What's Been Learned About How to Support Diversity in Academic Medicine
From 2006 to 2008, researchers at Yale University School of Medicine interviewed and surveyed former participants in the Minority Medical Faculty Development Program about their program experience, their subsequent career and the relationship between the two.
The program, now named the Harold Amos Medical Faculty Development Program, has been supported by the Robert Wood Johnson Foundation (RWJF) since 1983. It provides four-year research awards to young, highly qualified minority physicians committed to a career in academic medicine. See Grant Results for more information.
The purpose of this research project was not to evaluate the program but to identify components that might translate into policy strategies to attract, retain and support minority physicians on medical school faculties.
Preliminary Findings and Policy Implications
The following were among the preliminary findings of the study based on survey responses from 69 former program fellows, reported by the project director in November 2008 (work on a final report was ongoing as of March 2009).
- A majority of the survey respondents said that protected research time and peer support were key aspects of the RWJF program that were important to their career success.
- The five most important job aspects for respondents who were considering leaving their current academic institutions were also the five most important job aspects for those who did not plan to leave their current positions:
- Opportunities for career advancement
- Opportunities to collaborate with other faculty
- Clarity of productivity expectations
- Relationships with administration and leadership
- Institutional climate of racial/ethnic discrimination
- "Successfully supporting diversity across career stages is an active process for leaders in academic medical centers."
- It is important to capture "faculty experiences when opportunities for intervention and retention still exist."
- Lessons from the Minority Medical Faculty Development Program "could potentially be translated into best practices policy strategies that attract, retain and support diversity among academic faculty."
RWJF funded this unsolicited project from July 2006 through June 2008 with a $49,868 grant.
Like the physician workforce in general, medical school faculties have long lacked the racial and ethnic diversity of the nation as a whole. Despite an increase in recent years, minority representation in medical academia has remained—as characterized by the American Association of Medical Colleges (AAMC) in 2004—"alarmingly low."
That year the AAMC reported that Blacks, Hispanics, Native Americans/Alaska Natives and Native Hawaiians totaled 25 percent of the population but held only 7.2 percent of medical school faculty positions. What's more, for the most part, they were at the lower level of academic medicine, that of assistant professor, the report said.
RWJF Minority Medical Faculty Development Program
RWJF had already begun to address this problem in 1983 by initiating a fellowship program for young, highly qualified, competitively selected minority physicians committed to a career in academic medicine.
Named the Minority Medical Faculty Development Program, it provided participants with a four-year stipend to support their research efforts plus mentoring opportunities. Each participant's employing institution—usually a medical school—also received RWJF funding and, in return, promised the participant sufficient time in the laboratory, protected from teaching and other non-research duties.
The program's underlying purpose was to give promising minority physicians a boost into top-flight research institutions, which have traditionally served as the faculty training ground for the nation's mainstream medical schools.
In 2004, in response to the U.S. Supreme Court's landmark ruling on affirmative action efforts in higher education, RWJF expanded the program's eligibility from underrepresented minority physicians to "physicians from historically disadvantaged backgrounds (ethnic, financial or educational").
RWJF also changed the program's name to the Harold Amos Medical Faculty Development Program. Amos, who died in 2003, was the first Black to chair a Harvard Medical School department. Read more about the evolution of this long-running RWJF effort in faculty development in its 25th Anniversary booklet. Also read the Grant Results on the program.
Former Fellows as a Research Focus
Marcella Nunez-Smith, M.D., M.H.S., an assistant professor at Yale University School of Medicine, specializes in health care workforce diversity and development issues.
In 2005, as a participant in the Robert Wood Johnson Foundation Clinical Scholars Program, she studied the influence of race on the professional lives of 25 Black physicians practicing in New England. (She was lead author of the study article, which was published in Annals of Internal Medicine in January 2007.)
Following on that work, Nunez-Smith wanted to understand better the challenges faced by minorities in academic medicine. She viewed RWJF's minority faculty development program and its alumni as an ideal vehicle for that research and sought funding from RWJF to conduct it.
Improving health care for the neediest Americans has been a principal objective of RWJF since its founding as a national philanthropy in 1972.
Increasing the number of minorities in the medical profession is one of the Foundation's key strategies for achieving that goal. Research shows that minority physicians are more likely than nonminority physicians to practice in the inner city and other areas with large medically underserved populations.
In conjunction with initiatives to increase the supply of minority physicians, RWJF has sought to add to the number of minority medical school faculty members. RWJF's early leadership believed that minority professors and administrators at predominantly White medical schools provided needed role models and support for—and outreach to—students and prospective medical students from minority backgrounds.
From 2006 to 2008, researchers at Yale University School of Medicine led by Marcella Nunez-Smith, M.D., M.H.S., interviewed and surveyed former participants in RWJF's Minority Medical Faculty Development Program about their program experience, their subsequent careers and the relationship between the two.
The purpose was not to evaluate the program but to identify program components that might translate into policy strategies to attract, retain and support minority physicians on medical school faculties.
RWJF supported the work from July 2006 through June 2008 with a $49,868 grant (ID# 056814) to the Yale University School of Medicine in New Haven, Conn.
First Phase: Interviews
Nunez-Smith conducted in-depth telephone interviews with 13 former program fellows about their experiences in the RWJF program and subsequent careers, and she used the information to develop questions for a written survey of former program participants.
Of particular importance was that the interviewees identified features of the program that they believed facilitated career success as well as those that hindered career success. See Appendix 1 for the two lists of features.
The study team constructed the interview sample to include a range of individuals—by gender, race and ethnicity; year of program selection; current work setting; and academic rank. Of the 13, seven were currently in academia and six were in nonacademic positions.
Second Phase: Survey
The team developed a 27-question, Web-based survey and e-mailed former program fellows to request their participation. The survey was available online for three months, ending in November 2008. Participants were assured that their responses would be confidential.
The team intended for the survey questionnaire to be filled out by Minority Medical Faculty Development Program participants—from the program's start in 1983 to 2003, when the eligibility criteria and name were changed.
The total potential number of respondents was 161, according to Nunez-Smith. However, the study team could not reach 50 of them because of incorrect or unavailable contact information, leaving an effective sample of 111. Of those, 95 completed the survey questionnaire, Nunez-Smith said.
The questionnaire covered both program and career experiences, including:
- Rating six components of the faculty-development program in importance to career success. Protected research time, for example, was one component. See Appendix 2 for the list of all six components.
- Whether the respondents were considering leaving their current employing institution within the next three years and to what extent satisfaction with each of 12 aspects of their job affected their decision. See Appendix 3 for the 12 job aspects.
Marcella Nunez-Smith, M.D., M.H.S., presented preliminary study findings on November 4, 2008, at the American Association of Medical Colleges (AAMC) annual meeting in San Antonio. The survey period was still open, and she based her presentation on 69 questionnaires completed and analyzed at that time.
In a March 2009 interview, Nunez-Smiths said the 26 questionnaires subsequently completed (for a total of 95) appeared to be consistent with her November presentation. The final analysis and results, however, would not be available until later.
Based on slides presented by Nunez-Smith at the November meeting, the preliminary findings of the study included the following:
- Of the 69 survey respondents, 62 were currently working in academic settings, including 38 in academic research and 24 in other academic positions; seven were in nonacademic jobs. Other characteristics of the preliminary respondent group included:
- Fifty-one (76.1 percent) characterized their race as Black; 15 (22.4 percent) said they were of Hispanic/Latino ethnicity.
- Forty-nine (73.1 percent) were male.
- Of the 62 in academic settings, more than half (61 percent) had tenure or were on a tenure track.
- A majority of the respondents said that protected research time and peer support were key aspects of the RWJF program. Sixty-four respondents (92.8 percent) rated funding for protected research time as "very important" to their career success, whereas 49 respondents (71.0 percent) gave that rating to the opportunity to meet racial/ethnic minority peers at program meetings.
The four other program aspects on the questionnaire with the number of respondents rating them as "very important" were:
- Advocacy (intervention by program personnel with the fellow's home institution): 25 respondents (36.2 percent).
- One-on-one mentoring by members of the program's national advisory committee: 21 respondents (30.4 percent).
- Formal mentoring sessions with the fellow's primary faculty mentor: 16 respondents (23.2 percent).
- Award flexibility: Eight respondents (11.6 percent).
- Asked if they were considering leaving their current institution within the next three years, the 62 respondents in academic settings selected one of three possible responses:
- No: 29 respondents (46.8 percent)
- Yes: 13 (21.0 percent)
- Don't Know: 20 (32.3 percent)
- The five most important job aspects for respondents who were considering leaving their current academic institutions were also the five most important job aspects for those who did not plan to leave their current positions.
For those considering leaving (the 13 answering "Yes"), the following were the top five job aspects affecting their contemplation of departure (the percentage is the proportion who said the job aspect had a "moderate" or "strong" effect on them):
- Opportunities for career advancement: 85 percent
- Opportunities to collaborate with other faculty: 62 percent
- Clarity of productivity expectations: 54 percent
- Relationships with administration and leadership: 53 percent
- Institutional climate of racial/ethnic discrimination: 45 percent
- Opportunities to collaborate with other faculty: 83 percent
- Opportunities for career advancement: 76 percent
- Clarity of productivity expectations: 76 percent
- Relationships with administration and leadership: 75 percent
- Institutional climate of racial/ethnic discrimination: 59 percent
In her November presentation, Marcella Nunez-Smith, M.D., M.H.S., identified the following as policy implications of the study:
- "Successfully supporting diversity across career stages is an active process for leaders in academic medical centers." Elaborating in an interview, Nunez-Smith said medical school leaders should remain actively engaged with minority faculty members throughout their careers, not just in the early stages.
- It is important to capture "faculty experiences when opportunities for intervention and retention still exist." Nunez-Smith said medical school leaders should not wait until the exit interview to find out what they could have done differently to keep a minority faculty member from leaving. They need to intervene before that decision is made.
- Lessons from the program "could potentially be translated into best practices policy strategies that attract, retain and support diversity among academic faculty." Nunez-Smith said that medical schools might provide protected time to minority faculty members and facilitate their access to ethnically and racially composed peer support groups. Since many medical schools have too few minority faculty members to form peer groups on their own, they could join with other medical institutions to form peer groups on a regional basis, she said.
- Consider asking the organization funding a survey to send an explanatory letter to members of the survey sample. Some former participants in the RWJF program were initially reluctant to fill out the survey questionnaire because of uncertainty about RWJF's relationship to the survey.
The study team initially considered requesting that RWJF send an explanatory letter to all potential respondents but decided against that approach since the survey was not an RWJF undertaking. In retrospect, a letter on RWJF letterhead signed by an RWJF designee and the project director might have eliminated misgivings.
In future situations, such a letter should state clearly that RWJF is aware of the survey but not involved in fielding it. (Project Director/Nunez-Smith)
- Be sensitive and responsive to concerns about survey confidentiality, especially when the survey respondents have reason to think they might be identifiable. Despite written assurance that all responses would be confidential, some potential respondents expressed reluctance to participate for fear of being identified inadvertently—not an unreasonable concern given the relatively few minorities in medical school faculty positions.
When the study team received e-mails expressing this concern, the project director immediately responded with a return e-mail giving assurance that the individuals' responses would be kept secure and the survey results reported only in aggregate. In the end, all individuals who expressed this concern ended up completing the survey. (Project Director/Nunez-Smith)
AFTER THE GRANT
The study team planned to prepare an article on the research for publication once the survey data and analysis were finalized, Marcella Nunez-Smith, M.D., M.H.S., said.
GRANT DETAILS & CONTACT INFORMATION
Study on how to successfully support diversity in academic medicine
Yale University School of Medicine (New Haven, CT)
Dates: July 2006 to June 2008
Marcella Nunez-Smith, M.D., M.H.S.
Program Aspects That Facilitated and Hindered Career Success
From in-depth interviews with 13 former Minority Medical Faculty Development Program participants, the study team compiled this list of program aspects that facilitated career success. (The list is from a slide presentation by the project director to the American Association of Medical Colleges meeting in November 2008.)
- Money/protected time
- Support for local mentors
- Program mentoring
- Sense of community
- External review
- Positioned for funding
- Role-modeling training
Similarly, the team compiled this list of program aspects that hindered career success:
- Stigma of "minority-only" award
- Loss of community/network after program completion
- Negative mentoring experiences (e.g., mismatches and mentor changes)
The Six Program Components on the Survey Questionnaire
Question 5 of the survey asked respondents to rank each of the following aspects of the Minority Medical Faculty Development Program (MMFDP) award according to how important each aspect was to their career success:
- One-on-one mentoring by national advisory committee members.
- Opportunity to meet racial/ethnic minority peers at MMFDP national meetings.
- Funding for protected research time.
- Award flexibility (e.g., ability to alter budget, hold other awards simultaneously, transport [the RWJF fellowship] to another institution).
- Formal mentoring minority faculty sessions with your MMFDP award primary mentor.
- MMFDP advocacy (e.g., interventions on behalf of the award recipients with their home institutions).
The possible responses were:
- Not important
- A little important
- Somewhat important
- Very important
- Did not experience
The 12 Job Aspects on the Survey Questionnaire
Question 17 of the survey asked:
To what extent does satisfaction with each of the following aspects of your job affect your decision to stay at your current institution?
- Office or lab space
- Research assistant support
- Clinical workload
- Teaching responsibilities
- Administrative and committee responsibilities
- Relationship with other administration and leadership
- Opportunities for scholarly collaborations with other faculty
- Clarity of productivity (e.g., funding, publications, clinical review)
- Opportunities for career advancement
- Racial/ethnic minority representation among faculty
- Institutional climate of racial/ethnic discrimination
The possible responses were:
- Does not affect
- Slightly affect
- Moderately affect
- Strongly affect
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
"Physician Career Trajectories: Understanding Experiences of MMFDP Awardee." Yale University School of Medicine, fielded online for three months ending in November 2008.
Presentations and Testimony
Marcella Nunez-Smith, "After the Career Development Award: Experiences of Racial/Ethnic Minority Academic Physician Faculty," at the Diversity Research Forum during the 2008 Annual Meeting of the Association of American Medical Colleges, November 4, 2008, San Antonio.
Report prepared by: Michael H. Brown
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Sallie Anne George