6

Reflections on Meeting Day 1

In the final session on the first day of the meeting, leadership from four Historically Black Colleges and Universities (HBCUs) offered reflections on the barriers for Black men’s entry to medicine and current strategies to address these challenges. The panelists were Valerie Montgomery Rice, M.D.; Wayne A. I. Frederick, M.D., M.B.A., FACS; Veronica Mallett, M.D., M.M.M.; and Deborah Prothrow-Stith, M.D.¹ L. D. Britt, M.D.,² moderated a brief open audience discussion following the panel. The first day of the workshop closed with a poster session presenting perspectives from current medical students.

REFLECTIONS

Valerie Montgomery Rice, M.D.
President and Dean
Morehouse School of Medicine

Montgomery Rice reflected on the medical educational pipeline and the junctures at which boys are lost. Using the analogy of a leaky pipeline she developed, she reviewed the number of African American boys and men who

• do not complete high school;
• graduate but do not enroll in college;
• do not matriculate to or complete college;
• apply or take the Medical College Admission Test (MCAT) in preparation for medical school, but do not apply to medical school or do not get accepted; and
• become physicians.

She also touched on high rates of incarceration, family structure, and low socioeconomic status as some social and environmental factors that may influence the low achievement rates.

Montgomery Rice then presented the idea of a national clearinghouse for pipeline programs, a proposal for which is included in the Morehouse School of Medicine’s strategic plan. It would be a database of pipeline programs like those discussed over the course of the day, a resource to share what works. The clearinghouse would also require programs to

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¹ Montgomery Rice is president and dean of the Morehouse School of Medicine; Frederick is president of Howard University; Mallett is dean of the School of Medicine at Meharry Medical College; and Prothrow-Stith is dean and professor of medicine for the College of Medicine at the Charles R. Drew University.

² Britt is Henry Ford professor and Edward J. Brickhouse chairman of the Department of Surgery at Eastern Virginia Medical School.

have specific objectives and would use standardized metrics to assess program outcomes. Those looking to implement a program could search the clearinghouse for programs with attributes that match their community and its needs. Recognizing the importance of flexible programs with the capacity to adapt and be responsive to local environments, Montgomery Rice commented that the clearinghouse would offer a start, connections to those running successful programs, and development and implementation support.

Next, Montgomery Rice discussed the problem of declining African American applicants and matriculants to HBCU medical schools since 2002. The deans of the four HBCU medical schools represented on the panel—Charles R. Drew University of Medicine and Science, Howard University, Meharry Medical College, and the Morehouse School of Medicine—convened the Empower Conference, an annual conference launched in 2016, which seeks to address the decline of African American students from HBCUs who pursue health and science.³ For the 2018 conference, some workshops will address strengthening undergraduate curriculum, MCAT preparation, and financial and social determinants.

Montgomery Rice closed her presentation with a call to action. She declared,

Wayne A. I. Frederick, M.D., M.B.A., FACS
President
Howard University

Frederick first briefly described how Howard University is working to increase the applicant pool and number of African American students from HBCUs in its medical school. For 3 years, select undergraduate students from HBCUs are invited to come to Howard for medical school for the summer to receive didactic instruction and MCAT/test preparation, with paid accommodations. Since implementing the program, the number of HBCUs represented in the freshman medical school has risen from five (including Howard) to nine (also including Howard). He commented on the need to increase opportunity within HBCUs, saying,

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³ For more information, see http://empowerconf.com/Support_Files/HBCUEmpowerCommissionedPaper.pdf (accessed March 5, 2018).

Frederick also described a new science, technology, engineering, and mathematics (STEM) Scholar Program at Howard, which supports undergraduates interested in pursuing a Ph.D. or M.D./Ph.D. in a STEM field.⁴ He remarked that for these high-achieving students, many had competing offers from Ivy League schools, but chose Howard because they valued participation in a cohort.

Frederick discussed lessons learned from the Howard experience. First, he commented on the importance of community and cultivating supportive but also accountable environments. He said,

Frederick described the need to identify and cultivate interests. He described the need to expose young Black boys to STEM in middle school, encourage undergraduate students with interest and competences to pursue STEM careers, and support students’ interest with better advising at the undergraduate level starting in the freshman year. To increase retention and graduation rates, Howard has increased opportunities for STEM undergraduates. For example, Howard has a program for biology majors to pick a track within biology that provides opportunities for research and for exposure in hospitals. Howard’s Office of Undergraduate Studies also helps address financial barriers, helping to manage students’ financial circumstances and offering a 50 percent tuition rebate for direct tuition payments for the final semester for students who graduate on time.

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⁴ For more information on the STEM Scholars Program at Howard University, see https://www2.howard.edu/scholarships/bison-stem-scholars (accessed April 11, 2018).

Veronica Mallett, M.D., M.M.M.
Dean, School of Medicine
Meharry Medical College

Mallett reflected on disparities in the public education system and how they contribute to the dearth of Black men in medicine. She commented that, on one end of the spectrum, some Black boys in some underresourced schools in low-income neighborhoods are ostracized, stereotyped, and their behavior criminalized. On the other end, some high-performing schools have supportive environments and produce exceptional students. Mallett noted that this disadvantage has consequences throughout the life span, saying, “A growing number of students start kindergarten already trailing their privileged counterparts, and they rarely if ever catch up.” She added that these disparities are not incidental, but instead result from institutional racism and specific actions such as privileged people paying and lobbying for better schools and better resources in schools. Given that this racist educational infrastructure results from specific actions, it is neither inexorable nor unalterable. Mallett said, “We can do something about that, and we can hold the public school system accountable.” Specifically, she endorsed political advocacy and action to change the culture of schools and to address the institutional racism that structures disadvantage for students at an early age and has lifelong effects. “We really need to focus on healing the culture in public schools,” she said.

Deborah Prothrow-Stith, M.D.
Dean, College of Medicine
Charles R. Drew University

Prothrow-Stith discussed her list of significant points from the day’s panels and discussions. She opened her comments by acknowledging the role of HBCUs in providing supportive environments and cohorts. She said,

Prothrow-Stith then noted that the shortage of Black men in medicine is not an intractable problem. She said, “It’s not rocket science. We know what is needed. But it is hard because . . . it’s institutional racism that we are up against.” She then listed the following strategies as potential ways to address the problem:

• Changing public policy,
• Supporting and growing existing programs,
• Starting early and providing continuous support for students,
• Naming racism,
• Creating role models to change norms (i.e., negative public perceptions and images) about Black men and increase the career attractiveness of medicine and other STEM careers for Black men, and
• Addressing financial barriers.

DISCUSSION

To launch the discussion, moderator Britt posed two questions for the panelists. First, he asked what specific strategies they would implement if given $20 billion, or $2 billion every year for 10 years. Montgomery Rice started by saying she would do the following:

• Centralize and create a clearinghouse of pipeline programs such that any community would be able to apply for receiving funding for pipeline programs.
• Start a new medical school committed to diversity and inclusion.
• Partner with four major health systems to advance the residency training opportunities.

Frederick said he would do the following:

• Create a network of middle and high schools around existing HBCUs.
• Create a network of HBCUs and medical schools that have a focus on diversity.
• Focus on interprofessional education between medicine and other health professions.

Mallett would do the following:

• Create a moratorium on out-of-school suspensions and use restorative approaches to discipline in public schools.
• Foster a curriculum rebirth in HBCUs and, echoing Frederick, create a network of HBCU and diversity-focused medical schools.
• Foster campus partnerships with Greek organizations and service organizations to promote positive attitudes about excellence in learning and educational attainment.
• Create a task force to look at other educational systems and identify lessons from international experience.

Next, Britt asked the panelists what outcome measures should be used to evaluate the efficacy of the strategies implemented. Frederick said health care disparities, Prothrow-Stith offered metrics throughout the educational system, and Reede put forward a metric for systems change. Reede also proposed training researchers to develop new methodologies and metrics beyond standard ways of thinking about measuring advancement and success.

General Discussion

Montgomery Rice discussed the need for partnerships with “unlikely bedfellows.” She gave the example of insurers and suggested they might be good partners because they already collect and maintain a lot of data such as demographic information (including on race and ethnicity and other social factors) and health- and disease-related information, and because they can enroll their members in trials to test the efficacy and efficiency of programs.

Arthur C. Evans, Jr., Ph.D.,⁵ proposed taking a life span developmental perspective to move forward. He described a need to think holistically about challenges and barriers throughout the medical education pipeline in order to best address them. He remarked,

Evans also discussed using this life span perspective to examine the efficacy and efficiency of pipeline programs over time. He closed by suggesting the need to build and work with allies—to engage mentors and leaders who are not African American who can nevertheless support and provide insights into ways to increase the representation of Black men in medicine.

POSTER SESSION: INNOVATIVE APPROACHES TO BLACK MEN IN MEDICINE (STUDENT PERSPECTIVES)

The first day of the workshop closed with a poster session in which medical students offered their perspectives. Ross McMillan and Robert Wardlow, M.D./Ph.D. candidates from the Johns Hopkins School of

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⁵ Evans is chief executive officer of the American Psychological Association.

Medicine, and Gabriel Felix, a 3rd-year medical student at Howard University College of Medicine, presented “The Need for More of Us: Perspectives and Solutions for Increasing Black Men in Medicine by Black Men in Medicine.” Abbas Rattani, M.Be., a 3rd-year medical student at Loyola University Chicago Stritch School of Medicine, presented “Improving Black Male Matriculation in Medicine through Fashion as Art and Activism.” Martin Campbell, a 2nd-year medical student at Morehouse School of Medicine, presented “Black Men in Medicine: A Novel Approach to Mentorship and Policy Reform.”