To Achieve Diversity of Doctors, Start in Pre-Med Years

Newswise — ANN ARBOR, Mich. -- Twenty years ago, the call went out to medical schools: It was high time to “bridge the appalling diversity gap that separates medicine from the society it professes to serve.”

It wasn’t just a call for equal access to the profession – it was a call to improve public health. Studies were clearly showing that diversity among doctors meant better health for patients of color, better access for the poor and underserved, and more.

And yet, 20 years later, medical school classes are only slightly more diverse than they were in 1997. Meanwhile, the country’s mix of people with different skin colors, economic backgrounds and family immigration and education histories has gotten even more diverse.

What can move the needle on diversity in the physician pipeline?

Starting further up the pipe, says a team of University of Michigan Medical School researchers who have studied the issue.

In a new article in the journal Academic Medicine, they lay out the case for focusing on the very youngest college students who have an eye on medical school or another health-related graduate program.

They lay out evidence from other studies, and from their own evaluation of a U-M pre-med program. And they conclude that the support and training a student gets in the earliest years of pre-med studies can make or break his or her chances of going on to medical school or other graduate health sciences training.

Many students from groups that are underrepresented in medicine (URiM) fall out of the pre-med pipeline during college. They do so at higher rates than students from backgrounds that are represented in the medical profession at the same or higher levels than their proportion of the entire population – despite the fact that URiM and non-URiM students indicate the same interest in science at the start of college.

While historically the measure known as URiM focused on race and ethnicity, it now also includes students whose families have lower incomes, or who are the first in their families to go to college.

“We are learning that intentional connections between medical faculty and premedical students are incredibly important,” says Adrianne Haggins, M.D., the U-M Medical School who co-authored the new study. “We will be able to improve diversity in medicine only if we are able to create and sustain these links.”

The researchers cite studies of programs for URiM students at Stanford University and the Rutgers New Jersey Medical School.

They also present new data from the Health Sciences Scholars Program at U-M, which incoming freshman from any background can apply to if they know they have an interest in a medical, nursing, dental, pharmacy or public health career.

Each year, 120 students from a broad range of backgrounds enroll in the HSSP, which brings students together for classes, a living and learning community in a residence hall, counseling and opportunities to interact with healthcare and research professionals, develop their leadership skills and get academic support.

The program began in 2001, when health-related schools and colleges across U-M got together to address the call for better diversity. Admissions officers consider many demographic factors, including parents’ income and education. They also target high schools with large proportions of URiM students for recruitment.

In all, 1,065 students took part in HSSP in its first 10 years, and one in five was African-American, Hispanic or Native American. Of those students, 22 percent were the first in their families to go to college, and just over 10 percent had family incomes under $50,000.

The researchers surveyed these program alumni in 2015, and they overwhelmingly said they would recommend HSSP to others. Already, 15 percent of the entire HSSP alumni group had graduated from or were currently in medical school. Among members of URiM groups, 37 percent were in or had graduated from a graduate program in a health profession – including 11 percent who were in or had finished medical school.

“As the former director of the HSSP, I saw first-hand the vital role of mentorship and role modeling for students from backgrounds that are underrepresented in medicine,” says Helen Morgan, M.D., who led the program for several years and is an assistant professor of obstetrics and gynecology and of learning health sciences. “These relationships can set a foundation for success for these promising students to pursue careers in health care and medicine.”

The kind of assistance the HSSP offers can help students over some of the hurdles that might otherwise cause them to give up on a goal of becoming a physician or other healthcare professional. Factors such as bad grades in chemistry class have been shown to have such a defeating effect, and cause URiM students to leave the pipeline. So can constrained financial resources.

Paula Ross, Ph.D., a co-author of the new paper and director of advancing scholarship at the U-M Medical School, notes, “It is important to focus on the success of these students, rather than their deficits, as a strategy for improving diversity in medicine.”

In the end, the U-M team calls for more institutions and education researchers to see the pre-med years as crucial to the future diversity of the physician community. More data on the effects of programs aimed at pre-college and pre-med undergraduates, especially those from URiM backgrounds, is sorely needed, they add.

Even once a URiM student completes an undergraduate education that prepares them for medical school, other programs to help them further are already in place at medical schools and in residency programs. These multiple “touch points” can help bolster their chances of success.

“It is critical for the healthcare workforce to reflect the diversity of those they serve,” says Monica Lypson, M.D., MHPE, professor of medicine and a former assistant dean for graduate medical education at U-M, and associate chief of staff for education at the VA Ann Arbor Healthcare System. “In order to ensure a diverse workforce we must look at all aspects of the pipeline. Academic medicine must work to support efforts to diversify the pre-health professional arena. One key way to do that is by providing mentoring, coaching and sponsorship to pre-health professional students, medical students, residents and junior faculty.”

Reference: Academic Medicine (online first) doi: 10.1097/ACM.0000000000001404