Health career recruitment for minority students

Evidence Rating  
Scientifically Supported
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Decision Makers

Programs to recruit and train underrepresented minority (URM) students for careers in health fields generally include academic support and professional experiences for high school, college, or post-baccalaureate students, and may also offer financial support1, 2. Programs serve American students or foreign nationals who worked as health professionals before immigrating to the United States3. Programs can include information about health careers, classes, practicum experiences, advising about college or medical school admissions4, educational case management, or health-focused English as a second language (ESL) training3. Minorities comprise more than a quarter of Americans, but only 10% of health professionals5.

Expected Beneficial Outcomes (Rated)

  • Increased academic achievement

Other Potential Beneficial Outcomes

  • Increased high school completion

  • Increased college enrollment

  • Increased diversity of health care workforce

Evidence of Effectiveness

There is strong evidence that programs to recruit and train underrepresented minority (URM) students for careers in health fields improve participants’ academic achievement. Overall, programs can increase participants’ grades, likelihood of high school completion, SAT scores, and college entry. Post-baccalaureate programs can increase medical school entry. Undergraduate-focused programs can increase college retention, graduation, and medical school acceptance1, 2.

Programs focusing on admissions, academic enrichment, outreach, curriculum, or a combination of interventions have all increased the competitiveness of URM applicants to health professional programs; however, more interventions earlier in the educational pipeline may be needed to increase the overall number of URM applicants1. In some circumstances, programs to recruit and train American-born minority health professionals can increase the number of health professionals from URM groups2, 6. Programs serving immigrants with previous health professional training may increase educational attainment, income, and health care workforce participation for these individuals3.

In programs for undergraduates, longer interventions may yield stronger effects than shorter programs. Summer enrichment experiences can increase the likelihood of medical school acceptance, and research mentorships may increase the likelihood that students will complete the program. Experts recommend that these programs identify participants in their early college years so students can complete pre-health math and science courses with grades strong enough for medical school acceptance2. An evaluation of the Health Equity Scholars Program in California suggests that undergraduate pipeline programs can increase graduation rates and grade point averages among URM students7.

Participants in a research and mentorship program for URM medical students report increased knowledge, professional skills, and interest in future HIV vaccine research. Participants also suggest that successful programs have funding available, a supportive, central administration, and highly involved mentors and staff8.

Studies of the Stanford Medical Youth Science Program (SMYSP), a five-week summer residential program for high school students from families with low incomes that are interested in health careers, suggest participants are more likely to attend college and have increased science experience, at least in the short-term9. Studies of SMYSP also suggest that ongoing assessment, sharing of results, and strong partnerships between local organizations and universities committed to ethnic and income diversity throughout the educational pipeline are important to program sustainability4. Participation in a four-week Health Disparities Summer Internship Program in Brooklyn can increase awareness of and interest in the social determinants of health, increase student interest in plans to improve public and minority health, and improve analytical and communication skills10. Participants in Éxito!, a summer institute and six month paid internship program, report increased confidence in applying to doctoral programs, increased academic self-efficacy, and increased research skills11. In San Francisco, participants in the 12-week Summer HIV/AIDS Research Program (SHARP) for URM undergraduates report improved research skills, confidence in their abilities, and increased self-identification as scientists. SHARP evaluations also suggest most program alumni are employed in research positions and have been admitted to or are pursuing graduate degrees in HIV prevention-related fields12.

In New York City high schools, participation in an after school program, Mentoring in Medicine (MIM), has been associated with increased academic enrichment, knowledge of biology, self-efficacy, and ability to overcome personal issues to succeed in their career, as well as increased likelihood of choosing a health care career. MIM students and staff suggest that hands-on learning opportunities, class projects, and field trips are key elements of the program’s success13.

Minority patients that visit health professionals of the same race often report feeling more satisfied with care, having better communication, and longer visits than patients visiting providers of another race14, 15, 16. Sharing a language with a provider can also improve patient satisfaction and reduce disparities in quality and use of care14. Minority health professionals appear more likely to practice in primary care and inner city settings than their peers4, 15.

Experts suggest successful programs for recruiting and supporting graduate students in school psychology use a multi-level model of support that becomes progressively more tailored to each student as levels increase17. Teachers suggest successful programs offer interactions with mentors and health care professionals, teach broadly applicable skills, stimulate interest in health-related careers, develop presentation skills, and create optimism about furthering education18. Evaluations of an academic enrichment program for URM and rural high school students interested in pursuing a career as a health care provider in medically underserved counties of Alabama suggest a variety of interactive activities, hands-on experiences, and group discussions corresponding with student interests make the most successful programs19. The ReTOOL model suggests that successful cancer research training programs combine critical program inputs (e.g., funding, faculty advisors, committed mentors, culturally competent staff, institutional partnerships, and standardized program requirements) with supportive processes (e.g., continuous mentoring, research experiences, didactic curriculum, a pipeline approach, and structured application system)20.

Undergraduate focus groups suggest challenges to persisting in the health professional career pipeline include inadequate institutional resources (e.g., sparse clinical opportunities), strained personal resources (e.g., family pressure or conflict), insufficient guidance and mentoring, and societal barriers21. The significant cost of education, high debt burdens, and long training periods that delay the start of employment are also barriers to health professional careers, especially for URM students22. Health career recruitment programs that include generous scholarships, financial aid, or loan forgiveness packages for students from disadvantaged backgrounds can reduce racial disparities in student debt burdens for undergraduate and health professional schools23, 24. The racial wealth divide, limited access to financial resources among Black families, and disproportionately high debt burdens among Black medical school graduates appear to contribute to the low and declining rates of Black students enrolling in medical school23, 24.

Equity Analysis

Potential to decrease disparities: Supported by strong evidence

Programs to recruit and train underrepresented minority (URM) students for careers in health fields have strong potential to decrease disparities in academic achievement and enrollment in health professional schools between minority students and white students1, 2, 6. Such programs can be effective at many levels and support increased high school completion, college entry and completion, and medical school acceptance among URM students1, 2, 6, 7. Available evidence shows such programs can increase the diversity of the medical school applicant pool and interventions that start earlier in the education continuum may help broaden applicant pools even more1.

Experts suggest health career recruitment programs that increase diversity and inclusion in medical classrooms have the potential to improve health equity in the US by helping future health professionals develop cultural competence, reduce unconscious negative biases, increase critical thinking and innovative problem solving, and promote service-oriented mindsets, particularly for underserved populations6, 34. Increasing diversity among health professionals and expanding opportunities for patients to be cared for by health professionals of the same race or who speak the same language may reduce disparities in the quality and use of care, along with improving patient satisfaction and communication between patients and providers14, 15, 16. In some circumstances, patients visiting providers of the same race has been associated with improved appointment attendance, adherence to care plans, and better health outcomes; however, additional evidence is needed to confirm these effects. Generally, how well and how long providers have known their patients appears to have a stronger influence on positive patient health outcomes than race concordance35.

Historical Context

For most of American history, access to higher education and health professional schools was reserved for white males, typically from wealthier backgrounds. In the 1960s and 1970s, there were efforts to increase access to college and health professional schools for students identifying as minorities, from low income backgrounds, and for women. Recruitment efforts, pipeline programs, and affirmative action policies were designed to address the long history of structural barriers that prevented underrepresented minority (URM) students from enrolling in higher education, including medical schools22, 36, 37, 38, 39. However, available evidence suggests that substantial racial disparities persist in college and medical school enrollment, as well as in health professional employment22, 36, 39.

In recent decades, the cost of medical education has more than doubled and continues to rise, while compensation for health professionals and financial aid packages have not kept pace24, 40. More than half of medical students anticipate graduating with over $150,000 in debt, while almost 80% of Black students anticipate debt levels beyond $150,00024. The high cost of education and disproportionate debt burdens are significant barriers for URM students whose families have been systematically denied access to financial resources and opportunities to create wealth and build assets, which led to the racial wealth divide. Efforts to reduce the racial wealth divide and to reduce education debt burdens may improve the diversity of the health professional workforce23, 24.

Equity Considerations

  • When do health career recruitment and support pipeline programs begin in your community? In college? High school? Middle school? How could programs be expanded or implemented to increase duration and provide steady, longer-term support for participants, including for underrepresented minorities (URMs), throughout their academic careers, both during the school year and over the summer?
  • Which community organizations or partnerships could support health career recruitment pipeline programs by providing mentors, job shadowing experiences, or financial support?
  • Are health career recruitment programs in your community reaching URM students in your schools? Could outreach efforts be improved and expanded to engage additional students?
  • Are programs available for adult immigrants with previous international medical training and experience? What resources could help reach and engage these populations?

Implementation Examples

Many divisions of the US Department of Health and Human Services support programs to recruit and train underrepresented minority (URM) health professionals. The Health Resources and Services Administration (HRSA), for example, supports programs for minority students in medicine, nursing, dentistry, pharmacy, and other health professions, including K-12 programs through the Health Careers Opportunity Program (HCOP). The federal Office of Minority Health builds program capacity for postsecondary institutions that primarily serve minorities. Other agencies offer scholarships directly to students2.

Mentoring in Medicine (MIM) is a non-profit organization that offers a wide range of programs and events for URM elementary through college students. Examples include the MIM After School, Lunch and Learn, or Saturday Programs for middle and high school students; the Community Health Ambassador Internship (CHAMP Jr.) for high school students to perform health-related community service; and the Medical Pathway Program designed to help prepare URM students to apply to medical school. MIM headquarters is in the Bronx, NY, with a second office in Washington, DC and it is active nationwide, with programs in Anchorage, AK; Atlanta, GA; Billings, MT; Columbus, OH; Detroit, MI; Little Rock, AR; New Orleans, LA; Oakland, CA; and Philadelphia, PA13, 25. Health Career Collaborative (HCC) is a three year pipeline program for high school students from low income, minority communities that began in Philadelphia and has expanded nationally to Atlanta, GA; Austin, TX; Boston, MA; Chicago, IL; Durham, NC; East Palo Alto, CA; Gwinnett County, GA; Houston, TX; Irvine, CA; Kansas City, MO; Los Angeles, CA; and Oakland, CA18, 26.

In Chicago, the CHAMPIONS NETWork is a collaboration led by the University of Illinois between several partner organizations and nine high schools located in disadvantaged neighborhoods; CHAMPIONS offers a summer program to train a cohort of students to become health advocates and several school-year initiatives to support college preparation and career development27. MERIT (Medical Education Resources Initiative for Teens) is a non-profit organization based in Baltimore, MD that offers science enrichment, professional internships, college advising, and long-term mentoring for URM high school students28.

Tour for Diversity in Medicine (T4D) connects URM high school students and undergraduates with current physicians, dentists, pharmacists, and medical students who serve as mentors and group discussion facilitators. Since 2014, T4D has visited 43 campuses and mentored more than 3,500 students29. The Medical Student Mentorship Program (MSMP) pairs URM high school students with medical students at the University of Hawaii’s John A. Burns School of Medicine who serve as mentors and facilitate exposure to the processes involved in preparing and training for careers in medicine, health care, and research30.

Established in February 2012 and funded by the US Army Department of Defense, the ReTOOL program is a summer cancer research training program for URM undergraduate students that creates opportunities and promotes careers in oncology31.

Founded in 2004, Nth Dimensions develops and implements pipeline initiatives and summer internships for medical students to increase the number of women and URM in orthopedic surgery specialties32. Éxito! Latino Cancer Research Leadership Training, launched in 2010 at UT Health San Antonio, offers an annual five day summer institute to Latino/Hispanic master’s-level students providing tools and support to increase the number of students pursuing doctoral degrees and careers in Latino health disparities and cancer research. Éxito! also offers ten paid internships a year to students accepted into the Éxito! program11, 33.

Implementation Resources

Resources with a focus on equity.

US DHHS-Funding - US Department of Health and Human Services (US DHHS), Health Resources and Services Administration (HRSA). Find funding and scholarships.

AHEC - The National AHEC Organization. Area Health Education Centers (AHEC).

US DHHS-Diversity programs 2009 - US Department of Health and Human Services (US DHHS). Pipeline programs to improve racial and ethnic diversity in the health professions: An inventory of federal programs, assessment of evaluation approaches, and critical review of the research literature; 2009.

SMYSP - Stanford School of Medicine. Stanford Medical Youth Science Program (SMYSP).

SHPEP - Summer Health Professions Education Program (SHPEP). Mission: SHPEP’s goal is to strengthen the academic proficiency and career development of students underrepresented in the health professions and prepare them for a successful application and matriculation to health professions schools.

Bouye 2016 - Bouye KE, Mccleary KJ, Williams KB. Increasing diversity in the health professions: Reflections on student pipeline programs. Vol 6. 2016.

Footnotes

* Journal subscription may be required for access.

1 Simone 2018 - Simone K, Ahmed RA, Konkin J, et al. What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50. Medical Teacher. 2018;40(8):762-780.

2 US DHHS-Diversity programs 2009 - US Department of Health and Human Services (US DHHS). Pipeline programs to improve racial and ethnic diversity in the health professions: An inventory of federal programs, assessment of evaluation approaches, and critical review of the research literature; 2009.

3 Fernandez-Pena 2011 - Fernández-Peña JR. Integrating immigrant health professionals into the US health care workforce: a report from the field. Journal of Immigrant and Minority Health. 2011;14:441-448.

4 Winkleby 2007 - Winkleby MA. The Stanford Medical Youth Science Program: 18 years of a biomedical program for low-income high school students. Academic Medicine. 2007;82(2):139-45.

5 Noonan 2013 - Noonan A, Lindong I, Jaitley VN. The role of historically black colleges and universities in training the health care workforce. American Journal of Public Health. 2013;103(3):412-5.

6 Nivet 2014 - Nivet M, Berlin A. Workforce diversity and community-responsive health-care institutions. Public Health Reports. 2014;129(2):15-18.

7 Upshur 2018 - Upshur CC, Wrighting DM, Bacigalupe G, et al. The Health Equity Scholars Program: Innovation in the leaky pipeline. Journal of Racial and Ethnic Health Disparities. 2018;5(2):342-350.

8 Sopher 2015 - Sopher CJ, Adamson BJS, Andrasik MP, et al. Enhancing diversity in the public health research workforce: The Research and Mentorship Program for future HIV vaccine scientists. American Journal of Public Health. 2015;105(4):823-830.

9 Crump 2015a - Crump C, Ned J, Winkleby MA. The Stanford Medical Youth Science Program: Educational and science-related outcomes. Advances in Health Sciences Education. 2015;20(2):457-466.

10 McLean 2018 - McLean NA, Fraser M, Primus NA, Joseph MA. Introducing students of color to health sciences research: An evaluation of the Health Disparities Summer Internship Program. Journal of Community Health. 2018;43(5):1002-1010.

11 Ramirez 2019 - Ramirez AG, Gallion KJ, Perez A, et al. Éxito!: Making an impact in training Latinos for doctorates and cancer research. Journal of Cancer Education. 2019;34(5):928-937.

12 Fuchs 2016 - Fuchs J, Kouyate A, Kroboth L, McFarland W. Growing the pipeline of diverse HIV investigators: The impact of mentored research experiences to engage underrepresented minority students. AIDS and Behavior. 2016;20:249-257.

13 Holden 2015 - Holden L, Berger W, Zingarelli R, Siegel E. After-school program for urban youth: Evaluation of a health careers course in New York City high schools. Information Services and Use. 2015;35(1-2):141-160.

14 AHRQ-Kronick 2014 - Kronick R, Clancy C, Munier W, et al. 2013 national healthcare quality report. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014.

15 Gilliss 2010 - Gilliss CL, Powell DL, Carter B. Recruiting and retaining a diverse workforce in nursing: From evidence to best practices to policy. Policy, Politics & Nursing Practice. 2010;11(4):294-301.

16 CWF-Cooper 2004 - Cooper LA, Powe NR. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. New York: The Commonwealth Fund (CWF); 2004.

17 Grapin 2015 - Grapin SL, Lee ET, Jaafar D. A multilevel framework for recruiting and supporting graduate students from culturally diverse backgrounds in school psychology programs. School Psychology International. 2015;36(4):339-357.

18 Gefter 2018 - Gefter L, Spahr J, Gruber J, et al. Addressing health disparities with school-based outreach: The Health Career Academy program. Journal of Racial and Ethnic Health Disparities. 2018;5(4):700-711.

19 Patel 2017a - Patel A, Knox RJ, Logan A, Summerville K. Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt. Archives of Public Health. 2017;75(32).

20 Odedina 2019 - Odedina FT, Reams RR, Kaninjing E, et al. Increasing the representation of minority students in the biomedical workforce: The ReTOOL program. Journal of Cancer Education. 2019;34(3):577-583.

21 Freeman 2016 - Freeman BK, Landry A, Trevino R, Grande D, Shea JA. Understanding the leaky pipeline: Perceived barriers to pursuing a career in medicine or dentistry among underrepresented-in-medicine undergraduate students. Academic Medicine. 2016;91(7):987-993.

22 Toretsky 2018 - Toretsky C, Mutha S, Coffman J. Breaking barriers for underrepresented minorities in the health professions. San Franscisco: Healthforce Center, University of California at San Francisco (UCSF); 2018.

23 TCF-Mishory 2019 - Mishory J, Huelsman M, Kahn S. Bridging progressive policy debates: How student debt and the racial wealth gap reinforce each other. New York: The Century Foundation (TCF); 2019.

24 Dugger 2013 - Dugger RA, El-Sayed AM, Dogra A, et al. The color of debt: Racial disparities in anticipated medical student debt in the United States. PLOS ONE. 2013;8(9):e74693.

25 MIM - Mentoring in Medicine (MIM). Mentoring: Inspiring the next generation of health and science professionals.

26 HCC - Health Career Collaborative (HCC). Health science education and career exploration for high school students.

27 CHAMPIONS NETWork - CHAMPIONS NETWork. Youth empowerment for health equity: Program components include health education, community & population health, and workforce development.

28 MERIT - Medical Education Resources Initiative for Teens (MERIT). MERIT Health Leadership Academy: Our program.

29 T4D - Tour for Diversity in Medicine (T4D). The Tour: To educate, inspire, and cultivate.

30 MSMP - John A. Burns School of Medicine, University of Hawaiʻi at Mānoa. Medical Student Mentorship Program (MSMP). About us.

31 UF Health-ReTOOL - University of Florida Health (UF Health), Florida Agricultural and Mechanical University (FAMU). ReTOOL: Florida comprehensive cancer research training opportunities for outstanding leaders program.

32 Nth Dimensions - Nth Dimensions. Nth Dimensions is a pipeline program in the US for women and minorities seeking competitive specialties.

33 Exito! - Éxito! Latino Cancer Research Leadership Training. What do we do?

34 Kreuter 2011 - Kreuter MW, Griffith DJ, Thompson V, et al. Lessons learned from a decade of focused recruitment and training to develop minority public health professionals. American Journal of Public Health. 2011;101(Suppl 1):188-195.

35 Meghani 2009 - Meghani S, Brooks J, Gipson-Jones T, et al. Patient-provider race-concordance: Does it matter in improving minority patients' health outcomes? Ethnicity and Health. 2009;14(1):107-130.

36 Figueroa 2014 - Figueroa O. The significance of recruiting underrepresented minorities in medicine: An examination of the need for effective approaches used in admissions by higher education institutions. Medical Education Online. 2014;19:24891.

37 Thelin 2022 - Thelin JR, Edwards JR, Moyen E, Berger JB, Calkins MV. Higher education in the United States: Historical development & system. State University Education Encyclopedia. 2022.

38 US ED-Harvill 2012 - Harvill EL, Maynard RA, Nguyen HTH, Robertson-Kraft C, Tognatta N. Effects of college access programs on college readiness and enrollment: A meta-analysis. Washington, DC: Institute of Education Sciences (IES), US Department of Education (US ED); 2012.

39 NCES-Gandara 2001 - Gandara P. Paving the way to postsecondary education: K-12 intervention programs for underrepresented youth. Report of the National Postsecondary Education Cooperative Working Group on Access to Postsecondary Education. Washington, DC: US Department of Education (US ED), National Center for Education Statistics (NCES); 2001.

40 Jolly 2005 - Jolly P. Medical school tuition and young physicians’ indebtedness. Health Affairs. 2005;24(2):527-535.

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