The Importance of Diversity in Academic Medicine

Transcription

1 Building the Next Generation of Academic Physicians Initiative A Commitment to the Diversity of the Pipeline into Academic Medicine 1 Norma Poll-Hunter, PhD Director, Human Capital Diversity Policy and Programs, Association of American Medical Colleges John Paul Sanchez MD, MPH Principal Investigator, Building the Next Generation of Academic Physicians (BNGAP) Initiative, Albert Einstein College of Medicine Nicole Stern MD President, Association of American Indian Physicians Association of American Indian Physicians National Conference August 3, 2013

2 Presentation Objectives 2 To describe the representation of Native Americans in the physician and academic medicine workforces To describe the importance of targeting Native American medical students and residents for development as future academicians To discuss results from a 2012 study on Native American perspectives on academic careers

3 Definition of Academic Medicine 3 traditional tripartite mission of educating the next generation of physicians and biomedical scientists, discovering causes of and cures for disease, and advancing knowledge of patient care while caring for patients We strongly feel that it is the 'added value' or the synergy that should exist between these three roles-when they are brought effectively together-that defines academic medicine Kanter SL. What is academic medicine? Academic Medicine. 83 (3), March 2008.

4 Physician Workforce: Representation vs. Critical Mass 4

5 A Diverse Physician Workforce is Critical 5 Having a diverse physician workforce is a critical component in making health care and research available to/for those who need it most. The lack of diversity of medical students, coupled with ineffective cultural competency education, continues to produce training and treatment environments that are biased, intolerant and contributory to health disparities. AMSA. Enriching Medicine Through Diversity 2012

6 A Diverse Academic Medicine Workforce is Critical 6 To facilitate access and meet the needs of the underserved population, it is imperative that the institutional climate and healthcare workforce seek to resemble the diversity portrayed by our nation s population. Diversity should achieve health equity and reduce health disparities through culturally sensitive and patient-centered care. The Liaison Committee on Medical Education (LCME) accreditation standard: Each medical school must develop programs or partnerships aimed at broadening diversity among qualified applicants for admission recognizing our collective responsibility in care of our communities. Accreditation Council for Graduate Medical Education (ACGME): the competencies also recognize the skills needed to care for our communities.

7 Diversity in Academic Medicine Faculty 7 NIH found that minority investigators are less likely to be funded despite similar achievements. (Ginther et al.) URM junior faculty have reported distinct obstacles in comparison to their counterparts to achieving academic promotion. (Palepu et al.) Academic success can be accomplished with mentorship that honors the Native American women s responsibility to her culture over time (with clinical and academic opportunities) while also assisting with development of appropriate academic skills and opportunities (Elliot et al.)

8 Medical Student Interest in Academic Medicine Intent on career in Academic Medicine EVOLUTION OF ACADEMIC MEDICINE CAREER INTENTIONS Matriculating Student Questionnaire Graduation Questionnaire URM s more likely to show diminishing intent A lower proportion of URM medical students than non-urm medical students reported interest in an academic medicine career upon entering medical school (AAMC Matriculating Student Questionnaire). At the end of medical school, URM in comparison to non-urm continued to express significant disinterest interest in academic medicine careers (AAMC Graduate Student Questionnaire). Yr 1 Years in Medical School Yr 4 Jeff et al.reaping what we sow: the emerging academic medicine workforce J Natl Med Assoc Sep;100(9): Is interest re-cultivated during residency? NO. Straus et al. in their systematic review of the literature on career choice in academic medicine found that as residents progress through residency they become less interested in this area, highlighting the need to do a better job promoting and cultivating career interests in academic medicine among trainees in their formative training.

9 Develop a diverse academic medicine workforce that will train medical students and residents to effectively address evolving health care needs and work towards health equity in the U.S.

10 Collaboration 10 LMSA Michael Lopez E-Board AAIP NHMA Elena Rios A growing Initiative (institutional partnerships) AMA Baligh Yehia E-Board

11 Building the Next Generation of Academic Physicians Conduct an initial and ongoing assessment of medical student, LWW resident, Research Report and faculty interest in, pursuit of, and XXX success along an academic medicine career. Racial and Ethnic Minority Medical Students Perceptions of and Interest in Careers in Academic Medicine J.P. Sánchez, MD, MPH, Lutheria Peters, MPH, Elizabeth Lee-Rey, MD, MPH, Hal Strelnick, MD, Gwen Garrison, PhD, Kehua Zhang, PhD, Dennis Spencer, PhD, Gezzer Ortega, MD, MPH, Baligh Yehia, MD, MPP, MSHP, Anne Berlin, MA, and Laura Castillo-Page, PhD Research Report Develop and implement a strategy to assist a diverse group of medical students, residents, and faculty interested in academic medicine in assessing and achieving their personal and professional goals. Abstract Purpose To describe diverse medical students perceptions of and interest in careers in academic medicine. Method In 2010, the authors invited students attending three national medical student conferences to respond to a survey and participate in six focus groups. The authors identified trends in data through bivariate analyses of the quantitative dataset and using a grounded theory approach in their analysis of focus group transcripts. Results The 601 survey respondents represented 103 U.S. medical schools. The majority (72%) were in their first or second year; 34% were black and 17% were Hispanic. Many respondents (64%) expressed interest in careers in academic medicine; teaching and research were viewed as positive influences on that interest. However, black and Hispanic respondents felt they would have a harder time succeeding in academia. The 73 focus group participants (25% black, 29% Hispanic) described individualand institutional-level challenges to academic medicine careers and offered recommendations. They desired deliberate and coordinated exposure to academic career paths, research training, clarification of the promotion process, mentorship, protected time for faculty to provide teaching and research training, and an enhanced infrastructure to support diversity and inclusion. Conclusions Medical students expressed an early interest in academic medicine but lacked clarity about the career path. Black and Hispanic students perceptions of having greater difficulty succeeding in academia may be an obstacle to engaging them in the prospective pool of academicians. Strategic and dedicated institutional resources are needed to encourage racial and ethnic minority medical students to explore careers in academic medicine. Research Facilitate and evaluate the Report outcomes and impact of this initiative. Academic Medicine xxx September /ACM.0b013e31829f87a7 Numerous studies have described efforts to assess racial and ethnic minority physicians interest in careers in academic medicine and to address the obstacles that they may face. 1 6 Yet despite institution-level and broader federal efforts, there has been minimal growth in the representation of racial and ethnic minorities in the academic medicine workforce over the past decade. 7 In 2010, 28.6% of the U.S. population selfidentified as black or Hispanic; however, blacks and Hispanics constituted just 12.5% of physicians and 6.9% of medical school faculty. 7,8 Given that Please see the end of this article for information about the authors. Correspondence should be addressed to Dr. Sánchez, Building the Next Generation of Academic Physicians Initiative, Hispanic Center of Excellence, Albert Einstein College of Medicine, 1300 Morris Park Ave., Mazer 4th Floor, Bronx, NY 10461; telephone: (718) ; john.sanchez@einstein.yu.edu. Acad Med. 2013;88: First published online doi: /ACM.0b013e31829f87a7 Supplemental digital content for this article is available at medical students serve as a major source of prospective faculty, understanding their views about academia may play an important role in identifying ways to increase racial and ethnic minority inclusion in the academic medicine workforce. Because of the limited number of studies probing the perceptions of trainees, however, relatively little is known about racial and ethnic minority medical students interest in academia The limited research that exists indicates that female and MD-PhD students, but not students in racial and ethnic minority groups, are pursuing academic medicine as a career option. 12 This finding may be related to the creation of a more nurturing institutional climate through institutional, national, and federal workforce interventions for female and MD-PhD students. 1 Jeffe and colleagues 12 found that racial and ethnic minority medical students were less likely than their white counterparts to report an interest in pursuing academia on medical school entry and were more likely to report diminished intent on graduation. Additionally, Andriole and colleagues 13 found that among recent medical school graduates, being female or an MD-PhD program graduate was independently associated with a greater likelihood of full-time faculty appointment, whereas race and ethnicity were not. Little else is known about when, why, and how racial and ethnic minority medical students make their decisions about academia. 1,9 To contribute to the understanding of diverse medical students perceptions of academia, we designed a mixedmethods study to explore their awareness of, interest in, and preparedness for pursuing careers in academic medicine. By recruiting participants at meetings of three national medical student organizations, we were able to collect substantial data from black and Hispanic students to allow for comparisons with other racial and ethnic groups. Method Given the lack of prior research on medical students perceptions of academic medicine careers, we employed Academic Medicine, Vol. 88, No. 9 / September Copyright by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.

12 STUDY Native American Presence in and Perspectives on Academic Careers

13 QUANTITATIVE RESULTS Native Hispanic Black White Asian Other P How interested are you in academic medicine as a career I know which personal activities and achievements are important to document for a career in academic medicine I do not have sufficient guidance to develop a publishable research project Racial and ethnic minorities have a harder time succeeding in academic medicine American Value

14 QUANTITATIVE RESULTS Mean rating by educational level Medical Student Resident/Fellow n=5 Faculty N=45 Survey items n=17 Choose the best response for the interest/attitude and support statements I know which personal activities and achievements are important to document for a career in academic medicine

15 Responses for this item ranged from very satisfied (scored as 1) to very dissatisfied (scored as 5). Responses for this item ranged from very interested (scored as 1) to very disinterested (scored as 5). Responses for this item ranged from 1 = very positive to 5 = very negative. Responses for this item ranged from 1 = strongly agree to 5 = strongly disagree. QUANTITATIVE RESULTS Mean rating by educational level Medical Student Resident/Fellow Faculty Survey items There are numerous opportunities at my institution for me to develop teaching skills I do not have sufficient guidance to develop a publishable research project Racial and ethnic minorities have a harder time succeeding in academic medicine n=17 n=5 N= Responses for this item ranged from very satisfied (scored as 1) to very dissatisfied (scored as 5). Responses for this item ranged from very interested (scored as 1) to very disinterested (scored as 5). Responses for this item ranged from 1 = very positive to 5 = very negative. Responses for this item ranged from 1 = strongly agree to 5 = strongly disagree.

16 FOCUS GROUP RESULTS Medical Student Resident/Fellow Faculty Female Male

17 FACULTY FOCUS GROUP THEMES: Attraction Factors Love of teaching, and increasing the number of Natives were a major drivers of interest in academic medicine Majority of participants were involved in academic medicine by supporting GME; however, appeared to be a tenuous connection due to institutional definitions of being faculty Ability to work with Natives more likely to make academic medicine more attractive

18 FACULTY FOCUS GROUP THEMES: Challenges Institutional climate and culture issues were prominent in keeping individuals away from academia politics; not feeling like part of the institution; misalignment with cultural values IHS payback made it a challenge to stay or return to academia Most prominent theme identified as a challenge is lack of career development information pathway to academic career, developing a portfolio, and salary information

19 FACULTY FOCUS GROUP THEMES: Increasing Diversity Share that academia is a place to further interests beyond just clinical care Start early with career awareness Increase Natives in the pipeline Recruit IHS and tribal physicians to become clinical faculty Bring residents to reservations Improve access to information about careers in academic medicine

20 STUDENT & RESIDENT FOCUS GROUP THEMES: Attraction Factors Developing the next generation of medical students through mentoring and role modeling Opportunity to conduct research Interest in teaching Mentors play a significant role in interest in academia

21 STUDENT & RESIDENT FOCUS GROUP THEMES: Dissuading Factors Perceived need to be top of class to join faculty ranks Dealing with politics and bureaucracy Disinterest in research Concerns about securing research funding Self-doubt about being good enough Experiencing racist and discriminatory attitudes and behaviors

22 STUDENT & RESIDENT FOCUS GROUP THEMES: Important Considerations Inevitability of being a mentor or role model Importance of traditional medicine Passing on cultural ways Blending or balancing traditional and Western medicine Feeling guilty for not practicing

23 FACULTY FOCUS GROUP THEMES: Increasing Diversity Quality of K-16 education is a major issue Improving students test taking skills Role of parenting is key Presence of diverse leadership is key, in particular Native faculty Increasing overall number of Natives in pipeline

24 Discussion 24 What findings were surprising about faculty?...about students and trainees? What do you think is missing from the faculty perspective?...student or trainee perspective? How can AAIP strengthen efforts to help faculty thrive in academic medicine? How can AAIP nurture the next generation of academics?

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26 QUESTIONS? Norma Poll-Hunter J.P. Sanchez Nicole Stern

27 Norma POLL INSTITUTIONAL ADVISORS MENTORS ORGANIZATIONAL LEADERS MISSY BEGAY CHAMPIONS SUPPORTERS