The second panel of the meeting examined challenges and barriers for Black boys and men across academia, from elementary education to medical school and on through medical residency and academic careers. Lynne Holden, M.D.,1 presented the nationwide Mentoring in Medicine program she developed, which provides mentoring and support to students from elementary through health professional schools. Walter J. Lanier, J.D.,2 presented the Men of Color initiative he created at the Milwaukee Area Technical College (MATC), which aims to increase course completion, retention, and graduation rates among men of color at the college. C. Reynold Verret, Ph.D., president of Xavier University of Louisiana, describes how Xavier successfully produces the greatest number of Black physicians compared with other schools across the country. L. D. Britt, M.D.,3 presented observations from his career as a mentor and educator to Black men pursuing medical professions. The session was moderated by Marc Nivet, Ed.D.,4 who proposed in his opening remarks that the only way to effectively increase the number of African American medical students is to open up more African American medical schools and to increase the number of African American seats in all medical schools. Nivet led a brief discussion following the presentations.
1 Holden is president and chief executive officer of Mentoring in Medicine, emergency department physician and residency site director of the Emergency Medicine Residency Program at Montefiore Medical Center, and associate professor of clinical emergency medicine at the Albert Einstein College of Medicine.
2 Lanier is director of multicultural affairs and community engagement at the Milwaukee Area Technical College.
3 Britt is Henry Ford Professor and Edward J. Brickhouse Chairman at Eastern Virginia Medical School.
4 Nivet is executive vice president for institutional advancement at UT Southwestern Medical Center.
Lynne Holden, M.D. President and Chief Executive Officer Mentoring in Medicine
Holden first presented the Mentoring in Medicine program, reviewing its history, mission, and programs. Mentoring in Medicine offers school-based programs, which provide a daily elective class in low-resource inner city schools for students beginning in the second grade, and out-of-school camps that occur throughout the calendar year, which include virtual programming to reach students across the country. For college and postbaccalaureate students, Mentoring in Medicine offers programs with clinical exposure, internships, and seminars. The organization also has a “Parents STEM Network,” which provides in-house and virtual networking opportunities to help parents better understand the challenges their children face while studying STEM. Since its founding in 2008, Mentoring in Medicine has seen 176 of its students accepted and matriculating to 37 medical schools. Holden commented that all of these students were discouraged from applying to medical school.5
Based on interviews with students, parents, and educators, Holden and colleagues identified three primary barriers. They found the principal barrier was that a lack of confidence, or the self-perception that “they don’t have the resources. No one looks like me who is doing this.” The second biggest barrier they identified was a lack of educational resources. Financial resources came third (Holden et al., 2014).
Finally, Holden presented lessons learned, beginning with the need for a team to help students overcome psychological barriers. Holden stated,
You really have to erase a lot of pressures, a lot of everyday what’s happening in their environment, and you have to paint a different picture, a different movie. It takes a team of people to do that. It takes social workers, psychologists—it takes mentors. It just takes a lot of people to make it happen.
She added, “You have to make sure that you appeal to the heart. Let them be leaders. Whatever they learn, let them do it. Let them tell and share with their communities.”
Walter J. Lanier, J.D. Director of Multicultural Affairs and Community Engagement Milwaukee Area Technical College
Lanier opened his presentation by highlighting the importance of community colleges as an underused resource. In his words,
The community college is kind of a hidden jewel, a hidden resource, a hidden, naturally occurring pool in the educational ecosystem. We just miss it. There is already a bridge; there is already a body of people in the ecosystem of the community college that we can use to build this pool of Black men and students of color in medicine.
For context, Lanier commented that in 2014, of all Black undergraduate students, 44 percent were in community colleges.6 At the MATC, he said, 56 percent of students identify as a racial or ethnic minority, and 22 percent of students identify as men of color.
Lanier then described the Men of Color Initiative at the MATC,7 which offers a range of strategies to increase course completion, retention, and graduation/program completion, and to close equity gaps. These strategies include building cohorts, partnering with academic programs, community collaborations, aggressive data use to identify targets for intervention, promoting health and wellness, providing mentoring and role modeling, and offering professional development. The initiative also surveys students for input about their needs from their perspective.
To illustrate the potential of community colleges and describe the application of some of the Men of Color Initiative strategies, Lanier discussed a mental health awareness day hosted by MATC that brought together stakeholders including religious organizations, local health systems and health services agencies, local law firms, and advocacy organizations. He remarked,
It was a deep community collaborative to take the messages [of academia] and embed it inside the community college to propagate it broadly to our community . . . what made it catalytic was doing it at the community college, which is an institution that, as part of its mission, is connected to the ground.
6 See https://trends.collegeboard.org/sites/default/files/trends-in-community-colleges-research-brief.pdf (accessed February 26, 2018).
Lanier closed his presentation by challenging those in the room to think about the role community colleges can play in programs to strengthen the medical education pipeline.
C. Reynold Verret, Ph.D. President Xavier University of Louisiana
Verret opened his presentation by emphasizing the need to understand the origins of the shortage of Black men in medicine. He proceeded to discuss barriers and faciliators along the educational pipeline from his experience. First, he emphasized the need for programs to appeal to students’ interest in STEM careers to start earlier in the educational pipeline, and suggested targeting middle school. He commented that the focus on identifying talented STEM students in undergraduate programs is an outlier compared with other disciplines, saying
Talent begins at [8, 9, 10, or 11 years old]. If you don’t catch talent when it’s at that point . . . it goes away and finds another place. If we are asking ourselves to make cellists or great pianists, I would not say let’s find those 18-year-olds and make great musicians. That’s the way it is with scientists and with those who go into the health professions.
Verret then discussed disparities in public education as a barrier, arguing,
The majority of American children do not get the education they deserve. We tend to blame them for not achieving and not being prepared. They do not choose their schools any more than they choose their parents. But they are not prepared.
Contributing to this bifurcated educational system, Verret next identified the disproportionate pathologizing and criminalizing of behavior by race and gender in schools as a systemic challenge. These reflect systematic biases in the use of exclusionary discipline and referrals to special education services for Black students compared with students of other racial and ethnic groups and for boys compared with girls (Skiba et al., 2000, 2011; Wallace et al., 2008). Moreover, he noted, these students internalize the notion that they are damaged, with adverse consequences for their own norms and expectations. To that end, Verret argued for the need to change these norms and expectations, offering, “What students need is belief, the expectation to succeed.”
L. D. Britt, M.D. Henry Ford Professor and Edward J. Brickhouse Chairman Eastern Virginia Medical School
Britt began his presentation by pointing out that not only is the underrepresentation of Black men a problem in medicine, but also that “at no level of advanced education is there a robust number of Black men on an enhanced education trajectory. . . . Black men are underrepresented on every level of academia.” He declared that addressing this challenge requires effort, initiatives, and leadership. With respect to specific actions, Britt first emphasized the importance of partnerships with stakeholders, including those not in the health care sector. Some potential stakeholders he identified include the National Academy of Medicine, the American Association of Medical Colleges, the U.S. Department of Health and Human Services, the U.S. Department of Education, the associations at public and private secondary schools, churches and religious organizations, and community organizations. Second, Britt highlighted the need to “generate specific action items, not just talk about things that we all know.” Examples of specific actions he listed include summer camps, medicine-themed fairs (akin to science fairs), and “creative systems of magnet schools.” Third, he emphasized the need to cultivate a culture of financial stability and sustainability for financing medical education and proposed using foundation grants and loan forgiveness programs as possible strategies. Finally, echoing Nivet’s opening remarks, Britt underscored the need to expand medical schools and increase the number of seats in schools and residencies available for Black men.
Tammy Mayo-Blake, M.Ed., of the Health Resources and Services Administration, commented on her previous experience as a K–12 teacher and school counselor during a time when there was a movement to increase girls’ involvement in education. She noted that she was accountable for increasing their participation in her performance evaluation. Reflecting on the successes of that movement, she asked the deans of medical schools in the room whether there are specific conversations at their institutions to increase participation of African American boys going into science and medicine careers. Verret responded that, whereas the lack of participation of girls in K–12 education was understood as a problem, the low participation of Black boys may not be similarly understood as a problem because it is a consequence of a pedagogic approach that focuses
on achieving “class control . . . how to manage the class, how to control groups.” He asserted that this focus on control may lead to pathologizing and criminalizing Black boys’ behavior and suggested that other approaches to teaching may better meet the needs of Black boys who may have different learning styles. Britt emphasized the need to dismiss certain myths about what education and skills are needed to become a doctor, which result in poor or inadequate counseling and may discourage certain students from pursuing the health professions. For example, he cited the myth that undergraduate students must major in a science to go to medical school.
Bonnie Mason, M.D.,8 inquired about the high attrition rates of Black residents compared with residents from other racial and ethnic groups. She asked,
When are the people in this room going to develop either a race curriculum, a health disparities curriculum, or a way for our students who are called “N”? The N-word is being used in the operating room. The students are being cast aside and left out of classrooms when a patient says, “I don’t want to see you as a Black physician.”
In response, Britt emphasized the need to promote inclusive environments in addition to increasing the diversity of medical students. He expanded on this, saying that simply having a more diverse student body is insufficient. Students from diverse backgrounds must also all feel welcome and included in their learning environments. Leon McDougle, M.D., M.P.H.,9 expanded on Britt’s comment, and suggested that accountability to promote diversity and inclusion in residencies can be built into accreditation standards. He stated that his institution is advocating for the Accreditation Council for Graduate Medical Education to adopt a standard for diversity and inclusion similar to the existing one for medical schools. His proposed standard stated,
A residency training program has effective policies and practices in place and engages in ongoing systematic and focused recruitment and retention activities to receive mission-appropriate diversity outcomes for students, faculty, senior administration staff, and other relevant members of the academic community.
8 Mason is orthopedic surgeon and founder of Nth Dimensions, a nonprofit dedicated to increasing health equity by increasing diversity in some medical specialties. For more information, see http://www.nthdimensions.org (accessed Febrruary 27, 2018).
9 McDougle is chief diversity officer at The Ohio State University Wexner Medical Center.
Finally, William Owen, M.D., FACP,10 emphasized the need for institutional leadership and commitment to diversity and inclusion.
Marja Hurley, M.D.,11 questioned whether there are strategies to capture Black men who apply to medical schools who are not accepted, to encourage them to reapply, and to ensure that they are better prepared in their reapplication. Nivet commented that current strategies such as enrichment programs or a supplemental year are not enough. Verret described a program at Xavier University of Louisiana in which students can take courses and be involved in research for a fifth year. Cato T. Laurencin, M.D., Ph.D.,12 emphasized that this is a large group of untapped potential, and reiterated the need to first identify these students, “to get their names.” Second, he suggested the need to develop a “pathway or program that allows their reentry.”
Cedric M. Bright, M.D., FACP,13 asked the panelists when and how they discuss racism with their students. He also inquired about strategies to discuss racism in a way that students “maintain that positive self-image before it becomes totally torn down because they start to buy into that stereotype threat.”
Holden said that Mentoring in Medicine discusses racism from the beginning, and that their school-based programs incorporate a segment on health care disparities. For older students in undergraduate and postbaccalaureate programs, Mentoring in Medicine has speakers and mentors who discuss the challenges they have faced in their education and careers. The program also has psychiatrists and psychologists who discuss what racism is and strategies to deal with racist acts as well as the psychological stress of racism. Lanier responded that, “At the community college, I think the students kind of already know that coming in the door, that there is something going on relative to race.” Nevertheless, he emphasized the importance of Black leaders and physicians affirming these students’ experiences of racism. Moreover, he suggested that hearing about the challenges experienced by those who have achieved academic and professional success, such as the leaders in the room, would “affirm and seal and strengthen” the ability of these students to persevere. Finally, he suggested the need to support students in navigating their experiences of racism, provide strategies they can employ to maintain
10 Owen is dean and chancellor of Ross University School of Medicine.
11 Hurley is professor of medicine and orthopedics and associate dean at UConn Health.
12 Laurencin is university professor, Van Dusen Distinguished Professor of Orthopaedic Surgery, and director, The Raymond and Beverly Sackler Center at the University of Connecticut.
13 Bright is associate dean for Inclusive Excellence, director of the Office of Special Programs, and associate professor of medicine at the University of North Carolina School of Medicine.
their mental health in the face of racism and discrimination, and advocate for students. Britt expanded on Lanier’s last comment, describing the need for better encouragement and advisement from mentors and counselors, especially when students are met with challenges and barriers. Whereas other students may be encouraged to persist and to try again if they encounter barriers or failures, Black boys and men may not receive the same encouragement to overcome these challenges.
Holden, L., B. Rumala, P. Carson, and E. Siegel. 2014. Promoting careers in health care for urban youth: What students, parents and educators can teach us. Information Services and Use 34(3–4):355–366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286884 (accessed February 26, 2018).
Skiba, R. J., R. S. Michael, A. C. Nardo, and R. Peterson. 2000. The color of discipline: Sources of racial and gender disproportionality in school punishment. Bloomington, IN: Indiana Education Policy Center. https://eric.ed.gov/?id=ED468512 (accessed May 4, 2018).
Skiba, R. J., R. H. Horner, C.-G. Chung, M. K. Rausch, S. L. May, and T. Tobin. 2011. Race is not neutral: A national investigation of African American and Latino disproportionality in school discipline. School Psychology Review 40(1):85–107. https://search.proquest.com/openview/a7389dd1667724ca0e8dd8102f1a107c/1?pq-origsite=gscholar&cbl=48217 (accessed May 4, 2018).
Wallace, J. M., S. Goodkind, C. M. Wallace, and J. G. Bachman. 2008. Racial, ethnic, and gender differences in school discipline among U.S. high school students: 1991–2005. Negro Educational Review 59(1–2):47–62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678799 (accessed May 4, 2018).
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