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Pipeline Programs: Looking Forward to Promote Diversity

BY SUSAN S. ANDERSON
SPECIAL TO THE AAMC REPORTER

Starting early: Students from CUNY's pipeline program learn about DNA at a center on Long Island.

While gains have been made in encouraging students who are members of underrepresented minority (URM) groups to apply to medical school, the primary reason for minority underrepresentation in medicine - the limited number of academically well-prepared students with diverse backgrounds in the applicant pool - remains. And with the dust still settling from the Supreme Court's decision affirming the right of institutions of higher education to use race as one factor in admissions, those involved in promoting diversity in medical education understand that their work is far from over.

For example, African-American and Hispanic students are still consistently underrepresented in college preparatory programs, and there are persistent gaps in academic achievement between high- and low-income students. Students who are the first in their families to attend high school or college often face unique challenges.

Adding pressure to medical education's efforts to address these issues are demographic trends that point to a not-too-distant future in which minorities will become the majority in this country. Physicians must have the skills and experiences to work comfortably and proficiently with patients from a variety of cultures and backgrounds.

Critical to ensuring more diversity in medical education are the numerous health sciences professions "pipeline" programs. How are those involved in these programs viewing the Supreme Court's latest decision, and what are they doing to prepare young people with varied backgrounds and experiences for a future in medicine?

Lisa Tedesco, Ph.D., vice president and secretary of the University of Michigan and a professor of dentistry, sits close to the center of the recent legal storm. From her perspective, the justices made an unambiguous statement. "They have given us terrific guidance in terms of how the schools can develop diversity by taking the whole individual into account in admissions," she says. "This is a moment where we can see how important pipeline and outreach programs are to developing diversity, as long as these programs are designed to create and expand diversity in the admissions pool."

Marlon Priest, M.D., a professor of emergency medicine and a program director for the AAMC's Health Professions Partnership Initiative (HPPI) and the Minority Medical Education Program at the University of Alabama- Birmingham (UABSOM), believes the Supreme Court's message is clear. "Those of you who have carried the water in the past, keep carrying the water," he says, referring to the ongoing struggle for diversity.

According to Dr. Priest, the only way to build a student population that reflects the face of the community is to make sure that every child has the opportunities for academic success and achievement. "For leaders to lead, they must represent the entire community," he says.

Starting early

Academic pipeline programs that start as soon as possible in a student's educational career are vital to developing a diverse applicant pool because not all students get the same start in life, according to Lauro Cavazos, Ph.D., professor of family medicine and community health at Tufts University School of Medicine and chair of the HPPI's national advisory committee.

"The root of these problems start back in elementary school. By the time they hit ninth grade, the die has been cast," says Dr. Cavazos. If students are not prepared to attend college and consider careers in the health sciences by ninth grade, they typically will not find themselves competing for a place in medical school, or in any other school, for that matter, he says. But the effort should not stop with the 12th grade: "We must nurture students all during their educational experience - they can trip anywhere along the line. Think of it as a continuum from kindergarten through college," he suggests.

One of the groups that have done something about getting students excited about science at an early age - and keeping them excited and prepared all the way through graduate and medical school - is Baylor College of Medicine's Center for Educational Outreach. According to William Thomson, Ph.D., the center's director and a professor of family and community medicine, the center's work is all about "creating a seamless pathway to medical school."

The Baylor program supplies curriculum materials on the environment for children as young as pre-kindergarten students, offering programs to make science fun and relevant through the use of adventure and stories through the eighth grade. At the other end of the pipeline, the center has partnered with the University of Texas-Pan American to offer a Premedical Honors College; an eight-year, combined B.S.-M.D. program created to increase the number of physicians practicing in predominantly Latino and other underserved communities in South Texas.

Nancy P. Moreno, Ph.D., the center's associate director and an associate professor of family and community medicine, notes that all of the programs are based on the philosophy that the nation's educational structure needs systemic change, not just a program here and there. "We've moved away from Band-Aid approaches. Now we're working closely with partners such as local school districts, universities, and scientists across the nation," she says.

Smoothing the road

Determined to prevent students from stumbling along the road to a career in the health professions, some schools and organizations have looked closely at the learning atmosphere in college classrooms. Trinity College, in Hartford, Conn., has joined with more than 30 other colleges and universities to form the Consortium on High Achievement and Success, a group dedicated to "promoting high levels of achievement among students of color at our primarily white campuses," according to Sharon Herzberger, Ph.D., vice president for student services and a professor of psychology at Trinity.

"Because a disproportionate number of the nation's leaders come from elite schools, such as the ones in the consortium, we can't waste a single person," she says. Trinity also has developed the Barrier Course Project, which offers supplemental instruction for students having difficulties in introductory science classes and trains teachers to provide students with motivating feedback.

The program also helps teachers avoid "stereotype threat" - a situation in which a student's "group" has been subject to negative stereotypes in society, prompting students to feel that they might be evaluated based on a set image. Students also learn how to study and work collaboratively because, as Dr. Herzberger notes, "that's how science is done."

Echoing the collaborative skills required to achieve success in the sciences, universities and medical schools are developing partnerships with their local public school systems to make great things happen.

One of the pipeline projects at UABSOM's Center for Community OutReach Development (CORD) is the Bridge to Health Care, funded in part by a 2000-2005 HPPI grant and led by the university's medical school. The CORD program works to increase the number of minority students entering the health professions from Birmingham City Schools by involving fifth, seventh, and ninth graders in activities ranging from academic enrichment to laboratory and clinical setting experiences, to career and school counseling.

"Our efforts have worked well because they are based on a true part-nership with the school system," says CORD Program Director Shirley Ginwright. "We did not come from on high to the schools to tell them what to do."

Asked why the medical school is involved with such a program, UABSOM's Dr. Priest underscores the importance of community involvement. "We are part of this community, and the fact that we are in the downtown area brings with it an obligation to improve the education of those who are living here," he says. The CORD programs expose students to health issues - in laboratory sessions held in the 4,000-square-foot McWane Science Center and during lectures - that disproportionately strike their own communities, including diabetes and sickle cell disease. By incorporating these topics into the public school curricula, Dr. Priest notes, "we can produce a new generation that will attack these health issues creatively."

A sense of responsibility to engage the local community also characterizes Mt. Sinai School of Medicine's educational outreach programs. For example, Mt. Sinai works with the Gateway Institute for Pre-College Education to encourage students living in the university's New York City neighborhood - a neighborhood in which the AIDS rate is three times the national average and a majority of the children live below the poverty line - to attend college and pursue professional careers.

The Gateway Institute administers specialized programs within 10 high schools in the city, geared toward preparing minority and low-income students for careers in science, health, engineering, medicine, and other areas. In addition, Mt. Sinai's involvement with two stand-alone schools provides a rigorous college preparatory curriculum: the Queens Gateway to Health Sciences Secondary School, covering grades seven through 12; and the Life Sciences Secondary School in East Harlem, which takes students as early as the sixth grade and, while not directly associated with the Gateway Institute, uses the same teaching methodologies.

According to Nathan Kase, M.D., dean emeritus and a professor of obstetrics, gynecology, and reproductive services at Mt. Sinai, these two schools differ from some pipeline programs in that they "take all comers" - including those students who may not necessarily have high academic qualifications but are extremely motivated to pursue careers in science or health. Both schools have already established a track record of excellence: about two-thirds of Queens Gateway graduates move on to college, and Life Sciences can boast four seniors elected to the National Merit Honor Society in its first graduating class this past spring.

Looking ahead

Forrester A. Lee, M.D., a professor of medicine and assistant dean for multicultural affairs at Yale Medical School, expressed concern about how the Supreme Court's decision will play out over time. "I think it may make it more difficult from kids with educationally disadvantaged backgrounds to get into the health professions," Dr. Lee says.

"In effect, the court said that schools should be allowed to have diverse campuses," Dr. Lee notes, but he sees a scenario where deciphering the exact definition of "diversity" could create situations at the schools in which they will have trouble defending their method of using race as one part of the selection process. Because of this, he expects to see a period of cautiousness when it comes to developing pipeline programs. "Justice [Antonin] Scalia's [dissenting] comments could be used as a road map" for groups intent on challenging a pipeline or outreach program, he warns.

However, focusing on the task at hand - to offer students rigorous academic preparation for their futures - and avoiding the noise and politics surrounding the issue can be a challenge. "The difficulty lies in the fact that nearly everybody will agree that they are for social equality and justice, but how that is achieved is where the trouble starts," says Dr. Lee, adding that "our first commitment is to educate our children and young people at all levels." Dr. Cavazos echoes these sentiments, while urging those involved with pipeline programs to "not let political rhetoric get in the way of helping kids get better educated and have better futures."

The success of these efforts will depend on the involvement of the academic medicine community. "Every academic medical center must make a commitment over time to the community in which it exists," Dr. Kase says, noting that medical schools and teaching hospitals occupy a unique place in neighborhoods where there are few, if any, models of success and achievement. These activities can deepen the relationship between community members and members of the university community, resulting in a larger number of minority and educationally disadvantaged students who decide on, and want to prepare for, a future career in medicine.

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