Transforming Healthcare through Educational Diversity: Academic Health Center Pipeline Project

Purpose: The purpose of this IRB approved research was to assess and develop a plan for an educational pipeline in which underrepresented (economically disadvantaged, ethnically and racially diverse, first generation college student) high school students will be recruited into a major urban, U.S. research University’s Colleges of Allied Health Sciences, Medicine, Nursing, and Pharmacy. Minorities are grossly underrepresented in the U.S. healthcare workforce, accounting for only 16.8% of nursing’s workforce (5.4% African American, 3.6% Hispanic, 5.8% Asian/Native American, 0.3% American Indian/Alaskan Native, 1.7% Multi-Racial) and empirical evidence supports a lack of diversity in the healthcare workforce negatively affects patient outcomes (AAMC 2006, AACN 2013, HRSA 2006). It is projected that minorities will account for over half the U.S. population by 2043. With an increase in minority patients, there is an escalation in the need for a culturally diverse workforce that has the propensity to provide high quality, culturally competent care (U.S. Census Bureau, n.d., AACN, 2013). Solutions to achieving workforce diversity are multifaceted and depend on fundamental reforms in precollege systems (Cohen, 2002). Hence, development of a databased pipeline program is critical to increasing the number of underrepresented students and subsequent healthcare providers.

Thirty-five articles published from 2000-2012 were found using the search terms “educational pipeline healthcare providers” and “evaluating educational pipelines”. Although all described pipeline programming to increase diversity, there were few that evaluated their programs or had research based outcome measures.

Methods: We reached out to and interviewed personnel at four universities identified as having best-practice pipeline models by the Urban Serving Universities. Information was gathered about specific components of their educational pipeline, demographics and criteria for selecting participants, initial funding and sustainability, program objectives, strategies for implementation including barriers, evaluation and outcome measures, and their successes and failures.

The second step to develop the educational pipeline program was to reach out to connect and involve the local community to receive their input and feedback on developing the educational pipeline plan. Twenty community town hall meetings were held with educational community groups, neighborhood groups, professional community groups, and student community groups in our local urban area. Local high schools and neighborhoods were selected based on having a high proportion of underrepresented students. There were twenty-two participants in educational town hall meetings; forty-eight participants in neighborhood town hall meetings; fourteen participants in professional community town hall meetings, and thirty-three participants in student town hall meetings.

Audio recordings from all best practice interviews and town hall meetings were transcribed and verified to ensure the quality of the data. All researchers independently reviewed all transcripts and identified themes and categories. The process of theme and category identification continued until there was 100% agreement.

Results: Three themes were identified that will unleash affinity for and achievement in healthcare professions: augmenting student capability, enhancing parental competence and enlisting potential collaborators. Within these themes are the following categories:

Augmenting Student Capability:

• Academic support (skill building, tutoring, and math and science enrichment and development)
• Building confidence (skill building, communicating academic expectations, helping support “can do this” attitude)
• Opening up the possibilities (early exposure, exposure over time, removing biases and stereotypes, exposure to various healthcare careers)
• Dealing with individuals (not blanketing issues, dealing with health issues, start with the basics)

Enhancing Parental Competence:

• Parental support (helping parents through the process, educating them about possibilities, making value of education understood, understanding college expectations)
• Process (communication, intentional about the outcomes, written information about career paths)
• Trust (addressing issues of health equity, lack of trust in healthcare providers, community perception, and awareness of options available)
• Finances (parents and students need to understand their financial situation, scholarship opportunities, how to apply for financial aid, how to apply for bridge programs)

Enlisting Potential Collaborators:

• Community enrichment (partnering with our community stakeholder groups to support success of the student)
• Mentoring (success by association, description of a concrete pathway to becoming a health provider)
• Opening up the possibilities (early exposure, exposure over time, removing biases and stereotypes, exposure to various healthcare careers)
• Systems of support (bridge between high school and colleges; clubs; mentoring; tutoring; providing school advisors, counselors, teachers and parents accurate information about career options; and college requirements/expectations)

Conclusion: Based on the findings, we recommended immediate implementation of pipeline components that do not require funding or require minimal funding, and to start small by partnering with one primary school and one high school. Future work will be needed to assess and develop a plan for a pipeline that focuses on retention and graduation.