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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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Suggested Citation:"Front Matter." Institute of Medicine. 2001. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.. Washington, DC: The National Academies Press. doi: 10.17226/10186.
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The Right Thing to Do, The Smart Thing to Do Enhancing Diversity in the Health Professions Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D. Brian D. Smedley and Adrienne Y. Stith Institute of Medicine Lois Colburn Association of American Medical Colleges Clyde H. Evans Association of Academic Health Centers INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee re- sponsible for the report were chosen for their special competences and with re- gard for appropriate balance. Support for this project was provided by The Robert Wood Johnson Foun- dation, The Henry J. Kaiser Family Foundation, the W.K. Kellogg Foundation, the Bureau of Health Professions, Division of Health Professions Diversity and Bureau of Primary Health Care of the Health Resources and Services Admini- stration, and the Office of Minority Health, U.S. Department of Health and Hu- man Services. The views presented in this report are those of the Institute of Medicine and are not necessarily those of the funding agencies. International Standard Book Number 0-309-07614-5 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2001 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

“Knowing is not enough; we must apply. Willing is not enough; we must do. —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal gov- ernment on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of out- standing engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engi- neering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

NICKENS SYMPOSIUM ADVISORY COMMITTEE FITZHUGH MULLAN, M.D. (Chair), Contributing Editor, Health Affairs, Bethesda, MD MAXINE BLEICH, President, Ventures in Education, New York, NY ROGER J. BULGER, M.D. (ex-officio), President, Association of Academic Health Centers, Washington, D.C. LAURO F. CAVAZOS, Ph.D., Professor, Tufts University School of Medi- cine, Department of Community Health, Boston, MA JORDAN J. COHEN, M.D. (ex-officio), President, Association of American Medical Colleges, Washington, D.C. CLYDE H. EVANS, Ph.D., Vice President, Association of Academic Health Centers, Washington, D.C. VANESSA NORTHINGTON GAMBLE, M.D., Ph.D., Vice President, Divi- sion of Community and Minority Programs, American Association of Medical Colleges, Washington, D.C. MARILYN H. GASTON, M.D., Assistant Surgeon General and Director, Bu- reau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Bethesda, MD MI JA KIM, R.N., Ph.D., Chicago, IL MARSHA LILLIE-BLANTON, Dr.P.H., Vice President, Health Policy, Henry J. Kaiser Family Foundation, Washington, D.C. SUSANNA MORALES, M.D., Department of Medicine, Weill Medical Col- lege of Cornell University, New York, NY ROBERT G. PETERSDORF, M.D., Distinguished Professor of Medicine, University of Washington School of Medicine, Seattle, WA VINCENT ROGERS, D.D.S., M.P.H., HRSA Northeast Cluster, Philadelphia, PA CARMEN VARELA RUSSO, Chief Executive Officer, Baltimore City Public Schools, Baltimore, MD

KENNETH I. SHINE, M.D. (ex-officio), President, Institute of Medicine, Washington, D.C. JEANNE C. SINKFORD, D.D.S., Ph.D., Associate Executive Director and Director, Division of Equity and Diversity, American Dental Education Asso- ciation, Washington, D.C. NATHAN STINSON, M.D., Ph.D., M.P.H., Director, Office of Minority Health, U.S. Department of Health and Human Services, Rockville, MD vi

REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures ap- proved by the NRC’s Report Review Committee. The purpose of this independ- ent review is to provide candid and critical comments that will assist the institu- tion in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Mary Lou de Leon Siantz, Georgetown University School of Nursing Susan C. Scrimshaw, University of Illinois at Chicago Curtis C. Taylor, Institute of Medicine Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by M. Alfred Haynes. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional pro- cedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the institution. vii

ACKNOWLEDGMENTS The Advisory Committee to the “Symposium on Diversity in Health Profes- sions in Honor of Herbert W. Nickens, M.D.,” wishes to thank a number of in- dividuals and organizations whose hard work and support contributed to the success of the symposium and publication of this volume. The symposium and this publication would not be possible without the generous financial support of The Robert Wood Johnson Foundation, The Henry J. Kaiser Family Foundation, the W.K. Kellogg Foundation, the Bureau of Health Professions, Division of Health Professions Diversity and Bureau of Primary Health Care of the Health Resources and Services Administration, and the Office of Minority Health, U.S. Department of Health and Human Services. Representatives of these organiza- tions served on the Advisory Committee, which was chaired by Fitzhugh Mul- lan, M.D., Contributing Editor of Health Affairs. The Advisory Committee would also like to thank Jordan J. Cohen, M.D., Roger J. Bulger, M.D., and Kenneth I. Shine, M.D., the presidents of the three sponsoring organizations and ex-officio members of the Advisory Committee, for their leadership and support of the symposium. Many individuals labored hard to plan and provide staff support for the symposium. In addition to the Advisory Committee members, staff of the Asso- ciation of American Medical Colleges (AAMC), including Vanessa Northington Gamble, Lois Colburn, Carol Savage, and Ella Cleveland; Clyde Evans of the Association of Academic Health Centers (AHC); Brian Smedley and Adrienne Stith of the Institute of Medicine (IOM); and Faith Mitchell of the Division of Behavioral, Social Sciences, and Education (DBASSE) of the National Research Council were actively involved in planning, organizing, and preparing the sum- mary of the event. Amelia Cobb and Parthenia Purnell of AAMC and Thelma Cox and Geraldine Kennedo of IOM provided logistical support during the symposium. Carol Savage of AAMC deserves special acknowledgment for her hard work to shepherd the entire symposium process, including commissioning of papers and inviting speakers. The Advisory Committee also wishes to thank the speakers and discussants who contributed to the symposium. These individuals are listed in the program agenda that appears in the appendix of this volume. viii

Table of Contents The Right Thing to Do, The Smart Thing to Do: ………….………………….1 Enhancing Diversity in the Health Professions Brian D. Smedley, Adrienne Y. Stith, Lois Colburn, Clyde H. Evans The Role of Diversity in the Training of Health Professionals ………………..36 Lisa A. Tedesco Increasing Racial and Ethnic Diversity Among Physicians: ………………….57 An Intervention to Address Health Disparities? Raynard Kington, Diana Tisnado, and David Carlisle Current Legal Status of Affirmative Action Programs in ……………………..91 Higher Education Thomas E. Perez College Admission Policies and the Educational Pipeline: …………….…….117 Implications for Medical And Health Professions Marta Tienda Toward Diverse Student Representation and Higher Achievement ………….143 in Higher Levels of the American Educational Meritocracy Michael T. Nettles and Catherine M. Millett ix

Trends in Underrepresented Minority Participation in ………………..…….185 Health Professions Schools Kevin Grumbach, Janet Coffman, Emily Rosenoff, and Claudia Muñoz Inequality in Teaching and Schooling: How Opportunity Is ………….……208 Rationed to Students of Color in America Linda Darling-Hammond Lost Opportunities: The Difficult Journey to Higher Education …………….234 for Underrepresented Minority Students Patricia Gándara Systemic Reform and Minority Student High Achievement ………….…….260 Philip Uri Treisman and Stephanie A. Surles Sustaining Minorities in Prehealth Advising Programs: ……………………281 Challenges and Strategies for Success Saundra Herndon Oyewole Rethinking the Admissions Process: Evaluation Techniques …….…………305 That Promote Inclusiveness in Admissions Decisions Filo Maldonado How Do We Retain Minority Health Professions Students? …...……………328 Michael Larimer Rainey Addendum ………………………………………….………………………..361 x

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The Symposium on Diversity in the Health Professions in Honor of Herbert W. Nickens, M.D., was convened in March 2001 to provide a forum for health policymakers, health professions educators, education policymakers, researchers, and others to address three significant and contradictory challenges: the continued under-representation of African Americans, Hispanics, and Native Americans in health professions; the growth of these populations in the United States and subsequent pressure to address their health care needs; and the recent policy, legislative, and legal challenges to affirmative action that may limit access for underrepresented minority students to health professions training. The symposium summary along with a collection of papers presented are to help stimulate further discussion and action toward addressing these challenges. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in Health Professions illustrates how the health care industry and health care professions are fighting to retain the public's confidence so that the U.S. health care system can continue to be the world's best.

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