National Academies Press: OpenBook

In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce (2004)

Chapter: Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions

« Previous: Appendix B: Committee and Staff Biographies
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Commissioned Papers

Editors’ Note:

The following papers were commissioned by the study committee to provide additional analysis and information regarding several key areas of the study charge. For each paper, nationally known experts were asked to review available literature and draw upon their professional expertise to provide an in-depth analysis of institutional and policy-level strategies to increase diversity in the health professions workforce.

The papers were prepared independently of the IOM study committee’s deliberations and analysis, although some of the commissioned paper authors were asked to present their findings before the study committee in public meetings. The opinions expressed in the papers are solely those of the authors. Several of the papers include findings and recommendations; these should not be confused with the findings and recommendations of the study committee, as indicated in the preceding committee report.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

This page intentionally left blank.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Paper Contribution A
Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions

Gabriel Garcia, Cathryn L. Nation, and Neil H. Parker

In fiscal year 2001–2002, Americans spent more than $1.4 trillion on the cost of health care (CMS, 2003). Despite this staggering investment, an estimated 41.2 million individuals were uninsured and another 92 million lacked adequate access to care (Mills, 2002; KFF, 2002). Not surprisingly, a disproportionate number of these more than 133 million people live in inner cities, rural areas, low-income neighborhoods, and communities with large numbers of minority residents. The diversity of the U.S. population continues to grow, yet the lack of diversity among its health providers is striking by any measure. Recent bans on affirmative action, together with persistent inequities in educational opportunity for many poor and minority students, pose major challenges for schools seeking to diversify their classes. In the face of these realities, a growing sense of urgency has emerged. Evidence regarding race- and ethnicity-based disparities in health status is mounting, and the need to increase diversity in the health workforce as a strategy for improving the nation’s health is both logical and clear.

This paper builds on previous work undertaken by the authors as part of the Medical Student Diversity Task Force appointed by University of California President Richard C. Atkinson in October 1999 (UCOP, 2000). The paper uses medicine as a model and starting point for examining admissions practices and institutional strategies for increasing the diversity of health professions classes. It begins with a review of the increasing diversity of the population and the profound disparities in health status among racial and ethnic groups as an imperative for change. A commentary about the responsibilities of U.S. medical schools for training clinicians,

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

researchers, and leaders who will collectively meet the needs of the public follows. The paper briefly reviews the history of affirmative action and recent challenges that affect admissions. The medical school admissions process is described in detail, with a focus on strategies and best practices essential to recruiting and enrolling diverse classes of students. Special commentaries for clinical psychology, nursing, and dentistry are also provided. Across the health professions, however, the authors concur that institutional commitment, strong leadership, support for comprehensive strategies, and thinking “outside the box” have never been needed more urgently.

DIVERSITY IN THE HEALTH PROFESSIONS

The Demographic Imperative

Major advances in science and technology have enabled the quality of medical care to improve for many individuals. Notwithstanding these achievements, significant disparities in health status continue to exist between white people and other racial and ethnic minority groups. In a landmark report issued in 1985 by the U.S. Department of Health and Human Services (DHHS), these disparities were described in terms of excess deaths for six health conditions: cancer, cardiovascular disease and stroke, chemical dependency, diabetes, unintentional injuries, and infant mortality (DHHS, 1985). Fifteen years later in 2000, the Surgeon General reported that minority groups continue to have substantially higher morbidity and mortality associated with the same and other health conditions as their white counterparts. These gaps were so great that a national Race and Health initiative was launched by DHHS in 1998. The project was recently expanded and incorporated as part of Healthy People 2010, a national public health initiative calling for the elimination of these disparities by 2010.

For many individuals, race- and ethnicity-based disparities in health status are compounded by reduced access to services, lack of adequate insurance, and inadequate availability of physicians and other health-care professionals. Among the nation’s more than 284 million people (U.S. Census Bureau, 2003), an estimated 133 million lack adequate access to care (Mills, 2002; KFF, 2002). In California alone, more than 4 million residents live in 165 areas designated by the state and federal governments as medically underserved or as health professions shortage areas (Grumbach et al., 1999). Nationally, this number jumps to a stunning 56 million (BHPR, 2003). Although differences exist in the criteria used by state and federal agencies to make such designations, health professions shortage areas, overwhelmingly, are home to poor and minority communi-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

ties that lack access to health services and to adequate numbers and types of health-care personnel.

The ramifications of these findings for the health of the nation are substantial. By the year 2020, the U.S. population is projected to reach nearly 325 million. Of these, an estimated 117 million will be nonwhite (U.S. Census Bureau, 1999). Research relevant to these changes shows that physicians from groups traditionally underrepresented in medicine are more likely than others to serve those from minority and economically disadvantaged backgrounds, to practice in physician shortage areas, and to serve patients with chronic illness and multiple diagnoses (UCOP, 2000).

The Educational Mission of U.S. Medical Schools

The mission of U.S. medical schools is to meet the needs of the citizenry by training competent and compassionate physicians.

Meeting Public Health Needs

Public support and investment in medical education totals more than $10 billion annually through federal Medicare and Medicaid payments alone (MedPAC, 1998). This investment stems from the view that medical schools and teaching hospitals are a “public good” that benefit society by training tomorrow’s practitioners, providing state-of-the-art patient care, and offering promise of new treatments for alleviating human illness and suffering. In fulfilling this trust, medical schools have an obligation to recruit, admit, and train graduates who will collectively meet the health needs of the public. As the public becomes increasingly diverse, the need for medical schools nationwide, and particularly those in racially and ethnically diverse states such as California, Texas, and New York, to diversify student enrollments is clearly evident from the standpoint of educational opportunity, public health, and workforce need.

Despite the select successes of some medical schools, diversity efforts on a national scale have had limited overall success. Medical student education in the United States is conducted in 126 allopathic and 19 osteopathic medical schools. Together, these schools admit approximately 20,000 new students each year. Yet among students who started medical school in fall 2002, fewer than 1,970 (or less than 10 percent) are from groups traditionally underrepresented in medicine (AAMC, 2003; AACOM, 2003).

Preparing Clinicians, Scientists, and Leaders

Although the lack of diversity in medicine is long-standing, U.S. medical schools and teaching hospitals have been subject to increasing aware-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

ness and criticism by the public, managed care organizations, and policy makers, who argue that medical education is not adapting to meet changing societal needs. In response to this claim, the Hastings Center brought together representatives from 14 countries to develop a consensus view of what society expected of its doctors (Callahan, 1996). The American Association of Medical Colleges (AAMC) began to address the need for changes in medical education and developed several white papers through its Medical School Objectives Projects I–IV (MSOP). The first such report in this series, entitled “Learning Objectives for Medical Education,” focused on “expressed concerns that new doctors were not as well prepared as they should be to meet society’s expectation of them” (AAMC, 1998, p. 1).

Four areas were identified in the report as essential characteristics of practicing physicians; these are that doctors be altruistic, knowledgeable, skillful, and dutiful. The AAMC (1998, p. 4) report stated that, “physicians must be compassionate and empathetic in caring for patients and must be trustworthy and truthful in all of their professional dealings…. They must understand the history of medicine, the nature of medicine’s social compact, the ethical precepts of the medical profession, and their obligations under law…. They must seek to understand the meaning of the patients’ stories in the context of the patients’ beliefs and their family and cultural value…. As members of a team addressing individual or population-based health care issues, they must be willing both to provide leadership when appropriate and to defer to the leadership of others when indicated.”

At the turn of the past century, doctors tended to the ill in their homes or in public hospitals. Advances in technology and the development of the modern hospital required that students become clinical scientists prepared to care for the sick in hospital settings. Students were selected for their abilities to master a curriculum heavily weighted to the basic and clinical sciences. They were rewarded for being science majors and for achieving high grade point averages (GPAs) and Medical College Admissions Test (MCAT) scores. Although Americans have always had high expectations about the knowledge and skill of their doctors, the growing diversity of the population has created new expectations. Patients today speak many languages and virtually all want doctors who are able to communicate with them in languages and ways they understand.

Increasing attention by accreditation bodies and state and national policy makers has similarly focused on the need for medical schools to better address changing societal needs. The Liaison Committee for Medical Education, which accredits allopathic schools, recently added a requirement that medical schools produce graduates who are culturally competent. Discussions at various state and national levels have also begun to consider the value of adding a language requirement as a prerequisite for admission to medical school. These and other initiatives addressing both undergradu-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

ate and graduate medical education are driven by growing recognition of the need to improve access to care, reduce disparities in health status, and respond more effectively to the changing needs of the public.

The need for diversity in the scientific and research community is equally compelling. Graduates of medical schools frequently do more than just practice medicine. Many are directly and indirectly involved in research at the basic science and clinical levels. All medical students and physicians should be trained to understand research design and its applications and limitations to various patient populations. Research and provider communities should understand that the number of research and clinical trials involving individuals from all races and ethnicities is inadequate, and that this insufficiency limits the application of some research findings.

To improve health outcomes, clinicians and researchers will require increased understanding of the disparities in health status that exist between racial and ethnic groups. Improving health outcomes will also require that health-care providers make efforts to improve their own cultural competency and to enhance their awareness of the diversity of belief systems and behavioral determinants that are characteristic of the patient populations they serve.

PAST AND PRESENT CHALLENGES TO DIVERSITY

Public health needs in America have changed, but efforts to diversify the health professions workforce are by no means new concepts or goals. Just as the achievements of individual schools have varied over time, so have the obstacles to their progress been influenced by changing law, public policy, and societal values. Past challenges remain and new ones have emerged. Critical to the success of some institutions is the use of affirmative action policies that encourage and allow consideration of race/ethnicity as one among many factors considered in the admissions process. Recent bans on affirmative action, however, have created new obstacles for a number of public institutions seeking to diversify their student bodies. A brief review of the history of affirmative action and recent major state initiatives and legal challenges in this area provides useful context for those charged with developing effective institutional policies in the future.

Historical Ramifications of Segregation

For the first two-thirds of the twentieth century, U.S. medical schools were de facto segregated. The Flexner Report of 1910, which shaped medical education in the subsequent century, encouraged the support of medical education at the historically black colleges and universities to provide a physician workforce that would serve black Americans, yet its recommen-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

dations resulted in the closure of five of the seven majority medical schools that trained African American physicians (Shea and Fullilove, 1985). As recently as 1964, 93 percent of all medical students in the United States were men and 97 percent were non-Hispanic whites. Of the remaining 3 percent, all but a few were enrolled in the nation’s (then) two predominantly black medical schools, Howard University in Washington, DC, and Meharry Medical College in Nashville, Tennessee. At that time, less than 0.2 percent of all medical students were Mexican American, Puerto Rican, American Indian, or Alaskan Native. Prevailing societal values and practices within the profession were reflected in restricted opportunities for minority medical school graduates to participate in specialty training, medical society membership, hospital staff membership, and other professional activities.

Affirmative Action as a Remedy

Beginning in the late 1960s, a handful of other medical schools changed their admissions policies and favored a more integrated student body through affirmative action. An example at the time was the University of California Davis campus, where the medical school guaranteed 16 percent of the seats in each incoming class to African American and Mexican American applicants. By 1970, the AAMC adopted a recommendation to medical schools that strongly encouraged vigorous expansion of efforts to recruit and enroll minority students. The AAMC’s stated goal was “to achieve equality of opportunity by relieving or eliminating inequitable barriers and constraints to access to the medical profession” (AAMC, 1970).

The widely recognized underrepresentation of minorities in medicine during the middle of this century was one of the driving forces behind the passage of the Federal Comprehensive Health Manpower Training Act of 1971 and its articulation of a new national policy intended to produce a physician workforce that would draw on the knowledge and skills of people from all segments of society. These efforts yielded promising early results. In the 6-year period between 1968 and 1974, enrollment of minority students increased from 3 percent of all entering students to approximately 8 percent nationwide (AAMC, 2000).

No significant changes in minority enrollment in medical schools occurred until 1990, when the AAMC established Project 3000 by 2000. This initiative called on U.S. medical schools to increase the number of minority students to 3,000 entering students by the year 2000. It recognized that medical schools have the means and the responsibility to improve educational opportunities for young people and their communities, but that they cannot solve the problem of minority underrepresentation alone. The initiative established both enrichment programs for college students and educa-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

tional exercises for medical school admissions committee members, which led to a slow but steady rise in minority enrollment until peak levels of 2,014 students (12.4 percent) were reached in 1994.

The Bakke Decision

In the mid-1970s, and the years that followed, previous gains leveled off. Among the prime causes was a 1974 reverse discrimination lawsuit heard by the U.S. Supreme Court and brought by Allan Bakke against the University of California (UC). Bakke was a 33-year-old white man who applied to the UC-Davis School of Medicine during the time when positions in the entering class were “reserved” for qualified minority students. When Bakke was denied admission, he argued that the admissions process at UC-Davis was discriminatory because only minority students could compete for those seats.

The complexity of the Supreme Court’s 1978 decision was reflected in the more than 150 pages and nine opinions necessary to express its result. Six justices wrote separate opinions, with no more than four agreeing fully in their reasoning. Justice Powell cast the deciding vote. In his written opinion, Powell stated, “the State has a substantial interest that legitimately may be served by a properly devised admissions program involving the competitive consideration of race and ethnic origin.” He also quoted the president of Princeton University regarding the benefits of diversity on the learning process, stating that, “it occurs through interactions among students of both sexes; of different races, religions and backgrounds … who are able, directly or indirectly, to learn from their differences and to stimulate one another to examine even their most deeply held assumptions about themselves and their world” (Powell, 1978).

As a result of the Court’s decision, Bakke was admitted to medical school at UC-Davis and the school’s special admissions program was invalidated insofar as it reserved seats for minority applicants. More significantly, however, the Court’s decision affirmed the use of race as one among many factors that could be considered as part of the medical school admissions process. Throughout the 1980s and early 1990s, the Supreme Court’s decision set the standard for U.S. medical schools—and for many higher educational institutions nationwide—that sought to increase the diversity of their student bodies.

Recent Anti-Affirmative Action Initiatives

In the mid-1990s, several high-profile changes in public higher education challenged the use of affirmative action in admissions. The first occurred in July 1995, when the University of California Board of Regents

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

approved a new policy prohibiting the use of “race, religion, sex, color, ethnicity, or national origin as criteria for either admission to the University or to any program of study.” Within 18 months of the regents’ action, two other challenges to affirmative action occurred. In March 1996, the U.S. Supreme Court refused to review the Fifth District Court of Appeals decision in Hopwood v. Texas, which found that the civil rights of four white applicants had been violated by the minority admissions process of the University of Texas School of Law. The Court ruled that the school could not use race as a factor in its admissions process. Although not binding for the rest of the nation, this ruling prohibits the consideration of race in the admissions process among all public higher educational institutions in Texas, Louisiana, and Mississippi.

In the November 1996 state general election, California voters passed Proposition 209, thereby adding state constitutional backing to the anti-affirmative action effect of the (then) new regents policy. Proposition 209 provided that the state, including the University of California, “shall not discriminate against, or grant preferential treatment to, any individual or group on the basis of race, sex, color, ethnicity, or national origin in the operation of public employment, public education, or public contracting.” Although the regents rescinded the policy in May 2001, the effects of Proposition 209 nevertheless prohibit the consideration of race in the admissions process. The state of Washington subsequently passed a similar initiative and other states have considered measures intended to achieve the same goal. These state mandates have had significant effects on the rates of admission of underrepresented minority students to medical schools in these states. In fact, reductions in minority student enrollments in these states have been a major cause of the nearly 12 percent decline in the matriculation of underrepresented students at U.S. medical schools between 1995 and 2001 (Cohen, 2003) (Table PCA-1).

The Supreme Court Ruling in the University of Michigan Lawsuits

The U.S. Supreme Court recently heard two admissions cases, Grutter v. Bollinger and Gratz v. Bollinger, involving the University of Michigan and the constitutionality of using race-conscious decisions as part of its admissions process. Although neither case directly involved medical school or other health profession admissions, the Court’s ruling was widely recognized as one that would have profound bearing on the future of affirmative action in public higher education nationwide.

In June 2003, the Court ruled on these separate but parallel cases. In Grutter v. Bollinger, the justices voted 5-4 to uphold the University of Michigan’s law school affirmative action policy. Writing the majority opinion, Justice O’Connor wrote that diversity served a compelling interest in

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

TABLE PCA-1 Underrepresented Minority Matriculants to U.S. Medical Schools, 1995–2001

State

1995

2001

Change %

Change

California

179

126

–53

–29.6

Louisiana

46

35

–11

–23.9

Mississippi

14

5

–9

–64.3

Texas

218

181

–37

–17.0

Washington

14

6

–8

–57.1

All other states

1,554

1,433

–121

–7.8

Total

2,025

1,786

–239

–11.8

 

SOURCE: Cohen, 2003.

higher education, thereby enabling the school to continue taking race and ethnicity into account. Avoiding the use of quotas, the Court ruled that the school may take steps to “narrowly tailor” its admissions program. In Gratz v. Bollinger, the Court’s 6-3 vote struck down the affirmative action policy for undergraduate admissions, which awarded points related to ethnic background on an admissions rating scale. With these rulings, the Supreme Court recognized the value of diversity in higher education and preserved the ability to consider race as a factor in admissions decisions.

Although the Supreme Court’s ruling is a victory for those committed to success in this area, it does not change the fact that affirmative action is now prohibited in some of the most populous states in the nation. It also does not change the fact that bans already in effect for several large and prominent public higher education systems have contributed substantially to the decline in the enrollment of minority students in U.S. medical schools. Further challenges to affirmative action appear likely; if enacted, these can be expected to have similar effects.

Ramifications and Implications of Affirmative Action Bans

It has been estimated that if affirmative action is prohibited nationally, the number of minority medical students will decrease from 10 percent to fewer than 3 percent (Cohen, 2003). Should this occur, the effect would be less diverse student populations and diminished ability for students to learn in an environment that increases cultural competence and promotes understanding and tolerance of individuals with different backgrounds and opinions. This change would decrease the diversity of future faculty, thereby decreasing the minority representation among those involved in research, teaching, and future leadership of health sciences schools, physician groups, and clinics and medical centers. The applicant pools for these professions will again shrink as prohibitions against race-conscious admissions impact

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

access to undergraduate higher education. Outreach programs and efforts targeted at segments of the population historically underrepresented in the sciences and health professions will be jeopardized, and highly successful programs such as the Robert Wood Johnson Medical Minority Education Program would likely decrease or cease to exist. Scholarship programs to address the financial needs of minority students also could be ruled illegal.

The Small Size of the Applicant Pool

Although affirmative action policies have provided a mechanism by which higher educational institutions can—or could—pursue diversity initiatives, the small size of the minority applicant pool in the health professions is a persistent challenge. By its nature, medical education in the United States is a graduate educational program. A requirement for all applicants is completion of the necessary premedical requirements, which for most prospective applicants means earning an undergraduate college degree. A review of the output of all U.S. undergraduate institutions shows that the likelihood that a person 18 years or older will obtain a college degree is 82 percent for whites, yet only 6.9 percent for African Americans and 4.5 percent for Hispanics (U.S. Department of Education, 2000). The admissions process at the nation’s most selective colleges and universities yields a class composed of 69.8 percent white students but only 6.3 percent African Americans and 5.5 percent Hispanics (IPEDS, 1999). These long-standing disparities in educational opportunity and achievement ensure that many of the nation’s poor and minority students will disproportionately fail to achieve entrance to medical school in proportion to their representation in society.

The term “underrepresented minority” (URM) has been used by the AAMC since the early 1970s to define minority groups excluded from participation in the medical profession through societal discriminatory practices. To date, the four groups recognized as URMs include African Americans or blacks, Mexican Americans, Native Americans (American Indians, Alaskan Natives, and native Hawaiians), and mainland Puerto Ricans. Changes in the racial and ethnic demography of the United States over the past three decades have motivated the AAMC to look again at this definition. Because eligibility for participation in minority enrichment programs sponsored by the AAMC is tied to this definition, alternative guidelines have been established by the federal government that define how race and ethnicity information is collected. Concern about the admissions practices of medical schools created by recent attacks on affirmative action increases the urgency for a new definition.

DHHS recognizes underrepresented minorities as “racial and ethnic populations that are underrepresented in the health profession relative to

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

the number of individuals who are members of the population involved” (42 U.S.C. 295). Adoption of this definition would acknowledge the substantial demographic changes that have occurred and the lack of significant progress in the integration of these groups in medical education. If approved, the AAMC could then establish targeted enrichment programs and promote affirmative action admissions programs designed to fully integrate these groups in the medical profession.

Persistent Socioeconomic and Educational Inequities

Although the Civil Rights movement of the 1960s and 1970s outlawed overt barriers to admission, it did not rectify the legacy of discrimination that persists. Major obstacles remain for students living in homes and communities with high rates of poverty. These students lack access not only to quality educational programs but also to advanced placement programs, college-level courses, quality advising, role models, and mentors. Students whose parents have lower levels of educational achievement, who live in low-income households, or who are exposed to violence and racism in the community face increased challenges in reaching their full potential. Exclusion from educational and professional opportunities experienced over several generations persists because there are fewer well-trained teachers in rural and inner city public schools than in middle- and upper class communities. The stereotype of lower expectations for minority students by teachers and other adults also has negative self-fulfilling effects for those who do not believe in their own potential. This widespread lack of support for disadvantaged students who wish to excel makes peer pressure to join gangs, use drugs, and drop out of school a frequent choice for many students living in America’s inner cities and poorest communities.

Inadequate Advising

While inequities in educational opportunities for many URM students contribute to the small size of the health professions applicant pool, inadequate advising creates other less obvious dilemmas even for those students who go on to college with an interest in the health sciences. Students who experience academic difficulty in science and nonscience courses during their first year of college often seek help from premedical advisors at a critical stage in their education. While some receive the advice they need to pursue their goals, others are discouraged from a career in medicine or science on the basis of grades received in one or two courses. Turnover among health sciences advisors creates further challenges in ensuring that all students have access to reliable information about admissions and the full range of resources that are available to help them (UCOP, 2000).

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Data provided by the AAMC to the University of California’s Medical Student Diversity Task Force in 2000, for example, suggest that California undergraduate health sciences majors enter college in a ratio of three non-URM students to one URM student. The UC task force examined these data and found that the differences and changes in the sizes of these groups during the college years were substantial. The final report of the task force stated that if “attention is focused on those freshmen health science majors who score well on the Scholastic Aptitude Test (SAT), the picture becomes more encouraging. Among this group, the ‘attrition rate’ of URM health sciences majors is about the same as for non-URM students. And, if acceptance to medical school is taken as the end point, these URM students do slightly better. It is therefore particularly noteworthy that among the pool of URM students that enter college with an interest in a health career, the majority who change career goals do so during (or shortly after) their freshman year” (UCOP, 2000, p. 27).

Because URM students are less likely than their majority peers to have role models in the health professions and a support system that encourages their educational interests, access to quality advising services is essential. Improved quality and consistency of premedical advising is thus a viable mechanism for encouraging those students with interest to continue and for providing students with access to resources that will enhance their preparation.

THE ADMISSIONS PROCESS

The goal of the admissions process is to identify candidates who will be successful in their individual careers and collective contributions as future clinicians, teachers, researchers, and leaders. For committees making these choices, the challenge is to select an entering class that reflects the mission of the school and is capable of outstanding performance and future success. The process typically involves the review of applications from thousands of students who are competing for admission to an average entering class of 90 to 140 students. For any given school, a look at its mission and mission statement and in-depth review of the actual process and factors that are valued for admission will provide a strong indication of its commitment to diversity. The composition of admissions committees and the orientation provided to members about the value of diversity will influence the choices made about whom to admit. Then, in turn, tangible evidence of diversity on campus—or the lack thereof—will influence the choices made by students about where to enroll.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Medical School Missions and Mission Statements

The mission of a medical school is a statement of purpose. Because each school has its own history and set of institutional values, the missions of U.S. schools vary considerably. At any given school, however, its mission shapes the role of that institution in the educational community. It often drives the admissions process to identify and accept applicants who reflect its values and will embrace its educational goals and contribute to the desired learning environment. The mission will impact curricular design to enhance the likelihood that a student will learn concepts and participate in professional activities, such as research, public service, teaching, and advocacy, that reflect the school’s core values. The net effect tends to be the graduation of students whose careers are influenced by the faculty from whom they learn and whose choices of professional activities are transformed through their educational experiences.

Choosing Students

Although the predominant major of medical school applicants is still in the biologic sciences, this is not required nor is it necessarily ideal. Data from the AAMC show, for example, that English majors achieve the highest scores on the biological science section of the MCAT. The AAMC’s Medical School Admissions Requirement indicates that schools are responding to these and other findings by focusing on the personal attributes of students in their admissions decisions. Most committees use some mechanism to assess the qualifications of each applicant’s academic preparation, aptitude for science, enthusiasm for learning, evidence of outstanding interpersonal and communication skills, and motivation for a career in medicine. The details of the selection process, however, and the weight and value assigned to particular academic and nonacademic factors vary widely across schools; these, in turn, affect the diversity of students admitted.

Role and Relevance of Grades and MCAT Scores

There is ample evidence that undergraduate science GPA and MCAT scores are predictors of grades and performance on standardized tests during medical school. The individual MCAT scores and the undergraduate GPA in science and nonscience courses contribute something unique to the prediction of medical school grades, and the combination is more powerful than either alone. Results of the MCAT are also good predictors of test scores on the United States Medical Licensing Exam (USMLE); by contrast, the GPA adds little additional predictive value (Julian, 2000). Despite this evidence, a base multiple regression model considering gender, URM sta-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

tus, science GPA, and MCAT scores in physical sciences and biological sciences explained only 29.1 percent of the variation in USMLE Step 1 test scores (Basco et al., 2002). Most variation in standardized test scores is not predicted by either demographic information or traditional measures of academic performance; grades in the clinical years are least well predicted by either MCATs or GPAs.

Medical schools also consider potential variables that suggest that a student may encounter academic difficulty—traditionally defined as withdrawal from school, a nonmedical leave of absence, dismissal, or delay of graduation date. Most studies have found that an increased risk of encountering academic difficulty is associated with low MCAT scores (particularly biological sciences scores), low science GPAs, low selectivity of the undergraduate institution, female gender, being an URM member, or older age. The majority of students who experience academic difficulty, however, eventually graduate from medical school, and the risk and timing of these episodes has been found to vary among the different groups of students studied (Huff and Fang, 1999).

Standardized test results and grades are thus useful but not exceptional or unique predictors of medical school performance. They are designed and validated by their ability to predict future test scores. GPAs and MCAT scores are not useful in predicting clinical performance, even when adjusting for the students’ undergraduate institution (Silver and Hodgson, 1997). Standardized tests measure already developed skills but not the mastery of a particular curriculum or a student’s innate ability. Experiences that are closely tied to an individual’s racial and ethnic identity can lower the results of standardized tests independent of socioeconomic status. This outcome is more likely to occur for a minority or other student whose abilities are negatively stereotyped by society; this is particularly true for the student who is deeply invested in achieving good results on a test. This “stereotype threat” may interfere with test performance for any student (or group of students) for whom abilities are negatively stereotyped in the larger society (Steele and Aronson, 1995). Admissions committees that place the greatest weight on standardized test scores limit the opportunities of minority students to participate in the medical profession.

Personal Characteristics

Academic success during the first 2 years of medical school is not, in and of itself, predictive of success in meeting the clinical training and patient care requirements of the third and fourth years of medical school and future practice. To be successful in clinical settings, students must demonstrate an ability to apply what they have learned and communicate and interact effectively with patients, faculty and staff, peers, and others. Good

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

judgment, common sense, maturity, compassion, and professionalism are among the qualities that are expected, valued, and routinely evaluated as part of student performance during the clinical years of medical school and residency training.

Defining the desirable traits of physicians is best accomplished by relying on the measures of professionalism being developed by medical associations and translating them into attributes that can be measured at the time of application to medical school. Such definitions should factor in the health needs of society and the means to create a workforce that will meet those needs. By considering patient care a first priority, physicians are expected to be ethical, honest, and dedicated. In making decisions for their patients, they should be knowledgeable, willing to learn, and able to use newly acquired knowledge to modify their practice to ensure optimal patient care. Not surprisingly, “good doctors” are considered those who relate well to their patients, possess good communication skills, and understand the cultural context in which they deliver medical care (Leahy et al., 2003).

Motivation for the medical profession is assessed through a track record that reflects the desire to positively affect the health care of individuals and communities through public service, cultural activities, educational endeavors, and scholarly activities. Many schools seek evidence of leadership, with awareness and participation in activities that are intended to have a positive influence on others. Competitive applicants will have a record of activities and leadership roles in which they are perceived as innovators in their chosen field, advocates for the communities they serve, and contributors toward a legacy that reflects their creativity and drive.

Attention to Details

Recruitment of a diverse class requires that admissions committees take into account the “distance traveled” by each applicant. Certain characteristics are important to consider, particularly for those students who have not had optimal access to educational opportunities. The following characteristics are among those that merit careful attention.

Parental income, education, and occupation. The lack of role models in the applicant’s home and family, or the possibility that they may be the first in their family to achieve a college or professional degree may limit their contact with people who can help them navigate the challenges of higher education.

Precollege education. The quality of teachers, curriculum, and available resources varies tremendously across high school districts and is closely tied to educational outcomes.

Hours worked while attending college. Applicants who made a signifi-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

cant commitment to a part-time job during their undergraduate years to support themselves or their families cannot be expected to have participated in extracurricular activities to the same degree as those applicants without similar obligations.

Cultural barriers. Expected educational outcomes vary among racial and ethnic groups. The applicant may have been subject to an environment in which high levels of educational achievement were neither expected nor valued.

Geographic location or neighborhood where applicant was raised. The location in which a student was raised and attended schools directly affects the number and quality of his or her educational opportunities.

Prior experience with prejudice. Underperformance on standardized tests based on stereotype threat is a frequent outcome for students whose abilities have been persistently questioned or challenged by the society at large.

Special family obligations and other circumstances. Minority students from poor families are frequently asked to contribute to the finances of their household or obliged to provide supervision and assistance to siblings or disabled relatives.

Appointment and Training of Committee Members

Admissions committees consist of individuals, appointed by their schools, to review applications and make determinations about which students they will admit. An admissions dean, and his or her staff, assist committees with this work. In the not-too-distant past, committees were often composed of basic sciences faculty who were (primarily) academically distinguished white men. Over time, the composition of many medical school admissions committees has changed to reflect changes in the curriculum as well as changing expectations of accreditation bodies, graduate medical education programs, and the public. Although most committees now include basic sciences and clinical faculty, alumni, medical students, and residents, the lack of diversity of most medical school faculties is also a characteristic of their admissions committees.

The education and training of admissions committees regarding the value of diversity and the relevance of a diverse health workforce for improving access to health services and reducing health disparities are suspected to vary widely across institutions. Increased awareness by committees of research findings and relevant literature would be appropriate for this purpose. Examples include findings showing that physicians are more likely to treat higher proportions of patients from their own racial and ethnic groups (Keith et al., 1985; Komaromy et al., 1996); minority physicians have higher percentages of patients covered by Medicaid in their

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

practices (Davidson and Montoya, 1987); minority patients who have a regular physician are four times as likely to report care from a minority physician than white patients (Moy et al., 1995); and increased diversity more effectively engages health professionals in a biomedical and public health research agenda that addresses health disparities and other public health needs (Cohen, 2003).

Recruitment Efforts

While the admissions process determines who is admitted to medical school, the small size of the national URM applicant pool creates the situation that many top minority students will receive more than one offer about where to enroll. In making their choices, students will consider a number of factors. The number of minority students and faculty on campus, for example, is an obvious sign of the extent to which an institution supports a culture of diversity. The presence of targeted enrichment and support programs for minority faculty and students also gives a view of the institutional climate and support for diversity. Correspondingly, the absence of a critical mass of minority students and faculty, and the absence of dedicated enrichment and academic support programs, may be deterrents for minority students who have more than one choice about where to enroll. Active recruitment efforts dedicated to welcoming and encouraging admitted students to enroll are a factor in making a final choice for some students.

CLINICAL PSYCHOLOGY, DENTISTRY, AND NURSING

Clinical Psychology

The number of ethnic minority students enrolled in graduate programs in psychology has been increasing steadily over the past two decades. In 2002–2003, 14.3 percent of 39,672 full-time students enrolled in doctoral-level departments of psychology described themselves as black, Hispanic, Native American, or multiethnic; of 6,411 students enrolled in master departments of psychology, the equivalent statistic is 11.3 percent (APA, 2003a). The number of Ph.D. degrees awarded to all ethnic minorities (including Asian students) rose from 6.3 percent in 1978 to 8.1 percent in 1988 to 15.5 percent in 1998 (APA, 2003b). Because psychology is a field in which ethnic minority psychologists make up only 7.5 percent of full-time faculty in graduate departments of psychology and 6 percent of the total, the profile of the profession is that of relatively more ethnic minority psychologists in training than in the profession or academia, a situation parallel to that in medicine.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

This growth in minority enrollment has resulted from institutional commitments and recruitment programs started by the professional graduate schools and strong support from professional associations. The American Psychological Association (APA) has had a significant track record of attention to multicultural awareness and competence, recruiting of ethnic minority students, and career guidance, even before the establishment of the APA Office of Ethnic Minority Affairs in 1979. In February 1994, the APA Council of Representatives passed a resolution placing a “high priority on issues related to the education of ethnic minorities. These issues include planning appropriately diverse curricula, promoting psychology as a course of study and career option, as well as recruitment, retention, advising and mentoring students at all levels of education” (Holliday et al., 1997, p. 3). Also in 1994, a Commission on Ethnic Minority Recruitment, Retention and Training in Psychology (CEMRRAT) was established with the aim, among others, to promote an educational pipeline for ethnic minority students. CEMRRAT’s Work Group on Student Recruitment and Retention has prepared two booklets to assist ethnic minority students and admissions officers in the application process: How to Apply to Graduate and Professional Programs in Psychology and Minority Student Recruitment Resources Booklet. A subsequent CEMRRAT task force (CEMRRAT2 TF) has continued this process for the APA.

The ambivalence or resistance of psychology faculty to the need and value of diversity in the student body, faculty, and curriculum is considered a major barrier to effective minority student recruitment and training. In response, the APA has promoted initiatives that provide incentives to psychology programs for ethnic minority recruitment, retention, and graduation activities. These activities include, among others, securing grants to support students in historically black colleges and universities and to establish regional centers of excellence in the recruitment, retention, and training of ethnic minority students. Other activities involve developing publications that address best practices in recruitment and retention of ethnic minority students and recognizing graduate programs in psychology with demonstrated excellence in the recruitment and retention of ethnic minority students through their annual APA Suinn Minority Achievement Awards.

Efforts by individual schools are outlined in Model Strategies for Ethnic Minority Recruitment, Retention and Training in Higher Education, which was published in May 2000 by the APA Office of Ethnic Minority Affairs (APA, 2000). This document details 13 model strategies to enhance recruitment and retention of ethnic minority students and faculty. The strategies, based on the assumption that students of color bring an added value to the educational program and institution, range from course development to enrichment programs for undergraduates and mentoring and social or community services for enrolled students. Strategies for admis-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

sions officers emphasize the use of a holistic or comprehensive review of applications rather than the setting of thresholds for academic and test performance. Although this report does not highlight programs at all graduate schools, it summarizes well the types of initiatives that are in place.

Finally, the APA has encouraged and supported stronger linkages among institutions with varying missions at different points in the educational pipeline (high schools, community colleges, and 4-year colleges). Characteristic of this support is its provision of funding and technical assistance necessary for encouraging psychology programs to develop multicultural curricula and academic and social climates that are supportive of diversity. These efforts include the dissemination of information related to diversity and multicultural education strategies; outcomes in postsecondary education; and evaluative processes that document the impact of the new initiatives on both the institutional climate and the numbers of ethnic minorities that have participated in the process.

Dentistry

The first report on oral health ever issued by a U.S. Surgeon General reported dramatic improvements in the overall oral health status of Americans and recognized the contributions of the dental profession in making this progress (DHHS, 2000). The report, however, identified major disparities in the oral health status of some populations and disproportionate disease of individuals living in poor and underserved communities. In 2002, the American Dental Education Association (ADEA) appointed a group of national experts to examine the roles and responsibilities of academic dental institutions in improving the oral health of all Americans. The report of the ADEA president’s commission, Improving the Oral Health Status of All Americans: Roles and Responsibilities (Haden et al., 2003), summarized these disparities and cited data concerning Dental Health Professions Shortage Areas issued by the Health Resources and Services Administration’s Bureau of Health Professions. These data show that during the years 1993–2002, the number of designated shortage areas grew from 792 to 1,892 nationally, and more than 40 million Americans reside in these areas (HRSA, 2002b).

The ADEA report concluded with a series of recommendations for improving the oral health of the public, with a focus on meeting the needs of underserved communities. In addition to urging dental schools to monitor workforce needs and increase the cultural competency of all students, the report recognized the importance of increasing the diversity of the workforce as a strategy for meeting the needs of the increasingly diverse public. Expanding outreach programs, identifying best practices for recruit-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

ing and retaining URM students and faculty, and reviewing and amending admissions criteria were among the recommendations cited.

Accredited dental education programs in the United States are offered by 56 dental schools. Although the closure of five dental schools between 1986 and 1993 contributed to the 37 percent decline in first-year enrollments that occurred in the 1980s, the opening of three new schools since 1997 enabled the total number of first-year positions to increase from a low of 3,573 in 1989 to an average of 4,100–4,300 during the 1990s (Valachovic et al., 2001; Weaver et al., 2000). During the same period, the total number of applicants to U.S. schools increased nearly 100 percent to a peak of approximately 9,800 in 1997. For the next several years, and despite relatively stable enrollments, the total number of applicants declined.

Although these overall trends apply to total applications and enrollments for all students, it is important to emphasize that trends for URM applicants, defined as black/African American, Hispanic/Latino, and Native American, differ in critical ways. Data reported by the ADEA show that between 1980 and 1999, URM applicants increased slightly from 8 percent to 10.5 percent of total applicants and 10.2 percent of first-year enrollees. A careful look at data for the past decade, however, shows that the number of first-time, first-year URM enrollees in U.S. dental schools declined by 23 percent between 1990 and 1998 (Weaver, 2003). Although the ADEA is pursuing a number of initiatives to increase diversity in U.S. dental schools, it is nevertheless astonishing to note that its December 2000 report stated that among the nation’s (then) 55 dental schools, half of all schools had one or no black/African American first-year students, and nearly half had one or no Hispanic/Latino enrollees. Although gains have been made since then, the 2001 nationwide enrollment of 499 URM dental students is a reminder that despite ongoing efforts, total URM enrollments have not increased appreciably in more than a decade.

In 2002, with a goal of improving these numbers, the Robert Wood Johnson Foundation (RWJ) implemented a new grant program entitled “Pipeline, Profession, and Practice: Community Based Dental Education.” Through a competitive process, a total of 11 U.S. dental schools were granted approximately $1.5 million per dental school over a 5-year period. In their grant applications, each school identified goals for increasing its URM enrollments. If each school reaches its goals, total URM enrollment would increase by 90 new first-year students—representing a 20 percent increase over the total number of first-year URM students in all U.S. dental schools. The California Endowment is funding California dental schools to conduct the same type of programs; if these schools increase their enrollments to the same extent as those funded by RWJ, the ADEA estimates that

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

total URM dental student enrollment could increase by 25 percent nationwide.

Through the leadership of the ADEA, foundation partners, and various associations and health professions coalitions, U.S. schools have the opportunity to be active partners in increasing the diversity of their future dental student classes. Like medicine, the track records of individual dental schools vary; schools with poor prior records will require new efforts and institutional commitment if they wish to make change. New York University’s College of Dentistry provides a recent example. In fall 1997, the school’s entering class of 230 students included only one African American student. Determined to promote change, the recently appointed dean, Dr. Michael Alfano, appointed a committee that made recommendations addressing the need for leadership, increased outreach to students and patients, creation of multiyear partnerships with undergraduate schools, development of recruitment and retention efforts for faculty, and outreach to community leaders requesting their support in encouraging qualified URM students to apply. The majority of the committee’s recommendations were implemented, along with others identified by the faculty, dean, and staff. The results of these efforts are reflected in the entering class of 2003, where nine African American students are currently enrolled as first-year students (Personal communication, M. Alfano, New York University, September 2003).

Nursing

The enumeration and examination of the deepening nursing shortage nationwide highlight the need in nursing, as in the other health professions, to increase the diversity of its workforce as it ensures adequate supply. In 2002, the National Sample of Registered Nurses revealed that of the estimated 2,694,540 registered nurses (RNs) in the United States in 2000, only 331,428 (12.3 percent) represented racial or ethnic minority groups: 133,041 were African American/black (non-Hispanic); 93,415 were Asian; 54,861 were Hispanic/Latino; and 13,040 were American Indians/Alaskan Natives (HRSA, 2002a). Although the 12.3 percent figure represents an increase from 7 percent in 1980, it is still well below the 30 percent of the general population identified as being from a racial or ethnic minority group.

One solution to correcting this disparity is to prepare a more diverse group of men and women to meet the health-care needs of an increasingly diverse population. The importance of achieving this goal was highlighted in a report prepared by the National Advisory Council on Nurse Education and Practice, which showed that minority nurses, despite their low numbers, are integral to developing and implementing models of care that address the unique needs of minority populations. To do so, however, re-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

quires continued efforts in nursing schools and training programs to correct their own lack of diversity. While the minority student population in U.S. nursing schools approaches 26 percent, as compared with 10.5 percent in medical schools and 11 percent in dental schools, 73.5 percent of nursing students in baccalaureate programs are from nonminority backgrounds.

In their efforts to attract and retain minority students, nursing schools face profession-specific challenges in addition to those common to many of the health science professions. Commonly cited reasons why members of minority groups do not pursue nursing range from the public perception of the field (lack of mentors, gender biases, confusion and misunderstanding about nursing practice, and role stereotypes) to economics (costs of training programs, future earnings compared with other health disciplines). The lack of ethnic and gender diversity in nursing faculty further compounds real and perceived difficulties in recruiting qualified minority students.

The variability of the nursing educational programs leading to a degree and licensure poses a particular challenge to consistent and effective minority student recruitment and retention that is unique to nursing. Training to become a practicing RN is accomplished by completing a 3-year diploma program typically administered in hospitals; a 2- to 3-year associate degree usually offered at community colleges; or a 4-year baccalaureate degree offered at senior colleges and universities. Unlike other health professions, which draw generally from a pool of baccalaureate-trained, academically advanced students, many nursing schools draw from a pool of applicants with a wider range of skill and experience to bring to an increasingly demanding regimen of courses and requirements. Even when nursing programs successfully draw a diverse group of applicants through outreach efforts in their local communities, academic disadvantage and inability to master the coursework often lead to failure rates as high as 50 percent.

A national effort to address these challenges is ongoing. In December 2001, the American Association of Colleges of Nursing published Effective Strategies for Increasing Diversity in Nursing Programs (AACN, 2001). This report includes a summary of the successful efforts by more than 10 nursing programs in the United States that, through innovative and effective recruitment strategies, measurably improved their student ratios. Examples of strategies in practice include:

  • Investment of nursing students in community care programs in the region surrounding the school. Nursing students of diverse backgrounds who train and work in community clinics, local high schools, and health service programs function as both mentors and recruiters to the field of nursing. Such exposure also contributes to students’ preparation for practice in a variety of settings.

  • Outreach and recruitment in diverse communities. Students inter-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

ested in nursing training through diploma and associate degree programs typically enroll in local programs offered in the community college system. Drawing from within the community, those schools in racially diverse regions recruit student populations that reflect regional demographics.

  • Supporting students from within the student population. Peer support of minority students encourages academic success and increases the likelihood of retaining the student within the training program.

In several areas of the country, state legislatures have mandated that health professions schools increase the diversity of their student populations, prompting analysis and change at all points of the educational pipeline. In June 2003, DHHS awarded $3.5 million in grants to support nursing education opportunities for disadvantaged students. Finally, leaders in the nursing education community state a collective awareness of the “need to do better” and continue to share resources and strategies (Personal communication, C. Waltz, University of Maryland, August 28, 2003). Accelerated programs to prepare nurses for practice and further study are increasing in number and scope and student support and mentoring efforts are increasingly the likelihood of success for students enrolling in nursing degree and training programs.

STRATEGIES AND BEST PRACTICES

Attorney Maureen Mahoney of the University of Michigan Law School stated clearly the reason for affirmative action and integration of the school by saying that the state has “a compelling interest in having an institution that is both academically excellent and racially diverse” (University of Michigan, 2003).

Health professions programs committed to increasing the diversity of their future classes must be committed to the principal of diversity and its value; to be successful, schools require strong, active leadership and development of comprehensive strategies addressing both current and future applicants. For individual schools, articulation of a mission statement and cultivation of an institutional culture that supports diversity are essential to creating a foundation on which to base campus policies, practices, and programs to enhance diversity. Carefully tailored admissions strategies, including affirmative action programs where lawful, will increase the likelihood that a school is successful. Attention to the selection and education of admissions committee members, together with careful consideration during the admissions process of factors predictive of academic success and supportive of diversity, will contribute to improving admissions outcomes. Recruitment efforts for students already admitted, but not yet enrolled, will also make a difference. Finally, and although not part of the actual admis-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

sions process, improved outreach to students, communities, and health professions advisors are among the activities that should be supported by and linked to admissions offices.

This section identifies recommended strategies and best practices for health professions schools seeking to increase and maintain diversity in their classes. While these recommendations are based largely on medicine, similarities exist for many health professions programs, particularly those with substantial basic science prerequisites and standardized tests requirements such as the MCAT. The following suggestions and commentary thus apply broadly across the health professions and may be adapted and tailored to meet various profession-specific needs. Where applicable, distinctions are noted for public institutions subject to legal prohibitions banning the consideration of race or ethnicity as part of the admissions process.

Recommendation: Demonstrate institutional commitment to diversity through strong and active leadership.

University leaders committed to diversity should select deans of their health professions programs with a record of active support in this area. Health professions programs, through their leaders, must support diversity initiatives by making personal statements of support, by cultivating and funding programs that support a culture of diversity on campus, and by recruiting faculty and staff who share this goal.

Stanford University President John Hennessey voiced his support for affirmative action and the need for admissions processes tailored to achieve this goal in these remarks:

The consideration of race and ethnicity as one factor among many in the admissions process is consistent with our history as an institution and our belief that the next generation of leaders must reflect the strengths and talents of all our nation’s citizens…. We remain committed to affirmative action, to the importance of diversity broadly defined, and to the principles set forth in the Supreme Court’s 1978 decision in the Bakke case as practical and appropriate means to achieve such diversity (Hennessey, 2003).

Public health professions schools in states where race-conscious admissions policies have been forbidden are unable to use race-conscious affirmative action programs to achieve a diverse student body. For these schools, strong and active leadership is even more critical. In his farewell remarks to the University of California’s board of regents on September 18, 2003, President Richard C. Atkinson discussed his commitment to diversity and concern for the future: “I came into office just after The Regents approved Resolution SP-1 and as voters were preparing to approve Proposition 209, forbidding the consideration of race and ethnicity in university admissions,

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

among other things. I continue to believe those were the wrong decisions. As I wrote in The Washington Post not long ago, ‘We have pursued both excellence and diversity because we believe they are inextricably linked, and because we know that an institution that ignores either of them runs the risk of becoming irrelevant in a state with the knowledge-based economy and tremendously varied population of California.’”

Recommendation: Develop mission statements that reflect institutional commitment to diversity.

Health professions programs committed to increasing the diversity of their faculty and students must adopt mission statements that explicitly support the goal of campus diversity. From such statements of purpose, admissions policies, educational programs, and practices of individual schools should be developed and aligned to support this goal.

Recommendation: Select “well-rounded” students by evaluating both academic factors and personal attributes within the context of the “distance traveled” by the applicant.

Admissions committees should evaluate academic and nonacademic factors with a goal of selecting bright and multidimensional individuals. This effort should include a definition of “ideal candidates” for admission, the factors to be assessed, and the delineation of an admissions process that is consistent with institutional goals and desired outcomes. The process should be developed with outcomes in mind and should be consistent and reproducible. At each step of the admissions process, careful consideration and attention should be given to “the distance traveled by the applicant.”

Ideal candidates will have completed a broad undergraduate education, satisfied medical school science requirements, and excelled in the other coursework. They also, through their experiences, will have demonstrated leadership, teamwork, compassion, altruism, friendliness, and interest in their neighbors and communities.

Recommendation: Ensure that admissions committees understand the role and relevance of grades and test scores in predicting future success in clinical settings.

The admissions process is inherently prone to bias that may disfavor disadvantaged and minority students by the “ease” of measuring variables related to knowledge (grades and MCAT scores) and the “difficulty” inherent in assessing the personal attributes that make an applicant particularly well suited for admission.

It is important to note that aptitude tests such as the SAT or the MCAT were not designed as tools to evaluate a specific curriculum nor do they measure students’ aptitude in subjects they intend to study. Rather, they are

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

predictors of performance in subsequent standardized tests. There have been attempts to create an admissions process that does not consider the MCAT scores, which present a large hurdle for many otherwise qualified applicants. As an example, the Texas A&M College of Medicine program called Partnerships for Primary Care encourages applicants to medical school who are likely to practice primary care medicine in underserved areas of Texas. Eligible applicants must earn the equivalent of a GPA of 3.50 on a 4.00 scale; be predicted to graduate in the top 10 percent of their class; achieve a minimum of 1200 on the SAT or 26 on the ACT; have a legal residence in a rural or underserved area, or health profession shortage area as defined by the Health Professions Resource Center, Texas Department of Health; be a U.S. citizen or permanent resident; be a resident of the state of Texas; and commit to attend one of the seven partner universities in the Texas A&M University system. College students need to maintain a 3.50 GPA on a 4.00 scale annually and complete the required medical school prerequisite courses with no grade below a “C.” They must also remain in good standing at all times, participate in community service and medically related activities, demonstrate leadership, and complete a baccalaureate degree within a standard acceptable time frame (usually four years).

Based on these performance criteria, the student is guaranteed a position at Texas A&M College of Medicine. There is no requirement for the MCAT in this program. Its purpose is to eliminate the MCAT as a hurdle for medical school candidates who live in underserved areas. These applicants are more likely to be a member of a minority group and more likely to return to underserved areas to practice, both important educational goals for the school and the state. Since the program’s inception, this and other race-neutral measures have increased the number of minority students in their entering classes in the post-Hopwood era to levels that exceed those prior to 1996. Further details are available at the Texas A&M College of Medicine website, http://medicine.tamu.edu/studentaffairs/pcc01.htm.

Although there have been other proposals to ignore the results of standardized tests in the medical school admissions process, the frequent use of tests for institutional accreditation and professional licensure makes such changes unlikely unless national credentialing systems change drastically.

For schools prohibited from the use of affirmative action, a series of race-neutral alternatives for admissions and the granting of financial aid have been proposed to enhance diversity. Virtually all of these use another variable or set(s) of variables to define a group that will yield a diverse group of students but that is not determined by race. One such approach is to use class-conscious, rather than race-conscious, affirmative action. Many schools already give consideration to economic hardship and poverty as well as race. These models provide short-term solutions to enhancing diversity by race-neutral means, yet they provide only a partial solution with

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

several adverse effects. Although minority families are more likely to be among the poorest Americans than the richest, socioeconomic hardship is an inefficient route to integration if racial and ethnic diversity is the ultimate goal. Middle-class and upper class minorities who have not had significant economic disadvantages would not be considered under this approach, yet they may be among the strongest candidates for success in medical school. Ultimately, these models are flawed in that they depend on the effects of disparities in educational opportunities, the core objective of which is ostensibly to end such disparity.

A preferred admissions approach is to use standardized test results as a dichotomous variable and to decide on a threshold value below which a student is not believed to be competitive for admission to medical school and above which factors other than the test scores will determine eligibility for school. With such an approach, the initial screen will be strongly weighted by standardized test scores, but the ultimate decision will rest on other measures of knowledge, skills, and personal qualities. Students who have performed well in college and have acquired the skills and attitudes that will serve them well in medicine will have a strong chance of acceptance to medical school, even in the presence of less than stellar MCAT scores.

Schools that have adopted this approach find and accept candidates whose performance in college is exceptional and have a track record of activities that reflect the expectations derived from the mission of the school, even though the MCAT scores of those students are not in the highest percentile. Because many URM students may find themselves in this group, an environment that recognizes their strengths and supports them through the future testing requirements by teaching test-taking and other skills is most likely to help students succeed.

Recommendation: Ensure that careful assessment of personal qualities is a priority consideration for each candidate.

Evaluating students on their personal qualities and their acquisition of skills useful in the medical profession necessitates a method to categorize these variables and determine their relative value. This method should be consistent with the mission of the school and the expectations derived from that mission. Research-intensive medical schools should look for a track record of and a desire to continue productive and creative scholarly activities. Public-service-oriented schools will look for evidence of participation in activities intended to improve the health of needy communities and an indication of leadership and innovative approaches to service. Schools with missions to serve specific communities—described in religious, geographic, or racial/ethnic terms—will look for evidence of prior and future service to these communities. The decision by the University of California-Irvine Col-

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

lege of Medicine to develop a program dedicated to improving the health of the Latino community in California is a good example. This newly proposed program seeks to identify and recruit talented students with Spanish-language ability and a prior record of service to the Latino community—both race-neutral variables that are likely to enrich the applicant pool and ultimately their entering classes.

Many schools will find that their missions encompass research, teaching, public service, or other particular goal. Development of an evaluation process that will assess each goal will increase the likelihood that the admissions process will achieve its intended result for each campus. Creating evaluation forms for each major goal helps to categorize these elements in the admissions process. In one model currently used by a California medical school, the knowledge assessment form evaluates the results of the MCATs and the GPA as well as the actual transcript to assess academic trends. Another form allows the educational context or “distance traveled” to be studied and actual performance to be adjusted. In some schools, each file reviewer and interviewer is asked to evaluate the elements of the distance traveled so that each evaluator may place the applicant’s accomplishments in context. The skill assessment form evaluates the “tools set” that the student has acquired in his or her extracurricular activities and how these skills will help the student’s career.

Value is given to depth of study and achievement rather than superficial sampling, accomplishments rather than future plans, and demonstrated ability rather than aptitude. The attitude assessment form depends on the description in the letters of recommendation about each candidate’s determination, dedication, and desire to learn and serve. Sample forms that rate these elements are enclosed in this paper and are currently used by one school.

Using summary forms that are devoid of grades and test scores is labor intensive and requires a large cadre of well-motivated and trained volunteer faculty and students. However, analyzing and ranking the personal attributes of the candidates and how the candidate’s knowledge, character, and accomplishments fit the mission of the school are vital for selecting a diverse class. The executive admissions committee at one school ultimately will make a decision based on two simple questions:

  1. How will this candidate contribute to and benefit from your medical school?

  2. Will accepting this candidate be in keeping with the mission of your medical school?

Other schools use similar questions, including an assessment of the extent to which an applicant is predicted to be a leader and to contribute

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

substantially to his or her community. The institution that embraces the diversity of the student body as a significant educational goal and the diversity and cultural competence of the medical workforce as an important societal goal will value a process that yields a class that embraces these values. The process will define excellent academic preparation as necessary but not sufficient for a successful career and will value those qualities that give the future physician the right “toolbox” for future success.

Recommendation: Appoint admissions committee members who reflect the diversity that is sought in the student body.

Medical schools have different systems for appointing faculty to serve on their admissions committees. Some schools recruit faculty volunteers, others rely on candidates appointed by their department chairs; many use a blend of these approaches. Committee members should include a diverse group of individuals who share a clear understanding of the mission of the school, its societal commitment, and how these missions are reflected in the admissions process. They should be willing to embrace the core values of the institution, evaluate candidates for admission with those values in mind, and appreciate how their own biases may affect their admissions recommendations.

Recommendation: Educate committee members about societal health needs and the role of a diverse health workforce in meeting those needs

Ongoing support and education of committee members should be provided in a variety of areas. This should include provision of an orientation manual that explains the admissions process and desired outcomes in detail with illustrations, case studies, and simulated admissions exercises. Awareness of public health needs and familiarity with predictors of good performance, the educational context, stereotype threat, and other challenges of minority and disadvantaged applicants are necessary for faculty to understand fully the nature of their task. The expanded minority admissions exercise developed by the AAMC includes case studies that allow faculty to practice and score their performance. An updated version is currently under development.

Recommendation: Actively recruit disadvantaged and minority students who have been accepted but have yet to enroll.

For many medical students, the final step in the admissions process is based on personal choice. For students receiving offers of admission from more than one medical school, a number of factors are considered before making a final choice. Data provided by the AAMC indicate that among first-year URM students admitted to at least one California medical school in the fall of 1998, more than 95 percent received more than one offer.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Although the factor(s) considered most important by an individual student may differ, most students consistently identify the following as among the most important: academic reputation of the school, anticipated costs of attendance, financial aid offered, location of the school (e.g., urban versus suburban or rural settings), and diversity of the student body, faculty, and surrounding community.

Recruitment efforts for students already admitted involve simultaneously putting the school’s “best face” forward and providing an honest assessment of the learning climate and institutional culture on campus. At some schools, this is likely to occur during the interview process itself, with seasoned interviewers recognizing the opportunity to begin recruiting their applicants as soon as they have identified them as highly desirable. Often, this project involves the faculty, students, and staff of the school, all of whom are stakeholders in creating an ideal learning climate that is both excellent and diverse. Different approaches are used, but typical strategies include pairing current students with an accepted applicant to maintain communications and answer questions and inviting accepted applicants to a preview weekend when the school can optimally display its learning climate and diverse community. It is important to note, however, that most applicants will assess the school’s commitment to diversity by looking at the numbers of minority students and faculty and the quality of enrichment and support programs in place and by considering the mission and goals of the institution.

Recommendation: Develop educational programs that allow disadvantaged and minority students to succeed.

Successful in this regard are early matriculation programs that allow students who have had little exposure to research to establish a relationship with a research mentor, develop skills for research endeavors, and learn leadership skills. One of these programs (the Stanford Early Matriculation Program) has been shown to enhance the likelihood that a minority medical student will have a competitive research grant funded (from 42 percent to 65 percent), that a minority student will publish a manuscript in a peer-reviewed journal (from 16 percent to 22 percent), and that a minority student will graduate from medical school (from 90 percent to 98 percent).

Students who enter medical schools with limited prior educational opportunities may have had limited didactic preparation in upper level science courses. These students benefit greatly from schools that provide an environment in which learning skills are assessed and taught, the option to take required courses ahead of schedule is available, and the flexibility to decelerate their coursework is permissible to allow mastery of the curriculum at their own pace. It is important for all medical schools to allow all students

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

to succeed, and this requires the need to accommodate varying levels of achievement and different learning styles.

Medical schools should enhance the ability of their students to choose from all careers in medicine to determine those that best fit their skills and interests. Research-intensive medical schools should create an educational environment that encourages participation in scholarly activities, ensures mentorship by faculty, stimulates interest in academic medicine, and enables the student to develop the skills necessary for a career as an educator and researcher. Public-service-oriented schools should teach students how to translate new medical knowledge into effective medical care to all citizens in the community. Faculty should be encouraged to lead by example in teaching students to deliver culturally respectful and competent care to all patients and to work toward reducing the disparities in health status that exist.

Recommendation: Establish and maintain outreach programs to increase student interest in the health professions and their eligibility for admission.

Many schools have programs that span the educational pipeline, beginning in elementary school and continuing through high school, into college, and beyond. Successful programs should include efforts to provide information to prospective applicants and be tailored appropriately to various educational levels. Medical, dental, and other health professions schools should send representatives to other campuses and undergraduate institutions as well as to community forums and fairs that hold informational sessions for prospective applicants, making special efforts to reach disadvantaged and underrepresented students. These efforts will help to ensure that students identify a health professions career as an option and that they have access to reliable information when preparing for and applying to medical school.

For students who apply, but are not initially accepted, many medical schools and some dental schools offer postbaccalaureate programs to help students prepare and reapply. These programs are available to students who seek to improve their application; some are available to those making a career change. These programs typically offer programs that can be adjusted to meet the needs of individual students; most, however, offer MCAT (or other standardized test) preparation, additional science coursework, and support with the application process for disadvantaged students who are reapplying. Many postbaccalaureate programs have had highly successful records in helping promising young students gain admission. Health professions schools that do not offer a postbaccalaureate program should consider creating a program or partnering with a school that has an existing program with a record of success.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Recommendation: Improve and maintain active partnerships with undergraduate health sciences advisors.

The academic and personal advising that many students receive in high school and college plays an influential role in building confidence and in determining whether many students will go on to apply to medical or health professions programs. For those experiencing academic difficulties at an early stage, tutoring and advising by knowledgeable teachers or advisors often make the critical difference in developing the skills and confidence needed for success. Many students believe that science grades are the exclusive or primary factor considered in the admissions process. As a result, poor grades or difficulty with an introductory undergraduate course such as inorganic chemistry or physics may deter an otherwise promising undergraduate from giving further consideration to the health sciences as an educational option. For students with relatively poor high school preparation, such as those entering college with few opportunities to have taken advanced placement courses, these perceptions can play a powerful role at an early stage in their decision making relative to a future career in medicine.

REFERENCES

AACN (American Association of Colleges of Nursing). 2001. Effective Strategies for Increasing Diversity in Nursing Programs. [Online]. Available: http://www.aacn.nche.edu/Publications/issues/dec01.htm [accessed August 26, 2003].

AACOM (American Association of Colleges of Osteopathic Medicine). 2003. AACOMAS Update. [Online]. Available: http://www.aacom.org/data/advisorupdate/ [accessed August 21, 2003].

AAMC (Association of American Medical Colleges). 1970. Report of the Association of American Medical Colleges Task Force to the Inter-Association Committee on Expanding Educational Opportunities in Medicine for Blacks and Other Minority Students, April 22, 1970. Washington, DC: AAMC.

AAMC. 1998. Report I. Learning Objectives for Medical Education: Guidelines for Medical Schools. Washington, DC: Medical School Objectives Project.

AAMC. 2000. Minority Graduates of U.S. Medical Schools: Trends, 1950–1998. Washington, DC: Association of American Medical Colleges.

AAMC. 2003. Medical School Profile System. [Online]. Available: http://services.aamc.org/msps/report.cfm [accessed August 21, 2003].

APA (American Psychological Association). 2000. Model Strategies for Ethnic Minority Recruitment, Retention and Training in Higher Education. Washington, DC: APA Office of Ethnic Minority Affairs.

APA. 2003a. 2004 Graduate Study in Psychology, Research Office, APA. Washington, DC: American Psychological Association.

APA. 2003b. Summary Report: Doctorate Recipients from United States Universities (selected years). Washington, DC: APA Research Office.


Basco WT Jr., Way DP, Gilbert GE, Hudson A. 2002. Undergraduate institutional MCAT scores as predictors of USMLE Step 1 performance. Academic Medicine 77:S13–S16.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

BHPR (Bureau of Health Professions). 2003. Health Professional Shortage Areas: Shortage Designation. Health Resources and Services Administration. [Online]. Available: http://bhpr.hrsa.gov/shortage/index.htm [accessed August 21, 2003].


Callahan D. 1996. The goals of medicine: Setting new priorities. The Hastings Center Report 26:S1-S27.

CMS (Centers for Medicare & Medicaid Services). 2003. Highlights—National Health Expenditures, 2001. [Online]. Available: http://cms.hhs.gov/statistics/nhe/ [accessed August 20, 2003].

Cohen JJ. 2003. The consequences of premature abandonment of affirmative action in medical school admissions. Journal of the American Medical Association 289:1143–1149.


Davidson RC, Montoya R. 1987. The distribution of medical services to the underserved: A comparison of majority and minority medical graduates in California. Western Journal of Medicine 146:114–117.

DHHS (Department of Health and Human Services). 1985. Health, United States, 1983 and Prevention Profile. Publication number (PHS) 84-1232. Pp. 1–256. [Online]. Available: http://www.cdc.gov/nchs/data/hus/hus83acc.pdf [accessed July 13, 2003].

DHHS (Department of Health and Human Services). 2000. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health. Pp. 1–332.


Grumbach K, Coffman J, Liu R, Mertz E. 1999. Strategies for Increasing Physician Supply in Medically Underserved Communities in California. San Francisco: University of California, California Policy Research Center.


Haden NK, Catalanotto FA, Alexander CJ et al. 2003. Improving the Oral Health Status of All Americans: Roles and Responsibilities of Academic Dental Institutions. The Report of the ADEA President’s Commission. Washington, DC: American Dental Education Association. Pp. 1–22.

Hennessey J. 2003. Statement on Affirmative Action. Meeting of the Stanford University Faculty Senate, Stanford, CA, January 23, 2003.

Holliday BG et al. 1997. Visions and Transformations: The Final Report. American Psychological Association, Washington, DC, January 1997. [Online]. Available: http://www.apa.org/pi/oema/visions/resolution.html [accessed December 16, 2003].

HRSA (Health Resources and Services Administration). 2002a. The Registered Nurse Population: March 2000. Findings from the National Sample Survey of Registered Nurses. Washington, DC: Bureau of Health Professions, Division of Nursing. Pp. 1–125.

HRSA (Health Resources and Services Administration). 2002b. Shortage Designation Branch, Bureau of Health Professions. [Online]. Available: http://bphc.hrsa.gov/databases/newhpsa/newhpsa.cfm [accessed November 26, 2002].

Huff KL, Fang D. 1999. When are students most at risk of encountering academic difficulty? A study of 1992 matriculants to U.S. medical schools. Academic Medicine 74:454–460.


IPEDS. 1999. 1997 Fall Enrollment. Barron’s Profiles of American Colleges.


Julian E. 2000. The predictive ability of the Medical College Admissions Test. Contemporary Issues in Medical Education 3(2):1–2.


Keith SN, Bell RN, Swanson AG, Williams AP. 1985. Effects of affirmative action in medical schools: A study of the class of 1975. New England Journal of Medicine 313:1519–1525.

KFF (Kaiser Family Foundation). 2002. Underinsured in America: Is Health Coverage Adequate? Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured.

Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. 1996. The role of black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine 334:1305–1310.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Leahy M, Cullen W, Bury G. 2003. “What makes a good doctor?” A cross sectional survey of public opinion. Irish Medical Journal 96(2):38–41.


MedPAC (Medicare Payment Advisory Commission). 1998. Rethinking Medicare’s Payment Policies for Graduate Medical Education and Teaching Hospitals. Report to the Congress. Washington, DC: Medicare Payment Advisory Commission. Pp. 1–19.

Mills R. 2002, September 30. Health insurance coverage: 2001. Current Population Reports. Washington, DC: U.S. Census Bureau, U.S. Department of Commerce, Economics and Statistic Administration. Pp. 1–24.

Moy E, Bartman BA, Weir MR. 1995. Access to hypertensive care. Archives of Internal Medicine 155:1497–1502.


Powell L. 1978. Bakke, 438 U.S. at 312–13 n.48.


Shea S, Fullilove M. 1985. Entry of blacks and other medical students into U.S. medical schools: Historical perspective and recent trends. New England Journal of Medicine 313:933–940.

Silver B, Hodgson CS. 1997. Evaluating GPAs and MCAT scores as predictors of NBME I and clerkship performances based on students’ data from one undergraduate institution. Academic Medicine 72:394–396.

Steele CM, Aronson J. 1995. Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology 69:797–811.


UCOP (University of California Office of the President). 2000. Special Report on Medical Student Diversity. Medical Student Diversity Task Force, Office of Health Affairs, University of California. Oakland, CA: UCOP. Pp. 1–75.

University of Michigan. 2003. University Record. [Online]. Available: http:/www.umich.edu/~urecord/0203/June16_03/19_mahoney.shtml [accessed June 23, 2003].

U.S. Census Bureau. 1999. U.S. Population by Race: 1980, 2000, and 2020. U.S. Population Trends. [Online]. Available: http://www.census.gov/mso/www/pres_lib/poptrnd/sld023.htm [accessed August 21, 2003].

U.S. Census Bureau. 2003. Population Briefing: National Population Estimates for July 21, 2002. [Online]. Available: http://eire.census.gov/popest/data/national/popbriefing.php [accessed August 21, 2003].

U.S. Department of Education. 2000. National Center for Education Statistics. [Online]. Available: http://nces.ed.gov/ [accessed August 21, 2003].


Valachovic RW, Weaver RG, Sinkford JC, Haden NK. 2001. Trends in dentistry and dental education. Journal of Dental Education 65(6):539–563.


Weaver RG. 2003. Priming the Pipeline II: Recruiting Dental Professionals for the Future. Presentation to the National Dental Association’s 2003 Minority Faculty and Administrators’ Forum. New Orleans, August 1, 2003.

Weaver RG, Haden NK, Valachovic RW. 2000. U.S. dental school applicants and enrollees: A ten-year perspective. Journal of Dental Education 64:867–868.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

APPENDIX TO COMMISSIONED PAPER A

DISADVANTAGED STATUS EVALUATION FORM

This form is included in the folders of applicants who consider themselves disadvantaged according to the following American Medical College Application Service (AMCAS) question: “Do you wish to be considered a disadvantaged applicant by any of your designated medical schools which may consider such factors (social, economic, or educational)?”

APPLICANT’S NAME: ___________________________________

Average parental education (See AMCAS “Parent Information” Section—Pg. 2):

  1. Elementary school or less

  2. High school

  3. Some college, no degree (Q: fix vertical alignment)

  4. College, advance degree (Q: advanced?)

Parental occupation (Please fill in):

Geographic location where applicant was raised (See AMCAS “Bio. Info.” Section—Pg. 2):

Inner City

Rural

Suburban or City

Hours per week applicant worked for self-support during school year (See AMCAS “Experience” Section—Various Hrs.):

20 or more

15–20

<15

English is applicant’s second language (See AMCAS “Bio. Info.” Section—Pg. 2):

Yes

No

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

Additional factors indicated (e.g., physical handicap, immigrant, experience with prejudice, special family situation/responsibilities, cultural differences)?

(See AMCAS “Bio.” Section for Hardships & Family Income)

Please list:____________________________________________________

Please circle which best describes your assessment of this applicant as Disadvantaged:

1

2

3

4

Very Disadvantaged

Somewhat Disadvantaged

Little Evidence of Disadvantaged Status

No Evidence of Disadvantaged Status

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

2002–2003 ADMISSIONS SEASON – MD FILE REVIEW FORM

Please circle your scores for each category.

HIGH

LOW

RESEARCH OR OTHER

SCHOLARLY PROJECTS

1

2

3

4

  1. In-depth experience with significant productivity (e.g., publication). Evidence of critical independence and outstanding scholarship.

  2. In-depth (>1 year) experience in a single area. Letters suggest above average scholarship and potential as an independent investigator.

  3. Some experience (<1 year), usually in nonindependent or technical capacity. Or, may have short experiences (e.g., in summers) in different fields. May be seen as “industrious, learns techniques quickly,” etc., but no suggestion of scholarly independence.

  4. Little (3 months or less) or no experience.

LEADERSHIP

1

2

3

4

  1. Outstanding in all areas. Demonstrated clear evidence of innovative thinking, left a legacy of her/his work.

  2. Held a leadership position of consequence, elected or appointed. Sustained commitment to activities.

  3. Felt to be a strong team player and/or congenial and mature.

  4. Showed up for activities as a member but added little value to them beyond his/her participation (or less).

ORIGINALITY, CREATIVITY

1

2

3

4

  1. Everyone comments on it—unusual accomplishment in science, fine arts, etc.

  2. Comments by more than one person—may have substantial musical, artistic, literary, organizational, etc., talents.

  3. One person comments (usually a research advisor)—no, or little, other evidence for it.

  4. No mention in letters; no evidence in research or otherwise (music, art, organizational talents, etc).

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

NONACADEMIC ACCOMPLISHMENTS

(includes working)

1

2

3

4

  1. Outstanding accomplishments (national recognition in sports, artistic endeavors, established business or program, etc.).

  2. Above-average skill/achievement in an extracurricular area (e.g., varsity sports, arts, editor of yearbook, etc.) plus participation in other areas. Heavy work load (>15 hrs/wk) during academic year required for self-support.

  3. Participation in routine extracurricular activities (intramurals, premed club, etc.), routine jobs.

  4. Few, if any, extracurricular activities—routine jobs, few hours.

We interview to confirm that an applicant is outstanding, not just to gain more info. not evident in the Supplemental Application.

1

INTERVIEW

(Most impressive type of candidate)

2

PROBABLY

INTERVIEW

(Interview if there are not 500 candid. in Group 1)

3

PROBABLY

DO NOT

INTERVIEW

(Very good but not outstand.)

4

DO NOT

INTERVIEW

(Fine person but not competitive with others)

Please circle one. Why YOU DO or DO NOT favor an interview? Please explain below.

Indicate specific aspects of the application that an interviewer should clarify during the interview.

INTERVIEW FORM

Name of Candidate:_____________________

Date of Interview: _______

Undergraduate University:________________

Time of Interview: _______

Interviewer:_____________________________

Place of Interview: _______

Note: The interview report should provide the Admissions Committee with more information about the candidate’s apparent strengths and weaknesses and should supply information that is not evident from the file. It is most important that you give evidence (i.e., SPECIFIC DETAILS OF YOUR

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×

CONVERSATION) rather than mere impressions. We request that you address at least the following issues in your interview:

  1. Does your interaction with the candidate conform to expectations derived from reading the application? If not, what are the discrepancies, re: major commitments, scholarly interests, and long-range goals?

  2. In the candidate’s research, are you able to determine the motivation, persistence, level of independence—i.e., range from talented technician, to independent execution of a research protocol established by others, or to responsibility for developing an original research proposal and execution thereof? What role did the candidate play in interpretation and reporting of results? Does the candidate have an appreciation of how the results of the research project(s) fit into a larger field of knowledge? What are the candidate’s plans for research in the future?

  3. Do you think the letters of support fairly represent the candidate?

  4. Does the candidate have a lively interest in the world outside of academics and an interest in the welfare of others?

  5. Does the candidate have any significant knowledge of our school and how it would benefit him/her in pursuit of stated goals?

  6. Has the candidate volunteered any consideration for exploring a career in academic medicine? Do you consider that a career in academic medicine will be likely for this candidate?

  7. Do you think the candidate has a reasonable understanding of the positive and the negative aspects of a career in medicine?

  8. Please evaluate the educational context of this applicant with respect to high school education; parental income, education, and occupation; hours per week of work during college; geographic location where applicant grew up; prior experiences with prejudice; cultural and language barriers or other special family circumstances.

  9. Have you explored answers to questions raised by file reviewers?

  10. Do you detect any characteristics that cause you to question the candidate’s suitability for a career in medicine or the ability to think logically and critically?

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
  1. Are there specific concerns the candidate may have about our school?

  2. Is follow-up necessary by the Admissions Office or Committee? Yes___ No___ (If yes, please specify: e.g., “Solicit further information from Dr. X on candidate’s research role,” etc.)

  3. Summary Statement:

We will only interview the most compelling 8–10 percent of our applicant pool. We will only make an initial offer of acceptance to one-third (1/3) of applicants interviewed. Please rank this applicant with an “X” anywhere along this scale based on your review of the file and your interview. If you interview a random pool of applicants, you should only score 1/3 of your interviewees in the top group.

1

2

3

  1. A must-have candidate, with evidence of independent thinking and creativity, potential for an academic medicine career or leadership role, outstanding depth of education and community service activities, and a contribution to the learning environment and diversity of the school.

  2. An excellent candidate who may have an outstanding track record in one or more areas of interest to us but lacks the special qualities of our top applicants.

  3. Capable of the intellectual demands of medical school but whose accomplishments and potential for success in scholarly, educational, or service activities are not exceptional.

  1. Briefly state the most significant item in this application that resulted in this ranking.

Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 231
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 232
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 233
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 234
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 235
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 236
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 237
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 238
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 239
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 240
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 241
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 242
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 243
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 244
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 245
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 246
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 247
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 248
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 249
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 250
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 251
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 252
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 253
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 254
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 255
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 256
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 257
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 258
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 259
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 260
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 261
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 262
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 263
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 264
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 265
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 266
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 267
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 268
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 269
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 270
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 271
Suggested Citation:"Commissioned Papers: Contribution A: Increasing Diversity in the Health Professions: A Look at Best Practices in Admissions." Institute of Medicine. 2004. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. doi: 10.17226/10885.
×
Page 272
Next: Contribution B: The Role of Public Financing in Improving Diversity in the Health Professions »
In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce Get This Book
×
Buy Hardback | $68.00 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities--including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives--are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation’s health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions.

In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!