Underrepresented Individuals Research Articles

Professional identity formation, intersectionality and equity in medical education.

A great many factors interlink to produce barriers, opportunities and enablers at every stage of the education continuum that produce considerable potential for inequity.1,2 While one individual may receive privilege in terms of financial, support and educator guidance, the other may face financial hardship and discrimination in the journey to reach the same objective of being a healthcare practitioner. Even at an organizational level medical training dynamically constitutes many different models of education that help define the features of learners, setting the path for their future careers.3 The impact of this variety of experience has been particularly noticeable in 2020 as the events of the year in relation to under-represented individuals have caused shockwaves throughout the world that have sharply called into question the ways in which health professional education addresses race and ethnic inequalities.

The Influence of Diversity and Qualifications in Presidential Nominations: The Case of United States Attorneys

In this project, we employ original data on the future positions of United States Attorneys (USAs) to assess the influence of formal qualifications in structuring the post-service careers of a group of elite political figures. Compared to USAs who are white men, we find that presidents are significantly more likely to nominate USAs who are females or minorities to positions on the federal bench and in the upper federal bureaucracy. In other words, and after controlling for a number of additional individual-level differences, we find the same professional credential—service as a USA—to be more advantageous in the context of nomination to these positions for traditionally underrepresented individuals than for white men. We also find that more fine-grained qualifications influence the likelihood of promotion; in some instances, those individual qualifications also operate differently across demographically traditional and nontraditional nominees.

Abstract IA14: Emerging priorities for the Center to Reduce Cancer Health Disparities in diversity workforce training and cancer health disparities research

Abstract This panel presentation will provide an overview of the current training and research funding priorities at National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD). CRCHD is NCI's focal point for the training of competitive cancer researchers from diverse populations and supporting cancer health disparities research across the cancer continuum. The NCI's CRCHD's Continuing Umbrella of Research Experiences (CURE), Intramural CURE (iCURE), and the Partnerships to Advance Cancer Health Equity (PACHE) will be highlighted as successful models for diversity training and cancer health disparities research. The CURE Program supports extramural research training and education experiences for under-represented individuals beginning in middle school and continuing through to first academic appointment. The newly launched iCURE Program supports mentored research experiences within the NCI Intramural Research Program for students and fellows. In addition, the PACHE Program supports cancer and cancer health disparities research, education, and outreach through partnerships between Minority-Serving Institutions and NCI-designated Cancer Centers. New and established NCI funding opportunities in cancer health disparities research, including opportunities supporting both basic and translational research addressing cancer health disparities, will also be presented. Additionally, strategies will be explored for navigating successful cancer research careers and for developing competitive grant applications. Citation Format: Sanya A. Springfield. Emerging priorities for the Center to Reduce Cancer Health Disparities in diversity workforce training and cancer health disparities research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA14.

Abstract IA01: How the National Cancer Institute is working to reduce cancer health disparities

Abstract Disparities in cancer incidence and mortality among members of racial/ethnic minority groups continue to be a daunting public health challenge. While cancer disparities have been well documented, further efforts are needed to understand the factors that cause these disparities and to develop interventions. The National Cancer Institute (NCI) has had programs dedicated to addressing disparities for more than two decades, which now pursue a multipronged approach. Among the most recent NCI efforts is a stipulation included in all Cancer Moonshot funding opportunities that requires applicants to include information on how they will integrate data on populations affected by disparities or data on these populations into the proposed study. The Cancer Moonshot also includes specific disparities-related components, including those to fund the development of preclinical research models and screening programs that target specific racial/ethnic populations. More longstanding NCI efforts include those supporting a portfolio of studies, from basic to translational, that are unmasking biologic, socioeconomic, and cultural factors that contribute to disparities and identifying ways to directly address those factors through precision medicine and other approaches. Recent examples include the RESPOND study, which is focused on better understanding prostate cancer disparities in African American men. Other NCI programs are aimed at increasing the participation of people who are members of racial/ethnic minority groups in clinical studies, including innovative precision medicine studies. These include the NCI Community Oncology Research Program and the Partnerships to Advance Cancer Health Equity program that supports collaborations among institutions that serve large underserved populations and NCI-designated Cancer Centers. NCI also supports programs intended to improve the participation of under-represented populations in the cancer research and clinical workforce. This is helping to ensure that people from varied backgrounds can contribute their viewpoints and experiences to the cancer research enterprise and further deepen the talent pool from which research institutions can draw. From a clinical perspective, improving the diversity of clinicians/researchers can also improve trust among patients from racial/ethnic minority groups, which in turn can help increase the likelihood that these patients will consider participating in clinical studies. NCI programs that are helping to improve the diversity of the cancer workforce include the Continuing Umbrella of Research Experiences (CURE) that supports extramural research training and educational experiences for underrepresented individuals beginning in middle school and continuing through to first academic appointments through individual (F31 and K awards) and institutional (R25) grants, as well as the iCURE program that provides mentored research experiences within the NCI Intramural Research Program for students and fellows. Additional awards aid early-stage investigators in establishing themselves as independent investigators in the laboratory and clinical settings (R37, K23) and promote workforce diversity in basic cancer research (R21). Citation Format: Norman E. Sharpless. How the National Cancer Institute is working to reduce cancer health disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA01.

Abstract C041: Complexities of hereditary breast cancer: Investigating a large African American family

Abstract Breast cancer (BC) is a very serious health concern being the second most commonly diagnosed cancer among American women. Although the overall incidence rate of BC in African American (AA) and European American women converged in 2012, AA women are reported to have a higher mortality rate at every age, and a higher incidence rate under the age of 45, which is a hallmark of hereditary BC. Characteristics of hereditary BC include a family history of the disease, early ages of onset, bilateral BC, male BC, as well as the occurrence of other associated cancers such as ovarian and prostate. Cancer incidences in these families are influenced by inherited risk factors; currently, mutations in known susceptibility genes, including BRCA1/2, explain ~20-30% of hereditary cases, leaving up to ~70% genetically unsolved. Despite the universal need to decipher the currently unexplained cases, it is important to note that these statistics are mainly the result of studying individuals of European descent. The mutational landscape that explains AA hereditary BC is more obscure since, comparatively, it has been vastly understudied. Recognizing this knowledge gap, our group is committed to adding to the current limited resources necessary to better understand AA BC genetics. We are doing this through a strategic community-based recruitment protocol to enroll underrepresented individuals in Alabama, adding to the Alabama Hereditary Cancer Cohort. With over 150 AAs enrolled to date, we have ascertained some impressive AA BC families. Of those families, Family 1CAD is one of the largest with over 15 family members enrolled. Their participation was fostered through an invitation to their family reunion. There, it was disclosed that a deceased family member had a pathogenic BRCA1 mutation (p.M1796R). Therefore, all participating family members were first screened for the BRCA1 mutation through polymerase chain reactions and Sanger sequencing; interestingly, not all cancer-affected individuals screened positive for this mutation. Therefore, five cancer-affected individuals (three mutation-positive and two mutation-negative) were selected and screened using an exploratory research-based gene panel that targets genes that have been suggested, predicted, or clinically proven to be associated with BC and associated cancers. Firstly, this screening confirmed each individual’s mutation status. It also provided additional insight; for example, all three cancer-affected individuals who have BRCA1 M1796R also share a truncation variant in a candidate gene on the panel, which plays an important role in cell cycle regulation (GeneX). A preliminary analysis using AA BC cases from The Cancer Genome Atlas and ethnic-specific controls from the Exome Variant Server, suggests that truncation variants in GeneX are associated with AA BC risk. We are in the process of validating these findings and determining how this truncation variant modifies risk in BRCA1 mutation carriers. Citation Format: Sophonie Omeler-Fenaud, Madison Bishop, Elizabeth Stallworth, Isaac McNeely, Nancy Merner. Complexities of hereditary breast cancer: Investigating a large African American family [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C041.

Applying an educative approach to engage stakeholder values in evaluations of STEM research and education programmes

Stakeholder values regarding a programme’s worth and their own principles or standards can aid or impede an evaluation. The evaluator’s challenge and responsibility is to successfully engage multiple stakeholder value orientations in the evaluation process. Stakeholder engagement is essential within evaluations of programmes aimed at broadening participation of underrepresented individuals and institutions in science, technology, engineering and mathematics (STEM). This article describes an educative approach to engage stakeholder values within evaluations of STEM research and education programmes funded by the U.S. National Science Foundation (NSF). Reflections and implications for evaluation theory and practice applicable to any STEM evaluation context, and more broadly to the field of evaluation, are discussed.

Why Bias Matters in Medicine: Qualitative Insights from Anonymous, Online Reports

PurposeBias has been shown to influence the experience and mental health of healthcare professional trainees and faculty in academic medicine. The authors investigated the character and impact of self-reported bias experiences sustained in the academic medical arena that were submitted anonymously online to the website SystemicDisease.com. MethodThis qualitative study analyzed 22 narratives submitted online to SystemicDisease.com between September 2015 and March 2017. Both deductive and inductive content analysis was performed, using a combination of a priori axial and open coding. ResultsThe most commonly reported biases occurred on the basis of race and/or gender. Multiple submitters indicated this bias had influenced or threatened their intended career trajectory. Healthcare professional trainees also expressed altruistic concerns toward other underrepresented individuals as well as toward patients from disadvantaged backgrounds. ConclusionRacial and gender bias constitute a considerable barrier for trainees and professionals in academic medicine. Institutional awareness of these impacts can inform interventions designed to foster a more inclusive professional climate.

Is Community-engaged Learning Possible During a Pandemic: A Call for Culturally Competent Medical Education.

This article was migrated. The article was marked as recommended. Previously, medical school curriculum focused on faculty or physician-led basic science and traditional clinical experiences, with medical students only gaining experience of the community in which they practice during residency. In an effort to enable students to understand US healthcare disparities, the introduction of public health topics regarding marginalized communities and underrepresented individuals have been included in the classroom. However, missing from this shift is the inclusion of authentic public health educational experiences for medical students. These learning experiences are vital to truly understanding the marginalized and discriminated patient populations physicians will encounter. The recent COVID-19 pandemic has brought forth challenges for medical educators in numerous ways including how to effectively prepare students in understanding cultural competency through community-engaged learning for a new set of patient population; the pandemic patient. Due to health disparities, each patient experienced this pandemic differently based on their individual, cultural and community setting; also highlighting the importance of community-engaged learning. Here, the authors posit the role and importance of community-engaged learning in medical education and its utilization during the changing medical landscape due to COVID-19.

Governance of Voice in Digital Platforms

We study the governance of voice in digital platforms in light of contestations and struggles over meaning and resources among their stakeholders. In particular, we argue that social media platforms as fields are subject to power imbalances that might constrain the voices of marginalized and under-represented individuals and groups. Consequently, the governance decisions that private firms (i.e. platform owners) undertake are critical in providing users and communities with the capacity to self-present and identify. Through a qualitative longitudinal study of a popular social media platform, we study the means through which a marginalized community leverages the governance tools at its disposal to overcome the contestation within the platform. We present implications for the governance of digital platforms and their evolution.

Diversity and Inclusion in Unregulated mHealth Research: Addressing the Risks

mHealth devices and applications, with their wide accessibility and ease of use, have the potential to address persistent inequities in biomedical research participation. Yet, while mHealth technologies may facilitate more inclusive research participation, negative features of some unregulated use in research - misleading enrollment practices, the promotion of secondary mHealth applications, discriminatory profiling, and poorer quality feedback due to dependencies on biased data and algorithms - may threaten the trust and engagement of underrepresented individuals and communities. To maximize the participation of currently disenfranchised groups, those involved in unregulated mHealth research must become aware of potential risks, adopt targeted education policies, audit algorithms for hidden biases, and engage citizen scientists and other community members to identify and forestall possible harms.

Long-term tracking demonstrates effectiveness of a partnership-led training program to advance the careers of biomedical researchers from underrepresented groups.

The demographic profile of the biomedical workforce in the U.S. does not reflect the population at large, raising concerns that there will be insufficient trained researchers in the future, and the scope of research interests will not be sufficiently broad. To diversify and expand the pool of researchers trained to conduct research on cancer and cancer health disparities, a series of training activities to recruit and train primarily Hispanic students at both the undergraduate and graduate level were developed. The strengths of both a Hispanic Serving Institution and an NIH-designated Comprehensive Cancer Center were leveraged to develop appropriate research training and professional development activities. The career progression of the participants and degree completion rates was tracked, along with persistent interest in biomedical research in general and cancer and cancer health disparities research in particular for these underrepresented individuals. Finally, this report demonstrates that these training activities increased general knowledge about cancer among participants.

I can see myself enjoying that: Using imagery perspective to circumvent bias in self-perceptions of interest.

People experience life satisfaction when pursuing activities that genuinely interest them. Unfortunately, cultural stereotypes (e.g., "science is not for girls") and preexisting self-beliefs can bias people's memories, thereby hindering their ability to identify the domains that they actually experience as interesting. The current experiments tested a novel method for circumventing this problem by manipulating visual imagery perspective as people recalled their experiences. Four experiments measured (or manipulated) participants' actual experience of interest as they completed a task; the experiments also measured (or manipulated) participants' self-beliefs about their interest in the domain. The experiments then manipulated imagery perspective as participants recalled their interest in the task. Prior research suggests that imagery from an actor's first-person perspective facilitates a bottom-up processing style, whereas imagery from an external third-person facilitates a top-down processing style (Libby & Eibach, 2011). Consistent with this account, across all 4 experiments, first-person imagery (vs. third-person) caused people's recall to be less biased by the top-down influence of their self-beliefs and better aligned with their past experienced interest. The final experiment demonstrated downstream consequences of these effects on female undergraduates' intentions to pursue future activities in a domain (STEM) that negative stereotypes typically might dissuade them from pursuing. Thus, the present results suggest that first-person imagery can be a useful tool to reduce the influence of biased self-beliefs, while increasing sensitivity to past bottom-up experiences during recall. Further, these results hold practical implications for reducing psychological barriers that can keep underrepresented individuals from pursuing interests in counterstereotypical domains. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Microaggressions in Clinical Training and Practice.

Microaggressions in Clinical Training and Practice.

Working the Margins of Community-Based Adult Learning: The Power of Arts-Making in Finding Voice and Creating Conditions for Seeing/Listening by S. Butterwick and C. Roy

Working the Margins of Community-Based Adult Learning is a well-rounded example of how art and creative forms of expression can influence, aid, and elevate transformative learning in community-based adult education. Specifically, the authors Shauna Butterwick and Carole Roy use an edited book format in a cohesive way to “gather stories from the margins and explore how various art and creative forms of expression can enable the voices of underrepresented individuals and communities to take shape and form” (p. ix).

Manifestation of Sexual Minority Identity in First‐Year Medical Students

How do sexual minority medical students navigate their first year of medical school? How do their sexual identities affect this learning environment and wellness? Two theories about underrepresented individuals offer general perspectives to social experiences. Queer theory establishes that sexual identity is a vital part of the human experiences, while minority stress theory indicates that minorities experience higher levels of stress in situations than their majority counterparts. How can these theories be used to be proactive and supportive of sexual minority students? This qualitative research examines first‐year sexual minority medical students at Indiana University School of Medicine–Bloomington as they experience encounters with peers, instructors and LGBTQA+ specific curriculum. This research was approved by the Indiana University Institutional Review Board (IRB # 1810842950). Each sexual minority medical student volunteer completed 2 interviews about their experiences and were observed during a classroom activity. Thematic analysis of field notes and interview transcripts was performed. Five major themes of identity manifestation were identified and will be discussed in this poster: Advocacy, Representation, Ignorance/Disrespect, Heteronormativity, and Humor. A model for manifestation of LGBTQA+ identity in medical school is also proposed using the tenets of queer and minority stress theories. Understanding the unique experience of sexual minority medical students may provide instructors with more tools to better assist students during a major life transition.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

An Institutional Coordinated Plan for Effective Partnerships to Achieve Health Equity and Biomedical Workforce Diversity

The rapid growth and accumulation of specialized knowledge in today’s biomedi­cal fields, combined with entrenched and emerging health issues that persist among certain groups within the US population, emphasizes the significant need to diversify the nation’s biomedical science workforce. The under-representation of minorities in science results in inadequate scientific input from divergent social or cultural perspec­tives and detracts from our nation’s ability to resolve health disparities. The University of North Texas Health Science Center at Fort Worth has developed a coordinated approach with local, regional, and na­tional partners to increase participation of underrepresented students along the career pathway from K-12 to faculty level. Career stage specific activities that include research, mentoring, networking, career development, grantsmanship and health disparities curriculum are provided for participants. Successful outcomes from our coordinated plan includes an increase in participant self-efficacy, research presenta­tion awards, increase in grant awards and publications, and career advancement. Through partnerships within our institution, local school districts, and minority serving institutions nationwide, our coordinated plan provides mutually beneficial co-learning experiences to increase the number of under-represented individuals entering translational research focused on increasing the biomedical research workforce diversity and achieving health equity. Ethn Dis. 2019;29(Suppl2):129-134); doi:10.18865/ ed.29.S1.129.

An Institutional Coordinated Plan for Effective Partnerships to Achieve Health Equity and Biomedical Workforce Diversity.

The rapid growth and accumulation of specialized knowledge in today's biomedical fields, combined with entrenched and emerging health issues that persist among certain groups within the US population, emphasizes the significant need to diversify the nation's biomedical science workforce. The under-representation of minorities in science results in inadequate scientific input from divergent social or cultural perspectives and detracts from our nation's ability to resolve health disparities. The University of North Texas Health Science Center at Fort Worth has developed a coordinated approach with local, regional, and national partners to increase participation of underrepresented students along the career pathway from K-12 to faculty level. Career stage specific activities that include research, mentoring, networking, career development, grantsmanship and health disparities curriculum are provided for participants. Successful outcomes from our coordinated plan includes an increase in participant self-efficacy, research presentation awards, increase in grant awards and publications, and career advancement. Through partnerships within our institution, local school districts, and minority serving institutions nationwide, our coordinated plan provides mutually beneficial co-learning experiences to increase the number of under-represented individuals entering translational research focused on increasing the biomedical research workforce diversity and achieving health equity.

Female and minority experiences in an astronomy-based science hobby

Despite policy changes and targeted outreach, issues of underrepresentation persist for women and minorities in science fields. Previous research has explored extrinsic motivational factors for underrepresented groups in both formal educational settings. However, little research has investigated intrinsic motivation within informal educational experiences like active participation in free choice learning activities like a science-based hobby. Interviews were conducted with 17 astronomy hobbyists who self-identified as under-represented individuals (race, ethnicity and gender). Respondents’ hobby experiences and motivational aspects emerged from analysis of the descriptive accounts provided by the interviews. Findings suggested there was a positive relationship between the degree of hobby participation and number of challenges presented in various phases of hobby growth. Additionally, disparities in sampled minorities’ access to authentic Science, Technology, Engineering, and Mathematics (STEM) experiences served as a factor influencing their hobby motivation and subsequent development. Other factors that influenced minority engagement included differential participation in hobby clubs, lack of access to mentors, and the delay of active hobby participation until adulthood. Findings suggest science hobbies as an avenue to motivate underrepresented groups in science interests. This information may prove useful in guiding next steps regarding policy and research in the under-representation of women and minorities in STEM hobbies and STEM careers alike.

Iron Sharpens Iron: A Student’s Perspective on Diversity Outreach

POWER (Providing the Outside World with Empowerment and Resources), a student organization within the Texas Tech’s Collegiate Recovery Program established December 2015, elaborated on their members experience when engaging in the important effort of diversity outreach to persons in recovery from substance and alcohol use disorders and eating disorders. POWER describes their mission statement to provide a foundation and a voice for underrepresented individuals in recovery by delivering positive end results through opportunities for success with a vision to instill hope for a promising future. These members along with the director of the CCRC and another staff member shared what they have found to be most effective and ineffective when presenting to diverse groups in their community. The presenters provided educational and recovery resources used in reaching out but also the varying and tailored approaches and techniques utilized when conducting outreach work to specific marginalized populations. These materials and techniques have been honed through many presentations and experience since 2015. During their presentation, student leaders, and members of POWER, shared their own personal experiences of marginalization as well as their experience as presenters/peer leaders.

Developing Sustainable Methods for Broadening Participation by Transforming Mainstream Science and Technology Communities Through the Normalization of Inclusion

Advances in science and technology (S&T) have fueled significant progress in modern society, creating greater demand for a skilled workforce. An important source for S&T talent is being missed due to the loss in greater numbers of people from underrepresented backgrounds such as women, ethnic and racial minorities, and people with disabilities. Progress has been realized in supporting underrepresented individuals (URIs) in S&T by creating strong support systems through same-identity or minority–majority communities such as the Grace Hopper Celebration of Women in Computing, Tapia Celebration of Diversity in Computing, Association of Women in Mathematics, Society of Women in Engineering, the Society of Chicanos and Native Americans in Science, and many more. And yet there is a significant gap between the potential URIs in the S&T workforce and their actual presence. The time has come to expand diversity and inclusion efforts in mainstream scientific communities where professional lives and careers are played out. However, for real change to occur, we cannot just support the underrepresented; we need to transform mainstream communities into places where everyone is not just welcome but is thriving and productive. The easy part of this equation is to apply evidence-based methods for supporting URIs in mainstream communities. The hard part is transforming communities through education, empirical experiences, and sustained efforts that result in tangible benefits to all. This article explores issues and posits potential approaches to develop sustainable methods for broadening participation by transforming mainstream S&T communities through the normalization of inclusion.