Accounting for the High Enrollment of African Americans on Winship Cancer Institute's Myeloma Clinical Trials

Background

Thirty-four percent of Multiple Myeloma (MM) clinical trial participants at Winship Cancer Institute (Winship) are African American (AA); however, AAs make up only 4.5 percent of myeloma clinical trial participants in the United States. Given our high enrollment, we aimed to measure AAs' trust in providers and identify if clinical trial enrollment barriers exist.

Methodology

A member of the ethics research team surveyed AA patients who had consented to a MM clinical trial at Winship. Three validated surveys were used: Trust in Medical Research (TMR); Human Connection (THC) which measures how much patients feel they are heard and valued by their physicians; and the Duke Intrinsic Religiosity Scale (DUREL) which measures strength of religious engagement and belief. The survey also included questions about the impact of side effects, distance to the trial center and trial related costs on the decision to participate in clinical trial.

Results

Ninety-two percent (61/67) of patients approached consented. The mean TMR score and the mean THC score were significantly higher (P-value < 0.001) than the results obtained in key national surveys (TMR 14.9 compared to 11.65; THC 57.7 compared to 54.6). These two surveys were significantly correlated, meaning trust and human connection increase or decrease in tandem. The 3 religiosity subscale results showed high religiosity (3.84, 4.36, and 4.35 with 5 being the highest score). The mean scores of the importance of the investigational agent's side effects, trial costs, and distance to trial center on the decision to enroll in a clinical trial were also high (8.5, 7.8, and 6.5, respectively, with 10 being the most important).

Conclusion

In our study population, high trust and human connection overcame other trial participation barriers: strong religious beliefs and concerns about side effects, costs, and travel distance. We present a roadmap to guide investigators to increase human connection, and hopefully trust.

Racial and Socioeconomic Disparities in Neurotrauma: Research Priorities in the New York Metropolitan Area through a Global Neurosurgery Paradigm

The New York Neurotrauma Consortium (NYNC) is a nascent multidisciplinary research and advocacy organization based in the New York Metropolitan Area (NYMA). It aims to advance health equity and optimize outcomes for traumatic brain and spine injury patients. Given the extensive racial, ethnic, and socioeconomic diversity of the NYMA, global health frameworks aimed at eliminating disparities in neurotrauma may provide a relevant and useful model for the informing research agendas of consortia like the NYNC. In this review, we present a comparative analysis of key health disparities in traumatic brain injury (TBI) that persist in the NYMA as well as in low- and middle-income countries (LMIC). Examples include: (a) inequitable access to quality care due to fragmentation of healthcare systems, (b) barriers to effective prehospital care for TBI, and (c) socioeconomic challenges faced by patients and their families during the subacute and chronic post-injury phases of TBI care. This review presents strategies to address each area of health disparity based on previous studies conducted in both LMIC and high-income country (HIC) settings. Increased awareness of healthcare disparities, education of healthcare professionals, effective policy advocacy for systemic changes, and fostering racial diversity of the trauma care workforce can guide the development of trauma care systems in the NYMA that are free of racial and related healthcare disparities.

Mentoring Experiences and Publication Productivity among Early Career Biomedical Investigators and Trainees

Objective

To identify which mentoring domains influence publication productivity among early career researchers and trainees and whether publication productivity differs between underrepresented minority (URM) and well-represented groups (WRGs). The mentoring aspects that promote publication productivity remain unclear. Advancing health equity requires a diverse workforce, yet URM trainees are less likely to publish and URM investigators are less likely to obtain federal research grants, relative to WRG counterparts.

Methods

A mentoring-focused online follow-up survey was administered to respondents of the NRMN Annual Survey who self-identified as mentees. Publications were identified from a public database and validated with participant CV data. Bivariate and multivariate analyses tested the associations of publication productivity with mentoring domains.

Results

URM investigators and trainees had fewer publications (M = 7.3) than their WRG counterparts (M = 13.8). Controlling for career stage and social characteristics, those who worked on funded projects, and received grant-writing or research mentorship, had a higher probability of any publications. Controlling for URM status, gender, and career stage, mentorship on grant-writing and funding was positively associated with publication count (IRR=1.72). Holding career stage, gender, and mentoring experiences constant, WRG investigators and trainees had more publications than their URM counterparts (IRR=1.66).

Conclusions

Grant-writing mentorship is particularly important for publication productivity. Future research should investigate whether grant-writing mentorship differentially impacts URM and WRG investigators and should investigate how and why grant-writing mentorship fosters increased publication productivity.

The Role of Public Health Partnerships in the Success of the Jackson Heart Study Undergraduate Training and Education Center

Background

The Jackson Heart Study (JHS) is a single-site prospective epidemiologic investigation of cardiovascular disease (CVD) among African Americans from the central Jackson, Mississippi area. The study is a collaboration between Jackson State University (JSU), University of Mississippi Medical Center (UMMC), Tougaloo College (TC), and the Mississippi State Department of Health (MSDH). The JHS Undergraduate Training and Education Center (JHSUTEC) at TC was developed to increase the numbers of college-aged African American students entering public health and health-related fields. To achieve this goal, the UTEC designed the Jackson Heart Study (JHS) Scholars program.

Methods

JHS Scholars are required to take additional classes and participate in public health and/or biomedical research. The scholars engage in research locally during the academic year. However, many scholars participate in research outside of the Jackson Metropolitan area during the summer. Because of this, national collaborators were needed to act as mentors and hosts.

Results

Since the inception of the JHSUTEC, more than 15 collaborations have been formed that have shared resources and student successes. As of May 2018, more than150 students have successfully completed the JHS Scholars program and many have continued into careers in public health, biomedical research, and medicine. Since 2004, JHS scholars have published 29 papers and 15 scholars have received diversity supplements.

Conclusion

Collaborative activities and public health partnerships have contributed to the success of the JHSUTEC program and have served as a pathway of entry into STEM fields for minority students.

Disparities Elimination Summer Research Experience (DESRE): An Intensive Summer Research Training Program to Promote Diversity in the Biomedical Research Workforce

The Disparities Elimination Summer Research Experience (DESRE) was created to provide hands-on health equity research training opportunities to undergraduate and graduate students, particularly those from backgrounds underrepresented in biomedical research. Funded by NIH's National Institute on Minority Health and Health Disparities, a total of 22 students participated in 4 annual cycles of an intensive, 6-week, full-time, residential research training program consisting of didactics, community immersion experiences, peer mentoring, ethics training, and hands-on health disparities research. Demand for the program was high; by the 4th year of implementation, more than 500 applications were received for the cohort's six slots. More than half of DESRE participants came from minority-serving institutions and/or identified as a member of a minority group. Students reported a significant increase in self-reported competency across all of the program's 26 learning objectives from pre- to post-assessment. Further, the program had a 77% success rate in promoting a career in biomedical research and/or health disparities elimination, including 100% of minority participants either entering a graduate program and/or entering careers focused on health equity. Key success factors and lessons learned are discussed.

Training the Next Generation of Health Equity Researchers: Exploring STEM Pathways and Best Practices

Training the Next Generation of Health Equity Researchers: Exploring STEM Pathways and Best Practices

Self-Efficacy as an Indicator for Success in a Premedical Curriculum for Underrepresented Minority High School Students

CONTEXT

The Aspiring DOctors PreCollege Program at the Ohio University Heritage College of Osteopathic Medicine Cleveland Campus is unique among other precollege pipeline and mini-medical school programs in that it engages learners from urban underserved communities for an entire academic year as a cocurricular adjunct to their high school course load. One day per month, students are brought to the medical college campus and introduced to the field of osteopathic medicine. Students also participate in activities related to preparing for college admissions, diversity in higher education, mental health and wellness, and financial stewardship. All these activities are done with the goal of increasing the number of underrepresented minority (URM) students in the health care professions.

OBJECTIVE

Self-efficacy has been identified as a measure of internal motivation and belief in one's ability to succeed in the face of challenges. The purpose of this study is to determine what effect, if any, participation in this program has on URM student self-efficacy.

METHODS

Students were asked to complete a validated self-efficacy questionnaire at the start and end of this program to determine their levels of self-efficacy and if there were changes after participating in this program.

RESULTS

Ten of the 12 seniors completed pre- and post-self-efficacy surveys. Two main discoveries were made through this pilot. First, when tested at the beginning of the program, all students had high levels of self-efficacy (mean score, 4.45 of 5). Second, 2 items were specifically increased by a statistically significant amount. The students increased in self-efficacy concerning the responses "I can learn what is being taught in class this year" (P = .024) and "My ability grows with effort" (P = .015).

CONCLUSIONS

With the competitive standards of acceptance into the Aspiring DOctors PreCollege Program, students enrolled in this program had high levels of self-efficacy from the onset. While there was modest increase across the board, many of these indicators remained consistently high after the program. Using self-efficacy as a screening tool for premedical students may be helpful in identifying candidates likely to succeed in a future medical career.

Building the Network of Minority Health Research Investigators: A Novel Program to Enhance Leadership and Success of Underrepresented Minorities in Biomedical Research

Background

To address the myriad of health problems and disparities that affect the United States (US) population, the mix of health care professionals and researchers must reflect the full diversity of the nation. There continues to be discrepancy between the number of trained scientists and biomedical researchers from underrepresented populations relative to the overall population. A scarcity of formal and informal networking opportunities for minority researchers and health care providers contribute to this lack of diversity.

Objective

The purpose of this article is to report the outcomes of an established junior minority faculty mentoring program. The Network of Minority Health Research Investigators (NMRI) was established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in 2002. We present outcome data from 2008 to the present.

Methods

The Oversight and Planning Committees of the NMRI developed an 18-question survey. The NMRI program analyst conducted a pilot test of the survey and made modifications to ensure readability and understanding. From 2008 - 2018, we administered the survey in both paper and electronic versions to junior and senior members of NMRI. Descriptive results identified the participants. We used open coding to extrapolate recurring statements, words, and themes that were organized into four final categories: reasons for attending NMRI; mentoring; career development; and social support.

Results

Participants were primarily post-doctoral researchers or assistant professors seeking promotion to instructor or associate professor with tenure (64%). Consistent reasons for participating in the Network included: career development; emotional support; mentorship for research; developing or refining skills for grant writing; lab management; poster presentations; and applying for tenure. Areas of research interest included diabetes, kidney diseases, nutrition, obesity, and bioinformatics.

Conclusions

While the number of responses to the survey varied annually, the qualitative results suggest that career development and social support provided through the Network were the largest motivators for participation.

Underrepresented Minority Dentists: Quantifying Their Numbers And Characterizing The Communities They Serve

The underrepresentation of Blacks, Hispanics or Latinos, and American Indians or Alaska Natives among dentists raises concerns about the diversity of the dental workforce, disparities in access to dental care and in oral health status, and social justice. We quantified the shortage of underrepresented minority dentists and examined these dentists' practice patterns in relation to the characteristics of the communities they serve. The underrepresented minority dentist workforce is disproportionately smaller than, and unevenly distributed in relation to, minority populations in the United States. Members of minority groups represent larger shares of these dentists' patient panels than of the populations in the communities where the dentists are located. Compared to counties with no underrepresented minority dentists, counties with one or more such dentists are more racially diverse and affluent but also have greater economic and social inequality. Current policy approaches to improve the diversity of the dental workforce are a critical first step, but more must be done to improve equity in dental health.

Recognizing and Reckoning With Unconscious Bias: A Workshop for Health Professions Faculty Search Committees

INTRODUCTION

As part of national efforts to reduce disparities in access to care, health professions schools have committed to increasing the proportion of faculty members from underrepresented minority groups. Responsibility for recruiting and vetting candidates for faculty positions, however, tends to rest in decentralized search committees that may receive no training in the science of human judgment. Simply as a product of living in a stratified culture, we form unthinking stereotypes about certain groups of people. Fortunately, when people become sensitized to their unconscious biases, they can minimize cognitive errors.

METHODS

This 2-hour workshop is designed to introduce health professions faculty search committee members to the concept of unconscious bias and to spur reflection on how it can influence the decisions they make. In small-group activities, participants create and test materials that can facilitate their efforts to hire qualified candidates.

RESULTS

Search committee members who attended the workshop consistently rated it somewhat or very helpful in carrying out their roles. At one institution, the proportion of faculty members from underrepresented minority groups has increased each year that the workshop has been implemented.

DISCUSSION

The modules follow the work flow of a typical search process and are generalizable to any health professions department. While the challenge of diversifying the faculty involves many factors external to a university, calling search committee members' attention to unconscious bias is a strategy that faculty affairs officers can control.