By 2055, the U.S. will not have a single racial or ethnic majority, according to the Pew Research Center. Perhaps nowhere else is this demographic shift being felt more profoundly than in the medical fields, because with this diversity comes unique healthcare-related issues, opportunities, and challenges.
Some health professions schools have been working to expand access to healthcare and the health professions for different populations — and to remedy the growing pains that accompany this demographic shift — by developing programs, services, and healthcare providers that are responsive to the needs of diverse communities.
SUNY Downstate Medical Center
Located in Brooklyn, SUNY Downstate Medical Center — part of the State University of New York (SUNY) System — serves a culturally diverse group of students and patients. More than one-third of its 1,800-plus students are from racial and ethnic groups underrepresented in health sciences professions, and many others are first-generation, immigrants, or socioeconomically disadvantaged. As the only academic medical center in Brooklyn, Downstate also serves a large patient population — specifically, over 2.5 million residents.
Actively involved with and invested in the local community, Downstate has garnered the trust of diverse groups by providing education, training, and culturally competent care to those it serves. “Based on the demographics of the population we serve, it’s important for us to have a presence … in the community so that we can provide not only the healthcare that’s needed by this demographic, but also the education and opportunities that come from being affiliated with an institution like Downstate Medical Center,” says Kevin L. Antoine, JD, assistant vice president in the Office of Diversity and Inclusion.
From the Brooklyn Health Disparities Center to its many pipeline programs, Downstate has outreach efforts to address the myriad needs, interests, and problems of the area’s different populations. The Health Education Alternatives for Teens (HEAT) program, the first of its kind in Brooklyn, provides “age and developmentally appropriate, culturally competent care for LGBTQ youth who are living with or are at very high risk for contracting HIV or AIDS,” according to Downstate’s website.
The program, which is led by clinicians, is open to local teenagers — regardless of their ability to pay. Participants learn about sexuality, disease prevention, and coping mechanisms for living with HIV or AIDS, and they gain access to medical, mental health, and support services. “It’s a safe haven they can come to, where they can talk about if they have health problems, how to care for them, how to get treatment — and [it’s] confidential,” Antoine says, adding that it gives many young people much-needed confidence.
Part of the HEAT program, Teens Helping Each Other (THEO) aims to turn local at-risk high school students into peer educators, says Shaundelle Moore Goldsmith, JD, director of the Office of Diversity and Inclusion. Downstate clinicians and students train participants how to be advocates for their peers by educating them on HIV prevention, teen pregnancy, substance use, and domestic violence. They learn how to facilitate discussions about these topics using creative means such as improvisational theater, games, songs and raps, and videos and then present what they’ve learned at schools, churches, and community programs throughout Brooklyn.
High school students also have the opportunity to learn about the human body and the medical profession through Downstate’s new Annual Anatomy Day, part of the graduate school’s STEM program. “There are five stations set up in the lab where students can see actual human anatomy via cadavers,” says Antoine. “They rotate through the stations, learning something about the anatomy at [each one]. When they go back to their high school, they are required to make a presentation on what they learned.”
Downstate shows its commitment to the community in other ways as well. Through the Brooklyn Free Clinic, which is student-run and physician-supervised, members of the Downstate community work to address health disparities in the area by offering free services. Students provide health screenings to patients, as well as access to network specialists. According to Goldsmith, these experiences improve students’ ability to communicate with diverse patients and thus ensure better health outcomes.
“Each school has a cultural competency component in its training, but what we’re working on now … is making sure we’re aligned in systematically training all of our students and getting them up to speed on how culture affects how they interact with patients,” says Goldsmith.
While Downstate’s community outreach efforts serve many purposes — including developing cultural competence and ensuring effective communication — perhaps the most important one is building trust among Brooklyn’s diverse community. As Antoine says, many of the “issues that occur between healthcare practitioners and patients [are due to] the trust component.”
University of Texas Health Science Center at San Antonio, School of Nursing
Recognizing that students, like patients, have unique needs, the School of Nursing at the University of Texas Health Science Center at San Antonio has taken a tailored approach to addressing those of its diverse student population.
“We have found that if we listen to where each of our students is [in their educational journey] and design programs to address their unique family circumstances, their learning needs, their economic needs, and their social needs, then they are more apt to be successful,” says Eileen T. Breslin, PhD, a registered nurse and the Patty L. Hawken Nursing Endowed Professor and dean of the School of Nursing. “We know that patients get better if you listen to what their needs are, … so we’re taking that same approach with our students.”
David A. Byrd, PhD, associate dean for admissions and student services, conducted a focus group to determine students’ needs in order to develop programs to meet those. “From that, we developed the Student Success Center,” Byrd says. “And that’s what led to so many of the services we provide, like supplemental instruction, peer mentoring, and personal tutoring.”
Designed to improve the academic performance of all students, the Student Success Center (SSC) was created as part of the Realce: Academic Enhancement for South Texas Nurses program, which is funded by a five-year, $2.5 million U.S. Department of Education Title V grant; as a Hispanic-Serving Institution, the university was able to secure these funds. The Realce program has two main activities, or goals: to increase opportunities for faculty-student engagement and provide tailored academic support services for students — which the SSC does.
“One of the philosophies we had when we developed the center is that we wanted it to serve every student, whether that be a first-semester struggling student or one who is about to graduate,” Byrd says. “We didn’t want to leave anybody out, so we’ve had to be very diverse in the types of programs we provide.”
For instance, Byrd discovered that although some people need additional support, many are reluctant to seek it out. Because of this, the center developed a peer-mentoring program through which first-semester students are paired with a second-semester mentor who offers academic advice and helps them navigate the campus. Academic coaching is also available through the SSC. Furthermore, the school has invested in technology to identify and assist students who are having difficulty before it’s too late.
Using the software program Starfish Retention Solutions, an early-warning system, the school is alerted and can take steps to intervene when a student’s academic performance begins to suffer. The SSC is also able to conduct diagnostic testing to determine where, specifically, he or she is having trouble. “Whatever the barriers might be that are preventing a student from being successful, the instrument allows us to home in on those and develop a long-term plan [in which] the student will continue to work with one of our coaches to overcome those challenges,” says Byrd.
“If we wait until midterms or close to finals to start helping, it’s kind of like closing the barn door after the horse has escaped; it’s not going to do any good,” Byrd adds. “The earlier we can identify the struggling student, the more effective we are going to be in providing support for him or her.”
In addition to academic support, the SSC works to ensure that nursing students — many of whom are first-generation and low-income, Byrd says — are financially literate. By educating them on how to budget, the center hopes to help reduce the amount of student loan debt they have after graduation. “Financial literacy,” Byrd says, “is just as important as the academic support we provide.”
The other activity of the Realce program — increasing faculty-student engagement — is fulfilled via the school’s Summer Undergraduate Nursing Immersion Experience. The program pairs students with faculty to advance the faculty members’ research and help get them published, while the students gain valuable hands-on experience and a mentor.
The hope, Byrd says, is that students will eventually have a “scholarly product” to present. But an additional goal of the initiative is to encourage them to earn terminal degrees and become nursing professors to help address the shortage, “specifically the shortage of underrepresented faculty members in nursing,” says Byrd.
He plans to evaluate the effectiveness of the program soon and conduct additional focus groups to stay attuned to students’ changing needs. But thus far, based on a 10 percent increase in first-time pass rates for the NCLEX exam — the nursing licensure test — the school’s efforts seem to be having a positive effect. Breslin believes much of this is due to the school’s all-in approach to ensuring student success.
“We’ve really come to understand that it is about partnerships with students, faculty, staff, and the administration — that we are all vested,” she says.
University of Arizona College of Medicine-Tucson
In Tucson, Ariz., Hispanics make up more than 40 percent of the population — the majority of whom speak Spanish at home. With such large representation both locally and nationally, including growing Hispanic student and patient populations, the University of Arizona College of Medicine-Tucson created a plethora of Spanish-language programs through its Hispanic Center of Excellence to prepare future physicians to better communicate with and treat these patients.
The Bilingual Medical Spanish (BMS) Distinction Track is the most developed of all the programs and is open to medical students with intermediate to advanced proficiency in Spanish. A four-year longitudinal track, BMS emphasizes the “development of oral proficiency in medical Spanish, cultural competence, and core medical competencies through a combination of online and classroom-based instruction, clinical shadowing, rotations, standardized patient interviews, and cultural immersion experiences,” according to the college’s website.
“[These are students who] know Spanish, who are able to communicate, but they don’t have the specific vocabulary that is used to communicate with patients,” says Oscar Beita, MD, director of the Office of Diversity and Inclusion and an assistant professor of family and community medicine. “Our goal is to train the students to be able to do a history, a physical exam, and to be able to advise patients and give them therapeutic recommendations in Spanish.”
Students attend Spanish-language classes — which progress with the regular medical school curriculum — twice a week at the beginning of the program, and later once a week. “We introduce the vocabulary of each block, such as cardiovascular or urology, and the specific questions they need to know,” Beita says. “We also go into diagnostic procedures that are related to each block.”
Role-playing with trained Spanish-speaking actors allows students to practice what they’ve learned. “Students have to interview simulated patients,” Beita says, “and we record them so we can review them with students to see what questions they asked, the vocabulary they used, and their interaction with the patient.” Students then gain hands-on experience by shadowing Spanish-speaking residents, giving them the opportunity to use both conversational and medical Spanish with clinicians and patients. Additionally, during their first summer, they are required to complete at least 100 hours in settings where they are practicing their Spanish, Beita says.
Global MedCats, a six-week international program, offers an immersive Spanish-language experience in Costa Rica or Spain. Beita helped develop the program in Costa Rica, where students with higher proficiency are placed in groups of up to five and live with local Spanish-speaking families. While building language skills is the primary focus, the experience also teaches them about cultural competence and health disparities.
“In those six weeks, the students get five hours a day of Spanish with an instructor who is very experienced, and they take a course called Health Systems in Latin America. As part of that course, which is two times per week, they visit [health centers] at different levels in the pyramid of care,” says Beita. “Also two times a week, they are shadowing clinicians in the hospital.”
He believes these programs and others will help resolve some of the issues that arise due to miscommunication between patients and doctors. Although just 34 students are currently enrolled in the BMS track, Beita expects that in the future the college will graduate many more who are certified as bilingual Spanish-speaking healthcare providers.
“Ninety percent of medicine is communication,” he says, “and if you don’t understand [your] patients, that’s a huge problem.”●
Alexandra Vollman is the editor of INSIGHT Into Diversity.