BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Guyatt G, Rennie D, editors and The Evidence-Based Medicine Working Group. Users' guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press, 2002



The JAMA series on how to use the medical literature has been expanded and put into book and CD-ROM format. The Evidence-Based Medicine Working Group along with editors Gordon Guyatt and Drummond Rennie have provided practitioners with a valuable resource for evaluating evidence relevant to their practice. The authors of this “how to” book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts. The material is presented in 3 formats: a 700 page manual for evidence-based practice (EBP) (Manual) that is thorough and comprehensive; a 440 page pocket version of the essentials of EBP (Essentials) that provides an indepth discussion of the basics; and a hyperlinked CD-ROM that contains the contents of the Manual and is included with both hardcopy versions. The Essentials book is small enough to keep in a large pocket, although the print is small and may be difficult for really tired eyes to read. The Manual …

https://ebn.bmj.com/content/ebnurs/5/1/8.full.pdf

Users' Guides to the Medical Literature

The proportion of black, Latino, and Native American faculty in U.S. academic medical centers has remained almost unchanged over the last 20 years. Some authors credit the "minority tax"—the burden of extra responsibilities placed on minority faculty in the name of diversity. This tax is in reality very complex, and a major source of inequity in academic medicine. The “minority tax” is better described as an Underrepresented Minority in Medicine (URMM) faculty responsibility disparity. This disparity is evident in many areas: diversity efforts, racism, isolation, mentorship, clinical responsibilities, and promotion. The authors examine the components of the URMM responsibility disparity and use information from the medical literature and from human resources to suggest practical steps that can be taken by academic leaders and policymakers to move toward establishing faculty equity and thus increase the numbers of black, Latino, and Native American faculty in academic medicine.

/pdf/addressing-disparities-in-academic-medicine-what-of-the-5gpdvwp0fg.pdf

Addressing disparities in academic medicine: what of the minority tax?

Background: Little is known about the training experience of minority medical students. We explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role race/ ethnicity plays in students’ experiences. Methods: Medical students (N=3080) at 5 medical schools were surveyed in 2006 using validated instruments to assess burnout, depression, and QOL. Students were also asked about the impact of race/ethnicity on their training experience. Results: The response rate was 55%. Nearly half of students reported burnout (47%) and depressive symptoms (49%). Mental QOL scores were lower among students than among the age-matched general population (43.1 vs 47.2; P.001). Prevalence of depressive symptoms was similar regardless of minority status, but more nonminoritystudentshadburnout(39%vs33%;P.03). Minority students were more likely to report that their race/ethnicityhadadverselyaffectedtheirmedicalschool experience (11% vs 2%; P.001) and cited racial discrimination, racial prejudice, feelings of isolation, and different cultural expectations as causes. Minority studentsreportingsuchexperiencesweremorelikelytohave burnout, depressive symptoms, and low mental QOL scores than were minority students without such experiences (all P.05). Conclusions:Symptomsofdistressareprevalentamong medical students. While minorities appear to be at lower risk for burnout than nonminority students, race does contribute to the distress minority students do experience. Additional studies are needed to define the causes of these perceptions and to improve the learning climate for all students.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/413324/ioi70135_2103_2109.pdf

Race, ethnicity, and medical student well-being in the United States

In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the US Health Care Workforce, Board on Health Sciences Policy, Institute of Medicine. Washington, DC, National Academies Press, 2001, hardcover, 377 pp, $43.00. In the Nation's Compelling Interest was written by the Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the US Health Care Workforce at the Institute of Medicine (IOM) at the request of the WK Kellogg Foundation to "assess institutional and policy-level strategies for achieving greater diversity among healthcare professionals." Specifically, the IOM was asked to assess potential benefits of greater representation of under-represented minorities (URMs) in health care, and to evaluate policies that may increase the diversity of health care providers. The report provides significant evidence describing barriers to access for minority students, and offers innovative solutions. Chapter One of the text is an executive summary of the report. It briefly describes the Committee's findings and provides a synopsis of the data analysis and recommendations for change. Subsequent chapters provide in-depth analysis of each finding. Chapter Two is titled "Reconceptualizing Admissions Policies and Practices." The authors document how URMs typically do not have the same academic opportunities in primary and secondary education to obtain high scores on tests such as SATs, CREs, MCATs, and others that are frequently considered when granting admissions to postsecondary or graduate programs. The authors view this as unfortunate, stating that these tests are actually a poor predictor of later academic success, and that the tests may not be the most effective measure of a student's potential for success. Alternative strategies to realistically evaluate a minority applicant's abilities are suggested. However, even when an applicant is admitted to a health professional educational institution (HPEI), his or her success is not guaranteed, supporting a reconsideration of admissions policies. Chapter Three, "Costs and Financing," evaluates fiscal barriers to postsecondary education encountered by minority students who are more likely to be poor. Unfortunately, grant and scholarship opportunities have declined in recent years at the same time that tuition and fees have significantly increased. The text analyzes potential sources of grant and scholarship opportunities, and makes recommendations to improve available funding by the private sector, HPEIs, local and state governments, and Congress. Public-private partnerships and creative collaborations across multiple entities have the potential to successfully support students through their undergraduate and graduate education. …

In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce

Purpose To explore the barriers and facilitators experienced by ethnic minority medical students in achieving personal and professional success. Method In 2002 and 2003, 43 minority medical students participated in one of six two-hour focus groups located in Philadelphia, Pa; Kansas City, Mo; Baltimore, Md; Miami, Fl; New York, NY; and Los Angeles, Calif. Focus groups consisted of an average of seven (range 5-10) individuals. Eighty-eight percent were of black/African descent, 10% were Hispanic, and 2% were Asian/Pacific Islanders. Students discussed their views of personal and professional success, including opportunities and obstacles, and completed a brief demographic survey. Discussions were audiotaped, transcribed verbatim, and reviewed for thematic content in a three-stage independent review/adjudication process. Results All 748 comments were grouped into themes relating to definitions of success (35%) and to perceived facilitators (25%) or inhibitors (40%) of success. Participants strove to achieve professional/academic status, financial security, and quality of life. In so doing, participants identified facilitators of success, including support systems, professional exposure, financial aid, and personal characteristics. Lack of financial and social support, challenges with standardized tests, experiences with racial stereotyping and discrimination, and self-imposed barriers were among inhibitors to success. Conclusions The opportunities for and barriers to academic success identified by minority students should be heeded by educators and administrators who develop programs and policies to recruit minority medical students and to ensure their professional development. To enhance the institutional climate for diversity, programs that improve cultural awareness and reduce biases among all students, faculty, staff, and administrators are needed.

Exploring Obstacles to and Opportunities for Professional Success Among Ethnic Minority Medical Students

As racial and ethnic diversity in the general population of the United States increases, research continues to show that diversity in the physician workforce improves health care quality and access to care for ethnic minorities.1–3 In 2004, three ethnic minority groups, African Americans, Latino Americans, and American Indians, represented more than 25% of the U.S. population but only 6% of the nation’s physicians.4 Several reports, including those of the Institute of Medicine and the Sullivan Commission, have called for measures to increase the diversity of the medical workforce.1,4,5 Recruitment and retention of racial and ethnic minority faculty at medical schools have been identified as key factors in increasing the pipeline of minority medical students. Minority faculty provide support for minority students in the form of role models, educators, and mentors.6,7 Unfortunately, minority faculty continue to be alarmingly underrepresented, comprising only 4.2% of medical school faculty nationwide in 2005.8 In that same year, approximately 20% of minority faculty were located at three historically black medical schools and three Puerto Rican medical schools accredited by the Liaison Committee on Medical Education.9 Minority academic medicine faculty are less likely to hold senior rank, are promoted at lower rates,10–12 and report more discrimination than white faculty.13 In addition, high rates of discrimination and harassment during medical education and training14,15 might explain differences in the level of physicians’ professional satisfaction according to race and ethnicity.16 A recent study of physicians of African descent found that race-related experiences can create “racial fatigue” and result in personal and professional costs for physicians.17

Diversity in the student body at medical schools has been shown to enhance the educational experience for all students.18 In addition to addressing health disparities in academic medicine and improving the education and training of all medical students, increasing the number of minority faculty may improve care by increasing the numbers of physicians working with underserved populations19 and by multiplying options for minority patients who prefer racially concordant physicians.20–22

The far-reaching effects of anti-affirmative-action policies, such as Proposition 209 in California, have negatively affected minority student enrollment and recruitment. Proposition 209, a constitutional measure passed in 1996, outlawed race- and gender-based admissions and hiring policies at California public institutions. As of 2008, the University of California–San Francisco (UCSF) School of Medicine faculty includes 2.1% African American and 2.6% Latino faculty. UCSF is working on a variety of strategies to increase diversity through initiatives such as the Underrepresented in Medicine Mentorship Program, the School of Medicine Task Force on Underrepresented Minorities, the Chancellor’s Advisory Committee on Diversity, and a new position for a director of academic diversity.

In our study, we bring the voice of minority faculty to current diversity efforts by examining the effects of anti-affirmative-action policies on the diversity climate and by making specific recommendations for academic institutions seeking to increase diversity. Previous studies have focused on junior faculty or students,23,24 whereas our study explores both the junior and senior faculty experience. To explore the diversity climate at UCSF, we designed a qualitative study to examine the perceptions of minority faculty with regard to diversity and discrimination on campus. Our objectives were to (1) elicit and explore the perspectives of minority faculty regarding racial and ethnic diversity in academic medicine, and (2) generate collective recommendations on ways to increase diversity in academic medicine at our institution and nationwide.

/pdf/minority-faculty-voices-on-diversity-in-academic-medicine-fuddzepium.pdf

Kara L. Odom

Papers

Exploring Obstacles to and Opportunities for Professional Success Among Ethnic Minority Medical Students

Minority faculty voices on diversity in academic medicine: perspectives from one school.