Index
A
Academic advising
and recruitment of URM students, 161
Academic performance
educational inequities and, 7, 67-68, 160, 242, 246
group differences on standardized tests, 7, 66-70
institutional climate and, 68-70, 147, 161, 170
predictive power of, 381
socioeconomic factors and, 66, 67-68
stereotype threat and, 68-70
support services and programming and, 14, 156, 164-165, 170, 174
Access to care
coalition building for, 209-210
communication problems, 26
community benefit standard and, 179-180, 184-185, 187, 188-189
diversity of health professionals and, 5, 26, 29-31, 234, 260, 305, 380
financial assistance for education, 113, 286, 297, 305, 307
innovative admissions programs and, 259-260
institutional partnerships and, 14, 15, 163, 170-171, 173-174
for low-income and Medicaid populations, 30, 32, 233, 305
for minority patients, 26, 28, 29-31, 49, 233, 234-235, 305
Accreditation.
See also individual accrediting bodies
and admissions policies and practices, 75-76, 129-130, 133-134, 204, 248, 326-328, 333, 338-339
community benefit standard and, 17, 197, 198, 199, 200, 208, 209
composition of standard-setting bodies, 12, 135, 140, 141, 321, 322-323
cooperation of other organizations in, 141, 330, 332, 339-340
coordination responsibilities, 127, 128
core competencies, 127, 129, 328-329, 332, 335-336, 337
cultural competencies, 11-12, 134, 140-141, 166, 206-207, 329-337, 375-376
goals of, 11, 127-128, 130, 131-132, 317-319, 335
institutional, 319
and institutional climate, 330-331, 370
and licensing, 332
medical education, see Liaison Committee on Medical Education
monitoring and evaluation of outcomes, 12, 139-141, 319, 326, 332, 336-338, 339
and pedagogy, 368
peer review teams, 140
potential to enhance diversity, 127, 132-133, 138-141, 336-339
process, 139-140, 320, 322-323
professionalism and humanistic considerations, 75-76
program, 319
psychology, 11-12, 135-138, 139-140, 333-334, 335
race-conscious policies, 88
recommendations, 12-13, 19, 139, 140-141, 324, 330, 331-332, 336-339
and recruitment and retention of URMs, 12, 132-133, 137-138, 140, 141, 328, 338, 339
roles of accrediting bodies, 11, 138-141, 319, 320-323, 336
sanctions and reinforcement, 13, 140, 141, 332, 340
and social accountability, 11, 323-332, 338, 340
standardized tests and, 258
standard-setting process, 321, 322-323, 330
standards related to diversity, 11-12, 128-138, 236, 332-336
U.S. Department of Education role, 2, 11, 12-13, 127, 128, 129, 130, 131, 133, 138-141, 319-320, 322, 344
Accreditation Council for Graduate Medical Education (ACGME), 75, 134-135, 329
Admissions committees
AAMC Expanded Minority Admissions Exercise, 79-80, 261
composition of, 8-9, 77-78, 82, 248-249, 255, 261
demographic characteristics, 77-78, 85
incentives for participation, 78, 85, 204
training, 8, 78-79, 82, 204, 248-249, 255, 257, 261
Admissions policies and practices
“academic difficulty” considerations, 246
and access to care, 259-260
accreditation standards and, 75-76, 129-130, 133-134, 248, 326-328, 333
affirmative action litigation, 3, 4, 24, 25 n.3, 27, 29, 50, 71, 72-73, 76-77, 79, 81, 145, 239, 240-241, 258, 326-328, 345
applicant pool size and, 242-243
cultural competency considerations, 380
Disadvantaged Status Evaluation Form, 267-268
“distance traveled” considerations, 82, 85, 247-248, 257, 260
eligibility in the local context, 71
evaluation forms, 260, 267-268, 270-272
impacts on diversity, 27, 70, 71-75, 239-242, 326-328
innovative strategies and best practices, 2, 75-83, 254-264, 326
institutional climate and, 83, 145, 146, 160-161, 169-171, 173-174, 249, 251, 256-257, 326, 345, 348
Interview Form, 270-272
MD File and Review Form, 269-270
mission-oriented review, 8, 76-77, 81, 82, 85, 244, 245, 257, 259-260, 263, 338
organizational behavior and, 366
process, 244-249
qualitative review of applicants, 7-8, 75-76, 79-80, 81, 82-83, 84-85, 170, 204, 245, 246-248, 259-261
race-conscious, 27, 70, 88, 327-328
race-neutral, 7, 27, 71-75, 81, 239-242, 256-257, 258-259, 260, 326-327
recommendations, 8-9, 19, 85, 255-264, 328
and recruitment and retention strategies, 83, 249, 250-251, 253, 254-256, 260, 261-262
segregation and, 237-242
standardized test scores and grades and, 6-7, 8, 55, 56-75, 79, 81-82, 83, 84, 203-204, 236, 244, 245-246, 257-258, 259
Advanced Clinical Training and Service Program, 120
Advisory Committee on Student Financial Assistance, 91
Advisory Committee on Training in Primary Care Medicine and Dentistry, 300, 304
Affirmative action
accreditation and, 129-130
admissions impacts, 3, 4, 24, 25 n.3, 27, 29, 50, 71, 72-73, 79, 145, 238-239, 240-241, 255, 256, 258, 326, 327-328, 345
anti-affirmative action initiatives, 50, 71, 239-240
Bakke decision, 239
Brown v. Board of Education, 326
class-conscious, 258-259
employment effects, 364
Gratz decision, 240, 241, 326, 327-328
Grutter decision, 3, 4, 24, 25 n.3, 27, 29, 50, 79, 145, 199-200, 240-241, 326-327, 345
Hopwood decision, 4, 24, 71, 72-73, 76-77, 240, 258, 327
impact of bans, 80, 233, 237, 240, 241-242, 326-327
percent plans and, 71-75
as remedy for segregation, 238-239
African Americans.
See also Underrepresented minorities
academic performance issues, 66, 67, 68-70
access to care, 26
Armed Forces personnel, 290-291
clinician preferences, 31, 325
cross-racial interactions, 351-352
educational inequities, 7, 67-68, 242
faculty, 41-42, 46, 48, 50, 158
financial aid awards to, 93-94, 105-106
financial status of families, 89-90, 91
in graduate school, 48-49
in health professions workforce, 24, 30-31, 38, 42-43, 45-46, 48, 49, 163, 242, 253, 274-275, 339
medical breakthroughs by, 37
pedagogy, 158
recruitment strategies, 163
satisfaction with care, 32
school enrollment and graduation trends, 40, 45, 47, 51, 72-75, 83, 170, 171, 238, 253
standardized test performance, 63, 64, 65-66
Agency for Healthcare Research and Quality, 305
Aid Latino Community to Attain Nursing Career Employment (ALCANCE), 162
Alaska, 296
Alaska Natives. See Native Americans
Alfano, Michael, 253
Alliances for Graduate Education and the Professoriate, 280-281, 293
American Association of Colleges of Nursing, 99, 254, 309, 335
American Board of Internal Medicine (ABIM), 75-76
American Board of Medical Specialties, 75, 329
American Dental Association, Commission on Dental Accreditation Programs, 333
American Dental Education Association (ADEA), 112, 114, 251, 252-253
American Hospital Association, 190
American Indians. See Native Americans
American Medical Association, 274, 321
American Medical College Application Service, 267-268
American Psychological Association, 275
Commission on Ethnic Minority Recruitment, Retention, and Training in Psychology, 250
Committee on Accreditation, 135-138, 139-140, 333-334
cross-cultural principles and guidelines, 167-169
fellowships, 111
Office of Ethnic Minority Affairs, 250
Office of Program Consultation and Accreditation, 135
recruitment and retention initiatives, 249-251
Suinn Minority Achievement Awards, 163, 250
Area Health Education Centers, 110, 276-277, 285, 295, 297, 300
Arizona State University, 361
Arkansas, financial aid programs, 294, 295
Armed Forces Health Professions Scholarship Program, 289
Asian Americans/Pacific Islanders
access to care, 26
cross-racial interactions, 351-352
debt impacts, 102
financial status of families, 89-90
in health professions workforce, 42-43, 46, 48, 274-275
initiative, 282
satisfaction with care, 32
school enrollment and graduation trends, 40, 51, 72-73, 74, 253
standardized test performance, 63, 64, 65-66, 70
U.S. population, 23
Association of Academic Health Centers, 309
Association of American Medical Colleges (AAMC), 3 n.1, 7, 27-28, 38, 78-79, 236, 238, 243, 244, 245, 261, 273 n.1, 275, 304, 309, 321, 323, 324, 327, 330-331, 336, 368, 369
Association of Canadian Medical Colleges, 321, 324
Association of Hispanic-Serving Health Professions Schools, 282
Association of Specialized and Professional Accreditors, 130, 320
Atkinson, Richard C., 233, 256
Atlanta University Center, 163
B
Bakke, Allan, 239
Beason, Charlotte, 131
Binet, Alfred, 56
Bob Jones University, 181, 197
Brigham, Carl, 57
Bush, George H.W., 182
C
California
admissions policies, 71, 84, 241, 256-257, 261, 327
community benefit standard applied to nonprofit health care organizations, 183, 185, 187, 188, 189, 193
diversity in health professions, 30, 31, 244
financial aid programs, 294, 296
minority access to care, 26, 30, 234
Office of Statewide Health Planning and Development, 113, 187
Proposition 209 (Civil Rights Initiative), 4, 24, 240, 256-257
California Endowment, 11, 112-113, 252, 283, 309
California HealthCare Foundation, 309
California Wellness Foundation, 11, 112, 113-114
Canadian Medical Association, Council on Medical Education, 321
Carnegie Foundation, 321
Case Western Reserve Medical School, 368
Catholic Health Association of the United States, 190
Cecil G. Sheps Center for Health Services Research, 286
Center for California Health Workforce Studies, 283
Center for Medicare and Medicaid Services, 114, 291, 298, 302, 305, 307-308, 311
Centers for Disease Control and Prevention, 305
Centers of Excellence (COP) program, 108-109, 110, 276-277, 284, 300
Centers of Research Excellence in Science and Technology, 282-283, 293
Children’s Hospitals Graduate MedicalEducation Program, 278-279, 286-287
Civil Rights Act of 1964, 327
Civil Rights movement, 243
Clark-Atlanta University, 163
Clinical research
benefits of diversity, 237
minority enrollment in, 35-36
Clinical Training grants, 280-281
Coffman, Janet, 283
Cohen, Jordan, 36, 275, 324, 327, 336
College Board, 95-96
Colleges and universities
community benefit standard applied to, 196-198
historically black medical schools, 163, 282, 291, 292-293, 301
Colloton, John, 323
Colorado, financial aid programs, 294, 295
Columbia University, 169-170, 171
Commission on Collegiate Nursing Education, 130-131, 335
Commission on Dental Accreditation, 131-133, 140, 332
Committee on Accreditation of Canadian Medical Schools, 133, 321, 322
Commonwealth Fund, 325
Community benefit standard
and access to care, 179-180, 184-185, 187, 188-189
and accreditation, 17, 197, 198, 199, 200, 208, 209
areas for improvement, 194
Bob Jones University v. United States, 181, 196
coalition building and, 208, 209
community health perspective, 191
evolution of policies and practices, 186-194
financial threshold approach, 16, 189
Healthy Community perspective, 191, 192
historical and legal background, 15-16, 178-186, 199
Legal/Historical perspective, 191
manual for planning and implementing programs, 190
Market-Failures perspective, 191
organizational practices, 193-194
payments in lieu of taxes, 184
private sector initiatives, 189-192
public policy options, 197-199
Public Trust Model, 190-191
recommendations, 2-3, 17-18, 20, 200
reporting requirement approach, 16, 186-189
state initiatives, 16, 186-189
strengths, 193
Utah County v. Intermountain Health Care decision and, 180, 182
and workforce diversity, 16-17, 194-197, 200
Community Care Network Demonstration, 190
Community Catalyst, 209
Community colleges, 56
Community health centers, 26
Community Voices Program, 209-210
Costs of education
and access and completion, 9, 88, 90-96, 102
and career choice, 102-103
and career satisfaction, 103-104
defined, 89
dentistry, 96, 97, 102, 104, 303-304
impacts on URMs, 9, 102-104, 118, 122, 161, 283, 303-304
institutional climate and, 102, 146, 161, 164, 171, 348
and lifestyle, 104
medical education, 88, 96-98, 303-304
nontuition expenses, 101-102
nursing, 99-101
perceptions of burden, 102
planning for debt management, 104
tuition and student debt, 93, 96-101, 115, 303-304
undergraduate school, 90-96
Council for Higher Education Accreditation (CHEA), 127, 128, 129, 130, 320
Council on Graduate Medical Education (COGME), 115, 288, 302, 303-304, 311
Cultural Competence Initiative, 282
Curriculum
core competencies, 127, 129, 328-329, 332, 335-336, 337
cross-cultural, 34-35, 165-169, 174
cultural competencies, 11-12, 134, 140-141, 166, 206-207, 329-337, 375-376
CVS, 120
D
Delivery of health care, attitudes of practitioners and, 373, 375
Democracy outcomes
diversity in training and, 6, 34, 35
institutional climate and, 147, 148, 172
Dental Health Professions Shortage Areas, 251
Dentists and dentistry
accreditation standards, 131-133, 140, 252, 333, 335, 338
admissions process, 169-170, 251-253
costs of education and debt loads, 96, 97, 102, 104, 303-304
financial assistance, 11, 115, 119-120, 121, 252-253, 297-298
improving institutional climate for, 154, 156-157, 169-171
participation trends of minorities, 24, 45-48
patient characteristics, 5
postbaccalaureate programs, 263
school enrollment and graduation trends, 44, 46, 47, 252
URM workforce, 45-46, 251, 274
Dirksen, Everett, 301
Disadvantaged, defined, 289
Disadvantaged Faculty Loan Repayment, 108-109
Disadvantaged Status Evaluation Form, 267-268
Discrimination.
See also Segregation
and academic performance, 66, 164
District of Columbia, 238
minority population, 23
Diversity in health professions.
See also Institutional climate for diversity;
Underrepresented minorities
and access to care for minority patients, 5, 26, 29-31, 234, 260, 305, 380
accreditation and, 11-12, 17, 127, 132-133, 138-141, 197, 198, 199, 200, 336-339
admissions policies and, 27, 70, 71-75, 239-242, 326-328
advising inequities and, 243-244, 264
behavioral climate and, 13, 146, 172, 349, 351-352
benefits of, 23-24 n.1, 29-37, 51, 144, 147-152, 275, 345-346
campus-related initiatives, 13, 145, 148, 171-172
and choice and satisfaction with care, 5, 31-32, 325
community benefit standard and, 16-17, 194-197, 200
compositional, 143, 146-147, 148, 348-349, 350, 353-354, 363, 379-380, 381-382
consequences of, 353-354
defined, 144-147, 171, 310, 347-354
demographic imperative, 3, 234-235, 306-307, 325
GAO recommendations for increasing, 310
and health policy, 36-37
interactional, 13, 145, 148, 171, 353, 363
and learning, 29, 34-35, 147-152, 35-43 63
mission of medical schools and, 235-237, 330
organizational behaviors and, 364-366
pedagogy and, 145, 158, 171, 379-380
psychological climate and, 13, 350-351
and quality of care, 5, 23-24 n.1, 29, 31-33, 37, 325
and quality of training, 6, 29, 33-35
rationale for increasing, 26-27
and research leadership, 29, 36-37
and research on disparities, 35-36
segregation and, 13, 172, 237-242, 349
social contract, 325-332
socioeconomic and educational inequities and, 7, 160, 161, 233, 242, 243, 283
standards related to, 11-12, 128-138, 236, 332-336
strategies for increasing, 23-26
transforming effect of initiatives, 363-366
Diversity in the Health Professions Priority Area Grants, 113-114
Dole, Robert, 207
Donnelly, Brian, 181-182
Drew, Charles R., 37
Duke, Elizabeth M., 282
E
Education Appropriations Act, 305
Education of URM health professionals.
See also Accreditation;
Admissions policies and practices;
Costs of education;
Financing of education and research
cross-cultural training and cultural competencies, 6, 33-35, 165-169, 236, 307, 374, 375-376
enrollment and graduation trends of URMs, 24, 40-41, 43-45, 46, 47, 48-49, 50, 94, 95-96, 115-117, 118, 235, 240, 241, 282, 284
experiences in higher education and HPEI settings, 68-70
financial status of URM families and, 9, 67-68, 89-90, 91, 92
graduate, 24
and quality of care, 307
strategies to encourage, 206-208
undergraduate, 24
Education Policy Center, 283
Educational Excellence for Hispanic Americans, 282
Equal Employment Opportunity Commission, 338
Exceptional Financial Need program, 304
Extramural Associates Research Development Award, 288
Extramural Loan Repayment for Individuals from Disadvantaged Backgrounds Conducting Clinical Research, 278-279, 288
F
Faculty.
See also Pedagogy
academic rank of, 50
on admissions committees, 77-78, 82
cultural competence of, 330, 332, 334, 336
dentistry, 46-48
financial assistance for, 105, 106, 276-277, 284, 286, 287
geographic variation in diversity, 41
and learning environment, 155, 351, 361-362
nursing, 41-42
recruitment, hiring, and retention, 14, 15, 143, 145, 157-160, 161, 171, 173, 174, 284, 286, 308, 330, 332, 334, 336, 339, 361-362
sensitivity training of, 14-15, 156, 157, 166, 174-175
student-centered orientation, 14, 156
student interaction with, 155
URM workforce, 41-42, 46-48, 121, 157-160, 241, 308
Faculty Loan Repayment Program, 276-277, 284-285
Federal Comprehensive Health Manpower Training Act of 1971, 238
Financial Aid for Disadvantaged Health Professions Students, 304
Financing of education and research.
See also specific sources
and academic performance, 93, 295
and access to care, 113, 286, 297, 305, 307
average awards, 96
budget deficit and, 304
clearinghouse on program options, 309, 311
College Board recommendations, 95-96
community benefit standard and, 198-199
coordination and collaboration needs, 11, 301-302, 303, 307, 309, 310, 311
data collection and analysis, 305-306, 309, 311
debt loads of students and new practitioners, 93, 303-304
defined, 89
demographic changes and, 306-307
for dental school, 11, 115, 119-120, 121, 252-253, 297-298
discretionary funds, 107-111, 118, 122, 273, 275-293, 300
and enrollment and retention of URMs, 50, 94, 95-96, 115-117, 118, 282, 284
evaluation of programs, 11, 115-117, 119, 283, 284-285, 299-300, 301, 304-306, 307-308, 309, 311
for faculty, 105, 106, 276-277, 284, 286, 287
federal aid, 2, 9, 91-92, 95-96, 101, 107-111, 122, 273, 275-294, 299-300
financial status of URM families and, 9, 89-90, 91, 92
goal-setting in programs, 119, 302-303
graduate school sources, 105-106
information-seeking by students, 94-95
innovative ways of using, 11, 95, 119-122, 173-174, 294-299, 311
intergovernmental transfers, 297-298
for international medical graduates, 302
lack of recognition of programs, 301-302
loan repayment programs, 95, 105, 106, 108-109
mandatory (nondiscretionary) funds, 114-115, 122, 273, 282-283, 293-294, 296-299, 300
merits-based assistance, 92, 93-94, 304
needs-based assistance, 9, 92, 112, 303, 304
for nursing, 101, 119, 255, 276-277, 296, 298
private sources, 2, 9-10, 12, 111-114, 252-253
public-private partnerships, 11, 119-123, 308-310, 311
race and gender influences on awards, 93-94
recommendations, 11, 12, 19, 117, 118, 121-122, 262-263
and recruitment and retention of URMs, 9, 171, 173-174, 298, 307, 308, 311
siloing of small programs, 118, 301
state and local aid, 2, 11-12, 92, 118, 120-122, 274, 282-283, 303, 309
tobacco settlements used for, 298-299
tuition waivers, 106
for undergraduate URM students, 106-114
unmet needs, 9, 89, 92-93, 102, 204
unpredictability of funding, 118, 300
work study, 106
Fisk University, 163
Flexner Report of 1910, 237, 321, 367, 368
Florida
financial aid programs, 285, 294, 296
Fogarty International Center, 289
Ford Foundation Pre-doctoral and Dissertation Fellowships for Minorities, 11, 112, 114, 158
Free Application for Federal Student Aid (FAFSA), 101
G
Gándara, Patricia, 283
Georgia, 297
Geriatric Education Centers program, 286
Graduate Medical Education, 280-281, 289-290
Reform Incentive Pool, 11
Graduate Record Examination (GRE), 61, 63, 64-65, 69
Grumer, Barbara, 129-130
H
Harlem Hospital Medical Center, 170-171
Harvard University, 150
Hastings Center, 236
Hawaiians, native, 23, 242, 274, 275, 285
Health Care Financing Administration, 307.
See also Center for Medicare and Medicaid Services
Health Care Reform Act, 209
Health Careers Opportunities Program (HCOP), 107, 108-109, 115, 276-277, 284, 285, 300
Health Education and Training Centers, 110, 276-277, 285
Health maintenance organizations, 183-184
Health professions.
See also individual occupations
barriers to inclusion of URMs in, 28, 203-204
focus of this study, 28
participation trends of URMs, 1-2, 23-24, 38-49, 238, 274-275
Health Professions Education Foundation, 112, 113
Health Professions Education Fund, 113
Health Professions Education Summit, 329
Health professions educational institutions (HPEIs).
See also Colleges and universities;
Education of URM health professionals;
Institutional climate for diversity;
Medical school;
specific institutions
community benefit standard applied to, 194-198
and enrollment and retention of URMs, 50, 94, 95-96, 115-117, 118, 282, 284
historically black schools, 163, 282, 291, 292-293, 301, 349
leadership needs, 144, 152, 153, 156-157, 256-257, 328, 350
mission and mission statement, 8, 14, 76-77, 81, 82, 85, 159, 173, 174, 203, 244, 245, 257, 259-260, 263, 330, 346
predominantly white, 349
research-intensive, 158
tax-exempt status, 194-198
Health Professions Loan Repayment Program, 280-281
Health Professions Scholarship Program, 108-109, 280-281, 290
Health Research and Educational Trust, 190
Health Resources and Services Administration (HRSA), 2, 251
Bureau of Health Professionals, 107-110, 115, 116
discretionary funds for financial aid, 9, 107-110, 116, 199, 275-279, 282-287, 300, 301, 302
Division of Health Careers Diversity and Development, 110
evaluation of URM workforce initiatives, 11, 305
Office of Minority Health, 282
Healthy Cities, 192
Healthy People 2000 and 2010, 234, 307
Henderson, Tim, 294, 295, 296, 297
Hennessey, John, 256
Henry J. Kaiser Family Foundation, 309
Higher Education Act, 128, 319
Hispanics/Latinos.
See also Underrepresented minorities
access to care, 26
clinician preferences, 31, 325
cross-racial interactions, 351-352
educational inequities, 7, 67-68, 242
as faculty, 44, 46, 48, 50, 158
financial aid awards to, 93-94, 105-106
financial status of families, 89-90, 91
in graduate school, 48-49
in health professions workforce, 23-24, 30, 38, 42-43, 45-46, 48, 49, 162, 253, 274-275
pedagogy, 158
satisfaction with care, 32
school enrollment and graduation trends, 40, 45, 47, 51, 72-75, 83, 170, 171, 238
standardized test performance, 63, 64, 65-66
Historically Black Colleges and Universities initiative, 282
Hospital Community Benefit Standards program, 189
Hospitals. See Nonprofit hospitals and health care organizations
Houston Associates, 115
Howard University School of Medicine, 43, 238
I
Indian Health Service (IHS), 108-109, 111, 285
Indiana, 183
Initiative for Minority Student Development, 287
Innovations in Health Professions Education Grant Fund, 297
Institute for Primary Care and Workforce Analysis, 294-295
Institute of Medicine, 309, 325, 329, 334, 339
Institutional and policy-level strategies, 51-52.
See also Accreditation;
Affirmative action;
Intervention strategies
barriers to URM participation, 4, 49-50, 203-204
coalition building, 18, 208-210
community benefit and, 197-199
data and research needs, 18, 205-206
defined, 25
education of stakeholders, 18, 206-208
leadership needs, 256-257
rationale for examining, 23-24, 26-27
recommendations, 18, 20, 210, 256-257
supportive mechanisms, 205-210
Institutional climate for diversity
and academic performance, 68-70, 147, 161, 170
accreditation and, 330-331, 370
admissions policies and, 83, 145, 146, 160-161, 169-171, 173-174, 249, 251, 256-257, 326, 345, 348
affiliations with community health care
facilities, 14, 15, 163, 170-171, 173-174, 175
attitudes and, 145, 146, 148, 157, 350, 354, 373
behavioral, 13, 146, 172, 349, 351-352
campus-related initiatives, 13, 145, 148, 171-172
and clinical practice, 381-382
compositional diversity and, 143, 146-147, 148, 348-349, 350, 353-354, 363, 379-380, 381-382
cross-cultural curriculum, 34-35, 165-169, 174
cross-racial interactions, 13, 351-352, 353
curricular and cocurricular activities, 34-35, 155-156, 165-169, 174
defining, 13, 144-147, 171, 347-354
and democracy outcomes, 147, 148, 172
in dentistry, 169-171
design principles for improving, 13-14, 152-156, 172-173
external influences, 145-146, 348
faculty recruitment, hiring, and retention
strategies and, 14, 15, 143, 145, 157-160, 161, 171, 173, 174, 361-362
financial aid policies and, 102, 146, 161, 164, 171, 348
holistic approach to change, 13-14, 144, 152, 172-173, 346-347
leadership and, 144, 152, 153, 156-157, 204, 350
and learning outcomes, 6, 34-35, 147-152, 158, 172, 262-263, 354-363, 368-369, 370-371, 374-375, 378-379
long-term perspective, 144
mediation mechanisms, 15, 165, 175
in medical education, 366-382
mission statement and, 14, 159, 173, 174, 346
monitoring and evaluation of intervention strategies, 13-14, 144, 152, 153, 167, 171, 175, 370-371
organizational impediments, 364-366
orientation for students, 14, 164, 174
pedagogy and, 143, 145, 155, 158, 164, 171, 352, 359-361, 367-368, 371-376
peer group influences, 351, 352, 355, 360, 363
psychological, 13, 145, 146, 172, 348, 349, 350-351
recommendations, 2, 15, 19, 174-175
resource allocation and, 144, 152
segregation and, 13, 145, 146, 151-152, 155, 156, 172, 237-242, 348-349, 351
sensitivity training of staff, 14-15, 156
student development, 155-156, 377-379
student recruitment, 14, 83, 143, 145, 160-161, 162-163, 169-171, 173-174, 249, 262
student retention, 14-15, 161-165, 169-171, 173-174
support services and programming, 14, 156, 164-165, 170, 174
Institutional culture, 146, 347-348
Institutional isomorphism, 365
International medical graduates, 302
Intervention strategies.
See also Affirmative action;
Institutional and policy-level strategies
academic advising, 243-244, 264
in admissions policies and practices, 2, 75-83, 254-264
community-based learning experiences, 119-120
data collection and analysis, 305-306
early matriculation programs, 262-263
financial aid, 11, 95, 119-123, 294-299, 308-310, 311
institutional climate improvements, 13-14, 144, 152-171, 175, 370-371
monitoring and evaluation of, 13-14, 144, 152, 153, 167, 171, 175, 370-371
pipeline enhancement programs, 25, 27, 110, 118, 119, 161, 250, 252, 263, 299
postbaccalaureate programs, 263
J
Joint Commission on Accreditation of Healthcare Organizations, 382
K
Kids into Health Careers, 110
Krueger, Alan B., 328
L
Latinos. See Hispanics/Latinos
Learning
active formats, 158, 352, 357-358, 360, 361, 368, 378, 379
apprenticeship format, 367-368
assessment of, 373
automatic thinking and, 357
case-based and didactic, 372
collaborative and cooperative environments, 155, 158
complex social structures and, 358
contextual issues in environments for, 357-359
development concepts, 354-357
diversity in training and outcomes in, 6, 29, 34-35
faculty diversity and, 155, 351, 361-362
formats for, 158, 372-373, 378-379
experiential/field studies techniques, 158
external assessments of, 370-371
institutional climate for diversity and, 6, 34-35, 147-152, 158, 172, 262-263, 354-363, 368-369, 370-371, 374-375, 378-379
Kegan’s orders of consciousness, 356-357, 377-378, 381
negative reinforcements to, 374-375, 381
in nontraditional settings, 366-367
pedagogy and, 158, 350, 352, 359-361, 367-368, 378-379
Piagetian perspective, 355, 377, 379-380
problem-based, 368-369
segregation and, 151-152
self-authorship/self-directed, 377-378
theory and research, 147-152, 354-359
transformative, 358-359, 378-379
women’s epistemological model of, 356
Liaison Committee on Medical Education, 75, 133-135, 236-237
commitment to achieving diversity, 134-135, 336-339
development of standards, 322-323
historical perspectives, 320-321, 368
standards related to diversity, 133-134, 140, 336-339
Licensing, 61, 166, 245-246, 258, 332, 368
Loan Repayment Program for Health Disparities Research, 278-279, 288
Loans for Disadvantaged Students, 108-109
Louis Stokes Alliances for Minority Participation, 280-281, 292-293
M
Mahoney, Maureen, 255
Martin Luther King, Jr./Charles R. Drew Medical Center, 326
Maryland, 183
Massachusetts, 183-184, 187, 209, 302
Mathematica Policy Research, Inc., 286
McMaster University, 368
Medicaid Graduate Medical Education, 122, 273, 282-283, 294, 295, 296-299, 303
Medical College Admissions Test (MCAT), 57, 60-61, 63, 65-66, 79, 236, 245-246, 257-258
Medical College of Georgia, 297
Medical school
accreditation standards, 133-135, 370
admissions committee appointment and training, 249-250
admissions policies and process, 70-71, 244-249
assessments of learning, 370-371
choosing students, 245-248
clinical training, 381-382
composition of student body, 379-381
cross-cultural training and cultural competencies, 34, 286
current status of, 375-376
enrollment and graduation trends, 43-45, 161
faculty, 42-44
financial assistance, 96, 98, 295
goals and objectives, 369
grades and MCAT scores and, 70, 245-246
hidden/unintended curriculum, 374-375, 376, 381
institutional climate for diversity, 366-382
knowledge and skills, 371-372
learning formats, 372-373
mission and mission statement, 235-237, 245, 330
negative reinforcements to learning, 374-375, 381
“othering” perspective of students, 376
participation trends of minorities, 24, 42-45
preparing clinicians, scientists, and leaders, 235-237
problem-based learning, 368-369
public health mission, 235
public support and investment in, 235
recruitment efforts, 83, 249, 307
structure of education in, 367-369
student development, 377-379
Medical School Objectives Projects I-IV, 236, 369
Medicare Graduate Medical Education program, 114-115, 118, 198-199, 282-283, 293-294, 298, 301, 302-303, 307, 308-309, 311
Medicare/Medicaid Act of 1965, 180
Meharry Medical College, 43, 238
Mellon Foundation Fellowships, 158
Mental health
and diversity, 37
Mentored Minority Career Enhancement Award, 280-281, 292, 301
Mentored Minority Research Enhancement Coordinating Center, 280-281, 292, 301
Mentored Minority Supplemental Award, 280-281, 292, 301
Mexican Americans, 31, 45, 238, 242, 339, 351-352
Minorities.
See also Underrepresented minorities
access to care, 26, 28, 29-31, 49, 233, 234-235, 305
adherence to treatment plans, 33
in clinical trials, 35-36
defined, 23
demographic changes, 1, 23, 73, 235, 305, 306-307
educational inequities, 7, 67-68, 160, 242, 246
focus of this study, 27-28
health status and disparities, 30, 35-36, 49, 234, 237, 307
preferences and satisfaction with care, 31-32, 33
representation in health professions, 23-24
utilization of health services, 30, 33
Minority Access to Research Careers, 278-279, 287
Minority Biomedical Research Support, 278-279, 287
Minority Faculty Fellowship Program, 108-109, 110
Minority Fellowship Program, 108-109, 111
Minority Health Knowledge Management Initiative, 282
Minority Management Development Program, 282
Minority Medical Education Program, 27, 242
Minority Participation in Medical
Education Grant Program, 11, 120-121
Minority Training Programs Tracking System, 282
Montana, 296
Morris Brown College, 163
Mount Sinai School of Medicine, 103
Muñoz, Claudia, 283
N
National Advisory Council on Nurse Education and Practice, 253, 335
National Agenda for the Nursing Workforce, 335
National Association of Hispanic Nurses, 162
National Board of Medical Examiners, 61, 75
National Center for Complementary and Alternative Medicine, 289
National Center for Health Workforce Analysis, 117, 294, 295-296, 305-306, 311
National Center for Research Resources, 289
National Center on Minority Health and Health Disparities, 288
National Comparative Survey of Health Care, 325
National Conference of State Legislatures, 294
National Health Service Corps (NHSC), 108-109, 110, 118, 278-279, 285-286, 304
National Institute of Drug Abuse, 111
National Institute of General Medical Sciences, 287
National Institute on Aging, 111
National Institutes of Health
discretionary funding for students, 199, 278-279, 287-289, 301
evaluation of URM workforce initiatives, 305
grant programs for minority researchers, 36, 111
leadership diversity, 36-37
Office of Behavioral and Social Science Research, 289
National Institutes of Mental Health, 108-109, 111
National League for Nursing, 99, 100
Accrediting Commission, 128-130, 334
National Library of Medicine, 288-289
National Medical Fellowships, Inc., 10, 111-112, 304
National Postsecondary Student Aid Studies, 93, 102, 105-106
National Register of Health Service Providers, 29
National Research Council, 58
Ford Foundation Pre-doctoral and Dissertation Fellowships for Minorities, 112, 114
National Resident Matching Program, 302
National Sample Survey of Registered Nurses, 38
National Science Foundation, discretionary funding for students, 163, 280-284, 292-293, 301
National Student Loan Survey, 102
Native Americans.
See also Underrepresented minorities
clinician preferences and satisfaction with care, 31
educational inequities, 7
faculty, 41-42, 46, 48, 50, 158
financial status of families, 90
in graduate school, 49
in health professions workforce, 42-43, 46, 48, 49, 162, 242, 253, 274-275, 339
pedagogy, 158
school enrollment and graduation trends, 40, 45, 47, 51, 83, 238
New Hampshire, 184, 185, 187-188
New Mexico minority population, 23
New York state, 235
community service plans for nonprofit hospitals, 16, 182, 183
financial aid program, 11-12, 120-121, 297, 299, 302, 303
Physician Diversity Project, 209
Nickens, Herbert, 325
Nonprofit hospitals and health care organizations
areas for improvement, 194
charitable obligations of, 181-182
community benefit standard applied to, 186-189, 195-196
evaluation of charitable behavior of, 192
organizational practices, 193-194
recognition and support of, 189-190
roles and obligations of, 191-192
strengths of, 193
tax-exempt status, 15-16, 178-185, 190-191, 195-196
workforce diversity, 195-196
Nurses and nursing
accreditation standards, 128-131, 334-336
admissions process, 56, 253-255
baccalaureate, 56
costs of education, 99-101
faculty, 41-42
financial assistance, 101, 119, 255, 276-277, 296, 298
participation trends of minorities, 24, 26, 38-42, 253, 274-275
recruitment of URMs, 160, 162, 163
school enrollment and graduation trends, 40-42, 254
shortages, 38-39, 119, 160, 163, 253, 298
variability of programs, 254
Nursing Education Loan Repayment Program, 276-277, 285
Nursing Workforce Diversity Program, 108-109, 110, 276-277, 285
O
O’Connor, Sandra Day, 240-241, 345
Office of Management and Budget, 38
Oklahoma, 296
Oregon, 31
Orthodontic Education Company, 11, 119-120
P
Pedagogy
accreditation standards and, 368
active teaching methods, 158, 352, 357-358, 360, 361
collaborative and cooperative environments, 155, 158, 359-360
communication skills approach, 371-372, 378
and compositional diversity, 145, 158, 171, 379-380
cultural competency approach, 371, 378-379
Giroux’s antiracist approach, 378-37 9
and institutional climate for diversity, 143, 145, 155, 158, 164, 171, 352, 359-361, 367-368, 371-376
knowledge/skills method, 372
and learning outcomes, 158, 350, 352, 359-361, 367-368, 378-379
student-centered, 350, 352, 359, 361-362, 379
traditional, in medical schools, 367-368
Peer groups, influence on institutional climate, 351, 352, 355, 360, 363
Perry, William, 355
Pew Charitable Trusts, 129, 309
Pew Health Commission Competencies, 334-335
Pharmacy and pharmacists, 120
Physician Diversity Project, 209
Physician Payment Review Commission, 308-309
Physicians, URM.
See also Medical school
access issues, 5, 29, 30, 189, 248-249
career choices and satisfaction, 103-104
essential characteristics, 7, 236, 247
expectations of, 235-236
participatory decision-making style, 32, 33
patient characteristics, 5, 235, 248-249
patient preferences and satisfaction with, 5, 31-32, 325
quality of care, 33
recruitment of, 308
resident salaries, 104
VA, 291
workforce, 42-43, 238, 274, 291
Pipeline enhancement programs, 25, 27, 110, 118, 119, 161, 250, 252, 263, 299
Ponce School of Medicine, 43
Powell, Lewis Franklin, Jr., 239
Primary Care Medicine and Dentistry Grant Program, 286
Princeton University, 239, 328
Project 3000 by 2000 Health Professions Partnership Initiative, 238-239, 304
Prospective Payment Assessment Commission, 308-309
Psychology/psychologists
accreditation standards, 135-138, 333-334, 335
admissions process, 61, 249-251
costs of education, 98-99, 100
cross-cultural training, 167-169
earnings, 98
faculty, 48, 50, 157, 249, 250
financial assistance, 298
institutional climate, 157
participation trends of minorities, 24, 48-49, 275
patient characteristics, 5
recruitment programs, 163, 250
school enrollment and graduation trends, 48-49, 51, 249-250
workforce, 48
Public Health Institute, 190
Public Health Service Act
evaluation set-aside, 305
Titles VII and VIII, 9, 11, 107-110, 115, 118, 275, 300, 335
Public–private partnerships, 11, 119-123, 205, 308-310, 311
Puerto Ricans, mainland, 45, 159, 238, 339
Puerto Rico, medical school faculty, 43
Q
Quality of care
diversity and, 5, 23-24 n.1, 29, 31-33, 37, 325
nursing shortages and, 38-39
patient satisfaction with racially concordant clinicians, 5, 31-32
R
Racial and ethnic groups.
See also Minorities;
Underrepresented minorities;
specific groups
educational inequities, 7, 67, 160, 161, 233, 242, 283
OMB categories, 38
Recommendations
accreditation, 12-13, 19, 139, 140-141, 324, 330, 331-332, 336-339
admissions committees, 8-9, 261
admissions policies, 8-9, 19, 85, 255-264, 328
coalition building, 18, 20, 209
community benefit standard, 2-3, 17-18, 20, 200
data collection and research, 18, 20, 206
education of stakeholders, 18, 20, 208
financing options, 11, 12, 19, 117, 118, 121-122, 262-263
institutional and policy-level strategies, 18, 20, 210, 256-257
institutional climate for diversity, 2, 15, 19, 174-175
Recruitment and retention of URMs
academic advising and, 161
accreditation policies and, 12, 132-133, 137-138, 140, 141, 328, 338, 339
admissions policies, 83, 249, 250-251, 253, 254-256, 260, 261-262
educational inequities and, 160, 161
faculty, 157-160, 161, 171, 173, 284, 286, 308, 330, 332, 334, 336, 339
financial incentives, 9, 171, 173-174, 298, 307, 308, 311
institutional climate for diversity and, 14-15, 83, 143, 145, 160-165, 169-171, 173-174, 249, 262
institutional partnerships, 14, 15, 163, 170-171, 173-174
in nursing, 162
recommendations, 14-15, 174-175
students, 14-15, 83, 143, 145, 160-165, 169-171, 173-174, 249, 262
support services and programming, 14, 156, 164-165, 170, 174
Regional Centers for Health Workforce Studies, 294
Registered Nurse Education Loan Repayment Program, 113
Registered Nurse Education Scholarship Program, 113
Research.
See also Clinical research
accreditation outcomes, 12, 139-141, 319, 326, 332, 336-338, 339
data collection and analysis, 18, 205-206, 305-306, 309, 311
demonstrations on URM relationships to Medicare and Medicaid programs, 307-308, 311
on financing innovations, 11, 115-117, 119, 283, 284-285, 299-300, 301, 304-306, 307-308, 309, 311
grant programs for minority researchers, 36
on health disparities of minorities, 35-36
on institutional and policy-level strategies, 205-206
leadership diversity, 29, 36-37
outcomes of institutional climate for diversity, 13-14, 144, 152, 153, 167, 171, 175, 370-371
Research Initiative for Scientific Enhancement (RISE), 287
Research Supplements for Underrepresented Minorities, 278-279, 288-289
Reserve Officer Training Corps (ROTC) program, 290
Rhode Island, 185
Robert F. Wagner Graduate School of Public Services, 189
Robert Wood Johnson Foundation, 11, 27, 242, 252-253, 309, 324
Rogers, Paul, 207
Rosenoff, Emily, 283
Roybal, Edward, 181-182
S
Scholarship of Excellence program, 120
Scholarships for Disadvantaged Students, 108-109, 276-277, 284
Scholarships for Health Professions Students, 111
Scholastic Aptitude Test (SAT), 57, 58, 60, 62, 63-64, 244, 257
School-Based Scholarships for the Disadvantaged, 304
Schroeder, Steven, 324
Segregation
and admissions policies, 237-242, 328
affirmative action as a remedy, 238-239
Bakke decision, 239
and educational inequities, 7, 67-68, 72, 328
historical ramifications, 13, 172, 237-242, 349
and institutional climate for diversity, 13, 145, 146, 151-152, 155, 156, 172, 237-242, 348-349, 351
Senior Executive Service, 310
Sensitivity training, 14-15, 156, 157, 166, 174-175
Sepulveda, Enrique, 283
Social Accountability Budget, 190
Social contract
core competencies as part of, 328-329
cultural competencies as part of, 329-332
defined, 324
diversity as part of, 325-332
health professions’ and medical
education’s responsibility within, 323-324
Social Security Amendments of 1983, 302
South Dakota, 296-297
Spelman College, 163
Spencer Foundation Fellowships, 158
St. Louis University, 163
Standardized tests.
See also specific tests
and accreditation, 258
admissions policies and practices, 6-7, 8, 55, 56-75, 79, 81-82, 83, 84, 236, 244, 245-246, 257-258, 259
appropriate use of, 7, 58, 61-62
attributes measured by, 59
background, 56-58
benefits, 58
consequences of reliance on, 70-75
elimination of, 258
experiences in higher education institutions and HPEIs and, 68-70
and grade point average, 60, 63
group differences in performance, 7, 63-70
misinterpretations and misuses, 58-60, 84
precision and fairness of, 7, 59
pre-college influences on preparation for, 67-68
predictive power, 6-7, 60-62, 84, 246, 257-258, 381
preparation programs, 263
racist and eugenicist ideology and, 56
ranking of academic institutions with, 59-60
“stereotype threat” and, 7, 68-70, 82, 243, 246, 248, 261
“successful intelligence” theory and, 62
underperformance/overprediction, 62-63, 248
validation for diverse applicants, 62-63
Stanford University, 69, 77, 80, 82-83, 256
Early Matriculation Programs, 262-263
State University of New York at Albany, 294
States.
See also individual states
community benefit policies, 16, 186-189
financial aid, 2, 11-12, 92, 118, 120-122, 274, 282-283, 303, 309
Steele, Claude, 68-69
Stereotype threat, 68-70
Sternberg, Robert, 62
Stevens, David, 134
Strategies for Improving the Diversity of the Health Professions, 283
Student Assistance Programs, 110
Substance Abuse and Mental Health Services Administration, 108-109, 111, 305
“Successful intelligence” theory, 62
Sullivan Commission on Diversity in the Healthcare Workforce, 207
Sullivan, Louis, 207
Support of Continuous Research Excellence (SCORE), 287
T
Tax Reform Act of 1986, 181
Tennessee, 163, 238, 296, 297, 298
Texas
college admissions policies, 71, 72-73, 80, 240, 241, 258, 327
community benefit standard applied to nonprofit health care organizations, 183, 186, 188
diversity of health professionals, 30, 235
financial aid programs, 294, 295, 296
Health Professions Resource Center, 258
Texas A&M University, 72-73, 76-77, 80, 81-82
Partnerships for Primary Care, 258
Thorndike, E.L., 56
Tienda, Marta, 72-73
Tobacco settlements, 298-299
Training of health professionals, cross-cultural, 6, 33-35, 165-169
Tribal Colleges and Universities initiatives, 282, 291
Tuskegee syphilis experiments, 35
U
Undergraduate Scholarship Program, 278-279, 289
Underrepresented minorities (URMs)
on accrediting bodies, 12, 135, 140, 141, 321, 322-323
on admissions committees, 77-78
advising inequities, 243-244, 264
barriers to inclusion in health professions, 28, 243-244
college enrollment and graduation trends, 24, 40-41, 43-45, 46, 47, 48-49, 50, 94, 95-96, 115-117, 118, 235, 240, 241, 282, 284
costs of education, 9, 102-104, 118, 122, 161, 283, 303-304
defined, 3 n.1, 6, 24 n.2, 27-28, 38, 242-243, 252, 273 n.1
eligibility for enrichment programs, 161, 242
financial assistance for college, 106-114
financial status of families, 9, 67-68, 89-90, 91, 92
participation trends in health professions, 1-2, 37-49, 238
primary and secondary education, 3-4, 24, 27, 84
recruitment and retention, 250-251, 255, 298
stereotype threat, 68-70, 82, 243, 246, 248
Uniformed Services Health Professions Revitalization Act of 1972, 289
Uniformed Services University of the Health Sciences, 289
Universidad Central del Caribe School of Medicine, 43
University of California
admissions policies, 71, 73-75, 84, 233, 238, 239-240, 256-257
at Berkeley, 74
at Irvine, 259-260
Medical Student Diversity Task Force, 233, 244
at San Francisco, 150, 283, 294
University of Colorado, 11, 101, 119-120, 121
University of Denver, 361
University of Illinois at Chicago, 294, 326
University of Maryland, 361
University of Massachusetts at Amherst, 361
University of Michigan
affirmative action lawsuits, 3, 24-25, 29, 145, 147-148, 240-241, 255, 326-328, 345, 379-380
diversity and learning outcomes, 151-152
faculty recruitment strategies, 157
multicultural audit, 154
Program on Intergroup Relations, 360, 361
University of Minnesota, 374
University of Nebraska Medical Center, 162
University of New Mexico, 325-326
University of North Carolina at Chapel Hill, 286
University of Puerto Rico School of Medicine, 43
University of Texas, 72-73, 157, 240, 294
University of Washington, 294
U.S. Army, Alpha and Beta tests, 57
U.S. Bureau of the Census, 300, 305
U.S. Department of Defense, discretionary funds for financial aid, 274, 280-281, 289-291, 301-302, 307
U.S. Department of Education, accreditation role, 2, 11, 12-13, 127-128, 129, 130, 131, 133, 138-141, 319-320, 322, 344
U.S. Department of Health and Human Services
definition of underrepresented minority, 242-243, 273 n.1
discretionary funds for financial aid, 274, 255, 275-289, 299-300
evaluation of effectiveness of initiatives, 299-300, 304-305
nondiscretionary funds for financial aid, 114, 274
Office of Assistant Secretary for Planning and Evaluation, 299, 305
Office of Inspector General, 284-285
Office of Public Health and Science, 305
Office of Research, Development, and Information, 305
Office of the Secretary, 305
Race and Health initiative, 234
U.S. Department of Homeland Security, 304
U.S. Department of Veterans Affairs, 274, 280-281, 291-292, 301-302, 305, 307
U.S. General Accounting Office, 116-117, 300, 310
U.S. Medical Licensing Exam, 61, 245-246, 258, 370
U.S. News & World Report, college rankings, 59
U.S. Office of Management and Budget, 300
U.S. Surgeon General, 37, 234, 251
tax status of health care organizations, 16, 180, 182-183, 184, 186, 188
V
Vanderbilt University, 101, 163
Voluntary Hospitals of America, 190
W
Warm Spring Reservation (Oregon), 31
Washington Business Group on Health, 207-208
Washington state
college admissions policies, 241, 327
financial aid programs, 294, 296
Washington State University, 162
White House Hispanic Agenda for Action Initiative, 282
Williams, Daniel Hale, 37
W.K. Kellogg Foundation, 4, 11, 25, 112, 114, 189, 207, 209, 309
World Health Organization, 192, 324
World War I, 57
World War II, 57