INSIGHT Into Diversity recently spoke with the chief diversity officers of the country’s leading medical, dental, and veterinary higher education organizations about their roles in diversifying these health professions, as well as supporting member institutions as they seek to build inclusive programs and reach diverse students.
Kim D’Abreu is the senior vice president for access, diversity, and inclusion for the American Dental Education Association (ADEA). In this role, she designs and implements programming to ensure the cultural competence of dental students and faculty. D’Abreu previously served as associate director in the ADEA Center for Educational Policy and Research, where she led education policy development and implementation.
Lisa Greenhill, EdD, serves as the associate executive director for institutional research and diversity at the Association of American Veterinary Medical Colleges (AAVMC). In addition to directing internal research on academic veterinary medicine, Greenhill manages the organization’s DiVersity Matters (DVM) initiative, which promotes diversity and inclusion in the veterinary profession and in curricula.
Marc Nivet, EdD, is the chief diversity officer for the Association of American Medical Colleges (AAMC), where he leads the organization’s Diversity Policy and Programs department. Nivet provides leadership on community engagement, diversity, and health equity issues to member institutions in the U.S. and Canada.
Has the number of underrepresented minorities in your respective field changed in recent years, and if so, how has this change affected the tactics your organization and its member institutions employ in recruiting and retaining these students?
Greenhill: Since 2005, when we launched our DVM initiative, we have seen the number of students of color in our U.S. [veterinary] schools more than double. In 2005, we had 951 students of color out of about 11,000 students, and now we’re just under 2,000. But there’s not an even distribution. Tuskegee is our only historically black university with a veterinary school, and frankly, a large percentage of our students of color remain [there], which means that many of our institutions have one or two minority students in each class, [if] at all. There’s still a lot of work to be done.
Historically, the profession has always had a wealth of applicants, and there wasn’t a lot of emphasis on diversity; schools always had more than enough applicants to fill the classes. Now, I think colleges realize they need to be a lot more strategic, whether they have a numerically deep pool of applicants or not. Schools have summer programs, and they’re doing things for very young kids — middle [and]high school kids — that they never did before.
In terms of improvements, not everyone is doing those things, so there’s still a lot of need in various areas of the country to do more recruiting. Funding for recruiting is limited, and the ability to do on-site programming is also sometimes limited because of [that]. But we’re really looking at ways of doing things differently and using technology differently, and then hoping that in the coming years we’ll see the fruits of those labors.
Nivet: We’ve been working on diversifying medical schools across the country for well over 50 years, and we’ve seen some improvement. Certainly we’re not near the level of success that I think we would’ve hoped for by now, but the challenge primarily has to do with the pipeline to medical schools and getting more minority students into high-performing K-12 school systems — and creating more science enrichment, medical field exposure activities, and mentorship opportunities for junior high and high school minority and low-income students.
Many of the medical schools in the country have those kinds of programs, but much more is needed to go further back in the pipeline to really reach these target populations. Partnerships with member institutions have been critical to [increasing] applications from diverse candidates; showing up at recruitment fairs run by organizations that are interested in recruiting diverse students to medical schools is critically important.
D’Abreu: We’ve seen a modest uptick in both applications and the enrollment of first-year, pre-doctoral dental students entering the four-year DDS program. When you look at the subgroups, the increase can really be accounted for by an [uptick] in Latino students. We have seen over the last 10 years — and certainly within the last five years — a statistically significant increase in Latino students in particular. We haven’t actually done the analysis to look at that subgroup, but we can hypothesize perhaps that Latino students are increasing in the population, so maybe the increase [in dental programs] can be attributed to that.
Generally speaking, the approaches that have been yielding some good results are, first, having our dental schools engage in a holistic review in their admissions processes. Dentistry was part of an interprofessional study on admissions practices across health professions. In that study, 93 percent of our dental schools reported they were using some or many of the elements of holistic review in their admissions processes and that these were helpful in identifying and enrolling a more diverse student body. The second thing that has been successful is really investing in the pipeline into the profession. When I think about the most successful schools, they have pipeline programs that start in middle and elementary school and work their way up to professional programs.
Where I think we need work is in growing the diversity of faculty and addressing issues of climate. I think figuring out ways for diverse students to have mentoring and some research exposure while in dental school [is also] important. With the climate issue, at the graduate level, students are a lot more focused on what they need to do to get through, finish their work, and graduate on time. My guess is that graduate students would be less likely to push against climate issues that are really challenging, such as microaggressions, bias, and a hostile work environment. I think there would be graduate student support across the health professions campus for improving climate, but I don’t think you’re going to have the kind of scale and — for lack of a better word — notoriety as some of the undergraduate programs because of graduate students’ roles.
In February, 65 medical and dental students at Harvard — calling themselves the Racial Justice Coalition — staged a walk-out to protest the lack of diversity at the university. They also highlighted the goals of the national WhiteCoats4BlackLives organization, which include ending racism as a matter of public health. In what ways can your member schools provide students an education grounded in social justice?
Greenhill: Veterinary medicine has been engaged in social justice issues, but because of the nature of our work, it looks a bit different. For many, it’s difficult to understand the relationship between social justice and veterinary medicine, but it is there. We know that the human-animal bond is important; for many people, their companion animal is a member of their family, providing support, companionship, and a pathway to better outcomes. Within those relationships, we know that access to veterinary care remains an issue here and around the world, and for some, the cost of care is prohibitive. For others, particularly [those who are] low-income or from communities of color, we see an inability to simply live with their animals. If they’re not homeowners, apartment living with a dog or cat can be very limited, and therefore, better health outcomes are limited. Much like there are maldistributions for human medicine and dentistry, there are also maldistributions of veterinary clinics.
Our member institutions are increasingly involved in programming; for example, [there are] shelter medicine programs that provide low-cost spay and neuter procedures and access to basic preventive care. Then there are some really great programs like at the University of Wisconsin-Madison. [It has] a program called WisCARES [Wisconsin Companion Animal Resources, Education, and Social Services], which is a collaboration between its College of Veterinary Medicine and the School of Social Work, and they focus on meeting very specific needs of the homeless population in the surrounding area by making sure that social workers provide assistance to pet owners, while veterinarians provide basic pet care for their animals.
Our students are also involved in programs like WhiteCoats4BlackLives, and some of our student organizations have really led the charge in … finding ways of providing co-curricular coursework for students who have a specific interest in social justice.
Nivet: The first thing schools need to do is ensure that they have inclusive environments for all their medical students and that their curriculum is based on the eradication of biases and racism. Both the curriculum and the environment are critically important for producing the next generation of leaders who are leading the kinds of activities that are essential for … understanding the issues fully. Medical schools should try to work with students to make the necessary changes, whether it’s through the curriculum or through an inclusive environment for all students, … to be supportive of their students as they advocate for positive change.
D’Abreu: In 2013, ADEA’s accreditation standards changed to include more robust language pertaining to students’ participation in community-based education programs and to include cultural competence in the curriculum to prepare students to practice in underserved areas. So, how can we make sure that education is grounded in equity, social justice, and fairness? We promote [social justice] by encouraging our faculty to submit educational sessions at our annual meeting focused on health equity and social justice in the curriculum, and we have a repository for curriculum material that we ask people to submit to called MedEd PORTAL.
I think, many times, a health professions campus can be the front porch to the community. For example, one of our schools received calls from the principals of local elementary schools who said the number-one reason for kids being absent was toothaches from cavities, and how could the dental school become a partner in making sure that the kids in the community had care? Figuring out ways for dental schools to partner and have greater engagement with their communities is one of the things we’re trying to support at the national level.
How do your organizations work to strengthen the pipeline of underrepresented minority students from a young age?
Greenhill: Our applicants report that they express an initial interest in the profession before the age of 10. This is one of the reasons historically why the profession hasn’t had to do a lot of recruiting. You ask little children in kindergarten what they’re going to be, they’re going to say a fireman or a veterinarian. But our challenge now is to make sure they sustain that interest and stay in the pipeline.
I believe there’s a population of students of color, or from otherwise marginalized communities, who also [say] they want to be veterinarians at a very young age but for any number of reasons — lack of role models, lack of access to shadowing individuals, all kinds of things — get deterred or distracted from staying in that pipeline. So recruiting students and families is the way to curb that.
The work I’ve done with our members is getting them to understand that in many of the communities they’re interested in targeting, winning the students is only 10 percent of the battle; it really is about convincing their support systems that this is a good choice for them and that they’ll be taken care of and supported in a meaningful way.
Nivet: We primarily do our work through the support of our members’ interventions locally and in the community. A couple of our member schools [are focused on] … leveraging, building, and allowing workshops internally for students in the K-12 educational system, like providing materials on what it means to be a medical student, the journey, the pathway to becoming a medical student. Our work is really about exposure and creating excitement about medical careers among underprivileged youth.
D’Abreu: We know that the pipeline starts to leak even in those gateway courses — general chemistry and biology — in college. To the extent that you can back that up with good preparation in high school so that when they hit the college-level courses, they’re ready, that’s helpful. Academic preparation to bolster the numbers earlier pays dividends.
[Another factor] is exposure to what the career looks and feels like, which is much more the case for dentistry in some ways — and probably for veterinary medicine, too — than medicine. Dentistry doesn’t have a sexy TV show with a diverse cast to sell the profession. What you need are students with some exposure; you need students with a good relationship with their dentist. You need more dentists of color in the community, who are talking a good story about dentistry as a profession. A very strong proportion of students in dental school had a very positive experience either shadowing a dentist or with their family dentist — and that started young. Particularly for dentistry, the visible role model piece [is] really important.
As the chief diversity officer of your respective organizations, what role do you play in ensuring that member colleges and schools are advancing the cause of diversity and inclusion and preparing future doctors, dentists, and veterinarians to care for a diverse population?
Greenhill: I see my role as both the champion and the cheerleader. I provide opportunities for my members to convene national discussions, to collaborate across institutions on programming, and I really try to put the right people together at institutions. But I also provide independent programming for our members where maybe they don’t have the capacity to provide for themselves or where I see national gaps in programming that may be better filled by my office.
Last fall, I launched a program called “Diversity and Inclusion On Air”; it’s a podcast that we do through Google Hangouts that features individuals from the profession talking about all kinds of different diversity issues that our students and faculty need to know about, as well as practitioners out in the field who may not have been on campus in 20 years. We’ve covered everything from how they deal with cultural competence in Australia to sexual orientation and gender identity in the job search, and what kinds of things our students who identify as LGBTQ or beyond should be mindful of or know about as they prepare to graduate and look for a job. That’s not content that the colleges can provide all the time, or you may see it at one institution, but it’s not available at all 30. My office takes on the responsibility of identifying that gap and trying to fill it nationally.
Nivet: The responsibility and the opportunity I’m afforded is to work closely on issues with the deans of our medical schools to really understand the effectiveness of their interventions. We provide lots of tools and resources to help their diversity efforts on the ground be more effective, whether that’s providing education and planning around diversity and inclusion, workshops on the holistic approach to admissions, or research to show them the effectiveness that a diverse physician workforce and a diverse faculty afford. Our work is to build a capacity member organization, leverage diversity and inclusion, and help our members be effective at driving diversity and inclusion through development and engagement to move the field forward.
D’Abreu: A big part of my work is providing professional development for our dental school faculty. For example, we offered a diversity workshop series in the past year. We did a webinar follow-up, and we helped faculty develop diversity action plans that they are going to be implementing over the next year. So we bring people together with workshops and conferences, put resources that we think will be helpful on our website, provide some technical assistance, and if schools need a consultant for a specific area like climate, then we try to direct them to those resources. We’ve also run a couple of scholarship programs for faculty of color and women to help advance their careers.
From a policy perspective, we try to make sure that ADEA policies are inclusive of language around diversity and inclusion. For example, we just updated the association’s policy statement to include stronger language in support of LGBTQ communities. Additionally, we do about four to six training workshops tailored to individual schools each year. We have two trainers come out and talk to schools about how to do holistic review, and we talk to various admissions committees. Lastly, we make sure that the leadership of the schools is aware of contemporary issues affecting higher education that could affect dental education. One example of that is the U.S. Supreme Court ruling on race-conscious admissions that is coming up. We’ll make sure that our schools have talking points and guidance needed to understand the results of that case. We’ll have our ear to the ground on national policy — health or education policy — things affecting our schools that they need to know about.●
Rebecca Prinster is a senior staff writer for INSIGHT Into Diversity.