Perspectives on National Institutes of Health Funding Requirements for Racial and Ethnic Diversity Among Medical Scientist Training Program Leadership.

Importance: Since 1964, the National Institutes of Health (NIH) has funded the Medical Scientist Training Program (MSTP) MD-PhD program at medical schools across the US to support training physician-scientists. Recent studies have suggested that MSTPs have consistently matriculated more students from racial and ethnic backgrounds historically underrepresented in science than MD-PhD programs without NIH funding; however, the underlying basis for the increased diversity seen in NIH-funded MSTPs is poorly understood. Objective: To investigate how administrators and faculty perceive the impact of MSTP status on MD-PhD program matriculant racial and ethnic diversity. Design, Setting, and Participants: This qualitative study used a positive deviance approach to identify 9 high-performing and 3 low-performing MSTPs based on the percentage of students underrepresented in science who matriculated into the program between 2014 and 2018. This study, a subanalysis of a larger study to understand recruitment of students underrepresented in science at MSTPs, focused on in-depth qualitative interviews, conducted from October 26, 2020, to August 31, 2022, of 69 members of MSTP leadership, including program directors, associate and assistant program directors, and program administrators. Main Outcomes and Measures: The association of NIH funding with institutional priorities, programs, and practices related to MD-PhD program matriculant racial and ethnic diversity. Results: The study included 69 participants (mean [SD] age, 53 [10] years; 38 women [55%]; 13 African American or Black participants [19%], 6 Asian participants [9%], 12 Hispanic participants [17%], and 36 non-Hispanic White participants [52%]). A total of 51 participants (74%) were in administrative roles, and 18 (26%) were faculty involved in recruitment. Five themes emerged from the data: (1) by tying MSTP funding to diversity efforts, the NIH created a sense of urgency among MSTP leadership to bolster matriculant diversity; (2) MD-PhD program leadership leveraged the changes to MSTP grant review to secure new institutional investments to promote recruitment of students underrepresented in science; (3) MSTPs increasingly adopted holistic review to evaluate applicants to meet NIH funding requirements; (4) MSTP leadership began to systematically assess the effectiveness of their diversity initiatives and proactively identify opportunities to enhance matriculant diversity; and (5) although all MSTPs were required to respond to NIH criteria, changes made by low-performing programs generally lacked the robustness demonstrated by high-performing programs. Conclusions and Relevance: This study suggests that NIH funding requirements may be a powerful incentive to promote diversity and positively affect representation of students underrepresented in science in the biomedical scientific workforce.

Grow502: Centering Community in Medical Education via a Student-Created Organization Focused on Cultivating a Healthy Community.

The COVID-19 pandemic continues to disproportionately impact communities of color and expose health inequities. Minoritized communities experience disparities in chronic diseases, premature death, and cancer, and gaps continue to widen; systemic injustice in housing, nutrition, and environment are major contributors. At the height of the COVID-19 pandemic and racial justice movement, students at the University of Louisville School of Medicine created Grow502 to speak truth to the challenges of health disparities in Louisville, Kentucky. The goal was to pursue a healthier community by raising awareness. Community leaders and health professionals provided expert consultation. This partnership led to the co-creation of a curriculum focused on education, advocacy, community engagement, and creative media. Grow502 sought to support communities impacted by injustices due to racism, limited health literacy, redlining, and limited green space by creating programming centered on education and empowerment. Effective strategies to reduce disparities involve creating interventions with authentic engagement and context. Grow502 involves community stakeholders as active partners. We continue to intentionally seek effective collaborations and interventions that merge our mission and our diverse communities impacted by health disparities.