In the Nation's Compelling Interest Ensuring Diversity in the Health-Care Workforce (2004) / Chapter Skim
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5 Transforming the Institutional Climate to Enhance Diversity in Health Professions
5 Transforming the Institutional Climate to Enhance Diversity in Health Professions
Pages 143-177
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From page 143... ...
The chapter begins by providing a framework for understanding how the institutional climate influences diversity efforts and how diversity is linked to the educational mission of health professions training institutions. Second, the chapter reviews literature that assesses the impact of racial and ethnic diversity in educational settings on student and institutional outcomes.
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Institutional diversity efforts, however, cannot be developed and implemented without adequate resources to invest in programming, training, support services, and other tools that are an important aspect of a comprehensive diversity plan. · The need for planning and evaluation.
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The institutional climate is influenced by several elements of the institutional context (see Figure 5-1) , including the degree of structural diversity, the historical legacy of inclusion or exclusion of students and faculty of color, the psychological climate (i.e., perceptions of the degree of racial tension and discrimination on campus)
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Each of the dimensions of the institutional climate may influence diversity efforts, in both positive and negative ways.
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While the majority of this research has been conducted with undergraduate students, many of the principles regarding diversity's benefits extend to health professions training settings (Tedesco, 2001) , as will be discussed below.
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, and prior scores on learning outcome measures. In the national sample, informal interactional diversity was especially significant for all four racial/ethnic groups in predicting intellectual engagement and academic skills, as was the impact of classroom diversity on these measures for white and Latino students.
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also assessed the relationship between undergraduate students' diversity experiences and their assessments of civic, job-related, and educational outcomes. Using longitudinal data from nationwide surveys of students and faculty, Hurtado found that students who reported that they studied with someone of a different racial or ethnic background while in college were more likely upon one-year follow-up to report having greater acceptance of people of different racial/ethnic groups, greater cultural awareness, greater tolerance of people with different beliefs, a greater ability to work cooperatively with others, and greater critical thinking skills, among a range of other learning, job-related, and civic outcomes.
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, in a survey of recent Harvard and University of California, San Francisco, medical school graduates' attitudes regarding diversity in medical education, found that students reported experiencing greater levels of diversity in medical school than in their prior educational experiences, as the percentage of students reporting contact with other groups increased from 50 percent prior to college to 85 percent in medical school. These trends were true for majority group as well as URM students.
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he costs of this persistent and BOX 5-1 Racial and Ethnic Segregation in Detroit-Area Schools Schools in the Detroit metropolitan area are among the most segregated in the nation, although many metropolitan school districts are also characterized by high levels of segregation: · In 60 of the 83 school districts in the three-county Detroit metropolitan area, the black student population is 3 percent or less; · 82 percent of African American students attend schools in only three dis tricts; · More than 90 percent of the area's white students attend schools in districts with black student populations under 10 percent; · Only two school districts in the area come close to reflecting the overall proportions of the Detroit metropolitan region's African American, Latino, and white students (University of Michigan, 2000)
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HOW CAN HEALTH PROFESSIONS TRAINING PROGRAMS ENSURE THE SUCCESS OF DIVERSITY EFFORTS? As noted above, efforts to improve the structural diversity of higher education institutions are a positive first step, but alone they are insufficient to improve the institutional climate for diversity and ensure that diversity benefits both students and the institution.
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2. Systematically assess the institutional climate for diversity in terms of historical legacy, structural diversity, psychological climate, and behavioral elements to understand the dimensions of the problem.
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The report's recom mendations fell into six broad areas: structuring and communicating the institu tion's commitment to improving the climate for diversity; changing institutional foundations to promote multiculturalism; improving academic programs; recruiting and retaining diverse students, faculty, and staff; creating a process to facilitate communication and handle grievances; and providing additional resources to pro mote multiculturalism and diversity. As a result of this process, the School of Dentistry initiated a process of orga nizational change, with the goal of building a community of diverse students, facul ty, and staff in which all members can gain awareness and skills regarding diversi ty issues.
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Contact between students and faculty outside of class is associated with higher student achievement, yet URM students report lower levels of such contact. Institutions should develop programs and incentives to encourage broad segments of students to interact formally and informally with faculty.
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Ensure that programming for diversity involves general support services as well as coordinated activities and support programs for URM students. Administrators and faculty sometimes express concern, appropriately, that URM students may "self-segregate" on predominantly white campuses.
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In addition to providing support for URM students as role models and mentors, racially and ethnically diverse faculty can be expected to "bring new kinds of scholarship to an institution, educate students on issues of growing importance to society, and offer links to communities not often connected to our campuses" (Smith, 2000, p.
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. Given the important benefits of faculty diversity for enhancing institutional diversity efforts, what are some successful strategies that health professions training institutions can adopt to improve faculty diversity efforts?
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URM faculty can assist in these efforts. Identifying and recruiting qualified URM candidates for faculty positions can be improved by utilizing active search processes, Smith argues, that go beyond simply posting positions and recruiting though networks that are familiar to the faculty.
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Health professions training institutions have experimented with a wide range of strategies to recruit URM students, with varying degrees of success. Recruitment efforts are affected by a number of factors, such as the quality of primary and secondary education for URM students, changes among students in career interests, competition from other nonhealth fields for talented students (e.g., almost all health professions schools have seen modest declines in the overall number of applicants since the late 1990s; Grumbach et al., 2001)
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Retention of URM Students Recruitment, admission, and matriculation of URM students represent only the first steps for health professions training programs to ensure successful educational experiences for URM students. While data are not uniformly available for all health professions, URM medical students experience higher rates of academic failure, withdrawal, and lower graduation rates than non-URM medical students (Rainey, 2001)
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In 2000 2001, the number of minority applicants increased 84 percent, and the school's minority enrollment increased 43 percent. Some of the school's specific steps have been to: · develop outreach materials in Spanish and target information to URM stu dents' parents regarding the shortage of American Indian, Hispanic, and African American nurses; · develop a system to attract URM potential recruits and follow-up with per sonal contact; · recruit in minority communities and encourage families to attend an "explor atorium for kids," with current nursing students on hand to teach children about nursing (Rosseter, 2002)
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to promote interest among African American students in careers in research psychol ogy. Undergraduate students from AUC colleges are selected to participate in the program, which provides mentoring and exposes students to psychological re search.
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. In developing and implementing student academic and social support programs, many HPEI administrators are often faced with the question of whether to target programs to URM and other students at risk for academic difficulties, or to provide remedial and support services to all students, regardless of background and prior levels of preparation.
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. Transforming the Health Professions Education Curriculum In many health professions training settings, the curriculum is perhaps the most resistant to change (Rainey, 2001)
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. Cross-cultural education strategies -- defined as programs to help trainees to understand the sociocultural dimensions underlying a patient's health values, beliefs, and behavior, with the goal of preparing trainees to care for patients from diverse social and cultural backgrounds and to recognize and address racial, cultural, and gender biases in health-care delivery -- are increasingly being developed and implemented in medical, dental, nursing, and professional psychology training settings (Brach and Fraser, 2000)
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In addition, cross-cultural education programs may assist in efforts to attract URM students to health professions education (e.g., URM students may have greater interest in HPEI programs that include significant cross-cultural education components) , and to develop a supportive institutional climate for diversity.
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382) ; · The quality of education, training, and research in psychology can be enhanced by understanding the interface between racial and ethnic group affiliation and socialization experiences; · The understanding and treatment of all people can be enhanced by understanding how race and ethnicity intersect with other dimensions of identity, such as gender, age, sexual orientation, disability, and other factors; BOX 5-5 Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists Commitment to Cultural Awareness and Knowledge of Self and Others Guideline 1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their percep tions of and interactions with individuals who are ethnically and racially different from themselves.
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Some common elements of successful strategies include efforts to: · conduct a self-assessment, identify areas where support for diversity efforts must be improved, and develop a strategic plan for improvement; · recruit URM applicants; · reduce barriers to the admission of URM students, while maintaining the academic quality of admits; · reduce financial barriers to URM student participation; and · recruit URM faculty. Columbia University's School of Dental and Oral Surgery (SDOS)
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This created an opportunity for SDOS and the dental department at Harlem Hospital to collaborate to develop a postdoctoral specialty training program for dentists completing their residency at Harlem Hospital. The residents, who were mainly African American and Hispanic, were required to commit to service in the community as members of the hospital staff, or as faculty in the dental school and/ or in practice in the Harlem community.
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. SUMMARY AND RECOMMENDATIONS The institutional climate for diversity -- defined as the perceptions, attitudes, and expectations 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.
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More importantly, the institutional climate is malleable and can be altered through systemic intervention efforts aimed at each of the elements of the institutional context. Research on Diversity and Learning A growing body of research demonstrates that college students, of all racial and ethnic backgrounds, benefit from interaction with a diverse group of college student peers (see also discussion in Chapter 1)
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To begin, institutions should carefully examine their mission statement and assess how faculty diversity assists the institution to meet its goals. Identifying and recruiting qualified URM faculty candidates can be improved by utilizing active search processes that go beyond simply posting positions and recruiting though networks that are familiar to the faculty.
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that affect the success of institutional diversity efforts. These strategies include, but are not limited to efforts to: · recruit and retain URM students and faculty through a range of academic and social supports, including but not limited to mentoring programs, academic supports, and other strategies integrated into on going programs; · educate faculty and students regarding the benefits of diversity to the institutional mission; and · encourage participation by diverse faculty on core institutional committees, including but not limited to admissions, faculty search, internal review, and promotions and tenure.
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(2003) illustrate, training affiliations with community-based health-care facilities can increase access to health care among diverse patient populations and attract more URM students and faculty to training settings.
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1998. Enhancing campus climates for racial/ethnic diversity: Educational policy and practice.
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2001. Increasing diversity benefits: How campus climate and teaching methods affect students outcomes.
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