Wayne State University Pipeline Programs

Authors

Wilson described initiatives at Wayne State University to address the low college attendance and graduation rates among African Americans. Wayne State University first implemented a student network, a pilot program that offered support for 50 African American male students. The program provided a physical space for the students to gather, study together, and support each other. The network also connected students to Black alumni, faculty, staff, and peer mentors and hosts events like social gatherings, networking opportunities, invited speakers, and field trips. Wilson summed up the effort, saying, “We provide the infrastructure and the structure for them to get together and support each other . . . where they come and they study together. They form a learning community.” Wilson reported that the network increased the retention rate between freshman and sophomore years from approximately 60 percent to 95 percent. Based on the success of the program, Wayne State University scaled up the initiative to include all Black male students in the Student African American Brotherhood.¹⁰

Despite the success of programs like the network and the Brotherhood at Wayne State University, Wilson acknowledged that undergraduate college students are a relatively successful group and that programs at the undergraduate level are late in the pipeline to intervene. Thus, he cautioned that there remains a need to look at the challenges African American boys face before they get to college. To that end, he raised the conflation of U.S.- and foreign-born Blacks as a challenge, saying, “When we talk about African American, we typically talk about Black.” He proceeded to describe the need to distinguish U.S.-born Black students from foreign-born Black students, because the educational achievement and health disparities experienced by native-born Blacks are the result of a legacy of disadvantage and discrimination in the United States. By contrast, foreign-born Blacks have educational and sociocultural experiences that may not be comparable, and which in some instances may reflect privilege. He noted that a similar situation is seen among Hispanic students, where the educational and life experiences of U.S.-born Hispanic students differs from those from Spain and South America. Thus, he encouraged disaggregating data within racial and ethnic groups to parse and better understand the differences in educational achievement between racial and ethnic subgroups.

University of Illinois College of Medicine Pipeline Programs and Potential for New Technology

Authors

Affiliations

Azar began by describing the highly diverse student body at the University of Illinois College of Medicine, of which 25 to 30 percent come from underrepresented minority groups. He attributed this diversity to the school's faculty, a commitment to diversity, a focus on excellence, and the work of the current and past associate deans for diversity and inclusion. Azar also underscored the need to value education:

We have to work on emphasizing the value of education. I notice when I am talking to those kids who, like me, studied in another country, and their parents came here [from another country], that the value of education is engrained in the mind of the students. Somehow, we are not trying to do [this] to our kids at home, and then we find out that they are interested in other stuff than education. None of them want to go to medical school because it may be tough. But it is important, I think.

Azar then described the strategies the University of Illinois College of Medicine employs to strengthen the medical education pipeline. These include postbaccalaureate programs and summer prematriculation programs prior to entering medical and dental schools as well as managing students' financial issues and wellness programs to address social and economic issues for current medical students. The university also promotes role modeling and mentorship, not only to support students, but by promoting faculty from underrepresented minority backgrounds to become leaders and role models. Finally, for students who do not match into residency programs, the college pays loans and interest for 1 year after graduation. Azar commented that the school has not made any payments to date and that he hopes it will not have to. Instead, the school's primary focus is on preparing students to transition to residencies. Thus, this program serves as a financial incentive, or a mechanism for the school to hold itself financially accountable for better preparing its students.

Reflecting on his experience working simultaneously at the University of Illinois and at Google, Azar noted that the underrepresentation of Black men is common to both settings—academia and technology. Thus, he suggested that efforts to attract, train, and retain underrepresented minorities in both sectors will require systems-based and culturally based solutions, as well as strong role modeling. He commented:

We have discussed several examples of our effort to solve the problems of attracting, retaining, and training minority medical students. They are not different from the other solutions that, as you have seen, I have mentioned earlier. But they are systems based, if you are thinking about ways to combat, for example, racism, cultural based, trying to change the social systems and so on, and focusing on this individual encouragement and role modeling. But they are all grassroots efforts. For every student, it requires the work of 10 other people perhaps.

Azar discussed the potential for solutions from new technologies to address the shortage of Black men in medicine—for example, how pipeline programs can use data and new technologies, virtual programs, and analytics. He concluded his presentation by challenging those in attendance:

How can Silicon Valley help to enhance the solutions that have been proposed in this workshop to address the crisis of the growing absence of Black men in medicine and science? How can Silicon Valley attract more Black men to work in data and technology careers, especially health IT [information technology]? And how can they help us improve the pipeline programs and other strategies to address the medical education system, to address cultural norms and values, and to support individual students?

Elements of Accountability for Diversity at the Ross University School of Medicine

Authors

Affiliations

Owen opened his talk by presenting his “organizational credo” for the Ross University School of Medicine: “Attending medical school is not a privilege, but a right for all eligible students.” He added that the challenge of this credo is how to define eligibility. At Ross, eligibility is operationalized as using holistic selection criteria. He expanded, “We manage eligibility for admissions to our own expectations. . . . We also treat applying to medical school as an opportunity to prepare the applicant to become a matriculate.” Some of these accepted students are underrepresented minorities with substantially lower Medical College Admission Test (MCAT) scores and grade point averages compared with more traditional and “overwhelmingly Caucasian” applicants. To support them, Ross places these students in a “medical education readiness program” that provides preparatory work during the first few semesters of medical school and also “teaches them how to study.” These students are also connected to mentors from a similar background.

Owen identified commitment from leadership as key to increasing diversity at Ross University. He said,

What is most impactful at Ross for accountability and diversity is that it percolates into the organization from the top, from the board of trustees. [Management consultant] Peter Drucker said eloquently and simplistically, “Trees die from the top.” So the mandate for minority success and access at Ross comes from the top, comes from the board of trustees. It comes from the bosses.

Owen described the inclusion of diversity as a key performance indicator for the school. He added that recruitment and retention of underrepresented minorities are monitored over time, and placement rates are benchmarked and discussed at the highest level of the organization, including among trustees. He added that having accountability at the level of leadership removes the responsibility for increasing diversity at the level of admissions committees, saying

This board of trustees [top]-down approach for accountability mitigates the effect of moral licensing: . . . [the] subconscious justification of an unfair decision by a failure to recognize what are biased and self-indulgent choices occurring by admissions committees.

Owen reflected on his experience being held accountable for diversity. He recalled interviewing as a candidate to become dean when a member of the board of trustees asked, “How do you feel about diversity?” He said,

A school that is tolerant of moral licensing would be okay if I gave a lukewarm response about diversity. But such tolerance at Ross is a virtual prediction of leadership failure, much like the rejection of a foreign tissue because it is in our DNA. Ross trustees would not accept an organizational leader who is anything less than a zealot for inclusion. So in hindsight, I think I gave the right answer to the trustee's surprising question when I said to him, “Oh, I love diversity.” I see it every day when I look in the mirror.

Reflections on Diversity in Osteopathic Medical Schools

Authors

Affiliations

White-Faines started her talk by proposing that U.S. osteopathic medical schools, with their more holistic philosophy on patient care and abolitionist roots, are well positioned to promote and improve upon diversity within the U.S. physician workforce. She reminded the audience that the growth and evolution of osteopathic medical schools now positions D.O. physicians equitably alongside their allopathic counterparts. White-Faines then encouraged the audience that progress occurs when there is “the will” to change. She offered from personal experience:

In the 1970s, there was such a movement to oppose women being in colleges. But Amherst, like many liberal arts schools, made an intentional decision that they want women in their colleges. It is time for our schools to make intentional decisions. It is not something to think about. You just do it. And so it is about being honest. It is about being authentic. It is about all of us calling it out when we see it. It is about being intentional. And it is not so much of how or what do we need to do. The question is, “Do we have the will to do it?”

White-Faines finished by identifying her perspective on critical factors to address the shortage of Black men in medicine. They include intervention through pipeline programs, harnessing partnerships and collaborations, and leveraging financial resources to expand and maximize opportunities. She especially emphasized the importance of building cohorts and using messengers or champions. In particular, she offered African American medical school alumni as an underused resource, which should be empowered and engaged in the efforts to increase the representation of Black men in medicine.

Diversity in the Learning Environment: Liaison Committee on Medical Education Guidance Principles

Authors

Affiliations

LCME, co-sponsored by the American Association of Medical Colleges and the American Medical Association, is the accrediting body for medical education programs leading to a medical doctorate, M.D., degree in the United States and Canada. Of note, accreditation directly targets medical education programs (and indirectly the physicians they produce), whereas certification targets individuals. The LCME accreditation process involves self-study and peer review to determine whether a medical school meets nationally accepted standards of medical education program quality. LCME standards are “concise statements of the expected level of quality or attainment” and comprise elements, or “components that collectively constitute a standard; operationally, elements identify the variables that must be examined to determine a medical education program's compliance with a particular standard.” The LCME evaluates each element as “satisfactory,” “satisfactory with a need for monitoring,” or “unsatisfactory” to inform whether it determines a medical school to be in “compliance,” “compliance with monitoring,” or “noncompliant” with the each standard.

With regard to the LCME approach to diversity, Catanese focused on the LCME's Standard 3 on academic and learning environments and, specifically, on Element 3.3 on diversity and pipeline programs and partnerships. See Box 7-1 for the LCME Standard 3 and Element 3.3 and Box 7-2 for the criteria by which survey teams assess whether Element 3.3 is satisfactory or not.¹¹ In summary, Catanese described key elements for schools that meet LCME Standard 3 and Element 3.3, including having mission-appropriate policies and practices to recruit and retain diverse students, faculty, and staff; pipelines and partnerships directed to and focused on identified diversity groups; and evaluation and monitoring processes to assess the effectiveness and progress of those activities. She added that, although her presentation focused on the standard and element directly pertaining to diversity and pipeline programs, diversity also plays a role in other elements of LCME's accreditation—for example, the elements pertaining to professionalism and curricula on cultural competence and health care disparities. She described the intent of LCME to identify the following:

BOX 7-1

Liaison Committee on Medical Education Standard 3 on Academic and Learning Environments and Element 3.3 on Diversity/Pipeline Programs and Partnerships.

BOX 7-2

Liaison Committee on Medical Education Consensus Statement Related to Satisfaction with Element 3.3, Diversity/Pipeline Programs and Partnerships.

Diversity practices, policies, and processes [embedded] in an environment that allows them not only to have the desired [diversity] outcomes, but to really have a positive effect on the academic and learning environment of the institution as a whole.

To conclude, Catanese emphasized that LCME seeks to give guidance through its standards and elements, and not to be prescriptive. She said, LCME expects “an institution to really identify its mission-appropriate diversity goals and to direct its resources and attention to achieving them specifically.”