How can we ease the social isolation of underrepresented minority students?

Build & Belong: A Peer-Based Intervention to Reduce Medical Student Social Isolation

PROBLEM

Medical school can be a socially isolating experience, particularly for students underrepresented in medicine. Social isolation and perceptions of not belonging can negatively impact students' academic performance and well-being. Therefore, interventions are needed to support students and these efforts should be appealing, brief, and low-burden.

INTERVENTION

Guided by evidence-based approaches, we developed the Build & Belong intervention for medical students as a brief peer-to-peer approach that consisted of four components. First, M3 and M4 students wrote reflections on belonging in medical school. Second, M3 and M4 students video recorded messages for M1 and M2 students using their written reflections. Third, M1 and M2 students watched and discussed the videos in small groups. Fourth, the M1 and M2 students wrote letters to future students. Our intervention differs from previous student belonging interventions in the peer delivery of messages.

CONTEXT

The Build & Belong intervention aimed to improve medical students' social belongingness. Using a longitudinal observational study design, the intervention was piloted at a medical school in the Mid-Atlantic United States in 2017-2018. Students completed surveys before and after the intervention. Paired samples tests (t-tests and Wilcoxon) assessed pre- to post-intervention changes in social isolation, social connectedness, and social assurance.

IMPACT

Among 63 medical students, with 25.9% from backgrounds underrepresented in medicine, we assessed follow-up outcomes in 38 students. Social isolation scores significantly decreased from baseline (M = 54.8, SD = 7.06) to follow-up (M = 51.3, SD = 6.67; p < .001). Social isolation changes were evident regardless of sex, although males reported a greater reduction (M Δ = -5.32, p < .001) than females (M Δ = -2.79, p = .014). Black/African American students had the largest reduction in social isolation (M Δ = -7.24, p = .010). Social assurance and connectedness scores did not change significantly between baseline and follow-up. Medical students appeared to resonate with messages delivered by more experienced peers (M3s and M4s), particularly messages that normalized feelings of not belonging and strategies to reduce those feelings.

LESSONS LEARNED

The Build & Belong intervention appears to reduce social isolation scores among medical students. This pilot test of the Build & Belong intervention provides initial evidence of the effectiveness of a brief, low-cost intervention. Build & Belong may provide a scalable strategy to reduce medical students' social isolation. Our peer-based approach is distinct from administrator-led strategies; peers were seen as trusted and reliable sources of information about belonging and ways to overcome the challenges experienced during medical school.

Is There Color or Sex Behind the Mask and Sterile Blue? Examining Sex and Racial Demographics Within Academic Surgery

BACKGROUND

The lack of underrepresented minorities has been a persistent issue within the surgical workforce. Equal sex representation has also been a problem in surgery. Underrepresented minorities females face the unique challenge of being a minority in both race and sex.

OBJECTIVE

The objective of this retrospective cross-sectional study is to determine the racial and sex demographics of medical trainees and faculty and determine the degree to which minority women are underrepresented at higher ranks and leadership.

METHODS

Race and sex demographic data for all medical students, surgical residents and faculty was extracted from the AAMC data files. This data was compared to the US population using chi squared tests. Race and sex breakdowns of the different surgical subspecialties was also analyzed using chi squared tests. Demographics of surgical faculty at various ranks are also reported.

RESULTS

White men made up 37% of all surgical residents. Black men made up only 1.9% of all surgical residents whereas Black women made up 2.6%. The subspecialty with the smallest percentage of Black women was Orthopedic Surgery with 0.6%. The specialty with the highest representation of Black women was Ob/Gyn with 6.2%. There was a decrease in representation of Black women with each increase in professional rank, with 2.8%, 1.6%, and 0.7% for assistant, associate, and full professor, respectively, as compared to Black men, who as a percentage, remained stable at the various ranks with 2.1%, 2.4%, and 2.1% for assistant, associate, and full professor, respectively.

CONCLUSIONS

There is a striking lack of minority women in surgery. This trend is amplified as surgeons progress from student, to resident, to attending, and then to leadership positions.

The Health Equity Scholars Program: Innovation in the Leaky Pipeline

Despite attempts to increase enrollment of under-represented minorities (URMs: primarily Black/African American, Hispanic/Latino, and Native American students) in health professional programs, limited progress has been made. Compelling reasons to rectify this situation include equity for URMs, better prepared health professionals when programs are diverse, better quality and access to health care for UMR populations, and the need for diverse talent to tackle difficult questions in health science and health care delivery. However, many students who initiate traditional "pipeline" programs designed to link URMs to professional schools in health professions and the sciences, do not complete them. In addition, program requirements often restrict entry to highly qualified students while not expanding opportunities for promising, but potentially less well-prepared candidates. The current study describes innovations in an undergraduate pipeline program, the Health Equity Scholars Program (HESP) designed to address barriers URMs experience in more traditional programs, and provides evaluative outcomes and qualitative feedback from participants. A primary outcome was timely college graduation. Eighty percent (80%) of participants, both transfer students and first time students, so far achieved this outcome, with 91% on track, compared to the campus average of 42% for all first time students and 58-67% for transfers. Grade point averages also improved (p = 0.056) after program participation. Graduates (94%) were working in health care/human services positions and three were in health-related graduate programs. Creating a more flexible program that admits a broader range of URMs has potential to expand the numbers of URM students interested and prepared to make a contribution to health equity research and clinical care.