Analyzing diversity, equity, and inclusion content on dermatology fellowship program websites

Diversity, Equity, and Inclusion (DEI) initiatives have garnered increasing attention within medical education as there have been increased efforts to diversify the physician workforce among medical students, residents, fellows, and attendings. One way in which programs can improve their DEI initiatives and attract a more diverse pool of applicants is through DEI content on their graduate medical education websites. Prior studies characterizing the content and prevalence of DEI material on residency webpages have shown that dermatology residencies have relatively low levels of DEI content on their websites in which almost ¾ of all programs having no DEI content. Little is known, however, if similar findings are to be expected for the three main dermatology subspecialty fellowship program webpages: Dermatopathology, Pediatric Dermatology, and Micrographic Surgery and Dermatology Oncology. Fellowship programs were identified using the Accreditation Council for Graduate Medical Education's online database of fellowship programs. Programs were evaluated on a standardized scoring system for five equally weighted criteria: fellowship-specific DEI webpage, DEI commitment statement, DEI initiatives (summer research opportunities for under-represented minorities, DEI council, etc.), link to the institution's DEI homepage, and information about bias training. The mean score among all programs was 12.5. Pediatric dermatology ranked the highest among all specialties, while Mohs ranked the lowest. A link to the institution's DEI homepage was the most prevalent factor accounting for 42.1% of all programs collected, whereas information about bias training and fellowship-associated DEI webpage were the least prevalent. The results of this study reveal an overall lack of DEI content across all dermatology subspecialties' webpages and represent an actionable area of improvement for fellowship directors to increase their DEI efforts to attract a diverse pool of applicants to their program.

A CURE Lab in Introductory Biology at a Regional Comprehensive University Negatively Impacts Student Success in the Associated Lecture Course Among Students from Groups Underrepresented in Science

Course-based undergraduate research experiences (CUREs) have been proposed as a mechanism to democratize access to the benefits of apprentice-style scientific research to a broader diversity of students, promoting inclusivity and increasing student success and retention. As we evaluate CUREs, it is essential to explore their effectiveness within the environments of regional comprehensive universities and community colleges, because they are important access points for a wide variety of students. It is also important to address the potential influence of volunteer bias, where students can opt to enroll in either the CURE or a traditional lab, on the outcomes of CUREs. We evaluated a CURE at a regional comprehensive university under conditions both with and without volunteer bias. We find that nonvolunteer students report a lower sense of discovery and relevance of the CURE compared with students who volunteered for the course. Importantly, we also find that our replacement of the traditional lab class with a CURE resulted in lower scores on exams in the associated lecture course among students who are both BIPOC and Pell eligible. We call for additional research on the effects of CUREs at nonresearch-intensive institutions and without volunteer bias, to better understand the impact of these classes.

Zoom out: An intervention on the virtual learning environment improves minority students' grades in two field experiments in Israel

Closing the achievement gap for minority students in higher education requires addressing the lack of belonging these students experience. This paper introduces a psychological intervention that strategically targets key elements within the learning environment to foster the success of minority students. The intervention sought to enhance Palestinian minority student's sense of belonging by increasing the presence of their native language. We tested the effectiveness of the intervention in two field experiments in Israel (n > 20,000), at the height of the COVID-19 pandemic when all classes were held via Zoom. Lecturers in the experimental condition added a transcript of their names in Arabic to their default display (English/Hebrew only). Our findings revealed a substantial and positive impact on Palestinian student's sense of belonging, class participation, and overall grades. In experiment 1, Palestinian student's average grade increased by 10 points. In experiment 2, there was an average increase of 4 points among Palestinian students' semester grade. Our intervention demonstrates that small institutional changes when carefully crafted can have a significant impact on minority populations. These results have significant implications for addressing educational disparities and fostering inclusive learning environment.

Towards inclusive learning environments in post-graduate medical education: stakeholder-driven strategies in Dutch GP-specialty training

BACKGROUND

A recent study found that ethnic minority General Practice (GP)-trainees receive more negative assessments than their majority peers. Previous qualitative research suggested that learning climate-related factors play a pivotal role in unequal opportunities for trainees in post-graduate medical settings, indicating that insufficient inclusivity had put minority students at risk of failure and dropout.

STUDY OBJECTIVES

We aimed to develop broadly supported strategies for an inclusive learning climate in Dutch GP-specialty training.

METHODS

We employed Participatory Action Research (PAR)-methods, incorporating Participatory Learning and Action (PLA)-techniques to ensure equal voices for all stakeholders in shaping Diversity, Equity, and Inclusion (DEI)-strategies for GP-specialty training. Our approach engaged stakeholders within two pilot GP-specialty training institutes across diverse roles, including management, support staff, in-faculty teachers, in-clinic supervisors, and trainees, representing ethnic minorities and the majority population. Purposeful convenience sampling formed stakeholder- and co-reader groups in two Dutch GP-specialty training institutes. Stakeholder discussion sessions were based on experiences and literature, including two relevant frameworks, and explored perspectives on the dynamics of potential ethnic minority trainees' disadvantages and opportunities for inclusive strategies. A co-reader group commented on discussion outcomes. Consequently, a management group prioritized suggested strategies based on expected feasibility and compatibility.

RESULTS

Input from twelve stakeholder group sessions and thirteen co-readers led to implementation guidance for seven inclusive learning environment strategies, of which the management group prioritized three: • Provide DEI-relevant training programs to all GP-specialty training stakeholders; • Appoint DEI ambassadors in all layers of GP-specialty training; • Give a significant voice to minority GP-trainees in their education.

CONCLUSION

The study's participatory approach engaged representatives of all GP-specialty training stakeholders and identified seven inclusive learning climate strategies, of which three were prioritized for implementation in two training institutions.

A systematic review of barriers to pursuing careers in medicine among Black premedical students

Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine

BACKGROUND

Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce.

METHODS

Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05.

RESULTS

First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures.

CONCLUSION

Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

Investigating the relationship between participation in the building infrastructure leading to diversity (BUILD) initiative and intent to pursue a science career: A cross-sectional analysis

This paper presents an analysis of survey data to examine the association between supervised structured mentoring and students' intent to pursue a career in science. Data were collected from students in the 10 Building Infrastructure Leading to Diversity (BUILD) research training programs, developed through grants from the National Institutes of Health. Propensity score matching and multinomial logistic regression demonstrated that exposure to BUILD programs-meaning participation in undergraduate research, receipt of mentoring from a primary mentor, and/or participation as a funded scholar and/or associate of each BUILD site's training program-was associated with increased intent to pursue a science career. These findings have implications for STEM program evaluation and practice in higher education.

Psychological and emotional experiences of participants in a medical school, early assurance admissions program targeting students from groups underrepresented in medicine

BACKGROUND

There are growing number of pathway programs, with an early assurance of admission, that target undergraduate students from groups underrepresented in medicine (URiM) to enable their competitiveness for and matriculation to medical school, including the Penn Access Summer Scholars (PASS) program. The psychological and emotional experiences of students in these programs, however, have not been previously described.

METHODS

Students from the summer 2021 cohort of the PASS program were interviewed using a structured set of questions that explored four specific areas: (i) the application process; (ii) the benefits and value of being in the PASS program; (iii) the emotional and psychological challenges and stresses of being in the PASS program; (iv) feelings and emotions about not taking the MCAT or having to interview at multiple schools. The transcribed, de-identified interviews were then subjected to a qualitative analysis.

RESULTS

Students in PASS reported that the program was valuable to them in that it reduced the stress of the pre-medical process; relieved worry and anxiety surrounding the MCAT; enabled development of supportive relationships and provided meaningful exposures to the medical profession and biomedical research. Despite this, students reported feelings of imposterism, guilt, and fear of disappointing, along with varying degrees of regret over not taking the MCAT and not interviewing at more than one medical school.

CONCLUSIONS

URiM and other marginalized students participating in early assurance admissions programs likely enter medical school with a range of positive and negative emotions as a result of their participation in these programs. These data can be used to inform the development of programing and other initiatives that further support the transition and success of these students in medical school.

Underrepresented in Medicine Student Perspectives on the Selection of a Summer Research Program

OBJECTIVES

Many summer research programs (SRPs) for URiM students exist; however, only a few have been established by otolaryngology programs, who have a unique opportunity to provide a diverse experience. We sought to assess URiM undergraduate student perspectives on the most valuable program features that influence decision-making and how this might be useful to otolaryngology programs seeking to establish pathway programs.

MATERIALS AND METHODS

An externally facing REDCap survey composed of 37 questions in scaled, multiple-choice, and open-ended form. The survey was delivered to applicants via email over two time periods in April 2021 and February 2022. All survey responses were analyzed using descriptive statistics and categorized according to demographic information, program features, and advertising mechanisms.

RESULTS

Seventy-one percent of our applicants self-identified as URiM. Over 60% experienced financial hardship, and 31% experienced educational hardship. The single most important feature when selecting a summer research program (SRP) was access to mentorship followed by clinical shadowing and research opportunities. When program features were aggregated into groups, institutional features were the most important, followed closely by funding features. Finally, students prefer to learn about SRPs through their university, followed by social media, despite many students learning about our program through other means.

CONCLUSIONS

Paid programs with effective advertising, research, mentoring, and clinical shadowing are highly valued by URiM undergraduate students. Understanding student perspectives is critical for programs aiming to address the "leaky pipeline" while being deliberate in their support of underrepresented students.

LEVEL OF EVIDENCE

5 Laryngoscope, 134:637-644, 2024.

"Reduced to My Race Once Again": Perceptions about Underrepresented Minority Medical School Applicants in Canada and the United States

Phenomenon: To increase racial diversity in medical school classes, many institutions have created underrepresented minority (URM) application streams. However, many URM students experience overt and passive marginalization throughout their training and this may be related to how matriculants from URM streams are perceived by their peers. Approach: We conducted a discourse analysis of online discussion forums to explore how URM streams across Canada and the United States are perceived. We analyzed 850 posts from 13 discussion threads published between 2015 and 2020. We used inductive content analysis to develop a data-driven coding scheme from which we identified common themes. Findings: Despite an overall appreciation of the benefits of a diverse workforce, participants engaged in prominent discussions surrounding the merits of URM streams. We identified perceptions that students admitted from URM streams are less academically and clinically competent, with URM applicants reporting feeling unworthy for admission in the eyes of non-URM applicants. Users felt that the influence of socioeconomic status was under-appreciated, and that admissions officers inadequately addressed this barrier. There were some applicants who perceived the admissions process as "broken" with non-URMs displaying a fear of social change, and URMs fearing that the system defines them by their racialized status. Insights: Online discussion forums provide unique insight into perceptions surrounding URM streams. We identified potentially harmful misconceptions about URM students applying to these streams and highlight that actionable measures to reduce marginalization against URM matriculants must begin before medical school.

Developing a Graduate Class on Synthetic Cells at a Minority Serving Institution: Lessons from the University of New Mexico

This article describes the development, methodology, enrollment, and outcomes of a graduate technical elective course on synthetic cells and organelles offered at the University of New Mexico, a minority-majority institution, in Fall 2022. The course had a significant ethics component and took advantage of readily available, low cost, and no-cost teaching materials that are available online. The course was effective in attracting a diverse enrollment of graduate students and senior undergraduates, some of whom participated in a survey of their backgrounds and motivations after the course was over. The article also provides results from this survey. Courses such as the one described have the potential to increase access and participation in emerging fields of research and technology such as synthetic cells.

Implicit Association Test Alone Is Not Sufficient to Increase Underrepresented Minority Representation in Physician Assistant Programs

PURPOSE

Physician assistant (PA) program matriculants are consistently less diverse than the US population. This study evaluates whether administration of an Implicit Association Test (IAT) to PA program admission committees is associated with changes in the likelihood of (1) receiving an admission interview, (2) receiving an offer of admission, and (3) matriculation of individuals underrepresented in medicine (URiM).

METHODS

Admission committees from 4 PA programs participated in an IAT before the 2019/2020 admissions cycle. Applicant outcome data (n = 5796) were compared with 2018/2019 cycle (n = 6346). Likelihood of URiM students receiving offers to interview, offers of admission, and matriculation were evaluated using random effects multiple logistic regression models. Fully adjusted random effects models included URiM status, year (control vs. intervention), multiplicative interaction terms between URiM and year, applicant age, and undergraduate grade point average (GPA) Secondary analyses examined associations of each race/ethnicity individually.

RESULTS

Underrepresented in medicine status, age, and GPA were significantly associated with all admission outcomes ( P < .05). The intervention effect was not statistically significant. In sensitivity analyses examining each individual race rather than URiM status, our results did not importantly differ.

CONCLUSION

Findings suggest admission committee member participation in IAT before admissions had no significant impact on the likelihood of admission of URiM students. This may suggest that making individuals aware of their implicit biases is not, in and of itself, sufficient to meaningfully affect the diversity of PA program admission metrics.

Medical student specialty decision-making and perceptions of neurosurgery. Part 2: Role of race/ethnicity

OBJECTIVE

Although individuals underrepresented in medicine (URM) make up 33% of the United States population, only 12.6% of medical school graduates identify as URM; the same percentage of URM students comprises neurosurgery residency applicants. More information is needed to understand how URM students are making specialty decisions and their perceptions of neurosurgery. The authors aimed to evaluate the differences between URM and non-URM medical students and residents in terms of the factors that contribute to specialty decision-making and perceptions of neurosurgery.

METHODS

A survey was administered to all medical students and resident physicians at a single Midwestern institution to assess factors influencing medical student specialty decision-making and perceptions of neurosurgery. Likert scale responses converted to numerical values on a 5-point scale (strongly agree was the high score of 5) were analyzed with the Mann-Whitney U-test. The chi-square test was performed on the binary responses to examine associations between categorical variables. Semistructured interviews were conducted and analyzed using the grounded theory method.

RESULTS

Of 272 respondents, 49.2% were medical students, 51.8% were residents, and 11.0% identified as URM. URM medical students considered research opportunities more than non-URM medical students in specialty decision-making (p = 0.023). When specialty decision-making factors were assessed, URM residents less strongly considered the technical skill required (p = 0.023), their perceived fit in the field (p < 0.001), and seeing people like them in the field (p = 0.010) than their non-URM counterparts when making specialty decisions. Within both medical student and resident respondent cohorts, the authors found no significant differences between URM and non-URM respondents in terms of their specialty decision-making being affected by medical school experiences such as shadowing, elective rotations, family exposure, or having a mentor in the field. URM residents were more concerned about the opportunity to work on health equity issues in neurosurgery than non-URM residents (p = 0.005). The predominant theme that emerged from interviews was the need for more intentional efforts to recruit and retain URM individuals in medicine and specifically neurosurgery.

CONCLUSIONS

URM students may make specialty decisions differently than non-URM students. URM students were more hesitant toward neurosurgery due to their perceived lack of opportunity for health equity work in neurosurgery. These findings further inform optimization of both new and existing initiatives to improve URM student recruitment and retention in neurosurgery.

Diversifying faculty recruitment in biomedical sciences

A wealth of data has consistently demonstrated that a diverse faculty maximizes productivity and innovation in the research enterprise and increases the persistence and success of groups that are underrepresented in STEM. While the diversity of students in graduate programs has steadily increased, faculty diversity, particularly in the biomedical sciences, continues to remain relatively flat. Several issues contribute to this mismatch between the pipeline and the professoriate including biases in search and hiring practices, lack of equity and equal opportunities for individuals from underrepresented backgrounds, and unwelcoming campus climates that lead to marginalization and isolation in academic life. A comprehensive approach that addresses these challenges is necessary for institutions of higher education to achieve their faculty diversity goals and create a climate where individuals from all groups feel welcomed and succeed. This article focuses on the first step in this approach-diversifying faculty recruitment through adopting search practices that generate an applicant pool that matches national availability, ensures equity in evaluation and hiring practices, and promotes inclusion and belonging in the hiring experience. These strategies have been recently used at the University of California, Irvine's School of Biological Sciences and while the long-term impact remains unknown, short-term outcomes in recruitment and hiring have demonstrated significant improvement over previous years.

Educating the next generation of cancer researchers: Evaluation of a cancer research partnership training program

African American, American Indian and Alaska Native, Hispanic (or Latinx), Native Hawaiian, and other Pacific Islander groups are underrepresented in the biomedical workforce, which is one of the barriers to addressing cancer disparities among minority populations. The creation of a more inclusive biomedical workforce dedicated to reducing the burden of cancer health disparities requires structured, mentored research and cancer-related research exposure during the earlier stages of training. The Summer Cancer Research Institute (SCRI) is a multicomponent 8-week intensive summer program funded under the Partnership between a Minority Serving Institute and a National Institutes of Health-designated Comprehensive Cancer Center. In this survey study, we found that students who participated in the SCRI Program reported greater knowledge and interest in pursuing careers in cancer-related fields than their counterparts who did not participate in SCRI. Successes, challenges, and solutions in providing training in cancer and cancer health disparities research to improve diversity in the biomedical fields were also discussed.

The US Supreme Court and Affirmative Action: The Negative Impact on the Physician Workforce

PURPOSE

Maintaining admissions of underrepresented students to medical schools is essential to securing a diverse health care workforce. Empirical evidence indicates that minority patients may prefer practitioners of their own race. The recent US Supreme Court decision concerning affirmative action makes this goal more difficult, but medical schools can still work within the language of the law to redouble their efforts to seat a diverse class of medical students.

METHODS

We examined the literature correlating the availability of minority physicians and the health outcomes of the patients they serve. We also examined the literature on race-conscious policies of medical schools intended to address the shortage of minority physicians considering the benefits achieved through a diverse field of health care workers. We also examined the law and the recent US Supreme Court opinion, including the application of equal protection principles, to suggest strategies to seat a diverse class of students within the scope of the law.

FINDINGS

Institutions have maintained the status quo of disparate distributions of professions by race through structural biases that also limit access to medical schools. The new US Supreme Court decision is expected to exacerbate this disparity unless medical schools engage in admissions protocols that actively solicit the character and unique abilities that each of the applicants can offer to contribute to the medical school and the health care profession.

IMPLICATIONS

The new US Supreme Court mandate is likely to create challenges for medical schools in their efforts to recruit and seat minority applicants. The mandate provides little discussion, suggesting a lack of understanding of the downstream public health consequences to patients if medical school applicants are denied the benefits of race-conscious admissions policies. Nevertheless, the language of the US Supreme Court's opinion may provide a viable path forward, at least with respect to medical schools where the need for a diverse pool of health care practitioners is particularly compelling.

Increasing representation and diversity in health research: A protocol of the MYHealth research training program for high school students

BACKGROUND

Despite decades of calls for increased diversity in the health research workforce, disparities exist for many populations, including Black, Indigenous, and People of Color individuals, those from low-income families, and first-generation college students. To increase representation of historically marginalized populations, there is a critical need to develop programs that strengthen their path toward health research careers. High school is a critically important time to catalyze interest and rebuild engagement among youth who may have previously felt excluded from science, technology, engineering, and mathematics (STEM) and health research careers.

METHODS

The overall objective of the MYHealth program is to engage high school students in a community-based participatory research program focused on adolescent health. Investigators will work alongside community partners to recruit 9th through 12th graders who self-identify as a member of a group underrepresented in STEM or health research careers (e.g., based on race and ethnicity, socioeconomic status, first generation college student, disability, etc.). MYHealth students are trained to be co-researchers who work alongside academic researchers, which will help them to envision themselves as scientists capable of positively impacting their communities through research. Implemented in three phases, the MYHealth program aims to foster a continuing interest in health research careers by developing: 1) researcher identities, 2) scientific literacy, 3) scientific self-efficacy, and 4) teamwork and leadership self-efficacy. In each phase, students will build knowledge and skills in research, ethics, data collection, data analysis, and dissemination. Students will directly collaborate with and be mentored by a team that includes investigators, community advisors, scientific advisors, and youth peers.

DISCUSSION

Each year, a new cohort of up to 70 high school students will be enrolled in MYHealth. We anticipate the MYHealth program will increase interest and persistence in STEM and health research among groups that have been historically excluded in health research careers.

US Postgraduate Trainee Racial, Ethnic, and Gender Representation and Faculty Compensation By Specialty

This study compares postgraduate trainee racial, ethnic, and gender representation and faculty compensation for 21 clinical specialties using 2015-2022 data.

Influence of participant and reviewer characteristics in application scores for a hematology research training program

The American Society of Hematology Clinical Research Training Institute (CRTI) is a clinical research training program with a competitive application process. The objectives were to compare application scores based on applicant and reviewer sex and underrepresented minority (URM) status. We included applications to CRTI from 2003 to 2019. The application scores were transformed into a scale from 0 to 100 (100 was the strongest). The factors considered were applicant and reviewer sex and URM status. We evaluated whether there was an interaction between the characteristics and time related to application scores. In total, 713 applicants and 2106 reviews were included. There was no significant difference in scores according to applicant sex. URM applicants had significantly worse scores than non-URM applicants (mean [standard error] 67.9 [1.56] vs 71.4 [0.63]; P = .0355). There were significant interactions between reviewer sex and time (P = .0030) and reviewer URM status and time (P = .0424); thus, results were stratified by time. For the 2 earlier time periods, male reviewers gave significantly worse scores than did female reviewers; this difference did not persist for the most recent time period. The URM reviewers did not give significantly different scores across time periods. URM applicants received significantly lower scores than non-URM applicants. The impact of reviewer sex and URM status changed over time. Although male reviewers gave lower scores in the early periods, this effect did not persist in the late period. Efforts are required to mitigate the impact of applicant URM status on application scores.

Summer Clinical Oncology Research Experience (SCORE) Program: Engaging Undergraduates from Diverse Backgrounds in Cancer Research

Diversifying the future cancer research workforce requires that students engage in cancer research, persist in paths toward science, technology, engineering, mathematics, and medicine (STEMM) fields, and choose cancer research careers. The Summer Clinical Oncology Research Experience (SCORE) Program at Memorial Sloan Kettering, designed in 2010 to engage undergraduate (U) and post-baccalaureate (PB) students from diverse backgrounds in cancer research, is an 8-week summer program pairing an U or PB student with a faculty mentor to conduct cancer research. We report demographics and career paths for 2010-2019 SCORE students. Of 116 students, 112 (97%) attended public universities, and 75 (64%) were in their first 2 years of college. Race/ethnicity was Black/African American, 20 (17%); Hispanic/Latinx, 15 (13%); multiracial, five (4%); Asian, 40 (34%); White/Caucasian, 36 (31%). A total of 112 (97%) identified as female; 47 (41%) were first-generation college students, and 85 (73%) were from immigrant families. As of 2021, 114 (98%) persisted in paths toward STEMM careers: 44 (38%) medical school (MS) students, 14 (12%) residents, two (2%) practicing physicians, 12 (10%) pursuing non-MD STEMM advanced degrees, 21 (18%) working in non-MD STEMM fields, 17 (15%) applying to MS, and 4 (3%) U science majors. Cancer research participation significantly increased from 5% pre- to 84% post-SCORE. A total of 63/116 (54%) students subsequently co-authored 152 peer-reviewed publications, including 105 (69%) in oncology. SCORE engaged underrepresented U and PB students in cancer research, and 98% of these students persisted in paths toward STEMM careers. Long-term follow-up is needed to assess the enduring engagement of these underrepresented students in cancer research.

Diversity of medical dosimetry applicants and graduates

Diversity is a critical component in the advancement of human endeavor in science. Students who complete their education and training at diverse schools can serve patients from a wide range of ethnic backgrounds and promote cross-cultural competence. However, developing a diverse environment of professionals is a long-term effort which often takes generations to complete. Increasing awareness of underrepresented genders and/or minorities helps to establish goals for building a future of improved diversity. Specific to radiation oncology, professions such as medical physicists and radiation oncology physicians have reported underrepresented females and minorities. The problem is that there is a paucity of literature regarding diversity of medical dosimetry professionals. The professional organization does not track diversity data for those members currently working in the profession. Therefore, the purpose of this research was to present aggregate data demonstrating the diversity of medical dosimetry applicants and graduates. The methodology involved quantitative data collection from medical dosimetry program directors which answered the research question, what is the diversity of medical dosimetry applicants and graduates? In comparison to the U.S. population, there were less applicant and accepted students of Hispanic/Latino and African American ethnicities whereas the Asian population was higher. While the U.S. population data reveals 3% more females, there were 35% more female than male applicant and accepted students in this study. However, the results differ significantly from medical physics and radiation oncology physicians with only 30% female clinicians.

Overcoming financial and social barriers during COVID-19: A medical student-led medical education innovation

Background

Underrepresented minorities in medicine (URMM) may face financial and social limitations when applying to medical schools. The computer-based assessment for sampling personal characteristics (CASPER) test is used by many medical schools to assess the nonacademic competencies of applicants. Performance on CASPER can be enhanced by coaching and mentorship, which URMMs often lack, for affordability reasons, when applying to medical schools.

Methods

The CASPER Preparation Program (CPP) is a free, online, 4-week program to help URMM prepare for the CASPER test. CPP features free medical ethics resources, homework and practice tests, and feedback from tutors. Two of CPPs major objectives include relieving URMM of financial burdens and increasing their accessibility to mentorship during the COVID-19 pandemic. A program evaluation was conducted using anonymous, voluntary postprogram questionnaires to assess CPPs efficacy in achieving the aforementioned objectives.

Results

Sixty URMMs completed the survey. The majority of the respondents strongly agreed or agreed that CPP relieves students of financial burden (97%), is beneficial for applicants with low-socioeconomic statuses (98%), provides students with resources they could not afford (n = 55; 92%), and enables access to mentors during the pandemic (90%).

Discussion

Pathway coaching programs, such as the CASPER Preparation Program, have the potential to offer URMMs mentorship and financial relief, and increase their confidence and familiarity with standardized admission tests to help them matriculate into medical schools.

Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training

BACKGROUND

Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows.

METHODS

Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population.

RESULTS

Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons.

CONCLUSION

This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

A Case Study of Enhancing the Data Science Capacity of an RCMI Program at a Historically Black Medical College

As data grows exponentially across diverse fields, the ability to effectively leverage big data has become increasingly crucial. In the field of data science, however, minority groups, including African Americans, are significantly underrepresented. With the strategic role of minority-serving institutions to enhance diversity in the data science workforce and apply data science to health disparities, the National Institute for Minority Health Disparities (NIMHD) provided funding in September 2021 to six Research Centers in Minority Institutions (RCMI) to improve their data science capacity and foster collaborations with data scientists. Meharry Medical College (MMC), a historically Black College/University (HBCU), was among the six awardees. This paper summarizes the NIMHD-funded efforts at MMC, which include offering mini-grants to collaborative research groups, surveys to understand the needs of the community to guide project implementation, and data science training to enhance the data analytics skills of the RCMI investigators, staff, medical residents, and graduate students. This study is innovative as it addressed the urgent need to enhance the data science capacity of the RCMI program at MMC, build a diverse data science workforce, and develop collaborations between the RCMI and MMC's newly established School of Applied Computational Science. This paper presents the progress of this NIMHD-funded project, which clearly shows its positive impact on the local community.

Project MED (Medicine, Exposure, and Development): Promoting Access to Healthcare Education for Historically Underrepresented Groups Through Community Engagement, Sustainability, and Technology

In the U.S., disparities in the healthcare workforce have led to inadequate health outcomes in communities of historically underserved groups. To address the lack of resources and opportunities in health career education for historically underserved group students, Project MED was established. The mission is to expose high school students to the breadth of opportunities in the healthcare field and to prepare students for successful careers in healthcare. Through 3 main pillars-Learn, Lead, and Launch-Project MED has developed a robust repository of 20 workshops, recruited and trained eight mentors, and curated a database of ≥100 opportunities for over 50 students.

Meeting the Accreditation Standard for Diversity

ABSTRACT

While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.

A Student-Centered, Entrepreneurship Development (ASCEND) Undergraduate Summer Research Program: Foundational Training for Health Research

Increasing the participation of students of African descent and other minoritized populations in the scientific workforce is imperative in generating a more equitable biomedical research infrastructure and increasing national research creativity and productivity. Undergraduate research training programs have shown to be essential tools in retaining underrepresented minority (URM) students in the sciences and attracting them into STEM and biomedical careers. This paper describes an innovative approach to harness students' entrepreneurial desire for autonomy and creativity in a Summer Research Institute (SRI) that has served as an entry point into a multiyear, National Institutes of Health Building Infrastructure Leading to Diversity (NIH BUILD)-funded research training program. The SRI was designed as an 8-week, student-centered and course-based research model in which students select their own research topics. We test here the effects of SRI training on students' science self-efficacy and science identity, along with several other constructs often associated with academic outcomes in the sciences. The data shown here comprise analysis of four different training cohorts throughout four subsequent summers. We show significant gains in students' science self-efficacy and science identity at the conclusion of SRI training, as well as academic adjustment and sense of belonging. SRI participants also displayed substantially improved retention in their science majors and graduation rates.

Topic: Intentional diversity in academia: Recruiting, admitting, enrolling, and retaining underrepresented students in nursing programs

Currently, 60 % of the United States population is White, while the remaining belong to ethnic or racial minorities. By 2045, the Census Bureau predicts that there will no longer be any single racial or ethnic majority group in the United States. Yet, people across all healthcare professions are overwhelmingly non-Hispanic and White, leaving people from underrepresented groups severely underrepresented. The lack of diversity in healthcare professions is an issue because there is overwhelming evidence that patients from underrepresented groups experience disparities in healthcare at alarmingly high rates when compared to their White counterparts. Diversity is especially important in the nursing workforce since nurses are often the healthcare providers that engage with patients the most frequently and intimately. Additionally, patients demand a diverse nursing workforce that can provide culturally competent care. The purpose of this article is to summarize nationwide undergraduate nursing enrollment trends and discuss strategies to improve recruitment, admissions, enrollment, and retention of nursing students who belong to underrepresented groups.

Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): Diversifying the Clinical Cancer Research Workforce

A lack of diversity in the clinical cancer workforce causes undue burden limiting research and patient care advancements. Recruitment and retention of individuals underrepresented in medicine/research can enhance patient-provider concordance. The Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) uniquely prepares underrepresented minority students to quickly transition into the clinical research workforce and seek advanced graduate degrees. Experiential learning theory and culturally responsive pedagogy ground SPARCC's rigorous competency-based curriculum incorporating cancer care, clinical trial development, social supports, and mentored research experiences. Concurrent mixed-methods analysis includes evaluations of workshops, clinical-practicums, and pre-, post-, and 6-month-post-knowledge, attitudes, and practices. Analysis of data included stepwise multivariate regression analysis, Spearman's rho correlations, and assessments of inter-item reliability via Cronbach's alpha (IBM® SPSS® 24.0). Inductive content analysis coded phrases and analytic patterns were distilled enhancing descriptions of experiences. From January 2019 to March 2019, 62% of applications came from underrepresented minorities. Ten students were accepted, 90% identified as underrepresented minority. All ten students completed the pre-, post-, and 6-month-post-evaluations. Overall scores increased significantly from pre-evaluation to 6-month-post-evaluation. Evaluation data came from 431 responses of 60 workshops, with a mean score of 9.1 (10-point scale). Students completed three clinical practicums, which received an overall mean score of 8.2 (10-point scale). A robust curriculum, structured recruitment, diverse faculty, and comprehensive evaluations made SPARCC a compelling strategy for supporting underrepresented minority students to seek immediate employment as clinical research professionals or application to advanced graduate degree programs.

Underrepresented Minority Recruitment: Manpower as Motivator in Late Twentieth-Century Occupational Therapy and Physical Therapy

This article offers a historical perspective on diversity, equity, and inclusion initiatives in health professions. Historians have highlighted how workforce shortages have facilitated increased gender diversity in male-dominated scientific and clinical occupations. Less attention has been given to manpower as a motivator for enhancing racial/ethnic diversity. I explore the history of minority recruitment, retention, and inclusion initiatives in occupational therapy and physical therapy after 1970 and examine the evolving ways in which the longstanding underrepresentation of racial/ethnic minority health professions students and practitioners was recognized, mobilized, and instrumentalized in each field. I argue that broad-based manpower concerns, though often compelling initial motivators for action, were insufficient for sustaining successful and long-term minority initiatives, due to constant shifts in job market demand. Instead, this article shows that annual and institutionalized minority-specific awards and fundraisers were the most effective strategies for maintaining minority recruitment initiatives over multiple decades.

Association Between Stress and Program Length in Underrepresented Minority Physician Assistant Students

INTRODUCTION

The purpose of this study was to determine if there was a relationship between physician assistant (PA) program length and stress measures in PA students, particularly PA students classified as underrepresented minorities in medicine. The stress measures included emotional and physical well-being.

METHODS

The 2019 End of Program survey data were analyzed using multiple regression to determine if emotional and physical well-being could be predicted by PA program length, age, gender, PA school debt, and UR minority in medicine status.

RESULTS

Shorter PA programs were associated with higher physical well-being scores, although there was no difference between UR minority in medicine and non-UR minority in medicine students. Older students, males, and students with higher levels of PA school debt had lower scores for emotional and physical well-being.

DISCUSSION

Shorter program lengths should be considered for optimal physical well-being in all students. Further research is needed to understand optimal program length and experiences of these students .

Diversity in the Physician Assistant Pipeline: Experiences and Barriers in Admissions and PA School

INTRODUCTION

The purpose of this study was to identify perceived barriers faced by physician assistant (PA) students who identified as an underrepresented minority in medicine (URM-med), sexual or gender minority (SGM), coming from low socioeconomic status (low SES), or a person with a disability (PWD).

METHODS

More than 2700 PA students across the United States provided information regarding their PA school application process and program experiences. This study examined differences among URM-med, SGM, low SES, and PWD compared to those who were not in those groups to determine the relationship between these factors and student concerns about bias in the application process, as well as a variety of experiences in PA school.

RESULTS

Using ordinal logistic regression analyses to examine the odds of experiencing a variety of barriers or experiences in applying to PA school and postmatriculation experiences, results suggested that, among disadvantaged groups within the PA student body, barriers include concerns about bias in the application process, lack of belonging, and the lack of academic and social support.

DISCUSSION

PA students who identified as URM-med, SGM, low SES, and/or PWD faced barriers as they navigated the path to becoming a PA. To decrease these barriers, emphasis on raising awareness and interest in pursuing a career as a PA should occur early. Programs should work to identify biases within admissions processes, diversify faculty, and identify ways to support minority students once matriculated. Ultimately, increasing the diversity of healthcare providers has the potential to increase access to and quality of care for patients.

An intensive summer pipeline program for pre-pharmacy students to increase underrepresented minority matriculation to pharmacy school

BACKGROUND AND PURPOSE

To describe the Summer Academic Enrichment Program (SAEP) for underrepresented minority (URM) matriculants at Virginia Commonwealth University (VCU) School of Pharmacy.

EDUCATIONAL ACTIVITY AND SETTING

The SAEP is a six-week summer pipeline program at VCU for undergraduate and post-baccalaureate students interested in applying to medical, dental, physical therapy, or pharmacy school, divided into school tracks. Demographic and matriculation information about the pharmacy track program participants was obtained from the program and school administration from inception in 2012 through 2019. A retrospective analysis of the impact of SAEP on URM matriculation at VCU School of Pharmacy was conducted.

FINDINGS

Of the 80 pharmacy track participants, 56.3% (n = 45) have enrolled at VCU School of Pharmacy. Among those 45 that matriculated, 33.3% (n = 15) identified as one or more of the following URM populations: Black or African American 28.9% (n = 13), Hispanic or Latinx 4.4% (n = 2), and American Indian 2.2% (n = 1). In comparison, the same URM classifications for students enrolled at VCU School of Pharmacy over the last nine years ranged from 5% to 11% Black or African American, 0% to 5% Hispanic or Latinx, and 0% to 2% American Indian with a total URM representation range of 7% to 25% during this timeframe.

SUMMARY

SAEP is a program utilized to increase matriculation of students from diverse backgrounds, including URM populations. This type of pipeline program is described as one way to improve URM representation.

Brain Camp: A Summer Pipeline Program to Increase Diversity in Neurosciences

BACKGROUND

Despite calls to increase diversity in the health care workforce, most medical fields including neurology have seen minimal advances, owing in part to the lack of developing a robust pipeline for trainees from underrepresented backgrounds. We sought to create an immersive, replicable neurology-themed summer camp and longitudinal mentorship program for underrepresented-in-medicine (URM) high-school students to encourage them to enter the training pipeline in neuroscience-related fields.

METHODS

We established an annual, no-cost 1-week camp for local URM students with the goals of exposing them to different health care professions within neuroscience while providing them with college application resources and long-term mentorship. A postprogram survey was distributed to assess the students' attitudes towards the camp and their desires to pursue health care careers.

RESULTS

Over the 4 years since the founding of the camp (2016-2020), a total of 96 students participated, of whom 53% were URM, 74% came from very low-income households, and 61% had parents who did not attend college. In total, 87 students (91%) completed the postcamp survey. Nearly all (97%) of the respondents were likely to recommend the camp to their peers, and the vast majority (85%) felt that Brain Camp made them more likely to pursue careers in health care.

CONCLUSIONS

Brain Camp seeks to address the unmet need for low barrier-to-entry programs designed for URM high-school students interested in health care careers. We envision that our camp may serve as a blueprint for other similar programs across the nation with the goal of addressing the URM pipeline in neuroscience.

How well do urology residency program webpages recruit underrepresented minorities?

INTRODUCTION

Historically, the field of medicine has suffered from a lack of diversity. This project examines if urology residency program websites were actively attempting to recruit underrepresented minority applicants with the hypothesis that while some programs would attempt to attract such applicants on their website, the majority would not.

MATERIALS AND METHODS

A cross-sectional analysis of program webpages for information regarding underrepresented minorities was performed. Electronic Residency Application Service residency database was used to identify 130 urology residency programs. Three were no longer accepting residents and were not included. The publicly available webpages of 137 urology residency training programs identified were reviewed.

RESULTS

Only 26.3% (36) of programs included any information regarding diversity or inclusion on their webpage. The most common references to diversity were a link to a Department of Diversity and Inclusion (28, 20.4%) and information regarding a "commitment to diversity" (28, 20.4%). Only two programs included all seven categories searched for.

CONCLUSIONS

Residency program websites may be an important tool to recruit underrepresented minorities and currently there is significant room for improvement. Given that urology is already behind other fields in terms of representation, it is especially important to make an active, visible attempt to recruit underrepresented minorities.

Cultivating PhD Aspirations during College

Science, technology, engineering, and mathematics (STEM) career barriers persist for individuals from marginalized communities due to financial and educational inequality, unconscious bias, and other disadvantaging factors. To evaluate differences in plans and interests between historically underrepresented (UR) and well-represented (WR) groups, we surveyed more than 3000 undergraduates enrolled in chemistry courses. Survey responses showed all groups arrived on campus with similar interests in learning more about science research. Over the 4 years of college, WR students maintained their interest levels, but UR students did not, creating a widening gap between the groups. Without intervention, UR students participated in lab research at lower rates than their WR peers. A case study pilot program, Biosciences Collaborative for Research Engagement (BioCoRE), encouraged STEM research exploration by undergraduates from marginalized communities. BioCoRE provided mentoring and programming that increased community cohesion and cultivated students' intrinsic scientific mindsets. Our data showed that there was no statistical significant difference between BioCoRE WR and UR students when surveyed about plans for a medical profession, graduate school, and laboratory scientific research. In addition, BioCoRE participants reported higher levels of confidence in conducting research than non-BioCoRE Scholars. We now have the highest annual number of UR students moving into PhD programs in our institution's history.

Research as a Coping Mechanism for Racial Trauma: The Story of One Medical Student

Issue: The intersection of being a Black Woman in Medicine is a unique experience that exacerbates racial trauma and can lead to the hypervigilance, withdrawal, and emotional exhaustion that many minority students experience. Yet, there are not enough avenues for medical students like myself to healthily explore and heal from their experiences. I propose that qualitative research mentorship might be one such avenue. Evidence: It was neither my Black identity nor my female identity alone that isolated me: there were a handful of other Black students, and my school had matriculated a class that had equal numbers of men and women. Instead, it was the intersection of being Black and a woman that was unique and specific to me. As the only Black Woman in my cohort of almost 200 people, I took on a research project investigating the experiences of other Black learners. It was not until I sought out and cultivated mentors to guide me through conducting this research that I was positioned as a storyteller and a visionary to encourage future generations of those underrepresented in medicine to heal through sharing their stories and starting a ripple of change. It was empowering specifically because the qualitative research was specific to my experience. These interviews confirmed that my experience was not felt in isolation, and that I was not the only Black student doubting my abilities, qualifications, and right to be in medical school. Implication: Implementing formal qualitative mentorship programs, where medical schools encourage learners to explore some of the difficult and personal parts of their identities that address these intersections and support them, will ultimately make the universities healthier and create belonging for all students. Sharing stories through qualitative research has helped me (a) create positive experiences to achieve personal healing, (b) reveal systemic inequities, explain my individual experiences, and (c) develop agency and power to make change. Research became my most powerful coping tool and it can be just as powerful and healing for other underrepresented in medicine students. The framework I have provided can be used by institutions and faculty who strive to facilitate that healing.

Mentoring Underrepresented Minority Physician-Scientists to Success

As the nation seeks to recruit and retain physician-scientists, gaps remain in understanding and addressing mitigatable challenges to the success of faculty from underrepresented minority (URM) backgrounds. The Doris Duke Charitable Foundation Fund to Retain Clinical Scientists program, implemented in 2015 at 10 academic medical centers in the United States, seeks to retain physician-scientists at risk of leaving science because of periods of extraordinary family caregiving needs, hardships that URM faculty-especially those who identify as female-are more likely to experience. At the annual Fund to Retain Clinical Scientists program directors conference in 2018, program directors-21% of whom identify as URM individuals and 13% as male-addressed issues that affect URM physician-scientists in particular. Key issues that threaten the retention of URM physician-scientists were identified through focused literature reviews; institutional environmental scans; and structured small- and large-group discussions with program directors, staff, and participants. These issues include bias and discrimination, personal wealth differential, the minority tax (i.e., service burdens placed on URM faculty who represent URM perspectives on committees and at conferences), lack of mentorship training, intersectionality and isolation, concerns about confirming stereotypes, and institutional-level factors. The authors present recommendations for how to create an environment in which URM physician-scientists can expect equitable opportunities to thrive, as institutions demonstrate proactive allyship and remove structural barriers to success. Recommendations include providing universal training to reduce interpersonal bias and discrimination, addressing the consequences of the personal wealth gap through financial counseling and benefits, measuring the service faculty members provide to the institution as advocates for URM faculty issues and compensating them appropriately, supporting URM faculty who wish to engage in national leadership programs, and sustaining institutional policies that address structural and interpersonal barriers to inclusive excellence.

Use of the “Future Life Map” exercise to improve awareness of career options and opportunities in underrepresented minority undergraduate students pursuing STEM careers

Objectives

There has long existed significant underrepresentation of minority students in STEM training and careers. Ongoing efforts to improve opportunities and participation for underrepresented minority students have focused on multiple areas, from increased funding to early exposure to research in STEM. We developed the novel Future Life Map career planning exercise with the goal of contributing to this multi-faceted approach. The exercise emphasizes on the consideration of multiple potential career destinations and routes to those destination. The exercise was designed with the goal of improving participant awareness of options and career planning self-efficacy to improve success and retention of underrepresented minority student participation and retention in STEM.

Methods

We implemented the Future Life Map exercise with 2 separate groups of under-represented minority undergraduate students pursuing careers in STEM. Participants then completed an anonymous survey to evaluate the exercise and describe the value they derived from completing the Future Life Map.

Results

The exercise presentation and its supporting documents were highly rated by participants with >81% of respondents rating it as “very informative” (4 or 5 on a 5-point Likert Scale). Participants reported that they were very likely to recommend the exercise to others (25 of 27 participants) and were likely to repeat the activity for their own future decision making (22 participants). Themes that emerged from participant reporting of the value of the exercise were: increased awareness of career and training options, improved understanding of the research required to make informed career/life decisions, and new awareness of specific information about career options under consideration.

Conclusion

The Future Life Map exercise was successful in improving participant awareness of career options, career planning ability, and helped participants to feel more empowered. This is likely of particular benefit for improving participation and retention of under-represented minority students pursuing careers in STEM.

Improving Representation of Underrepresented Minority (URM) Students in Oncology Biomedical Research Workforce: Outcome Evaluation from the ReTOOL Program

The Research Training Opportunities for Outstanding Leaders (ReTOOL) program was implemented in 2012 to increase the representation of racial and ethnic minorities in the biomedical workforce. Specifically, the ReTOOL program aims to foster the capacity for scientific research among underserved populations as well as address the cultural appropriateness of research projects. This paper describes the impact of the ReTOOL program in enhancing the research training of underrepresented minority (URM) students. Forty URM students who completed the ReTOOL program between 2012 and 2019 were invited to participate in the program evaluation. The response rate was 73% with 29 participants. Of the 29 participants, 26 trainees self-identified as Black or African-American. A structured survey developed for the program was employed for data collection, using a Likert Scale ranging from 1 to 5, with 5 being the best. The item ratings ranged from 4.45 to 4.80. Responses to open-ended questions show that ReTOOL has been instrumental in socializing and acculturating participants into the habits of scientific thinking. The combined use of quantitative and qualitative inquiry depicts that ReTOOL has been highly successful in fostering participant enrollment in advanced health-related or professional degree programs.

Preparing historically underrepresented trainees for biomedical cancer research careers at Huntsman Cancer Institute/University of Utah Health

Given the well-documented inequities in health care outcomes by race, ethnicity, and gender, many health career pipeline programs have focused on supporting the development of a diverse and inclusive workforce. The State of Utah, is vast, but sparsely populated outside the Salt Lake City metropolitan area. More than 96% of our nearly 85,000 square miles is designated rural (<100 people/square mile) or frontier (<7 people/square mile). The Salt Lake City area is home to the Hunsman Cancer Institute, the only NCI-designated Comprehensive Cancer Center in the region, also noted the limited diversity in the biomedical cancer research workforce. Our primary objective was to increase the number of underrepresented trainees who pursue higher education with the goal of a career in cancer research. PathMaker is a regional, competitive pipeline program that nurtures high school or undergraduate trainees from historically underrepresented backgrounds towards a career in cancer research. Our faculty and staff team collaboratively developed a cohort model curriculum that increased student awareness of research career options; provided academic and professional development, cultural and social support, evolutionary success strategies, active mentorship, and leadership skill development; and fostered an environment of continuous evaluation and improvement. Since pilot program initiation in May 2016, the PathMaker Research Program (PathMaker) has engaged a total of 44 underrepresented trainees in cancer research labs at Huntsman Cancer Institute, the majority still in college. Eleven trainees graduated college: five employed in STEM, one pursuing a PhD in STEM; two in medical school, and three are lost to follow-up. Alumni report high levels of satisfaction with PathMaker and will be followed and supported for academic success. PathMaker is a replicable model to increase diversity and inclusion in the biomedical cancer research workforce.

Does the AAMC's Definition of "Underrepresented in Medicine" Promote Justice and Inclusivity?

In 2003, the Association of American Medical Colleges reframed the concept underrepresented minorities as underrepresented in medicine (URiM), which defines representation in medicine relative to representation in the US population. Schools are permitted to construct URiM definitions, suggesting the importance of regarding them as fluid works in progress as US demographics evolve. Where medical school admissions processes consider applicants' backgrounds and experiences of identity minoritization to be valuable, progress toward inclusive representation has been made. This article considers whether school-based URiM definitions are ethically sufficient and canvasses possible next steps in realizing equitable representation in medical education.

How Has American Constitutional Law Influenced Medical School Admissions and Thwarted Health Justice?

Medical schools have sought to diversify their classes to motivate inclusion, to draw upon the educational benefits of diversification, to promote educational opportunity, to facilitate representation of persons with minoritized identities in the US physician workforce, and to advance racial and ethnic equity in health status and access to health services regionally and nationally in the United States. The US Supreme Court has allowed schools' race-conscious admissions when their purpose is to diversify an incoming class but not to remediate inequity. This article explains why this limit to affirmative action laws' implementation blunts medical schools' capacity to do their part to secure health justice for all in the United States. Since the Supreme Court is poised to rule more narrowly on affirmative action law again, this article also considers key threats to health justice posed by further limiting or eliminating race-conscious admissions.

Virtual Vanderbilt Summer Science Academy highlighted the opportunity to impact early STEMM students career knowledge through narrative

Due to COVID-19 precautions, the Vanderbilt University summer biomedical undergraduate research program, the Vanderbilt Summer Science Academy (VSSA), rapidly transitioned from offering an in-person training program to a virtual seminar format. Our program typically supports undergraduate development through research and/or clinical experience, meeting with individuals pursuing postgraduate training, and providing career development advice. Evidence supports the idea that summer programs transform undergraduates by clarifying their interest in research and encouraging those who haven’t previously considered graduate studies. We were interested in exploring whether a virtual, synchronous program would increase participants’ scientific identity and clarify postgraduate career planning. Rather than create a virtual research exposure, our 5-week "Virtual VSSA" program aimed to simulate the casual connections that would naturally be made with post-undergraduate trainees during a traditional summer program. In seminars, presenters discussed 1) their academic journey, explaining their motivations, goals, and reasons for pursuing a career in science as well as 2) a professional story that illustrated their training. Seminars included Vanderbilt University and Medical School faculty, M.D., MD/Ph.D., as well as Ph.D. students from diverse scientific and personal backgrounds. In addition, weekly informational sessions provided an overview of the nature of each degree program along with admissions advice. Through pre-and post-program surveys, we found that students who registered for this experience already strongly identified with the STEMM community (Science, Technology, Engineering, Mathematics, and Medicine). However, participation in the Virtual VSSA increased their sense of belonging. We also uncovered a gap in participants’ understanding of postgraduate pathways prior to participation and found that our program significantly increased their self-reported understanding of postgraduate programs. It also increased their understanding of why someone would pursue a Ph.D. or Ph.D./MD versus M.D. These changes did not uniformly impact participants’ planned career paths. Overall, by providing personal, tangible stories of M.D., MD/Ph.D., and Ph.D. training, the Virtual VSSA program offered seminars that positively impacted students’ sense of belonging with and connection to the STEMM disciplines.

Lessons From the First Decade of the Native American Summer Research Internship at the University of Utah

PROBLEM

American Indian/Alaska Native (AI/AN) populations are facing multiple health crises, including limited access to care, high rates of chronic disease, and early mortality that is far worse than other underrepresented minorities in the United States. According to the Association of American Indian Physicians, AI/AN people represent 2.0% of the U.S. population but only 0.2% of medical students and 0.1% of full-time faculty at MD-granting institutions. Increasing the number of AI/AN clinicians and scientists is one strategy to improve health outcomes in the AI/AN population and address these crises.

APPROACH

In 2010, the University of Utah partnered with research, cultural, and professional mentors to create a 10-week summer Native American Research Internship (NARI) program for AI/AN college students across the United States who are interested in pursuing biomedical careers. NARI attracts and supports AI/AN students by offering mentored summer research internships in an innovative, culturally aware framework that adapts to observed challenges to optimize educational experiences and support biomedical career aspirations.

OUTCOMES

During the first decade of the NARI program, 128 students from 22 U.S. states, representing 46 tribal nations and 57 colleges and universities, participated. Of those 128 students, 113 (88%) have completed a bachelor's degree and the remaining 15 (12%) are currently working toward a bachelor's degree. No NARI student has dropped out of college. Twenty-six (20%) NARI alumni have matriculated to medical school and 30 (23%) to graduate school. Eight (6%) participants have completed medical school, and 3 (2%) are pursuing a PhD in science. An additional 36 (28%) have gained employment in biomedical research fields.

NEXT STEPS

The NARI program has increased the participation of AI/AN students in medicine and the biomedical sciences. The innovative, culturally aware, and adaptive framework is a model for other programs for AI/AN students and students in other underrepresented communities.

Enrollment Management in Undergraduate Medical School Admissions: A Complementary Framework to Holistic Review for Increasing Diversity in Medicine

Medical schools implemented holistic review more than a decade ago, which led to more deliberate consideration and inclusion of applicants historically underrepresented in medicine. This article presents a theory of holistic enrollment management that unites holistic review with enrollment management principles. This theory contextualizes medical school admissions as a complex marketplace with multifaceted, competing forces. Applying an enrollment management framework of mission, market, means, and metrics can improve the capacity of a medical school to efficiently advance its mission over time. Medical schools employing a clear, compelling, and focused mission to direct all aspects of the medical education enterprise can more effectively attract applicants who are better prepared to enact that mission throughout their careers. Medical schools share a marketplace and collectively compete to identify, attract, admit, and matriculate the most mission-aligned student body within the pool of applicants they share. Institutions that deliberately mobilize resources within this dynamic marketplace will engage, admit, and matriculate the most suiting applicants and attract even more mission-aligned matriculants over time. Widespread adoption of this holistic framework of enrollment management may enhance the capacity of the medical education system to better capitalize on the existing diversity in the national pool of applicants, encourage more underrepresented applicants to apply in the future, admit and matriculate a more diverse national student body, and ultimately better prepare new physicians to meet the increasingly diverse health care needs of the nation.

Using a Mentorship Approach to Address the Underrepresentation of Ethnic Minorities in Senior Nursing Leadership

Healthcare organizations must be intentional and purposeful in creating diversity programs. A nursing leader mentorship program for racial and ethnic minority nurse managers was introduced at a large academic medical center to meet this need. The program design was based on the successful Leadership Institute for Black Nurses, first conducted at a university school of nursing. The participants in the 4-month program were 16 nurse managers from 2 city hospitals and their mentors.

Training matters! Narrative from a Black scientist

As STEM (Science, Technology, Engineering, and Math) professionals, we are tasked with increasing our understanding of the universe and generating discoveries that advance our society. An essential aspect is the training of the next generation of scientists, including concerted efforts to increase diversity within the scientific field. Despite these efforts, there remains disproportional underrepresentation of Black scientists in STEM. Further, efforts to recruit and hire Black faculty and researchers have been largely unsuccessful, in part due to a lack of minority candidates. Several factors contribute to this including access to opportunities, negative training experiences, lack of effective mentoring, and other more lucrative career options. This is a narrative of a Black male scientist to illustrate some of the issues in retaining Black students in STEM and to highlight the impact of toxic training environments that exists at many institutions. To increase Black participation in STEM careers, we must first acknowledge, then address, the problems that exist within our STEM training environments in hopes to inspire and retain Black students at every level of training.

Striving for Inclusive Excellence in the Recruitment of Diverse Surgical Residents During COVID-19

The COVID-19 pandemic has dramatically altered the 2020 residency application cycle and resulted in many changes to the usual application processes. Particular attention should be placed on the obstacles faced by applicants who are underrepresented in medicine (URiM) as they may be disproportionately affected by the changes in 2020. These challenges are especially relevant in competitive surgical specialties, where racial and gender diversity already lags behind other medical specialties. Inclusive excellence is a guiding philosophy in creating equitable resident selection processes. It focuses on the multilayered processes that form the foundation of inclusive institutional culture, while recognizing that excellence and inclusivity are mutually reinforcing and not mutually exclusive. A key tenant in inclusive excellence for resident recruiting involves applying an equity lens in all decision making. An equity lens allows programs to continuously evaluate resident selection policies and processes through an intentional equity-forward approach. In addition to using an equity lens, programs should emphasize the importance of equity-focused skill building, which ensures that all individuals engaged in the resident selection process have the tools and knowledge to recognize biases. Finally, institutions should implement specific programming for URiM applicants to provide them with information about key aspects of department culture and mechanisms of support for URiM trainees. Every residency program should adopt a sustained perspective of inclusive excellence, in this application cycle and beyond. The status quo has existed for far too long, and COVID-19 offers institutions and their residency programs a unique opportunity to try new and innovative equity-forward practices.