Planning committee co-chair Theodore Corbin, M.D., M.P.P. (Drexel University), moderated a session to explore solutions to build and invest in Black students pursuing careers in science, engineering, and medicine; promote policies to ensure continued support for these programs; and identify the power and authoritative entities to make change. The presenters were David Satcher, M.D., Ph.D. (Satcher Health Leadership Institute, Morehouse School of Medicine), and Sonsiere Cobb-Souza (Office of Minority Health, U.S. Department of Health and Human Services [HHS]).
THE IMPORTANCE OF RELATIONSHIPS
Dr. Satcher drew from his own experience to discuss the importance and challenges of Black medical students in predominantly white medical schools. Although neither of his parents finished elementary school, he recounted, they were committed to the education of their children. Satcher attended a segregated school 20 miles from his home in Alabama, which he said shaped his and other students’ lives. He graduated from Morehouse College in 1963. He related he had some difficulty gaining admission, but he was accepted with the understanding that he maintain a B average and work to pay his tuition. A job in the biology department piqued his interest in research. He also became active in the civil rights movement. When he was seeking to enter medical school, he said, the word was that Duke University would accept one Black student, and many people assumed he would be the student selected. However, he had been jailed several times for his activism, and Duke admitted another Black undergraduate without this history. Although he was initially depressed when he was not accepted, he said looking back, it turned out that “it was one of the best things that happened to me.” He was admitted to Case Western Reserve University, where he earned his M.D. and Ph.D.
Dr. Satcher explained that the M.D./Ph.D. program was organized with 1 year of medical school, 2 years in the Ph.D. program, then a return to the medical school. He developed a good relationship with his Ph.D. research advisor, and he had a support system that included financial aid. He also became involved in the community in Cleveland.
He related a pivotal experience in his clinical rotations, which he describes more fully in a recent book (Satcher, 2020). On his first day of an OB/GYN (obstetrics and gynecology) rotation, he was ordered to examine four Black women who were in a room together with no curtains or other privacy between them. He refused because of these conditions, and he walked out. The physician in charge threatened Dr. Satcher’s position not only at Case Western but at any institution. The next day, he was called in to see Dean Frederick Robbins. Fearing the worst, Dr. Satcher learned that the other students, all of whom were white, also walked out and that changes would result. This encounter began a relationship with Dr. Robbins that continued until the Nobel laureate’s death in 2003. “The point is that the relationship that developed between Fred Robbins and me was a critical part of my own development,” Dr. Satcher said. “I’ve been in a lot of leadership roles. A lot of that occurred because I was fortunate enough to work with people like Fred Robbins, who was an outstanding scholar and who believed in justice.” When he spoke at Dr. Robbins’s funeral, he recounted how they worked together over the years. He concluded, “I tell this story because I think it’s important for everybody, not just the Black students but for all future physicians, that there be a more integrated student body so that students really get to know each other. It helps shape how they approach their patients. Integration of the student body serves a lot of purposes and has made a difference in this country.”
HIGHLIGHTS FROM THE NATIONAL WORKFORCE DEVELOPMENT PIPELINE INITIATIVES
Ms. Cobb-Souza provided an overview of the Office of Minority Health (OMH) in the U.S. Department of Health and Human Services. She highlighted past STEMM partnerships, with a focus on the National Workforce Development Pipeline to increase diversity in the health-care pipeline.
Office of Minority Health Partnerships
The mission of OMH is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities, Ms. Cobb-Souza explained. OMH has five main functions: promote policy, program, and practice adoption; convene partners; conduct demonstrations and evaluations; disseminate information; and collect and analyze data.
Past STEMM initiatives include the National African American Youth Initiative, Charles R. Drew Graduate Medical Education Program, President and Fellows of Harvard College internship program, and UNCF (United Negro College Fund) Special Programs Corporation. She highlighted the purposes and some of the elements of each program.
National Workforce Development Pipeline
OMH’s current STEMM initiative focuses on education, training, and exposure for students. Through the NWDP that began in 2015, 14 projects are aiming to fill the gap in the educational pipeline beginning in middle and high school to increase students’ awareness in and pursuit of careers in health care, as well as increase the availability of STEMM programs. The Sullivan Commission (2014) had recommended strengthening K–12 opportunities, she noted, which helped inform the program. About 13 percent of participating students are in middle school, 20 percent are in bridge programs in high school (taking college courses to earn an associate degree), and 67 percent are in high school.
The top challenges identified by students across the projects relate to academics and college readiness (28.6 percent), financial barriers (25.7 percent), psychosocial/mental health (20 percent), retention (14.3 percent), and accessibility (11.4 percent) (see Figure 3-1). Ms. Cobb-Souza noted that the principal investigators in each site had to develop strategies to address these challenges. For example, related to academics and college readiness, many of the students had delays in their reading, math, and science levels, which needed to be addressed. Many students must contribute financially to their households, so some of the programs have provided scholarships or stipends. A significant number were depressed or had other mental or emotional health challenges that called for support services. They need to develop strategies to maintain retention over the 5 to 6 years of the program. Finally, accessibility related to transportation and safety is significant in some locations.
Tools across NWDP programs include summer programming, stipends and scholarships, a wellness life skills curriculum, digital technology and online services, dual enrollment, and internships. She noted that
common success factors across the 14 programs, based on 4 years of data, show that academic enrichment is vital, as are early-career exposure, life skills and wellness, and financial support.
SOURCE: Sonsiere Cobb-Souza, Workshop Presentation, April 19, 2021.
She suggested that lessons learned from NWDP programs can be applied in other settings. As examples, she focused on programs at the University of Hawaii, the Public Health Institute in Oakland, California, and Medgar Evers College in New York City.
The University of Hawaii John A. Burns School of Medicine launched the Pre-Health Career Corps Program. It provides 4 years of summer programming, shadowing, mentoring, and research for high school students. Online learning connects remote students. After 2016, almost 72 percent of students went on to college after utilizing PHCC resources.1
The Public Health Institute’s FACES for the Future Coalition involves a partnership between 11 high schools and universities.2 The students receive career exposure, academic enrichment, life skills and wellness support, and youth leadership development. Of note, crisis counseling and case management are provided because 80 percent of the participants come from challenging households or have other family issues. All the students graduated from high school, compared with 70 to 85 percent graduation of comparable students not in the program. In addition, 97 percent continued in postsecondary STEMM pathways, including college, certification programs, or entry-level health employment.
___________________
1 For more information, see https://www.ahec.hawaii.edu/phcc/.
2 For more information, see https://www.phi.org/our-work/programs/faces-for-thefuture-coalition/.
The Medgar Evers Health Careers Connection Pipeline is a bridge program in New York City with two cohorts, Ms. Cobb-Souza explained.3 Students in the last 2 years of high school take classes to earn an associate degree when they leave high school. This allows them to advance to college or nursing school. Participating students have higher passing rates in Regents math and science exams than those not in the program.
From these programs, Ms. Cobb-Souza drew five lessons learned:
- Inspiration in STEMM subjects and careers needs to begin early, with the highest rates of success for the NWDP programs that begin in middle school.
- A multipronged program approach can allow students to complete STEMM and health programs while linking them to associate degree programs or other allied health training.
- Continued funding support ensures sustainability of program success to include individual student stipends, academic preparation, and ongoing state and federal initiatives.
- Culturally and linguistically effective early pipeline programs can train students from backgrounds that are underrepresented in science.
- Strong partnerships and collaboration are needed to ensure a whole student approach. Family engagement is also essential.
Ms. Cobb-Souza concluded with thanks to the 14 programs and their partners.
DISCUSSION
Dr. Corbin noted the presentations by Dr. Satcher and Ms. Cobb-Souza reinforce the importance of a supportive environment early on. When asked about students who do not complete the pipeline programs, Ms. Cobb-Souza said that those who exit can reenter and, in any event, the awardee organizations have committed to additional engagement with these students, such as through their counseling and wellness programs.
Dr. Louis Sullivan (Sullivan Alliance) referred to the data presented by Dr. Raj Chetty (Harvard University; see Chapter 2) about the impact of early interventions on adult earning capacity. He asked Ms. Cobb-Souza if OMH has looked at programs to intervene before middle school, perhaps in cooperation with the Department of Education. “Would we have greater
success if we intervened earlier?” he asked. Ms. Cobb-Souza agreed that early intervention helps. Students often enter the programs with lower levels of reading and math proficiency. The programs do not set minimum academic requirements to participate, and some of the greatest successes have been with students who entered the program behind the expected level. These students had the greatest improvement in academic performance at the middle school level. She added that OMH recently funded interventions targeted at grades 1 to 3. Dr. Sullivan urged offering mentorships and other programs at young levels.
Dr. George Daley (Harvard Medical School) asked the presenters about the value of investing in mentorship skills training, rather than hoping that good intentions or happenstance will suffice. Dr. Satcher commented that he was fortunate to have mentors at Morehouse and in his M.D./Ph.D. program, and he agreed with the need to invest in mentorship. Ms. Cobb-Souza said in internship and other initiatives across HHS that bring in students, the agency must commit to providing mentors to guide students. She agreed that mentorship skill training is needed. In answer to another question, Ms. Cobb-Souza said pipeline programs are being reviewed across HHS to improve coordination and minimize duplication.
Dr. Corbin observed that Dr. Satcher discussed the importance of Black students attending predominantly white institutions. Many medical schools have a holistic approach to admissions, Dr. Corbin said, but there are still challenges in admissions. Dr. Satcher reiterated that, to him, an integrated student body in medical school is important for patient relationships because, currently, Black patients do not necessarily do as well with white physicians as with Black physicians. “We want to get to the point where all physicians are prepared to provide the level of service and they are effective in taking care of patients of any race,” Dr. Satcher said.
Returning to the subject of early interventions, Dr. Satcher said one of the most important programs at the Satcher Health Leadership Institute is a program for young parents on how their children develop. Even while their babies are in utero, it is important for parents to feel comfortable in their role to help their children in the long run. Dr. Sullivan commented that one of the striking aspects of Dr. Chetty’s research (see Chapter 2) was the influence of place when families move to more affluent areas. Not everyone can move, which argues for investing in school systems nationwide so that all students have smaller classes, experienced teachers, and role models. Programs based on Dr. Chetty’s research could be developed with HHS, the Department of Education, and state education departments, he suggested.
“Short of that, we are always remediating and making up for deficiencies in the system that occur early on,” Dr. Sullivan stated.
Planning committee co-chair Gilda Barabino, Ph.D. (Olin College of Engineering), urged the importance of thinking about context and environment for success, and to consider “successful practices” rather than “best practices.” Programs can have the same elements but work differently in different places. Ms. Cobb-Souza agreed and noted that an OMH program evaluation is reviewing current efforts to identify evidence-informed practices.
Dr. Daley suggested an important conclusion from both sessions of the workshop so far is the need to start early and for educators at all levels to be not just good teachers but also mentors to encourage ambitions, recognizing the influence of self-fulfilling prophecies and expectations. Dr. Corbin suggested that mentorship and education be part of the faculty promotion process as part of scholarly activity. At the same time, he acknowledged the “minority tax”—the commitment to mentoring Black students at the expense of one’s own research—is real. To change the environment to be more supportive and encouraging while also protecting the time of minority faculty, Dr. Sullivan suggested resources that are not being fully used, including physicians in the community who can serve as mentors and role models.
REFERENCES
Satcher, D. 2020. My Quest for Health Equity: Notes on Learning While Leading. Baltimore, MD: Johns Hopkins University Press.
Sullivan Commission. 2014. Missing Persons: Minorities in the Health Professions. https://campaignforaction.org/wp-content/uploads/2016/04/SullivanReport-Diversity-in-Healthcare-Workforce1.pdf.
