The Right Thing to Do, The Smart Thing to Do Enhancing Diversity in the Health Professions

Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W.Nickens, M.D.

Brian D.Smedley and

Adrienne Y.Stith

Institute of Medicine

Lois Colburn

Association of American Medical Colleges

Clyde H.Evans

Association of Academic Health Centers

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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The Right Thing to do, The Smart Thing to do Enhancing Diversity in the Health Professions The Right Thing to Do, The Smart Thing to Do Enhancing Diversity in the Health Professions Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W.Nickens, M.D. Brian D.Smedley and Adrienne Y.Stith Institute of Medicine Lois Colburn Association of American Medical Colleges Clyde H.Evans Association of Academic Health Centers INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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

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The Right Thing to do, The Smart Thing to do Enhancing Diversity in the Health Professions “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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

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The Right Thing to do, The Smart Thing to do Enhancing Diversity in the Health Professions NICKENS SYMPOSIUM ADVISORY COMMITTEE FITZHUGH MULLAN, M.D. (Chair), Contributing Editor, Health Affairs, Bethesda, MD MAXINE BLEICH, President, Ventures in Education, New York, NY ROGER J.BULGER, M.D. (ex-officio), President, Association of Academic Health Centers, Washington, D.C. LAURO F.CAVAZOS, Ph.D., Professor, Tufts University School of Medicine, Department of Community Health, Boston, MA JORDAN J.COHEN, M.D. (ex-officio), President, Association of American Medical Colleges, Washington, D.C. CLYDE H.EVANS, Ph.D., Vice President, Association of Academic Health Centers, Washington, D.C. VANESSA NORTHINGTON GAMBLE, M.D., Ph.D., Vice President, Division of Community and Minority Programs, American Association of Medical Colleges, Washington, D.C. MARILYN H.GASTON, M.D., Assistant Surgeon General and Director, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Bethesda, MD MI JA KIM, R.N., Ph.D., Chicago, IL MARSHA LILLIE-BLANTON, Dr.P.H., Vice President, Health Policy, Henry J.Kaiser Family Foundation, Washington, D.C. SUSANNA MORALES, M.D., Department of Medicine, Weill Medical College of Cornell University, New York, NY ROBERT G.PETERSDORF, M.D., Distinguished Professor of Medicine, University of Washington School of Medicine, Seattle, WA VINCENT ROGERS, D.D.S., M.P.H., HRSA Northeast Cluster, Philadelphia, PA

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The Right Thing to do, The Smart Thing to do Enhancing Diversity in the Health Professions CARMEN VARELA RUSSO, Chief Executive Officer, Baltimore City Public Schools, Baltimore, MD KENNETH I.SHINE, M.D. (ex-officio), President, Institute of Medicine, Washington, D.C. JEANNE C.SINKFORD, D.D.S., Ph.D., Associate Executive Director and Director, Division of Equity and Diversity, American Dental Education Association, Washington, D.C. NATHAN STINSON, M.D., Ph.D., M.P.H., Director, Office of Minority Health, U.S. Department of Health and Human Services, Rockville, MD

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

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

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

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