In the Nation's Compelling Interest Ensuring Diversity in the Health-Care Workforce (2004) / Chapter Skim
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Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions
Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions
Pages 231-272
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Commissioned Papers Editors' Note: The following papers were commissioned by the study committee to provide additional analysis and information regarding several key areas of the study charge. For each paper, nationally known experts were asked to review available literature and draw upon their professional expertise to provide an in-depth analysis of institutional and policy-level strategies to increase diversity in the health professions workforce.
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Recent bans on affirmative action, together with persistent inequities in educational opportunity for many poor and minority students, pose major challenges for schools seeking to diversify their classes. In the face of these realities, a growing sense of urgency has emerged.
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Across the health professions, however, the authors concur that institutional commitment, strong leadership, support for comprehensive strategies, and thinking "outside the box" have never been needed more urgently. DIVERSITY IN THE HEALTH PROFESSIONS The Demographic Imperative Major advances in science and technology have enabled the quality of medical care to improve for many individuals.
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Meeting Public Health Needs Public support and investment in medical education totals more than $10 billion annually through federal Medicare and Medicaid payments alone (MedPAC, 1998)
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began to address the need for changes in medical education and developed several white papers through its Medical School Objectives Projects IIV (MSOP)
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Past challenges remain and new ones have emerged. Critical to the success of some institutions is the use of affirmative action policies that encourage and allow consideration of race/ethnicity as one among many factors considered in the admissions process.
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By 1970, the AAMC adopted a recommendation to medical schools that strongly encouraged vigorous expansion of efforts to recruit and enroll minority students. The AAMC's stated goal was "to achieve equality of opportunity by relieving or eliminating inequitable barriers and constraints to access to the medical profession" (AAMC, 1970)
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When Bakke was denied admission, he argued that the admissions process at UCDavis was discriminatory because only minority students could compete for those seats. The complexity of the Supreme Court's 1978 decision was reflected in the more than 150 pages and nine opinions necessary to express its result.
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Bollinger, involving the University of Michigan and the constitutionality of using race-conscious decisions as part of its admissions process. Although neither case directly involved medical school or other health profession admissions, the Court's ruling was widely recognized as one that would have profound bearing on the future of affirmative action in public higher education nationwide.
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Further challenges to affirmative action appear likely; if enacted, these can be expected to have similar effects. Ramifications and Implications of Affirmative Action Bans It has been estimated that if affirmative action is prohibited nationally, the number of minority medical students will decrease from 10 percent to fewer than 3 percent (Cohen, 2003)
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Scholarship programs to address the financial needs of minority students also could be ruled illegal. The Small Size of the Applicant Pool Although affirmative action policies have provided a mechanism by which higher educational institutions can -- or could -- pursue diversity initiatives, the small size of the minority applicant pool in the health professions is a persistent challenge.
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Inadequate Advising While inequities in educational opportunities for many URM students contribute to the small size of the health professions applicant pool, inadequate advising creates other less obvious dilemmas even for those students who go on to college with an interest in the health sciences. Students who experience academic difficulty in science and nonscience courses during their first year of college often seek help from premedical advisors at a critical stage in their education.
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. Because URM students are less likely than their majority peers to have role models in the health professions and a support system that encourages their educational interests, access to quality advising services is essential.
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It often drives the admissions process to identify and accept applicants who reflect its values and will embrace its educational goals and contribute to the desired learning environment. The mission will impact curricular design to enhance the likelihood that a student will learn concepts and participate in professional activities, such as research, public service, teaching, and advocacy, that reflect the school's core values.
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. Admissions committees that place the greatest weight on standardized test scores limit the opportunities of minority students to participate in the medical profession.
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Attention to Details Recruitment of a diverse class requires that admissions committees take into account the "distance traveled" by each applicant. Certain characteristics are important to consider, particularly for those students who have not had optimal access to educational opportunities.
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Over time, the composition of many medical school admissions committees has changed to reflect changes in the curriculum as well as changing expectations of accreditation bodies, graduate medical education programs, and the public. Although most committees now include basic sciences and clinical faculty, alumni, medical students, and residents, the lack of diversity of most medical school faculties is also a characteristic of their admissions committees.
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. Recruitment Efforts While the admissions process determines who is admitted to medical school, the small size of the national URM applicant pool creates the situation that many top minority students will receive more than one offer about where to enroll.
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has had a significant track record of attention to multicultural awareness and competence, recruiting of ethnic minority students, and career guidance, even before the establishment of the APA Office of Ethnic Minority Affairs in 1979. In February 1994, the APA Council of Representatives passed a resolution placing a "high priority on issues related to the education of ethnic minorities.
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The report of the ADEA president's commission, Improving the Oral Health Status of All Americans: Roles and Responsibilities (Haden et al., 2003) , summarized these disparities and cited data concerning Dental Health Professions Shortage Areas issued by the Health Resources and Services Administration's Bureau of Health Professions.
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implemented a new grant program entitled "Pipeline, Profession, and Practice: Community Based Dental Education." Through a competitive process, a total of 11 U.S. dental schools were granted approximately $1.5 million per dental school over a 5-year period.
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. Nursing The enumeration and examination of the deepening nursing shortage nationwide highlight the need in nursing, as in the other health professions, to increase the diversity of its workforce as it ensures adequate supply.
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nursing schools approaches 26 percent, as compared with 10.5 percent in medical schools and 11 percent in dental schools, 73.5 percent of nursing students in baccalaureate programs are from nonminority backgrounds. In their efforts to attract and retain minority students, nursing schools face profession-specific challenges in addition to those common to many of the health science professions.
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In several areas of the country, state legislatures have mandated that health professions schools increase the diversity of their student populations, prompting analysis and change at all points of the educational pipeline. In June 2003, DHHS awarded $3.5 million in grants to support nursing education opportunities for disadvantaged students.
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. Public health professions schools in states where race-conscious admissions policies have been forbidden are unable to use race-conscious affirmative action programs to achieve a diverse student body.
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The admissions process is inherently prone to bias that may disfavor disadvantaged and minority students by the "ease" of measuring variables related to knowledge (grades and MCAT scores) and the "difficulty" inherent in assessing the personal attributes that make an applicant particularly well suited for admission.
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Further details are available at the Texas A&M College of Medicine website, http://medicine.tamu.edu/studentaffairs/pcc01.htm. Although there have been other proposals to ignore the results of standardized tests in the medical school admissions process, the frequent use of tests for institutional accreditation and professional licensure makes such changes unlikely unless national credentialing systems change drastically.
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A preferred admissions approach is to use standardized test results as a dichotomous variable and to decide on a threshold value below which a student is not believed to be competitive for admission to medical school and above which factors other than the test scores will determine eligibility for school. With such an approach, the initial screen will be strongly weighted by standardized test scores, but the ultimate decision will rest on other measures of knowledge, skills, and personal qualities.
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Creating evaluation forms for each major goal helps to categorize these elements in the admissions process. In one model currently used by a California medical school, the knowledge assessment form evaluates the results of the MCATs and the GPA as well as the actual transcript to assess academic trends.
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For many medical students, the final step in the admissions process is based on personal choice. For students receiving offers of admission from more than one medical school, a number of factors are considered before making a final choice.
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Different approaches are used, but typical strategies include pairing current students with an accepted applicant to maintain communications and answer questions and inviting accepted applicants to a preview weekend when the school can optimally display its learning climate and diverse community. It is important to note, however, that most applicants will assess the school's commitment to diversity by looking at the numbers of minority students and faculty and the quality of enrichment and support programs in place and by considering the mission and goals of the institution.
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Medical, dental, and other health professions schools should send representatives to other campuses and undergraduate institutions as well as to community forums and fairs that hold informational sessions for prospective applicants, making special efforts to reach disadvantaged and underrepresented students. These efforts will help to ensure that students identify a health professions career as an option and that they have access to reliable information when preparing for and applying to medical school.
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1970. Report of the Association of American Medical Colleges Task Force to the Inter-Association Committee on Expand ing Educational Opportunities in Medicine for Blacks and Other Minority Students, April 22, 1970.
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Findings from the National Sample Survey of Registered Nurses. Washington, DC: Bureau of Health Professions, Division of Nursing.
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1998. Rethinking Medicare's Payment Policies for Graduate Medical Education and Teaching Hospitals.
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INCREASING DIVERSITY IN THE HEALTH PROFESSIONS 267 APPENDIX TO COMMISSIONED PAPER A DISADVANTAGED STATUS EVALUATION FORM This form is included in the folders of applicants who consider themselves disadvantaged according to the following American Medical College Application Service (AMCAS) question: "Do you wish to be considered a disadvantaged applicant by any of your designated medical schools which may consider such factors (social, economic, or educational)
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268 IN THE NATION'S COMPELLING INTEREST Additional factors indicated (e.g., physical handicap, immigrant, experience with prejudice, special family situation/responsibilities, cultural differences)
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INCREASING DIVERSITY IN THE HEALTH PROFESSIONS 269 20022003 ADMISSIONS SEASON MD FILE REVIEW FORM Please circle your scores for each category.
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Indicate specific aspects of the application that an interviewer should clarify during the interview. INTERVIEW FORM Name of Candidate:_____________________ Date of Interview: _______ Undergraduate University:________________Time of Interview: _______ Interviewer:_____________________________Place of Interview: _______ Note: The interview report should provide the Admissions Committee with more information about the candidate's apparent strengths and weaknesses and should supply information that is not evident from the file.
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8) Please evaluate the educational context of this applicant with respect to high school education; parental income, education, and occupation; hours per week of work during college; geographic location where applicant grew up; prior experiences with prejudice; cultural and language barriers or other special family circumstances.
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1 2 3 1 A must-have candidate, with evidence of independent thinking and creativity, potential for an academic medicine career or leadership role, outstanding depth of education and community service activities, and a contribution to the learning environment and diversity of the school. 2 An excellent candidate who may have an outstanding track record in one or more areas of interest to us but lacks the special qualities of our top applicants.
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