[The following notes were generated by Michele Haight, PhD.]

Marquita S. Norman, MD, MBA, Assistant Dean for Student Diversity and Inclusion, Associate Professor, Wake Forest University School of Medicine

Kara L. Caruthers, MSPAS, PA-C, Assistant Program Director PA Program, Associate Professor, University of Tennessee Health Science Center

Contact Information:
m.s.norman@wakehealth.edu
kcaruthe@uthsc.edu

Surviving Club Quarantine: Establishing Mentorship and Maintaining Wellness in a Diverse Student Population

DJ D-Nice “Club Quarantine” represents a unique opportunity for bonding, shifting and pivoting in these times of difficulty and challenge.

Mentorship: Talking with You
Coaching: Talking to You
Sponsorship: Talking about You

We are using the lens of “mentor” for our case discussions.

Seven Dimensions of Wellness:

• Physical
• Emotional
• Intellectual
• Social
• Spiritual
• Environmental
• Occupational

Graduate Health Professions students are impacted in all of the dimensions of wellness, but this presentation highlights the following four dimensions:

• Emotional: possessing the ability to feel and express human emotions; achieving a sense of fulfillment in life.
• Intellectual: encourages creative, stimulating mental activities…available to expand one’s knowledge and improve skills.
• Social: builds a sense of belonging
• Occupational: preparing and making use of your gifts, skills and talents in order to gain purpose, happiness and enrichment in your life.

We must be especially mindful of these wellness dimensions and how they are manifested in our students during their training.

We must bear in mind that we are still in a pandemic and our students have limited ways in which they are able to interact with one another.

Key Considerations from Case Discussions:

• What role-modeling experiences do students have for the culture and environment of higher education?
• What are some of the challenges and stressors of Graduate Health Professions education?
• Imposter Syndrome is prevalent among women and people of color.
• What are the institutional policies for students to be able to work during their training?
• Does the institution have emergency grant funding?
• What resources are available to ensure that students are psychologically safe throughout their training?
• What are the institutional policies and procedures that address issues of microaggressions, faculty-student power dynamics, mistreatment concerns and the impact of COVID-19 on vulnerable populations?
• It is important to remember that there are so many ways that students can feel troubled during their training and to be able recognize how that affects their training.

Additional Considerations

• Partnered students
• Parents of schoolchildren,
• Veterans,
• High-risk populations with chronic diseases.

If students do not have a solid educational foundation in K-12 and undergraduate education, then they bring all of these experiences with them to the graduate Health Professions workspace.

Coordinated Health Workforce Pathway K-12

• Pre training: How do students choose the Health Professions? How do students get into the Health Professions?
• Training: How are students retained? How do students overcome certain challenges?
• Workforce: How have students been prepared to transition to the workforce and address workforce-related issues?

We must hold ourselves accountable and ensure our students are well by practicing

Cultural humility and Cultural Responsiveness throughout their training.

Current Graduate Health Professions Students’ Demographics have changed:

• Increase in number of first generation students
• Increased ethnic diversity
• Wider Age Range
• Income differences

Across the Health Professions, accrediting bodies and professional organizations have adopted a strong focus on student diversity and wellness.

The pandemic has caused an increase in depression and imposter syndrome in Graduate Health Professions students.

Resources to address issues of diversity, equity and inclusion:

Wake Forest:

• Open, drop in, biweekly group for to support the mental health needs of women of color, led by a woman of color.
• Mindfulness Book Club, a-racial justice-focused for faculty, students and staff.
• Common Ground, a monthly safe space to discuss common issues and values.
• Affinity Groups (Wake Forest Health System)
• SNMA Movie Night.
• Continuous Quality Improvement (CQI) approach through the development of a Racial Diversity Task Force at the institutional (Wake Forest Health System) and local (Student Affairs) levels.

UTHSC:

• Zoom “Uncomfortable Conversations Series” (students, faculty and staff)
• PA Program Book Club*
• CARES Team /send concern to CARES team who is struggling
• Campus-wide Food Pantry
• QEP project on the social determinants of health

Diversity Equity and Inclusion Initiatives must address racism as a root cause.

We need to do the work at the institutional level to develop:

• Sustainable programs vs. performative gestures.
• Systemic review and adaptation to include:
  • Admissions
  • Curriculum
  • Clinical training
  • Remediation and Retention

We cannot return to “normal,” because “normal” was not working.

*Book Club Book List:

Black Man in a White Coat, Dr Damon Tweedy
The Political Determinants of Health, Daniel Dawes, JD
Redefining Realness, Janet Mock
The Spirit Catches You and You Fall Down, Anne Fadiman

[The following notes were generated by Michele Haight, PhD.]

Shani Fleming, MS, MPH, PA-C, Associate Professor, University of Maryland Baltimore Graduate School, Norma Iris Poll-Hunter, PhD, Senior Director Workforce, Diversity, Equity, Inclusion, Association of American Medical Colleges, Rick McGee PhD, Associate Dean for Professional Development, Professor of Medical Education, Northwestern University School of Medicine

Strategies for Promoting Inclusivity in Health Sciences Education:

• Pathways and Pipelines: Approaches to Increasing Diversity in the Health Professions
• Diversity in Medicine, the Impact of Pre-Med Programs
• Diversity in Research Training and Careers

Physician Assistant Programs:
Pathways and Pipelines: Approaches to Increasing Diversity in the Health Professions
Shani Fleming, MS, MPH, PA-C

• The Physician Assistant (PA) program was created in the 1960’s to address physician shortages and promote health equity.
• Physician Assistants work prominently in underserved communities and have the potential to significantly impact the care of racial and ethnic patients of color.
• Demographically, the PA profession is predominantly white and female; current trends show a troubling decrease in diversity and highlight the need for innovative pathways and initiatives to increase PA diversity.
• Health Equity is the ultimate goal and requires equal opportunities for underrepresented students in order to achieve educational excellence within the PA profession.
• The University of Southern California (USC) serves as a model PA pipeline program that bridges the gaps between parents, students, schools and the community to guide and support potential PA students.
• There are several Bachelor/Master PA programs allowing students to have an accelerated pathway for completion of a Bachelor’s degree and entry into the PA program. The University of Maryland Baltimore has partnered with local community colleges to create more affordable options for an accelerated Bachelor/Master PA program.
• Project Access is a grassroots, outreach program which visits schools and communities to inspire and motivate underrepresented students to pursue a career as a PA.
• The PAC (Physician Assistants of Color) program is a grassroots group which began on Facebook and is dedicated to increasing diversity in the PA profession through mentoring, increasing awareness and providing networking opportunities.
• The PA profession is well positioned to collaborate with existing pipeline programs such as STEM, Myerhoff Scholars, historically Black, Hispanic and Tribal Colleges, etc. to increase exposure and opportunities for underrepresented students in the health professions.
• In order to effect real change, we need to systematically examine the health professions institutional culture through an anti-racist lens to address racial disparities.
• Instead of preparing students to enter a flawed system, we need to work on dismantling policies, practices and procedures that are exclusionary for students of color.
• It is time to re-imagine admissions’ polices, recruitment strategies, and institutional culture. Now is our opportunity to move beyond “best practices” to innovative pathways for underrepresented students.

Medical School
Diversity in Medicine, the Impact of Pre-Med Programs
Norma Iris Poll-Hunter, PhD

• This presentation examines the medical education workforce pipeline and the impact of these pipelines along the physician-training continuum.
• Underrepresentation is pervasive across the health professions.
• Underrepresentation in medical schools has evolved to looking at how medical schools define this by looking at local communities.
• As the number of seats for medical students has increased over the years, the number of students who are underrepresented in medicine (UIM) has remained relatively stagnant.
• Over the past 30 years, the majority (80%) of entering medical students come families whose incomes are at the top socioeconomic quintiles. Educational equity needs to look at both underrepresentation of race and ethnicity as well as intersections of income and how income impacts communities with less economic advantage.
• In order to better understand underrepresentation, we must consider the system in which many inequities are embedded. There are systemic issues that need to be addressed in order to enact sustainable equity solutions.
• Pathway/pipeline programs are essential, but cannot exist in isolation. Pathways/pipelines and broader systemic, socio-political issues go hand in hand to impact the trajectory of diversity across the health professions.
• LCME accreditation requirements are an important lever for developing equity programs.
• There are many different pathway/pipeline programs, starting with K-12 and extending to post –baccalaureate. The focus of these programs is to build social capital, clinical exposure and research.
• Pathway/Pipeline programs make a difference in attracting non-typical medical students.

Successful Pathway/Pipeline Characteristics:

• A bundle of activities, not just one.
• Leadership and Faculty engagement. (This had the greatest impact on student outcomes.)
• Student participants pursue professional careers across disciplines: law, business, health professions, public health etc.
• Programs promote and increase diversity in the national pool and provide the ability to track participants.

Lessons Learned from Pre-Med Programs:

• Pre-med programs make a difference; they increase diversity as a part of the solution.
• Pre-med programs provide an emphasis on basic science study and learning skills through academic enrichment.
• Bundling activities makes a big difference.
• Faculty engagement is critical; it predicts success
• National and local partnerships are critical to sustainability and helping to spread the word.
• Grow local talent. Go to the community. Use zip code data; reach out to diverse talent.
• The pandemic has taught us to integrate well-being programs into pipeline initiatives to better prepare underrepresented students for the unique experiences they might encounter over the trajectory of their careers.

PhD Programs in Biomedical Research:
Diversity in Research Training and Careers
Rick McGee, PhD

• Compared to medical students and PAs, PhD students are paid to do their PhD training. After their second year, PhD students are more like residents because they enter the work world.
• There has been a huge decline in the role of the standardized test (GRE) for PhD admission.
• NIH funding drives PhD training.
• Diversity efforts began in 1972 as an outgrowth of the Civil Rights Movement and focused on minority-serving institutions.
• In the 1990s, this focus changed to research-intensive universities to develop diversity initiatives and to produce a much more intensive evaluation of program outcomes as a requirement to continue funding.
• Over the past 30 years the number of students completing STEM and Bachelor of Science (BS) programs has risen substantially; the number of students entering PhD studies has more than doubled.
• Programs such as SACNAS (Society for the Advancement of Chicanos/Hispanic and Native Americans in Science) and ABRCMS (Annual Biomedical Research Conference for Minority Students) support students and link underrepresented minority graduates to PhD programs. The AAMC GREAT (Group on Graduate Research, Education and Training) program made diversity efforts more prominent.
• Data suggested that, despite these programs, the number of NIH funded PIs had not changed at all for those who had been supported by these programs.
• Underrepresented diversity of faculty has changed very slowly over 40 years.
• Simply getting underrepresented minority students into PhD programs is not sufficient. “Mass action” did not work, especially at the faculty level.
• The dismal lack of impact of these programs prompted a concerted effort to create different ways to support PhD students beyond their PhD work.

These efforts included the following:

• Diversity Supplements
• Mentored Career Development Awards (K)
• More emphasis on what goes on during training: T-32, NIGM Grants
• Efforts to increase the skills of mentors and focus on inclusion.
• MOSAIC Program (K99/R00) which includes integration transition into faculty positions.
• Focused support through scientific societies.

Recent New Programs include:

• FIRST (Fellowship in Research and Science Teaching) Program, which supports cluster hires.
• NIH UNITE Program designed to end structural racism and achieve racial equity.

Contributors to African-American disparities in funding appear to be connected to the types of research African-American students are pursuing; these types of research are traditionally lower funded and undervalued by the NIH.

Efforts need to go beyond “numbers only” in terms of diversity and focus on inclusion and equity. These efforts need to understand and eliminate bias in review.