Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

Laying the Kahua (Foundation): Incorporating Elements of Attitude and Purpose for Underrepresented Student Success at the University of Hawai'i John A. Burns School of Medicine 'Imi Ho'ola Post-Baccalaureate Program.

The 'Imi Ho'ola Post-Baccalaureate Program is a proven pathway to medicine that has significantly increased the number of underrepresented and disadvantaged students that complete medical school in Hawai'i. A recent program evaluation indicated a relationship between student success and the significance of attitude and purpose from the Learning and Study Strategies Inventory. Curricular innovations in a 5-week introductory course during Phase 1, lay the foundation to promote a healthy attitude with purpose-led activities, such as personalized journal vision covers, weekly journal reflections, a multimedia autobiography, and projects focusing on medical specialties, well-being, and resiliency. Such purposeful innovations are vital for the success of underrepresented students, with the ultimate intent to diversify the physician workforce and to increase the number of physicians serving in underrepresented and underserved communities in Hawai'i and throughout the Pacific.

A Framework for Developing Antiracist Medical Educators and Practitioner-Scholars.

With an increasing awareness of the disparate impact of COVID-19 on historically marginalized populations and acts of violence on Black communities in 2020, academic health centers across the United States have been prioritizing antiracism strategies. Often, medical students and residents have been educated in the concepts of equity and antiracism and are ready to tackle these issues in practice. However, faculty are not prepared to respond to or integrate antiracism topics into the curriculum. Leaders in faculty affairs, education, diversity, and other departments are seeking tools, frameworks, expertise, and programs that are best suited to meet this imminent faculty development need. In response to these demands for guidance, the authors came together to explore best practices, common competencies, and frameworks related to antiracism education. The focus of their work was preparing faculty to foster antiracist learning environments at traditionally predominantly White medical schools. In this Scholarly Perspective, the authors describe their collaborative work to define racism and antiracism education; propose a framework for antiracism education for faculty development; and outline key elements to successfully build faculty capacity in providing antiracism education. The proposed framework highlights the interplay between individual learning and growth and the systemic and institutional changes needed to advance antiracist policies and practices. The key elements of the framework include building foundational awareness, expanding foundational knowledge on antiracism, embedding antiracism education into practice, and dismantling oppressive structures and measuring progress. The authors list considerations for program planning and provide examples of current work from their institutions. The proposed strategies aim to support all faculty and enable them to learn, work, and educate others in an antiracist learning environment.

'Imi Ho'ola: Creating Pathways to Success for Indigenous Students in Medicine at the University of Hawai'i John A. Burns School of Medicine.

'Imi Ho'ola is a program for those seeking to heal. Since 1973, 'Imi Ho'ola has provided educational opportunities to students from underrepresented populations in medicine and has demonstrated its success as a pathway for Native Hawaiians and other Pacific Islanders into the University of Hawai'i John A. Burns School of Medicine (JABSOM). The program's student-centered, individualized, and team-based approach offers participants the opportunity to develop effective learning and study skills while solidifying students' foundation in the basic sciences and humanities. 'Imi Ho'ola is an educational model that has had a longstanding impact on the diversity within JABSOM and has contributed to the success of indigenous students in medicine.

Medical School Hotline: Liaison Committee on Medical Education Accreditation, Part VII: Diversity/Pipeline Programs and Partnerships.

This article is part of an ongoing series describing various components of the John A. Burns School of Medicine (JABSOM) medical education curricula, activities, and initiatives relevant to the Liaison Committee on Medical Education (LCME) accreditation standards.1 JABSOM's LCME visit will take place in early 2017. This article provides an overview of JABSOM's diversity/pipeline programs and partnerships.

Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project.

BACKGROUND: Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training. METHOD: Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement. RESULTS: Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians. CONCLUSION: To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity.

UNLABELLED: The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. METHODS: We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002). RESULTS: The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. CONCLUSION: The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

Imi Ho'ola program: producing primary care physicians for Hawai'i and the Pacific.

BACKGROUND: The impact on health care delivery due to the impending shortage of primary care physicians is of national concern. To meet the growing health care needs of Hawai'i and the Pacific, the Imi Ho'ala Post-Baccalaureate Program (IHP) provides educational opportunities for students from disadvantaged backgrounds to pursue careers in medicine. Students selected to participate in the IHP have demonstrated a commitment to serve in areas of need of Hawai'i and the Pacific. IHP alumni enter the John A. Burns School of Medicine (JABSOM) as first year medical students. Following graduation, these students enter a variety of residency training programs. PURPOSE: The purpose of this study was to determine whether IHP alumni who successfully graduate from JABSOM choose primary care as their specialty of choice. METHODS: A retrospective review of IHP alumni from 1973 - 2010 was conducted. All IHP alumni who graduated from JABSOM and are currently in practice were included in the study. RESULTS: Of the 213 IHP graduates, 71.6% (n=152) are primary care physicians currently in practice. CONCLUSIONS: The majority of IHP alumni are currently serving as primary care physicians. Selection criteria, educational curriculum, and experiential nature of the program may contribute to Imi Ho'ala's success in producing primary care physicians.