1. Advising and Remediating Advising and Remediating Minority Learners: How Can We Use Past Failures to Inform Future Success? ? STFM 2013

2. PRESENTERS Elizabeth H. Naumburg, MD Montgomery Douglas, MD Colleen T. Fogarty, MD, MSc Wanda Gonsalves, MD Tracy Kedian, MD

3. Goals for the session 1. Identify the persistent gap in URM enrollment and completion of medical training. 2. Recognize key elements needed to support minority learners. 3. List specific remediation strategies available to help minority learners.

4. PLAN FOR THE SESSION Setting the context- data on URM learners. Small group discussion of cases to stimulate ideas about issues and solutions. Discussion to explore particular barriers and potential solutions.

5. Definition of Underrepresented Minorities Until 2003 referred to African Americans, Native Americans, Alaska Natives, Mexican Americans, and Mainland Puerto Ricans After 2003 racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.

6. Diversity in Medical Education: Facts & Figures 2012 AAMC

7. Diversity in Medical Education: Facts & Figures 2012 AAMC

8. Diversity in Medical Education: Facts & Figures 2012 AAMC

9. Percent of Medical Students Graduating at 10 years Year of Matriculation Total Percent Completed Black/African American Hispanic/Latin o Native American 1987 (1997) 9688.293.387.9 1995 (2005) 9690.094.292.1 Garrison, G., Mikesell, C. & Matthew, D. Medical school graduation and attrition rates. Analysis in Brief, AAMC Vol 7, No 2, April 2007

10. Garrison, G., Mikesell, C. & Matthew, D. Medical school graduation and attrition rates. Analysis in Brief, AAMC Vol 7, No 2, April 2007

11. Medical Students’ SES Background and Their Completion of the First Two Years of Medical School. Analysis in Brief AAMC December 2011

12. AAFP 2000-2009

13. AAFP 2000-2009

14. AAFP 2000-2009

15. CASES 15 minutes

16. Reports from the Cases One or two of each: Barriers Solutions

17. Theoretical Barriers to Success Institutionalized bias or racism Weaker educational background Language barriers Confidence issues Increased commitments to family of origin Financial Pressures Alienation from family with transition to professional life Native born vs. foreign born

18. URM Experiences in Residency Discrimination – Subtle, seldom overt Differing expectations – Inconsistent, unequal treatment Social isolation and social support – Sense of being an outsider among peers/supervisors – Strong support from black patients, support staff, colleagues, and dedicated black and white mentors. Consequences and Coping Styles “In the Minority: Black Physicians in Residency and Their Experiences” by Liebschutz, J, Darko G, Finley E et al. Journal of Nationa Medicial Association Vol. 98, No.9 9/2006.

19. COGME 2005 Report Focuses on “Pipeline strategies” –Heavy emphasis on K-12 education –Some emphasis on Med school admissions criteria –Little emphasis on residency training strategies Recommend residency directors use qualitative criteria to interview/select URM candidates Track that data to see which is predictive of performance

20. Interventions for Success Cultural competency for students, faculty and residents Mentoring programs Proactive Board preparation Pipeline Programs Supportive Communities

21. What kinds of solutions? Supportive environment with other URM trainees and faculty Strong mentoring Focus on strengths Residency director/faculty advisor identify and address contextual challenges (family, financial, identity formation) Early intervention for academic difficulties

22. Some References Impact of Race on the Professional Lives of Physicians of African Descent. Nunez-Smith et al. Ann Intern Med. 2007;146;45-51 In the Minority: Black Physicians in Residency and Their Experiences. Liebschutz et al. Journal of the NMA. Sept 2006; 98(9):1441-1448 Contributors of Black Men’s Success in Admission to and Graduation From Medical School. Thomas et al. Academic Medicine, Vol. 86, No. 7 / July 2011 When are students most at risk of encountering academic difficulty? A study of the 1992 matriculants to U.S. medical schools. Acad Med. 1999 Apr;74(4):454-60. The Impact of Mentoring and Advising At-risk Underrepresented Minority Students on Medical School Performance. Tekian. Acad. Med. 2001;76:1264.