**2. Background**

In 1990, the American Association of Medical Colleges (AAMC) initiated Project 3000 by 2000 which involved launching a national campaign to increase the annual matriculation number of underrepresented minority medical students from 1,485 to 3,000 by the year 2000. The goal of this project was to increase diversity

in healthcare in the US and create a culturally competent healthcare workforce that reflects the country's diverse population [3]. The AAMC also proposed a list of core competencies for students prior to entering medical school. This competency framework was intended to inform the medical school admissions processes and to deemphasize the importance of cognitive measures during admissions [4]. Similarly in 2009, the UK Government appointed a task force called the Panel on Fair Access to the Professions. The panel found that the individuals from non-privileged backgrounds had reduced access to various professions including healthcare [5]. This led to a program called Widening Access (WA). Similar to AAMC project, WA also encouraged increasing the fairness of the admissions process and providing more opportunities to students from lower socio-economic backgrounds entering medical school [6]. As a result of these projects, medical schools have witnessed a shift from knowledge-based admissions to holistic review of student applicants. Institutions have changed their admission policies to provide equal emphasis on skills and lived experiences. Measures such as situational judgment tests, multiple mini-interviews, and psychometric tests have been introduced to the admissions process to assess said competencies [7, 8].

These measures have widened the applicant pool which would otherwise have been limited due to grade-based admissions process. This resulted in a slight increase in students from underrepresented minority groups (URM) [9]. This has also opened up more opportunities for students who are non-science majors, have a lapse in education since graduation, or are of a higher age [10]. As more institutions embrace this movement towards widening access, predictably the medical student cohort will no longer be homogenous but would rather be comprise of unique individuals with diverse knowledge, skills, and abilities. As a result, institutions will have to make concerted efforts to support the appropriate progression of their students throughout the continuum of their medical education.

## **3. Supporting transition of matriculating medical students**

While great strides have been made to widen access, attrition of URM and their underrepresentation in medical workforce continues to be a challenge [11]. For example, in the UK, ethnic minority medical students as a group on average were found to perform worse when compared to their white colleagues during medical school and training [12]. Similarly, URM students were more likely than non-URM students to experience graduation delays and failure [13]. In addition to the stress associated with adjusting to the rigor of medical school, URM students were more likely to view themselves as "fraud" and doubt their abilities to succeed [14]. This phenomenon has found to be secondary to systemic problems associated with factors such as low socio-economic status or quality of undergraduate studies etc. [15].

Institutions have strived to address these challenges and support meaningful transitions of their medical students. There has been an rise in innovative pipeline programs to increase the academic preparedness of URM students [16]. Academic enrichment programs on science and pre-med courses, and academic support programs have also been introduced to meet the diverse needs of matriculating students and support their transition into medical school [17]. Mentoring programs have been established to provide social support vital to professional identity formation of URM students [18, 19]. Several institutions have introduced pre-matriculation courses to increase student awareness on academic preparedness for medical school. These programs supported student transition by introducing knowledge and skills required for medical school, integrating students into the learning environment and/or helping them immerse into the community [17]. Some institutions

#### *How to Support Student Academic Success DOI: http://dx.doi.org/10.5772/intechopen.100061*

have used these courses to proactively identify students who could potentially be at risk of academic difficulties during medical school [20]. Some have been designed to introduce the students to the rigors of the medical school curriculum. The goal of these programs were to "normalize the playing field" for students with diverse levels of pre-med knowledge and skills [21].

There were also several post matriculation remediation programs that were introduced to identify and support struggling medical students. These programs provided academic and emotional support, the outcomes of which were predominantly context dependent [22]. Due to the varying levels of success of these proactive and reactive approaches to supporting student success, institutions have grappled with the challenging question – how to support student academic success?

According to self-determination theory, student engagement in their own academic success is closely related to three basic psychological needs – autonomy, competence, and relatedness. Students who feel autonomous, competent and have a sense of belonging are typically more intrinsically motivated to maximize their potential [23]. The three psychological needs can be hindered by external pressures such as exceptionally challenging learning tasks, negative and disparaging feedback, judgments, threats, and punishments [24]. A learning environment that fails to address the three basic psychological needs of students could impact students' internal motivation and engagement in lifelong learning.

Therefore, the learning environment that is inherent to the traditional curriculum and its ability to support the progression of diverse group of students has come under scrutiny.
