IAMSE Fall 2022 Session 5 Highlights

[The following notes were generated by Michele Haight, PhD.]

Presenter: Janet Coffman, PhD, Professor of Health Policy, HealthForce Center, Philip R. Lee Institute for Health Policy Studies, Department of Family and Community Medicine, University of California, San Francisco, Co-Associate Director for Policy Programs, Institute of Health Policy Studies

Breaking Barriers for Racial/Ethnic Groups Underrepresented in the Health Professions

Why are we here?

• The racial/ethnic diversity of the US population is increasing.
• Native Americans, Blacks, Latino/as, and some Asian/Pacific Islander ethnic groups are underrepresented in most health professions that require a college or graduate degree.
• As the required educational level increases, the diversity level decreases.

We need to better understand the barriers faced by persons from these racial/ethnic groups to implement more effective strategies to create a more representative workforce.

Racial/ethnic concordance with providers is necessary for building trust with patients.

Barriers to Increasing Racial/Ethnic Diversity in the Health Professions

Structural Racism consists of multiple, interconnected levels of racism in societal structures: institutional, personally mediated, and internalized; all of these are socially mediated.

Institutional Barriers

BIPOC students (Black, Indigenous and People of Color) are more likely to:

• Have attended poorly resourced public schools with inadequate preparation for STEM courses and less extensive education in written and oral communications.
• Attend community colleges and state universities that may lack adequate resources to enable students to complete courses in a timely fashion, or to provide adequate pre-health advising and sufficient psycho-social support.
• Work during college due to the cost of higher education which limits the amount of time available to attend school, adequately study and is prohibitive to participating in internships, especially unpaid ones. This impacts their ability to earn good grades and participate in extra-curricular activities that are important for admission to medical school and other health professions’ programs.

The length of education in medicine and other professions that require a graduate degree compounds the cost and perception of unaffordability of attending professional school.

Institutional leadership does not necessarily have a demonstrated commitment to diversity.

There is a lack of role models concordant with students’ race/ethnicity.

Personally Mediated Barriers

• Overt bias
• Microaggressions
• Lack of guidance and support from professors/TAs in gateway courses and lack of pre-health advisors.

All of these send messages to BIPOC students that they do not belong.

There must be zero tolerance for personally mediated racism through anti-bias training and support for learners who experience racism from faculty and patients.

Internalized Barriers

• Stereotype threat, especially negative stereotypes about the intellectual capacity of BIPOC students. These can negatively impact students’ performance.
• Lack of a sense of belonging by BIPOC students.

Framework for Increasing Racial/Ethnic Diversity of Health Professions Students

• Form institutional partnerships.
• Provide tailored student support to create academic success: academic support, psychological support, social support, and financial support that focuses on scholarships and paid internships rather than loans and provides assistance with childcare and transportation.

 For example, Berkeley Biology Scholars Program.

• Engage faculty in institutional change.

Strategies for Undergraduate Institutions

• Improve remediation practices to create more intensive courses, emphasize thinking not memorization, and provide psycho-social support. Build confidence and independent thinking. For example, CUNY START program.
• Commit to Diversity, Equity, and Inclusion by establishing a Chief DEI Officer and Vice Chair for DEI positions and provide sufficient protected time and resources for DEI officers to do the work.
• Invest in mentoring for BIPOC students.
• Develop communities of practice and partnerships across colleges and professional schools. Establish recruitment partnerships with pre-health student associations and provide opportunities for campus visits, conferences, enrichment programs, etc.

For example, UC Davis Pre-Health Conference and California Medicine Scholars (which is focused on increasing the number of community college students who pursue careers in medicine).

• Create Post-baccalaureate Programs focused on those who unsuccessfully applied to medical school.
• Combine and condense undergraduate and graduate education.

 For example, the Sophie Davis Program which is a 7-year joint BS/MD degree program.

1. Transfer to medical school with advanced standing.
2. Progression to medical school is based on performance in medical courses instead of pre-med courses and MCATs.
3. Implement an accelerated, year-round curriculum that enables students to complete medical school in 3 years. These programs can be focused on BIPOC students.
4. Change Admissions requirements.

Breaking barriers for BIPOC students in the health professions requires multiple strategies that:

• Address all forms of racism
• Partner with K-12, college, and professional schools.
• Focus on more than health professions education.
• Encompass collaboration across all levels of education.

One example of a multi-level approach is the UCSF Latinx Center of Excellence.