11

Reflections on the Workshop and Final Thoughts

The final session offered reflections on the workshop and an open audience discussion focused on brainstorming potential strategies to address the crisis of Black men in medicine. To launch the discussion, the moderators invited a representative from each panel—moderator or panelist—to present key points made by individual participants in their panel session. Moderator Vivian Pinn, M.D.,¹ also asked each representative to identify what they perceived to be the most important strategy from their panel to address the absence of Black men in medicine and science. Following these reflections, the moderators opened the floor for a general discussion of ideas and innovative solutions to address the crisis of Black men in medicine worth exploring. Cedric M. Bright, M.D., FACP, and Kendall Campbell, M.D., FAAFP, also moderated the discussion.²

REFLECTIONS ON THE WORKSHOP

Exploring Challenges and Barriers for Black Men Along the Life Trajectory

Wizdom Powell, Ph.D.,³ framed this session as a discussion of “all of the things that happened outside of the educational system” and of the “social and lived experiences that can impact the trajectory.” Powell then presented her notable points from each of the three panelists. She described how Camara Jones, M.D., M.P.H., Ph.D.,⁴ identified racism as a fundamental root cause of the absence of Black men in medicine and science. She stated that addressing the challenges that Black men face will require naming, defining, and discussing levels of racism (institutional, personally mediated, and internalized). In so doing, it then becomes possible to disarm racism at each level. Jones added that it is important to ask “How is racism operating here?”

She also encouraged a change of focus from the individual to the community, to cast aside ahistorical accounts of disadvantage and debunk the myth of meritocracy, and to develop and exercise agency to set up more equitable structures. Targets for interventions Jones identified include

___________________

¹ Pinn is senior scientist emerita at the Fogarty International Center and former director (retired) in the Office of Research on Women’s Health at the National Institutes of Health.

² 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; Campbell is associate dean for diversity and inclusion and director of the Research Group for Underrepresented Minorities in Academic Medicine at East Carolina University Brody School of Medicine.

³ Powell is director of the Health Disparities Institute at University of Connecticut Health.

⁴ Jones is senior fellow at the Satcher Health Leadership Institute at Morehouse School of Medicine.

shorter and more flexible pipelines, more seats for Black medical students, vigorous investment in public education, affordability of medical education, composition of medical school admissions committees, and practices of medical school admission committees.

Reflecting on his experience traversing the medical education pipeline, Roger A. Mitchell, Jr., M.D.,⁵ discussed the need to acknowledge the “heavy backpack” young Black men carry, to act to improve the social determinants of health around some Black men, and to increase access and exposure to science, technology, engineering, and mathematics (STEM) education. In particular, Mitchell highlighted the importance of active mentoring and having a “mirror of relevance” to help young Black men develop a positive self-narrative.

In the third presentation from the panel, Arthur C. Evans, Ph.D.,⁶ discussed substance use and behavioral and mental health issues as challenges to Black men’s educational attainment. Specific opportunities Evans identified to potentially address these challenges include

• Disrupting the school-to-prison pipeline by identifying the youth who are experiencing social, emotional, and behavioral problems and connecting them to appropriate services;
• Making early intervention opportunities like trauma response teams and psychological first aid available at the community level without normalizing traumatic events; and
• Reframing substance use and mental health issues as mental wellness issues.

Evans also suggested celebrating resilience and focusing on strengths to develop a positive racial identity.

In summation, Powell identified the most important strategy to address challenges along the life trajectory to be the “cultivation of more comprehensive wraparound programs for Black men as they matriculate through medical education, but also before there.” She continued, “We have to speak to the wounds that exist within Black men if we are going to really help them progress in the field of medicine.”

___________________

⁵ Mitchell is chief medical examiner for the District of Columbia.

⁶ Evans is chief executive officer of the American Psychological Association.

Examining Challenges and Barriers for Black Men Along the Educational Trajectory

Lynne Holden, M.D.,⁷ identified, in her view, five key points from the session on challenges and barriers for Black men along the medical education pipeline. First, she described the importance of pipeline programs and listed critical elements of these programs, for example, “K through 12 . . . longitudinal, desiloed, innovative, . . . comprehensive, involving parents, . . . mentoring, and broad community partnerships, and also incorporating protective practices for young males.” Second, she discussed opportunities to expand existing programs and to look at “low hanging fruit.” Some of these “low hanging fruit” might include

• Building capacity for guidance counselors and pre-health advisers,
• Finding students who take the Medical College Admission Test and do not apply to medical school,
• Finding students who are not initially accepted into a program and do not reapply,
• Reaching out to community college students,
• Expanding seats within and creating new medical schools at Historically Black Colleges and Universities (HBCUs), and
• Looking at osteopathic and offshore medical schools for lessons on increasing diversity.

Third, Holden identified the need to look at all levels of academia, especially after medical school. Specific areas for further research might include the transition between medical school and residency, especially among medical students who do not match with a residency program, or the effect of minority tax among faculty who are underrepresented minorities.⁸ Fourth, she described the need for more granular data and research to correct misinformation about Black men’s achievement. Fifth, Holden described the importance of leadership to address the crisis of Black men in medicine, describing how top-down efforts to increase diversity, where leadership makes a call to action and integrates equity/representation, diversity, and inclusion into their mission and vision, have been key to successfully increasing representation of underrepresented minorities. Finally, Holden identified rigorous pipeline programs that start early and

___________________

⁷ 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.

⁸ For more information on the minority tax, see Chapters 2 and 4.

groom children over time to be the most important strategy from her session to address the dearth of Black men in medicine.

Discussion on Current Innovative and Exploratory Strategies to Support Entry into Science and Medicine for Black Men

Joan Y. Reede, M.D., M.S., M.P.H., M.B.A.,⁹ discussed what she perceived as several key themes across the panel session on current strategies to support Black men’s entry into science and medicine. First, she pointed to investment in innovative strategies that are financially stable; follow students across a trajectory; are targeted, purposeful, and “aggressive”; and are holistic—or, have financial and leadership support, in addition to pipeline programming. Second, Reede discussed the need to focus on persistence as well as resilience. As James L. Moore III, Ph.D.,¹⁰ described during his presentation, whereas resilience refers to bouncing back from a setback, persistence is a sustained effort. Third, Reede identified the importance of building community and socially supportive environments in which pipeline programs are embedded. Fourth, she discussed the need to address challenges in the public education system, especially the negative consequences of funding schools through local property taxes. Finally, Reede underscored the importance of data and evidence to inform program development and the need to monitor student performance and evaluate programs to ensure that programs are effective. She identified the need for analytics, data, metrics, and developing the evidence base as the most important strategies, in her opinion, from her panel session.

Exploring Accountability in Medicine and What Health Professional Schools Can Do to Address the Crisis

David Acosta, M.D.,¹¹ presented his notable points from the panel session on how health professional education programs can address the crisis of Black men in medicine and how they can hold themselves accountable for increasing diversity. He pointed out that leadership matters and added, “Leaders have to be deliberate and intentional about diversifying their workforce.” He also questioned how schools could leverage existing leadership. He discussed accountability and connections between

___________________

⁹ Reede is dean for diversity and community partnership at Harvard Medical School.

¹⁰ Moore is interim vice provost for diversity and inclusion and chief diversity officer, executive director, Todd A. Bell National Resource Center on the African American Male, and College of Education and Human Ecology distinguished professor of urban education at The Ohio State University.

¹¹ Acosta is chief diversity and inclusion officer at the Association of American Medical Colleges.

actual and expected performance, asking, “How do we take ownership for becoming institutionally effective for our students’ success and how to be held accountable to that?”

As a positive example of internal accountability, he pointed to the University of Illinois College of Medicine program that Dimitri T. Azar, M.D., M.B.A., dean of the college, described to cover loan and interest costs for the year following medical school graduation for students who do not match with a residency while they work to reapply and match.¹² Acosta described this approach as investing in a student’s success. He also identified collaborations with other partners, including the biomedical sciences, engineered technology, and industry, and leveraging accreditation standards and elements as key strategies. As moderator, Pinn commented that what she heard as the most important strategy from this panel session was clearly the importance of leadership. She said, “Leadership from the top makes a difference of what happens underneath.”

Discussion on Financial Barriers to Medical Education

Theodore Corbin, M.D., M.P.P.,¹³ identified the key points, in his mind, from the panel on financial barriers. First, he endorsed increasing awareness and access to existing scholarships and other funding opportunities—including, for example, the National Medical Fellowships Emergency Scholarship Program that finances non-educational costs for students at risk of discontinuing their medical education owing to financial crises.¹⁴

Relatedly, he discussed the need to recognize and understand the financial challenges to preparing and applying for undergraduate education, medical school, and residency, and for required exams in addition to the costs of the education tuition, as well as the need to recognize social and familial challenges of students while in school. As additional key strategies to address financial barriers, Corbin also identified advocacy to support U.S.-born Black men in private and public institutions and exploring partnership opportunities for scholarships, endowments, and philanthropy with local efforts. He highlighted Joseph B. Hill’s¹⁵

___________________

¹² For more information on this University of Illinois College of Medicine program, see Chapter 7.

¹³ Corbin is vice chair for research and associate professor in the Department of Emergency Medicine at the Drexel University College of Medicine.

¹⁴ For more information on the National Medical Fellowships Emergency Scholarship Program, see Chapter 8.

¹⁵ Hill is senior vice president and diversity officer, Enterprise Office of Diversity, Inclusion, and Community Engagement at Thomas Jefferson University and Jefferson Health System.

presentation on the Jackson/Minton Scholarship Fund, a partnership between Thomas Jefferson University and the Sigma Pi Phi fraternity as an example. Corbin also identified what he perceived to be important gaps in the conversation—opportunities around faculty and loan repayment programs. Finally, in Corbin’s view, the most important strategy to address financial barriers is acknowledging and addressing non-education-related costs of pursuing a medical education, or, “recognizing and understanding the costs that are associated with every test through every walk of life.”

Examining Approaches from Philanthropy and What Philanthropies Can Do to Address the Crisis

Bright presented his highlights from the panel on philanthropy. He first commented on what he identified as themes across the panelists. Bright noted that funding programs are in place, but potential grantees need a repository to find funding opportunities and how to apply for them. He added that funding strategies at touch points along the continuum of medical education and not just at the graduate level are important. Bright also commented on the need for funders to understand the financial and social obligations that negatively affect men of color along the medical education trajectory, and proposed that many factors, including barriers to education but also social and behavioral issues, need to be addressed. To that end, programs may need some degree of flexibility to meet the varied needs of students. Finally, Bright remarked that developing strategies for sustainable financing will require thinking outside of the box.

Next, Bright offered two solutions for philanthropy to help address the shortage of Black men in medicine. First, he proposed maintaining an open dialogue between academia and philanthropies to align goals to address junctures in the medical education pipeline where Black boys and men are “leaking out.” Second, he suggested the need for programs designed to help mitigate the financial and social barriers faced by underresourced men of color. As the most important strategy from the panel, Bright identified the “need to have more committed folks that are doing these types of programs to make sure that we have the entities in place to help our students.”

Discussion on Approaches in Government and What Government Can Do to Address the Crisis

Elizabeth Ofili, M.D.,¹⁶ discussed the significant points made by the panel on government. First, she reviewed lessons from National Institutes of Health diversity initiatives, which showed that outcomes may be better than expected, it is important to know what is being measured and to understand the return on investment from these initiatives, the need for more evaluations, and a need for sustained dissemination of lessons learned. She raised the potential opportunity to partner with the National Collegiate Athletic Association (NCAA), as Hannah A. Valantine, M.D., M.R.C.P.,¹⁷ proposed. Ofili also reviewed the effectiveness of the Health Resources and Services Administration health workforce programs at achieving a high number of trainees from historically disadvantaged backgrounds. Ofili discussed the need for long-term tracking and monitoring and to develop linkages between these tracking/monitoring systems and community-based outcomes, such as opportunities for geocoding and predictive analytics. Ofili identified the importance of evaluations and partnerships as key strategies from government. Regarding evaluations, she discussed the need to determine what exactly should be evaluated and to explore whether and how evaluations could or should be standardized. In terms of partnerships, Ofili emphasized the opportunity for broader partnerships beyond the traditional ones.

Discussion

Before moving into the open audience discussion, Pinn asked if there were any issues not discussed during the meeting that should have been. Britt raised the importance of new partners and the need to identify and recruit additional stakeholders to join the discussion. As potential stakeholder voices not well represented at the meeting, Bright offered that medical students join the discussion. Cato T. Laurencin, M.D., Ph.D.,¹⁸ suggested that industry participate.

___________________

¹⁶ Ofili is professor of medicine, director of the Clinical Research Center, and senior associate dean of Clinical and Translational Research at Morehouse School of Medicine.

¹⁷ Valantine is chief officer, Scientific Workforce Diversity, and senior investigator at the National Heart, Lung, and Blood Institute.

¹⁸ Laurencin is university professor, Van Dusen Distinguished Professor of Orthopaedic Surgery, and director, The Raymond and Beverly Sackler Center at the University of Connecticut.

GENERAL DISCUSSION ON INNOVATIVE SOLUTIONS AND FINAL THOUGHTS

Laurencin prompted meeting participants to generate ideas based on workshop presentations and discussion that could potentially stimulate action to address the absence of Black men in science and medicine. Note that individual participants raised the ideas presented in the following section during the discussion; in some cases, the ideas are attributed to individual speakers identified in parentheses. The ideas are not intended to reflect a consensus among workshop participants.

Strengthening the Medical Educational Pipeline

Some strategies to support individual students to navigate the medical educational pipeline include exploring, replicating, or expanding pipeline programs with potential; identifying and recruiting new and more students; and enhancing advising and mentorship for underrepresented minority students in the health professions. Specific examples of pipeline programs with potential that several participants raised include

• Creating “Persistence, Resilience, Emotional Quotient, and Perseverance” Programs for children from kindergarten through 12th grade (K–12) through college (Laurencin)
• Replicating or adapting, and scaling up, successful pipeline programs, such as those at The Ohio State University¹⁹ and Wayne State University²⁰ (Laurencin)
• Increasing awareness about and access to existing programs such as through building up and enhancing a national clearinghouse of pipeline programs²¹ (Valerie Montgomery Rice, M.D.,²² and an unidentified workshop participant)
• Reviving the National Achievement Scholar program (Laurencin)
• Exploring partnerships with NCAA²³ (Laurencin)

Some participants proposed strategies that could help build up the pool of students pursuing careers in the health professions. Examples of these strategies include

___________________

¹⁹ For discussion of programs at The Ohio State University, see Chapter 5.

²⁰ For discussion of the Wayne State University pipeline programs, see Chapter 6.

²¹ For discussion of the National Clearinghouse of Pipeline Programs at Morehouse School of Medicine, see Chapter 6.

²² Montgomery Rice is president and dean of the Morehouse School of Medicine.

²³ For discussion of the possibility of engaging college student athletes and the NCAA, see Chapter 10.

• Using sports as an entry point to attract younger children to and to engage them in medicine and science (Pinn)
• Finding and engaging talented students not already in science and medicine, such as those who excel in music (unidentified workshop participant)
• Identifying strategies to identify and support college students and graduates who do not get accepted to or do not matriculate into medical schools (e.g., funneling into postbaccalaureate programs, encouraging them to reapply) (Corbin)

Several participants also discussed the need for better advising to help students navigate STEM education and careers. Potential ideas include

• Appointing a point person in schools tasked with advising Black male students about careers in science and medicine (Pinn)
• Reaching out to college guidance counselors and pre-medicine counselors to provide better information about pursuing science and medicine careers and to correct misinformation (Pinn)
• Changing attitudes and beliefs about what obstacles to becoming doctors or researchers can and cannot be overcome (Bright)
• Engaging current students—undergraduate pre-health and science majors, medical students, and medical residents—in peer-to-peer counseling and in mentoring for younger students (e.g., K–12) (unidentified pre-health student participant)

Two additional proposed strategies that could be explored to strengthen the medical education pipeline were engaging with diversity offices (Campbell) and supporting HBCUs (unidentified workshop participant).

Engaging Organizations in Implementing Change

Some participants also raised the idea of the potential of interventions at the level of schools and organizations. These include getting academic leadership to acknowledge the absence of Black men in science and medicine as a problem and to make commitments to address the problem, harnessing technology to overcome financial barriers, and engaging with new and additional partners. In terms of gaining commitments from academic leadership, Laurencin, Montgomery Rice, and Pinn endorsed reaching out to the Association of American Medical Colleges and its Council of Deans and asking them to acknowledge the lack of Black men in medicine as a problem and making a commitment to work to change it, such as through a letter of commitment. A participant also proposed reaching out to the

American Association of Colleges of Osteopathic Medicine for a similar letter from osteopathic medical schools. With respect to technologies that colleges and universities can employ to address financial barriers associated with medical education, Pinn proposed using virtual interviews to reduce travel-associated costs, and Bright raised the potential of online resources such as the Khan Academy to prepare students for coursework and standardized tests. Many participants endorsed engaging new and additional partners, including stakeholders not represented at the meeting. Some potential partners discussed include

• Government at the national, state, and local levels, especially departments of education;
• Industry from a range of sectors, such as the biomedical sciences, pharmaceuticals, medical devices, and technology;
• Health systems and medical centers, including academic health centers through the Association of Academic Health Centers; and
• Higher education organizations like the College Board and the Association of Governing Boards of Colleges and Universities.

Engaging Communities in Implementing Change

Several participants mentioned the need for strategies to increase awareness about the absence of Black men in medicine as a problem in the community. Pinn raised the idea of developing a media and marketing strategy and increasing media outreach to reach potential students, and a participant suggested developing a marketing campaign to engage leaders (especially athletes) to speak actively about the need for Black men in medicine and the importance of this issue. Montgomery Rice also proposed identifying and recruiting technology and media partners to help develop and disseminate a communications strategy. Building on Montgomery Rice’s suggestion, Azar put forward engaging Google in marketing.

Two participants raised the need to change attitudes of and expectations for the kinds of students health professional schools are looking to capture and redefining metrics of success. An unidentified participant said,

Bright also stated,