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1.  Recruitment of underrepresented minority students to medical school: minority medical student organizations, an untapped resource. 
Recruitment of more underrepresented minority students (black, Hispanic and native American) to increase racial diversity in the physician workforce is on the agenda for medical schools around the nation. The benefits of having a racially diverse class are indisputable. Minority physicians are more likely to provide care to minority, underserved, disadvantaged and low-income populations. Therefore, medical schools would benefit from diversity through utilizing strategies for recruitment of underrepresented minority (URM) students. Numerous recruitment strategies have been employed to increase the number of underrepresented minority students. However, formal collaboration with minority medical student organizations is an underutilized tool in the recruitment process. Many medical schools have informally used minority medical students and members of various minority organizations on campus in the recruitment process, but a formal collaboration which entails a strategic approach on using minority medical student organizations has yet to be included in the literature. This paper discusses the innovative collaboration between the University of Toledo College of Medicine (UTCOM) chapter of the Student National Medical Association (SNMA) and the college of medicine's admissions office to strategize a recruitment plan to increase the number of underrepresented minority students at the UTCOM. This paper suggests that minority medical student organizations, particularly the SNMA, can be used as a recruiting tool; hence, admissions offices cannot negate the usefulness of having formal involvement of minority medical student organizations as a recruiting tool. This approach may also be applicable to residency programs and other graduate professional fields with a severe shortage of URM students.
PMCID: PMC2575864  PMID: 17913109
2.  Biomedical Science Ph.D. Career Interest Patterns by Race/Ethnicity and Gender 
PLoS ONE  2014;9(12):e114736.
Increasing biomedical workforce diversity remains a persistent challenge. Recent reports have shown that biomedical sciences (BMS) graduate students become less interested in faculty careers as training progresses; however, it is unclear whether or how the career preferences of women and underrepresented minority (URM) scientists change in manners distinct from their better-represented peers. We report results from a survey of 1500 recent American BMS Ph.D. graduates (including 276 URMs) that examined career preferences over the course of their graduate training experiences. On average, scientists from all social backgrounds showed significantly decreased interest in faculty careers at research universities, and significantly increased interest in non-research careers at Ph.D. completion relative to entry. However, group differences emerged in overall levels of interest (at Ph.D. entry and completion), and the magnitude of change in interest in these careers. Multiple logistic regression showed that when controlling for career pathway interest at Ph.D. entry, first-author publication rate, faculty support, research self-efficacy, and graduate training experiences, differences in career pathway interest between social identity groups persisted. All groups were less likely than men from well-represented (WR) racial/ethnic backgrounds to report high interest in faculty careers at research-intensive universities (URM men: OR 0.60, 95% CI: 0.36–0.98, p = 0.04; WR women: OR: 0.64, 95% CI: 0.47–0.89, p = 0.008; URM women: OR: 0.46, 95% CI: 0.30–0.71, p<0.001), and URM women were more likely than all other groups to report high interest in non-research careers (OR: 1.93, 95% CI: 1.28–2.90, p = 0.002). The persistence of disparities in the career interests of Ph.D. recipients suggests that a supply-side (or “pipeline”) framing of biomedical workforce diversity challenges may limit the effectiveness of efforts to attract and retain the best and most diverse workforce. We propose incorporation of an ecological perspective of career development when considering strategies to enhance the biomedical workforce and professoriate through diversity.
doi:10.1371/journal.pone.0114736
PMCID: PMC4262437  PMID: 25493425
3.  Do Research Activities During College, Medical School, and Residency Mediate Racial/Ethnic Disparities in Full-Time Faculty Appointments at U.S. Medical Schools? 
Purpose
To determine whether post-secondary-education research experiences and other variables mediate racial/ethnic disparities in U.S. medical school graduates’ full-time faculty appointments in academic medicine.
Method
Individualized, de-identified records for 1994–2000 U.S. medical school matriculants who graduated with MDs before 2005, completed graduate medical education before 2009, and had data for all variables were examined for potential mediators of racial/ethnic disparities in full-time faculty appointments using the SAS macro “MEDIATE” for estimation and statistical inference. Controlling for gender, parents’ occupation, and graduation year, the authors estimated the effects of potential mediators in separate models comparing Asian/Pacific Islander (PI) versus underrepresented minority (URM; including African American, Hispanic, and Native American/Alaska Native) graduates and white versus URM graduates.
Results
Of 82,758 eligible graduates, 62,749 (75.8%) had complete data; of these, 11,234 (17.9%) had full-time faculty appointments, including 18.4% (7,848/42,733) of white, 18.8% (2,125/11,297) of Asian/PI, and 14.5% (1,261/8,719) of URM graduates. Proportion of total race/ethnicity effect on full-time faculty appointment explained by all mediators was 66.0% (95% CI, 44.7%–87.4%) in a model comparing Asians/PIs with URMs and was 64.8% (95% CI, 52.2%–77.4%) in one comparing whites with URMs. Participation in post-secondary research activities (in college, medical school, residency), authorship during medical school, academic achievement, and faculty career intentions at graduation were among the significant mediators explaining the effect of race/ethnicity on full-time faculty appointment.
Conclusions
Post-secondary-education research experiences for URM students are among the mediators of racial/ethnic disparities in full-time faculty appointments and therefore may increase academic medicine faculty diversity.
doi:10.1097/ACM.0b013e31826e3297
PMCID: PMC3592974  PMID: 23018339
4.  Progress and pitfalls in underrepresented minority recruitment: perspectives from the medical schools. 
PURPOSE: To assess current initiatives at U.S. medical schools to recruit underrepresented minorities (URM) and to identify perceived barriers to enrollment of URM students. METHODS: We developed a survey that was mailed to the dean of Student Affairs of all U.S. allopathic and osteopathic medical schools in 2002. Respondents were asked to list their schools' URM recruitment programs and rate the effectiveness of these programs. They were also asked to indicate barriers to URM recruitment from a list of 37 potential barriers and rate their overall success with URM recruitment. RESULTS: The study had a 59% response rate. All schools reported a wide variety of initiatives for URM recruitment with > or =50% of all schools using each of the 11 strategies. The three most commonly listed barriers to URM recruitment were MCAT scores of applicants (90%), lack of minority faculty (71%) and lack of minority role models (71%). Most schools rated their recruitment efforts highly; on a scale of 1 to 10 (10 being very successful), the average score was an 8. CONCLUSION: While schools continue to invest tremendous efforts in recruiting minority applicants, admissions criteria, lack of URM faculty and the need for external evaluation remain important barriers to achieving a diverse physician workforce.
PMCID: PMC2594778  PMID: 16296213
5.  Faculty Self-reported Experience with Racial and Ethnic Discrimination in Academic Medicine 
BACKGROUND
Despite the need to recruit and retain minority faculty in academic medicine, little is known about the experiences of minority faculty, in particular their self-reported experience of racial and ethnic discrimination at their institutions.
OBJECTIVE
To determine the frequency of self-reported experience of racial/ethnic discrimination among faculty of U.S. medical schools, as well as associations with outcomes, such as career satisfaction, academic rank, and number of peer-reviewed publications.
DESIGN
A 177-item self-administered mailed survey of U.S. medical school faculty.
SETTING
Twenty-four randomly selected medical schools in the contiguous United States.
PARTICIPANTS
A random sample of 1,979 full-time faculty, stratified by medical school, specialty, graduation cohort, and gender.
MEASUREMENTS
Frequency of self-reported experiences of racial/ethnic bias and discrimination.
RESULTS
The response rate was 60%. Of 1,833 faculty eligible, 82% were non-Hispanic white, 10% underrepresented minority (URM), and 8% nonunderrepresented minority (NURM). URM and NURM faculty were substantially more likely than majority faculty to perceive racial/ethnic bias in their academic environment (odds ratio [OR], 5.4; P < .01 and OR, 2.6; P < .01, respectively). Nearly half (48%) of URM and 26% of NURM reported experiencing racial/ethnic discrimination by a superior or colleague. Faculty with such reported experiences had lower career satisfaction scores than other faculty (P < .01). However, they received comparable salaries, published comparable numbers of papers, and were similarly likely to have attained senior rank (full or associate professor).
CONCLUSIONS
Many minority faculty report experiencing racial/ethnic bias in academic medicine and have lower career satisfaction than other faculty. Despite this, minority faculty who reported experiencing racial/ethnic discrimination achieved academic productivity similar to that of other faculty.
doi:10.1111/j.1525-1497.2004.20409.x
PMCID: PMC1492150  PMID: 15009781
schools, medical; minority groups; faculty, medical; prejudice; job satisfaction
6.  Training African-American residents in the 20th century. 
Bellevue Hospital, the oldest public hospital in the United States and a lineal descendant of an infirmary for slaves, accepted its first African-American resident, Dr. Ubert Conrad Vincent, in 1918. This occurred at a time when many medical centers were not accepting African-American residents. At the end of WWII, one-third of the accredited medical schools still barred African Americans. However, Bellevue Hospital continued to train African-American residents. Between the 1920s and 1940s four African Americans matriculated at Bellevue Hospital. There were six in the 1950s, four in the 1960s, and 25 in the 1970s. By the 1980s, 40 African Americans matriculated, and between 1990 and 1995, 61 matriculated. Despite its historic first, Bellevue lagged slightly behind the national average. While the number of African-American residents occupying U.S. residency slots increased from 2.8% in 1978 to 6.5% in 1996, African Americans comprised 3.6% of residency slots at Bellevue between 1985-1995. Currently, only 7% of practicing physicians and 5% in faculty positions are latino, African-American, and Native American. Increasing the number of under-represented minority (URM) physicians is important to the United States, as URM physicians are more likely to serve the poor and uninsured, therefore improving the overall healthcare of the underprivileged. A study by the Association of American Medical Colleges indicated that minority medical school graduates were five times more likely to report that they planned to serve minority populations than other graduates. In their position paper, the American College of Physicians expressed the belief that increasing the number of URM physicians will help reduce healthcare disparities that can hurt minority populations and lead to poor health outcomes. The Supreme Court acknowledged the importance of racial diversity by upholding the University of Michigan affirmative action admissions policy in its June 2003 ruling. URM physicians are needed not only to serve minority populations but also to serve as mentors and role models for prospective and current students. The first African-American resident to graduate from the Bellevue Residency Program did indeed treat the underserved, as Dr. Vincent founded the Vincent Sanatorium, dedicated to treating African-American patients, and training African-American nurses and doctors. Over the course of the 20th century, Bellevue Hospital has trained increasing numbers of African-American physicians. It is hoped that, like their predecessor, Dr. Vincent, they will provide care to underserved communities and to the community as a whole, as well as serve as role models for generations to come.
PMCID: PMC2594890  PMID: 15040520
7.  Improving Underrepresented Minority Medical Student Recruitment with Health Disparities Curriculum 
Journal of General Internal Medicine  2010;25(Suppl 2):82-85.
ABSTRACT
BACKGROUND
Diversity improves all students’ academic experiences and their abilities to work with patients from differing backgrounds. Little is known about what makes minority students select one medical school over another.
PURPOSE
To measure the impact of the existence of a health disparities course in the medical school curriculum on recruitment of underrepresented minority (URM) college students to the University of Chicago Pritzker School of Medicine.
METHODS
All medical school applicants interviewed in academic years 2007 and 2008 at the University of Chicago Pritzker School of Medicine (PSOM) attended an orientation that detailed a required health care disparities curriculum introduced in 2006. Matriculants completed a precourse survey measuring the impact of the existence of the course on their decision to attend PSOM. URM was defined by the American Association of Medical Colleges as Black, American Indian/Alaskan Native, Native Hawaiian, Mexican American, and Mainland Puerto Rican.
RESULTS
Precourse survey responses were 100% and 96% for entering classes of 2007 and 2008, respectively. Among those students reporting knowledge of the course (128/210, 61%), URM students (27/37, 73%) were more likely than non-URM students (38/91, 42%) to report that knowledge of the existence of the course influenced their decision to attend PSOM (p = 0.002). Analysis of qualitative responses revealed that students felt that the curriculum gave the school a reputation for placing importance on health disparities and social justice issues. URM student enrollment at PSOM, which had remained stable from years 2005 and 2006 at 12% and 11% of the total incoming classes, respectively, increased to 22% of the total class size in 2007 (p = 0.03) and 19 percent in 2008.
CONCLUSION
The required health disparities course may have contributed to the increased enrollment of URM students at PSOM in 2007 and 2008.
doi:10.1007/s11606-010-1270-8
PMCID: PMC2847120  PMID: 20352498
health disparities; curriculum; education; medical students; underserved
8.  Evidence for Increasing Diversity in Graduate Medical Education: The Competence of Underrepresented Minority Residents Measured by an Intern Objective Structured Clinical Examination 
Objective
Some have commented that the limited number of underrepresented minorities (URMs) in United States' residency programs is due to a lack of qualified candidates. At the University of Michigan, an objective structured clinical examination is administered to incoming residents at the beginning of training to determine baseline competence. In this study we wanted to determine if competence differed for underrepresented minorities when compared to non-URM residents.
Method
The postgraduate orientation assessment, a 10-station examination, was developed that focused specifically on the knowledge and skills needed in the first 6 to 18 weeks of training. Stations assessed competence in informed consent, aseptic technique, evidence-based medicine, diagnostic images, critical laboratory values, cross-cultural communication, and Joint Commission requirements such as surgical fire safety, pain assessment, and management. We used various assessment measures including standardized patients, computer-based testing, and multiple-choice questions.
Results
Our study found no significant differences in overall mean scores between URM residents and all other residents for the 5 years during which we administered the examination, except for 2002. This stands in contrast to the consistently worse performances of URM students on USMLE Step 1 and Step 2 Clinical Knowledge. Also, URM residents did not perform better or worse than their non-URM colleagues on standardized patient stations during the course of 5 years during which the examination was administered.
Conclusions
The postgraduate orientation assessment provides residency program directors with a standard format to measure initial clinical skills. When compared to incoming non-URM residents from a variety of medical schools, URM residents perform as well as other trainees. Our results may aid in the recruitment efforts of URM medical students into academic residency programs such as those at the University of Michigan.
doi:10.4300/JGME-D-10-00050.1
PMCID: PMC2951774  PMID: 21976083
9.  Variables Associated with Full-time Faculty Appointment among Contemporary U.S. Medical School Graduates: Implications for Academic Medicine Workforce Diversity 
Purpose
The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates.
Method
With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools’ 1997–2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables. They report adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results
Of 1,965 graduates in the sample, 263 (13.4%) held full-time faculty appointments in 2007–2008, including 14.4% (123/853) of women graduates and 8.6% (17/198) of underrepresented minority (URM) graduates. Women (OR: 1.386, 95% CI: 1.023–1.878), MD/PhD program graduates (OR: 2.331, 95% CI: 1.160–4.683), and graduates who reported a career-setting preference for “full-time university faculty” on the Association of American Medical Colleges’ Graduation Questionnaire (OR: 3.164, 95% CI: 2.231–4.486) were more likely to have a full-time faculty appointment. Graduates who chose family medicine (OR: 0.433, 95% CI: 0.231–0.811) and surgical specialties (OR: 0.497, 95% CI: 0.249–0.994) were less likely to have a full-time faculty appointment. URM race/ethnicity was not independently associated with full-time faculty appointment (OR: 0.788; 95% CI: 0.452–1.375).
Conclusions
Efforts to increase representation of women graduates in academic medicine seem to have met with greater success than efforts to increase representation of URM graduates. Greater participation of URM students in MD/PhD programs and in interventions during medical school that promote interest in academic-medicine careers may increase URM graduates’ representation in academic medicine.
doi:10.1097/ACM.0b013e3181e10159
PMCID: PMC3236355  PMID: 20592523
10.  Diversifying Biomedical Training: A Synergistic Intervention 
For over three decades, the scientific community has expressed concern over the paucity of African American, Latino and Native American researchers in the biomedical training pipeline. Concern has been expressed regarding what is forecasted as a shortage of these underrepresented minority (URM) scientists given the demographic shifts occurring worldwide and particularly in the United States. Increased access to graduate education has made a positive contribution in addressing this disparity. This article describes the multiple pathway approaches that have been employed by a school of medicine at an urban Midwest research institution to increase the number of URM students enrolled in, and graduating from, doctoral programs within basic science departments, through the combination of R25 grants and other grant programs funded by the National Institutes of Health (NIH). This article outlines the process of implementing a strong synergistic approach to the training of URM students through linkages between the NIH-funded “Bridges to the Doctorate (BRIDGES)” and “Initiative for Maximizing Graduate Student Diversity (IMGSD)” programs. The article documents the specific gains witnessed by this particular institution and identifies key components of the interventions that may prove useful for institutions seeking to increment the biomedical pipeline with scientists from diverse backgrounds.
doi:10.1615/JWomenMinorScienEng.v16.i3.20
PMCID: PMC3143029  PMID: 21796238
minorities; pipeline; biomedical; education; training
11.  Race, Disadvantage and Faculty Experiences in Academic Medicine 
Journal of General Internal Medicine  2010;25(12):1363-1369.
ABSTRACT
Background
Despite compelling reasons to draw on the contributions of under-represented minority (URM) faculty members, US medical schools lack these faculty, particularly in leadership and senior roles.
Objective
The study’s purpose was to document URM faculty perceptions and experience of the culture of academic medicine in the US and to raise awareness of obstacles to achieving the goal of having people of color in positions of leadership in academic medicine.
Design
The authors conducted a qualitative interview study in 2006–2007 of faculty in five US medical schools chosen for their diverse regional and organizational attributes.
Participants
Using purposeful sampling of medical faculty, 96 faculty were interviewed from four different career stages (early, plateaued, leaders and left academic medicine) and diverse specialties with an oversampling of URM faculty.
Approach
We identified patterns and themes emergent in the coded data. Analysis was inductive and data driven.
Results
Predominant themes underscored during analyses regarding the experience of URM faculty were: difficulty of cross-cultural relationships; isolation and feeling invisible; lack of mentoring, role models and social capital; disrespect, overt and covert bias/discrimination; different performance expectations related to race/ethnicity; devaluing of research on community health care and health disparities; the unfair burden of being identified with affirmative action and responsibility for diversity efforts; leadership’s role in diversity goals; and financial hardship.
Conclusions
Achieving an inclusive culture for diverse medical school faculty would help meet the mission of academic medicine to train a physician and research workforce that meets the disparate needs of our multicultural society. Medical school leaders need to value the inclusion of URM faculty. Failure to fully engage the skills and insights of URM faculty impairs our ability to provide the best science, education or medical care.
doi:10.1007/s11606-010-1478-7
PMCID: PMC2988158  PMID: 20697960
medical faculty; underrepresented minorities; race
12.  Addressing indigenous health workforce inequities: A literature review exploring 'best' practice for recruitment into tertiary health programmes 
Introduction
Addressing the underrepresentation of indigenous health professionals is recognised internationally as being integral to overcoming indigenous health inequities. This literature review aims to identify 'best practice' for recruitment of indigenous secondary school students into tertiary health programmes with particular relevance to recruitment of Māori within a New Zealand context.
Methodology/methods
A Kaupapa Māori Research (KMR) methodological approach was utilised to review literature and categorise content via: country; population group; health profession ffocus; research methods; evidence of effectiveness; and discussion of barriers. Recruitment activities are described within five broad contexts associated with the recruitment pipeline: Early Exposure, Transitioning, Retention/Completion, Professional Workforce Development, and Across the total pipeline.
Results
A total of 70 articles were included. There is a lack of published literature specific to Māori recruitment and a limited, but growing, body of literature focused on other indigenous and underrepresented minority populations.
The literature is primarily descriptive in nature with few articles providing evidence of effectiveness. However, the literature clearly frames recruitment activity as occurring across a pipeline that extends from secondary through to tertiary education contexts and in some instances vocational (post-graduate) training. Early exposure activities encourage students to achieve success in appropriate school subjects, address deficiencies in careers advice and offer tertiary enrichment opportunities. Support for students to transition into and within health professional programmes is required including bridging/foundation programmes, admission policies/quotas and institutional mission statements demonstrating a commitment to achieving equity. Retention/completion support includes academic and pastoral interventions and institutional changes to ensure safer environments for indigenous students. Overall, recruitment should reflect a comprehensive, integrated pipeline approach that includes secondary, tertiary, community and workforce stakeholders.
Conclusions
Although the current literature is less able to identify 'best practice', six broad principles to achieve success for indigenous health workforce development include: 1) Framing initiatives within indigenous worldviews 2) Demonstrating a tangible institutional commitment to equity 3) Framing interventions to address barriers to indigenous health workforce development 4) Incorporating a comprehensive pipeline model 5) Increasing family and community engagement and 6) Incorporating quality data tracking and evaluation. Achieving equity in health workforce representation should remain both a political and ethical priority.
doi:10.1186/1475-9276-11-13
PMCID: PMC3402985  PMID: 22416784
Māori; Indigenous; Under-represented Ethnic Minority; Recruitment; Health workforce development; Transitioning; Tertiary retention/completion
13.  Successful Efforts to Increase Diversity in a Cardiology Fellowship Training Program 
Background
A large volume of literature has documented racial disparities in the delivery of cardiovascular care in the United States and that decreased access to procedures and undertreatment lead to worse outcomes. A lack of diversity among physicians is considered to be a major contributor. The fellowship training program in cardiovascular medicine at The Ohio State University Medical Center had never trained a fellow from a minority group underrepresented in medicine (URM) before 2007.
Intervention
In 2005, the fellowship made it a priority to recruit and match URM candidates in an effort to address the community's lack of diversity and disparities in cardiovascular care.
Methods
Program leaders revised the recruitment process, making diversity a high priority. Faculty met with members of diverse residency programs during visits to other institutions, the focus of interview day was changed to highlight mentorship, additional targeted postinterview communications reached out to highly competitive applicants, and a regular mentoring program was constructed to allow meaningful interaction with URM faculty and fellows.
Results
Since these changes were implemented, the program has successfully matched a URM fellow for 5 consecutive years. Such candidates currently make up 4 of 16 total trainees (25%) in the fellowship in cardiovascular medicine.
Conclusions
The cardiovascular medicine fellowship training program at The Ohio State University was able to revise recruitment to attract competitive URM applicants as part of a concerted effort. Other educational programs facing similar challenges may be able to learn from the university's experiences.
doi:10.4300/JGME-D-12-00307.1
PMCID: PMC3771180  PMID: 24404314
14.  Student perspectives on the diversity climate at a U.S. medical school: the need for a broader definition of diversity 
BMC Research Notes  2013;6:154.
Background
Medical schools frequently experience challenges related to diversity and inclusiveness. The authors conducted this study to assess, from a student body’s perspective, the climate at one medical school with respect to diversity, inclusiveness and cross-cultural understanding.
Methods
In 2008 students in the doctor of medicine (MD), physical therapy (PT) and physician assistant programs at a public medical school were asked to complete a diversity climate survey consisting of 24 Likert-scale, short-answer and open-ended questions. Questions were designed to measure student experiences and attitudes in three domains: the general diversity environment and culture; witnessed negative speech or behaviors; and diversity and the learning environment. Students were also asked to comment on the effectiveness of strategies aimed at promoting diversity, including diversity and sensitivity training, pipeline programs, student scholarships and other interventions. Survey responses were summarized using proportions and 95 percent confidence intervals (95% CI), as well as inductive content analysis.
Results
Of 852 eligible students, 261 (31%) participated in the survey. Most participants agreed that the school of medicine (SOM) campus is friendly (90%, 95% CI 86 to 93) and welcoming to minority groups (82%, 95% CI 77 to 86). Ninety percent (95% CI 86 to 93) found educational value in a diverse faculty and student body. However, only 37 percent (95% CI 30 to 42) believed the medical school is diverse. Many survey participants reported they have witnessed other students or residents make disparaging remarks or exhibit offensive behaviors toward minority groups, most often targeting persons with strong religious beliefs (43%, 95% CI 37 to 49), low socioeconomic status (35%, 95% CI 28 to 40), non-English speakers (34%, 95% CI 28 to 40), women (30%, 95% CI 25 to 36), racial or ethnic minorities (28%, 95% CI 23 to 34), or gay, lesbian, bisexual or transgendered (GLBT) individuals (25%, 95% CI 20 to30). Students witnessed similar disparaging or offensive behavior by faculty members toward persons with strong religious beliefs (18%, 95% CI 14 to 24), persons of low socioeconomic status (12%, 95% CI 9 to 17), non-English speakers (10%, 95% CI 6 to 14), women (18%, 95% CI 14 to 24), racial or ethnic minorities (12%, 95% CI 8 to 16) and GLBT individuals (7%, 95% CI 4 to 11). Students’ open-ended comments reinforced the finding that persons holding strong religious beliefs or conservative values were the most common targets of disparaging or offensive behavior.
Conclusions
These data suggest that medical students believe that diversity and a climate of inclusiveness and respect are important to a medical school’s educational and clinical care missions. However, according to these students, the institution must embrace a broader definition of diversity, such that all minority groups are valued, including individuals with conservative viewpoints or strong religious beliefs, the poor and uninsured, GLBT individuals, women and non-English speakers.
doi:10.1186/1756-0500-6-154
PMCID: PMC3684552  PMID: 23595029
Diversity climate; Diversity; Medical student perspectives; Medical education
15.  Improving the Diversity Climate in Academic Medicine: Faculty Perceptions as a Catalyst for Institutional Change 
Purpose
To assess perceptions of underrepresented minority (URM) and majority faculty physicians regarding an institution’s diversity climate, and to identify potential improvement strategies.
Method
The authors conducted a cross-sectional survey of tenure-track physicians at the Johns Hopkins University School of Medicine from June 1, 2004 to September 30, 2005; they measured faculty perceptions of bias in department/division operational activities, professional satisfaction, career networking, mentorship, and intentions to stay in academia, and they examined associations between race/ethnicity and faculty perceptions using multivariate logistic regression.
Results
Among 703 eligible faculty, 352 (50.1%) returned surveys. Fewer than one third of respondents reported experiences of bias in department/division activities; however, URM faculty were less likely than majority faculty to believe faculty recruitment is unbiased (21.1% versus 50.6%, P = .006). A minority of respondents were satisfied with institutional support for professional development. URM faculty were nearly four times less likely than majority faculty to report satisfaction with racial/ethnic diversity (12% versus 47.1%, P = .001) and three times less likely to believe networking included minorities (9.3% versus 32.6%, P = .014). There were no racial/ethnic differences in the quality of mentorship. More than 80% of respondents believed they would be in academic medicine in five years. However, URM faculty were less likely to report they would be at their current institution in five years (42.6% versus 70.5%, P = .004).
Conclusions
Perceptions of the institution’s diversity climate were poor for most physician faculty and were worse for URM faculty, highlighting the need for more transparent and diversity-sensitive recruitment, promotion, and networking policies/practices.
doi:10.1097/ACM.0b013e3181900f29
PMCID: PMC2824594  PMID: 19116484
16.  Integrating Theory and Practice to Increase Scientific Workforce Diversity: A Framework for Career Development in Graduate Research Training 
CBE Life Sciences Education  2011;10(4):357-367.
Few, if any, educational interventions intended to increase underrepresented minority (URM) graduate students in biological and behavioral sciences are informed by theory and research on career persistence. Training and Education to Advance Minority Scholars in Science (TEAM-Science) is a program funded by the National Institute of General Medical Sciences at the University of Wisconsin–Madison with the twin goals of increasing the number of URM students entering and completing a PhD in BBS and increasing the number of these students who pursue academic careers. A framework for career development in graduate research training is proposed using social cognitive career theory. Based on this framework, TEAM-Science has five core components: 1) mentor training for the research advisor, 2) eight consensus-derived fundamental competencies required for a successful academic career, 3) career coaching by a senior faculty member, 4) an individualized career development plan that aligns students’ activities with the eight fundamental competencies, and 5) a strengths, weaknesses, opportunities, and threats personal career analysis. This paper describes the theoretical framework used to guide development of these components, the research and evaluation plan, and early experience implementing the program. We discuss the potential of this framework to increase desired career outcomes for URM graduate trainees in mentored research programs and, thereby, strengthen the effectiveness of such interventions on participants’ career behaviors.
doi:10.1187/cbe.10-12-0145
PMCID: PMC3228654  PMID: 22135370
17.  The missing curriculum: experience with emotional competence education and training for premedical and medical students. 
Medical education has long overlooked teaching the normal psychodynamics of everyday adult life (psychonormality) in favor of training in psychopathology. Proficiency in psychonormality skills (i.e., emotional competence) includes skilled management of internal emotions, external situations and relationships, and promotes patient satisfaction and healthcare outcomes as well as better mental health for practitioners. In particular, teaching psychonormality skills can be helpful to underrepresented minority (URM) students whose psychonormality experiences may differ from the culture of mainstream medical education. This paper outlines a clinically derived, pragmatic, five-step course designed to educate and train students for emotionally competent medical practice. A real-life example taken from an introductory workshop presentation of this course at a Student National Medical Association meeting is presented to illustrate the student-oriented application of the concepts. The enthusiastic reception accorded such workshops suggests an unmet need for this type of training in medical curricula. Benefits could include improved doctor-patient relationships and associated healthcare outcomes as well as higher retention of competent, professional, satisfied and healthier physicians, particularly URMs. Medical schools and residencies are encouraged to carefully evaluate the impact of incorporating psychonormality education and emotional competence training into their present curricula and faculty development.
PMCID: PMC2594773  PMID: 16296219
18.  Mentoring Programs for Underrepresented Minority Faculty in Academic Medical Centers: A Systematic Review of the Literature 
Purpose
Mentoring is critical for career advancement in academic medicine. However, underrepresented minority (URM) faculty often receive less mentoring than their nonminority peers. The authors conducted a comprehensive review of published mentoring programs designed for URM faculty to identify “promising practices.”
Method
Databases (PubMed, PsycINFO, ERIC, PsychLit, Google Scholar, Dissertations Abstracts International, CINHAL, Sociological Abstracts) were searched for articles describing URM faculty mentoring programs. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) formed the model for analyzing programs.
Results
The search identified 73 citations. Abstract reviews led to retrieval of 38 full-text articles for assessment; 18 articles describing 13 programs were selected for review. The reach of these programs ranged from 7 to 128 participants. Most evaluated programs on the basis of the number of grant applications and manuscripts produced or satisfaction with program content. Programs offered a variety of training experiences, and adoption was relatively high, with minor changes made for implementing the intended content. Barriers included time-restricted funding, inadequate evaluation due to few participants, significant time commitments required from mentors, and difficulty in addressing institutional challenges faced by URM faculty. Program sustainability was a concern because programs were supported through external funds, with minimal institutional support.
Conclusions
Mentoring is an important part of academic medicine, particularly for URM faculty who often experience unique career challenges. Despite this need, relatively few publications exist to document mentoring programs for this population. Institutionally supported mentoring programs for URM faculty are needed, along with detailed plans for program sustainability.
doi:10.1097/ACM.0b013e31828589e3
PMCID: PMC3835658  PMID: 23425989
19.  Predictors of Student Success in Graduate Biomedical Informatics Training: Introductory Course and Program Success 
Objective
To predict student performance in an introductory graduate-level biomedical informatics course from application data.
Design
A predictive model built through retrospective review of student records using hierarchical binary logistic regression with half of the sample held back for cross-validation. The model was also validated against student data from a similar course at a second institution.
Measurements
Earning an A grade (Mastery) or a C grade (Failure) in an introductory informatics course.
Results
The authors analyzed 129 student records at the University of Texas School of Health Information Sciences at Houston (SHIS) and 106 at Oregon Health and Science University Department of Medical Informatics and Clinical Epidemiology (DMICE). In the SHIS cross-validation sample, the Graduate Record Exam verbal score (GRE-V) correctly predicted Mastery in 69.4%. Undergraduate grade point average (UGPA) and underrepresented minority status (URMS) predicted 81.6% of Failures. At DMICE, GRE-V, UGPA, and prior graduate degree significantly correlated with Mastery. Only GRE-V was a significant independent predictor of Mastery at both institutions. There were too few URMS students and Failures at DMICE to analyze. Course Mastery strongly predicted program performance defined as final cumulative GPA at SHIS (n = 19, r = 0.634, r 2 = 0.40, p = 0.0036) and DMICE (n = 106, r = 0.603, r 2 = 0.36, p < 0.001).
Conclusions
The authors identified predictors of performance in an introductory informatics course including GRE-V, UGPA and URMS. Course performance was a very strong predictor of overall program performance. Findings may be useful for selecting students for admission and identifying students at risk for Failure as early as possible.
doi:10.1197/jamia.M2895
PMCID: PMC3002135  PMID: 19717804
20.  Race and Academic Achievement in Racially Diverse High Schools: Opportunity and Stratification 
Teachers College record (1970)  2010;112(4):1038-1063.
Background/Context
Brown v Board of Education fundamentally changed our nation's schools, yet we know surprisingly little about how and whether they provide equality of educational opportunity. Although substantial evidence suggests that African American and Latino students who attend these schools face fewer learning opportunities than their White counterparts, until now, it has been impossible to examine this using a representative sample because of lack of data.
Purpose/Objective/Research Question/Focus of Study
This study uses newly available data to investigate whether racially diverse high schools offer equality of educational opportunity to students from different racial and ethnic groups. This is examined by measuring the relative representation of minority students in advanced math classes at the beginning of high school and estimating whether and how this opportunity structure limits the level of achievement attained by African American and Latino students by the end of high school.
Setting
This study uses data from the Adolescent Health and Academic Achievement Study (AHAA) and its partner study, the National Longitudinal Study of Adolescent Health (Add Health), a stratified, nationally representative study of students in U.S. high schools first surveyed in 1994–1995.
Population/Participants/Subjects
Two samples of racially diverse high schools were used in the analysis: one with African Americans, Whites, and Asians (26 schools with 3,149 students), and the other with Latinos, Whites, and Asians (22 schools with 2,775 students).
Research Design
Quantitative analyses first assess how high schools vary in the extent to which minority students are underrepresented in advanced sophomore math classes. Hierarchical multilevel modeling is then used to estimate whether racial-ethnic differences in representation in advanced math have an impact on African American and Latino students’ achievement by the end of high school, relative to the Whites and Asians in the school. Specifically, we estimate the effects of Whites’ and Asians’ overrepresentation in sophomore-year math (or Latino or African American underrepresentation) within the school on students’ senior-year grades and their postsecondary enrollment.
Findings/Results
Findings show that schools vary in the extent to which African American and Latino students are underrepresented in advanced sophomore math classes. This pattern of racial inequality in schools is associated with lower minority senior-year grades and enrollment in 4-year postsecondary institutions, net of students’ own background.
Conclusions/Recommendations
Evidence consistently suggests that schools can play an active role in the provision of opportunities for social mobility or in the exacerbation of social inequality, depending on how they are structured. It is important to consider racial stratification within schools as a mechanism of inequality of educational opportunity.
PMCID: PMC2893342  PMID: 20593006
21.  Chemistry courses as the turning point for premedical students 
Previous research has documented that negative experiences in chemistry courses are a major factor that discourages many students from continuing in premedical studies. This adverse impact affects women and students from under-represented minority (URM) groups disproportionately. To determine if chemistry courses have a similar effect at a large public university, we surveyed 1,036 students from three entering cohorts at the University of California, Berkeley. We surveyed students at the beginning of their first year at the university and again at the end of their second year. All subjects had indicated an interest in premedical studies at the time they entered the university. We conducted follow-up interviews with a stratified sub-set of 63 survey respondents to explore the factors that affected their level of interest in premedical studies. Using a 10-point scale, we found that the strength of interest in premedical studies declined for all racial/ethnic groups. In the follow-up interviews, students identified chemistry courses as the principal factor contributing to their reported loss of interest. URM students especially often stated that chemistry courses caused them to abandon their hopes of becoming a physician. Consistent with reports over more than 50 years, it appears that undergraduate courses in chemistry have the effect of discouraging otherwise qualified students, as reflected in their admission to one of the most highly selective public universities in the US, from continuing in premedical studies, especially in the case of URM students. Reassessment of this role for chemistry courses may be overdue.
doi:10.1007/s10459-009-9165-3
PMCID: PMC2814029  PMID: 19504170
Chemistry; Diversity; Ethnicity; Medical education; Minorities; Premedical education; Science education; Race
22.  Addressing the Challenge of Diversity in the Graduate Ranks: Good Practices Yield Good Outcomes 
CBE Life Sciences Education  2013;12(1):19-29.
This paper describes practices designed to improve graduate student training outcomes in the sciences. It describes work to increase student diversity in the graduate ranks and documents the success of trainees. The practices designed to achieve these outcomes are broadly applicable to all graduate training programs and students.
In this paper, we examine the impact of implementing three systemic practices on the diversity and institutional culture in biomedical and public health PhD training at Brown University. We hypothesized that these practices, designed as part of the National Institutes of Health–funded Initiative to Maximize Student Development (IMSD) program in the Division of Biology and Medicine, would have a positive effect on underrepresented minority (URM) recruitment and retention and objective measures of student success. These practices include: 1) develop strategic partnerships with selected undergraduate institutions; 2) provide a personalized education program of student support and skill-based modules to supplement discipline-based course work; and 3) transform institutional culture by engaging faculty in supporting diversity-related goals and practices. Data comparing URM numbers and key academic milestones before and after implementation of IMSD practices support the initial hypothesis and effectiveness of these practices at Brown. Program components are broadly applicable as best practices for others seeking to improve URM recruitment and achievements of graduate students traditionally underrepresented in the sciences.
doi:10.1187/cbe.12-04-0054
PMCID: PMC3587852  PMID: 23463225
23.  College Graduation Rates for Minority Students in a Selective Technical University: Will Participation in a Summer Bridge Program Contribute to Success? 
There are many approaches to solving the problem of underrepresentation of some racial and ethnic groups and women in scientific and technical disciplines. Here, the authors evaluate the association of a summer bridge program with the graduation rate of underrepresented minority (URM) students at a selective technical university. They demonstrate that this 5-week program prior to the fall of the 1st year contains elements reported as vital for successful student retention. Using multivariable survival analysis, they show that for URM students entering as fall-semester freshmen, relative to their nonparticipating peers, participation in this accelerated summer bridge program is associated with higher likelihood of graduation. The longitudinal panel data include more than 2,200 URM students.
doi:10.3102/0162373709360064
PMCID: PMC3489281  PMID: 23136456
persistence; retention; underrepresented minority; survival analysis; STEM; bridge program
24.  What Do I Want to Be with My PhD? The Roles of Personal Values and Structural Dynamics in Shaping the Career Interests of Recent Biomedical Science PhD Graduates 
CBE Life Sciences Education  2013;12(4):711-723.
This paper addresses the process of career-interest formation as it relates to faculty careers in a diverse cohort of 38 recent biomedical sciences PhD graduates (including 23 women and 18 underrepresented minorities). The authors show that personal values and structural dynamics in the biomedical workforce play strong roles in shaping career interest.
Interest in faculty careers decreases as graduate training progresses; however, the process underlying career-interest formation remains poorly defined. To better understand this process and whether/how it differs across social identity (i.e., race/ethnicity, gender), we conducted focus groups with 38 biomedical scientists who received PhDs between 2006 and 2011, including 23 women and 18 individuals from underrepresented minority (URM) backgrounds. Objective performance and quality of advisor relationships were not significantly different between scientists with high versus low interest in faculty careers. Career interests were fluid and formed in environments that generally lacked structured career development. Vicarious learning shaped similar outcome expectations about academic careers for all scientists; however, women and URMs recounted additional, distinct experiences and expectations. Scientists pursuing faculty careers described personal values, which differed by social identity, as their primary driver. For scientists with low interest in faculty careers, a combination of values, shared across social identity, and structural dynamics of the biomedical workforce (e.g., job market, grant funding, postdoc pay, etc.) played determinative roles. These findings illuminate the complexity of career choice and suggest attracting the best, most diverse academic workforce requires institutional leaders and policy makers go beyond developing individual skill, attending to individuals’ values and promoting institutional and systemic reforms.
doi:10.1187/cbe.13-02-0021
PMCID: PMC3846521  PMID: 24297297
25.  International students in United States’ medical schools: does the medical community know they exist? 
Medical Education Online  2012;17:10.3402/meo.v17i0.15748.
Background
Matriculation of international students to United States’ (US) medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education.
Methods
While these students’ numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature.
Results
These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools – both public and private – to support international students’ education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME). However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement.
Conclusion
By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to healthcare disparity eradication, minority health issues, and service in medically underserved areas.
doi:10.3402/meo.v17i0.15748
PMCID: PMC3368516  PMID: 22679360
international students; medical school admission; diversity; minority; recruitment

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