Increasing Underrepresented Minority Students in Medical School: a Single-Institution Experience.

PURPOSE: Underrepresented minority student recruitment initiatives from medical school admissions and diversity offices can bring equity for those learners underrepresented in medicine. Measuring growth of the applicant pool helps determine the impact of such initiatives in helping diversify the healthcare workforce. AIM: The authors evaluated underrepresented minority applicant pool growth at the Brody School of Medicine to determine whether predominantly White institutions or historically Black colleges and universities have accounted for the most growth in minority applicants in recent years. METHODS: Outreach outcomes across the state were obtained by comparing applicant and matriculant demographics. Data on all applicants and matriculants were retrieved from the school's institutional records and classified according to student self-identification as underrepresented minority. Using Chi-square tests, authors aimed to determine whether the proportion of minority students increased among applicants and matriculants since 2016, the year of restructuring outreach. In further analysis, the number of graduates from historically Black colleges and universities as compared to minority graduates from predominantly White schools was evaluated. RESULTS: The authors identified 7,848 applicants and 654 matriculants over the evaluation period. The proportion of learners identifying as underrepresented minority increased from 17% before 2016 (622/3,672) to 20% after 2016 (835/4,176; p = 0.001). The proportion of applicants who did not graduate from a historically Black college or university increased slightly after 2016 (89% of underrepresented minority applicants before 2016 vs. 92% of underrepresented minority applicants after 2016), but this increase was not statistically significant (p = 0.097). CONCLUSION: Applicant growth has been more significant for underrepresented minority applicants from predominantly White institutions. Graduates of targeted historically Black colleges and universities who applied to Brody School of Medicine were better prepared, resulting in increased chances of admission.

Increasing the Representation of Black Men in Medicine by Addressing Systems Factors.

In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collaborative members identified premedical and academic medicine systems factors that represented opportunities for change. The premedical factors include financing and funding, information access, pre-health advisors, the Medical College Admission Test, support systems, foundational academics, and alternative career paths. The academic medicine factors include early identification, medical school recruitment and admissions, and leadership accountability. The authors offer several points of intervention along the medical education continuum, starting as early as elementary school through medical school matriculation, for institutional leaders to address these factors as part of their diversity strategy. The authors also present the Action Collaborative's process for leveraging collective impact to build an equity-minded action agenda focused on Black men. They describe their initial focus on pre-health advising and leadership accountability and next steps to develop an action agenda. Collective impact and coalition building will facilitate active, broad engagement of partners across sectors to advance long-term systems change.

A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools.

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.

Pathway Programs in North Carolina: A Historical Perspective.

To diversify the medical workforce, programs must be developed that enhance and prepare students from minoritized and underresourced communities to compete for admission to medical education. North Carolina has a rich history of providing pathway programs that assist minoritized students in developing into the physicians who will serve the communities from which they emerged.

The COVID-19 Vaccine and the Black Community: Addressing the Justified Questions.

Established in 2019, the Roundtable on Black Men and Black Women in STEM convenes a broad array of stakeholders that focus on the barriers and opportunities encountered by Black men and Black women as they navigate the pathways from K-12 and postsecondary education to careers in science, engineering, and medicine. Through meetings, public workshops, and publications, the Roundtable advances discussions that raise awareness and/or highlight promising practices for increasing the representation, retention, and inclusiveness of Black men and Black women in STEM. In keeping with the charge of the Roundtable, Roundtable leadership and leaders of the COVID-19 action group conducted an informational video in January 2021 to provide an in-depth discussion around common, justified questions in the Black community pertaining to the COVID-19 vaccine. The manuscript addresses selected questions and answers relating to the different types of COVID-19 vaccines and their development, administration, and effectiveness. Discussion focuses on addressing vaccine misconceptions, misinformation, mistrust, and hesitancy; challenges in prioritizing vaccinations in diverse populations and communities; dealing with racism in medicine and public health; optimizing communication and health education; and offering practical strategies and recommendations for improving vaccine acceptance by clinicians, health care workers, and the Black community. This manuscript summarizes the content in the YouTube video ( https://www.youtube.com/watch?v=wdEC9c48A_k ).

Coronavirus Vaccine Distribution: Moving to a Race Conscious Approach for a Racially Disparate Problem.

Strikingly ignoring the critical impact of systemic racism in vulnerabilities to the deadly coronavirus, phase one of the vaccine rollout is not reaching the Black population that has suffered the most from COVID. An urgent need exists for a race-conscious approach that ensures equitable opportunities to both access and receive the vaccines.

Characteristics of Medical School Applicants: A Single-Institution Study.

BACKGROUND AND OBJECTIVES: Medical schools aim to admit talented learners who are honest, patient centered, and caring, in addition to possessing the required cognitive skills. The Association of American Medical Colleges (AAMC) describes core competencies for entering medical students in three categories: science, preprofessional, and thinking and reasoning. The authors sought to determine desired characteristics of medical school applicants at a rural, community-based medical school in light of the published core competencies. METHODS: This qualitative study involved an analysis of data from discussion groups, all from a convenience sample of participants. The authors led the discussion groups, and large sticky note pads and pens were provided to scribe responses. Group members were given the prompt, "What do you see as traits or characteristics of your ideal doctor?" We used a content analysis approach to analyze the data. RESULTS: The total number of responses across groups was 243, representing 15 unique characteristics. The 15 characteristics, listed in decreasing order of frequency, included good communicator, knowledgeable, dedicated, compassionate, respectful, community oriented, well rounded, patient, team player, available, leader, positive attitude, equal treatment, prevention focused, and urgency when needed for patient care. Of the top characteristics with 20 or more responses, alignment with AAMC competencies was noted, but less so with being community oriented as defined by study participants. CONCLUSIONS: This study demonstrates that there are unique characteristics that a rural community and its medical school consider when admitting applicants to their medical program. Further research is needed to explore the need for additional competencies for rural medical schools to consider for entering medical students.

The Report of the W. Montague Cobb /NMA Health Institute Consensus Panel on the Plight of Underrepresented Minorities in Medical Education.

Many programs have been designed to increase the number of minorities participating in medical education. Despite these programs, the number of underrepresented minorities (URMs) has never reached the level of representation as is noted in the general census reporting of 12-13%.Using a focused literature review methodology, the Cobb Institute W. Montague Cobb Institute/NMA Health Institute (The Cobb Institute)1 reviewed articles from medical and social science publications to elucidate the causes for the dearth of URMs. Multiple articles have been written to examine this phenomenon and they have identified many challenges. Factors identified include stigmata and stereotyping, growing up in under resourced communities, sub-standard public education opportunities, lack of role models and mentors, lower standardized test scores, and admissions committee practices; all negatively impact URMs on the path to graduate medical education. The W. Montague Cobb Institute/NMA Health Institute (The Cobb Institute) has identified many common impediments along the path to matriculation and offer recommendations and strategies to address the URM matriculation issue. The Cobb Institute concluded there is a substantial need to invest more in 'working' programs with proven outcomes aimed at increasing admittance into medical schools for black males in particular and URMs in general. PURPOSE: The purpose of this paper is to discuss and identify effective programs and strategies used to increase admissions of underrepresented minorities (URM) in general, and black males in particular, into medical school. We will examine best practices and make recommendations regarding successful actions which can lead to increasing black males in the admissions process.

Commentary: what role should physician organizations play in addressing social justice issues?

A study by Peek and colleagues in this issue reveals that although racial and ethnic health disparities are recognized as a major national challenge, few physician organizations with both the influence and ability to change practice standards and address disparities appear to be effectively directing their resources to mitigate health disparities. In this commentary, the author examines the history of U.S. health disparities through the lens of social justice. He argues that today, physician organizations have the opportunity to change the paradigm of medicine from being a reactive industry to becoming a proactive industry through collaborations such as the Commission to End Health Disparities, which brings together more than 60 organizations, and the National Medical Association's "We Stand With You" program to improve health and combat disparities. Physician organizations can also address health disparities through advocacy for fair reimbursement policies, funding for pipeline programs to increase the diversity of the workforce, diversity in clinical trials, and other issues. Health disparities present to us in organized medicine a challenge that is cleverly disguised as an immovable object but that is truly a great opportunity for innovation, improvement, and growth. Physician organizations have a unique opportunity to provide avenues of innovation and accomplishment.

A study of national physician organizations' efforts to reduce racial and ethnic health disparities in the United States.

PURPOSE: To characterize national physician organizations' efforts to reduce health disparities and identify organizational characteristics associated with such efforts. METHOD: This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [<1,000 members] versus large [>5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based. RESULTS: The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organizational characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P < .001). Primary care (versus subspecialty) organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy. CONCLUSIONS: Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts.

Race/ethnicity and workplace discrimination: results of a national survey of physicians.

BACKGROUND: Promoting racial/ethnic diversity within the physician workforce is a national priority. However, the extent of racial/ethnic discrimination reported by physicians from diverse backgrounds in today's health-care workplace is unknown. OBJECTIVE: To determine the prevalence of physician experiences of perceived racial/ethnic discrimination at work and to explore physician views about race and discussions regarding race/ethnicity in the workplace. DESIGN: Cross-sectional, national survey conducted in 2006-2007. PARTICIPANTS: Practicing physicians (total n = 529) from diverse racial/ethnic backgrounds in the United States. MEASUREMENTS AND MAIN RESULTS: We examined physicians' experience of racial/ethnic discrimination over their career course, their experience of discrimination in their current work setting, and their views about race/ethnicity and discrimination at work. The proportion of physicians who reported that they had experienced racial/ethnic discrimination "sometimes, often, or very often" during their medical career was substantial among non-majority physicians (71% of black physicians, 45% of Asian physicians, 63% of "other" race physicians, and 27% of Hispanic/Latino(a) physicians, compared with 7% of white physicians, all p < 0.05). Similarly, the proportion of non-majority physicians who reported that they experienced discrimination in their current work setting was substantial (59% of black, 39% of Asian, 35% of "other" race, 24% of Hispanic/Latino(a) physicians, and 21% of white physicians). Physician views about the role of race/ethnicity at work varied significantly by respondent race/ethnicity. CONCLUSIONS: Many non-majority physicians report experiencing racial/ethnic discrimination in the workplace. Opportunities exist for health-care organizations and diverse physicians to work together to improve the climate of perceived discrimination where they work.

Health care workplace discrimination and physician turnover.

OBJECTIVE: To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. METHODS: Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. RESULTS: Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value < .01), and 40% were contemplating a career change (vs 10% among those who had not experienced workplace discrimination, p value < .001). CONCLUSION: Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

Racial differences in health concern.

An understanding of racial differences in risk-related affect may help explain racial differences in health behaviors and outcomes and provide additional opportunities for intervention. In phone interviews with a random community sample of 197 whites, 155 blacks and 163 Latinos, we assessed concern that respondents' health would be hurt by their diet, an inability to exercise, an inability to follow a doctor's recommendations and disease. A multivariate analysis of variance with follow-up profile analysis revealed that whites were less concerned than blacks and Latinos about an inability to follow their doctors' recommendations (ps < 0.01). There were no racial differences in the other health concern variables. Interventions to inform blacks and Latinos about their health risks must strike a balance between creating enough health concern to encourage health behavior but not so much that it interferes with health-promoting behaviors.

Perceived racial/ethnic bias in healthcare in Durham County, North Carolina: a comparison of community and national samples.

BACKGROUND: We sought to compare findings of a national survey of perceptions of racial/ethnic discrimination in healthcare to those of a community survey, with emphasis on the perceptions of Latinos. METHODS: Responses from a national survey were compared to a telephone survey of residents of Durham County, North Carolina. RESULTS: Black respondents in the Durham sample were more likely than those in the national sample to feel that a healthcare provider had treated them with disrespect because of health insurance status (28% vs 14%; P < 0.001). Approximately one third of Durham Latinos and 14% of Latinos in the national sample felt they had been treated with disrespect because of their English-language ability (P < 0.01). Compared to a national sample of white participants, white respondents in Durham were more likely to believe that black persons are worse off in terms of receiving routine medical care (40% vs 27%; P < 0.01) and having health insurance (58% vs 43%; P < 0.01). As compared to their national counterparts, there was a similar trend for how white respondents in Durham perceived how Latinos fared (P < 0.001 for all comparisons). CONCLUSIONS: Overall the perception of bias in healthcare was greater among Durham residents, especially among newly immigrated Latinos, than among their national counterparts.