the retention and graduation of students
from ethnic/racial groups is limited and most often focused on Black student populations,
indicating rates o f persistence are lower for Black students especially those attending
predominately white institutions (Astin, 1982; Sedlacek & Pelham, 1976; Sedlacek &
Webster, 1978; Tracey and Sedlacek, 1987).
Interest in research which will aid institutions of higher education in retaining and
graduating students o f all backgrounds is evident. The need for research related to the
increasingly diverse student population is becoming more apparent.

Lea, Sedlacek and

Stewart (1979) suggest that there is a need for research which focuses on student subgroup
differences in attrition and retention, why predictors interrelate, cooperative studies among
schools sharing applicant pools, and research which can be translated into practical terms to
be used in addressing retention concerns.

Medical Student Needs for Non-Academic Help Resources
In an early review o f the interaction between the psychological health of medical
students and the medical education process, Adsett (1968) identified three possible sources
o f psychological problems among medical students. The three areas o f conflict identified are:

23
" (a) adjustment associated with late adolescence and early adulthood, (b) activation o f long­
standing latent intrapsychic conflicts, and (c) the relationship taken to the medical education
process or medical school milieu (p.728).
Drawing on his experiences at the University o f Oklahoma Medical Center, Adsett
(1968) focuses attention on conflicts related to the medical education process. He points out
that "as a rule, serious psychological problems adversely affect academic performance; that
they probably account for most o f the medical student attrition is evidenced by the fact that
at the University o f Oklahoma there is no significant difference between college grades and
Medical College Admission Test scores o f those who drop out o f medical school and those
who graduate" (p.729).
Adsett (1968) offers his observations regarding the conflict experienced primarily by
male medical students during the four years o f medical education. The first year medical
student is identified as the most frequent visitor to the student health services for
psychological concerns stemming from a sense o f comparative underachievement. The first
year student may have much o f his/her self-esteem linked to "ability to excel in competition
with others," such that considerable turmoil is experienced when individual performance is
below that to which the student has become accustomed. Additionally, first year medical
students may experience anxiety around exams or aversions toward aspects o f their expected
coursework. The second year student is a less frequent visitor to the health service and is
probably better acclimated to the medical education experience. With academic pressure
lessened and greater exposure to pathology and psychopathology the student has an
opportunity to consider personal long standing problems. By the third year o f study the
number o f those seeking help tends to increase again. The concerns for these more clinically

24
focused students center around insecurity and anxiety associated with the application of
theory to practice. Additionally, the third year student is likely to experience feelings of anger
and inadequacy for "being low man in the hierarchy o f ward personnel." Fourth year students
was observed to present at the health service less than their "underclass colleagues." Pointing
to the probability that the final year is less stressful and that these students are treated more
like physicians, Adsett(1968) suggests that the senior student focuses attention on moving
from the role o f trainee to taking on greater responsibility for independent practice as a
clinician.
Acknowledging the "small group of female medical students who are likely to increase
in number in future years," Adsett (1968) observed a proportionally higher percentage of
female students seeking services, most often to address role conflict concerns.
A series o f articles in the September, 1990 edition o f Academic Medicine examined
the biopsychosociaJ well-being o f medical students and residents. Three o f these articles have
relevance here.
Dickstein, Stephenson and Hinz (1990) reported that psychiatric complaints among
medical students differ depending on their academic class. The study was comprised o f 217
medical students seen for psychiatric consultation during an eight year period at the University
of Louisville. The sample represents 20% o f the total medical student population for those
years. First year students primarily tended to report academic difficulties while fourth year
students and older medical students presented career and relationship difficulties. Looking
at gender differences these researchers found that male medical students in the sample more
often identified themselves as heavy drinkers, and women commonly perceived themselves
as more personally distressed. The women in the study seemed to be more stressed by the

25
pressures o f medical school and the resulting role strain, or they were more likely to report
their stress than were the male subjects. Perceived stress was found to be significantly
correlated with psychological and physical symptoms o f stress only in the male subjects.
Parkerson, Broadhead and Tse (1990) used data from the health promotion program
for students at Duke University School o f Medicine to examine the health status and life
satisfaction o f 286 first year students from four consecutive classes; these students completed
health and risk questionnaires at the beginning and end o f their freshman year o f study. The
researchers noted a general "worsening o f all health parameters for both men and women"
during the course o f the freshman year but found the most significant changes to be an
increase in depression scores for both men and women. In examining differences between
students who considered themselves to be very satisfied with life and those who were less
than satisfied at the end o f freshman year, the researchers found the most significant
differences to be that "more o f the satisfied than the less satisfied had very strong social ties,
participated in regular physical exercise, slept more than six hours per night, and had fewer
stressful life events."
Pyskoty, Richmam, and Flaherty (1990) examined the psychosocial assets and mental
health o f Black, Hispanic, and White medical students at a state medical college. Subjects
completed a questionnaire (focusing on psychosocial and behavioral variables) during initial
registration and again in the fall o f their second year. Areas assessed included current
interpersonal relationships, medical school stressors, personality characteristics related to self­
esteem, external locus o f control and mental health. The initial assessment revealed that both
Black and Hispanic students perceived greater social support and showed higher self-esteem
than did the White students; no differences were found across the group in measures of

26
depression and hostility, although White students showed the highest anxiety ratings. By the
following fall at the second assessment, the Hispanic students, but not the Black students,
retained their initial advantages with regard to social support, and measures of self esteem
continued to show the same trends. Measures o f mental health at the second assessment
indicated decreased anxiety for White students and increased hostility over time for the Black
students. Associating the advantages shown by the Black and Hispanic students at the initial
assessment with their participation in a special enrichment program, the researchers suggest
"enhancing the formal support networks o f minority students," and that enrichment programs
"focus on inner as well as external resources to facilitate greater feelings o f control and selfefficacy among minority students."
The aforementioned studies indicate both the general and specific negative impact of
the medical school environment on Black and Hispanic students.

Considering the

observations o f Adsett (1968) supported by the investigation of Dickstein et al. (1990) it
appears that medical student distress tends to vary with year o f study, predictably moving
from a focus on personal academic performance in a competitive environment to concerns
about personal adequacy as an independent practitioner; in between, the medical student has
the opportunity to have individual long-standing conflicts surface for attention. When the first
year o f study is the focus o f inquiry it becomes evident that within a year's time medical
student distress is likely to increase and social support becomes a significant factor for the
students (Parkerson et al., 1990; Pyskoty et al. 1990).
For Black and Hispanic students it seems probable that increased distress during the
initial year o f study and possible increased alienation as they progress through their medical
education presents a considerable risk for attrition if appropriate supports are not identified

27
and maximized. The extent to which these two groups o f students will seek the assistance
necessary to insure their success becomes an important consideration.

Help-Seeking Behavior
Gourash (1978) provides a review o f the literature on help-seeking which she defines
as "any communication about a problem or troublesome event which is directed toward
obtaining support, advice, or assistance in times of distress". Results o f her review with
regard to who seeks help indicate: help-seeking declines with age; help-seeking is more
prevalent among Whites than Blacks; "users tend to be young, white, educated, middle-class,
and female"; those who solicit help tend to turn to family and friends, and to contact
professional services as a last resort; and, that some patterns exist between certain types of
problems and sources o f help. The social network is identified as a major source o f help
serving as a "natural support system that counteracts the effects o f stressful life events," and
as an "effective strategy for coping with stress" (p. 414-417).
The decision made by an individual to seek help, formal or informal, has been
associated with the extent o f troublesome life events or symptoms o f distress experienced
(Brown, 1978; Gourash, 1978; Neighbors & Howard, 1987).
experiences,

The impact of such

mediated by the individual's sense o f self reliance and perceived

ability/preparedness to manage the stresses, often influences the decision to seek assistance
(Brown, 1978), yet there are studies which indicate that a considerable number o f people
reporting problems do not seek help at all (Gurin, 1960). Additionally, there is evidence for
race differences in seeking help ffom professional sources. Broman (1987) reported these
findings:

28
Race is a significant sociocultural characteristic that predicts professional help
seeking. Blacks are more likely than whites to seek help from mental health sources,
particularly for economic and health problems. Blacks also seek help more often than
whites from other professional sources such as teachers, lawyers, social workers, and
emergency rooms. Whites more often seek help from medical sources for all types
o f problems, and from members o f the clergy, (p. 487)

Literature regarding the use o f university mental health and other non-academic
support services by ethnic/racial group students in the minority while attending predominately
white institutions indicates a perceived and evident lesser use of formal sources of help by
those students in the minority than by White students at the same institutions (Davis &
Swartz, 1972; Leavitt, Carey & Swartz, 1971; Mackey, 1972; Winer, et al., 1974). Although
research in this regard has remained limited and primarily focused on comparisons o f Black
and White students, a few rather significant studies have been conducted.
In her analysis o f Black student utilization o f the mental health clinic at Stanford
University during the period from 1969 to 1972, Gibbs (1975) found that use o f the clinic by
Black students decreased despite a proportionate increase in the Black student population.
Gibbs (1975) also noted that the presenting problems o f Black users were similar to those of
White users, with the difference being that the stress experienced by Black users is likely to
be associated with their "marginal ethnic identity and socioeconomic status, and to the
cultural attitudes and behavior patterns resulting from this dual marginality" (p. 440). These
findings suggest the need for careful consideration o f the extent of anxiety experienced by the
student who presents for services in a predominately white institution, as well as a need for

29
outreach to students in the minority to inform them o f service availability.
Pliner and Brown (1985) surveyed Asian American, Black, Hispanic, and White
students enrolled at the University o f Houston, to determine anticipated reactions to possible
future stressful events, and to determine preferences for formal versus informal help. In
considering the four domains o f stressful events (i.e., academic, financial, family, and
personal), the researchers found the following:
Ethnic subgroups vary in their perceptions of stressors in academic and personal
domains. In the academic domain older Black and Hispanic students perceived events
as potentially more stressful than did older Asian Americans, and Hispanics had
significantly higher stress scores than did Whites. The scores o f older Black students
were not higher than those o f White students, (p. 150)

Although Pliner and Brown (1985) did not find evidence to indicate that ethnicity
added to the prediction o f preference for source o f help, they did find that age was positively
correlated to the preference for formal sources o f help, while socioeconomic status was
negatively correlated with seeking formal sources. The researchers recommend focusing on
actual use o f mental health facilities in future research to avoid discrepancies in findings
possibly attributable to the differences in stating a preference and using a service, and/or
attributable to potential versus actual use of mental health services (Pliner & Brown, 1985.
p. 150).
Cimbolic, Thompson and Waid (1981) surveyed Black and White students at a
predominately white institution to determine preferences for help source from among nine
potential sources, other than university counselors,

in addressing personal and

30
educational/vocational concerns. Important in this study is the inclusion o f "self' among the
choices o f help sources. Results indicated that Black female and White male and female
students all preferred to solve their own problems (personal and educational/vocational)
rather than seek other sources. Black males indicated equal preference for self and student
friend for personal problems; and preferred student friend for help with educational/vocational
concerns (Cimbolic, Thompson & Waid, 1981, p. 345). These results indicate a need for
programs which assist students in helping themselves and peers as they confront problems in
the university setting, and for efforts to increase awareness about available services and the
appropriateness o f counseling.
Cheatham, Shelton and Ray (1987) surveyed students at a large Eastern university to
"determine whether Black and White students made different causal attributions about
personal problems and to examine racial and sex differences in the behavior involved in
seeking help" (p. 560). Results of this study, using a number o f within group analyses,
indicated race and sex differences but not causal attribution were related to the help seeking
behavior o f the students. It was found that women and men respond to their personal
problems differently, and Blacks and Whites reveal more similarity than difference in their
experiences o f personal problems and help- seeking behavior, with greater preference for
network sources over professional sources.
Research regarding the help-seeking behavior o f ethnic/racial group students in the
minority at predominately white institutions suggests the need for further investigation in a
number o f regards. Most o f the existing literature focuses on the comparison o f Black and
White students in an attempt to determine differential patterns in seeking assistance and the
sources o f assistance used. Closer examination o f within-group differences of Black and

31
other ethnic/racial groups seems essential in order to more precisely determine the factors
which influence help-seeking behavior. Exploration o f the interaction between differential
experiences o f troublesome events among students from the same ethnic/racial group in the
presence o f the pressures o f being in the minority in the academic environment may also
contribute to an understanding o f preferences for sources o f help. It is likely that the limited
presence o f ethnic/racial professionals in the environment may be a factor which contributes
to limited use o f formal sources o f help. From a methodological perspective there is a need
to more directly determine what sources o f help have been used by ethnic/racial group
students, rather than to merely determine who might be approached under hypothetical
circumstances.

Sum m ary
The research literature indicated that student retention in higher education is a
complex interaction o f individual and institutional factors further complicated by external
environmental influences. For students pursuing professional training in medical schools the
factors which affect persistence become even greater. As adult students with greater life
stage demands, medical students are apt to experience any variety o f events which may
compete with the goal o f attaining the medical degree and becoming a physician. The medical
student from an ethnic/racial group in the minority at a predominately white institution, and
underrepresented in the field o f medicine has an additional layer o f complexity added to the
concerns. In an environment where this student is recognized as different and often assumed
to be present by special consideration, the underrepresented minority medical student must
manage the additional pressures and anxiety of the circumstances while remaining competitive

32
and progressing through the academically demanding curriculum.
As evidenced in the literature, the ethnic/racial minority student, for a number of
reasons, is unlikely to seek assistance when confronted with personal concerns. Although
there is evidence to suggest a preference for seeking help among ethnic /racial minority group
members for economic and health problems (Broman, 1987), the more specific evidence
associated with students suggests a greater reticence to such behavior. For this student,
personal concerns too often become intrusions which lead to reevaluation o f commitment to
the goals o f completing the medical education and persisting at the institution.

The

distraction posed by a personal concern soon invades the student's ability to focus on the
academic demands, resulting in a decrease in performance, despite ability, and potential
interruption o f studies. The limited likelihood that the minority medical student will seek
assistance creates a downward spiral which can end in student attrition.
Given the limited research and potential negative impact o f nonacademic concerns on
minority medical students, clearer understanding o f the factors which may prohibit helpseeking among this population is necessary. Additionally, institutions which have shown a
commitment to increasing the numbers o f ethnic/racial minority students they train need to
be assisted in retaining and graduating the students they enroll, and therefore must have
access to tools beyond the academic curriculum.
The primary focus o f the proposed study is to examine differential help-seeking
attitudes, preferences and behavior o f two underrepresented ethnic/racial medical student
groups, based on their own experiences o f personal problems since entering medical school.
Differences will be described and explained based on ethnicity/race, other personal
characteristics, and college attended.

The examination o f individual, nonacademic, and

33
nonfinancial factors will be used to suggest institutional interventions which may be useful in
increasing the retention o f Black and Hispanic medical students attending the four medical
colleges in the state o f Michigan.
The purpose o f this study is to assess student responses to areas previously researched
with different populations and to extend the literature and knowledge available regarding this
population o f students. O f particular interest will be the reasons identified by Black and
Hispanic medical students for not using help resources along with the differential use of
sources o f help and preferences for help sources across institutions.
The research questions to be examined in this investigation are presented below with
a brief discussion o f the implications associated with the possible findings:

1. What is the relationship between students' demographic characteristics and
their attitudes toward seeking help, use of help resources, and reasons for not
using help resources?
This question is primary in establishing the differential patterns o f Black and Hispanic
medical students in seeking help, and in identifying the demographic differences which may
predict help-seeking as associated with the nonacademic concerns examined. The hypotheses
are posed consistent with the literature on help-seeking behavior. It is expected that the two
groups will differ particularly with regard to their use o f help resources.
It is anticipated that Black students will indicate preferences for formal supports
within the college environment at a higher rate than will Hispanic students. This supposition
is based on the observation that there are fewer Hispanic faculty and support staff available
to students than there are Black faculty and support staff —though neither exist in adequate

34
supply. Such findings would suggest the need for increased numbers o f Hispanic personnel
in the medical schools in positions directly related and accessible to students.
Findings associated with this question will emphasize the unique needs o f the
ethnic/racial minority group students in addressing concerns which may be similar in nature
but which have differential effects. Additionally, the information gathered will provide insight
for the development o f support programs appropriate for specific groups o f students based
on personal characteristics.
To find no differences among the respondents based on an examination of
demographic characteristics may be indicative o f comparable levels o f isolation and of
perceived lack o f accessible services. Such findings could be further explicated with a careful
comparative analysis o f the reasons for not using help resources, and may suggest the need
for institutions to periodically evaluate services made available to an ever changing student
population.
Findings contrary to those presented in the hypotheses might suggest the need for
further examination o f the individual characteristics o f this population as compared with those
o f subjects in similar help-seeking behavior studies.

2. How does problem severity relate to the number and type of help sources
used by students to address the categories of nonacademic problems?
Students who experience multiple problems, or those who are greatly affected by nonacademic concerns are more likely to seek help from sources beyond themselves in order to
alleviate their distress than would be their peers who are less affected or who experience
fewer problems. Additionally, it is probable that more formal sources o f help will be sought

35
to address problems o f greater severity. If this hypothesis is supported, then it would be
important for the institutions to identify appropriate resources for students experiencing
nonacademic difficulty, and to communicate support for their seeking formal assistance
beyond that which may be available within the college.
For those institutions with higher representation of Black and Hispanic students it is
anticipated that these students will be more willing to utilize the services available than will
their counterparts at the other institutions. Such a finding would suggest that there is a
greater likelihood o f successful completion when students who perceive a more supportive
environment, based on less isolation, experience nonacademic concerns.
If the hypotheses are not supported by this investigation this may suggest that students
who perceive themselves to have experienced more severe problems are choosing to take
greater personal responsibility for their distress and it is likely they run the risk o f having their
nonacademic concerns affect their ability to perform academically. If this is found to be true,
once again clear messages o f support in identifying appropriate types o f support services,
minimizing the concern o f being stigmatized, will be essential. It is also possible that such
findings would indicate the need for instituting peer support programs as well. The reasons
for not using help resources will be important in the interpretation o f these findings as may
be an investigation o f other factors associated with the individual institutions.

3. How do preference for sources of help, problem severity, and help sources
used by students to address nonacademic concerns relate to academic difficulty
experienced by students?
This question establishes the relationship between a student's academic integration and

36
aspects o f social integration which are related to retention. One hypothesis examines the
relationship between problem severity and academic difficulty establishing the risk factor for
students experiencing nonacademic concerns. Others are aimed at delineating the differential
patterns o f help-seeking behavior as associated with problem severity and academic
performance. Findings associated with this question will determine who uses what supports,
to address what nonacademic problems, and the relationship between nonacademic problems,
use o f supports, and academic difficulty. Development o f effective interventions to retain
Black and Hispanic medical students will depend on the associated predictors and findings.
Should the hypotheses not be supported in this study this will provide additional
information regarding the coping strategies o f respondents and suggest additional areas for
investigation.

CHAPTER III
STUDY DESIGN AND PROCEDURES

The purpose o f this chapter is to present the plan for this investigation o f Black and
Hispanic medical students' help-seeking behaviors.

This descriptive study specifically

explores the variables which might influence the medical student's use of non-academic
support services to address personal concerns (i.e. physical, familial, interpersonal,
emotional/psychological). Attitudes, preferences, use of help resources in addressing personal
concerns, and reasons for not using help resources are examined to assess differential patterns
among subjects and to determine the relationship o f these variables to academic risk.
Differences are measured based on personal characteristics, and within the context o f medical
school attended as derived from a self-report questionnaire. The sections below present the
following information: descriptions o f the population and resulting sample, instruments,
operational definitions, procedures for collecting data, statistical hypotheses, data analysis,
and potential limitations.

Description of the Population
Subjects for this study were Black and Hispanic students enrolled during the 1990-91
academic year in undergraduate medical training at the Michigan medical schools, namely.
Michigan State University - College of Human Medicine; Michigan State University - College

37

38
o f Osteopathic Medicine; University of Michigan Medical School; and Wayne State
University School o f Medicine. Enrollment data for the Michigan medical schools during the
1990 academic year is presented in Table 1. Based on data reported by each school for the
"Michigan Medical Schools Council of Deans Annual Report on Undergraduate Medical
Education in the State o f Michigan 1990-1991," the population o f interest was estimated to
include 320 Black and 105 Hispanic students across all years of study at the four medical
schools (see Table 1). Total student enrollment for the four schools during the 1990-91 year
was estimated at 2,828; therefore Black student estimates represented 113% o f the total
student enrollment and Hispanic student estimates represented 3 .7% o f the total enrollment
for the four schools o f medicine.

Table 1
1990 Enrollment o f Black and Hispanic Students in Michigan Medical Schools
by Year of Study

Yr. 1

BLACK
Yr. 2
Yr 3

Yr. 4

Yr. 1

HISPANIC
Yr. 2
Yr. 3

Yr.

M SU-CHM

18

16

6

15

5

11

6

7

M SU -CO M

4

9

11

5

2

8

1

3

U OF M

17

26

29

21

18

8

11

6

W AYNE

54

44

23

22

0

7

4

8

39
Description of the Sample
O f the 425 Black and Hispanic medical students reported to be enrolled in the four
Michigan medical schools during the 1990-91 academic year, surveys were mailed to 377
students based on mailing addresses or labels provided by the institutions. From the 377
students contacted, 116 questionnaires were returned. O f the 116 questionnaires received,
103 usable responses were obtained (N = 103) and these, resultingly, comprise the sample for
this study.
The sample is primarily composed o f Black single females o f traditional medical
school age with no children. Most of the respondents are from the MSU College o f Human
Medicine. The distribution o f respondents by class standing is fairly even, with the greatest
percent being among second year students.

Instruments
A five part questionnaire was administered to subjects for this study.

The

questionnaire was comprised o f a previously derived measure o f attitudes adapted for this
study, measures created by the researcher to determine preference for and use o f help sources,
reasons for not using help resources, and a brief survey o f academic performance and
demographic factors. The origin and development o f each measure is presented below in the
order in which it is included in the questionnaire.

Attitudes Toward Seeking Psychological Help
The measure of attitudes toward seeking psychological help was adapted from Fischer
and Turner's (1970) 29-item "Attitudes Toward Seeking Professional Psychological Help"

40
Table 2
Demographic Data of Sample
(N = 103)

Variable
Ethnicity/Race
Black
Hispanic

Frequency

Percent

73
30

70.9
29.1

68
35

66.0
34.0

Gender
Female
Male
Age (as o f 1991)
22-25
26-30
31-35
36-40
41-42

31
41
16
7
3

30.1
39.8
15.5
6.8
2.9

Marital Status
Single
Married

76
26

73.8
25.2

83
12
4
3

80.6
11.7
3.9
2.9

1

1.0

Number o f Children
Zero
1
2
3
4

41
Table 3
Distribution of Sample on Academic Background Variables
(N = 103)

Variable

Frequency

Percent

College
MSU-CHM
MSU-COM
U of M
Wayne

32
27
19
25

31 1
262
18 4
24.3

Class Standing
1st year
2nd year
3rd year
4th year

22
34
21
24

21.4
33.0
20.4
23 .3

Undergraduate Institution
Low underrepresented population
High underrepresented population
HBCs and predominately und. pop.

71
10
8

68.9
9.7
7.8

42
scale. This instrument had been used in a previous study with medical students to determine
the relationship between year in medical school and attitudes toward seeking professional
psychological help (Kligfeld & Hoffman, 1979), Using separate classical regression analyses
for men and women, Kligfeld and Hoffman (1979) found that male medical students
developed more positive attitudes toward seeking professional psychological help as they
progressed in their medical training, while women entered medical training having more
positive attitudes than the men and showed no significant changes in attitude during medical
school. These findings were contrary to the results in the literature as related to attitudinal
differences between males and females.

This scale requires respondents to indicate agreement or disagreement, on a 4-point
continuum, with statements regarding aspects of general orientation to seeking professional
help for psychological problems. Factor analysis, performed by the originators, of this
instrument produced four subscales: I - Recognition of need for psychotherapeutic help; II Stigma tolerance; III - Interpersonal openness; and IV - Confidence in mental health
practitioners. The internal consistency estimate for this measure was calculated to be r=.83
suggesting moderately good consistency o f responses within the whole scale. Reliability
estimates for the individual subscales (Need, r=.67; Stigma, r=.70; Openness, r=.62;
Confidence, r=.74) suggest moderate consistency. Intercorrelation for the subscales was
fairly low suggesting the factors are reasonably independent.
Through an examination o f the Fischer and Turner (1970) scale items for face validity
as related to the proposed study, the researcher decided to eliminate the stigma tolerance
subscale consisting o f 5 items, one item from the seven item openness subscale, and three

43
items from the 9 item confidence subscale. The decision to eliminate these items is based on
the severity o f problem/treatment indicated by the items from the stigma tolerance and
confidence subscales, and concern that the item from the openness subscale might confound
response to other items in the questionnaire (i.e., "It is difficult to talk about personal affairs
with highly educated people such as doctors, teachers, and clergymen").
The resulting measure, "Attitudes Toward Seeking Psychological Help," contains 20
items to be responded to on a 4-point Likert-type scale with low scores indicating agreement
with the items and high scores disagreement. Three subscales were maintained: Scale I,
Recognition o f need for psychotherapeutic help; Scale 2, Interpersonal openness; and Scale
3, Confidence in mental health practitioners.

Factor analysis using a subsample of 88

respondents produced internal reliability estimates as follows: Overall scale, r = .8624, Need,
r = .8208; Openness, r = .5653; and, Confidence, r = .7710. This measure is designated Part
I o f the questionnaire administered to the subjects.

Preference for Potential Help Sources Index
Christensen, et al. (1976) and Cimbolic, Thompson and Waid (1981) asked students
to rank order help sources to determine preferences among college students. Drawing from
the lists o f potential and actual help sources identified in these studies the researcher
developed a rank order measure to determine preference for potential help sources among
Black and Hispanic medical students.
The "Preference for Potential Help Sources Index" asks respondents to rank order 14
potential help sources, including self, who might be approached for assistance with a personal
concern. The index includes formal (professional) and informal sources o f help, and this

44
differentiation is used in the analysis. Additionally, comparative analyses are based on the top
three and bottom three preferences. This index is designated Part II o f the questionnaire.

Problems Experienced and Help Sought
The measure of "Problems Experienced and Help Sought" is designed to assess self
report o f actual nonacademic and nonfinancial problems Black and Hispanic medical students
may experience. Consistent with the purpose o f this study, to examine factors other than
academic ability which may interfere with the specified students' completion o f medical
education training, academic factors are excluded from consideration.

Additionally,

presuming that most medical students experience financial concerns of one kind or another
this area o f consideration is also excluded from the problem type list.
Within this measure respondents are first asked to indicate problems experienced, in
terms o f the extent to which they are affected, using a 5-point scale ranging from 0 for not
a problem to 4 designating a crucial problem by which the individual is extremely affected.
As a second step respondents are to indicate the sources of help they actually sought in
addressing the identified problem areas. There are 16 possible choices including no help
sought and a category for other which allows specification o f help sources not included. All
help source options presented in the Preference for Potential Help Sources Index are included
in this measure.
The "Problems Experienced and Help Sought" measure is Part III o f the
questionnaire.

45
Reasons for Not Using Help Resources
In order to determine possible reasons for non-use of help resources, the researcher
developed a 17 item measure for which respondents indicate level o f agreement with the
individual statements on a 4-point continuum. Initial consideration o f subscales for this
measure was based on logical groupings. This approach suggested five potential subscales:
Concern (k = 2); Services (k = 4); Stigma (k = 2); Providers (k = 6); and. Personal Preference
(k = 3). The small number o f items included in some o f the scales, so identified, could
potentially prove problematic for data analysis. Subsequently, three subscales were then
identified: I Concern and Preference (k = 7); II Providers (k = 6); and, III Services (k = 4).
Preliminary factor analysis using a subsample of n = 88 supported the development o f three
subscales with a different configuration o f items. Table 4 presents the final scales, their
related items and reliability coefficients based on the analysis of all cases.
This measure is concluded with an open-ended option which allows the individual
respondent to identify any additional reasons for not using help sources to address
nonacademic concerns. The "Reasons for Not Using Help Resources" measure is included
in the questionnaire as Part IV.
Table 5 provides an overview and definition o f scales for Parts I-IV o f the
questionnaire.

Academic Performance and Demographics
Part V o f the questionnaire collects information regarding the academic performance
of respondents. Responses to four questions were used to establish the following through self
report: whether a student had ever been dismissed from studies; whether a student had ever

46
Table 4

Scale Construction and Reliability of Reasons for Not Using Help Resources

Scale 4: Personal Aversion to Seeking Services
4.
5.
6.
14.
16.

k=5

Fear of peers
Fear o f instructors
Lack o f awareness regarding services
Preference for solving own problems
Preference for family helpers
Alpha = .6001

Scale 5: Unfavorable Assessment o f Providers
7.
8.
9.
10.
11.
12.
13.

k=7

Uselessness o f services
Lack o f available helpers
Lack o f competent providers
Lack o f ethnic minority helpers
Lack o f competent ethnic providers
Personal mistrust
Mistrust based on others
Alpha =.7968

Scale 6: Time

k=3
1. Lack o f time to seek
2. Lack o f time to participate
3. Low priority
A lpha=.7401

Table 5
Definition o f Scales

Scales and Subscales
Attitudes Toward Seeking Psychological Help
Recognition of Need
Interpersonal Openness
Confidence in Mental Hlth Practitioners

Prefernece for Potential Help Sources
Fromal Sources
Informal Sources

#of
Items

Range
L
H

Reliability
Estimates

20
8
6
6

20
8
6
6

.8479
.8022
.5270
.7702

Negative attitudes toward help
Lacks recognition of need
Not open interpersonally
Lacks confidence in providers

NA

(Ranked scores 1^preferred)
Preference for informal sources
Preference for formal sources

14
8
6

80
32
24
24

NA

Meaning of
High Score

Problem Severity
Physical
Familial
Interpersonal
Emotional/Psychological

0
0
0
0

4
4
4
4

8
6

0
0
0

8
6
15

NA

17
5
7
3

17
5
7
3

68
20
28
12

.7248
.6001
.7968
.7401

NA

NA

Physical concerns main problem
Family concerns main problem
Relations with others main problem
Mental health concemsmain prob.

Help Sought
Formal Sources
Informal Sources
Number of Sources (per area)

Reasons for Not Using Help Resources
Personal Aversion to Seeking Service
Unfavorable Assessment of Providers
Time

More fomal help used
More informal help used
Many help sources used
Disagree with positivr reasons
Aversion not the reason
Providers not the reason
Time concerns not the reason

It

vj

48
taken a leave and the reasons for doing so; grades received in courses taken; and appearance
before student performance/evaluation committees. This information was converted into a
risk index score, on a scale o f 0 to 4, indicating the academic difficulty experienced by
respondents as represented in their performance and actions taken on the part o f their
institution. A value o f zero (0) represented no academic problems had been experienced and,
therefore, minimal risk; a value o f one (1) indicated some difficulty in course work which
might be any problem from a remediated course or conditional/marginal pass to courses which
remained incomplete or not passed. A value of two (2) was assigned to voluntary leaves
taken by a student in academic difficulty. A value o f three (3) indicated that a student
appeared before a student performance or evaluation committee for review o f academic
progress; finally, a value o f four (4) indicated dismissal from the institution. Examination o f
frequency data for these items indicated one respondent at level 2 having voluntarily opted
for a leave. As a result this category was eliminated, the values were redistributed across the
remaining categories, and the final risk index had four levels, as already designated, with 0
being the lowest level o f academic risk and 3, dismissal, being the highest.
Additionally, the questionnaire asks for basic demographic/personal information on
each respondent. Factors included are sex, age, ethnicity/race, marital status, number o f
children, college enrollment, class standing, type o f program, age at entry into medical school,
and undergraduate institution.

Additional Information
Two optional open-ended items conclude the questionnaire inviting respondents to
identify services which could be useful and the aspects of medical school perceived to be most

49
stressful.

Operational Definitions
In order to insure consistency in the interpretation of information and findings
associated with this study the following definitions are provided.
Subject Characteristics
Ethnicity/Race
Black. Those respondents who identified their ethnicity/race with labels such as
Black, African-American, and Afro American are included in this category.
Hispanic. Respondents using labels such as Cuban, Mexican-American, Latino,
Puerto-Rican and Hispanic are included in this category.
Age
Traditional Aged. Based on the assumption that historically medical students tend to
be in their twenties, given the trend that they enter medical school directly from
undergraduate training. Accordingly, for this study traditional aged students are those up to
and including age thirty (30).
Non-traditional Aged. The non-traditional aged student is the student over age thirty
enrolled in any level o f undergraduate medical education.
Class Standing
Preclinical Students designating their class standing as in the first two years o f study
at the medical schools are categorized as in the preclinical units o f study. These students have
closer connections and greater interaction with campus faculty/staff and services.
Clinical. Students designating their class standing as in the latter two years o f study

50
are categorized as in the ctinical units o f study. These students have greater interaction in the
clinical/hospital setting and tend to have lesser contact with central administration,
faculty/staff, and services offered by the medical schools. They are more likely, therefore, to
have access to community resources.

Undergraduate Institutions
Undergraduate institutions identified by respondents were grouped into three
categories based on the ethnic/racial student enrollment data for undergraduate institutions
reported in the Chronicle o f Higher Education (April 11, 1990); this data is compiled and
reported bi-annually. Using 1988 enrollment figures the Chronicle provides enrollment
percentages for American Indian, Asian, Black, Hispanic, White and Foreign students. To
establish the parameters for the undergraduate institution categories the focus was on the
percent o f Black and Hispanic students enrolled as compared with the percent o f students
categorized as White.
Predominantly White. Institutions having greater than 70% White student enrollment
with combined Black and Hispanic enrollment less than or equal to 20%
High Minority. Institutions having a white student enrollment less than or equal to
70% with greater than 20% Black and Hispanic student enrollment.
Historically Black Colleges and Predominantly Minority Colleges. Institutions having
a combined Black and Hispanic student enrollment greater than fifty percent.

51
Research Variables
Academic Risk
For the purpose o f this investigation a student at academic risk is one who shows
some degree o f difficulty with aspects of the medical school curriculum as evidenced by the
respective consideration of course grades, requests for leave, appearance before a student
performance committee, and/or dismissal from studies; where these considerations are
ordered from lowest risk to greatest risk.
Sources of Help
Formal Help Sources. There are eight formal help sources which identify individuals
trained to address problem areas. The formal help sources include the following: psychiatrist,
psychologist, counseling center professional o f same ethnicity, any counseling center
professional, student affairs officer, faculty member o f same ethnicity, other faculty member,
and physician.
Informal Help Sources. The six informal help sources identify individuals associated
with the respondents and who may be o f assistance in addressing the personal concerns, but
who do not necessarily have the professional training to do so. The informal help sources are
as follows: self, non-student friend, student o f same ethnicity, other student, family member,
and clergy.
P ersonal C oncerns

Physical. Any injuries, accidents, or substance abuse experienced by respondents
which may incapacitate or limit physical functioning.
Familial Those concerns associated with parents, siblings, spouse, children or other
family members.

52
Interpersonal. Concerns regarding relationships with or regarding friends and other
students, male-female relationships, conflicts with faculty/staff, cultural conflicts, and
response to racism/sexism.
Emotional/Psvchological. Mental health related concerns including, but not limited
to, low self-esteem, anxiety, loneliness/isolation, suicidal ideation, value conflicts, depression.

Procedures for Collecting Data
Pilot Study
Given that aspects o f the questionnaire to be administered in this study were
developed by the researcher a small pilot study was undertaken to establish the content
validity o f the questionnaire. For this purpose responses to the survey, with some revisions
in the instructions, were obtained from 15 Caucasian medical students at Michigan State
University. Individual students were randomly asked to complete and return the survey to
the investigator. Pilot study participants were provided with necessary instructions and
information for contacting the researcher should follow-up information be o f interest.
Based on a review o f the pilot study surveys part V, a change was made in the
ordering o f the options for the academic performance item associated with courses
completed. The pilot survey had "courses passed" as the first option seeming to result in
further consideration o f the options. By moving the "passed" option to the end o f the list
respondents might be more likely to consider the other options.
No statistical analyses were performed on pilot study questionnaires.

53
Study
Questionnaires were mailed to Black and Hispanic students enrolled at the 4 medical
schools in Michigan. A list o f students were obtained from each o f the schools and were
mailed to students by the researcher. [By completing and returning the questionnaire each
respondent indicated voluntary agreement to participate in the study].
Each survey packet included a letter describing the purpose o f the study, instructions
for completing the questionnaire, contact information for the researcher, and a return
envelope. The return envelope was the only part o f the packet coded with a subject number,

for follow-up purposes. The investigator maintained a master list to track respondents. One
follow-up contact was made to encourage response from students. A post card reminder was
sent approximately two weeks after the initial mailing to those from whom no response had
been received. This reminder provided the researcher's telephone number as a means of
contact if the survey had been misplaced or not received or if there were questions.
College level administrators responsible for student affairs were be asked to establish
with the researcher the preferred means o f survey distribution (i.e., if the school would mail
prepared packets to the student or provide labels for a mailing). In all instances labels were
provided and responses were returned to the researcher in the coded envelopes. Return
envelopes were separated from the questionnaires and used to determine response by
individual name on the master list.

54
Research Hypothesis
Hypotheses pertaining to the help seeking attitudes, preferences and behavior of Black
and Hispanic medical students are presented below. These hypotheses examine the effects
o f the six independent variables (age, class standing, college, ethnicity/race, gender, and
problem severity) on the four dependent variables (attitudes, preferences, behaviordetermined by sources used and reasons for not using help sources, and academic risk).
The research hypotheses tested are organized under the broader

research questions

posed.
R esearch Q uestion 1: What is the relationship between students' demographic
characteristics and their attitudes toward seeking help, problems experienced and use o f help
resources, and reasons for not using help resources?
Hypothesis 1:

Black and Hispanic medical students will differ in:
1.1a: their report o f problems experienced.
1.1b: the number o f formal help sources used to address non-academic
concerns.
1.2: their attitude toward seeking psychological help.
1.3: their reasons for not using help resources.
1.4a: their preference for sources o f help.
1 4b: their preferences for sources o f help.
1.5: their attitudes toward seeking help.
1.6: their reasons for not using help resources.
1.7: their attitudes toward seeking psychological help.
1.8: their reasons for not using help resources.

55
1.9: their attitudes toward seeking psychological help.
1.10: their reasons for not using help resources

Research Question 2: How does problem severity relate to the number and type of
help sources used by students to address the categories o f non-academic problems?
Hypothesis 2.1a: Students reporting greater problem severity will use more sources
o f help than will students experiencing lesser problem severity for each concern area.
H ypothesis 2.1b: Students reporting greater problem severity will identify use of
more formal help sources than will students experiencing lesser problem severity.
H ypothesis 2.2:

When problem severity is held constant, use o f formal help

resources by student will differ for colleges having higher percentages of Black and
Hispanic students.

Research Question 3: How do preferences for sources of help, problem severity and
help sources used by students to address non-academic concern relate to academic difficulty
experienced by students?
Hypothesis 3.1: Students reporting greater problem severity will differ with regard
to academic risk, from students reporting lesser problem severity.
H ypothesis 3.2: Student experiencing higher levels o f academic risk will differ in
their use o f formal help sources from those experiencing lower levels of academic
risk.

56
Design
The design for this study in generally descriptive in nature in an attempt to define the
characteristics and relationships among variables associated with the help-seeking attitudes,
preferences, and behavior of Black and Hispanic medical students. There is no attempt in this
study to manipulate the variables under investigation, but rather to determine the relations of
the independent variables to the dependent variables. The independent variables for this study
are: age, class standing, college, ethnicity/race, gender, and problem severity. The dependent
variables are: attitudes, preferences, sources of help used, reasons for not using help sources
and academic risk.
For each hypothesis, with the exception o f Hypothesis 1,4b, the cell configuration for
the analyses is consistent with that presented in Figure 3, where Y represents the dependent
variable and Y,,...,Yj represent the levels, items and/or scales o f that variable, and X
represents the independent variable with X,,...,Xj representing the levels o f the variable.
Hypothesis 1.4b is based on a 4x2 factorial design, as presented in Figure 4 where the cells
contain means from the preference measure.
All data for the study was obtained from the self-report questionnaire completed by
students who thereby became a part o f the sample by self-selection.

57
X,

«

•

•

X,

Yi
■
t

Y;
Figure 3. Cell configuration for analyses

COLLEGE

RA CE

CH M

COM

UM

W AYNE

Black
Hispanic

Figure 4. Cell configuration for 4x2 factorial design

Data Analysis
In order to test the hypothesis for this study six (6) methods of analysis were
employed. Specifically, the methods were analysis o f variance (ANOVA), Krushal-Wallis
one-way analysis o f variance, Student's t-test (t-test), Mann-Whitney test, crosstabulation,
and Spearman's rho correlation coefficient. All analyses were run through the SPSS-X release
3.0 system.

58
Analysis of Variance
ANOVA was used to test the difference between multiple means on hypotheses
related to Part I: Attitudes Toward Seeking Psychological Help items and scales; Part II:
Preferences for Help Sources, where help sources were collapsed into formal and informal
categories; Part III: Problems Experienced and Help Sought, where sources o f help used were
collapsed by category into formal and informal categories; and. Part IV: Reasons for Not
Using Help Sources.
Both one-way and two-way ANOVAs were used. The two-way ANOVA affords
examination o f the interaction effects o f the independent variables included in the analysis to
determine effects due to the combination o f those factors.
ANOVA calculations produce the F statistic which is based on the variance between
groups divided by the variance within groups (Kerlinger; 1964). The sampling distribution
o f F is used to determine significance.

Kruskal-Wallis.
The Kruskal-Wallis one-way analysis o f variance was used to test the differences
between multiple means for the ranked data from Part II: Preferences. This nonparametric
procedure eliminates the need to meet the assumptions associated with the ANOVA described
above, and allows the analysis o f data that is based on ordinal scaling.

Student's t-test
The Student's t-test was used to test the differences between two group means on the
dependent variables. The t statistic is based on an equation which divides the difference

59
between the sample means by the standard error o f the difference between the means
(Kerlinger, 1964). The sampling distribution o f t is used to determine significance.

Mann-Whitney
The Mann-Whitney test was used to test the differences between two group means
on the rank ordered data. Using the observations ranked from smallest to largest for both
groups, the number of times scores from the first group precede those from the second group
is calculated and provides the U value. The U value is used to determine significance
(Kerlinger, 1964).

Crosstabulation
In order to examine the relationships among the categorical variables crosstabulation
was used. As a "joint frequency distribution o f cases according to two or more classification
variables," crosstabulation allows examination o f the subcategories o f a variable to determine
distribution o f the measure (Nie, et al., 1975).
For the analysis in this study crosstabulation was primarily used to determine the
percent o f observations for each subcategory under consideration. Chi-square values were
not computed in most instances because o f the multiple response nature o f the data being
analyzed with this method.

Spearman's Rho
In order to assess the relationship between problem severity and help sources used
statistical procedures o f correlation were used. Because the data to be analyzed was not

60
based on an interval scale, a nonparametric method was used. Spearman's rho or Spearman's
rank correlation coefficient uses the ranks o f the data to compute the correlation coefficient
for the two variables o f interest; the range o f coefficient values is from -1 to +1, with those
values indicating a perfect linear relationship between the ranks o f the variables (Nie, et al.
1975). As a guideline for determining the relative strength o f relationships using the possible
range o f correlation coefficients, labels suggested by Rountree (1981) were used:
0.0 to 0.2 very weak, negligible
0.2 to 0.4 weak, low
0.4 to 0.7 moderate
0.7 to 0.9 strong, high marked
0.9 to 1.0 very strong, very high (p. 170)
The correlation coefficient does not allow determination o f the percent of variation
explained in one variable by another.

In order to do so the correlation coefficient is

sequenced and this value can be interpreted as the percent o f variation explained in one
variable by variation in the other (Rountree, 1981).

Criteria for Hypothesis Testing
In determining an appropriate significance level for decisions about the null
hypothesis, consideration was given to the exploratory nature of the study. Given the limited
amount o f research in the area o f Black and Hispanic medical students' retention as it relates
to non-academic variables, this study provides an opportunity to examine relationships from
a broad perspective and to determine direction for more targeted and rigorous future
research. Since this is the case, relaxing some concern regarding Type I error (rejecting a true

61

null hypothesis) seems reasonable.
The rejection region or significance level for determining statistical significance on all
tests is set at p=. 10 to allow reasonable freedom in determining areas for future research.
Analyses were conducted on the overall and subscales o f each measure. Rejection o f a null
hypothesis for this study requires a significant difference on at least one scale of a measure
under consideration.

Potential Limitations
The ex post facto nature o f this study poses potential limitations on the treatment of
results and interpretation o f the data from the study (Kerlinger, 1964).
Because the study considers the relation o f existing or retrospective independent
variables to the dependent variable, there is no control over the independent variables and the
process is more deductive than inductive. Kerlinger (1964) identifies these major weaknesses
in ex post facto research, namely: "(1) the inability to manipulate independent variables, (2)
the lack o f power to randomize, and (3) the risk o f improper interpretation." (p. 371).
Given these weaknesses, hypothesis testing, which allows for testing alternative
explanations for the variations o f the dependent variables, becomes essential. This study is
therefore designed to test various hypotheses related to the dependent variables in an effort
to increase control and support interpretation o f results.

C H A PTER IV
ANALYSIS O F TH E DATA

This chapter presents an analysis o f the research data. Each research question is
restated with the associated hypotheses organizing the presentation o f relevant data and a
discussion o f results. Hypotheses, data, and results which address the association between
respondents' personal characteristics and measures o f attitudes, uses o f help resources and
reasons for not using help resources are presented first, followed by those which examine the
problems experienced and help sources used, and then those which present the association
between academic difficulty and measures o f preferences for sources o f help, problem
severity, and help sources used.

D em ographic C haracteristics
R esearch Q uestion 1: What is the relationship between students' demographic
characteristics and their attitudes toward seeking help, problems experienced, use o f help
resources, and reasons for not using help resources?
Null hypothesis 1.1a:

Black and Hispanic medical students will not differ in
their report o f problems experienced.

A lternative hypothesis:

Black and Hispanic medical students will differ in their
report o f problems experienced.
62

63
Using the severity rating for each concern area of Part III: Problems Experienced and
Help Sought, respondents were grouped by ethnicity/race.

A t-test was computed to

determine significance between the two groups on each o f the four concerns. None o f the
probability values met the criterion for significance (see Table 6). The null hypothesis is
supported and the alternative is rejected. There does not appear to be a difference in the
problems experienced by Black and Hispanic medical students.
Null hypothesis 1.1b:

Black and Hispanic medical students will not differ in
the number o f formal help sources used to address
non-academic concerns.

A lternative hypothesis:

Black and Hispanic medical students will differ in the
number o f formal help sources used to address nonacademic concerns.

Crosstabulations by race performed on the help sources used across all concern areas
revealed that for Black students the formal help sources used most frequently were as follows:
physician (53.4%); student affairs officer (30.1%); and faculty member o f the same ethnicity
(24.7%). For Hispanic students the formal help sources used most frequently were the
following: student affairs officer (30%); physician (30%); and other faculty member (13.3%).
Independent t-tests by race conducted on the mean number o f formal and informal
help sources used for each o f the problem areas reported in Part III produced probability
values meeting the criteria for significance on three variables: Physical-Informal (p = .091),
Emotional-Formal (p = .013), and Overall-Formal (p = .010); the variables o f interest here
are Emotional-Formal and Overall-Formal (Table 7). The null hypothesis is rejected and the
alternative is supported.

Table 6
Mean Scores and t-Tests for Differences Between Black and Hispanic
Medical Students' Problems Experienced

Variable

Black
(n=73)
Mean

SD

Hispanic
(n=30)__
Mean
SD

Student's t

Physical

.71

1.14

.43

.86

1.36

.179

Familial

1.88

1.26

1.80

1.24

.28

.778

Interpersonal

2.29

1.09

12.33

1.25

.98

.334

Emotional

1.71

1.26

12.07

1.28

1.01

.317

a = .10

*

Table 7
Mean Scores and t-Tests for Differences Between Black and Hispanic
Medical Students' Use of Formal and Informal Help Sources by Area of Concern

Variable

Black
(n=73)
Mean

SD

Hispanic
(n=30)
Mean

SD

Student’s t

P

Physical-Informal

.68

1.13

.37

.72

1.71

.091

Physical-Formal

.64

.81

.43

.77

1.24

.220

Familial-Informal

1.82

1.34

1.93

1.34

-.38

.702

Familial-Formal

.41

.90

.37

1.00

.21

.834

2.30

1.57

2.43

1.81

-.35

.729

Interpersonal-Informal

.47

.71

.30

.65

1.14

.258

1.93

1.64

2.17

1.76

-.63

.533

.81

1.15

.33

.71

2.54

.013

Overall-Informal

3.07

1.61

3.53

1.43

-1.44

.154

Overall-Formal

1.68

1.38

.93

1.26

2.68

.010

Interpersonal-Formal
Emotional-Informal
Emotional-Formal

66
Overall Black students used a greater number o f formal sources to address concerns
than did Hispanic students. Additionally, Black students used significantly more formal help
sources when addressing emotional concerns.
Null hypothesis 1.2:

Black and Hispanic medical students will not differ in
their attitudes toward seeking psychological help.

Alternative hypothesis:

Black and Hispanic medical students will differ in their
attitudes toward seeking psychological help.

Independent t-tests were performed to assess the difference in means o f Black and
Hispanic respondents on the scales o f Part I: Attitudes Toward Seeking Psychological Help
(Table 8). None o f the probability values met the criterion for significance (p<. 10). The null
hypothesis is not rejected. There is not sufficient evidence to suggest that Black and Hispanic
medical students differ in their attitudes toward seeking psychological help.
Null hypothesis 1.3:

Black and Hispanic medical students will not differ in
their reasons for not using help resources.

Alternative hypothesis:

Black and Hispanic medical students will differ in their
reasons for not using help resources.

Independent t-tests were performed to assess the difference in means o f Black and
Hispanic respondents on all scales o f Part IV: Reasons for Not Using Help Resources
Probability values met the criterion for significance (p < .10) on Scale 5 -Unfavorable
Assessment o f Providers (see Table 9). The null hypothesis is rejected and the alternative
hypothesis is supported. Black students endorse an unfavorable assessment o f providers (with
emphasis on a lack o f ethnic providers and a lack o f competent ethnic providers) as their
reason for not using help resources. Based on examination o f the items associated with this

Table 8
Mean Scores and t-Tests for Black and Hispanic Medical Students
on Scales of Attitudes Toward Seeking Psychological Help

Scale

Overall

Black
(n=73)
Mean

SD

Hispanic
(n=30)
Mean

SD

40.84

9.05

41.47

16.21

4.98

13.29

11.34

Student's t

P

11.13

-.28

.784

17.07

5.43

-.75

.457

2.99

12.33

3.71

1.25

.218

3.23

12.07

3.95

-.89

.378

[k=20]

Recognition of Need for
Psychotherapeutic Help
[Scale 1 k=8]

Interpersonal Openness
[Scale 2 k=6]

Confidence in Mental
Health Practitioner
[Scale 3 k=3]

a =10

Table 9
Mean Scores and t-Tests for Black and Hispanic Medical Students
on Scales of Reasons for Not Using Help Resources

SD

Hispanic
(n=30)
Mean

SD

Student's t

P

41.01

7.82

43.20

6.77

-1.42

.160

Personal Aversion to Seeking Services
[Scale 4 k=5]

11.18

3.39

11.30

2.60

- .20

.844

Unfavorable Assessment o f Providers
[Scale 5 k=7]

17.27

5.06

19.27

4.97

-1.84

.071

Time

6.40

2.39

6.53

2.64

- .24

.808

Scale

Overall

Black
(n=73)
Mean

[k=17]

[Scale 6 k=3]
a = .10

69
measure it appears that Black students identify the lack o f ethnic/racial group helpers, and the
lack o f competent ethnic/racial group providers as their primary reasons for not using
resources available, while Hispanic students endorse not experiencing a concern or crisis as
reason their reason for not using available help resources.
Null hypothesis 1.4a:

Black and Hispanic medical students will not differ in
their preferences for sources o f help.

A lternative hypothesis:

Black and Hispanic medical students will differ in their
preferences for sources o f help.

Because the responses to the Part II: Preferences for Potential Help Sources measure
are rank ordered, the Mann-Whitney test was used to test for mean differences on each help
source. Probability values for counseling center professional of the same ethnicity (p = .0009)
and other student (p = .0035) exceeded the criterion for significance (see Table 10).
Additionally, cross-tabulations revealed that only Black respondents indicated preference,
among their top three choices, for psychiatrist, psychologist, counseling center professional
o f same ethnicity, student affairs officer and faculty member o f same ethnicity. These choices
did not appear at all among Hispanic student preferences. Conversely, Hispanic students did
not include the sources self, non-student friend and family member among their bottom three
or least preferred help sources, while these sources did appear at a low frequency among
Black student responses. Analysis of variance by college and race, on preference for formal
and informal sources, indicated a significant difference (p = .05) on the means for Black and
Hispanic students on formal sources o f help, with Black students indicating preference for
more formal sources than did Hispanic students. The null hypothesis is rejected and the
alternate hypothesis is supported.

70
Table 10
Mann-Whitney Test of Preference for Potential Help Sources by Race

Counseling Center Professional of Same Ethnicity
Mean Rank

Cases

43.24

69 Black

64.16

29 Hispanic

Corrected for Ties
2-tailed P
U = 575.5

W = 1860.5

Z = 3.3264

.0009

Other Student

Mean Rank

Cases

56.38

72 Black

37.66

29 Hispanic

Corrected for Ties
2-tailed P
U = 657.0

W = 1092.0

Z = -2.9223

.0035

71
Null hypothesis 1.4b:

Black

and

Hispanic medical

students, within

institutions will not differ in their preference for
sources o f help.
A lternate hypothesis:

Black

and

Hispanic medical

students, within

institutions will differ in their preference for sources of
help.
Examination o f Part II crosstabulations on the top three and bottom three preferences
by college and ethnicity/race indicated that consistently the top three choices for both groups
o f students at all four colleges included self, family member, and non-student friend in some
configuration. Greater variability was observed among the bottom three or least preferred
sources o f help across the ethnic/racial groups within their colleges.

All, except COM

Hispanic students, included other faculty members among their least preferred help sources.
Analysis o f variance was performed on the preference measure by collapsing help
sources into two categories, formal and informal, and calculating the mean o f the ranks.
ANOVA results on formal sources by college and ethnicity/race revealed a significant source
o f variance to be explained by race (p = .050), but not by college (Table 11). No interaction
effect was observed and no significant differences were found in the analysis of informal
sources o f help.
Based on these results the null hypothesis is supported and the alternative hypothesis
is rejected. Although Black and Hispanic students differ in their preference for help sources,
when the observation is made specifically within each institution no significant differences in
the preferences o f the two groups are observed.

72
Table 11
Analysis of Variance on Preference for Informal and
Formal Help Sources by College and Race

INFORMAL

Source of Variation
Main Effects
College
Race
2-Way Interactions
College X Race
Explained
Residual
Total

Sum of
Squares

DF

Mean
Square

F

Sig
of F

13.833
5.853
5.121

4
3
1

3.458
1.951
5.121

1.377
.777
2.038

.248
.510
.157

1.654
15.487
236.127
251.613

3
7
94
101

.551
2.212
2.512
2.491

.219
.881

.833
.525

FORMAL

Source of Variation
Main Effects
College
Race
2-Way Interactions
College X Race
Explained
Residual
Total

Sum of
Squares

DF

Mean
Square

F

Sig
or f

8335
.671
6.992

4
3
1

2.084
.224
6.992

1.170
.125
3.926

.329
.945
.050

1.756
10.091
167.420
177311

3
7
94
101

.585
1.442
1.781
1.758

.329
.809

.805
.582

73
Null hypothesis 1.5:

Female and male students will not differ in their

attitudes toward seeking help.
A lternative hypothesis:

Female and male students will differ in their attitudes
toward seeking help.

Independent t-tests for the scales o f Part I: Attitudes Toward Seeking Psychological
Help by gender produced probability values which met the criterion for significance (p < .10)
on the overall scale for this measure, and Scale 1 - Recognition o f Need for Psychotherapeutic
Help (see Table 12). All scales indicated positive attitudes by female respondents.
ANOVA by sex and race was run for each scale of Part I. Results indicated significant
differences by sex on the overall scale, Scale 1 - Recognition o f Need for Psychotherapeutic
Help, and Scale 2 - Interpersonal Openness (Table 13).
Based on these analyses the null hypothesis is rejected and the alternative is supported.
Female students expressed more positive attitudes toward seeking psychological help, they
indicated greater likelihood o f recognizing a need for psychotherapeutic help, and indicated
greater interpersonal openness.
Null hypothesis 1.6:

Female and male students will not differ in their
reasons for not using help resources.

A lternative hypothesis:

Female and male students will differ in their reasons
for not using help resources.

Independent t-tests for the items and scales o f Part IV: Reasons for Not Using Help
Resources by sex produced no significant findings (Table 14). ANOVA by sex and race did
not indicated significant difference between the means for females and males, however a
significant interaction effects were noted on Scale 4: Personal Aversion to Seeking Services

Table 12
Mean Scores and t-Tests for Female and Male Medical Students
on Scales of Attitudes Toward Seeking Psychological Help

Scale

Overall

Female
fn=68)
Mean

SD

Male
(n=35)
Mean

SD

39.84

9.66

43.31

9.35

15.59

4.87

18.14

12.69

3.31

11.56

3.37

Student's t

P

-1.77

.081

5.18

-2.42

.018

13.63

3.03

-1.44

.154

11.54

3.67

.02

.989

[k=20]

Recognition of Need for
Psychotherapeutic Help
[Scale 1 k=8]

Interpersonal Openness
[ S c a ld k=6]

Confidence in Mental
Health Practitioner
[Scale 3 k=3]

a =10

75
Table 13
Analysis of Variance on Scales of Attitudes Toward Seeking
Psychological Help by Gender and Race

PART I
Source of Variation
Main Effects
Gender
Race
2-Way Interactions
Gender x Race
Explained
Residual
Total

Sum of
Squares

DF

Mean
Square

F

Sig
o fF

279.199
270.732
.002

2
1
1

139.600
270.732
.002

1.504
2.916
.000

227
.091
.997

26.661
305.860
9190.101
9495.961

1
3
99
102

26.661
101.953
92.829
93.098

.287
1.098

.593
.354

SCALE 1
Source of Variation
Main Effects
Gender
Race
2-Way Interactions
Gender x Race
Explained
Residual
Total

Sum of
Squares

DF

Mean
Square

F

Sig
of F

154371
138.603
3574

2
1
1

77.186
138.603
3574

3.065
5504
.142

.051
.021
.707

1
3
99
102

4.073
52.815
25.183
25.996

.162
2.097

.688
.105

4.073
158.444
2493.109
2651553

SCALE 2
Source of Variation
Main Effects
Gender
Race
2-Way Interactions
Gender x Race
Explained
Residual
Total

Sum of
Squares

DF

Meaa
Square

F

Sig
of F

47.890
28525
27586

2
1
1

23.945
28525
27586

2531
2.777
2.685

.103
.099
.104

.002
47.892
1017.099
1064.990

1
3
99
102

.002
15.964
10.274
10.441

.000
1554

.990
.205

Table 14
Mean Scores and Statistical Values for Female and Male Medical Students
on Scales of Reasons for Not Using Help Resources

SD

Male
(n=35)
Mean

SD

Student's t

P

41.09

7.66

42.74

7.36

-1.07

.290

Personal Aversion to Seeking Services
[Scale 4 k=5]

10.87

2.97

11.89

3.46

-1.48

.144

Unfavorable Assessment of Providers
[Scale 5 k=7]

17.81

5.39

17.94

4.52

-.13

.894

Time

6.21

2.35

6.89

2.61

-1.29

.200

Scale

Overall

Female
(n=68)
Mean

[k=17]

[Scale 6 k=3]
a = .10

77
(Table 15). This finding indicates that Hispanic males showed greatest disagreement with this
scale, but opposite effects exist on race and sex dimensions suggesting additional effects
associated with each o f those dimensions. These results do not offer sufficient support for
the alternative hypothesis; therefore, the null hypothesis is not rejected. Differences in this
regard can not be attributed to gender alone.
Null hypothesis 1.7:

Traditional aged and non-traditional aged students will
not

differ

in

their

attitudes

toward

seeking

psychological help.
A lternative hypothesis:

Traditional aged and non-traditional aged students will
differ in their attitudes toward seeking psychological
help.

Independent t-test for scales of Part I by age produced a probability value which met
the criterion for significance (p < .10) on Scale 3; Confidence in Mental Health Practitioners
(see Table 16). ANOVA by age and race (Table 17) also revealed significant differences by
age on Scale 3 (p = .054).
The null hypothesis is rejected and the alternative is supported. Non-traditional aged
students appear to have more positive attitudes toward seeking help particularly as related to
their confidence in mental health practitioners.
Null hypothesis 1.8:

Traditional aged and non-traditional aged students will
not differ in their reasons for not using help resources.

A lternative hypothesis:

Traditional aged and non-traditional aged students will
differ in their reasons for not using help resources.

Independent t-tests by age on Part IV indicated probability values which met the

78
Table 15
Analysis of Variance on Scales of Reasons for Not Using
Help Resources by Gender and Race

Scale 4: Personal Aversion to Seeking Services

Source of Variation
Main Effects
Sex
Race
2-Way Interactions
Sex x Race
Explained
Residual
Total
a = . 10

Sum of
Squares

DF

Mean
Square

F

Sig
of F

24.029
23.713
.080

2
1
1

12.014
23.713
.080

1.225
2.418
.008

.298
.123
.928

28.327
52.346
970.945
1023.301

1
3
99
102

28.327
17.452
9.808
10.032

2.888
1.779

.092
.156

Table 16
Mean Scores and t-Tests for Medical Students by Age Groups
on Scales of Attitudes Toward Seeking Psychological Help

Scale

Overall

Traditional
(n=68)
Mean
SD

Non-Traditional
(n=30)
Mean
SD

41,49

9.24

39.20

16.53

4.74

13.03

11.93

Student's t

P

9.66

1.09

.279

16.20

5.68

.28

.782

3.06

12.47

3.38

.78

.438

3.47

10.53

2.96

2.03

.046

[k=20]

Recognition o f Need for
Psychotherapeutic Help
[Scale 1 k=8]

Interpersonal Openness
[Scale 2 k=6]

Confidence in Mental
Health Practitioner
[Scale 3 k=3]

80
Table 17
Analysis or Variance on Scales of Attitude Toward
Seeking Psychological Help by Age and Race

Scale 3: Confidence in Mental Health Practitioners
Source of Variation
Main Effects
Age
Race
2-Way Interactions
G ender x Race
Explained
Residual
Total

Sum of
Squares

DF

Mean
Square

F

sig
of F

56.228
42345
15.827

2
1
1

28.114
42345
15.827

2.531
3.812
1.425

.085
.054
.236

2.193
58.421
1044.079
1102500

1
3
94
97

2.193
19.474
11,107
11366

.197
1.753

.658
.161

81
criterion for significance on Scale 4: Personal Aversion to Seeking Services (p = .058) (Table
18).
ANOVA by age and race also produced a significant value for Scale 4; with nontraditional aged students endorsing aversion as a reason for not seeking services (Table 19).
The null hypothesis is rejected and the alternative hypothesis is supported. Traditional
and non-traditional aged students seem to differ significantly in their endorsed reasons for not
using help resources; traditional aged students seem to have more o f a personal aversion to
seeking services than do their non-traditional aged counterparts.
Null hypothesis 1.9:

Preclinical level and clinical level students will not
differ in their attitudes toward seeking psychological
help.

A lternative hypothesis:

Preclinical level and clinical level students will differ in
their attitudes toward seeking psychological help.

Independent t-tests by class for the scales o f Part I produced probability values which
met the criterion for significance on Scale 3: Confidence in Mental Health Practitioners (Table
20), indicating positive attitudes by clinical level students. ANOVA by class and race also
indicated significant differences by class on Scale 3 (Table 21).
Based on these analyses the null hypothesis is rejected and the alternative is supported.
There is evidence that clinical level students have more positive attitudes toward seeking
psychological help than do preclinical students, based on their greater confidence in mental
health practitioners.
Null hypothesis 1.10:

Preclinical level and clinical level students will not
differ in their reasons for not using help resources.

Table 18
Mean Scores and Statistical Values for Medical Students by Age Groups
on Scales of Reasons for Not Using Help Resources

Traditional
(n=68'l
Mean

SD

Non-Traditional
(n=30)
SD
Mean

41.90

7.03

41.30

8.33

.34

.733

Personal Aversion to Seeking Services
[Scale 4 k=5]

10.78

3.03

12.13

3.26

-1.94

.058

Unfavorable Assessment o f Providers
[Scale 5 k=7]

18.40

4.77

16.83

5.09

1.43

.159

Time

6.43

2.18

6.60

3.10

-.28

.783

Scale

Overall

Student's t

P

[k=17]

[Scale 6 k=3]
a = .10

83
Table 19
Analysis of Variance on Scales of Reasons for Not Using
Help Resources by Age and Race

Scale 4: Personal Aversion to Seeking Services
Source of Variation
Main Effects
Age
Race
2-Way Interactions
Age x Race
Explained
Residual
Total

ct=10

S u n of
Squares

DF

Mean
Square

F

sig
of F

38.366
37.879
.208

2
1
1

19.183
37.879
.208

1.977
3.904
.021

.144
.051
.884

10.821
49.187
912.129
961.316

1
3
94
97

10.821
16.396
9.704
9.910

1.1L5
1.690

.294
.175

Table 20
Mean Scores and t-Tests for Medical Students by Class Standing
on Scales of Attitudes Toward Seeking Psychological Help

Scale

Overall

Pre-Clinical
(n=56)
Mean
SD

Clinical
(n=45)__
Mean
SD

42.38

10.55

39.64

8.33

1.45

.149

17.14

5.32

15.91

4.67

1.24

.219

Student’s t

P

[k=20]

Recognition of Need for
Psychotherapeutic Help
[Scale 1 k=8]

Interpersonal Openness
[Scale 2 k=6]

Confidence in Mental
Health Practitioner
[Scale 3 k=3]

13.11

3.23

12.84

3.27

.40

.687

12.13

3.96

10.89

2.67

1.87

.065

85
Table 21
Analysis o f Variance on Scales o f A ttitude Toward
Seeking Psychological Help by Class and Race

Scale 3: Confidence in Mental Health Practitioners
Source of Variation
Main Effects
Class
Race
2-Way Interactions
Class x Race
Explained
Residual
Total

a= . 10

Sum of
Squares

DF

Mean
Square

F

47.734
33..586
.002

2
1
1

23.867
33586
.002

2.012
2.832
.000

.096
.997

14.433
62.167
1150.526
1212.693

1
3
97
100

14.433
14.4333
11.861
12.127

1.217
1.217

.273
.273

sig
of F
.139

86
A lternative hypothesis:

Preclinical level and clinical level students will differ in
their reasons for not using help resources

Independent t-tests by class for the scales of Part IV did not produced any probability
values which met the criteria for significance (Table 22).
ANOVA by class and race was run for the scales o f Part IV and again no significant
differences were identified (Table 23). Significant interaction effects between race and class
were found on the overall scale and Scale 5.
Based on these analyses, the null hypothesis is not rejected. There does not appear
to be a distinct difference between preclinical and clinical level students in terms o f their
reasons for not using help resources; however, there does appear to be an opposite effect of
race and class across the groups in terms o f their overall reasons for not using help and their
assessment o f providers. Hispanic students in the preclinical levels o f study disagree with the
presented reasons for not using help sources and do not identify providers as a reason for not
using resources. Hispanic students in the clinical years o f study do endorse these as reasons,
while the opposite combination is true for Black students. Differences can not simply be
explained by class standing.

Sum m ary
The examination o f help-seeking attitudes preferences and behaviors as associated
with respondents' personal characteristics indicate that although Black and Hispanic students
do not differ in problems experienced, Black students used a greater number o f formal help
sources to address concerns. With regard to reasons for not using help resources. Black
students associated their reasons with unfavorable assessment o f providers while Hispanic

Table 22
Mean Scores and t-Tests for Medical Students by Class Standing
on Scales of Reasons for Not Using Help Resources

Scale

Overall

Pre-Clinical
Cn=56j_
Mean
SD

Clinical
(n=45)
Mean

SD

42.30

40.69

7.30

7.85

Student's t

1.07

p

.288

[k=17]

co
vl
Personal Aversion to Seeking Services
[Scale 4 k=5]

11.13

3.05

11.24

3.39

-.1 8

.854

Unfavorable Assessment o f Providers
[Scale 5 k=7]

18.48

5.48

17.00

4.60

1.48

.143

Time

6.71

2.46

6.11

2.41

1.24

218

[Scale 6 k=3]

a =10

88
Table 23
Analysis of Variance on Scales o f Reasons for Not Using
Help Resources by Class and Race

Scale 5: Unfavorable Assessment of Providers
Source of Variation
Main Effects
Class
Race
2-Way Interactions
Class x Race
Explained
Residual
Total

a= . 10

Sum of
Squares

DF

Mean
Square

F

Sig
o rF

120.798
41.777
65.988

2
1
1

60399
41.777
65.988

2.450
1.695
2.677

.092
.196
.105

122338
243336
2391.456
2634.792

1
3
97
100

122.538
81.112
24.654
26348

4.970
3.290

.028
.024

89
students endorsed having no concern to be addressed as the reason. Preferences for help
sources were in the direction o f formal sources for Black and informal for Hispanic students.
The college Black and Hispanic students attend had no effect on preferences for help sources
Female, non-traditional aged, and clinical level students have more positive attitudes
toward

seeking psychological help.

Female students recognized the need for

psychotherapeutic help and showed greater interpersonal openness. Both non-traditional
aged, and clinical level students display confidence in mental health practitioners.
No significant differences in terms o f reasons for not using help resources were
apparent by gender and class standing. However for age, non-traditional aged students
identified the providers as lacking, while traditional aged students seemed to have a personal
aversion to seeking services. There do appear to be additional effects to be examined in terms
of reasons for not using help resources when race is combined with gender or class standing.

Problem s Experienced and Help Sources Used
Research Question 2: How does problem severity relate to the number and type of
help sources used by students to address the categories o f non-academic concerns?
Null hypothesis 2.1a:

Students reporting greater problem severity will not
use more sources of help than will students
experiencing lesser problem severity for each concern
area.

A lternative hypothesis:

Students reporting greater problem severity will use
more sources o f help than will students experiencing
lesser problem severity for each concern area.

90
Spearman correlation coefficients were calculated for Part III using the severity values
for each concern area (physical, familial, interpersonal and emotional), correlated with the
values for the informal and formal help sources used (Table 24). The correlations o f interest
were those which paired the concern area with the informal and formal help sources used to
address that particular concern (e.g., physical correlated with Physical-Informal and with
Physical-Formal).
Examination o f values computed indicated all correlations o f interest to be significant
at or beyond a probability value o f p=.001, and indicated positive relationships existed for
each pair.
O f the eight pairs examined, five had moderately strong correlations, suggesting
substantial relationships (physical/Physical-Informal, rho=.5843; physical/Physical-Formal,
rho=.5576; familial/Familial-Informal, rho=.4601; familial/Familial-Formal, rho=.4412; and
emotional/Emotional-Formal, rho=.4315). The three remaining pairs had low correlation
coefficients, suggesting small or weak relationships.

For these pairs the correlation

coefficients were: emotional/Emotional-Informal, rho=.3639; interpersonal/InterpersonalInformal, rho= 3362; and, interpersonal/Interpersonal-Formal, rho=.3017.
The observations that all pairs covary indicates the tendency for students experiencing
greater problem severity to seek more help sources. The strength o f the relationships for the
majority of pairs suggest a substantial relationships between the pairs. Accordingly, the null
hypothesis is rejected and the alternative is supported; it appears that students reporting
greater problem severity use more help sources than students experiencing lesser problem
severity.

Table 24
Spearman Correlation Coefficients for Concern Areas with
Informal and Formal Help Sources Used

N = 103
OFORM

PINFORM

PFORM

FINFORM

FFORM

IFORM

EINFORM

EFORM

OtNFORM

Physical

.5843

.5576

.1518

-.0956

-.0287

.0924

.1190

.3120

.3352

Familial

.0757

.1405

.4601

.4412

.1023

.1898

.1419

.1632

.2345

Interpersonal

.0943

.0164

.0887

.0145

.3017

.3362

.1674

.1238

.1570

Emotional

.0367

.0994

.0686

.2799

.2216

.3639

.4315

.0905

.3694

92
Null hypothesis 2.1b:

Students reporting greater problem severity will not
identify use of more formal help sources then will
students reporting lesser problem severity.

A lternative hypothesis:

Students reporting greater problem severity will
identify use of more formal help sources than will
students reporting lesser problem severity.

Results from the correlational analysis, as described above, were used to compare the
relationship between informal and formal sources o f help for each concern area (see Table
24).
The correlation coefficients and coefficients of determination (rho2) for informal scales
were higher than for the corresponding formal scales on three o f the four sets under
investigation (i.e., Physical-Informal,/Physical-Formal, Familial-Informal/Familial-Formal,
Interpersonal-Informal/Interpersonal-Formal).

For the emotional concern area, the

correlation coefficient and coefficient o f determination for Emotional-Formal (rho = .4315)
exceeded that o f Emotional-Informal (rho=.3639).
Because a majority o f the correlation coefficients for the informal scales exceeded
those o f the formal scales the null hypothesis is not rejected, suggesting there is no difference
in the number o f formal help sources used by students based on greater versus lesser problem
severity except for in the case o f emotional concerns.
Null hypothesis 2.2:

When problem severity is held constant, use o f formal
help resources will not differ for colleges having
higher percentages of Black and Hispanic students.

A lternative hypothesis:

When problem severity is held constant, use of formal

93
help resources will differ for colleges having higher
percentages o f Black and Hispanic students.
ANOVA by college was performed to test the difference between the mean number
o f formal and informal source o f help used by students for each concern category as reported
in Part III (Table 25). Problem severity values o f 2 or greater were used in the analysis.
Results indicated significant differences across colleges for one category, specifically
Emotional-Formal, for which the probability value is p = .022.
An examination o f the group means on Emotional-Formal for each college suggests
COM (x = 1.86) to have a mean, with regard to this variable, significantly different from
CHM (x = 1.07) UM (x = .50) and WAYNE (x = .62). These findings are consistent with the
differences in the percent o f Black and Hispanic student enrollment at the colleges (COM 8.4%; CHM - 18.4%; UM - 16.4%; and WAYNE - 15.4%).
The null hypothesis is rejected and the alternative is supported.

For students

experiencing emotional concerns, students attending the school with the smallest percent of
Black and Hispanic student enrollment reported using a greater number o f formal support
services.
Summary
In examining the problems experienced and help sources used it appears that students
reporting greater problem severity use more help sources than do students reporting lesser
problem severity. Only for emotional concerns do the number o f formal help sources used
exceed that of informal help sources used. Additionally, there is a significant difference in the
number o f formal help sources used by students attending schools with lower percentages of
Black and Hispanic students enrolled, indicating greater use of formal sources in that instance.

94
Table 23

Analysis of Variance on Formal Sources of Help
Used for Emotional Concerns by College

Sum of
Squares

DF

Mean
Square

F

Sig
of F

Main Effects
College

14.601

3

4.867

3.495

.022

Explained

14.601

3

4.867

3.495

.022

Residual

68.229

49

1392

Total

82.830

52

Source of Variation

a= . 10

1393

95
Academic Difficulty
Research Question 3: How do preferences for sources of help, problem severity, and
help sources used by students to address non-academic concerns relate to academic difficulty
experienced by students?
Null hypothesis 3.1:

Students reporting greater problem severity will not
differ from students reporting lesser problem severity
with regard to academic risk.

A lternative hypothesis:

Students reporting greater problem severity will differ
from students reporting lesser problem severity with
regard to academic risk.

ANOVA for each concern area by academic risk was performed.

None o f the

obtained probability values met the criterion for statistical significance.

Additionally,

independent t-tests examining the problem severity for groups o f students who appeared
before the student evaluation/promotion committee and were dismissed versus those who
appeared before the committee but were not dismissed revealed no significant differences
(Table 26). The null hypothesis is not rejected based on these analyses.
There does not appear to be evidence that reported problem severity is significantly
associated with academic risk for the respondents.
Null hypothesis 3.2:

Students experiencing higher levels of academic risk
will not differ from those experiencing lower levels in
their use of formal help sources.

A lternative hypothesis:

Students experiencing higher levels of academic risk
will differ from those experiencing lower levels in their

Table 26
Mean Scores and t-Tests for Differences Between Students with Committee
and Committee/Dismissal on Problems Experienced

COSDIS

COSE

(n = ,1 3 3 _
Variable

Physical

Mean

.88

SD

Mean

SD

1.36

.31

1.11

Student’s t

1.24

P
.227

(0
0)
Familial

1.75

1.29

2.00

1.63

- .45

.657

Interpersonal

2.44

1.15

2.62

1.12

.42

.678

[•motional

1.75

1.48

1.77

1.48

- .03

.973

a = .10

97
use o f formal help sources.

Crosstabulations by academic risk for help sources used to address all categories of
concerns indicated the greatest percents and totals, for the four levels of academic risk, to be
concentrated between the sources self and family member (each having 77.7% o f the
responses). O f the possible formal help sources physicians and student affairs officer received
the highest percents and totals, 46.6% and 30.1% respectively.
ANOVA by academic risk was performed to test the difference between the mean
number o f formal and informal sources of help used by students for each concern category
reported in Part III (Table 27). Results indicated significant differences between means for
the four levels o f academic risk for one category, specifically Interpersonal-Formal, for which
the probability value is p = .066; means for students experiencing no academic difficulty (x
= .22) or some course difficulty (x = .37) were lower than for those appearing before
committee (x = .69) or dismissed (x = .65). The null hypothesis is therefore rejected, and the
alternative is supported. For students experiencing interpersonal concern, use of formal help
sources appears to be higher among those at greater academic risk.
Null hypothesis 3.3:

Students experiencing higher levels of academic risk
will not differ from those experiencing lower levels in
their preference for sources o f help.

Alternative hypothesis:

Students experiencing higher levels of academic risk
will differ ffom those experiencing lower levels in their
preference for sources o f help.

Crosstabulations by academic risk o f the top three and bottom three preferences
indicated by respondent in Part II indicated self (82.4%) to be the most preferred source of

98
Table 27
Analysis of Variance by Academic Risk on Formal
and Informal Sources of Help Used

Sum of
Squares

DF

Mean
Square

F

Sig
of F

Main Effects
Academic Risk

3.418

3

1.139

2.472

.066

Explained

3.418

3

1.139

2.472

.066

45.631
49.049

99
102

.461
.481

Source of Variation

Residual
Total

oc=. 10

99
help across all levels o f academic risk, followed by family member (75.5%). The least
preferred sources o f help across all levels o f academic risk was psychiatrist.
ANOVA by academic risk performed on the mean rank of formal and informal sources
o f help revealed no significant difference for either category. The null hypothesis is not
rejected.
Preference for sources o f help does not seem to differ based on level o f academic risk
Summary
In examining the association between academic risk and the relevant measures it is
found that there is no evidence to support a difference in academic risk based on greater
versus lesser problem severity. Preference for help sources also does not seem to differ based
on level of academic risk. However, for students experiencing interpersonal concerns use of
formal help sources appears to be higher among those at greatest academic risk.

CHAPTER V
SUMMARY, CONCLUSIONS, AND IMPLICATIONS

Sum m ary
Review o f the Problem
There is substantial evidence that indicates an imbalance between the number o f heath
care professionals and the number of people most in need o f health care services. For
underrepresented ethnic/racial groups designated as minority (i.e., Blacks, Hispanics and
Native Americans), who are underserved by the health care community, increased access to
medical care is closely linked to the number o f minority group physicians available. Minority
group physicians have been found to serve disproportionately more patients o f their
ethnic/racial group, to more often practice in health-manpower shortage areas and to serve
a higher percentage o f Medicaid patients.
Various public and private efforts have been initiated to increase the number of
underrepresented group physicians. The primary focus o f such efforts, since the 1970's, has
been increasing the number o f minority group students enrolled in medical school. Although
some gains have been made in numbers, the goal o f achieving parity for minority group
medical students has never been met. The rate o f growth in the underrepresented minority
population, combined with the issues o f the quantity and quality o f the minority medical
school applicant pool directly impacts achievement of the goal. Given the factor which works

100

101
against providing appropriate resources for unmet health care needs diverse strategies are
necessary.
In the wake o f demographic and educational preparation trends which impede
significantly increased numbers o f underrepresented minority group students, efforts to
maximize the potential of those students admitted to medical school must be considered. The
retention o f minority group medical students becomes an essential factor in providing care to
underserved populations.
Research regarding student retention is limited with regard to the factors associated
with an increasingly more diverse student population, and in terms o f the differences in
attrition and retention which may be associated with a diverse student population. Although
most research related to medical school retention focuses on academic factors there is
considerable evidence to suggest the need for a more systemic examination of the nonacademic factors which lead to medical student attrition, particularly among underrepresented
group students.
This research has attempted to explore the impact o f non-academic concerns on
underrepresented minority groups medical students and the students' approach to addressing
non-academic concerns.
The purpose o f this study was to examine the help-seeking attitudes, preferences and
behavior o f Black and Hispanic medical students in Michigan, and to determine the
relationship o f these factors to the academic performance o f the students.

Design and Method
A self report questionnaire was used to assess each o f the dependent variables and to

102
collect associated demographic and academic data from respondents attending the four
colleges o f medicine in Michigan. The questionnaire included five measures: Part I: Attitudes
Toward Seeking Psychological Help; Part II: Preferences for Potential Help Sources Index;
Part III: Problem Experiences and Help Sought; Part IV: Reasons for Not Using Help
Resources; and Part V: Academic Performance and Demographics.
Various statistical procedures were used to test the hypotheses for this descriptive
study. Procedures included parametric and nonparametric methods to analyze differences and
relationships across the measure. The methods were ANOVA, Kruskal-Wallis One-Way,
Student's t-test, Mann-Whitney test, crosstabulations and Spearman's Correlation Coefficient
The measures were assessed for differences among respondent by ethnicity/race, age, gender,
class standing and college attended. Analysis regarding problem severity and use o f help
sources and academic risk were also conducted.

R esults

Hypotheses specific to the three research questions were tested using the methods
indicated above. A total o f ten (10) o f the null hypotheses were rejected in favor of the
alternative hypotheses.

Demographic Characteristics
For the first research question, which addresses the relationship between students'
demographic characteristics and the measures, seven o f the twelve null hypotheses were
rejected; three o f these related to differences by race, one to differences by gender, two to
differences by age groupings and one to class standing.

103
Tests for the hypothesis relating to differences between Black and Hispanic medical
students on the problems experienced indicated no significant differences between the two
groups.
Analysis o f the differences by race on the number o f formal help sources used to
address non-academic concerns indicated that Black students used a greater number o f formal
help sources to address personal concerns, and specifically used more help sources when
addressing emotional concerns, than did Hispanic students.
No significant differences were found between Black and Hispanic students with
regard to their attitude toward seeking psychological help.
There were significant differences found between Black and Hispanic medical students
with regard to their reasons o f not using help resources. Specifically, Black students to a
greater extent endorsed an unfavorable assessment o f providers while Hispanic students
endorsed not having a concern or crisis.
Black and Hispanic students were found to differ significantly in their preferences for
sources o f help, with Black students indicating preferences for significantly more formal
sources o f help than did Hispanic students.
When differences between students by race within colleges were examined for the
preferences measure no significant differences and no interaction effects were found
suggesting that college o f attendance was not a factor in determining preference between
Black and Hispanic medical students.
Respondents' attitudes toward seeking psychological help were found to be
significantly different by gender. Female students indicated more positive attitudes toward
seeking psychological help, indicated greater likelihood o f recognizing need for

104

psychotherapeutic help, and indicated greater interpersonal openness. Male students, more
than female students, endorse a positive attitude toward an emotional problem being solved
with professional help rather than alone.
Results o f the examination of reasons for not using help resources yielded insufficient
data to reject the null hypothesis that female and male students will not differ in their reasons
for not using help resources. However, female students did indicate greater agreement with
a preference for family helpers.
Significant differences were found between traditional aged and non-traditional aged
students with regard to their attitudes toward seeking psychological help. Non-traditional
aged students appear to have more positive attitudes toward seeking help as evidenced by a
greater confidence in mental health practitioners.
With regard to reason for not using help resources significant differences were found
to exist for the age groups. Non-traditional aged students perceived providers to be lacking
or unavailable, while traditional aged students indicated a personal aversion to seeking
services and a preference for family helpers.
Analysis o f the differences between preclinical and clinical level students on attitudes
toward seeking psychological help yielded significant differences, suggesting clinical level
students have more positive attitudes.
Evidence to suggest significant differences between preclinical and clinical level
students in terms o f reasons for not using help resources was insufficient; the null hypothesis
was not rejected.

Problems Experienced and Help Sought

105
The second research question is concerned with problems experienced and help sought
to address those problems. Three hypotheses were posed; two were found to yield significant
differences.
Analysis o f the difference between students reporting greater versus lesser problem
severity on the number o f help sources used indicated significant differences. It appears that
students reporting greater problem severity use more help sources than do students
experiencing lesser problem severity.
The examination of differences between students based on problem severity as related
to use o f formal help sources revealed a significant difference for sources used to address
emotional concerns only. This finding was insufficient for rejection of the null hypothesis.
Significant differences were found between colleges for users o f formal help
resources. For students experiencing emotional concerns, students attending the college with
the smallest percent o f Black and Hispanic student enrollment reported using a greater
number o f formal support services.

Academic Difficulty
The third research question addressed relationships between the measures and
reported academic difficulty. One o f the three null hypotheses was rejected.
Testing o f the hypothesis associated with the difference between students experiencing
greater versus lesser problem severity on academic risk suggested no significant differences
exist.
With regard to the differences between higher and lower academic risk students' use
o f formal help sources, it was found that for students experiencing interpersonal concerns,

106
use o f formal help sources appears to be higher among those at greater academic risk.

No differences were found for higher academic risk students versus lower academic
risk students on preferences for sources o f help.

Conclusions and Discussion
Demographic Characteristics
The results associated with help seeking attitudes and behavior, and demographic
characteristics, can most readily be categorized by effects based on race, gender, age and class
standing.
In examining responses by race results showed Black and Hispanic students did not
differ significantly on the problems they experienced, nor in their attitudes toward using
psychological help; nevertheless, Black students used more formal help sources to address
their concerns than did Hispanic students.

Black students endorsed an unfavorable

assessment o f providers as reason for not using help resources, while Hispanic students
endorsed not having a concern to address as reason. Preferences for help sources were found
to be significantly different by ethnicity/race, but not further differentiated by college
attended.
Both Black and Hispanic students identified interpersonal problems as their greatest
concern, followed respectively by the familial, emotional, and physical categories.
Convergence in this regard suggests Black and Hispanic students are similarly affect by nonacademic concerns. Specifically, relationships maintained during medical school can have a
considerable impact on the individual student. Interpersonal concern may be associated with
significant others, peers, or faculty and staff o f the college. Given the possible range of

107
people with whom conflict may be associated for the medical student perception o f impact
on progress through medical school may vary greatly.
Consistent with a sentiment expressed by a respondent as an additional reason for not
using help resources, students often will "prefer to keep personal life and school separate" not
realizing how completely intertwined the two can be.

It is probably that many o f the

interpersonal concerns experienced by Black and Hispanic medical students are closely
associated with conflicts experienced in, or due to, the medical school environment. The
findings o f Edwards and Zimet (1976) indicated that a high percent o f students in their study
endorsed a lack o f time for recreation, family and friends, and difficulty getting to know
faculty members will as significant concerns. These concerns would likely be manifest in
interpersonal conflicts, and for the Black or Hispanic student could serve as a substantial
distraction from the academic task.
The fact that Black students were found to use more formal supports suggests that
somehow Black students have accepted formal resources as a viable option in a way Hispanic
students have not. The mean for Hispanic students on the informal sources used scales
exceeded the mean o f Black students on all except physical-informal.

This could be

attributable to a difference between the groups regarding cultural acceptability o f professional
help-seeking, not addressed by the measure, a difference in association with or knowledge of
formal helpers, and/or perceived acceptance in the formal help environment. This difference
poses the potential o f the two groups starting at comparable points in terms o f concerns and
attitudes yet ending up at very different outcome points based on employing different levels
o f interventions in course.
Very closely associated with the difference in use o f formal and informal help sources

108
by Black and Hispanic medical students is the difference in their reasons for not using help
resources. For Black students more than Hispanic students an unfavorable assessment of
providers is a key reason for not using help resources, while for Hispanic students more than
Black students having no concern to address is a key reason.
For Black students, who demonstrate their willingness to use formal help sources, the
issue becomes their assessment o f the providers made available; such that increasing the Black
student's access to providers who are "attractive" in terms o f competence and ethnicity will
increase the probability o f use o f formal resources. Hispanic students present an interesting
dilemma in that they do not differ from Black students in problems experienced, but primarily
use informal help sources, and differentially indicate no concerns or a key reason for not using
help resources. These factors taken together suggest that Hispanic students may minimize
concerns in order to justify their help-seeking behavior, and may as a result end up in greater
jeopardy. As Brown (1978) indicated, a decision to seek assistance may be associated with
the impact o f troublesome life events, mediated by the individual's sense o f self reliance and
perceived ability to/ preparedness to manage stress; accordingly Hispanic students may
perceive their ability to address concerns at a level that neutralizes the severity of a concern
decreasing the need for professional/formal help.
Although different than the actual sources used to address an experienced concern,
the assessment o f preference for potential help sources yielded comparable findings. Black
students were found to prefer significantly more formal potential help sources than were
Hispanic students. Observation o f preferences by college to determine differential patterns,
revealed no differences at that level. Black and Hispanic student experiences within colleges
did not delineate additional variance between the groups. The colleges do not seem to be

109
providing services which are perceived differently by the groups.
When Cheatham, Shelton and Ray (1987) examined race, sex and causal attribution
difference in the help-seeking behavior o f Black and White students they found more
similarities than differences between the racial groups, with both preferring network
(informal) sources over professional sources. The findings o f the present study indicate
differences between two ethnic/racial groups often classified together as minority and too
often treated homogeneously.
Results by gender on attitudes toward psychological help and reasons for not using
help resources indicated significant differences on the attitude measure and insufficient
evidence on the reason measure.
Comparable to the findings reported by Fisher and Turner (l 970) and Kligfeld and
Hoffman (1979) Black and Hispanic female medical students appear to have more positive
attitudes toward seeking psychological help.

Female medical students may be a good

resource for their peers in encouraging proactive help-seeking behavior. Ways o f reaching
male medical students need to be identified; the positive attitude on the part o f male
respondents to the item associated with getting professional help for an emotional problem
suggests there may be some openness on the part o f males to seeking assistance.
Agreement/disagreement with reasons for not using help resources statements did not
differ significantly by gender. This suggests some uniformity regarding reasons for not using
available resources in the wake o f differing attitudes toward psychological help. Further
assessment o f male attitudes and possible other factors seems necessary to determine gender
differences associated with help-seeking.
Non-traditional aged and traditional aged students were found to differ significantly

110
in both attitudes and reasons. Non-traditional aged students indicated more positive attitudes
toward seeking psychological help, primarily associated with their confidence in mental health
practitioners. They also identified reasons for not using help resources as associated with a
lack o f individuals to help and a lack of ethnic providers. Consistent with their more negative
attitudes toward seeking psychological help traditional aged students endorsed a personal
aversion to seeking service and a preference for family helpers.
It seems evident that older students will seek out and use formal help sources as they
are able to identify helpers whom they assess positively. Younger students seem to base their
rejection o f help sources more on personal aversions than on their assessment of providers.
These findings are consistent with those reported by Pliner and Brown (1985) which showed
age to be positively correlated with seeking formal sources.
These age differences suggest differences based on different developmental stages of
life and differences in life experience. Consistent with Erickson's (1963) psychological theory
of development, most traditional aged medical students are anchored in or emerging from the
young adult stage where the task is that o f resolving the intimacy versus isolation conflict.
The young adult is attempting to strengthen the sense o f identity forged in adolescence, and
to take on the task o f establishing a capacity for intimacy. The non-traditional aged student
is the adult stage addressing the crisis o f generativity versus stagnation which includes self
enrichment, productivity and creativity and establishment o f the next generation.
The different developmental stages o f these two groups o f students may result in
different perceptions o f services offered to them, for younger students formal help sources
may seem too threatening as they seek to establish their identity; because the older student
has moved beyond that point their identity grounding and concern for productivity allow and

111

encourage their use o f formal help resources to insure their success. Accordingly, concerns
o f the younger students regarding help resources stem from a personal aversion while those
o f the older students relate more to the competency o f the provider given that use o f such
services are productive.
Data examined by class standing revealed significant differences between preclinical
and clinical level students on attitudes toward psychological help, but not on reasons for not
using help resources.
The findings associated with attitudes are consistent with those found by Kligfeld and
Hoffman (1970).

Positive attitudes on the part of students in the latter stages of

undergraduate medical training may be closely related to the developmental stages discussed
above and may therefore actually "represent" a difference between young adults and maturing
adults rather than levels o f study. It is also possible that clinical level students in becoming
less preoccupied with the academic stresses of the preclinical years, become more willing and
able to tolerate self-examination.
The relationships found to exist between students' demographic characteristics and
their help-seeking attitudes, preferences and behavior are associated in: Black students
preferring and using more formal sources o f help; female, non-traditional and clinical students
having positive attitudes toward psychological help; Black and non-traditional aged students'
reasons for not using help resources being tied to their assessment o f the providers, while the
reasons for traditional aged student are linked to their personal aversion for services; and
those for Hispanic students associated with having no concern or crisis to be addressed.
These differences pose the need for an array o f strategies which maximize the influence of
membership in any o f the aforementioned groups to encourage use of services for addressing

112
non-academic concerns.
Problems Experienced and Help Sources Used
Students reporting greater problem severity in a concern area seem to use more help
sources, even thought the sources are primarily informal in nature, for a medical school
where the percent o f Black and Hispanic medical student enrollment is comparatively low,
students used a greater number o f formal support resources.
These findings suggest that students in distress do seek help. Although interpersonal
concerns occurred most frequently, the relationship between severity and help sources used
was strongest for the physical and familial categories. It is possible, because interpersonal
problems can encompass so many different types of relationships, that students find it difficult
to determine appropriate help sources for interpersonal concerns resulting on the relationships
between severity and sources used being weak.
The strongest relationship found is between the physical category and the
corresponding informal sources. A physical concern seems to get the attention o f medical
students more than any other and they are most willing to let those in their network know
what is happening for them. Similarly, for familial concerns the primary sources o f help are
informal. It seems logical that this relationship would exist and that family resources would
be the main source of help. As Gourash (1978) observed, those who solicit help tend to turn
to family and friends, and to contact professional services as a last resort. Added to this is
the consistent endorsement o f self as a help resource. Solving one's own problems is echoed
throughout responses in this study, suggesting a need for empowering students to help
themselves (Cimbolic, Thompson and Waid, 1981).
For the emotional concerns category the findings were reversed

It seems that

113
students who experience emotional problems tend to seek professional support to address
those concerns. Emotional problems may be more threatening to an individual's regular
functioning and as a result professional help becomes essential. Additionally, the stigma
which may be associated with this category o f problem may make it less risky to seek
assistance outside o f network sources rather than among them and have to fact the potential
o f being labeled by significant others.
That students, at the college with the lowest percent o f Black and Hispanic students
enrolled, reported using more formal help sources for emotional concerns may be associated
with a few factors. The college may offer formal help resources which the students find
highly accessible because o f who the providers are and/or because o f how the services are
organized (e.g., services in close proximity, inexpensive, etc.). As already discussed the
nature o f the problem may make it important to the student that formal sources be used to
minimize the knowledge o f network (informal) sources. The limited number o f same ethnicity
peers in the medical school environment may reduce the potential for using informal sources.
Problem severity and help sources used are positively related with informal sources
being the primary choice for Black and Hispanic medical students. Students could benefit
from programs which empower them and their associated network sources to address nonacademic concerns.
Academic Difllculty
Students reporting greater versus less problem severity do not seem to differ with
regard to academic difficulty. Those students who experience higher levels o f academic risk
do use more formal than informal help sources in addressing interpersonal problems, but don't
differ in their preferences for help resources.

114

The belief that students experiencing greater problem severity would also be at risk
o f academic difficulty was not supported by the findings. This suggests students may employ
effective coping strategies for managing their concerns, such that their use o f help sources
may allow them to control the impact o f non-academic concerns on their academic
performance.
The finding that associates higher levels o f academic risk with use o f formal help
sources raises another question: If students at academic risk are using formal help sources,
are these resources appropriate, and should it be expected that non-academic services impact
academic issues? Certainly a student at academic risk could benefit from the support afforded
by formal sources o f help, but at the point that academic difficulty becomes an issue would
using time for academic support services be more advantageous in insuring retention.
There is some evidence that addressing both the affective and cognitive domains is
necessary in order to have optimal academic outcomes for medical students (Geertsma,
1977). A single domain approach from either side seems ineffective at the point the student
has attracted the attention o f a performance evaluation committee. The student must perform
academically; removing the non-academic dissonance will allow the student to better focus
on academic issues but will not insure closing the content gap created by the non-academic
distraction.
Levels o f academic risk did not differentiate preferences for potential help sources
among the students.

Preferences for help sources seems to be based on more stable

characteristics rather than on situational factors such as academic risk.
Preferences and problem severity as associated with non-academic concern do not
seem to be differentiated by academic difficulty. The greater use o f formal help sources by

115
students experiencing greater academic difficulty suggest a desire for assistance on the part
o f students but may require a more strategic approach in the provision o f services which will
have an optimal effect for students at academic risk.
Sum m ary
The findings o f this exploratory study have highlighted some relationships between
help seeking attitudes, preferences, and behavior, and student characteristics, problems
experienced and academic difficulty. A complex o f factors related to who seeks which
services to address what concerns have been raised in drawing conclusions from the finding.
Possibly more questions have been raised in attempting to answer the ones posed for this
study, but this study has contributed to a better understanding o f Black and Hispanic medical
students.
Application o f the information from this study can be useful in structuring nonacademic support services for the retention o f Black and Hispanic medical students.

Limitations
The primary limitations o f this study are associated with its generalizability and
statistical power. The population o f interest is very specific and as a result is very restricted.
The data is not drawn from a truly random sample, but rather from a convenience
sample based on those for whom addresses were obtained, and from that group those who
then elected to participate in the study by returning the questionnaire. It became evident that
timing in mailing surveys also became a factor in structuring the sample. After the period
allowed for in the follow-up contact has past, and data analysis had begun, some students
contacted the researcher or returned the survey indicating they had been on break and wanted

116
to participate.
The fact that respondents self-select and provide information through self report in
a design o f this type may complicate the bias in the study. Individuals who respond to
questionnaires are likely to be different in some important ways from those who do not. It
is difficult to determine the missing factors under the circumstances. The ex post facto nature
o f the study forces the respondent to depend on memory and to accurately report information
which is used to a significant degree in the study (i.e., academic difficulty measures).
Care should be taken in attempting to generalize the findings from this study to other
medical schools and to other populations of Black and Hispanic students. If the population
distribution o f an institution is found to be comparable, and the general acadmic and service
environment is assessed to be similar to that of the schools included in this study, then
replication o f this study would certainly help in determining applicability beyond this very
select sample.

Implications for Future Research
This exploratory, descriptive study has focused on a limited range o f variables which
seemed logically associated with the help-seeking attitudes, preferences and behaviors of
Black and Hispanic medical students and a number o f additional questions have been raised
and need to be addressed in future research.
Firstly, some o f the measures used in this study have not been uniformly applied to
medical students in general. A comparable study for all medical students, using similar
characteristic variables would certainly be beneficial in understanding differential help-seeking
patterns and in determining the applicability o f past research to the general medical school

117
populations.

The findings showed interpersonal concerns to be the most significant concern for both Black
and Hispanic students. Knowledge o f the interpersonal concerns would aid in developing
programmatic responses to address those concern. Specifically, it needs to be clear with
whom interpersonal conflicts arise and where those categories are consistent across the two
groups. It is probable, based on comments from respondents, that many o f their interpersonal
conflicts are with faculty and staff o f the medical school.
Further exploration o f the differences between the two ethnic/racial groups regarding
how they approach problem solving for the specified concern areas would also aid in
responding to student needs more appropriately. It appears that Hispanic students, although
they may experience comparable concern, may be minimizing the impact o f those concerns
more than do Black students. This may, be associated with greater disenfranchisement from
the medical education system. If students believe they are not truly an accepted part o f the
system they may respond by making efforts to draw as little attention to themselves as
possible; sharing concerns in the educational setting would therefore be taboo and keep the
emphasis on use of informal supports. Clarifying the approach to problem solving used may
aid in creating a more comfortable environment for Black and Hispanic students.
It appears that informal source o f help are useful to students in addressing academic
problems. The nature o f that relationship needs to be explored. Additonal research on the
effects o f cognitive and affective strategies in remediating academic difficulties associated
with non-academic concerns is essential.
Information more closely associated with individual functioning and traits might help

to further explicate help-seeking behaviors o f medical students.

Administration of a

personality measure (e.g., Meyers-Briggs Type Indicator) would provide additional and useful
information about the person’s approach to problem solving in general, and would aid in
determining the specific factors associated with navigating school and life simultaneously.

APPENDIX

H E L P -S E E K IN G A T T IT U D E S . P R E F E R E N C E S . A N D B E H A V IO R S
O F B L A C K A N D H IS P A N IC M E D IC A L S T U D E N T S

A S tu d y by:
D e n ise M a y b a n k S h e p a r d , M A
M ic h ig a n S ta t e U n iv e rs ity

119

1 20
PA RT I
B elow a rc a n u m b e r o f s t a te m e n ts p e rta in in g to p sy ch o lo g y a n d m e n ta l h e a lth is su e s. R e a d e a c h s ta te m e n t c a re fu lly a n d
in d ic a te y o u r a g re e m e n t (1 ), p ro b a b le a g r e e m e n t (2 ), p ro b a b le d is a g r e e m e n t (3 ), o r d is a g re e m e n t (4 ). P le a s e e x p re s s your
fra n k o p in io n in ra tin g t h e s t a te m e n ts . T h e r e a rc n o "w rong" a n s w e rs , a n d th e o n ly r ig h t o n e s a rc w h a te v e r y o u h o n estly
feel o r believe. It is im p o r ta n t y o u a n s w e r e v e ry ite m .

Agree
1. A p e rs o n w ith a s tr o n g c h a r a c te r c a n g e t o v e r m e n ta l c o n flicts b y h im se lf, a n d
w o u ld have little n e e d o f a p sy c h ia trist.
2. T h e r e a re tim e s w h e n I h a v e fe lt c o m p le te ly lo st a n d w o u ld h a v e w e lc o m e d
p ro fe ssio n a l ad v ic e fo r a p e r s o n a l o r e m o tio n a l p ro b le m .
3. C o n s id e rin g th e tim e a n d e x p e n s e in v o lv e d in p sy c h o th e ra p y , it w o u ld h a v e
d o u b tfu l v alu e fo r a p e rs o n lik e m e .
4. I w o u ld w illingly c o n fid e in tim a te m a tte r s to a n a p p ro p r ia te p e rs o n if I th o u g h t it
m igh t h e lp m e o r a m e m b e r o f m y fam ily .
5. 1 w o u ld r a th e r live w ith c e r ta in m e n ta l c o n flic ts th a n e o th r o u g h th e o r d e a l o f
g e ttin g p sy c h ia tric tr e a tm e n t.
<>. E m o tio n a l d iffic u ltie s, lik e m a n y th in g s, te n d to w o rk o u t b y th e m s e lv e s .
7. T h e r e a rc c e r ta in p r o b le m s w h ic h s h o u ld n o t b e d isc u sse d o u ts id e o f o n e 's
im m e d ia te fam ily.
8. If I b e lie v e d I w a s h a v in g a m e n ta l b re a k d o w n , m y first in c lin a tio n w o u ld b e
to g e t p ro fe s s io n a l a tte n tio n .
9. K e e p in g o n e ’s m in d o n a jo b is a g o o d so lu tio n fo r a v o id in g p e r s o n a l w o rrie s
a n d co n c e rn s.
10. I w o u ld r a t h e r b e a d v is e d b y c lo s e frie n d s th a n by a p sy c h o lo g ist, e v e n fo r a n
e m o tio n a l p ro b le m .
11. A p e rs o n w ith a n e m o tio n a l p r o b le m is n o t likely to solve it a lo n e ; h e is lik ely
to solve it w ith p ro f e s s io n a l h e lp .
12. I re s e n t a p e rs o n — p ro f e s s io n a lly tr a in e d o r n o t — w h o w a n ts to k n o w a b o u t m y
p e rs o n a l d ifficu lties.
13. I w o u ld w a n t to g e t p s y c h ia tric a tte n tio n if I w as w o rrie d o r u p s e t fo r a lo n g
p e rio d o f tim e.
14. T h e id e a o f ta lk in g a b o u t p ro b le m s w ith a p sy ch o lo g ist s trik e s m e a s a p o o r w ay
to g e t rid o f e m o tio n a l c o n flic ts.
15. T h e r e a re e x p e rie n c e s in m y life 1 w o u ld n o t d isc u ss w ith a n y o n e .
16. It is p ro b a b ly b e s t t o k n o w e v e ry th in g a b o u t o n e se lf.
17. If I w e re e x p e rie n c in g a s e r io u s e m o tio n a l c risis a t th is p o in t in m y life, I
w o u ld b e c o n fid e n t th a t 1 c o u ld fin d r e lie f in p sy c h o th e ra p y .

Disagree

121

l*. T h e re is s o m e th in g a d m ir a b le in ih c a ttitu d e of a p e rs o n w h o is w illin g to c o p e
w ith his c o n flicts a n d fe a rs w ith o u t re s o rtin g to p ro fe ssio n a l h e lp .

1

2

3

4

I').

1

2

4

4

1

2

3

4

A t so m e fu tu re tim e I m ig h t w a n t to h a v e p sy c h o lo g ic al c o u n s e lin g .

20. A p e rs o n sh o u ld w o rk o u t h is o w n p ro b le m s : g e ttin g p sy c h o lo g ic a l c o u n s e lin g
w ould b e a last re s o rt.

PART 11
P lease ra n k o r d e r ( n u m b e r 1 th r o u g h 14) th e fo llo w in g list o f p o te n tia l s o u r c e s o f h e lp you c o u ld a p p ro a c h fo r a ss ista n c e w ith
a p e rs o n a l c o n c e rn (e .g ., d e p re s s io n , fe e lin g s o f in a d e q u a c y , r e la tio n s h ip c o n flic t). In d ic a te y o u r first p re f e re n c e w ith n u m b e r
o n e (1 ) a n d in d ic a te th e s o u r c e y o u w o u ld le a s t likely a p p r o a c h w ith n u m b e r 14.

P s y c h ia trist

S elf

P sy c h o lo g ist (o f f c a m p u s )

N o n -s tu d e n t frie n d

C o u n s e lin g C e n te r p ro fe s s io n a l
o f s a m e e th n ic ity

S tu d e n t o f s a m e e th n ic ity
O th e r s tu d e n t

A n y C o u n s e lin g C e n te r p ro fe s s io n a l
F a m ily m e m b e r
S tu d e n t A ffa irs O f f ic e r /A d v is o r
C le rg y (M in is te r)
F a c u lty m e m b e r o f s a m e e th n ic ity
P h y sic ian
O th e r fa c u lty m e m b e r

122
PART 111
F o r e a c h o f th e p ro b le m ty p e s p re s e n te d b e lo w , in d ic a te th e e x te n t to w h ic h y o u h av e e x p e rie n c e d a n d / o r b e e n a ffe c te d In
th a t ty p e o f p ro b le m sin c e y o u h av e b e e n in m e d ic a l sc h o o l. P le a s e u se th e fo llo w in g sc a le :

0 * not a problem
not affected

1 = slight problem
slightly affected

2 = some problem
sometimes affected

Physical

3 - substantial problem
very affected

0

1

0

1

4 = crucial problem
extremely affected

(e.g ., p e r s o n a l in ju rie s , a c c id e n ts, s u b s ta n c e a b u s c |

Familial
[e.g., r e la tio n s h ip s w ith , o r c o n c e rn s re g a r d in g p a r e n ts
sib lin g s, sp o u s e , a n d / o r c h ild rc n |

Interpersonal
[e.g ., re la tio n s h ip s w ith , o r c o n c e rn s re g a r d in g frie n d s
a n d o t h e r s tu d e n ts , c o n c e rn s a b o u t m a le -f e m a le re la tio n s h ip s ,
c o n flic ts w ith fa cu lty , c u ltu ra l c o n flic ts, r e s p o n d in g to
ra c is m /s e x is m |

Emotional/Psychological
(e.g ., m e n ta l h e a lth c o n c e rn s , low s e lf-e s te e m , an x iety ,
lo n e lin e s s /is o la tio n , su ic id a l th o u g h ts o r fe e lin g s,
c o n flic ts o v e r v a lu e s , m o ra ls o r b e lie fs, d e p re s s io n !

F o r e a c h o f th e p ro b le m ty p e s p re s e n te d b e lo w , in d ic a te th e s o u r c e ( s ) o f h e lp , if any, y o u s o u g h t t o a d d r e s s e a c h p ro b le m
If m o r e th a n o n e s o u r c e w a s u se d , p le a s e e n te r a ll a p p lic a b le n u m b e r s s e p a r a te d by c o m m a s (e .g ., 1, 4, 13).

0 = no help sought
1 = self
2 = family mem ber
3 = non-student friend
4 = student of sam e ethnicity
5 = other student
6 = clergy (m inister)
7 = student affairs officer/advisor

Physical

Familial

Interpersonal

Emotional/Psychological

8 = faculty member of sam e ethnicity
9 = other faculty member
10 = physician
1 1 = Counseling C enter professional of same ethnicity
12 = any Counseling C enter professional
13 = psychologist (off cam pus)
14 = psychiatrist
15 = other (specify source)

123
P A R T IV

T h e fo llo w in g s ta te m e n ts p ro v id e p o s s ib le e x p la n a tio n s fo r w hy m e d ic a l s tu d e n ts m a y n o t u se s e rv ic e s a n d in d iv id u a ls av ailab le
w ith in th e s c h o o l e n v iro n m e n t to a ss ist th e m w ith p e rs o n a l c o n c e rn s. P le a se in d ic a te th e e x te n t to w h ich y o u a g re e w ith cacti
M atcm cn t.

Agree

D isa g re e

L ack o f tim e to s e e k a p p r o p r ia te se rv ic e s, ui th e c o lle g e e n v iro n m e n t.
to a d d re s s c o n c e rn s

1

2

3

4

L ack o f tim e to p a rtic ip a te in s e rv ic e s a p p r o p r ia te fo r p a rtic u la r c o n c e rn

1

2

3

4

L o w p rio rity o f p e rs o n a l c o n c e rn s w h e n c o m p a r e d to o th e r d e m a n d s o f
m e d ic a l s c h o o l

1

2

3

4

F e a r o f p e e r s fin d in g o u t

1

2

3

4

F e a r o f in s tr u c to r s /a d m in is tr a to r s fin d in g o u t

1

2

3

4

L ack o f a w a re n e s s re g a rd in g s e rv ic e s a v a ila b le

1

2

3

4

P e rc e iv e d u s e le s s n e s s o f c o lle g e /u n iv e r s ity s u p p o r t se rv ic e s in a d d re s s in g
p e rs o n a l c o n c e rn s

1

2

3

4

L ack o f in d iv id u a ls av a ila b le to h e lp

1

2

3

4

P e rc e iv e d lack o f c o m p e te n t s e rv ic e p ro v id e rs in c o lle g e e n v iro n m e n t

1

2

3

4

L ack o f e th n i c /r a c ia l m in o rity h e lp e r s

1

2

3

4

P e rc e iv e d lack o f c o m p e te n t e th n i c /r a c ia l m in o rity se rv ic e p ro v id e rs

1

2

3

4

P e rs o n a l m is tru s t o f se rv ic e p ro v id e rs
M is tr u s t o f se rv ic e p ro v id e rs b a s e d o n in f o r m a tio n fro m o th e r s
P re f e re n c e fo r so lv in g o n e ’s o w n p r o b le m s
P re f e re n c e fo r s e e k in g p ro f e s s io n a l a s s is ta n c e o u ts id e o f th e c o lleg e e n v ir o n m e n t
P re f e re n c e fo r s e e k in g a s s is ta n c e fr o m fam ily , frie n d s , o r o th e r p e rs o n a l h e lp e r s
N o sig n ific a n t p e rs o n a l c o n c e rn s , c rise s, o r b o th e r s o m e e v e n ts o c c u r

P le a s e in d ic a te a n y a d d itio n a l re a s o n s w h y y o u m ig h t n o t u se n o n a c a d e m ic s u p p o r t s e rv ic e s w h ile in m e d ic a l school:

PA RT V
H a v e vou b e e n d is m isse d o r re c e s s e d fro m v o u r s tu d ie s at a n v p o in t sin ce e n te r in g m e d ic a l sc h o o l ?
[ ] Y es
[ ] No

H a v e v o u v o lu n ta rily ta k e n a le a v e fr o m v o u r s tu d ie s a t a n v p o in t sin c e e n te r in g m e d ic a l s c h o o l?
I 1 Y es
[ ] No '

If yes, p le a s e in d ic a te th e r c a s o n ( s ) fo r y o u r le a v e -- m o r e th a n o n e re a s o n m a y b e in d ic a te d b y d e s ig n a tin g the
p rim a ry re a s o n # 1 fo llo w e d b y n u m b e r in g a n y o th e r a p p lic a b le re a s o n s 2, 3, etc.:
P e rs o n a l h e a lth

[ ]

A c a d e m ic d iffic u lty

[

]

C h ild b e a r in g /c h ild r e a r in g

[ ]

F in a n c ia l d iffic u lty

[

]

R e se a rc h

| ]

P e rs o n a l d iffic u lty

[

]

S p e c ia l tr a in in g /e d u c a tio n p ro g ra m

[ ]

F a m ily d iffic u lty

|

)

O th e r , sp ecify : ____________________________________________________________________________________

F o r th e te r m s / s e m e s te r s y o u h a v e c o m p le te d p le a s e in d ic a te the num ber of courses in each c a te g o ry below :

C o n d itio n a l P ass, M a rg in a l P a ss , o r R e m e d ia te d to P a ss

______

R e p e a te d

______

N o t P assed

______

R e m a in in g in c o m p le te

______

P assed

______

Total Courses Attempted

_____

H a v e y o u a t a n y p o in t sin c e e n te r in g m e d ic a l s c h o o l b e e n r e q u ire d to a p p e a r b e f o r e a c o m m itte e (e .g .. C o m m itte e
o n S tu d e n t P e rf o rm a n c e , C o m m itte e o n S tu d e n t E v a lu a tio n ) fo r th e p u rp o s e o f h a v in g y o u r a c a d e m ic p e rf o rm a n c e
d is c u s s e d o r e v a lu a te d ?

[ ] Yes

[ 1 No

125
Please complete the following inform ation as it pertains to vou:

Sex:

[ ] F e m a le

( ] M a le

D a te o f B irth ( m o /v r ) :

R a c e /E th n ic ity :

_________________________________

_________________________________________

C o lle g e :

C la s s S ta n d in g :

[ ] M S U -C H M

[ ) M S U -C O M

[ j U of M

[ ] W a v n c S ta te

[ ] 1st y r [ ] 2 n d vr | ] 3 rd yr ( | 4 th >t

D id y o u a t a n y p o in t g o o n a d e c e le r a te d (5 y e a r) p ro g r a m ?

( 1 yes

( 1 no

M a rita l S ta tu s : __________________________________________
Y o u r a g e w h e n y o u e n te r e d m e d ic a l sc h o o l: ________
A g es o f y o u r c h ild re n :

_________________________________
U n d e r g r a d u a t e in s titu tio n :

O ptional
Id e n tify th o s e n o n - a c a d e m ic a n d n o n -f ln a n c ia l se rv ic e s w h ic h c o u ld b e u s e fu l to y o u a s y o u p ro g re s s th r o u g h y o u r m e d ic a l
train in g :

Id e n tify tw o (2 ) p r im a r y th in g s w h ic h m a k e m e d ic a l sc h o o l s tre s s fu l f o r y o u :

LIST OF REFERENCES

LIST O F REFERENCES

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