Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized

The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.

Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors

The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.

See, seek, support: a policy framework to uplift first-generation low-income medical professionals

The First-Generation and/or Low-Income (FGLI) identity is not readily visible, encapsulating those who are the first in their families to complete a 4-year college degree and/or those living near or below the poverty line. In the backdrop of unprecedented levels of socioeconomic inequality in a country where household income predicts educational attainment, we explore the current state of U.S. society regarding socioeconomic status and health care. We describe challenges in diversifying the health care workforce and present a multi-pronged policy approach for visibilizing, recruiting, supporting, and retaining FGLI trainees in medicine, with the promise of improving the quality of health care delivery altogether. Through this work, we aim to render the field of medicine more equitable for trainees, physicians, and patients alike.

Sustaining success for Black nursing students

Of the estimated 5.2 million nurses across the United States of America, only 6 % identify as Black or African American. Increasing the number of Black Registered Nurses (RNs) can benefit society by improving the well-documented healthcare disparities. Black students continue to report negative experiences in nursing school that contribute to difficulty in nursing education programs. Nursing programs struggle to adequately support Black students so that they are successful in their quest to become RNs. Often when students are unsuccessful, faculty focus attention on the student's failed strategies, as opposed to examining possible programmatic and faculty failures. The purposes of this article are to describe challenges Black students may face and to present practical strategies focused on the programmatic and faculty improvements that are needed to foster success. Strategies such as using root cause analyses, use of academic care coordinators, academic success teams, and intentional faculty development can be used to facilitate success for Black nursing students. Addressing programmatic and faculty issues may improve Black students' success in nursing programs.

The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

Workforce Diversity and disparities in wait time and retention among opioid treatment programs

BACKGROUND

Workforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs.

METHODS

We conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States.

RESULTS

We found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention.

CONCLUSIONS

Findings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.

Age and gender relations on LinkedIn pages of global staffing agencies

This study investigates the ways in which age and gender play out on the LinkedIn pages of global staffing agencies through an intersectionality lens. A discourse analysis of 437 LinkedIn posts (including visual images, captions, and comments) was conducted. This study found that the corporate discourse of diversity shaped the ways that age and gender were represented. The portrayals of age and gender were found to create gendered specializations of labor and reproduce gender stereotypes; additionally, some workers were represented as disembodied clusters of attributes. The results of this study show the complex ways in which age and gender systems unfold, including two systems mutually reinforcing, gender/age system surfacing, and two systems dissolving. The findings suggest that diversity has lost its performativity as a concept, as its portrayals may not support disadvantaged groups gaining access to better employment opportunities. This study proposes that staffing agencies actively address intersectional disadvantages and foster a gender- and age-transformative change.

Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review

Objective

Racial workforce diversity has been suggested as a critical pathway to address persistent racial mental health disparities. However, structural racism has been noted to diminish such workforce diversity efforts. The purpose of this critical review is to identify the mechanisms through which structural racism operates in organizations, including mental health organizations, to undermine workforce diversity efforts and reinforce inequities.

Methods

Using the theories of racialized organizations, the current review critically draws on literature underscoring the racial character of organizations as mezzo-level racialized structures that may systematically activate and uphold white privilege in the mental health workplace.

Results

Findings suggest that in the context of institutionalized white dominance, workers of color within mental health organizations may experience race-based cultural exclusion, identity threat, and racialized workplace emotional expression, and be burdened by racialized tasks. The workers of color may also become the means for organizations to attract communities of color due to their diverse characteristics, yet workers’ effects to address disparities in mental health are minimized due to potential racialized organizational forces, including the whiteness of organizational leadership and color-blindness.

Conclusions and Implications for Practice

Structural racism may create resistance to the efforts and effects of a racially diverse workforce within mental health organizations. This review calls for a race-conscious framework that drastically shifts the traditional organizational structure to an inverted hierarchy (i.e., client-centered management) to maximize diversity efforts in the mental health organizational workforce to address racial disparities in mental health.

"Raising the curtain on the equality theatre": a study of recruitment to first healthcare job post-qualification in the UK National Health Service

BACKGROUND

UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations.

AIM

To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups.

METHODS

The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers.

RESULTS

Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches.

CONCLUSION

These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

Medical Schools as Racialized Organizations: How Race-Neutral Structures Sustain Racial Inequality in Medical Education-a Narrative Review

In 2021, The American Association of Medical Colleges released a framework addressing structural racism in academic medicine, following the significant, nationwide Movement for Black Lives. The first step of this framework is to "begin self-reflection and educating ourselves." Indeed, ample evidence shows that medical schools have a long history of racially exclusionary practices. Drawing on racialized organizations theory from the field of sociology, we compile and examine scholarship on the role of race and racism in medical training, focusing on disparities in educational and career outcomes, experiences along racial lines in medical training, and long-term implications. From the entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics negatively impact the careers of trainees of color, particularly those underrepresented in medicine (URiM). Indeed, in addition to structural biases associated with otherwise "objective" metrics, there are racial disparities across subjective outcomes such as the language used in medical trainees' performance evaluations, even when adjusting for grades and board exam scores. These disadvantages contribute to URIM trainees' lower odds of matching, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. Additionally, hostile racial climates and less diverse medical schools negatively influence White trainees' interest in practicing in underserved communities, disproportionally racial and ethnic minorities. Trainees' mental health suffers along the way, as do medical schools' recruitment, retention, diversity, and inclusion efforts. Evidence shows that seemingly race-neutral processes and structures within medical education, in conjunction with individuals' biases and interpersonal discrimination, may reproduce and sustain racial inequality among medical trainees. Medical schools whose goals include training a more diverse physician workforce towards addressing racial health disparities require a new playbook.

Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors

The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.

Microaggressions, school satisfaction and depression: A national survey of nursing students

BACKGROUND

Microaggressions are thought to negatively impact learning and mental health in underrepresented (UR) nursing students.

PURPOSE

The purpose of this study was to investigate three hypotheses in a sample of nursing students: (a) whether, compared to White nursing students, UR nursing students experienced higher frequency of microaggressions, (b) whether microaggressions predict lesser satisfaction with nursing training and (c) whether microaggressions are associated with higher depression screening scores.

METHODS

A survey during Summer 2020 assessed 862 nursing students (71.8% female, Mean age = 28.8, SD = 9.27, 61.4% White, 20.0% UR) on microaggressions, satisfaction with their nursing program, and depression symptoms.

DISCUSSION

We found that compared to White nursing students, UR nursing students reported significantly greater microaggression frequency (with Black students reporting the highest frequency), lesser nursing training satisfaction, and equivalent potential depression rates.

CONCLUSION

Microaggressions deteriorate indicators of wellbeing, especially in UR nursing students. Strategic action to mitigate microaggressions and promote inclusion is needed.

Diversity, Disparities, and the Allergy Immunology Pipeline

Disparities in health outcomes in under-represented racial and ethnic minority groups are evident in allergic/immunologic diseases and have been most completely described in asthma. The last 2 decades have not led to any substantive improvement in these disparities, with under-represented minorities (URMs) receiving worse care in several quality measures. Increasing physician workforce diversity is one strategy to improve access to care and address the health disparity problem because URM physicians more often choose to both work in clinical settings and pursue research that benefits underserved communities.

Addressing Gender Disparity: Increase in Female Leadership Increases Gender Equality in Program Director and Fellow Ranks

INTRODUCTION

Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI.

MATERIALS AND METHODS

Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test.

RESULTS

In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04-12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34-6.6).

CONCLUSION

Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

Diversity and perception of equity and respect in the Society of Skeletal Radiology (SSR)

PURPOSE

To assess the perception of equity and respect in the workplace and within the SSR. We hypothesized that responses would differ by gender and minorities underrepresented in medicine (URiM) status.

METHODS

An electronic survey was sent to 1,531 SSR members between January 2020 and March 2020 to determine perception of equity and respect. Descriptive statistics were calculated, and analysis of differences in response by gender/minority status was performed using the Fisher's exact test. The study was exempt from IRB approval.

RESULTS

There were 176 responses (11.5%). Most respondents (61.9%) were between 30 and 50 years. Members identified as male (M) in 74.4%, as female (F) in 25.0%, and as "other" in 0.6%. URiM comprised 9.1% of members. Women worked more commonly in academia (p = 0.005), had the perception of unequal opportunities for leadership positions within the institution (p = 0.006), and emphasized the importance of having a mentor of the same gender (p = 0.001). URiM members were less likely to hold a leadership position (p = 0.1, trend), had a perception of unequal opportunities for leadership positions within the institution (p = 0.06, trend), and reported the importance of having a mentor of the same race (p = 0.06, trend). There were no significant differences between gender or URiM status and perception of the SSR to provide an inclusive environment and leadership opportunities (p ≥ 0.39).

CONCLUSION

While survey participation was limited and potentially biased, respondents perceived that women and minorities have fewer opportunities and are treated with lower regard in the workplace compared to male, non-minority colleagues.

The Matilda Effect: Underrecognition of Women in Hematology and Oncology Awards

BACKGROUND

The proportion of women in the field of hematology and oncology (H&O) has increased over recent decades, but the representation of women in leadership positions remains poor. In an effort to close the gender gap in academia, it is important to report on such inequities in hopes to close these gaps and improve career development.

MATERIALS AND METHODS

We conducted a retrospective, observational study of published award recipients from 1994 to 2019 from the seven major H&O societies in the world. Gender was determined based on publicly available data. The χ² and Cochran-Armitage tests were used for data analysis.

RESULTS

Of the 1,642 awardees over the past 26 years, 915 met inclusion criteria. Award recipients were overwhelmingly men (77.9%) and non-Hispanic White (84.7%). Women awardees received 30.3% of the humanistic and education-related awards, whereas only receiving 16.0% of basic science awards (p < .01). Women represent 35.6% of all hematologists and oncologists but only received 24.0% of awards given to these physicians (p = .004). Black, Hispanic, and Asian awardees represented 3.7%, 3.3%, and 6.8% of the total awardees, respectively.

CONCLUSION

From 1994 to 2019, women were less likely to receive recognition awards from the seven major H&O societies studied compared with men. We also observed a considerably low proportion of minority awardees across all oncology subspecialties. Further studies examining how selection criteria favor either gender would be warranted in order to achieve equal representation in academic awards.

IMPLICATIONS FOR PRACTICE

In this study, women and minority groups were found to be underrepresented amongst award recipients. Significant disparities were seen in disciplines that have been historically male predominant, such as basic sciences. As awards on an international level enhance academic resumes and assist with career advancement, it is important that awards are being given in an equitable manner. First steps to promote diversity and inclusion in academic medicine is reporting of gender and racial disparities in various areas of academia.

Diversifying the health workforce: a mixed methods analysis of an employment integration strategy

BACKGROUND

Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions.

METHODS

A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted.

RESULTS

In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer.

CONCLUSIONS

The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.

Student and Faculty Diversity is Insufficient to Ensure High-Quality Medical Spanish Education in US Medical Schools

Medical Spanish education aims to reduce linguistic barriers in healthcare and has historically been led by Hispanic/Latinx students and faculty, often without formal training or institutional support. We surveyed 158 US medical schools about their medical Spanish programs. We then examined national trends in Underrepresented in Medicine and Hispanic/Latinx faculty and students as factors associated with meeting medical Spanish basic standards for curricula, educators, assessment, and course credit. We received responses from 125 schools (79%), of which 98 (78%) reported offering some form of medical Spanish. Schools with greater racial/ethnic diversity were more likely to have medical Spanish required courses (P-values < 0.01) but not curricular electives. Overall, likelihood of meeting all basic standards did not differ by diversity characteristics. High-quality medical Spanish requires more than recruitment of diverse students and faculty. Institutions should prioritize meaningful inclusion by supporting evidence-based curricula and faculty educators.

Analytic Training for Junior Investigators in Minority Aging Research: The Michigan Model

Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues.

Update on workforce diversity in vascular surgery

OBJECTIVE

Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse population and to bring new ideas to spur technical innovation. The purpose of this study was to assess trends in workforce diversity within vascular surgery (VS) and general surgery (GS) as compared with orthopedic surgery (OS)-a specialty that instituted a formal diversity initiative over a decade ago.

METHODS

Data on the trainee pool for VS (fellowships and integrated residencies), GS, and OS were obtained from the U.S. Graduate Medical Education reports for 1999 through 2017. Medical student demographic data were obtained from the Association of American Medical Colleges U.S. medical school enrollment reports. The representation of surgical trainee populations (female, Hispanic, and black) was normalized by their representation in medical school. We also performed the χ² test to compare proportions of residents over dichotomized time periods (1999-2005 and 2013-2017) as well as a more sensitive trend of proportions test.

RESULTS

The proportion of female trainees increased significantly between the time periods for the three surgical disciplines examined (P < .001). Hispanic trainees also represented an increasing proportion of all three disciplines (P ≤ .001). The proportion of black trainees did not significantly change in any discipline between the two periods. Relative to their proportion in medical school, Hispanic trainees were well represented in all surgical specialties studied (normalized ratio [NR], 0.95-1.52: 0.95 OS, 1.00 GS, 1.53 VS fellowship, and 1.23 VS residency). Compared with their representation in medical school, women were under-represented as surgical trainees (NR: 0.32 OS, 0.82 GS, 0.56 VS fellowship, and 0.78 VS residency) as were black trainees (NR: 0.63 OS, 0.90 GS, 0.99 VS fellowship, and 0.81 VS residency).

CONCLUSIONS

Although there were significant increases in the number of women and Hispanic trainees in these three surgical disciplines, only Hispanic trainees enter the surgical field at a rate higher than their proportion in medical school. The lack of an increase in black trainees across all specialties was particularly discouraging. Women and black trainees were under-represented in all specialties as compared with their representation in medical school. The data presented suggest potential problems with recruitment at multiple levels of the pipeline. Particular attention should be paid to increasing the pool of minority medical school graduates who are both interested in and competitive for surgical specialties.

The NCI Center to Reduce Cancer Health Disparities: Moving Forward to Eliminate Cancer Health Disparities and Diversify the Cancer Biomedical Workforce

The National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD) was established in 2001 with the purpose of confronting and eliminating cancer health disparities, while increasing workforce diversity in cancer research. Over the last two decades, CRCHD has generated a broad range of research, training, and community outreach activities to address these overarching goals through a variety of programs including the Continuing Umbrella of Research Experiences (CURE), Partnerships to Advance Cancer Health Equity (PACHE), Special Populations Networks (SPN), Community Networks Program (CNP), CNP Centers (CNPC), and Patient Navigation Research Program (PNRP). CRCHD, through its CURE and now its Intramural CURE (iCURE) programs, has been fully dedicated to training the next generation of competitive researchers from backgrounds typically underrepresented in the cancer and cancer health disparities research fields. Today, CRCHD leads NCI's efforts in supporting research training and career development experiences beginning as early as middle school and continuing through to tenured track appointments. CRCHD has also developed a robust basic research focus in cancer disparities, which has recently expanded into translational disparities research and the generation of novel, authenticated animal models appropriate for advancing disparities research investigations. Additionally, CRCHD has fostered an integrated networks infrastructure to complement and support its disparities research and diversity training efforts, as well as provide cancer education and outreach among racially and ethnically diverse and medically underserved communities. Moving forward, the CRCHD will continue its steadfast efforts to move us closer to the day when diversity is a given and disparities no longer exist.

Nursing's leaky pipeline: Barriers to a diverse nursing workforce

BACKGROUND

Nursing educational programs have been charged with increasing the diversity of the nursing workforce; however, this depends on having a diverse and qualified applicant pool to select from.

PURPOSE

To determine the effects of student losses over time on nursing program diversity.

DESIGN AND METHODS

Descriptive longitudinal study. Progression of all students from a single university enrolled as pre-nursing majors from 2012 to 2016 (N = 2498) was tracked over seven key checkpoints during a seven-year time period.

RESULTS

Slightly more than half of the students (57%) were lost prior to nursing program application, which occurred at the end of the sophomore year. Losses were higher for minority students (70%), those requiring remedial coursework (65%), and first-generation students (62%). Older students, those with a prior degree, and those who started in another major were more likely to persist through some, but not all, of the checkpoints.

CONCLUSIONS

Pre-nursing program losses significantly decreased the diversity of the remaining nursing applicant pool, particularly for African American students. Losses were highest during the freshman level Anatomy and Physiology course. Nursing education programs need to develop early intervention programs to support diverse students during the critical pre-nursing period to increase the diversity of the nursing workforce.

From Job Satisfaction to Organizational Commitment: The Mediating Influence of Perceived Treatment of Diversity among Nigeria's Public Healthcare Employees

BACKGROUND:

In the Nigerian, like most developing economies’, health sector, employees’ perceptions about treatments of diversity are crucial not only to their satisfaction with the job but equally to their commitment to the organisation. The importance of this view of the public health sector, is that it could induce political behaviours, result in conflict situations and hence promote tensed work environments, if not properly managed. Despite these facts, there is again, a dearth of existing literature that shows an element of empirical analysis to demonstrate the moderating influence of workforce diversity on job satisfaction and organisational commitment of public healthcare employees in Nigeria.

AIM:

This study is focused on investigating the mediating effect of employees’ perceived treatments of diversity in the workplace on the relationship between job satisfaction and their commitment to the organisation.

METHODS:

The survey method was used to collect data. One hundred thirty-three public health workers from the Lagos State Health Ministry in Nigeria were involved in this research. The research used questionnaires as the main tools to perform this research. The statistics on the reliability of the tools used in this study were 0.747. The statistical analysis was carried out using SPSS (version 22) and AMOS (version 23) software for this study.

RESULTS:

The results from the statistical analysis indicate that job satisfaction significantly relates with all dimensions of workforce diversity in the following ways: education (r = 0.19), gender (r = 0.48), religion (r = -0.20), ethnicity (r = 0.42) and position (r = 0.15). The mediating effects of workforce diversity on the relationship between job satisfaction and employee commitment is also evident from the statistical analysis, especially with respect to education (affective commitment = 0.16, normative commitment = 0.18, continuance commitment = 0.18); gender (affective commitment = 0.32, normative commitment = 0.42); and religion (continuance commitment = 0.14).

CONCLUSION:

This study concluded that not only is job satisfaction significant to ensuring the commitment of healthcare workers to their organisation, but more critical is the role of workforce diversity as viable leverage for transiting the interest of employees from the level of job satisfaction to organisational commitment.

Workforce diversity among public healthcare workers in Nigeria: Implications on job satisfaction and organisational commitment

The aim of this research was to present a data article that identify the relationship between workforce diversity, job satisfaction and employee commitment among public healthcare workers in Nigeria. Copies of structured questionnaire were administered to 133 public healthcare workers from the Lagos state ministry of health in Nigeria. Using descriptive and structural equation modelling statistical analysis, the data revealed the relationship between workforce diversity and job satisfaction, workforce diversity and organisational commitment, and the role of job satisfaction on organisational commitment was also established.

Promotion of alternative-sized personal protective equipment

INTRODUCTION

With more diversity in the workforce, companies are producing PPE such as hard hats, safety glasses, coveralls, foot protection, and safety harnesses for a larger range of body shapes and sizes. However, gray literature reports suggest that barriers exist to getting alternate sized PPE from the manufacturer to the workers who need it. The purpose of this study is to determine the extent to which alternative-sized PPE is marketed.

METHOD

A web-based review of seven major manufacturers of PPE was conducted to determine: (a) whether or not they offer alternative-sized products, (b) if these products are clearly labeled, and (c) if images used to display PPE are representative of a diverse workforce.

RESULTS

Of the seven PPE manufacturers investigated, six had at least one product that was marketed as gender and/or size alternatives however, alternative sizes were more common for larger body types. Alternative-sized products rarely included size charts, and the models used to display PPE were overwhelmingly white males of average size.

CONCLUSIONS

Despite the growing availability of alternative-sized PPE, it can be difficult to find these products, which suggests that they are rarely promoted or labeled as alternative-sized. Our study indicates that companies should expand their product lines and more aggressively market and promote these items. Guidance on how to properly fit their products would also be extremely helpful to the end-user.

PRACTICAL APPLICATIONS

Manufacturers could improve the availability of alternative-sized PPE and increase their promotion of these products on their websites and in their catalogs. Individual companies and safety professionals may assist in this process by demonstrating demand for alternative-sized PPE.

Undergraduate Minor in Health Disparities in Society: a Magnet for Under-represented Pre-professional Students

Increasing the diversity of tomorrow's healthcare work force remains a challenge despite many thoughtful published reports and recommendations. As part of an effort to grow a more diverse pre-professional health population, we created an undergraduate minor, Health Disparities in Society, at the University of Florida. Most courses for the minor were identified from existing offerings, and we created only two new courses, an introduction course and a capstone service-learning course. The new minor quickly became the most popular in the College of Liberal Arts and Sciences (which has approximately 12,000 total undergraduate students), and importantly, students selecting the minor were more likely to be under-represented minorities than would be expected given undergraduate demographics. Pre-professional students choosing this minor reflect the desired diversity of the healthcare workforce of tomorrow.

Racial and Gender Disparities in the Physician Assistant Profession

OBJECTIVE

To examine whether racial, gender, and ethnic salary disparities exist in the physician assistant (PA) profession and what factors, if any, are associated with the differentials.

DATA SOURCES/STUDY SETTING

We use a nationally representative survey of 15,105 PAs from the American Academy of Physician Assistants (AAPA).

STUDY DESIGN

We use bivariate and multivariate statistics to analyze pay differentials from the 2009 AAPA survey.

PRINCIPLE FINDINGS

Women represent nearly two-thirds of the profession but receive approximately $18,000 less in primary compensation. The differential reduces to just over $9,500 when the analysis includes a variety of other variables. According to AAPA survey, minority PAs tend to make slightly higher salaries than White PAs nationally, although the differences are not statistically significant once the control variables are included in the analysis.

CONCLUSIONS

Despite the rough parity in primary salary, PAs of color are vastly underrepresented in the profession. The salaries of women lag in comparison to their male counterparts.

Examining the Impact of Critical Multicultural Education Training on the Multicultural Attitudes, Awareness, and Practices of Nurse Educators

Some nurse educators lack training in the educational methods that facilitate learning among underrepresented groups. Limited awareness of equitable pedagogical practices could threaten the academic achievement of underrepresented groups and hinder efforts to make the nursing profession more heterogeneous. Training in multicultural education could strengthen the capacity of educators to create culturally responsive learning environments. This quasi-experimental study examined the impact that training in critical multicultural education had on the multicultural attitudes, awareness, and practices of 37 nurse educators. A pre-posttest design without a control group found that the training was an effective way to strengthen the multicultural awareness and attitudes of nurse educators, although there was little impact on the multicultural practices. The nation's capacity to improve the quality of health care hinges upon educators who can create inclusive learning environments and graduate diverse nurses. The findings could inform policies seeking to promote diversity and inclusion in nursing education.

White Paper: SSAT Commitment to Workforce Diversity and Healthcare Disparities

The Society for Surgery of the Alimentary Track (SSAT) is committed to diversity and inclusiveness of its membership, promotion of research related to healthcare disparities, cultural competency of practicing gastrointestinal surgeons, and cultivation of leaders with unique perspectives. The SSAT convened a task force to assess the current state of diversity and inclusion and recommend sustainable initiatives to promote these goals. Working through the current committee structure of the Society, and by establishing a permanent Diversity and Inclusion liaison committee, the SSAT will maintain its commitment and strive towards diversity of thought and inclusiveness on every level to improve the well-being and betterment of its membership and the patients they serve.

Mentoring junior URM scientists to engage in sleep health disparities research: experience of the NYU PRIDE Institute

AIM

The aim of this study was to evaluate the National Institute of Health (NIH)-funded PRIDE Institute in Behavioral Medicine and Sleep Disorders Research at New York University (NYU) Langone Medical Center. The NYU PRIDE Institute provides intensive didactic and mentored research training to junior underrepresented minority (URM) faculty.

METHOD

The Kirkpatrick model, a mixed-methods program evaluation tool, was used to gather data on participant's satisfaction and program outcomes. Quantitative evaluation data were obtained from all 29 mentees using the PRIDE REDcap-based evaluation tool. In addition, in-depth interviews and focus groups were conducted with 17 mentees to learn about their experiences at the institute and their professional development activities. Quantitative data were examined, and emerging themes from in-depth interviews and focus groups were studied for patterns of connection and grouped into broader categories based on grounded theory.

RESULTS

Overall, mentees rated all programmatic and mentoring aspects of the NYU PRIDE Institute very highly (80-100%). They identified the following areas as critical to their development: research and professional skills, mentorship, structured support and accountability, peer support, and continuous career development beyond the summer institute. Indicators of academic self-efficacy showed substantial improvement over time. Areas for improvement included tailoring programmatic activities to individual needs, greater assistance with publications, and identifying local mentors when K awards are sought.

CONCLUSIONS

In order to promote career development, numerous factors that uniquely influence URM investigators' ability to succeed should be addressed. The NYU PRIDE Institute, which provides exposure to a well-resourced academic environment, leadership, didactic skills building, and intensive individualized mentorship proved successful in enabling URM mentees to excel in the academic environment. Overall, the institute accomplished its goals: to build an infrastructure enabling junior URM faculty to network with one another as well as with senior investigators, serving as a role model, in a supportive academic environment.

Measuring the Success of a Pipeline Program to Increase Nursing Workforce Diversity

The purpose of this study was to understand changes in knowledge and opinions of underserved American Indian and Hispanic high school students after attending a 2-week summer pipeline program using and testing a pre/postsurvey. The research aims were to (a) psychometrically analyze the survey to determine if scale items could be summed to create a total scale score or subscale scores; (b) assess change in scores pre/postprogram; and (c) examine the survey to make suggestions for modifications and further testing to develop a valid tool to measure changes in student perceptions about going to college and nursing as a result of pipeline programs. Psychometric analysis indicated poor model fit for a 1-factor model for the total scale and majority of subscales. Nonparametric tests indicated statistically significant increases in 13 items and decreases in 2 items. Therefore, while total scores or subscale scores cannot be used to assess changes in perceptions from pre- to postprogram, the survey can be used to examine changes over time in each item. Student did not have an accurate view of nursing and college and underestimated support needed to attend college. However students realized that nursing was a profession with autonomy, respect, and honor.

Race/ethnicity and sex in U.S. occupations, 1970-2010: Implications for research, practice, and policy

We used census data on the civilian non-institutional adult population to analyze trends in labor force participation by race/ethnicity and sex in U.S. occupations from 1970 to 2010 in decennial periods. We examined these data for the main effects and interactions of race/ethnicity and sex across the total labor market and within 35 detailed occupations. Results from a log-linear analysis revealed that, as a whole (across race/ethnicity), more women participated in the labor force from 1970 to 2010. The proportions of working racial/ethnic minorities to both the population and the people in the labor force increased across all decades except for Black men. Although White (Caucasian) men continuously comprised the largest racial/ethnic-sex group working across five decades in absolute numbers, their percentage of the total working population declined from 1970 (54%) to 2010 (37%). In our analyses of 35 occupations, significant sex differences within racial/ethnic groups emerged. Overall, with some exceptions, Asian men and women and White women were more likely to be absorbed into occupations typically associated with professional status whereas Black, Hispanic, and American Indian men and women were more likely to be absorbed into occupations typically associated with low skill, low wages, and low status. Implications for the role of psychologists in future research, practice, and policy are discussed.