In the Nation's Compelling Interest Ensuring Diversity in the Health-Care Workforce (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-22
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From page 1... ...
within health professions, however, is far below their representation in the general population. Increasing racial and ethnic diversity among health professionals is important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students, among many other benefits.
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As part of this process, HPEIs should proactively and regularly engage and train students, house staff, and faculty regarding institutional di versity-related policies and expectations and the importance of di versity to the long-term institutional mission. HPEI governing bodies should develop institutional objectives consistent with community benefit principles that support the goal of increasing health-care workforce diversity, including efforts to ease financial and nonfinancial obstacles to URM participation,
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Perhaps more importantly, the Court declared that the university's position that achieving a "critical mass" of racial and ethnic diversity in its law school was a compelling interest of the law school and the nation, a rationale that will have far-reaching implications, not just for URM students1 but also for the nation as a whole. Few professional fields will feel the impact of the decision in the Grutter case -- and the potential influence of greater levels of racial and ethnic diversity -- as profoundly as the health professions.
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Specifically, the IOM was asked to: · assess and describe potential benefits of greater racial and ethnic diversity among health professionals; · assess institutional and policy-level strategies that may increase diversity within the health professions, including: modifying HPEIs' admissions practices, o reducing financial barriers to health professions training among minority and lower-income students, o increasing the emphasis on diversity goals in HPEI program accreditation, o improving the HPEI campus "climate" for diversity, and o considering the application of community benefit principles to improve the accountability of nonprofit, tax exempt institutions (e.g., medical schools and teaching hospitals) to the diverse racial and ethnic communities they serve; and · identify mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies.
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demonstrates that greater diversity among health professionals is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, better patientprovider communication, and better educational experiences for all students while in training. Racial and Ethnic Diversity Among Health Professionals and Access to Health Care for Minority Patients Racial and ethnic minority health care professionals are significantly more likely than their white peers to serve minority and medically underserved communities, thereby helping to improve problems of limited minority access to care.
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For a range of reasons, including efficiency in sorting through a large number of applicants, and to attain a reasonable expectation of how applicants can be expected to perform in HPEIs, many admissions committees rely heavily on quantitative information, such as applicants' prior grades and standardized test scores, in identifying those applicants that will receive serious consideration. Standardized test scores are generally good predictors of subsequent academic performance but have been used -- in some cases inappropriately-as a barometer of applicants' academic "merit," often to the detriment of URM students.
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This shift of emphasis to professional and "humanistic" factors is also consistent with a growing recognition in health professions fields that these attributes must receive greater attention in the admissions process to maintain professional quality, to ensure that future health professionals are prepared to address societal needs, and to maintain the public's trust in the integrity and skill of health professionals (Edwards et al., 2001)
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. Several HPEIs have adopted admissions policies that: · Encourage admissions procedures to closely follow the institutions' stated mission with regard to teaching, research, and service -- particularly if the needs of medically underserved communities are a part of the institutional mission; · Encourage a comprehensive review of applicants' files, to understand how students' personal, community, and professional backgrounds may influence students' prior academic performance and contribute to the learning environment; · Require admissions committee members to receive training aimed at improving their ability to assess underrepresented applicants and sharpening interviewing skills; · De-emphasize standardized test data in the admissions equation, after a diverse group of academically qualified candidates are identified; and · Include representatives from groups affected by the institution's admissions decisions on admissions committees and increase incentives for faculty participation on admissions committees.
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Reducing Financial Barriers to URM Participation in Health Professions Education The costs associated with health professions training pose a significant barrier for many URM students, whose economic resources are lower, on average, than non-URM students. In recent years, financial barriers to both undergraduate and graduate education have risen sharply due to shifts in policies and priorities at the federal, state, and institutional levels.
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Recommendation 3-1: HRSA's health professions programs should be evaluated to assess their effectiveness in increasing the numbers of URM students enrolling and graduating from HPEIs to ensure that they maximize URM participation. Recommendation 3-2: Congress should increase funding for Public Health Service Act Titles VII and VIII programs shown to be effective in increasing diversity, and should develop other financial mechanisms to enhance the diversity of the health-care workforce.
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As such, accreditation is an important vehicle for institutional change, and a potential means to enhance diversity in health professions. The increasing diversity of the United States population requires that accreditation bodies be responsive to demographic changes and develop and enforce standards that ensure that health professionals are prepared to serve diverse segments of the population.
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Department of Education should strongly encourage accreditation bodies to be more aggressive in for mulating and enforcing standards that result in a critical mass of URMs throughout the health professions. Recommendations 4-2: Health professions education accreditation bodies should develop explicit policies articulating the value and im portance of providing culturally competent health care and the role it sees for racial and ethnic diversity among health professionals in achiev ing this goal.
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Transforming the Institutional Climate to Enhance Diversity The institutional climate for diversity -- defined as the perceptions, attitudes, and values that define the institution, particularly as seen from the perspectives of individuals of different racial or ethnic backgrounds -- can exert a profound influence on diversity efforts. Diversity is most often viewed as the proportion and number of individuals from groups underrepresented among students, faculty, administrators, and staff (i.e., structural diversity)
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Some elements of successful recruitment efforts include developing academic and educational partnerships with minorityserving institutions, addressing financial barriers, targeting outreach to URM students, and engaging pre-health advisors. As significantly, institutions should develop comprehensive strategies to retain URM students, by instituting a range of academic and social supports, including faculty and peer mentoring, tutoring and academic skills assessment, and teaching study skills.
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Recommendation 5-2: HPEIs should proactively and regularly engage and train students, house staff, and faculty regarding institutional di versity-related policies and expectations, the principles that underlie these policies, and the importance of diversity to the long-term institu tional mission. Faculty should be able to demonstrate specific progress toward achieving institutional diversity goals as part of the promotion and merit process.
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Eight of the eleven took the general reporting requirement approach; three took the minimum financial threshold approach. In addition, states are requiring such activities as: · community assessments to identify local unmet needs, · solicitation of community input in the development of community benefit plans, and · review of organizational mission statements to reflect a commitment to address community health needs.
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Furthermore, for publicly sponsored colleges and universities, community benefit concepts might also link governmental subsidies for these public institutions of higher education to performance measures related to student and trainee diversity goals. Community benefit principles should therefore form a conceptual cornerstone by which health professions education accreditation organizations and state governments can set expectations for the advancement of societal goals tied to racial and ethnic diversity of the health-care workforce.
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Recommendation 7-3: Broad coalitions should advocate to vigorously encourage HPEIs, their accreditation bodies, and federal and state sources of health professions student financial aid to adopt policies to enhance diversity among health professionals.
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IMPROVING THE INSTITUTIONAL CLIMATE FOR DIVERSITY. HPEIs should: · Develop and regularly evaluate comprehensive strategies to improve the institutional climate for diversity; · Proactively and regularly engage and train students, house staff, and facul ty regarding institutional diversity-related policies and expectations and the impor tance of diversity; · Establish an informal, confidential mediation process for students and facul ty who experience barriers to institutional diversity goals; and · Affiliate with community-based health-care facilities in order to attract and train a more diverse and culturally competent workforce and to increase access to health care.
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MECHANISMS TO ENCOURAGE SUPPORT FOR DIVERSITY EFFORTS include: · Additional research and data collection on diversity and its benefits; · Efforts to increase broad stakeholders' understanding of and consensus regarding steps that should be taken to enhance diversity among health profes sionals; and · The development of broad coalitions to encourage HPEIs, their accredita tion bodies, and federal and state sources of health professions student financial aid to adopt policies to enhance diversity among health professionals. REFERENCES Advisory Committee on Student Financial Assistance.
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1999. Enacting Diverse Environments: Improving the Climate for Racial/Ethnic Diversity in Higher Education.
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2001. The role of diversity in the training of health professionals.
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