When Katherine Miller begins college in the fall at the University of Florida, there’s a good chance her science courses will feel very familiar. She’s been working from college-level textbooks in Anatomy & Physiology, Biology, and more since seventh grade. “I can remember things that I had been taught years ago,” she says. “The teachers would work hard to make our course material applicable in a lot of ways.”

	Uchenna Ikediobi, former SSTRIDE student, mentor, and now 4th medical student is seen teaching the SSTRIDE Anatomy and Physiology class at Fairview Middle School in Leon County.

Miller, 18, is a recent graduate of the SSTRIDE program at Crestview (FL) High School, and the teachers she refers to are exclusive to that program. Short for Science Students Together Reaching Instructional Diversity and Excellence, SSTRIDE is an innovative outreach program designed to increase the number of minority and rural students who apply to and complete medical school. It is a project of the College of Medicine at Florida State University, funded and administered in partnership with the Big Bend and West Florida Area Health Education Centers (AHECs). Unlike job-shadowing experiences, career fairs, and camps which expose students to health care fields for short durations, SSTRIDE can play an active role in a student’s education for more than a decade – from seventh grade all the way through medical school.

Thesla Berne-Anderson, the program’s founder and director, believes that the key to SSTRIDE’s success lies in its combination of early intervention and the establishment of a continued vital support network which lasts throughout a student’s education. “We felt that the intervention should occur early, in the seventh grade,” she states, referring to the genesis of the program, now sixteen years ago. “We wanted the program to be comprehensive and focus in three main areas: academic achievement, student development and community involvement. There were other enrichment-type programs trying to work toward the same goals, articulating agreements with public school systems and forming partnerships. Being a science teacher myself, I realized that what no one had tried was the in-school program where we actually pay for a science teacher at the targeted middle school to give up a planning period to a teach a SSTRIDE Anatomy and Physiology course, and work in conjunction with the Florida State University College of Medicine and AHECs to form a support network. In addition, class sizes are reduced to no more than fifteen students and are taught with the assistance of pre-medical undergraduate students from FSU, for Leon County SSTRIDE, and from community college students, for the rural SSTRIDE programs.”

To describe SSTRIDE as being “multi-faceted” would be an understatement. Full-time staff administer different aspects of the program at the middle school, high school, undergraduate, and graduate levels. SSTRIDE participants enroll in advanced science courses which feature in-depth lab experiences, numerous guest speakers, and field trips to health care facilities. Older students engage in service-learning projects, conducting blood pressure and blood sugar clinics at local banks and community events. All students receive training and certification in CPR. The program offers professional prep courses focusing on the ACT, FCAT (Florida Comprehensive Assessment Test), and MCAT. SSTRIDE staff conducts mock interviews for students applying to college and medical school, along with tutoring services in any subject, multiple times each week. Job shadowing, internships at local hospitals, research opportunities, and a summer SSTRIDE Institute at Florida State University College of Medicine are provided as well. As part of the undergraduate SSTRIDE program, older students who matriculate at the FSU College of Medicine have the option to give back to the program by serving as mentors to younger SSTRIDE students in middle and high school.

	High school SSTRIDE students learn to draw blood in a phlebotomy class taught by Wilma Duncans-Burnett at Pensacola Junior College.

The goal is clear: to not only cultivate student interest in health care careers and to retain these students in the state, but to give students the tools they need to ensure that they follow through with these programs and succeed. By creating partnerships between local school districts, the FSU College of Medicine, local communities, and parents, SSTRIDE aims to provide participants with a tangible support network that lasts. For Miller, one of 12 graduating SSTRIDE students in a class of 400, this was an important benefit. “We grew closer as a group because it was a smaller group. The AHEC was very involved and had specialized attention for each one of us.”

The program itself began in 1994 in the city of Tallahassee, and has since been expanded to rural areas in three additional counties. Although the middle school component is the same for all students, the directors found that rural and urban high school students required different models. In Tallahassee, participating students are bused to an after-school program held at the FSU College of Medicine four days a week, usually for three hours each day. “We find that students don’t mind attending the medical school, to study and interact with college students” states Berne-Anderson. “They’re here working with pre-med students at the college on the second floor. We recruit from all area schools and that’s as a way to reaching all underserved and underrepresented students.”

High school SSTRIDE programs in rural counties operate differently. “We found that in rural communities, extra-curricular activities are so much a part of the culture that an after-school model was limiting participation,” states Penny Eubanks, Assistant Director of the West Florida AHEC (Area Health Education Center) and SSTRIDE Coordinator for the rural Okaloosa County program, where Katherine Miller attended. To address this, rural SSTRIDE programs adopted an in-school cohort model. Accepted students are part of a small group which completes coursework together throughout high school. “There’s a continuation,” states Eubanks. “The group has a ninth grade homeroom teacher together, then a different one in tenth and eleventh grades. For their senior year, they go back to the teacher they had originally.”

The in-school program requires administrators and school districts to be much more involved. “We have had tremendous support from Jason Driver, Assistant Principal at Crestview High,” says Berne-Anderson. “Not only has he assisted with the development of the model program, but has been actively involved since the inception of the rural program in 2003.” Eubanks agrees: “We receive funding for the SSTRIDE program and have an articulation agreement with local school districts where we pay for the periods we use the teachers to teach SSTRIDE classes. This year, the school district is taking over payment of the high school teachers, but we cover middle school teachers, tutors, an advisor/counselor position, extracurricular activity costs such as transportation for field trips … teachers receive a lot of extra lab supplies, and so on.”

	Ninth-grade SSTRIDE students Josh Herman and Jeremy Cheney perform ventilation following a practice endotracheal intubation on their "patient."

Berne-Anderson is quick to emphasize the importance of stable funding and a strong program infrastructure. “We are the only medical school in the state of Florida that has an outreach and pre-medical advising program within the walls of the college. We have an entire staff dedicated to SSTRIDE. For the college students, we’re like a family away from home; we take care of all of their needs.” Eubanks elaborates on the dedication of SSTRIDE staff: “we visit SSTRIDE classes two times a week, hold monthly meetings with the students’ parents, and work hands-on with tutoring –someone is there for all the grade levels no less than one day a week, usually more often. We have access to their grades, and keep track of their progress.” Any SSTRIDE student who does not maintain a 3.0 GPA is required to attend tutoring, but many students utilize the services anyway. “The older we got, the more we took advantage of it,” states Miller.

Currently, SSTRIDE programs exist in only four counties in the state, but directors would like to see the program model adopted elsewhere. “One great desire is for a program that people could take and set up at their schools,” states Eubanks. “There are always so many things you want to do. Some places would not be able to do everything, though.” Berne-Anderson agrees, and emphasizes the strong support they’ve received: “SSTRIDE is legislatively funded – we wouldn’t have been as successful if our Dean, Associate Dean, Assistant Dean, and AHEC directors hadn’t been committed to this program. Other institutions may be able to incorporate certain aspects of SSTRIDE, but overall it can be a costly program.”

By all accounts, the costs appear to be well-justified. To date, SSTRIDE has served over 500 pre-college students, 60 % which have remained in the program for two years or more…. each of the 158 seniors in the program have graduated, yielding a college entrance rate of 98 percent, with the other 2 percent opting to serve in the military. In addition, 80 percent of SSTRIDE students received statewide Bright Futures Scholarships and increased their SAT score by an average of 140 points. Similar successes have been achieved at the collegiate level as well; 71 percent of the more than 155 SSTRIDE mentors and teaching assistants have matriculated to medical school. Of Miller’s graduating cohort of twelve students in the rural Okaloosa County program, three will be attending FSU and joining the Undergraduate SSTRIDE program. One of those three was also accepted by FSU’s prestigious Honors Medical Scholars Program, which provides participants with the opportunity to progress at an accelerated rate and graduate with B.S. and M.D. degrees in as little as seven years.

Like many areas of the country, Florida faces problems with both recruitment and retention in terms of primary care physicians. “One of the main issues we face now,” Berne-Anderson states, “is that we don’t have enough residency programs in Florida for all of our graduates. That’s a big concern, if students have to go out of state to do their residency.” SSTRIDE attempts to address this by exposing students to rural medicine, working with underserved populations, and emphasizing the importance of primary care through a combination of guest speakers, service learning experiences, clinical exposure, and a multi-tiered curricula. The partnership with FSU’s College of Medicine is crucial in this regard. After completing two years of coursework in Tallahassee, medical students at FSU then transfer to six regional campuses around the state, practicing in both urban and rural areas.

	High school SSTRIDE students Kristin Thomas, Tiffany DiDonato, Shanice Bernard, and Skyler Cross, attired in decontamination suits, participate in a mock disaster exercise.

Berne-Anderson is optimistic that, in the long run, SSTRIDE will have a significant positive impact on recruitment and retention. “If we expose them to rural medicine and a primary care track,” she states, “we anticipate that a good number of them will practice in Florida.” Perhaps the most persuasive argument in favor of this theory comes from the students themselves. Miller reports that it is very possible that she will eventually seek employment in rural Florida. “They definitely push and promote for us to come back and practice in rural areas,” she states.

“If we intervene early in the pipeline, and the students come here (to FSU),” remarks Berne-Anderson, “the whole environment is conducive” to retaining students. “We can bring the students’ goals to life.”

For more information about SSTRIDE, feel free to contact Thesla Berne-Anderson, thesla.anderson@med.fsu.edu or or Penny Eubanks, peubanks@wfahec.org.