TAG: "Diversity"

Community colleges could be key in increasing student diversity for medical schools


Medical students who attended community college more likely to serve in poor communities.

IMPACT
The community college system represents a potential source of student diversity for medical schools and physicians who will serve poor communities; however, there are significant challenges to enhancing the pipeline from community colleges to four-year universities to medical schools. The authors recommend that medical school and four-year university recruitment, outreach and admissions practices be more inclusive of community college students.

FINDINGS
Researchers from UCLA, UC San Francisco and San Jose City College found that, among students who apply to and attend medical school, those from underrepresented minority backgrounds are more likely than white and Asian students to have attended a community college at some point. Community college students who were accepted to medical school were also more likely than those students who never attended a community college to commit to working with underserved populations.

The study also found that students who began their college education at a community college were less likely to get admitted to medical school than those students who never attended a community college or only attended a four-year university.

Using data from the 2012 Association of American Medical Colleges matriculant and applicant files and the AAMC’s Matriculating Student Questionnaire, researchers examined the association between students’ participation in a community college pathway, medical school admission and intention to practice medicine in underserved communities or work with minority populations.

Of 40,491 medical school applicants evaluated, 17,518 enrolled in medical school. Of those, 4,920 (28 percent) had attended a community college concurrently with high school, after high school or following graduation from a four-year college or university in order to take courses in preparation for medical school.

The researchers found that a higher proportion of underrepresented minority matriculants used the community college pathways compared with white students or other racial and ethnic groups. Thirty-four percent of Latinos had attended community colleges, (538 of 1,566 matriculants), compared with 28 percent of black students (311 of 1,109), 27 percent of white students (2,715 of 9,905), 27 percent of Asian students (963 of 3,628) and 30 percent of students identifying themselves as mixed-race or other race (393 of 1,310).

Applicants who attended community college after high school before transferring to a four-year college or university were 30 percent less likely to be admitted, compared to those students who never attended a community college or only attended a four-year university to medical school, after adjusting for age, gender, race and ethnicity, parental education, grade point average and MCAT score. The same group also was 26 percent more likely to intend to practice medicine in an underserved area than their non-community college educated peers.

AUTHORS
The research was conducted by Dr. Efrain Talamantes, Dr. Carol Mangione, Karla Gonzalez and Dr. Gerardo Moreno of the David Geffen School of Medicine at UCLA; Dr. Alejandro Jimenez of UC San Francisco; and Fabio Gonzalez of San Jose City College.

FUNDING
The work was supported by Veterans Affairs Office of Academic Affiliations through the VA/Robert Wood Johnson Foundation Clinical Scholars Program at UCLA. Dr. Moreno received support from a National Institute on Aging (NIA) Paul B. Beeson Career Development Award and the American Federation for Aging. Dr. Mangione received support from the Robert Wood Johnson Foundation Clinical Scholars Program, the UCLA Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly under a National Institutes of Health/NIA grant, and the NIH/National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute. Dr. Mangione holds the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, which partially supported this work.

JOURNAL
The study was published online by Academic Medicine.

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Dental school’s diversity pipeline a success


UCLA School of Dentistry outreach program helps underrepresented students.

Raquel Ulma went from growing up in a poor neighborhood in Puerto Rico to graduating from UCLA School of Dentistry to getting accepted into the UCLA Plastic and Reconstructive Surgery program. (Photo by Brianna Aldrich, UCLA)

When Raquel Ulma moved to Los Angeles with her husband, Greg, in 2002, he knew that it was time for her to start making her lifelong dream of becoming a dentist a reality, even though she had no idea how.

So Greg encouraged her to attend the annual California Dental Association session with a friend. “I actually crashed the dentistry event,” confessed Ulma, who goes by “Rocky.” “I approached the Hispanic Dental Association booth and struck up a conversation with a female dentist who was approachable and welcoming.”

Soon Ulma was telling Dr. Lilia Larin about her goal of becoming a dentist. The two exchanged contact information and Larin told her to expect a call from a faculty member from UCLA School of Dentistry who was starting a program designed to help people apply to dental school.

The next day, Drs. Marvin Marcus and Bruce Sanders contacted Ulma. Marcus told Ulma that she was the perfect candidate for his new program aimed at recruiting disadvantaged and underrepresented students into dentistry. She was from a poor neighborhood in Puerto Rico and had the basic science foundation, having majored in chemistry at the University of Puerto Rico and had completed master’s level coursework in organic chemistry.

“To be honest,” Ulma said, “I was a little star-struck that a school such as UCLA would have an interest in me.”

Shortly after her first contact with Marcus, Ulma became one of the first students to participate in UCLA School of Dentistry’s then-fledgling recruitment initiatives and helped paved the way for the current Post-Baccalaureate program, which guides students step-by-step, through the daunting dental school application process. Since 2003, the program has mentored 40 post-baccalaureate students, 30 of whom have gone on to attend dental school. The program, which is funded in part by UCLA School of Dentistry Dean No-Hee Park’s office, is the first of its kind in Southern California.

“Our educational pipeline initiatives are something I am very proud of and are an important element of our outreach and diversity goals,” said Dr. Park. “Our Post-Baccalaureate Program has helped young people reach their full potential and has enriched the dental field with professionals from all backgrounds.”

For Ulma, the coaching began with a meeting at the School of Dentistry’s Office of Student Affairs where Marcus and Sanders reviewed her undergraduate transcripts, looked at her dental admission test (DAT) scores and went over a draft of her application essay. Ulma had strong grades from her undergraduate work, but needed to work on her DAT scores and wasn’t as strong in the interview portion. Knowing this, Marcus and Sanders helped set-up a mock-interview panel that resemble an actual interview she would eventually face.

“The mock interview panel was a lot harder than I expected,” she said. “They asked a lot of questions, such as why I would be a good fit for that particular school and what makes me a good candidate for dental school.”

They also advised her to do some volunteer work in dentistry, so Ulma immediately began volunteering at the Wilson-Jennings-Bloomfield UCLA Venice Dental Center – a community clinic in West Los Angeles that provides dental care to low-income adults and children.

The entire process took about a year and a half, from reviewing her prerequisites and retaking the DAT to applying to numerous schools and interviewing. After that though, Ulma was accepted to her top choice, UCLA, and began dental school in 2004.

“Looking back at how far I’ve come is sometimes unbelievable,” Ulma said.

Originally from Levittown, Puerto Rico, a rough, urban neighborhood outside of the country’s capital, Ulma recalls the area where she grew up as, “a very bad neighborhood with high pregnancy rates, drug dealers and teenagers getting shot.”

Ulma’s police officer father also owned a woodworking shop where he made furniture to supplement his salary, and he would regularly bring her to the shop to keep her out of trouble.

“It was the experience of working with my father in his shop where I fell in love with using my hands to make something beautiful, yet functional,” she said.

Rather than follow her father exactly, though Ulma chose to pursue dentistry to combine her love of working with her hands along with helping people.

With the support of her husband and faculty at UCLA, Ulma achieved her long-held dream of becoming a dentist when she graduated with the D.D.S. class of 2008.

“During dental school, I would often meet with Dr. Marcus for breakfast and he would remind me to take it day-by-day,” she recalled. The support she received from Marcus and Sanders has inspired Ulma to volunteer her time to assist other students with their dental school applications.

Dental school was just the beginning for Ulma. In 2008, she successfully applied to and was accepted to the UCLA Oral and Maxillofacial Surgery (OMS) residency program, a highly competitive program that only offers two slots per year out of approximately 100 applications. Ulma graduated from the OMS residency program with an M.D. degree and a certificate of specialization in oral and maxillofacial surgery this June.

“She is truly a remarkable individual and I believe she will be a model for many women and minorities in the future,” Marcus said.

While in the OMS residency program Ulma met Dr. Earl Freymiller, professor of clinical dentistry and chairman of the section of oral and maxillofacial surgery. Freymiller, an oral surgeon, introduced Ulma to the Thousand Smiles Foundation. Ulma and Freymiller, along with other oral surgeons travel to Ensenada, Mexico several times a year where they perform surgery on children with cleft lip and palate.

“Dr. Freymiller has been such an invaluable mentor to me,” Ulma said. “I’ve witnessed patients he’s worked on come back years later to introduce them to their families and thank him for what he’s done for them. He is an example of who I want to become.”

In summer 2015, Ulma will start a three-year residency in the Plastic and Reconstructive Surgery program, and learn to perform complex facial and body reconstruction to help replace congenitally or traumatically missing body parts.

“I wouldn’t be where I am today without the Post-Baccalaureate program,” she said. “People do what they know. For example, if there isn’t a role model for how to get into dental school or the health sciences, then younger minorities won’t even see it as an option. I look at where I’m at in my career and feel incredibly lucky for the people who have been role models to me.”

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Fact sheets provide snapshot of adult Californians’ health by race, ethnicity


UCLA report digs deeper into differences among groups within Latino, Asian populations.

The UCLA Center for Health Policy Research has issued a series of easy-to-read fact sheets with health statistics on five major ethnic and racial groups in California — whites, Latinos, blacks, Asians and American Indians/Alaska Natives, as well as more detailed information on Latino and Asian subgroups.

A new visual report also provides infographics on key findings from the profiles, which used data from the 2011–12 California Health Interview Survey (CHIS) to explore a range of health topics, from insurance status to fruit-and-vegetable consumption to binge drinking.

The profiles provide a detailed and reliable source of information for policymakers, advocates, researchers, media and others interested in understanding the health of adult Californians, particularly those from previously understudied ethnic and racial minority groups.

Of specific interest are key health statistics for five groups within California’s Latino population (which accounts for 9.5 million of the state’s 27.8 million adults), including separate data for U.S.-born Mexicans and Mexicans born outside of the U.S., and health information on half a dozen Asian groups (3.9 million). Latino ethnic groups covered include Mexican, Salvadoran, Guatemalan, other Central American and South American. Asian groups include Chinese, Filipino, Japanese, Korean, Vietnamese and South Asian.

Among the findings for California’s estimated 27.8 million adults:

Number of uninsured
Approximately 6.2 million California adults (26.6 percent of the state’s adult population) had no health insurance for all or part of the past year.

Insured through work
Nearly six of 10 Asians in the state had employment-based health insurance, compared with five of 10 Californians overall. Among Asian ethnic groups, the figure ranged from a high of more than 7 of 10 for South Asians to fewer than 4 of 10 for Koreans. For Latinos overall, fewer than 4 of 10 had employment-based insurance was, while Guatemalans had the lowest rate — 2 of 10.

Mexican groups and poverty
More than 70 percent of adult Mexicans born outside the U.S. had household incomes under 200 percent of the federal poverty level (less than $46,100 for a family of four in 2012). For U.S.-born Mexicans, the proportion was much lower, at 44.3 percent.

Walking and health
About one-third of all Californians walked regularly on a weekly basis. Latinos had one of the highest rates, at nearly 35 percent, and Salvadorans were the most frequent walkers, with a 41 percent rate.

Californians and obesity
More than 6.8 million Californians — a full quarter of the adult population — were obese. Less than one in 10 Asians was obese, while nearly four in 10 blacks and American Indians/Alaska Natives were.

Read the full 2011–2012 Racial and Ethnicity Health Profiles.

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NEH awards $100K for health humanities program


UC Riverside medical school, humanities faculty collaborate to improve doctor-patient communication.

"Untitled" by Kaza Faust, UC Riverside Ph.D. student in archaeology

Every patient has a story to tell about their illness, their fears and why a prescription for treatment may be difficult to follow. How doctors and patients understand and communicate those stories can be life-altering in making accurate diagnoses, adhering to treatment or accepting an unwelcome prognosis.

The National Endowment for the Humanities has awarded UC Riverside $100,000 to develop a health humanities program focused on the role of stories in medicine and healing. The two-year, interdisciplinary grant will fund a collaboration of humanities scholars and School of Medicine faculty in an effort to identify how narrative can best be integrated into training medical students.

“Narrative medicine plays a role in creating empathy in doctor-patient encounters,” said Juliet McMullin, associate professor of anthropology and principal investigator of the research project. “If we’re trying to create physicians who are knowledgeable about the community, they need to have conversations with patients that get to the core of their needs.”

The grant is part of the NEH’s Humanities Initiatives at Hispanic-Serving Institutions (HSIs). HSIs are nonprofit, degree-granting institutions where at least 25 percent of full-time undergraduate students are Hispanic. The U.S. Department of Education named UCR an HSI in 2008, the first in the UC system to receive the honor.

“Latinos are a steadily evolving population in the U.S., and it is therefore crucial to foster a sense of cultural fluency among medical professionals and researchers,” said Tiffany Ana López, holder of the Tomás Rivera Endowed Chair, professor of theater and a co-principal investigator on the project. “The humanities play a crucial role in developing creative and agile approaches to communication that extends to health care, program development and problem solving generally.”

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UC medical centers named health care equality leaders


LGBT survey honors four UCs.

The nation’s largest lesbian, gay, bisexual and transgender civil rights organization has named four University of California medical centers as “Leaders in Healthcare Equality.” UC Davis, UCLA, UC San Diego and UC San Francisco medical centers earned top marks for their commitment to equitable, inclusive care for LGBT patients and their families, who can face challenges in accessing adequate health care.

UCSF Medical Center became the only institution in the United States to have received a perfect score on the national Healthcare Equality Index for six consecutive years.

The Human Rights Campaign Foundation’s 2013 Healthcare Equality Index designated 464 health care facilities as leaders for meeting key criteria for equitable care, including non-discrimination policies for LGBT patients, non-discrimination policies for employees, a guarantee of equal visitation for same-sex partners and parents, and training for staff in LGBT patient-centered care.

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UC Davis Health System has new chief diversity officer


David Acosta named associate vice chancellor for diversity and inclusion.

David Acosta, UC Davis

David A. Acosta, previously chief diversity officer at the University of Washington School of Medicine, has been named associate vice chancellor for diversity and inclusion at UC Davis Health System, effective July 8.

In his role as associate vice chancellor, Acosta will lead diversity activities across all health system operations, including the UC Davis School of Medicine, the Betty Irene Moore School of Nursing, UC Davis Medical Center and the physician practice group.

“I am delighted that David Acosta has agreed to lead our diversity and inclusion efforts,” said Thomas Nesbitt, UC Davis interim vice chancellor for human health sciences and dean of the medical school.  “With his wealth of experience, Dr. Acosta is well positioned to advance the diversity of our student body, faculty and staff – an essential undertaking to ensure that our institution provides the highest quality education and care and reflects the communities we serve.”

Acosta is a recognized leader in managing and directing diversity and inclusion programs. At the University of Washington’s medical school, he developed several key programs aimed at increasing the diversity of physicians and patient care.  These included:

  • A rural health fellowship program for Tacoma Family Medicine, an affiliated family medicine residency program at the university’s School of Medicine.
  • A National Institutes of Health-funded Center for Cultural Proficiency in Medical Education at Washington, which received a Washington State Association of Multicultural Education award.
  • A Hispanic Health Pathway certification program for medical students interested in working with Hispanic communities.

As the inaugural chief diversity officer at UW’s School of Medicine, Acosta co-authored the diversity strategic plan and founded the Center for Equity, Diversity and Inclusion.

“Diversity and inclusion should be the foundations for our interactions with each other, our patients and our communities, as well as for our research and education programs,” said Acosta. “I am proud to be part of UC Davis Health System, which is clearly committed to these fundamental principles. As associate vice chancellor, I will continue to nurture an institutional climate that values inclusion, equity, cultural humility and lifelong reflection.

Acosta was first associated with UC Davis in the early 1980s when he served as clinical preceptor for the school’s medical and family nurse practitioner students at Lassen Family Practice in Susanville.

Acosta earned his medical degree from UC Irvine and his undergraduate degree in biology from Loyola Marymount University in Los Angeles. He completed his residency training at Community Hospital of Sonoma County and a faculty development fellowship in the Department of Family Medicine at the University of Washington.

He is a member of the American Academy of Family Physicians, the National Hispanic Medical Association, and the National Alliance for Hispanic Health and the National Association for Rural Medical Educators, among others. He serves on several committees at the Association of American Medical Colleges (AAMC), including one focused on holistic review of medical school applicants and another, the AAMC Group on Diversity and Inclusion, where he serves as national chair.

As associate vice chancellor, Acosta will receive an annual base salary of $240,000. Additional compensation information is available upon request.

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UCSF names new diversity program manager, LGBT specialist


Larry Lariosa appointed to position.

Larry Lariosa, UC San Francisco

Larry D. Lariosa, M.A., a licensed marriage and family therapist, has been named diversity program manager and LGBT specialist at UC San Francisco’s Office of Diversity and Outreach.

The announcement of his appointment coincides with today’s historic Supreme Court rulings in two cases that bolster same-sex marriage and rights of LGBT families. A California native, Lariosa has dedicated his professional and personal life to the issues of cultural diversity and social justice over the past two decades.

Currently, he is serving as a clinical social worker at the UCSF Student Health & Counseling. In that role, he developed a variety of outreach programs addressing the unique needs of LGBT students and other marginalized groups, including students of color and international students.

In his new position, Lariosa will report to Renee Chapman Navarro, M.D., Pharm.D., vice chancellor of diversity and outreach, who was the first to be named to that new leadership role in December 2010.

“We are delighted to have Larry join the Office of Diversity and Outreach,” Navarro said. “His expertise and experience in working with diverse populations makes him an ideal fit for this critical position at UCSF. I look forward to Larry working with the campus and medical center to continue and strengthen the great work that has put UCSF on the map for raising awareness for critical diversity issues including LGBT health care and equity.”

Lariosa will be responsible for the design, execution and assessment of diversity and outreach programs that advance the strategic goals of the Office of Diversity and Outreach and the campus, UCSF Medical Center and UCSF Benioff Children’s Hospital.

Lariosa will direct and manage all activities of the UCSF Center for LGBT Health and Equity, a center that is considered a national leader in increasing awareness of the LGBT community and addressing issues of equality and inclusion.

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Director named for center devoted to boost women’s numbers in academia


UC Davis nursing school professor to lead CAMPOS.

Mary Lou de Leon Siantz, UC Davis

Betty Irene School of Nursing professor Mary Lou de Leon Siantz was recently appointed by UC Davis Chancellor Linda P.B. Katehi as director for the new Center for the Advancement of Multicultural Perspectives on Science (CAMPOS). The center is part of a new effort, led by Katehi, to increase the participation of women, especially Latinas, in academic science, technology, engineering and mathematics (STEM) careers.

Established by a grant of $3.725 million over five years from the National Science Foundation’s ADVANCE program, CAMPOS is a research center aimed at attracting women and Latina STEM scholars to UC Davis by providing an accessible and inclusive community of research collaborators and mentors throughout their careers.

CAMPOS is planned to be both a physical location for networking and exchanging ideas and a faculty-hiring initiative to increase diversity in key STEM fields. In making up to 16 new faculty hires, CAMPOS aims to build coalitions of STEM faculty who want to apply their research to serve underrepresented communities.

“I am honored to not only be representing the Betty Irene Moore School of Nursing in the chancellor’s initiative, but also for the recognition of the science behind the nursing profession and the critical role of Latina women in science for the 21st century,” Siantz said.

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LGBT questions to become standardized demographic elements in e-health records


UC Davis Health System invites patients to share sexual orientation, gender ID information.

UC Davis Health System will become the first academic health system in the country to incorporate sexual orientation and gender identity as standard demographic elements within the electronic health records for its patients. UC Davis physicians and patient advocates say the new measure is an important step toward improving health care for lesbian, gay, bisexual and transgender (LGBT) individuals who often have avoided medical clinics out of fear of being humiliated or rejected.

Today, the health system posted a questionnaire that invites its patients to share their sexual orientation (attraction to one’s own gender or a different gender) and gender identity (the gender an individual identifies with) with their providers. The questionnaire is accessible to about 76,000 patients who use UC Davis’ secure, online communications system to schedule appointments, request prescription refills and exchange messages with their physician’s office.

“Patients and physicians, even in the clinical setting, are not very good at talking about sex,” said Edward Callahan, professor of family and community medicine and one of the key coordinators for the new initiative. “Unfortunately, the problem is more than just one of embarrassment. LGBT individuals face significant health challenges that can be better addressed when a doctor’s office is seen as a truly welcoming and understanding environment. We’re inviting patients to voluntarily share their gender identity and sexual orientation information to help us create an atmosphere in which we’re able to provide the most knowledgeable and informed care possible.”

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Lack of awareness limits use of flexible career policies


Communications aimed at shifting organizational culture can overcome barriers.

Amparo Villablanca, UC Davis

To attract and maintain a diverse, qualified academic workforce, institutions of higher education should have — and promote — policies to help balance career and family life, according to an article published by UC Davis researchers in the June issue of Academic Medicine.

Policies allowing medical school faculty to care for family while advancing their careers are more available today than ever before, the authors said in the article. Yet these policies are also underused, primarily because faculty members do not know they exist.

Based on the outcomes of a comprehensive communications intervention conducted at UC Davis, the authors outline tactics that are effective in increasing awareness of family-friendly career policies.

“Brochures or Web pages about work-life balance are a good first step but not enough,” said Amparo Villablanca, a professor at UC Davis School of Medicine and lead author of the paper. “It truly takes a culture shift where accommodations for family care are clearly communicated, encouraged, supported and accepted to ensure that family-friendly policies are both understood and utilized.”

In addition to being a leader in cardiovascular medicine, Villablanca has a long track record of encouraging organizational changes that support women who are committed to both their careers and their families. She and Lydia Howell, chair of the Department of Pathology and Laboratory Medicine, and Laurel Beckett, chief of the Division of Biostatistics in the UC Davis Department of Public Health Sciences, were one of just 14 teams nationwide who received grants from the National Institutes of Health (NIH) for research on factors that influence the careers of women. The goals were to identify ways to overcome gender differences in career paths and needs and to stem the attrition of women from science and engineering.

The NIH funding was a response to the National Academy of Science report that showed, despite gender parity in scientific undergraduate and graduate programs, representation of women decreases with each step up the tenure-track and academic leadership hierarchy. The report also suggested that providing more support for working parents could be an effective strategy to keep women in the academic pipeline.

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Physician gender doesn’t affect patient care costs or mortality, study finds


UC Davis findings from nationwide evaluation contradict results of previous investigations.

Anthony Jerant, UC Davis

Female doctors’ patients do not use health care services more or die less frequently than patients treated by male doctors, a prospective, observational study by researchers at UC Davis Health System has found.

The study, published in the March-April issue of The Journal of the American Board of Family Medicine, is the first large, nationwide evaluation of the association between provider gender and patients’ use of health care services and mortality.

“Our findings suggest that if the goal is to contain costs and the risk of death, there is no reason to differentially recruit or train physicians of either gender,” said lead author Anthony Jerant, professor of family and community medicine at UC Davis. “We should instead focus on factors such as patients’ cigarette smoking and diet, which are known to influence health care utilization and mortality.”

Jerant and his colleagues analyzed the responses of a representative sample of 21,365 patients aged 18 years and older who participated in the U.S. Medical Expenditure Panel Surveys from 2002 to 2008. They found that the genders of the participants’ usual sources of health care, regardless of specialty field, did not affect patient health care or prescription drug expenditures, deaths or the number of visits to hospitals, emergency rooms and medical offices. A usual source of care was defined as any medical professional, doctor’s office, clinic, health center or other place the patient would go if sick or needing health advice.

The authors noted that their outcomes contradict the results of previous investigations suggesting that patient-centered communications and related medical-practice behaviors frequently associated with female providers may lower patients’ use of health care services and costs. In addition to being smaller than the current study, those prior investigations did not account extensively for patient health behaviors and characteristics, including weight and tobacco use, which could influence the frequency of medical visits.

“We suspect that failing to comprehensively account for these factors might have made it appear that provider gender is independently associated with health care utilization,” Jerant said.

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A prescription for increasing diversity


UC medical schools make progress in attracting underrepresented minority students.

 

Nicholas Orozco

>>Motion graphic: California medical school first-year enrollments of underrepresented minorities

By Alec Rosenberg

Nicholas Orozco grew up in urban, predominantly Latino East Los Angeles, where obesity rates are high and access to health care is low.

Laura Jordan grew up on the Hoopa Valley Indian Reservation in rural Humboldt County, where tribe members face health issues from diabetes to heart disease but the nearest hospital is 90 minutes away.

While their backgrounds vary widely, they share a common passion: wanting to practice family medicine in an underserved community such as their hometowns. Both are first-generation collegians who received a head start through University of California postbaccalaureate programs aimed at preparing disadvantaged students for medical school. And now both are UC medical students participating in PRIME programs that train physicians to meet the needs of California’s underserved rural and urban populations – Orozco at UC Berkeley-UC San Francisco and Jordan at UC Davis.

UC’s postbaccalaureate and PRIME programs are two contributing reasons that UC has steadily increased medical student diversity. Among first-year UC medical students, underrepresented minorities have risen to more than 24 percent of students this year, up from 14 percent in 2001 and topping rates at California’s private medical schools and the national average. That’s still short of matching the state’s diverse population, but UC medical schools come closer than many other graduate and professional schools.

“PRIME may serve as a model for other professions that are laboring to achieve more diversity in their student bodies,” said Dr. John Stobo, UC Health senior vice president. “Here’s an exemplary case of what education can do in the context of legislation that prohibits affirmative action.”

UC can’t consider race or gender in admissions after a policy passed by regents in 1995 and California voters passed Proposition 209 in 1996, but it can have programs aimed at students from disadvantaged backgrounds. More than half of PRIME students are from groups traditionally underrepresented in medicine. The systemwide initiative, launched in 2004 at UC Irvine, has grown to 336 students and now involves eight UC campuses – the first substantial increase in UC medical school enrollment in 40 years.

“PRIME is a major innovation in medical education,” said Dr. Charles Vega, director of UC Irvine’s PRIME program. “I believe it’s the way to spread well-being across the state in a meaningful way.”

Orozco faced many challenges growing up in East Los Angeles, including his family lacking health insurance. He earned a bachelor’s degree from UCLA but struggled academically, working 60 hours a week while also attending to family issues. He participated in UCSF’s postbaccalaureate program, receiving support that led to enrolling in the UC Berkeley-UCSF Joint Medical Program in PRIME.

Now a second-year student, Orozco has observed prison health care at San Quentin, received training at an urban clinic in Oakland and established, in partnership with another PRIME student and the Pacific Center, an LGBT free drop-in clinic in Berkeley. The clinic provides primary care to low-income clients and tries to connect them with relevant social services. “The PRIME program and postbaccalaureate program represent opportunities to work with different communities and create an environment for people to give back and affect change,” Orozco said.

Laura Jordan

Inspiring others

Jordan became interested in rural medicine while working in high school at the medical clinic on her hometown Indian reservation, where family and community members suffered from chronic conditions and had limited access to specialty care. “I saw a need,” she said.

Mentored by the clinic’s medical director and encouraged by her parents, Jordan graduated from Humboldt State University and then participated in UC Davis’ postbaccalaureate program for help in preparing for medical school. Despite being the only Native American student in her class at the time, she chose to attend medical school at UC Davis for its Rural PRIME program and its support network.

“I knew medical school was going to be difficult,” Jordan said. “They tell you it’s like drinking water from a fire hose, and it is. Once I got used to the pace, it got easier.”

Jordan helped inspire five other Native American students to attend the UC Davis School of Medicine. Now in her third year, she is hitting her stride, receiving a scholarship from the federal Indian Health Service and getting hands-on experience working at rural health clinics in Redding.

“Laura’s a good example of what we’re trying to do, which is raise people who are going to go back to the communities that need them,” said Dr. Mark Henderson, associate dean for admissions and outreach at the UC Davis School of Medicine.

Henderson praised the PRIME programs – UC Davis offers a rural program and a San Joaquin Valley program with UC Merced – along with TEACH-MS, a four-year federally supported program for medical students with a strong interest in primary care and care for the urban underserved. “The focus is on continuity of care,” he said, noting that UC Davis’ medical school also has increased its support staff and broadened the way it reviews applicants.

“We have to look holistically at each candidate,” Henderson said. “We have to evaluate whether we are choosing the right kinds of students to meet the physician workforce needs of California.”

(Click image for larger view)

A broader approach

UC Davis has joined UCLA in using the multiple mini interview, or MMI, with medical student candidates. The short assessments take into consideration communications skills, critical thinking and cultural sensitivity – a broader approach that has helped attract more diverse students, administrators say.

“I call it speed dating,” said Dr. Neil Parker, senior associate dean for student affairs and graduate medical education at UCLA’s medical school. “It doesn’t take you long when you meet somebody to get the gestalt of, ‘Hey, I’d like to know this person.’”

Diversity begets more diversity, Parker said. Through programs like PRIME and supporting student groups, UCLA has created a comfortable environment for diverse students, he said.

Still, barriers exist. A big one is cost. The average U.S. medical student’s debt load has risen above $166,000. Entertainment executive and philanthropist David Geffen donated $100 million to establish a fund that will award merit-based scholarships to up to 33 UCLA medical students a year, which should help address that issue. “I think some of the students we normally lose will come here,” Parker said. “I think our applicant pool will become larger and more diverse.”

A new model

Meanwhile, UC Riverside – the eighth-most diverse campus in the nation – is making diversity a cornerstone of its new medical school, which is opening this fall. It’s viewed as part of its mission to improve the health of the Inland Empire, whose population is nearly half Latino.

“I think there’s real value in diversity,” said UC Riverside medical school founding Dean G. Richard Olds. “Having health care professionals that come from our communities is a desirable thing. It’s what the patients want. It results in better health care.”

“The two main determinants of where doctors practice are where they grow up and where they do their residencies,” Olds said. The medical school will provide campuswide pre-med advising and is setting aside 24 slots of its initial 50-student class for UC Riverside undergraduates. Admissions will use the MMI and look at four measures designed to enhance diversity: students who are local, from disadvantaged backgrounds, are first generation collegians and speak English as a second language.

UC Riverside also will be building its own local residency programs. Using a new model, UC Riverside will be California’s first public medical school to open in four decades, the sixth in the UC system and the only community-based medical school in the West Coast. While UC Riverside won’t have a PRIME program per se, “Our entire program looks like the PRIME program,” Olds said.

Martín Escandón

A positive influence

A UC San Diego study of applicants to its medical school found that underrepresented minorities and disadvantaged students were more likely to be interested in a curriculum designed to train them to work with underserved communities. The findings, published in the journal Academic Medicine, suggest that programs such as PRIME may influence the application decisions of diverse students.

That’s certainly the case of second-year UCSF medical student Martín Escandón.

After graduating from the University of Washington, Escandón worked for AmeriCorps in Seattle’s predominantly Latino South Park neighborhood. He saw that many health issues were related to social problems, such as treating a 4-year-old asthmatic boy who lived in an industrial area filled with bad air. “The doctor said, ‘Why did he get asthma in the first place?’ It was hard to ignore.” Driven by a passion for family medicine, a sense of social justice and a belief that health care is a human right, Escandón called UCSF’s PRIME program “a perfect fit.”

“PRIME is the best part of medical school,” Escandón said. “PRIME is a place to focus on what I think are the most important things – community health, preventive medicine, advocacy for patients.”

Making a difference

“PRIME really speaks to students about why they’re going into medicine,” said Dr. Alma Martinez, UCSF medical school outreach director and PRIME executive director.

Martinez said the campus climate is more welcoming now than when she was a UCSF medical student. She credits the students, leadership and programs such as PRIME, postbaccalaureate efforts and the Doctors Academy, founded by UCSF Fresno Dr. Katherine Flores to prepare disadvantaged Fresno County high school students for college and for health science careers.

But all of those programs struggle financially. UCSF medical school’s postbaccalaureate program had 15 students at its peak. It has fallen to eight students, but will rise back up to 12 students, thanks to funding from Kaiser Permanente.

“We’re always fighting to find money,” Martinez said.

The next step is to expand these types of programs not only in California, but nationally, she said.

“It’s not enough to just attract diverse students to one location without increasing the entire pool,” Martinez said. “I think all schools should be working on outreach and postbaccalaureate programs to get more students. Every medical school needs to develop a postbaccalaureate program. If each school had eight to 12 students, that would make a difference.”

Related link:
UC San Diego to host medical education for diverse students conference Jan. 26

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