Urban Universities: Developing a Health Workforce that Meets Community Needs

7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs

1/36

Urban Universitiesdeveloping a health workforce

that meets community needs


2/36

the coalition of urban serving universities

Te Coalition o Urban Serving Universities (USU) is a president-led organizationcommitted to escalating urban university engagement to increase prosperityand opportunity in the nations cities, and to tackling key urban challenges. TeCoalition includes 42 public urban research universities representing all U.S.geographic regions. Te USU agenda ocuses on creating a competitive workorce,building strong communities, and improving the health o a diverse population.Te Coalition o Urban Universities (USU) has partnered with the Association

o Public and Land-grant Universities (A

P

L

U) to establish an Oce o UrbanInitiatives, housed at APLU, to jointly lead an urban agenda or the nationspublic universities.

the association of public and land-grant universities

Te Association o Public and Land-grant Universities (APLU) is a researchand advocacy organization o public research universities, land-grant institutions,and state university systems with member campuses in all 50 states, U.S. territoriesand the District o Columbia. APLU is the nations oldest higher educationassociation, with 218 members, including 76 land-grant institutions, and

18 historically black institutions. In addition, APLU represents the interests othe nations 33 American-Indian land-grant colleges through the American IndianHigher Education Consortium. APLU is dedicated to advancing learning,discovery and engagement. Te association provides a orum or the discussionand development o policies and programs afecting higher education and thepublic interest.


3/36

Urban Universitiesdeveloping a health workforce

that meets community needs

By Jennifer Danek, M.D. anD evelin Borrayo, Ph.D.


4/36

USU MeMBerS

Arizona State University

Boise State University

California State University, East Bay

California State University, Fresno State University

California State University, Fullerton

California State University, Long Beach

California State University, Northridge

Cleveland State University

Florida International University

Georgia State University

Indiana University-Purdue University Indianapolis

Morgan State University

Portland State University

San Francisco State University

San Jose State University

Temple University

Texas Tech Universi ty

The Ohio State University

The State University of New York System

Stony Brook University

SUNY College of Environmental Science and Forestry

SUNY Downstate Medical Center

SUNY Upstate Medical University

University of Akron

University of Albany

University at Buffalo

University of Central Florida

University of Cincinnati

University of Colorado-Denver

University of Houston

University of Illinois at Chicago

University of Louisville

University of Massachusetts Boston

University of Memphis

University of Minnesota

University of Missouri-Kansas City

University of New Mexico

University of North Carolina at Charlotte

University of Washington, Tacoma

University of Wisconsin-Milwaukee

Virginia Commonwealth University

Wayne State University

Wichita State University


5/36

Table of Contents

p

a

i 1

d s: i h

d, ub p 2

t f h w:

t r ub u 6

r r s ub u 7

r 18

e 22


6/36


7/36

v

Urban

Universities

Preface

Te Coalition o Urban Serving Universities (USU) is a president-led organization

o public urban research universities committed to improving the economic

prosperity and quality o lie and place in cities and metropolitan regions. As part

o their health initiative, members o the Coalition work together to increase the

numbers, diversity, and cultural competence o the health workorce to improve

health and reduce disparities in their communities.

Tis report is the product o the USU Urban Health Initiative. Principal authors

o the report are Jennier Danek, Director o USU Health, and Evelinn Borrayo,

Executive Director o the Latino Research and Policy Center at University o

Colorado Denver. Members o the Steering Committee include: Betty Drees, Dean

o the School o Medicine, University o Missouri Kansas City; Greer Glazer,

Dean o the College o Nursing, University o Cincinnati; Kevin Harris, Assistant

Vice President or Health Sciences Academic and Diversity Aairs, Virginia

Commonwealth University; Roderick Nairn, Provost, University o Colorado

Denver; and John Finnegan, Dean o the School o Public Health, University o

Minnesota.

As Chair o the Coalition and Co-Chairs o the Urban Health Initiative, we are

proud to present this report to our USU colleagues and the broader university

community. Te USU Health Workorce Study is our rst step to better understandthe health workorce eorts o our membershow they are currently engaging,

what is considered to be most eective, and where greater eort is needed.

While this report is directed to university presidents and health leaders, its

insights will be useul or ederal agencies and national associations working with

our institutions toward the shared goal o preparing the uture health workorce

or cities.

Wim Wiewel

President, Portland

State University

Chair, USU

Mark P. Becker

President, Georgia

State University

Presidential Co-Chair,

USU Urban Health

Michael Rao

President, Virginia

Commonwealth University

Presidential Co-Chair,

USU Urban Health


8/36

vi

Urban

Universities

Acknowledgements

USU would like to thank the many universities and individuals who contributed to

this report. Te USU Health Steering Committee was instrumental in the projects

design and implementation. We extend our gratitude to current and past members:

Betty Drees, Roderick Nairn, Sheryl Garland, Kevin Harris, Greer Glazer, Carole

Anderson, Alan Noonan, and John Finnegan. A special thanks to Jennier Danek

or leading the project, and to Evelinn Borrayo and the research team at University

o Colorado Denver, including Jenny Nguyen, Ava Drennen and Shi-Ming Shi, who

helped developed the survey and analyzed the data.

Tis project beneted rom the broad participation o USU member institutions,

including administrators, deans, aculty, and sta who coordinated the collection

o data and provided valuable input into the reports recommendations. We would

like to recognize Shari Garmise, Vice President o USU/APLU Oce o Urban

Initiatives, or her extensive input and assistance and Larry Van Dyne or his

editorial assistance.

We owe a special debt o gratitude to M. Roy Wilson, who got this work o

the ground as the ormer Chair o the USU Health Initiative and Chancellor o

University o Colorado Denver. His dedication to this project was critical to its

success. Wed also like to recognize the current USU Health Co-Chairs, Mark

Becker, President o Georgia State University, and Michael Rao, President oVirginia Commonwealth University or their leadership ensuring the projects

successul completion. Finally, we acknowledge the coalitions leadersthe board,

and the member presidentswho support these recommendations and whose

steadast commitment to an evidence-based agenda has kept the coalition ocused

on data and on advancing what works.


9/36

1

Urban

Universities

Introduction

iMProving health eqUity throUgh

Workforce innovation

Health Care Reorm has invigorated eorts to reconsider how our nations health

system should evolve to better meet the health needs o all. Broadening access

to care through insurance coverage or millions o Americans is but one solution

or a system encumbered by health workorce shortages, shiting population

demographics in the United States, and persistent health inequities. Our ability

to resolve health workorce gaps, in particular, will impact a multitude o other

initiatives to reorm the healthcare system and improve the publics health.Ensuring high-quality care and broader access hinges on our uture talentthe

clinicians, researchers, and health leaders who will serve in and shape the uture

health system.

Universities and their academic medical centers have an important role to play.

Tese institutions oten serve as anchors or local communities, possessing an

unparalleled scale and breadth o resources in education, research, and patient care.

Tis makes them well positioned to drive local innovations in health workorce

development and to improve health and health equity in their communities.

Tis report provides an account o how urban universities are tackling this goal by

enhancing and expanding a diverse, culturally sensitive, and well-prepared health

workorce to improve health and reduce disparities in our nations cities. Te report

contains recommendations on what universities need to urther increase their

capacity and eectiveness and to improve the knowledge base or university leaders

and policymakers making critical investments in our uture health workorce.


10/36

2

Urban

Universities

Demographic Shift: Improving

the Health of Diverse, Urban

Populations

According to the National Healthcare Disparities Report, disparities in

health status or minority and poor populations persist, and access to care is on

the decline across urban and rural populations. In U.S. cities, minorities are more

likely than whites to report cost barriers to care, such as lack o health insurance.

Tey are less likely to report they have a personal doctor and more likely to report

air to poor health. Te persistence o health disparities is particularly worrisome

in light o changing demographics. By the year , no one race wil l constitute a

majority. Moreover, population growth and cultural diversity is greatest in U.S.

cities and surrounding areas, where nearly percent o the population now lives.

increaSing DiverSity in health ProfeSSionS

o ensure that the health care needs o diverse populations are met, it is crucial

to prepare a diverse, culturally and linguistically competent health workorce.

Numerous reports, including those by the Institute o Medicine7 and the Sullivan

Commission in , identiy the lack o minorities in the health workorce ascontributing to unequal access and quality o care. Policymakers and education

leaders recognize the need or large-scale changes in health proessions education

and training, and over the past decade, they have sought to broaden the pipeline to

health proessions, increase awareness and accountability among universities, and

improve education nancing.

Yet progress in diversiying the health workorce has been slow. Arican-

Americans, Hispanic-Americans, and Native Americans comprise more than one-

third o the U.S. population. Yet, they account or only percent o physicians, 7

percent o dentists, percent o pharmacists, and percent o registered nurses.

Over the last decade, the proportion o minority graduates has increased in some

elds, such as public health and nursing. Others, such as medicine, have seen

virtually no change (see Figure ).


11/36

3

Urban

Universities

figure 1. health workforce diversity

Percentage of Degrees Conferred to Underrepresented

Minorities by Health Field (2000 to 2009)

2000 2009 change in Percentage

Medical Doctor (M.D.) 13.0% 12.0% -1.0%

Dentistry 9.0% 11.3% 2.3%

Pharmacy 11.9% 10.7% -1.2%

Nursing1 13.6% 15.1% 1.5%

Public Health1 16.5% 22.6% 6.1%

1 Includes bachelors, masters, and doctoral degrees

Source: U.S. Department of Education, Integrated Postsecondary Education Data System (IPEDS) ,

IPEDS Data Center, 2000, 20 09. http:// nces.ed.gov/ipeds/datacenter/.

Plans to increase coverage or the uninsured will intensiy current gaps in our

health workorce. Among the estimated million uninsured individuals, nearly

hal are minorities, and the vast majority live in urban environments. Te entry

o these individuals into the health system will require an expanded and equally

diverse set o health proessionals to care or them.

eDUcating More health ProfeSSionalS anDDePloying theM Where they are neeDeD

Te national shortage o health workers is well-documented. Fully percent o

the U.S. population mill ion peoplereside in communities where access

to primary health care providers is limited. Forty ve percent o these Health

Proession Shortage Areas (HPSAs) are in metropolitan areas, including inner city

neighborhoods that oten lack other critical resources needed or good health, like

sae areas to play or quality schools.

In addition to existing shortages, demand or health workers is expected toincrease as an elderly population expands and current health proessionals retire.

In response, most o the major health proessions associations have recommended

an increase in education and training.

he Association o American o Medical Colleges (AAMC) predicts that 91,000

more physicians will be needed by 2020 and has recommended a 30 percent

increase in medical school enrollment by 2015.13


12/36

4

Urban

Universities

he American Association o Colleges o Nursing (AACN) projects that 260,000

more registered nurses will be needed by 202514 and calls or an increase in

nurses with baccalaureate degrees by 80 percent and the doubling o nurses

with doctorates.15

he Association o Schools o Public Health (ASPH) estimates that 250,000

more public health workers will be needed by 2020 and recommends training

three times the current number o graduates over the next 11 years.16

Expanding the numbers o health proessionals alone wont solve the access

problem. Greater attention is needed to coordinate the growth and deployment

o the health workorce in order to ensure the right types o proessionals are

practicing in the communities where they are needed. From to , the

number o health graduates increased signicantly, but the growth was uneven:

pharmacy more than doubled, nursing and public health both increased by

percent, dentistry grew only by percent, and medicine was stagnant (see

Figure ).7 Now that more medical schools are opening and existing schools are

expanding, the supply o physicians is expected to increase or the rst time in two

decades. But unless more o these students choose primary care or start practicing

in high-need communities regardless o specialty, access to the health system is

likely to be worse in seven to ten years when these people join the workorce.

figure 2. growth in health professions

Percentage Change in Total U.S. Degrees

Conferred by Health Field (2000 2009)

0

10

20

30

40

50

60

70

80

90

100

Public

Health

Nursing

Percent

Pharmacy Dentistry Medicine

82% 83%

106%

19%

< 1%

1 Include Bachelors, Masters, and Doctorate degrees

Source: U.S. Department of Education, Integrated Postsecondary Education Data S ystem (IPEDS),

IPEDS Data Center, 2000, 20 09. http:/ /nces.ed.gov/ipeds/datacenter/.

1 1


13/36

5

Urban

Universities

Te need to anticipate demand and plan across health elds was part o the

rationale or creating a National Center or Health Workorce Analysis and the

National Health Workorce Commission. Te latter entity was legislated by the

Aordable Care Act, but is yet to be unded.

PreParing 21St centUry health ProfeSSionalS

As cities grow in size and density, and as they become more cultural ly diverse,

urban health systems will need to adapt. In , the percentage o the oreign-

born population reached percent, and more than 7 million people now speak

a language other than English at home. In certain cities, such as Louisville,

Jackson, and Indianapolis, the number o oreign-born persons doubled in the

past decade. As health systems evolve to

better deliver care or dierent urban-based

populations, they will require a new brand ohealth workers and leadersones who are

more collaborative and who have both technical

competence and the ability to understand and

address complex social issues.

Increasing attention is being placed on cultural

competence. Nearly all experts agree that

improving cultural awareness and providing

students with skills to work eectively with

patients o dierent cultural backgrounds

is crucial to maintaining individual and

community health. Studies on cultural competence interventions are promising.

Expectations or cultural competence are now built into accreditation standards

or health proessions schools. At the same time, theres little agreement on what

constitutes cultural competence, how to attract students who have or will be able

to develop these skil ls, and how health proessions schools develop or measure this

in the students they train. As more health employers demand cultural competence,

universities and health proessions schools will need to gure this out.

i s, su

s lus, Js,

d idps,

umb -

b pss dubd

ps dd.


14/36

6

Urban

Universities

Transforming the Future

Health Workforce: The Role

of Urban Universities

Urban universities have a unique capacity and responsibility to respond to health

workorce needs in their locales.Urban universities produce a large share o thenations health proessionals, educating percent o physicians and dentists and

percent o nurses and public health proessionals. Tese universities are oten

a gateway to higher education or urban students and to advanced training in

health proessions.

Addressing the ailing K education pipeline, particularly or urban and minority

students, must be a priority. oo many urban studentsmany rom high-need or

underserved communitiesdrop out beore they can even consider a health career.

A study by Americas Promise Alliance conrmed the dramatic high school

graduation gap between urban and suburban public school students in major

cities. Students who drop out o high school, in turn, are more likely to suer

rom poor health themselves, as educational attainment and health disparities are

closely linked.

Needed change within the health workorce can be attained i training institutions

make it a core priority and commit the resources required to achieve it. One o

the most important steps toward achieving diversity goals is the commitment

rom university leaders.7 Tey have the power to transorm institutional policies

and procedures and collaborate with other educational institutions to strengthen

the pipeline rom preschool to graduate school. By aligning admission practices

with broader institutional goals, health proessions leaders shape the incoming

student body and aect the infux o proessionals entering health proessions.

Universities also are primary innovators in health proessions education and

can leverage existing linkages with urban sites, clinics, and hospitals to increase

cultural competence and train health proessionals in those venues where they are

needed to practice.


15/36

7

Urban

Universities

Research Results from a

Study of Urban Universities

Te Coalition o Urban Serving Universities (USU) is a president-led organization

o public urban research universities committed to improving the economic

prosperity and quality o lie and place in cities and metropolitan regions. As part

o their health initiative, members o the Coalition work together to increase the

numbers, diversity, and cultural competence o the health workorce to improve

health and reduce disparities in their communities.

In the winter o , the coalition collected data rom member institutions

and public sources to better understand existing eorts and the needs o urban

universities in preparing an adequate, diverse, and ully prepared health workorce.

Te USU survey included both quantitative and qualitative data analysis related

to the ollowing areas: institutional priority and capacity, admissions practices,

pipeline programs, and innovative education eorts. Te survey response rate

was greater than percent, including institutions and o their health

proessions schools.

USUs study is a rst step to better understand the workorce eorts o its

membershow they are currently engaging, what is considered to be most

eective, and where greater eort is needed. Te survey provides baseline data and

identies areas or uture research. While this report is directed to USU presidents

and health leaders, its insights will be useul or ederal agencies and national

associations working with our institutions toward the shared goal o preparing the

uture health workorce or cities.

i. leaDerShiP: BUilDing caPacity to MeaSUre reSUltS

Preparing a more diverse and culturally competent health workorce is a stated goal

in the strategic plans o nearly all institutions. Presidents and health proessionsdeans consider it a very high priority. Institutional leaders are taking steps to

enact change, and a multitude o educational innovations and partnerships target

the issue.

Even with a stated high priority, many universities lack the capacity to execute and

measure progress on their health workorce goals. Nearly al l have eorts underway,

but ewer institutions have mechanisms to track institutional progress or report on


16/36

8

Urban

Universities

outcomes to leaders. In the strategic plans o health proessions schools, diversity

and cultural competence is oten identied as a core value, but is not always

accompanied by specic goals and objectives, responsible agents, or metrics (see

Figure ).

figure 3. survey results: institutional capacity

Preparing a More Diverse and Culturally Competent Health Workplace

so urs ce

0

20

40

60

80

100

120

In Strategic

Plans

Percent

Core

Value

Taking

Actions

Goals &

Objectives

Responsible

Agents

Metrics

19%

57%

76%

97%100%

34%

Source: 2011 USU Member Survey, includes data from 32 universities and 85 of their health

professions schools.

Te results o the study make clear that top leadership commitment is crucial

to meeting health workorce goals. University boards, presidents, and health

proessions deans set expectations, al locate resources, and hold themselves and

others accountable. Several institutions cited a clear message rom leaders as

enabling more substantive planning and collaboration across the dierent health

proessions schools and units o the university. Such a process was noted at

University o Colorado Denver, Ohio State University, and Georgia State, among others.

Many institutions are expanding senior leadership positions or diversity. Several,

including Portland State University and the State University o New York (SUNY)

Albany, have appointed chie diversity ocers. Indiana University-Purdue University

Indianapolis (IUPUI) credits three new leadership positions as advancing its eorts:

an Assistant Chancellor or Diversity, Equity, and Inclusion and two ull-time

associate deans o diversity aairs in medicine and dentistry. Te University o

Houston System hired an associate vice president to oversee the Urban Health

Initiative, a signature eort to prepare more o its diverse student body to become

uture health proessionals in Houston communities.


17/36

9

Urban

Universities

Unortunately, the data collected and used to measure progress on health

workorce goals is largely inadequate. Te lack o evidence and a data eedback

loop to inorm eorts and investments is a barrier or leaders. Box presents the

survey ndings on the use o data.

BoX 1. use of data

Student Tracking and Program Evaluation

Nearly all health professions schools collect data on underrepresented students

who apply and enroll, using the data to inform policies on diversity.

Sixty-four percent of these schools report tracking graduates to determine

if they practice in underserved communities, though data is often difficult to

obtain.

Universities frequently evaluate pipeline programs, but few have the capability

to track long-term outcomes of participating students.

Challenges to improving data collection and analysis include a lack of

infrastructure, cost, and definitional issues (e.g., defining such terms as

underrepresented, economically disadvantaged, and diversity).

Eorts to strengthen data systems oten stem rom leadership priority and

desire or greater accountability. As part o a highly visible Graduation Initiative,

the Caliornia State University (CSU) System improved its tracking o studentoutcomes and reporting across campuses. Campus leaders requently cited

the system-wide initiative as helping to align and better organize their work. Te

recent strategic plan or the SUNY System makes a commitment to develop the

right health proessionals or the right places, and will be tracking its metrics in

an annual report card to the public. Another example is the University o New

Mexicos Vision , the rst academic health center strategic plan that ocuses

on improving the health and health equity o a states population as a measure o

the institutions success. All o the colleges, schools, departments, and programs at

UNM Health Sciences Campus have incorporated into their annual perormance

plans how their education, service, and research enterprises will measurablyimprove the health o New Mexicos population.

Sustained institutional unding is requently cited as important. Virginia

Commonwealth University allocates permanent unding to support core

inrastructure or pipeline programs within the Division or Health Sciences

Diversity. Others point to the impact on diversity o declining resources. As one

institution explained, We created a dean-level position to promote, monitor, and


18/36

10

Urban

Universities

BoX 2. how urBan universities are

eXpanding the talent pipeline

k12 anD UnDergraDUate PrograMS

The University of Missouri, KansasCityoffers the Summer Scholars Program,

an academic enrichment program for underrepresented minority undergraduate

students who have interest in and aptitude for health careers. Of the 1,265

participants to date, 69 percent have enrolled in a health careers degree program,including 25 percent in medical school.

PoSt-BaccalaUreate PrograMS

The Ohio State UniversitysMeDPath is a one-year post-baccalaureate academic

enrichment program. Participants receive conditional acceptance into the College

of Medicine and matriculate once they complete the program. The program

doubled the number of underrepresented minority medical students in the School of

Medicine. In addition, 68 percent of MEDPATH graduates provide substantial care

to underserved populations, compared to 33 percent of non-MEDPATH graduates

from Ohio State.*

SySteMic effortS

University of Illinois at ChicagoUb h Pm is a preschool through

graduate level program that recruits and supports students from underserved

communities interested in pursuing health careers. The program is integrated

across the six health sciences colleges and includes both undergraduate and pre-

undergraduate initiatives. In 34 years, the university has graduated more than 6,000

African American, Latino, and Native American health care providers and health-

related researchers.

Virginia Commonwealth Universityrecently has consolidated its 21 health sciences

and research pipeline programs into a comprehensive model to increase access

and success in health careers for diverse students. Centralizing the programsenables the university to consolidate resources, improve linkages with the

community, create a connected experience for students, and track common data

and outcomes.

* L. McDougle, D.P. Way and Y.L. Rucker. Survey of Care for the Underserved: A Control

Group Study of Practicing Physicians who were Graduates of The Ohio State University

College of Medicine premedical Post Baccalaureate Training Program. Academic

Medicine. 85 (1) (2010): 3640.

measure progress on diversity. However, due to the budget crisis, the position was

temporarily eliminated.

ii. reaching More StUDentS: the talent PiPeline

Teres good evidence that pipeline programs work. Evaluation studies on pipelineinterventions demonstrate a range o positive outcomes, including improved


19/36

11

Urban

Universities

0

10

20

30

40

50

60

70

80

Outreach

& Information

Mentoring Academic

Enrichment

Test

Preparation

Scholarships

Undergraduate Students

Percent

K12 Students

academic success and increased enrollment in health proessions schools. USU

leaders also cite pipeline programs as one o their most eective strategies or

increasing and diversiying the workorce. About hal o USU member institutions

cite programs that are innovative or have documented success (See Box ).

Universities make signicant investments in their pipeline programs. At most

institutions, the principal source o unding comes rom the university and

health proessions school. At the same time, nearly all count on some ederal

support, particularly or K activities. Te ederal Health Resources and Services

Administrations itle VII programs, particularly the Area Health Education

Centers, the Centers o Excellence and Health Career Opportunity Programs,

are particularly instrumental to sustaining university health workorce diversity

eorts. On more than one occasion, programs got o the ground through these

ederal programs, and then were continued by the institutions themselves.

Te types o pipeline interventions being deployed by urban universities varytremendously. Te breadth and diversity o programs, as well as the overlap with

science, technology, engineering, and mathematics (SEM) programs and general

student services, make it dicult to characterize a standard health careers

pipeline program or to determine what types o activities are needed to yield

positive outcomes. Figure summarizes the requency o activities oered by

Source: 2011 USU Member Survey, includes data from 32 universities and 85 of their health

professions schools.

figure 4. survey results: eXpanding the talent pipeline

Activities for K12 and Undergraduate Students


20/36

12

Urban

Universities

BoX 3. regional pipeline partnerships

University of New Mexicoand New Mexico StateUniversityrecently have formed

a cooperative pharmacy program to increase educational opportunities and

the supply of pharmacists to areas of high need. High school students from

underserved counties are accepted into the program, complete two years of

undergraduate work at New Mexico State, and then matriculate to the University of

New Mexicos School of Pharmacy. Graduates have incentives to return to these

communities to practice.

The University of Houstonparticipates in a pre-health professions agreement with

Baylor College of Medicinecalled the h Psss adm. The program

targets students from DeBakey High School, a highly diverse school in Houston

focused on health professions. Students receive tuition assistance and academic

supports all the way to medical school. Since its founding in 1996, 147 Debakey

students have entered the program, and 75 of 76 University of Houston program

graduates (99 percent) have matriculated into medical school.

Cleveland State Universityhas launched a new partnership with Northeast Ohio

Medical University. The aim is to prepare diverse primary care doctors for urban

underserved communities. Several pathways to the medical degree are available

to Cleveland State students, including direct entry, a post-baccalaureate to M.D.

program, and a baccalaureate to M.D. pipeline.

urban universities. Outreach, such as health career airs and websites, are most

requent while academic and nancial support are less common.

Short-term pipeline interventions, such as pre-matriculation and post-

baccalaureate programs, are common among urban universities. Tese programs

have substantial and growing evidence to support their eectiveness. Studies show

they increase academic readiness and enrollment o underrepresented minorities

in health proessions schools. Participants in these programs are also more likely

to plan on working with underserved populations upon graduation.

Among urban universities, the use o pre-matriculation and post-baccalaureate

programs varies by health proession. Post-baccalaureate programs are oered at

percent o medical schools surveyed, compared to 7 percent o public health

schools, percent o dental schools, percent o nursing schools, and none o

the pharmacy schools. Te data are similar or pre-matriculation programs.

While most pipeline activities ocus on undergraduates, about hal o health

proessions schools oer pipeline programs or K students. Several institutions

have developed more in-depth partnerships with specialized urban high schools


21/36

13

Urban

Universities

ocused on health careers. IUPUIworks with Crispus Attacks Medical Magnet School;

San Francisco State University has the Metro Health Academy; University o Houston

works with Debakey High School or Health Proessions; and the University o Illinois

at Chicago has a partnership with UIC College Prep, a charter high school whose

curriculum is co-developed by aculty in the universitys six health sciences colleges.

Aside rom discrete pipeline programs, urban universities are developing more

systematic approaches to improve educational transitions to health careers.

Examples include combined or accelerated degree programs, regional cooperative

partnerships among educational institutions targeting high-need communities,

new undergraduate majors, and improved articulation agreements with

community colleges (see Box ).

Bridging programs are particularly common among schools o nursing. Tese

programs encourage nursing students to advance to higher levels o education.

San Jose State University (SJSU) ormed a partnership with the Evergreen Valley

Community College to enable second-year associate degree nursing students

to cross-enroll at SJSU, taking one higher level course each semester. Te pilot

partnership streamlines the educational transition and allows students to complete

their bachelors degree in nursing within months o ull-time enrollment.

SUNY Downstate has developed a -month accelerated nursing program serving

Brooklyn, Queens, and Staten Island in New York City. Other bridging programs

address the shortage o nursing aculty or the lack o diversity among nursing

leaders. BothArizona State University and University o Minnesota have successul

M.S. to Ph.D. nursing programs or Native Americans.

Only one third o urban universities cite institutional partnerships with minority-

serving institutions. Many o these partnerships target biomedical research

careers, and are supported in part by NIH. Such programs are in place at CSU-Los

Angeles, IUPUI, and University o Minnesota.


22/36

14

Urban

Universities

iii. recrUitMent anD aDMiSSionS

Nearly all health proessions schools consider diversity goals in admitting students,

but promising admission practices are not being used to the extent suggested in

the literature. Te most common admission strategies include using holistic

review or broadening the composition o the admission committee to refect

greater diversity and perspectives. De-emphasis on test scores or elimination o

screening algorithms are used less requently, although some have advocated that

approach, particularly where testing has low correlation with long-term academic

perormance (see Figure ).

figure 5. survey results: current admissions practices

0

10

20

30

40

50

60

7059%

53%

18%11%

Use holistic

review

Percent

Broaden

composition

of admissions

committee

De-emphasize

standardized

test scores

Eliminate

screening

algorithms

Tere are some dierences in admission practices among the health proessions.

Extending conditional or guaranteed admissions is more requent among schools

o medicine and pharmacy then among schools o public health, nursing, or

dentistry. Te majority o medical schools surveyed require mandatory training

or the admissions committee, a practice that is inrequent among other health

proessions schools. Consideration o cultural competence within the admissions

process also is more requent among medical schools (See Figure ).

Source: USU 2011 Member Survey, includes data from 85 health professions schools.


23/36

15

Urban

Universities

figure 6. survey results: variation in admission

practices By health profession school

0

10

20

30

40

50

60

70

80

90

Conditionaladmissions

Percent

Mandatorytraining of

admissionscommittee

Culturalcompetence

considered

Dentistry Medicine Nursing Pharmacy Public Health

Source: USU 2 011 Member Survey, includes data from 85 health professions schools.

Slightly more than hal o health proessions schools report evaluating their

admissions strategies and outcomes. Several schools pointed to innovative

approaches that improved their ability to attract and matriculate a more diverse

class. University o Minnesotas School o Public Health cites its core concepts

certicate as a way to both train more people in public health and enable students

who didnt initially gain acceptance to demonstrate academic competence while

making progress toward the masters degree. Many institutions identied

recruitment strategies as increasing their eectiveness (e.g. outreach to diverse

campus and national groups, online eorts, and hiring multicultural recruiters).

For one institution, the decisive actor in attracting the students it seeks was

oering more scholarships.


24/36

16

Urban

Universities

BoX 4. spotlight on innovation and success

h Psss edu fd i Us

neW aMericanS in nUrSingThrough a regional collaboration of area hospitals, FIU has created the rst

Foreign Doctor to Nurses program in the nation. nw ams nus is

an accelerated Bachelor of Science program with specialized courses to transition

foreign-born doctors to become practicing nurses. The idea was suggested to the

former dean, Divina Grossman, by a group of Cuban doctors in Miami who were

working outside their eldas cab drivers, at produce stands, or as security guards.

The impact, published in a 2008 article in the Journal of Nursing Education, is

unassailable.* The program taps an unmet need (the initial class had over 450

applicants), increases the supply of nurses, and on measures of nursing quality

and employer satisfaction, graduates outperform expectations. Since its rst class

in 2002, more than 500 graduates have entered the nursing workforce. The school

is partnering with the Hospital Corporation of America to expand the program

remotely to Tampa.

neighBorhooD helP PrograM

FIUs medical school, which opened in 2009, is similarly committed to improving

community health. The schools curriculum is designed around the g fm

fud nbd helP pm, an interdisciplinary approach

where teams of students from medicine, nursing, social work, and law work in

Miamis poorest and most diverse communities. The students, now exceeding 400,

visit with families in their homes over four years. They identify concerns and work

with family members to improve them. In addition to training culturally competentphysicians, Neighborhood HELP intends to impact health disparities directly. Initial

data shows participating families already have lower emergency room utilization

rates, and additional measures of health outcomes will be collected over time.

* D. Grossman and M.L. Jorda. Transitioning Foreign-educated Physicians to Nurses: The

New American in Nursing Accelerated Program. Journal of Nursing Education47 (12)

(2008): 54451

iv. innovationS in health ProfeSSionS eDUcation

raining in underserved communities is an important strategy or increasing

the cultural competence o health graduates. Nearly percent o urban health

proessions schools have community partnerships to increase student exposure

to, and understanding o, culturally diverse populations. Schools also are adaptingtheir ormal education, with 7 percent o health proessions schools reporting

they have integrated cultural competency into their curriculum.


25/36

17

Urban

Universities

Only about one quarter o schools, however, have either done a ormal needs

assessment o cultural competency within curricular oerings and training or

assessed cultural competency in students. Te lack o student assessment largely

refects the newness o the eld, varying denitions o what constitutes cultural

competence, and questions o how cultural competence can be measured.

Many institutions are expanding clinical sites or community-based education

to train students in venues where they are needed. Students rom health-

related schools at the University o Akron are assigned as part o their clinical

experience to work in the College o Health Proessions Nurse Managed Center

or Community Health, which has six clinics serving vulnerable and uninsured

individuals in Akron. Tis includes a womens and childrens homeless shelter, a

mens homeless shelter, a ederally unded housing complex, and a clinic serving

individuals with severe and persistent mental i llness. Florida International

University has several innovative programs to improve the workorce or South

Floridas diverse and underserved communities (see Box ).


26/36

18

Urban

Universities

Recommendations

i. high-level coMMitMent

Campus-wide planning to meet goals or increasing the size and quality o the

healthcare workorce should encompass both the initiatives o universities and

their health proessions schools. Only some o the eorts o universities to target

workorce improvements are coordinated currently, and this can lead to duplication

and diculties assessing critical gaps. Lack o coordination also hampers the

ability o university leaders and health proessions deans to collect reliable and

compatible data across all their health proessions schools and programs, which

makes it dicult to track progress on diversity, cultural competence, and othergoals.

Heres what top leaders can do:

Make their commitment visible. Where this has occurred, universities and health

leaders are better able to coordinate eorts, measure eectiveness, and partner

with their communities. he University o New Mexicos Vision 2020 is a good

example o how a visible commitment to improve health equity at the highest

level can galvanize both a campus and community to work together.

Ensure that what is valued is measured, monitored, and reported. hough improved

health and reduced health disparities in communities is diicult to measure,

other workorce outcomesaccess to health proessions, student diversity, the

location and practices o graduatesare more easily quantiied. Universities

should establish big-picture health workorce goals and be diligent about

tracking and reporting their outcomes.

Design health workorce programs based on local needs and outcomes. University

leaders should ensure that decision-makingparticularly expansion or

development o new health proessions schoolsis responsive to local need.

In turn, universities need national and state-level agencies and planners to

provide more reliable and appropriate health workorce data. his helps leaders

to better anticipate demand and plan across health ields.

Engage leaders across health proessions. Some o the most eective programs,

such as the University o Illinois Chicago Urban Health Program, are integrated

across the university and health proessions and beneit rom shared leadership

commitment and ownership. University presidents and health leaders should

create mechanisms that break down silos among the health proessions and

ensure greater collaboration.


27/36

19

Urban

Universities

Reine metrics by which institutions can assess progress and drive urther

health workorce improvements. Universities should identiy a set o measures

where data are already available and work with others to improve data and

inormation systems that enable even better measures.

Inventory programs that impact the health workorce to better assess and

coordinate existing services and identiy gaps.

Improve and harmonize data relevant to health workorce goals. Universities should

establish deinitions or relevant terms (e.g. disadvantaged students) and

identiy common data to be collected across university programs and health

proessions schools.

ii. the talent PiPeline

Crucial to the eort to recruit, train, and graduate more students in the health

proessions is improving the fow o students into health proession schools by

encouraging and preparing them rom a young age.

Urban universities should:

Identiy high-impact interventions. Evidence or pipeline programs is generally

strong, but less is known about the relative value o speciic interventions.

Universities should work with ederal agenciesincluding the National

Institutes o Health, the Health Resources and Services Administration, and

the National Science Foundationto reine and disseminate knowledge that

helps leaders to improve programs and direct resources appropriately.

Build on what works. Universities should be rigorous in deploying ev idence-basedstrategies or improving the pipeline to health proessions. Interventions that

are proven eectiveor example, post-baccalaureate programs in medicine

should be scaled-up or piloted in other ields where there is similar need.

Collaborate regionally. Some o the more innovative and promising health

workorce models are regional collaborationswith other universities,

K-12 systems, community colleges, local government, hospitals, and other

employers.

Partner with minority-serving institutions. Universities should consider speciic

strategies to link students at minority-serving institutions with advanced

health proessions education and training. While some are already engaged in

such partnerships, much more can and should be done.

Develop mechanisms to track pipeline participants longitudinally, and identiy

common measures to evaluate pipeline programs.


28/36

20

Urban

Universities

iii. recrUitMent anD aDMiSSionS

Institutions currently consider diversity and cultural competence in their

recruitment and admission strategies, but practices dier across health proessions

schools and are not consistently evaluated.

Urban universities should:

Align admissions practices with institutional goals. Health proessions leaders

should collaborate to provide consistency in support o an overarching vision,

to learn rom each others practices, and to optimize eorts across the board.

Consider adopting promising practices in admissions to promote diversity, including

holistic review, broadening the composition o admissions committees, and

requiring mandatory training o committee members.

Evaluate health proessions admission strategies and outcomes to make certain they

are eective and aligned with goals.

iv. cUltUral coMPetency

Universities are developing a number o innovations to attract and prepare

individuals with the background, qualities, and skills to improve health and

eliminate disparities. Nearly all are integrating cultural competence into their

programs, but they lack consistent denitions and ways to measure this trait or the

skill-sets associated with it.

Universities should:

Establish expectations or cultural competence that encompass campus climate,

institutional practices and policies, and education programs. o do so,

universities will need to deine cultural competence appropriate to their

mission and to identiy the results they seek.

Identiy learning outcomes or students and develop ways to measure the transer

o knowledge that enables graduates to eectively care or diverse populations.

Educate more students romand inthe communities where they are needed.

Evidence that health proessionals will more likely serve the communities they

come rom or the places where they train supports a place-based approach toworkorce development. A number o places where this is occurring, such as the

partnership between Cleveland State University and Northeast Ohio Medical

University, should be closely ollowed and their outcomes evaluated.

Work with local healthcare employers to improve the supply o culturally

competent graduates. he FIU oreign doctors to nurses program is a great

example o a local partnership that improved university oerings, while


29/36

21

Urban

Universities

meeting the needs o local employers and communities or health workers that

understand and can eectively serve South Floridas diverse communities.

v. gathering eviDence

Urban universities are creating and implementing solutions to develop a health

workorce that ameliorates health disparities. Tey have leveraged diverse

undingincluding their ownto sustain these eorts. In an environment

o increasingly tight budgets and accountability, better data is needed by both

institutions and policymakers to direct resources and investments to what works.

Members o the Coalition o Urban Serving Universities are well-positioned to

make headway in this area. Tey should:

Encourage well-designed evaluation studies to inorm health workorce eorts.

Federal partners should work with universities to und high-quality researchon health workorce interventions and disseminate the results. Institutions, or

their part, should publish more o their data so it can inorm the ield.

Partner with state workorce planners and others to ensure that a regular,

comprehensive analysis o local health workorce needs is available to guide

and evaluate university eorts.

Improve university data and inormation systems. Data collected and used to

measure progress on health workorce goals are largely inadequate. his lack o

evidence and a data eedback loop are barriers or leaders. Strengthening the

data inrastructure and processes to provide leaders with this capability should

be a top priority.

Develop learning communities.Eorts to improve data systems or to deine

common metrics would beneit rom a broader cooperative eort among

universities and health proessions schools. Similarly, universities and

policymakers should work together to identiy and target crucial areas where

evidence is lacking and can be improved.

I urban universities and their national partners work together we can make

greater progress in developing a health workorce that meets community needs.

Its imperative that our shared eorts evolvethat innovation becomes knowledgeand that this knowledge is translated into better and more strategic programs. In

the words o one university president: Our aim is to do whats important, better.


30/36

22

Urban

Universities

enDnoteS

Coalition o Urban Serving Universities, Urban Universities: Anchors GeneratingProsperity or Americas Cities () Retrieved rom http://www.usucoalition.org/

downloads/part/USU_White_Paper_Report_.pd

U.S. Department o Health and Human Services Agency or Healthcare Research and

Quality,National Healthcare Disparities Report: (AHRQ Publication No. -),(). Retrieved rom http://www.ahrq.gov/qual/nhdr/nhdr.pd

K.J. Bennett, B. Olatosi, and J.C. Probst, Health Disparities: A Rural-Urban Chartbook.(South Carolina Rural Health Research Center. ). Retrieved rom http://rhr.sph.sc.edu/report/(7-) percentHealth percentDisparities percentA percentRural

percentUrban percentChartbook percent- percentDistributionpercentCopy.pd

U.S. Census Bureau,An Older and More Diverse Nation by Midcentury ().Retrieved rom http://www.census.gov/Press-Release/www/releases/archives/population/.html

U.S. Census Bureau, Statistical Abstract o the United States, Population (). Retrieved

rom http://www.census.gov/prod/pubs/statab/pop.pd K. Grumbach and M. Rosalina, Disparities in Human Resources: Addressing

the Lack o Diversity in the Health Proessions, Health Afairs 27() ():-

; and . Goode et al., Te Evidence Base or Cultural and Linguistic Competencyin Health Care. (Washington, DC: National Center or Cultural Competence,

Georgetown University, ) available at http://www.cmw.org/usr_doc/Goode_evidencebasecultlinguisticcomp_.pd

7 B. Smedley, A. Butler, and A. Bristow, eds. In the Nations Compelling Interest: Ensuring

Diversity in the Nations Health Care Workorce (Washington, DC: National AcademiesPress, ).

Sullivan Commission,Missing Persons: Minorities in the Health Proessions. A Report othe Sullivan Commission on Diversity in the Healthcare Workorce (Durham, NC: Sullivan

Commission, ).

L. Sullivan and I. Suez Mittman, Te State o Diversity in the Health Proessions

a Century Ater Flexner.Academic Medicine () (February ). Retrieved romhttp://journals.lww.com/academicmedicine/Fulltext///Te_State_o_Diversity_in_the_Health_Proessions_a..aspx#P

U.S. Department o Health and Human Services, Improving Data Collectionto Reduce Health Disparities,(January , ). Retrieved rom http://www.

healthcare.gov/news/actsheets///disparitiesa.html; U.S. CensusBureau ().

D.J. Derksen and E. Whelan, Closing the Health Care Workorce Gap: Reorming Federal

Health Care Workorce Policies to Meet the Needs in the 21st Century. (Washington,D.C.: Te Center or American Progress. ) Retrieved rom http://www.

americanprogress.org/issues///pd/health_care_workorce.pd; and U.S.Department o Health & Human Services, Shortage Designation: Health ProessionalShortage Areas, Medically Underserved Areas/Populations. (). Retrieved rom http://bhpr.hrsa.gov/shortage/

U.S. Department o Health and Human Services. Designated Health Proessional

Shortage Areas Statistics. (June , ). Retrieved rom http://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR_

Smry&rs:Format=HML.


31/36

23

Urban

Universities

Association o American o Medical Colleges, Physician Shortages to Worsen Without

Increases in Residency raining(). Retrieved rom: https://www.aamc.org/newsroom/newsreleases//7/.html; and M.J. Dill and E.S. Salsberg.Te Complexities o Physician Supply and Demand: Projections through 2025 (Washington,DC: National Association o Social Workers Center or Workorce Studies, )Retrieved rom http://www.tht.org/education/resources/AAMC.pd

American Association o Colleges o Nursing,Nursing Shortage Fact Sheet ()Retrieved rom http://www.aacn.nche.edu/media/pd/NrsgShortageFS.pd

Institute o Medicine, Te Future o Nursing: Leading Change, Advancing Health ().Retrieved rom: http://www.theutureonursing.org/sites/deault/les/Future

percento percentNursing percentReport_.pd

Association o Schools o Public Health, Conronting the Public Health Workorce Crisis

() Retrieved rom http://www.asph.org/document.cm?page=

7 U.S. Department o Education (, ).

Health Reorm GPS.National Workorce Development Policy. () Retrieved romhttp://healthreormgps.org/resources/national-workorce-policy-development/

Grantmakers in Health, In the Right Words: Addressing Language and Culture in Providing

Health Care. () Retrieved rom http://www.gih.org/usr_doc/in_the_right_words_issue_brie.pd

J. H. Wilson and A. Singer, Immigrants in 2010 Metropolitan America: A Decade oChange. (Washington, DC: Metropolitan Policy Program at Brookings, ). Retrieved

rom http://www.brookings.edu/~/media/research/les/papers///%immigration%wilson%singer/_immigration_wilson_singer.pd

J. Betancourt, A. Green, et al. Dening Cultural Competence: A Practical Frameworkor Addressing Racial/Ethnic Disparities in Health and Health Care. Public HealthReports, ().

. Goode, et al. Te Evidence Base or Cultural and Linguistic Competency in HealthCare. (Washington, D.C.: National Center or Cultural Competence, Georgetown

University, ). Retrieved rom http://www.cmw.org/usr_doc/Goode_evidencebasecultlinguisticcomp_.pd

Coalition o Urban Serving Universities. American Urban Research Universities.(Washington, DC: USU, ).

K. Grumbach and M. Rosalina, Disparities in Human Resources: Addressing the Lacko Diversity in the Health Proessions, Health Afairs 27() ():-.

EPE Research Center, Cities in Crisis 2009: Closing the Graduation Gap: Educational andEconomic Conditions in Americas Largest Cities. (Washington, DC: Americas PromiseAlliance, ). Retrieved rom http://www.americaspromise.org/Our-Work/

Dropout-Prevention/Cities-in-Crisis.aspx

N. Freudenberg and J.Ruglis, Reraming School Dropout as a Public Health Issue,

Preventing Chronic Disease, 4() (7). Retrieved rom http://www.cdc.gov/pcd/issues/7/oct/7_.htm

7 Smedley et al. (); Sullivan Commission ()

M.R. Wilson, Administration and Leadership o the Health Proessions Partnership

Initiative: A Medical School Administrators PerspectiveAcademic Medicine, 81()(): -7; and C.L. Gilliss, D.L. Powell, and B. Carter, Recruiting andRetaining a Diverse Workorce in Nursing: From Evidence to Best Practices, Policy

Politics Nursing Practice, ():.

Smedley et al. (); Sullivan Commission ().


32/36

24

Urban

Universities

U.S. Department o Health and Human Services, Health Resources and Service

Administration, Bureau o Health Proessions, et al., Pipeline Programs to ImproveRacial and Ethnic Diversity in the Health Proessions: An Inventory o Federal Programs,Assessment o Evaluation Approaches, and Critical Review o the Research Literature.()

Retrieved rom: http://bhpr.hrsa.gov/healthworkorce/reports/RecruitReport.pd

K. Grumbach and E. Chen. Eectiveness o University o Caliornia Post-baccalaureate Premedical Programs in Increasing Medical School Matriculation orMinority and Disadvantaged Students. Journal o the American Medical Association,

() (): 7-; and D.A. Andriole and D.B. Jee. Characteristics o MedicalSchool Matriculants who Participated in Post-baccalaureate Premedical Programs.Academic Medicine. () (): .

K. Lupton, C. Vercammen-Grandjean, E. Wilson, and K. Grumbach. Specialty Choiceand Practice Location o Physician Alumni o the University o Caliornia. Academic

Medicine. 7()(): .

Sullivan Commission ().


33/36


34/36


35/36


36/36

Documents

Urban Universities: Developing a Health Workforce that Meets Community Needs