Category Archives: Uncategorized

Equity and inclusion for our future health workforce: What can we do right now?

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The UC Davis Food Access Map shows food and resources on UCD Campus and surrounding community

When we talk about diversity, equity and inclusion, there’s a lot of emphasis on diversity, and less so on equity and inclusion.  Sometimes they sound (and in policy, are treated) as an afterthought. Sometimes it feel vague- what do we mean by “equity” and “inclusion”?

For the future health workforce, in higher education, one critical component- the bare minimum- is ensuring students’ basic needs are met, so that they have the opportunity to participate in education itself. Or in other words, what is the point of admitting students to college or graduate school if we can’t guarantee they have enough to eat, a place to live, to pay their bills, or get healthcare when they need it?

We surveyed “under-represented” (including first-generation, low income, racially and ethnically minoritized, students with disability, sexual orientation and gender identify minorities) pre-health students from 2020-21, and found:

  • Over half had trouble paying rent and bills
  • One quarter went hungry because they didn’t have enough money for food.

What does that mean for their professional and educational aspirations?

  • Nearly 3/4 had concerns about the costs of attending and applying to graduate school in the health professions
  • Over 60% reported: application fee waivers did not meet their cost needs, that fee waivers did not help them apply to more programs, and that fee waivers did not arrive in the time needed.

Since the onset of the COVID-19 pandemic, the widening gap in economic inequity has been weighing down upon our future health workforce. While education programs have traditionally focused on academic preparation, mentorship and admissions, we need to be mindful about both their basic needs, and then how our own programs and policies are creating barriers.

Students who need to search for their next meal cannot perform their best at school– nor do they have the financial resources to take standardized tests, submit multiple applications, and for those who need them, get assessments and approvals for accommodations. The processes for applying for, and receiving, fee waivers, as well as the amount, if any- needs to shore up these gaps, not create more barriers.

Reducing financial precarity is critical for ensuring equity- and creating inclusive institutions.

 

*For more projects on student basic and economic needs, check out Student Affairs page.

Medical school admissions and institutional racism

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Large boulder in desert sands with clear blue skies and sandy brush in the background

Grant Marek/SFGATE The purported largest freestanding boulder in the world, Giant Rock, in the California Mojave Desert.

Nearly 25 years ago, during my lit review for my med school research thesis on diversity and medical education programs, I found many prior articles had already been published about the lack of diversity in medicine. 1985. 1996. and so on. In 2013, a physician fellow contacted me for advice on her brief research letter documenting the lack of diversity in medicine.

So, when the news cycle had once again “discovered” the dearth of Black men in medicine in 2018 (or was it 2016?), it felt like time to get back into workforce research. And instead of yet another quantitative paper, it also felt like time to ask, what is going on?

Some failed grant applications, a modicum support from UCD Center for a Diverse Health Workforce (not the Center’s fault- there has been barely any money for workforce research until last year), and a *lot* of team effort, and we managed to conduct key informant interviews with 39 deans and directors of 37 MD-granting medical schools, asking them about admissions in general. Then zeroing in on diversity.

We plugged away through the onset of the pandemic to finish the interviews. Coding and analysis, reading, more analysis, more reading, and the final writing-as-analysis phase were a real bear, even more so than usual. But finally this came out:

US Medical School Admissions Leaders’ Experiences With Barriers to and Advancements in Diversity, Equity, and Inclusion

It’s hard to pick a favorite quote so please read the paper if you can. As a teaser, here’s one:

“After our white coat ceremony, [my dean] received a lot of questions [from alumni and faculty], ‘Whatever happened to the six-foot-two blonde, white boys we used to have in our medical school, where did they all go?'”

Key takeaways:

  • Racism has wormed its way into so many places, small and large, throughout the entire admissions cycle and school of medicine.
  • This means there are many opportunities, from small process changes to large institutional system-wide transformations, to conduct anti-racist change (see the Supplement!)
  • Med schools, get out of US News and World Report already. It doesn’t matter as much if the Harvards of the world do it- but you can make a difference if the mid-tier schools do.