Antiracism in Action: Development and Outcomes of a Mentorship Program for Premedical Students Who Are Underrepresented or Historically Excluded in Medicine.

INTRODUCTION: Black, Latinx, and Native American and Alaska Native people are underrepresented in medicine. The increasingly competitive medical school application process poses challenges for students who are underrepresented in medicine or historically excluded from medicine (UIM/HEM). The University of California, San Francisco-University of California, Berkeley (UCSF-UCB) White Coats for Black Lives Mentorship Program provides a novel and antiracist approach to mentorship for these premedical students. METHODS: The program recruited UIM/HEM premedical and medical students through a survey advertised by email, on the program's website, social media, and by word of mouth. The program paired students primarily with race-concordant mentors, all of whom were UCSF medical students. From October 2020 to June 2021, program mentees engaged in skills-building seminars based on an antiracism framework and received support for preparing medical school applications. The program administered preprogram and postprogram surveys to mentees, which were analyzed via quantitative and qualitative methods. RESULTS: Sixty-five premedical mentees and 56 medical student mentors participated in the program. The preprogram survey received 60 responses (92.3% response rate), and the postprogram survey received 48 responses (73.8% response rate). In the preprogram survey, 85.0% of mentees indicated that MCAT scores served as a barrier "a great deal" or "a lot," 80.0% indicated lack of faculty mentorship, and 76.7% indicated financial considerations. Factors that improved most from preprogram to postprogram were personal statement writing (33.8 percentage-point improvement, P < .001), peer mentorship (24.2 percentage-point improvement, P = .01), and knowledge of medical school application timeline (23.3% percentage-point improvement, P = .01). CONCLUSION: The mentorship program improved student confidence in various factors influencing the preparation of medical school applications and offered access to skills-building resources that mitigated existing structural barriers.

Why Professionalism Demands Abolition of Carceral Approaches to Patients' Nonadherence Behaviors.

Some clinicians' and organizations' considerations of how a patient's prior adherence to health recommendations should influence that patient's candidacy for a current intervention express structural racism and carceral bias. When clinical judgment is influenced by racism and carceral logic, patients of color are at risk of having their health services delivered by clinicians in ways that are inappropriately interrogative, aggressive, or punitive. This commentary on a case suggests how an abolitionist approach can help clinicians orient themselves affectively to patients whose health behaviors express or have expressed nonadherence. This article argues that an abolitionist approach is key to facilitating clinicians' understandings of root causes of many patients' nonadherence behaviors and that an abolitionist approach is needed to express basic health professionalism and promote just, antiracist, patient-centered practice.

Algunos médicos y organizaciones opinan que la adhesión previa de un paciente a las recomendaciones de salud debería influir en su candidatura para una intervención actual, lo que expresa el racismo estructural y los prejuicios carcelarios. Cuando el racismo y la lógica carcelaria influyen en el juicio clínico, los pacientes de color corren el riesgo de que los médicos les presten servicios de salud que sean inadecuadamente inquisitivos, agresivos o punitivos. Este comentario sobre un caso sugiere cómo un enfoque abolicionista puede ayudar a los médicos en la orientación afectiva de los pacientes cuyos comportamientos de salud expresan o han expresado no adhesión. Este artículo sostiene que un enfoque abolicionista es clave para facilitar que los médicos comprendan las causas fundamentales de los comportamientos de no adhesión de muchos pacientes y que es necesario un enfoque abolicionista para expresar la profesionalidad sanitaria básica y promover una práctica justa, antirracista y centrada en el paciente.

A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis.

Preexposure prophylaxis is a highly protective HIV prevention strategy, yet nonadherence can significantly reduce its effectiveness. We conducted a mixed methods evaluation of a mobile health intervention (iText) that utilized weekly bidirectional text or e-mail support messages to encourage preexposure prophylaxis (PrEP) adherence among participants in the multi-site iPrEx open-label extension study. A convenience sample of PrEP users from the San Francisco and Chicago sites participated in a 12-week pilot study. Fifty-six men who have sex with men were enrolled; a quarter of them were less than 30 years of age, 13% were black/African American, 11% were Latino, and most (88%) completed some college. Two-thirds opted for text message delivery. Of the 667 messages sent, only 1 individual requested support; initial nonresponse was observed in 22% and was higher among e-mail compared to text message recipients. Poststudy, a majority of participants would recommend the intervention to others, especially during PrEP initiation. Moreover, younger participants and men of color were more likely to report that they would use the iText strategy if it were available to them. Several participants commented that while they were aware that the messages were automated, they felt supported and encouraged that "someone was always there." Study staff reported that the intervention is feasible to administer and can be incorporated readily into clinic flow. A pre-post intervention regression discontinuity analysis using clinic-based pill counts showed a 50% reduction in missed doses [95% confidence interval (CI) 16-71; p = 0.008] and 77% (95% CI 33-92; p = 0.007) when comparing pill counts at quarterly visits just before and after iText enrollment. A mobile health intervention using weekly bidirectional messaging was highly acceptable and demonstrated promising effects on PrEP adherence warranting further evaluation for efficacy in a randomized controlled trial.

Growing the Pipeline of Diverse HIV Investigators: The Impact of Mentored Research Experiences to Engage Underrepresented Minority Students.

Structured, mentored research programs for high school and undergraduate students from underrepresented minority (URM) backgrounds are needed to increase the diversity of our nation's biomedical research workforce. In particular, a robust pipeline of investigators from the communities disproportionately affected by the HIV epidemic is needed not only for fairness and equity but for insights and innovations to address persistent racial and ethnic disparities in new infections. We created the Summer HIV/AIDS Research Program (SHARP) at the San Francisco Department of Public Health for URM undergraduates as a 12-week program of hands-on research experience, one-on-one mentoring by a senior HIV investigator, didactic seminars for content and research methods, and networking opportunities. The first four cohorts (2012-2015) of SHARP gained research skills, built confidence in their abilities and self-identified as scientists. In addition, the majority of program alumni is employed in research positions and has been admitted to or is pursuing graduate degree programs in fields related to HIV prevention. While we await empirical studies of specific mentoring strategies at early educational stages, programs that engage faculty who are sensitive to the unique challenges facing diverse students and who draw lessons from established mentoring frameworks can help build an inclusive generation of HIV researchers.