Indigenizing Academics Through Leadership, Awareness, and Healing: The Impact of a Native American Health Seminar Series for Health Professionals, Students, and Community.

Health disparities have long affected American Indian and Alaska Native (AI/AN) populations. Transformations are needed in academia to help understand Indigenous 'ways of knowing.' Lifting the voices of AI/ANs in telling their stories could improve the education of students, faculty and the lay public. We collaborated to develop, implement and evaluate a Native American Health Seminar Series taught by AI/AN leaders on addressing health disparities among AI/AN people. A quasi-experimental mixed methods design included a 15-item survey to assess the impact of the Seminar Series on knowledge of AI/AN health issues and its influence, among students, on health career choices. During the 2018 academic year, three seminars were held and 243 participants attended. In total, 182 surveys (74.9%) were completed by faculty members, students and members of the lay public. Students (all categories combined) represented the highest participant group (48.4%), followed by the lay public at 30% and faculty at 21.6%. The highest scores on knowledge of Native health issues prior to seminar attendance were reported by those representing the lay public with a mean of 3.96 compared to 3.67 for faculty and 3.43 among students (p = 0.01), which was highly represented by Indigenous people. Increases in knowledge occurred in all participant groups. Among students, 65.6% initially indicated that they were not planning on pursuing a career in Native health. Among these, 56.9% indicated they were somewhat to extremely likely to pursue a career in Native health as a result of having attended the seminar.

Measurement of American Indian and Alaska Native Racial Identity Among Medical School Applicants, Matriculants, and Graduates, 1996-2017.

Importance: Accurate racial/ethnic identity measurement is needed to understand the effectiveness of outreach, recruitment, and programs to support American Indian and Alaska Native (AIAN) people becoming physicians. Objective: To examine how changes in race/ethnicity data collection by the American Medical College Application System are associated with trends in applicants, matriculants, and graduates self-reporting as AIAN. Design, Setting, and Participants: In this cohort study, interrupted time series regression was conducted using data from the American Medical College Application system identifying medical school applicants and graduates between January 1, 1996, and December 31, 2017, who identified as AIAN. The number of students identifying as AIAN was compared before and after the American Medical College Application System changed how it collected race/ethnicity data in 2002. Data analyses were conducted between December 2019 and May 2019. Exposures: Applicants could select only 1 racial identity from 1996 to 2001 and could select more than 1 racial identity from 2002 to 2017. Main Outcomes and Measures: Rates of AIAN groups before and after changing how race/ethnicity data were collected. Covariates were age, sex, and Medical College Admission Test scores. Results: The total number of individuals identifying as AIAN in the study was 8361; the mean (SD) number of applicants per year was 380.0 (89.9) overall: 257.3 (39.6) in 1996 to 2001, with a mean (SD) age of 26.6 (5.5) years and 830 (54.0%) male individuals, and 426.1 (50.1) in 2002 to 2017, with a mean (SD) age of 25.5 (5.6) years and 3441 (50.5%) female individuals. Before the change, there was a decrease of 5% per year (relative rate [RR] of 0.95; 95% CI, 0.91-0.98; P < .001) in the rate of AIAN applicants. In 2002, the change in data collection was associated with an immediate 78% relative increase in applicants (RR, 1.78; 95% CI, 1.55-2.06; P < .001). From 2002 to 2017 there was a 10% increase in applicants per year (RR, 1.10; 95% CI, 1.06-1.14; P < .001). For matriculants, yearly trends indicated a nonsignificant 3% decrease before the change, whereas the change was associated with an immediate 62% relative increase in matriculants (RR, 1.62; 95% CI, 1.35-1.95; P < .001), with no difference in trend after the change. For graduates, a nonsignificant yearly decrease of 2% was found in the mean number of graduates before the change, whereas the change was associated with an immediate 94% relative increase (RR, 1.94; 95% CI, 1.57-2.38; P < .001), followed by no change in trend after the modification. Conclusions and Relevance: Changing the method of race/ethnicity data collection captured more AIAN applicants, matriculants, and graduates. Yearly trends indicate concerning although nonsignificant differences after the change for AIAN graduates. These findings should inform diversity efforts.

Shifting the Tide: Innovative Strategies to Develop an American Indian/Alaska Native Physician Workforce.

Despite extensive efforts to diversify the US physician workforce and increases in both the number of US medical schools and number of students enrolled, there has been no difference in the matriculation and graduation of American Indians and Alaska Natives (AI/AN). Furthermore, advancement remains elusive for AI/AN US medical school faculty, which currently constitutes approximately 0.1% of all US medical school faculty and remains disproportionately underrepresented at the Associate and Full Professor ranks. The Northwest Native American Center of Excellence (NNACoE) aims to address these worrisome trends by implementing innovative programs to support a meaningful journey toward recruiting, training, and supporting AI/AN youth, medical students and faculty. NNACoE has piloted three innovations: 1) Tribal Health Scholars, a 14-week clinical shadowing experience for AI/AN youth in their tribal clinic; 2) Wy'East Post-baccalaureate Pathway, a 9-month structured curriculum with conditional acceptance into Oregon Health & Science University School of Medicine; and 3) Indigenous Faculty Forum, a longitudinal professional development conference for AI/AN medical school faculty to foster career advancement. NNACoE piloted all three programs in 2017 and is actively expanding efforts, while systematically evaluating all programs. Pilot results demonstrate that all Tribal Health Scholars are pursuing college and health science majors, 10 AI/AN Wy'East Post-Baccalaureate Scholars are enrolled to date, and 63 Indigenous medical school faculty are participating in professional development. More systematic evaluation of AI/AN-specific programming is needed to better illuminate how to successfully recruit, train and retain AI/ANs in the US physician workforce.

Concerning trends in allopathic medical school faculty rank for Indigenous people: 2014-2016.

BACKGROUND: Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade. OBJECTIVE:  To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied. METHODS: Data from the Association of American Medical Colleges' Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools. RESULTS: The majority of medical school faculty were White, 62.4% (n = 300,642). Asian composition represented 14.7% (n = 70,647). Hispanic, Latino, or of Spanish Origin; Multiple Race-Hispanic; Multiple Race-Non-Hispanic; and Black/African American faculty represented 2.2%, 2.3%, 3.0%, and 3.0%, respectively. Indigenous faculty members, defined as American Indian/Alaska Native (AIAN), Native Hawaiian or Other Pacific Islander (NHPI), represented the smallest percentage of faculty at 0.11% and 0.18%, respectively. White faculty predominated the full professor rank at 27.5% in 2016 with a slight decrease between 2014 and 2016. Indigenous faculty represented the lowest percent of full professor faculty at 5.2% in 2016 for AIAN faculty and a decline from 4.6% to 1.6% between 2014 and 2016 for NHPI faculty (p < 0.001). CONCLUSIONS: While US medical school faculty are becoming more racially and ethnically diverse, representation of AIAN faculty is not improving and is decreasing significantly among NHPI faculty. Little progress has been made in eliminating health disparities among Indigenous people. Diversifying the medical workforce could better meet the needs of communities that historically and currently experience a disproportionate disease burden.