Developing Racial and Ethnic Diversity in Iowa’s Physician Workforce – Recruiting Minority Students and Faculty Des Moines University College of Osteopathic Medicine

Presenters: Carolyn L. Beverly, M.D., M.P.H. Assistant Professor, Family Medicine, COM Medical Director, College of Health Science Project Director Mary Pat Wohlford-Wessels, Ph.D. Former Associate Professor, Family Medicine Assistant Dean, Academic Quality and Medical Education Research, Des Moines University, COM Project Associate Currently Vice President, Institutional Effectiveness, Kansas City University of Medicine and Bioscience, COM

Acknowledgement This project was made possible by grant number 1 D1DHP from the Bureau of Health Professions, Health Resources and Services Administration, U. S. Department of Health and Human Services. DMU’s proposal was funded through the Iowa Department of Public Health.

Diversity at Des Moines University Like all post-secondary educational institutions in Iowa, Des Moines University (DMU) has experienced some challenges in recruiting and retaining a well qualified diverse student population. The same challenges exist with hiring an appropriately diverse faculty in the University’s College of Osteopathic Medicine (COM).

Diversity in Medical Education Two data sources were used to develop the background for this project and presentation – the AACOM Annual Report & the AAMC Minority Report.

Diversity in Medical Education The AACOM 2004 Annual Report: Underrepresented minorities (URMs), (Black/African American, Hispanics and Native Americans), have kept pace with, but not gained on other groups in terms of enrollment. Students from the Asian/Pacific Islander minority group have steadily increased their share of first-year and total enrollment.

Diversity in Medical Education Underrepresented minorities were 8.3% of total first-year enrollment in , somewhat below the level of a decade ago. Asian/Pacific Islanders have increased their share of first-year enrollment from about 10% to more than 15% over the decade.

Diversity in Medical Education A similar pattern exists in total enrollments, with URMs generally maintaining a level share, and the Asian/Pacific Islanders’ share rising to its current level of 15.4% of total enrollment.

Osteopathic Medical School Enrollment - Total Enrollment of Ethnic Minority Groups by School (03-04)

Osteopathic Medical Schools - Total Enrollment of Ethnic Groups

Diversity in Medical Schools AAMC Data Source: Minorities in Medical Education; Facts and Figures 2005 In 2004, Blacks constituted 7.8% and Hispanics constituted 7.1% of all applicants. Of all minority applicants in 2004, Asians were the largest group (nearly 19%). In 2004 nearly half (49.4%) of all applicants to medical school were accepted. Of the total number of Hispanic applicants 48.8% were accepted, and of Black applicants, 41.3% were accepted.

Medical School Applicants by Race and Ethnicity, AAMC

Medical School Applicants by Race and Ethnicity, 1974 – 2004 AAMC

Total Enrollment by Ethnic Group (03-04)

Medical School Faculty by Race and Ethnicity – AAMC 2004

Medical School Faculty by Rank within Race and Ethnicity

In Summary - National Issues Medical Schools have made significant investments in minority student recruitment, yet the yield is less than expected, this is especially true for underrepresented minorities. The same old recruitment strategies have not worked – medical schools may need to invest in innovative programs. Medical Schools do not have sufficient minority faculty mentors – in the basic sciences or among clinical faculty.

DMU’s Funded Recruitment Project Two Objectives:  Student Recruitment African American & Hispanic  Physician Recruitment African American & Hispanic  Lecturers  Clinical Preceptors  Mentors

Enrollment in Iowa’s Medical Schools University of IowaDes Moines University Class Size Class Size Under represented minority (2005) 14%4% Other Minority (2005)7%16%

Student Objective – Two Components Focus Group Research and Survey Research Focus Group Research – to determine student perceptions related to:  being a minority  having minority faculty and preceptors  the three most important determinants in selecting a medical school  solicit feedback to be used in the development of a survey instrument

Focus Group Themes Regarding Student Perceptions Hispanic vs. African American Students perceptions A parent or teacher had significant influence on the students decision to attend medical school Wanted to be perceived as excellent students, rather than minority students Little identification with their minority status Didn’t feel the need to be connected to a minority community Generational Passion (facilitator vs. student expressed passion)

Influence to become a physician

Influence – AAMC 2004

Top 5 Influences on Becoming Physicians DMU StudentsAAMC Science Course1. Health-Related Work Experience 2. Parent2. Experience with Illness/Accident 3. Health-Related Work 3. Science Course Experience4. Physician 5. Experience with 5. Parent Illness/Accident

Reason Student Chose DMU

AAMC 2004 data

Top 5 Reasons Why Students Selected Their Schools DMU ReasonsA A M C 2004 R e a s o n s Hispanics/BlacksHispanicsBlacks 1. Friendliness of school1. Location1. Friendliness 2. Reputation2. Friendliness2. Teaching Methods 3. Teaching Methods3. Teaching Methods3. Community Experience 4. Curriculum4. Reputation4. Curriculum 5. Ability to Place Residents5. In-State School5. Ability to Place Residents

Minority Mentors

DMU students were asked how important it is to have opportunities to work with minority mentors during medical school— Top 5 Answers, most to least importance: 1.Being able to serve minority populations in the future 2.Being able to work in an underserved area 3.Serving as a minority physician mentor in the future 4.Being mentored by a minority physician 5.Minority clinicians during year 3 and 4

The importance of minority basic science faculty was ranked second to last out of 11 items; and the importance of minority researchers ranked dead last!! All URM COM students believed that there was not sufficient content regarding minority health and cultural competence in the curriculum.

So What is DMU-COM Doing To Address This Situation?

1. Office of Enrollment Management Eight person staff committed to increasing diversity enrollment among students in all of the 3 Colleges on DMU campus.

Strategies for Increasing Minority Enrollment: Identify and participate in events targeted to under-represented minority undergraduate students with an interest in the health professions

Targeting Underrepresented Minority Undergraduate Students: McNair Scholars Programs—a TRIO program Student National Medical Association (SNMA) National Black Graduate Student Association (NBGSA) Society for Advancement of Chicanos and Native Americans in Science (SACNAS)

Targeting Underrepresented Minority Undergraduate Students: National Association of Minority Medical Educators (NAMME) AAMC identified schools with highest number of URM applicants to medical schools Historically Black Colleges and Universities (HBCU); Hispanic Association of Colleges and Universities (HACU)

Strategies for Increasing Minority Enrollment, con’t: Assist in identifying URM candidates for DMU-sponsored diversity scholarships, such as the Glanton Scholarship

Minority Recruiting Activities Began tracking number of URM students with whom they came in contact with during recruiting events  Feb-Jun 06: approx. 150 under graduates self-identified as URMs  23 undergraduate institutions with significant URMs were visited

Minority Recruiting Activities  McNair Scholars Conference and Graduate School Fair  North Carolina Area Health professions recruiting Fair  Past attendees of the Medical Summer Institute will receive mailings encouraging applications to DMU-COM

Planning Minority Recruiting Activities NAMME Natl. Conf. and Recruitment fair Central Michigan University SNMA Premed. Student Conf. and Med. School Fair 2 separate McNair Scholars conf. and recruiting fairs SNMA and NBGSA Annual Conferences SACNAS Natl. Conf. AAMC Minority Student Med. Career Awareness Workshop/Recruitment Fair HACU Annual conf. and college fair Annual Biomedical Research Conf. for Minority Students

06-07 Visits to undergraduate institutions with high minority enrollments Mississippi Tour Tennessee Tour George Wash. Univ. New York Univ. Univ. of TX El Paso New Mexico State Univ. of OK Florida Atlantic Univ. Univ. of Michigan/Michigan State UT Austin/San Antonio Univ. of IL Chicago/Urbana- Champaign Loyola and Xavier

Enrollment Office Abbreviations TRIO Programs: Sponsored by the US Dept. of Education—educational opportunity outreach programs designed to motivate and support students from disadvantaged backgrounds. They include 2 outreach and support programs targeted to serve and assist low-income, first- generation college students and students with disabilities to progress through the academic pipeline from middle school to post baccalaureate programs.

Enrollment Office Abbreviations NAMME: National Association of Minority medical Educators SACNAS: Society for Advance of Chicanos and Native Americans in Science HACU: Hispanic Association of Colleges and Universities

2. Department of Educational Support Services Efforts 1.Raise awareness of students to implicit biases they may have regarding persons different than themselves  They take several Implicit Attitude Tests regarding race, gender, sexual orientation and religion—interactive web-based ways to uncover hidden biases.

Department of Educational Support Services Efforts 2. “Campus climate” survey to assess current perception of how well the university is doing in the area of diversity promotion and acceptance—for students; staff; faculty; and administration

Department of Educational Support Services Efforts 3.Minority student focus groups to:  assess the university’s strengths and weaknesses in attracting and retaining students of diverse backgrounds  identify ways to enhance students’ future experiences and opportunities while at DMU

Summary We’re not sure we know what prospective minority students want and expect. Our student responses to our survey are different from the 2004 AAMC responses. More information is needed to determine the best recruiting strategies; what we’ve invested in hasn’t produced a difference in yield. Some schools are doing a great job, and we could learn from them.

Minority Population and Practicing Physicians in Iowa Race% of Population in Iowa % of Physicians in Iowa African American Hispanic4.60.9

Physician Recruitment Objective  Physician Recruitment—add five additional physicians to our adjunct faculty African American & Hispanic  Lecturers  Clinical Preceptors  Mentors

Physician Recruitment Choice of underrepresented minorities targeted  IA Chapter of the National Medical Association  Prominent Hispanic physician in Des Moines

Physician Recruitment Methods chosen to find these minority physicians:  Contacting medical societies  Checking current DMU adjunct faculty list  Word of mouth  INMA membership directory

Physician Recruitment Initial plan  Develop more culturally appealing recruitment documents  Group presentation at the next INMA meeting  Face to face with Hispanic physician

Physician Recruitment Second Plan  Face to face individual meetings with a meal or one to one in person or via telephone.  Time and labor intensive work for one person.

Physician Recruitment Third Plan  Dr. Wohlford-Wessels located one source in IA that keeps an extensive database of physicians that includes race-ethnicity.  We sent out two mass mailings with recruitment information to everyone on the list.

Physician Recruitment Results 1 st planGroup: 2 expressed interest Face to Face: Three signed up as preceptor 2 nd plan7 people expressed interest Four signed up for preceptor or lecturer 3 rd plan6 contacted me with interest One signed up as a lecturer

Physician Recruitment Results Final efforts were concentrated on follow-up phone calls. Successfully recruited eight physicians as adjunct professors—grant requirements were for five to be recruited Three other physicians were very interested but we couldn’t get them approved in a timely manner.

Grant Timing Issues Because the vast majority of the commitments and adjunct appointments were made towards the end of the grant period AND the school year, there were some timing problems in coordinating commitments with the curriculum schedule.

Grant Timing Issues The timing of our courses did not allow enough time for coordination between DMU course coordinators and adjunct professors.

Grant Timing Issues Adjunct lecturer interests were attempted to be matched with current lecture courses and schedules. Course coordinators were asked verbally and in writing on several occasions to assist us in letting us know what opportunities existed.

The reality is currently that the vast majority of courses already have a pre- set selection of lectures and lecturers to give them. DMU does have a great need for preceptors and we hope that more of these adjunct professors will be willing to precept our students.

Grant Timing Issues As a result, our contract was modified to allow the adjunct professors to be reimbursed for signed Letters of Appointments. The grantor gave us sufficient funding to cover the commitments made by the adjunct professors.

Grant Timing Issues These funds are set aside in Accounting and will be available as each commitment is completed.

Adjunct Professor Committments Preceptorships:14 Lectures:10 Lectures/Panel Discussions: 8

Thank you for your Attention!