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Health Professions Faculty for the Future: Proceedings of a Workshop (2021)

Chapter: 3 Building Pathways and Broadening Recruitment (Steps 1 and 2)

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Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
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Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
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Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
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Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
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Page 20
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 21
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 22
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 23
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 24
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 25
Suggested Citation:"3 Building Pathways and Broadening Recruitment (Steps 1 and 2)." National Academies of Sciences, Engineering, and Medicine. 2021. Health Professions Faculty for the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26041.
×
Page 26

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

3 Building Pathways and Broadening Recruitment (Steps 1 and 2) HIGHLIGHTS • Building diverse faculty members begins long before health profes- sions school. (Sánchez) • Formal pre-faculty development can help recruit, retain, and sup- port diverse practitioners and faculty. (Sánchez) • There are multiple factors that facilitate or inhibit a person’s d ­ ecision to pursue a faculty career, including visibility and repre- sentation of diverse faculty. (Sánchez) • It is a professional obligation for faculty to pull others “up the ladder.” (Chappell) Kathy Chappell introduced the moderator and speaker of the next ses- sion, Norma Poll-Hunter, senior director at the Association of American Medical Colleges, and John Paul Sánchez, director of the learning environ- ment fellowship from the University of New Mexico, whose personal and professional experiences guided the participants through steps 1 and 2 of the framework. To begin, said Chappell, the title selected for these steps looks to build an early “pipeline” into health professions education, but it was brought to the attention of the planning committee while preparing for the workshop that a pipeline can be seen as a straight line into the health professions. This may not be indicative of how many from underserved communities find their way into the health professions, which may more resemble a series of “on” and “off-ramps” in career development. This speaks to the fluidity of the framework where building pathways (versus a 17 PREPUBLICATION COPY—Uncorrected Proofs

18 HEALTH PROFESSIONS FACULTY FOR THE FUTURE pipeline) into education and broadening recruitment—particularly with a lens of diversity, equity, and inclusion—will be incorporated. PRE-FACULTY DEVELOPMENT: A CRITICAL FACTOR IN DIVERSIFYING HEALTH PROFESSIONS FACULTY John Paul Sánchez, Health Sciences Center, University of New Mexico Pre-faculty development is a critical factor in diversifying health profes- sions faculty, said Sánchez, who is also president and founder of Building the Next Generation of Academic Physicians (BNGAP). Building a diverse and inclusive next generation of faculty requires starting early by broaden- ing recruitment and building a pathway to health professions education. There are a number of significant challenges in diversifying health profes- sions faculty, said Sánchez; however, there are also numerous opportunities to engage with students and prepare them to become the faculty of the future. Sánchez began by reflecting on his own journey to becoming a faculty member. Sánchez is of Puerto Rican ancestry and grew up in the Bronx, New York. During college, Sánchez participated in formal programs that strength- ened his academic skills and awareness of professional opportunities, gave him reassurance that he would be valued in becoming a prac­itioner, and t helped him develop a professional portfolio. As a person of color, said S ­ ánchez, these formal programs helped him in attaining his master in public health and his medical degree. Sánchez asked the other workshop partici- pants to reflect on their own journeys and to share in the chat box responses to “When did you first gain formal guidance on becoming an educator or faculty member?” A selection of responses is shown in Box 3-1. Sánchez noted that many of his colleagues and mentors had little formal guidance on the way to becoming faculty members, and that they tend to report the rise to faculty as “serendipitous,” “happenstance,” or “incidental.” When considering why health professional education has not achieved greater diversity within the faculty workforce, said Sánchez, it is important to reflect on the lack of diversity even within the practitioner workforce. A significant factor in building a diverse faculty is for diverse individuals to first be practitioners, he said. As seen in Tables 3-1 and 3-2, African Ameri- cans, Hispanics, and American Indians together make up about 30 percent of the U.S. population; however, the proportion of graduate students, practitioners, and faculty from these groups is significantly lower than 30 percent. Within specific health professions, the disparity is even greater; for example, Hispanics make up around 16 percent of the U.S. workforce, but only 3.7 percent of pharmacists and chiropractors are Hispanic (HRSA, 2017). PREPUBLICATION COPY—Uncorrected Proofs

BUILDING PATHWAYS AND BROADENING RECRUITMENT 19 BOX 3-1 Key Points Made by Individual Participants Sánchez asked participants to reflect upon the opportunities that helped them become educators and/or faculty members. Here are some responses: • I received a master’s in nursing education. (Regina Beard) • In my doctoral program, and it was choice, not required. (Shelley Cohen Konrad) • As a student tutor at the Medical University of South Carolina, the director at the Center for Academic Excellence developed us as “supplemental instructors” versus tutors. Training blended with lots of encourage­ ent, m safe practice, and feedback. (Reamer Bushardt) • I never had formal guidance. My mother was a part-time and full-time faculty member at Emory University. (Christine Wright) • It wasn’t until I asked someone about it that someone gave me some direction. I was already a practicing clinician. (Lori Bordenave) • During PA school, advisors encouraged me to consider education due to my thesis and participation in interprofessional activities (Shani Fleming) • When I was an undergraduate, one of my professors, an Ed.D., encour- aged me to teach with him, and I was hooked! (Lawrence Sherman) • A faculty member took an interest in me and my career. (Valarie Fleming) • All of my guidance was informal. I came into the field of PA education as a medical technologist and crafted my own journey with informal responses from established faculty! (Janie McDaniel) • I did not receive formal guidance when considering transition from clini- cal work to academia. Honestly, was ill prepared for the experience … since then have unofficial mentors I use … one of whom is on this w ­ ebinar. (Lydia Navarro-Walker) • My “formal training” was only mentorship from the only other faculty member at our very small program. It continues to this day; more of a give-and-take now that I feel like I have something to offer. (Kevin) SOURCE: Adapted from the presentation by Sánchez, August 11, 2020. Sánchez said there are two significant disparities that need attention: one, representation within practitioner ranks, and two, representation within faculty ranks. Faculty are critical in many ways, said Sánchez, because they serve as role models and mentors to students and new pro- fessionals, they are champions for programs and policies, and they sit on admissions and other important committees. Sánchez asked “What factors influence an individual’s trajectory to a faculty career, particularly diverse individuals?” Poll-Hunter, who works within AAMC’s Diversity Policy and Programs unit, quickly scanned the responses for the most common themes, which included mentorship, sponsors, seeing diverse faculty as role PREPUBLICATION COPY—Uncorrected Proofs

20 HEALTH PROFESSIONS FACULTY FOR THE FUTURE TABLE 3-1  U.S. Health Occupations by Race/Ethnicity, 2011–2015 Hispanic White U.S. Workforcea (#) 25,776,728 102,850,895 U.S. Workforcea (%) 16.1 64.4 Health Occupationsb (%) Community and Social Services Occupations Counselors 10.7 64.6 Social Workers 12.0 60.6 Life, Physical, and Social Sciences Occupations Psychologists 6.3 83.5 Health Diagnosing and Treating Practitioners Occupations Advanced Practice Registered Nursesc 4.5 84.0 Chiropractors 3.7 86.7 Dentists 6.1 74.8 Dietitians and Nutritionists 8.5 68.7 Optometrists 3.9 78.4 Pharmacists 3.7 70.4 Physicians 6.3 67.0 Physician Assistants 10.0 72.7 Occupational Therapists 4.0 83.8 Physical Therapists 4.8 77.8 a Population 16 years and older who are employed or seeking employment. b Self-reported occupations. c Includes nurse anesthetists, midwives, and nurse practitioners. NOTES: Occupations are titled and grouped as in the U.S. government’s Standard Occupation Classification system. NR = data not reported because relative standard errors (RSE) > 30; estimate does not meet standards of reliability or data not present. Numbers in parenthesis represent estimates with relative standard errors (RSE) > 20 percent and should be interpreted with caution. Not all totals equal to 100 percent due to rounding. SOURCES: Presented by Sánchez, August 11, 2020; HRSA Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2011–2015) 2017 Report. PREPUBLICATION COPY—Uncorrected Proofs

BUILDING PATHWAYS AND BROADENING RECRUITMENT 21 Non-Hispanic Native American Hawaiian and Indian/Alaska Other Pacific Multiple/Other Black Asian Native Islander Race 18,597,223 8,534,837 902,977 251,578 2,910,645 11.6 5.3 0.6 0.2 1.8 18.8 2.8 0.8 0.1 2.2 21.5 3.0 0.8 0.1 2.0 4.9 3.4 0.2 (0.0) 1.6 5.7 4.1 0.2 NR 1.3 1.9 5.4 0.5 NR 1.8 3.0 14.3 (0.1) NR 1.7 15.0 6.0 0.3 (0.1) 1.4 1.8 13.7 NR NR 1.8 5.9 17.9 0.2 0.1 1.8 4.8 19.6 0.1 0.0 2.1 7.1 7.3 0.6 NR 2.2 4.4 6.6 0.2 NR 1.1 4.4 11.1 0.2 (0.1) 1.6 TABLE 3-2  Approximate Hispanic, African American/Black, and American Indian/Alaska Native Population and U.S. Workforce Demographics by Discipline, 2015 Population % Graduate Students % Clinicians % Faculty % Physician Assistant 30 10 11 10 Medicine 30 15 10 7 Dentist 30 12 7 15 NOTE: American Indian or Alaska Native plus Native Hawaiian and Other Pacific Islanders for data of census, graduates, and faculty. SOURCES: Presented by Sánchez, August 11, 2020; AAMC, 2020; NCCPA, 2019; U.S. C ­ ensus Bureau, 2020. PREPUBLICATION COPY—Uncorrected Proofs

22 HEALTH PROFESSIONS FACULTY FOR THE FUTURE models, academic advisors, and leadership (see Box 3-2). These responses highlighted the importance of the role of others in either identifying or inspiring individuals to pursue faculty careers. Given the responses of the workshop participants, Sánchez noted that “the problem is definitely multifactorial.” He shared two frameworks to help elucidate the various factors that contribute to recruitment, retention, and success of faculty. The first was an adaptation of a framework on social determinants of health (see Figures 3-1a and 3-1b), which Sánchez called “determinants of health in academia.” The second framework was a modified model of social cognitive career theory, and it includes factors that influence a person’s career decision making (see Figure 3-2). Sánchez shared anonymous quotes from three potential faculty members that illumi- nate some of the factors that may prevent diverse students from considering faculty careers: • Self-doubt about being good enough: “I don’t know that my grades are as stellar as they should be because I picture an academic teacher BOX 3-2 Key Points Made by Individual Participants Sánchez asked workshop participants to reflect on what factors they believe influence an individual’s trajectory to a faculty career. These are some results: • Mentors with whom I identify. (Miguel Paniagua) • Seeing someone from your diverse group as a faculty. (Christine Wright) • Role models, financial aid for education, lower barriers for entry. (Peter Cahn) • Personal connection, alignment with personal mission, mentorship. (Shani Fleming) • Encouragement from senior faculty; good teaching in the classroom as role models. (Janelle O’Connell) • Encouragement and role models. (Virginia Valentin) • Visibility, representation. (Emelia) • Factors include good role models, identifying potential learners who show promise as a future educator. (Melanie Bowzer) • Leadership, leadership, leadership. (Holly Humphrey) • Early exposure to mentors! Exposure to career fields within health care is another major influence. (Alice Vestergaard) • Seeing and knowing people that look like me involved in the positions. (Lemmietta McNeilly) SOURCE: Adapted from the presentation by Sánchez, August 11, 2020. PREPUBLICATION COPY—Uncorrected Proofs

BUILDING PATHWAYS AND BROADENING RECRUITMENT 23 FIGURE 3-1a  Original determinants of health framework. SOURCES: Presented by Sánchez, August 11, 2020; adapted from Satcher and ­Higginbotham, 2008. FIGURE 3-1b  Adapted determinants of health and determinants of success in the academia framework. SOURCES: Presented by Sánchez, August 11, 2020; adapted from Satcher and Higginbotham, 2008. PREPUBLICATION COPY—Uncorrected Proofs

24 HEALTH PROFESSIONS FACULTY FOR THE FUTURE FIGURE 3-2  Modified model of social cognitive career theory. SOURCES: Presented by Sánchez, August 11, 2020; adapted from Lent et al., 1994. as somebody with excellent grades and I’m just kind of a floater. I’m not really someone who stands out academically. I mean, obviously we all stand out as medical students, but among those I’m pretty average. I would love to do it, but I don’t think I have the research or the academic excellence” (Sanchez et al., 2013). • Parents’ view of clinical versus faculty careers: “I think a lot of people in our parents’ generation, especially among Asian immi- grants, see clinical practice as the ‘iron rice bowl.’ Basically, once you get the training, you can keep on eating out of it with a steady income and steady job” (Zhang et al., 2017). • Difficulty finding LGBT mentors: “I haven’t had any mentors, and I feel like because I lack that, I kind of want to provide support later on. There are no mentors who do research or teaching in LGBT health or who are out or who are supporting or very supportive of people who might be out in academic medicine” (Sanchez et al., 2015). Sánchez then stated: If we’re serious about diversifying our faculty workforce, if we’re serious ­ about creating equitable processes in the recruitment, retention, and pro- motion of our faculty, and if we’re serious about creating a sense of b ­ elonging, attention must be paid to pre-faculty development. Sánchez defined pre-faculty development as providing potential fac- ulty with “foundational self-efficacy, knowledge, skills, and experiences to be successfully appointed, and eventually promoted and tenured, within an academic institution” (Sánchez and Williams, 2019). Sánchez asked PREPUBLICATION COPY—Uncorrected Proofs

BUILDING PATHWAYS AND BROADENING RECRUITMENT 25 workshop participants to reflect on what types of formal pre-faculty devel­ opment programs were a part of their journey. Poll-Hunter scanned the responses in the chat box and noted that the common theme among them was there are “not a lot of resources for pre-faculty development.” Sánchez agreed with this assessment, and said that he never had formal pre-faculty development, despite having served in various faculty positions and as a dean. As a consequence, it is extremely gratifying for Sánchez to help his trainees and to give them a better experience than he had. Sánchez told participants about his organization—Building the Next Generation of Academic Physicians (BNGAP, 2020)—that is aimed at sup- porting pre-faculty development. The mission of BNGAP is to “help diverse trainees become aware of, interested in, and prepared to explore academic careers.” The group started by engaging with diverse trainees to understand the perceived challenges and facilitators to becoming future faculty, said Sánchez. The information that was gathered served to develop educational interventions to support a diverse pre-faculty workforce and to help build a pre-faculty identity for trainees. At each step of the way, the organization assesses outcomes and effects. BNGAP originally focused on medicine, but it has been adapted for dentistry, nursing, pharmacy, and public health. Three concepts have emerged through the work of BNGAP, Sánchez said. First, it is critical to build community through conferences, chapters, newsletters, and by identifying role models and mentors who can connect with pre-faculty to keep them on track. One community-building entity, said Sánchez, is the BNGAP National Center for Pre-Faculty Development, which is a resource for networking and sharing best practices. Second, BNGAP seeks to address and dispel misconceptions about being a diverse faculty member. One example is the “minority tax” (extra responsibilities placed on minority faculty in the name of diversity)1; BNGAP encourages trainees to transform this “tax” into “capital” by seeking writing fellow- ships or publishing opportunities. Finally, BNGAP helps trainees build career knowledge and skills through curricula that have been developed. There are curricula aimed at a variety of audiences ranging from college students to graduate students to those finding their first faculty position. Sánchez added that it is not only critical to encourage trainees to become faculty, but also to become deans and chairs of departments. In closing, Sánchez encouraged workshop participants to take three steps after the workshop. First, keep talking about pre-faculty development, with colleagues, leaders, and trainees. Second, he encouraged collaboration to build formal, interprofessional pathway programs for a diverse pre- faculty. Third, he asked participants to “turn to a diverse trainee” and tell 1  See https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0290-9 (accessed D ­ ecember 9, 2020). PREPUBLICATION COPY—Uncorrected Proofs

26 HEALTH PROFESSIONS FACULTY FOR THE FUTURE them, “I want you to be a future faculty member. I am here to answer any questions that you may have, and I’m going to tell you how great it is to be a faculty member.” Sánchez encouraged participants to reach out to trainees to make them aware of potential faculty careers, to cultivate their interest in education, and to recognize the work they already do as educators. This type of conversation, said Sánchez, was fundamental for his journey, and it “does not require funding or protected time, and it is something really easy that we can all do.” Chappell agreed with Sánchez, and added that at a certain point in a professional’s career, it is a “professional obligation to reach back and pull somebody up the ladder.” REFERENCES AAMC (Association of American Medical Colleges). 2020. Medical education facts: Applicants, matriculants, enrollment, graduates, MD-PhD, and residency applicants data. https://www. aamc.org/data-reports/students-residents/report/facts (accessed December 15, 2020). BNGAP (Building the Next Generation of Academic Physicians). 2020. About BNGAP. http:// bngap.org/about-us (accessed December 15, 2020). HRSA (Health Resources and Services Administration). 2017. HRSA Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2011–2015) 2017 Report. https://bhw.hrsa.gov/ sites/default/files/bureau-health-workforce/data-research/diversity-us-health-occupations. pdf (accessed December 15, 2020). Lent, R. W., S. D. Brown, and G. Hackett. 1994. Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior 45(1):79–122.  NCCPA (National Commission on Certification of Physician Assistants). 2020. Reports. https://www.nccpa.net/news-press.aspx?id=63&page=1&category=2&newsPressYear= 2020 (accessed December 15, 2020). Satcher, D., and E. J. Higginbotham. 2008. The public health approach to eliminating dispari- ties in health. American Journal of Public Health 98(9 Suppl):S8–S11. Sánchez, J. P., and V. N. Williams. 2020. Introduction. In Succeeding in academic medicine: A roadmap for diverse medical students and residents, edited by J. P. Sánchez. Cham, Switzerland: Springer Nature. P. viii. https://doi.org/10.1007/978-3-030-33267-9. Sánchez, J. P., L. Peters, E. Lee-Rey, H. Strelnick, G. Garrison, K. Zhang, D. Spencer, G. Ortega, B. Yehia, A. Berlin, and L. Castillo-Page. 2013. Racial and ethnic minority medical stu- dents’ perceptions of academic medicine careers. Academic Medicine 88(9):1299–1307. Sánchez, N., S. Rankin, E. Callahan, H. Ng, L. Holaday, K. McIntosh, N. Poll-Hunter, and J. P. Sánchez. 2015. LGBT health professionals perspectives on academic careers—­ Facilitators and challenges. LGBT Health July. https://pdfs.semanticscholar.org/5aa5/ b29ff7a4c387ffd782147f302c55bc8d373a.pdf (accessed December 15, 2020). U.S. Census Bureau. 2020. Explore data. https://www.census.gov/data.html (accessed Decem- ber 15, 2020). Zhang, L., Lee, E. S., Kenworthy, C. A., Chiang, S., Holaday, L., Spencer, D. J., Poll-Hunter, N. I., & Sánchez, J. P. 2017. Asian medical students’ perceptions of careers in medicine. Journal of Career Development 46(3):235–250. https://doi.org/10.1177/0894845317740225 (ac- cessed December 27, 2020). PREPUBLICATION COPY—Uncorrected Proofs

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To explore various aspects of faculty development, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop in August 2020 titled Health Professions Faculty for the Future. At the workshop, presenters provided examples of how educators are using effective teaching strategies and of practices in health professional education. This publication summarizes the presentation and discussion of the workshop.

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