“Promoting Diversity In Health Professions: Pipeline Program Case Studies & Strategies”

Dr. Jyoti Puvvula:

Why do we need a culturally and linguistically diverse workforce?  What’s important about including URM (Underrepresented minorities) in health professions?

  1. Benefits students- higher cultural competence and intellectual score measurements

  2. Makes sense from a business perspective- patients likely to go to providers from their own cultural backgrounds

  3. Promotes access to care and  service in underserved areas  

  4. Remedies the civil rights and social injustices of our history  

The US population is diverse but the health workforce doesn’t reflect that; Minorities make up less than 10% of the physician workforce.  URMs are even less so.  

So the homogenous makeup of the physician workforce represents an opportunity gap, which is described as the disparity in individual and educational outcomes due to a person’s race, gender, seuxal orientation, or civil and/or political status.  Statistically, 1 in 5 American children grow up in poverty, this is 1 in 3 for URMs.  


This is evidenced in education as early as the American elementary school system, which are more segregated today than in history.  Although overt signs of segregation, such as marking colored and white areas have been abolished, the signs of racism and therefore racial segregation are now subtle and driven by resource allocation, poverty, and political decision-making.  The system challenges URMs daily,  as evidenced by the staggeringly low rates of URMs  continuing on to higher education.  High school achievement and subsequent graduation is a fundamental barrier.  


The root cause of all these systemic inequalities is RACISM:  legally, politically, and within our educational system.  We are systematically disadvantaging swaths of our country, so when a URM’s application finally gets to the medical admissions committees, the discussion then becomes “can we take a chance”, rather than, a holistic view of resilience.  “Let’s think beyond the testing and scores to decide what makes a good physician.”


Our solutions should be twofold:

First, examine the UPSTREAM work that needs to be done.  We need to work at dismantling structures of racism, classism that make paths clear only some people to make it to higher education.


Second, the primary focus of our talk are DOWNSTREAM solutions, this is where “pipeline programs” can make an impact in increasing the diversity of students who apply to health programs.  Pipeline programs are short-term mentoring and experience programs have been shown to decrease opportunity gaps.  


These programs offering invaluable experiences, everything from application help to volunteer and research opportunities.  However, the biggest influence programs have are in mentoring and socialization aspects.  It has been shown that URM have substantially less contacts and role models in medicine and health professions more broadly.  These programs allow student to meet physicians and also “see” themselves in these professions.  


The program I run, the Summer Urban Health Fellowship (SUHF), started in 1991, at one of the first “safety net” hospitals.  Safety net hospitals primarily serve underserved communities including the homeless, indigent, undocumented and poor.   The hospital tracked patients to understand why they are coming to the ER and found that many were visiting for things like medication refills or non-acute issues, it showed a sore lack of primary care providers in th area.  Studies have shown  that making a community healthier begins with primary care, and that we need at least 1 physician for every 3000 to 3500 patients, most of these areas have patient populations that go without any preventative services.    


The SUHF targets the communities of South Los Angeles, the Watts and Jordan Downs neighborhoods and Wilmington, CA.  These two areas are primarily African-American and Latino/a and regarded as “environmentally distressed”, which means they are some of the top polluted communities in the country.  In addition, they have some of the lowest life expectancies in California.  The lead and pollution levels are considered toxic.  

Pulls up map showing chronic disease areas in CA, showing how high rates of diabetes, mental health issues etc. are in both South LA and  Wilimington in contrast to their neighbors.  SLA and Wilmington were deep red (high), while areas within five miles were green (low) for conditions.   


“The life expectancy of the communities we work in is 12 years less than their neighbors.”  These areas are also considered to have a “health professionals shortage” meaning there is a high need to recruit primary care physicians to work in these communities.  


The SUHF program has many components but mulit-level mentoring is the largest and most impactful part.  In addition, these students organize Health Fairs, learn to do needs assessments and other research with and alongside underserved communities, but primarily gain a deep understanding these communities and their strengths.  The goal is to  transform students to both practitioners and advocates.  To date, the program has been very successful with many students going into medicine and public health.  We have graduated over 600 students and 72% are URMs.   


Luis Ortega (University of Minnesota medical student) and Mary Tate, University of Minnesota Medical School Office of Diversity:

The goal of the Office of Diversity is to recruit, retain, and graduate a diverse student body translates, which then translates into a diverse faculty at UM and subsequent workforce.  A little about UM, it has two campuses, Twin Cities and Duluth.  Duluth has a  central mission to recruit students from rural backgrounds, but also those interested in primary care, rural health and native health.  


The rest of the talk focused on UM’s diverse array of pipeline programs tackling many aspects of socializing students to health.  The UM programs seemed to start as early as age 9 in getting students to think about health and health professions, as well as introducing them to medical environments, the medical school process, and focused on work within UM’s ethnically diverse communities.  


Dr. Oscar Garza, Assistant Prof of Pharmacy:

He was the founder of the PRAXIS Institute for Community Health and Education with the goal to reframe and restructure how we engage our communities in the prep of health professionals.  Preparing our future health professionals to serve the communities they want to work in.  


Video “Structural Violence in the medication experience”...

Chronicled those in the pipeline program - undergrad with pipeline youth (middle and high school students); bilateral learning and mentoring experience

  • Lack of being heard...due to language barriers or paternal

  • Students describe fear of failure but also want their stories to be heard

  • It’s important for people to know about others’ cultures

  • Asset mapping, digital stories, panels and events

  • Skills to give back to the community, so people will listen

  • Need more Latino/a doctors with Spanish skills

New course employing digital narratives, partnered students with Latino initiatives across the country!


His main point is that sometimes programs miss what the real issues, expectations and fears students carry with them when entering a pipeline program. Understanding their experience can help students leverage their strengths and assets.  In addition, the Institute was created as an intentional process “to unpack damage they’ve done as an institution” to underserved communities in the area. Their focus is on Central and South Minnesota, where the largest concentrations of Latinos reside.  However, these areas also lack most of the opportunities, which are concentrated in urban centers.  The Institute tries to bridge that gap.  

An example of how dire this issue is for Minnesota: in pharmacy UM will graduate six Latino pharmacists in the state by next year.  These pharmacists are tasked with serving the largest growing population in the state, a very difficult thing to do.  


Dr. Leonel Leiva:

Discussed DGH’s involvement in Santa Marta and the history of Cuban medical scholarship in El Salvador.  Through community vote, he was chosen from his community of farmworkers to study in Cuba from 2006-2013 to become a doctor.  

The Cuban way of life, and the difficult academic level was hard at first.  Cuban medical school also focuses on “patient narratives” and primary health care.   He and the other Salvadorans in his program succeeded in earning their degrees and returned to El Salvador in 2013.  However, they were met with resistance to practicing medicine.  Though he and others had the merit to practice (board scores of 80-90%), clear mastery of their skills, there was considerable undercutting by the Salvadoran establishment to keep them from practicing in the health system.  A new government has taken effect and they are hoping in the future they have more support since the new government has taken effect.  This conference and type of actions have helped considerably, this is how they can advocate for changes.  In addition, the medical students have created organizing by states in order to better enact health reforms.  


Q: An obvious benefit of pipeline programs are the socialization to health professions aspect.  What are pipeline programs doing in addressing students fears of perfection, the myth that students must be perfect to enter medical school?

All panelists discussed specifics in how their programs addressed fears.  It’s important to understand that the support along the way helps students succeed.  

Jyoti encouraged all health professionals to consider mentorship a personal responsibility, for example, mentoring a student after work and engaging in underserved communities.

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