Effect of Pipelines on Enrollment of Underrepresented Students in Healthcare: A Systematic Review
Open accessAbstract
Study Design: Systematic review. Objective: To evaluate the effectiveness of pipelines in increasing enrollment of underrepresented students into graduate healthcare programs. Materials and Methods: Eight databases (CINAHL, Medline, Nursing and Allied Health Premium, OVID, ScienceDirect, Education Index, Proquest, Google Scholar) were searched in October 2021. Inclusion criteria: studies investigating the effect of pipeline programs on enrollment of underrepresented students in individual graduate healthcare programs within the USA. Studies evaluating a pipeline program where students went on to be enrolled at another institution were excluded. Two reviewers screened articles, extracted data and assessed study quality, with a third reviewer resolving disputes. Primary data collected was percentage of underrepresented students enrolled per cohort. Additional data included the profession of the healthcare program, entrance point into the pipeline and interventions used in the pipeline. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for pre/post studies with no control group. Results: After duplicates were removed, 1524 studies were evaluated, with five studies included. Following initiation of a pipeline, fifteen institutions reported increased enrollment of underrepresented students, three reported decreased enrollment, and one reported no change. All studies were of low quality for drawing associative conclusions. Conclusion: Pipelines may be effective at increasing underrepresented students enrolled in graduate healthcare programs. Results are limited in scope, representing only medical and dental programs, and lacking in long-term outcomes.
AI snapshot
Written from the paper’s full text.
TL;DR
This systematic review evaluated whether pipeline programs increase enrollment of underrepresented minority (URM) students in graduate healthcare programs, finding that 15 of 19 programs reported increased enrollment after pipeline initiation. However, all five included studies were rated low quality for drawing associative conclusions, and evidence was limited to medical and dental programs.
Key findings
- Of 19 graduate-level healthcare programs (3 medical, 16 dental) across five studies, 15 reported increased URM enrollment following pipeline initiation, three reported decreased enrollment, and one reported no change.
- All five studies were judged to have poor-quality evidence for drawing associative conclusions, largely due to lack of statistical analysis of power and significance and unclear/ inconsistent delivery of pipeline interventions.
- Common pipeline components were mentorship (n = 19), academic assistance (n = 18), application assistance (n = 17), financial assistance (n = 16), priority admission (n = 2), and social support/advising after admission (n = 3).
- Sixteen programs admitted students at the undergraduate level, two at the high school level, and one at a combination of high school and undergraduate levels; the time between pre- and post-pipeline outcomes ranged from one to eleven years, with only one study reporting interim years.
Methods
- Systematic review conducted per PRISMA guidelines and prospectively registered with PROSPERO (ID CRD42021281463); eight databases (CINAHL, Medline, Nursing and Allied Health Premium, OVID, ScienceDirect, Education Index, Proquest, Google Scholar) were searched in October 2021 with no publication date restrictions.
- Inclusion criteria: studies investigating the effect of a pipeline on enrollment of URM students within an individual graduate-level clinical healthcare program in the USA; studies where students enrolled at another institution, non-US institutions, or lacking both pre- and post-intervention data were excluded.
- From 2228 records identified (1524 after duplicate removal), 1407 were excluded on title/abstract and 118 full texts reviewed, yielding five included studies; two reviewers independently screened, extracted data, and assessed quality, with a third resolving disputes. Quality was assessed with the NIH Quality Assessment Tool for pre-post studies with no control group.
Limitations
- Stated by the authors: (1) homogeneity of health professions included (medical and dental only), (2) low quality of evidence with unclear significance, (3) lack of long-term outcome data, (4) lack of clarity and consistency in applying the pipeline intervention, and (5) age of the included studies (all at least 10 years old).
- Stated: none of the studies evaluated or reported the significance of enrollment changes, and 18 of 19 programs reported post-pipeline outcomes at only a single time point, making sustainability unclear.
- Stated: no study commented on the consistency with which services were applied across participants, making it difficult to isolate the effect of the pipeline or any specific component amid potential confounders.
- Evident from the text: the review's conclusions rest on only five studies, and the authors note generalizability is difficult given the narrow set of professions represented.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
- Findingown data§ RESULTS
Following initiation of a pipeline, fifteen health profession education programs reported increased enrollment of URM students.
“Following initiation of a pipeline, fifteen health profession education programs reported increased enrollment of URM students, three institutions reported decreased enrollment, and one institution reported no change.”
- Also stated in: § Abstract · plain
“Following initiation of a pipeline, fifteen institutions reported increased enrollment of underrepresented students, three reported decreased enrollment, and one reported no change.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Findingown data§ RESULTS
Two healthcare education programs welcomed students into a pipeline at the high school level.
“two welcomed students at the high school level”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Following initiation of a pipeline, three dental education programs reported decreased enrollment of URM students.
“Following initiation of a pipeline, fifteen health profession education programs reported increased enrollment of URM students, three institutions reported decreased enrollment, and one institution reported no change.”
- Also stated in: § DISCUSSION · plain
“There were three dental education programs that reported decrease in enrolled URM students post-pipeline.”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data§ DISCUSSION
All included studies are at least 10 years old.
“all studies are at least 10 years old”
Quote in the paperSubstantial claim - Findingown data§ RESULTS
Following initiation of a pipeline, one institution reported no change in enrollment of URM students.
“Following initiation of a pipeline, fifteen health profession education programs reported increased enrollment of URM students, three institutions reported decreased enrollment, and one institution reported no change.”
Quote in the paperNot a substantial claim
- Findingown data§ DISCUSSION
None of the included studies commented on the consistency with which pipeline services were applied across participants.
“none commented on the consistency with which the services were applied across participants.”
Quote in the paperSubstantial claim - Findingreasoning§ DISCUSSION
There is a notable lack of studies reporting on outcomes from pipelines across the range of diagnosing and treating professions.
“There is a notable lack of studies reporting on outcomes from pipelines across the range of diagnosing and treating professions.”
Quote in the paperSubstantial claim - Findingown data§ RESULTS
Mentorship was a component in 19 of the included pipeline programs.
“mentorship (n = 19)”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Application assistance was a component in 17 of the included pipeline programs.
“application assistance such as pre-application guidance and interview practice (n = 17)”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Financial assistance was a component in 16 of the included pipeline programs.
“financial assistance such as merit and need-based scholarships and loans (n = 16)”
Quote in the paperNot a substantial claim - Findingown data§ DISCUSSION
Eighteen of the nineteen included healthcare education programs reported post-pipeline outcomes at just a single time point.
“Additionally, eighteen of the nineteen healthcare education programs included in this review reported post-pipeline outcomes at just a single time point.”
Quote in the paperSubstantial claim - Findingown data§ DISCUSSION
None of the included studies evaluated or reported the significance of the changes to enrollment rates of URM students following initiation of a pipeline.
“None of the studies in this review evaluated or reported the significance of the changes to enrollment rates of URM students following the initiation of a pipeline.”
Quote in the paperSubstantial claim - Findingown data§ RESULTS
The five included studies provided data from nineteen graduate-level healthcare programs.
“These included data from nineteen graduate-level healthcare programs”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Five studies published between 1999 and 2010 were included in the review.
“In total, five studies published between 1999 and 2010 were included in this review.”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Academic assistance was a component in 18 of the included pipeline programs.
“academic assistance such as providing personal tutoring and advanced coursework, as well as instruction in improved study skills and test taking strategies (n = 18)”
Quote in the paperNot a substantial claim - Findingown data§ RESULTS
Sixteen of the healthcare education programs welcomed students into a pipeline at the undergraduate level.
“Sixteen of the healthcare education programs welcomed students into a pipeline at the undergraduate level”
Quote in the paperNot a substantial claim - Findingown data§ DISCUSSION
The studies included in this review were from medical and dental education programs only.
“The studies included in this review were from medical and dental education programs only.”
Quote in the paperSubstantial claim - Interpretationown data§ CONCLUSION
The institution of a pipeline may increase representation of racial and ethnic minority students within medical or dental education programs.
“The institution of a pipeline may increase representation of racial and ethnic minority students within medical or dental education programs.”
Quote in the paperSubstantial claim - Interpretationown data§ Abstract
Pipelines may be effective at increasing enrollment of underrepresented students in graduate healthcare programs.
“Pipelines may be effective at increasing underrepresented students enrolled in graduate healthcare programs.”
Quote in the paperSubstantial claim - Study design and conductown data§ RESULTS
The poor quality of evidence was largely due to the included studies' lack of statistical analyses of the power and significance of outcomes.
“This was largely due to studies’ lack of statistical analyses of the power and significance of outcomes”
Quote in the paperSubstantial claim - Study design and conductreasoning§ RESULTS
All five included studies were of poor quality evidence for drawing associative conclusions on the efficacy of pipelines in increasing enrollment of URM students.
“All five studies were found to have poor quality evidence for drawing associative conclusions on the efficacy of pipelines in increasing enrollment of URM students.”
- Also stated in: § Abstract · plain
“All studies were of low quality for drawing associative conclusions.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Premisenone given§ INTRODUCTION
Patient-provider concordance in race or ethnicity, language, and other sociocultural characteristics improves patient experiences and health outcomes.
“Perhaps most importantly, patient–provider concordance in terms of race or ethnicity, language, and other sociocultural characteristics improves patient experiences and health outcomes.[,,,,]”
Quote in the paperNot a substantial claim - Study design and conductreasoning§ MATERIALS AND METHODS
Due to the pre-post nature of the included studies, the lack of randomization, and the absence of control groups, Cochrane Risk of Bias tools were deemed inappropriate for this review.
“Due to the pre-post nature of the studies included in this review, the inevitable lack of randomization in such studies, and the absence of control groups, the Cochrane Risk of Bias tools which would typically be used in a systematic review, were deemed to be inappropriate in this case.”
Quote in the paperSubstantial claim - Interpretationreasoning§ CONCLUSION
Conclusions about the impact of a pipeline on other allied health profession education programs cannot be drawn from the present review.
“Based on the present review, conclusions about the impact of a pipeline on other allied health profession education programs cannot be drawn.”
Quote in the paperSubstantial claim - Interpretationreasoning§ DISCUSSION
The current trends in program- or institution-specific pipelines are unclear.
“the current trends in program- or institution-specific pipelines are unclear”
Quote in the paperSubstantial claim - Study design and conductown data§ RESULTS
The poor quality of evidence was largely due to lack of clarity and consistency in how the interventions of the pipeline programs were delivered.
“as well as a lack of clarity and consistency in how the interventions of the pipeline programs were delivered [Table 3].”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 17
- May combine two claims. 8
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSOne article (Brunson et al.) reported data from fifteen distinct institutions.
“One article (Brunson, et al.[]) reported data from fifteen distinct institutions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSSocial support and advising once admitted was a component in 3 of the included pipeline programs.
“social support and advising once admitted to the program (n = 3)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSPriority admission was a component in 2 of the included pipeline programs.
“priority admission (n = 2)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSThe time between reported pre- and post-pipeline intervention outcomes ranged from one to eleven years.
“The time between the reported pre- and post-pipeline intervention outcomes ranged from one to eleven years”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSOne healthcare education program welcomed a combination of high school and undergraduate students into a pipeline.
“one welcomed a combination of high school and undergraduate students”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ RESULTSOnly one included study reported outcomes for each of the interim years between pre- and post-pipeline intervention.
“with only one study reporting outcomes for each of the interim years.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data§ RESULTSOf the nineteen graduate-level healthcare programs, three were medical schools and sixteen were dental schools.
“three of which were medical schools and sixteen of which were dental schools.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ INTRODUCTIONProviders who are members of underrepresented minority groups are more likely to serve minority populations, thereby increasing access to healthcare for underserved and underinsured patients.
“Providers who are members of underrepresented minority (URM) groups are also more likely to serve minority populations, thereby increasing access to healthcare for underserved and underinsured patients.[,,]”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ DISCUSSIONThe heterogeneity among pipelines, the inconsistency with which they are applied, and the lack of multi-arm studies make identification of the most effective pipeline interventions difficult to isolate.
“The heterogeneity among pipelines, the inconsistency with which they are regularly applied and the current lack of studies having multiple arms to tease out differences between specific components makes identification of the most effective pipeline interventions difficult to isolate.[]”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Premisenone given§ INTRODUCTIONThe healthcare workforce has representative diversity on the whole, but racial and ethnic minorities are overrepresented among entry-level, lower paying jobs and underrepresented among higher skilled, higher paying diagnosing and treating professions.
“While the healthcare workforce has representative diversity on the whole, racial and ethnic minorities are overrepresented among entry-level, lower paying jobs and underrepresented among higher skilled, higher paying diagnosing and treating professions.[,,]”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given§ MATERIALS AND METHODSThis review was prospectively registered with PROSPERO under ID CRD42021281463.
“This review was prospectively registered with PROSPERO under ID CRD42021281463.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning§ DISCUSSIONThe components that are feasible based on resource availability or that are most successful will likely be specific both to the institution and the targeted minority group.
“In practical terms, the components that are feasible based on resource availability or that are most successful will likely be specific both to the institution and the targeted minority group.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone given§ MATERIALS AND METHODSA systematic literature review was performed in accordance with PRISMA guidelines.
“A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.[]”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown data§ MATERIALS AND METHODSData extraction and risk of bias assessments were performed independently by two authors, with disagreements settled by a third author.
“Data extraction and risk of bias assessments for each study were performed independently by two of the present study’s authors, with disagreements settled by a third author who served as a tie-breaker.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown data§ AbstractResults are limited in scope, representing only medical and dental programs, and lacking in long-term outcomes.
“Results are limited in scope, representing only medical and dental programs, and lacking in long-term outcomes.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Premisenone given§ INTRODUCTIONThe whole community benefits from having a representative workforce as it reduces barriers to quality care for all members and fosters greater cultural humility among providers.
“Furthermore, the whole community benefits from having a representative workforce as it reduces barriers to quality care for all members and fosters greater cultural humility among providers.[,]”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Premisenone given§ INTRODUCTIONIn order to increase representation in the workforce, there must first be improved racial and ethnic diversity within professional education.
“In order to increase representation in the workforce, there must first be improved racial and ethnic diversity within professional education.[]”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Premisenone given§ INTRODUCTIONPipeline programs have been recommended as a means to recruit and retain minority students into healthcare education programs.
“Among other methods, pipeline programs have been recommended as a means to recruit and retain minority students into healthcare education programs.[,,,,,,,]”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone given§ Materials and MethodsTwo reviewers screened articles, extracted data, and assessed study quality, with a third reviewer resolving disputes.
“Two reviewers screened articles, extracted data and assessed study quality, with a third reviewer resolving disputes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Premisenone given§ INTRODUCTIONThere is a general expectation that the healthcare workforce will be reflective of the population that it serves.
“There is a general expectation that the healthcare workforce will be reflective of the population that it serves.[]”
Quote in the paperNot a substantial claim
The paper relies on this without support.
There is no standard definition of what constitutes a pipeline program.
“There is no standard definition of what constitutes a pipeline program.”
The paper relies on this without support.
Current literature related to pipeline programs primarily consists of case studies and government reports.
“Current literature related to pipeline programs primarily consists of case studies and government reports.”
The paper relies on this without support.
Currently, there is no literature evaluating the overall efficacy of pipeline programs in making meaningful improvements to representation within professional healthcare education programs.
“Currently, there is no literature evaluating the overall efficacy of pipeline programs in making meaningful improvements to representation within professional healthcare education programs.”
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- Authors
- Tombers, N., Bauer, J., Boraas, A., Lundberg, J., Pfeifer, R., & Reinartz, C.
- Affiliations
- College of St. Scholastica (US)
- Corresponding author
- Tombers, Nicole
- ORCID
- Lundberg, Jordan
- Venue
- Education in the Health Professions
- Published
- 2023-01
- Volume
- 6
- Issue
- 1
- Pages
- 1-7
- ISSN
- 2590-1761 (ISSN-L)
- OpenAlex
- W4319316719
- Semantic Scholar
- 9950bcece523822628190442cf447de2a6b5830e
- Cited by
- 9
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 1
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Education in the Health Professions (publishedVersion, cc-by-nc-sa)
- Topics
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical Education and Admissions
- Social Sciences › Safety Research › Career Development and Diversity
- Keywords
- pipeline programs, underrepresented students, medical school enrollment, dental school enrollment, health professions education, student recruitment
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