Journal of Genetic Counseling, Vol. 2, No. 3, 1993
Minority Recruitment into the Genetic Counseling Profession Stephanie C. Smith, 1,4 Nancy Steinberg Warren, 2 and Lavanya Misra 3
In the past, genetic counseling training programs have had an abundance of applicants for the number of slots available. They have, however, had a very limited pool of minority applicants. At the June 1992 meeting of the genetic counseling training programs directors the topic of minority recruitment was explored. The resources and recommendations that resulted from this discussion can be used by other medical training programs. KEY WORDS: minority recruitment; genetic counseling training.
For several years there has been a continuous discussion about the shortage of trained genetic counselors. Some institutions have positions that have been unfilled for months and were then filled by persons who are not trained genetic counselors. Other institutions, especially in areas where the patient population is primarily of one ethnic group, have created positions to assist the genetic counselors. (The job titles for these positions are diverse. Examples are genetic assistants and genetic aides.) As we discuss the shortage of professionals practicing in underserved areas (which are mainly in areas where the majority of the population in other settings are classified as minorities) we need to examine who are underserved, why they are underserved and ways that we can overcome this shortage. 1Department of Preventive Medicine, University of Mississippi School of Medicine, Jackson, Mississippi. 2Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio. 3St. Lukes/Roosevelt Hospital, New York, New York. 4Correspondence should be directed to Stephanie C. Smith, Department of Preventive Medicine, University Medical Center, 2500 North State St., Jackson, Mississippi 39216-4505~ 171 1059-7700/93/0900-0171507.00/19 ]993 NationalSocietyof GeneticCounselors,Inc.
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Table I. /dinorityDefined Ethnic group
U.S. government
Geneticcounseling
(African descent) Includes Caribbean, Black-Hispanics, Haitian-Americans, etc.
yes
yes
Hispanics
(Spanish descent) Includes Puerto-Ricans, Mexican-Americans, Central and South Americans
yes
yes
Native Amerleans Includes American Indians, Eskimos,or Aleut
yes
yes
Aslan or Pacific Islander
yes
yes
Only if of a defined
yes
African-American
Males
minority group
Data from the 1990 United States Census Bureau revealed that there was an overall 9.8% increase in the total population from 1980 to 1990. However, there have been reports that the Census missed a portion of the population. Groups that may have been underreported included minority populations and the homeless. Table I defines minority populations as declared by the U.S. Government. These are also the groups that have been identified as being underserved by existing health care programs. Not only was there a large increase in the total population there were also significant increases in minority populations (see Table II). It is important to look at the minority populations and how their growth impacted the data from the 1990 Census. Each group is examined in terms of the percentage increase in that group, the resulting percentage of the total population for each group, and the overall percentage impact on the increase in the total population. As reflected in Table II the growth rate of each minority group is different. Native-Americans who comprise only 0.8% of the total population had more of an increase within their group than the African-American group which is the largest (in terms of percent of the total population) minority group. Asian-Americans (or Pacific Islanders) had the most notable increase in the size of the population with a 107.8% increase comprising only 2.9% of the total population with a 0.3% increase in the total population. Those listed as "other" indicated an ethnic group different from those on the Census questionnaire and included persons from East
173
Minority Recruitment in Genetic Counseling Table II. Minority Populations and the 1990 Census Data
Racial group
Year 1980
Year 1990
Increase Total within racial population group (%) (%)
Increase in total population (%)
African-American
26,495,000 29,986,000
13.2
12.1
0.4
Hispanic
14,609,000
22,354,000
53.0
8.9
2.5
Native-American
1,420,000
1,959,000
37.9
0.8
0.2
Asian or Pacific Islanders
3,500,000
7,274,000
107.8
2.9
0.3
Other (East Indians, Israelis, Arabs, etc)
6,758,000
9,805,000
45.1
3.9
1.0
Indian and Arabic descent. In that group there was a 45.1% increase making up 3.9% of the total population with a 1.0% increase in the total population. By the time of the year 2000 census minorities could comprise as much as 40% of the total population. Information from the 1992 Professional Issues Survey of the National Society of Genetic Counselors (NSGC) revealed the ethnic diversity and gender of the membership (Table III). This is the first time that the NSGC attempted to identify the ethnicity of its membership. (Prior to this survey, persons who contacted the Executive Office about the ethnic diversity of the NSGC were instructed to call minority genetic counselors who may or may not have had the information.) The make-up of the membership reflects the ethnic diversity of the U.S. but it does not attain the percentage totals for each minority group in the total population. Of those responding to the Professional Issues Survey only 6% were males. For the field of genetic counseling the definition of minorities in the profession must be broadened to include males (Table I). A needs assessment questionnaire regarding the feasibility for a more concerted effort to recruit minorities was sent to the genetic counseling training programs. The programs were asked about the number and ethnicity of their students in the last 10 years. The total number of students accepted in the programs from 1982-92 was 730. The total number of minority students was 62 or 8.5% (Table IV). Of those 62 students accepted 56 (90.3%) completed their training. This was a comparable retention rate to that of other students. The number of male students was 50 (6.8%) of the total students. All of the minority students indicated that they had not been recruited by any of the programs.
174
Smith, Warren, and Misra Table IlL Ethnic Composition of the NSGC Survey Respondents (n = 500) a
Ethnic group Hispanic-American
Total
Membership (%)
10
2.0
Asian-American
7
1.4
African-American
3
0.6
Native American
1
0.2
Other (includes East Indians, Israelis, Arabs, etc)
5
1.0
11
2.2
463
93.5
Multiple responses b White
aThe information used to generate the above data was unpublished at the time the Table was created and was obtained from then President-Elect Betsy Gettig. Full survey data can be found in Perspectives in Genetic Counseling (Vol. 14(2), Summer 1992, pp 7-10). b Some respondents listed multiple ethnicities (i.e., African-Hispanic American).
Barriers that might prevent minorities from entering the profession are many and varied. Two barriers that were frequently cited in a telephone survey of other minority genetic counselors were: (1) the lack of available information about the field at their undergraduate institutions, and (2) tuition costs. At this workshop a preliminary survey of tuition costs at each of the 17 training programs was elicited. Directors were also questioned as to whether or not there was any type of financial assistance targeted for minority students and when students were made aware of such sources of support (i.e., whether or not this information was disclosed at the time applications and information were being sought by potential students and their college advisors or after a student had been accepted into the program). There is tremendous variability in tuition costs between institutions and accounting periods (i.e., semesters, quarters, annual, and the entire length of the training program). Public institutions were less costly than private. The training program directors were also polled about tuition costs for out of state students. This and other tuition data are summarized in Table V. Directors expressed a need for a mechanism to identify ethnocultural status of potential applicants so that financial assistance resources can be made available to those eligible. An exhaustive pre-workshop literature search did not reveal any articles regarding recruitment of minorities in genetics. There were, however, several articles on minority recruitment in other health care professions and these are reviewed in the Appendix.
175
Minority Recruitment in Genetic Counseling Table IV. Summary of Data on Minority Recruitment from 15 Master's Genetic Counseling Programs
Students accepted 1982-1992 Total minority students
Number of students
Percent
730
100
62
8.6
African-American
17
2.7
Asian-American
21
3.4
Hispanic-American
17
2.7
Native American
0
0.0
Others
7
1.1
Males
50
6.8
How recruited Self Other
All 2 (recruiting service)
Minority retention Completed training Retention rate
56 90.3
Any discussion of the necessity for more recruitment of minority students must take place in the context of appropriate strategies. For example, recruitment must be directed toward student populations containing the targeted ethnocultural groups. The Executive Director of the NSGC receives many calls from high school and college students who are exploring the field. Currently there is no mechanism to identify ethnicity of callers. If the caller's ethnicity could be identified and provided to program directors, the directors could then contact the student directly. However, a long discussion ensued about issues related to such an effort, such as consent, how to identify ethnicity sensitively when students contact the Executive Office, whether it was appropriate for the NSGC to take the lead in minority recruitment, how to provide the information to the training programs, should there be a fee for this service and, if so, who should pay for this information. The NSGC career packet for high school and college students has been recently updated, and the FY92 budget allocated funds for distribution of this packet to minority college science advisors.
176
Smith, Warren, and Misra Table V. Cost of Graduate Training Programs in Genetic Counseling a
Program Northwestern b
Tuition in-state/yr
Tuition out-of-state/yr
Assistantships
$15,075
$15,075
Yes
U Michigan
7,000
14,000
No
U So. Carolina
3,188
6,376
Yes
U California-Berkeley
3,400
11,000
No
Medical College of Virginia
4,501
10,871
Occasionally
U California-Irvine
3,036
9,454
Yes
U Minnesota
3,500
7,000
Occasionally
Howard
6,625
6,625
Few
10,000
10,000
Yes
5,247
10,320
Yes
912
6,156
No
U Colorado
2,300
7,000
No
U Wisconsin
6,000
19,000
No
U Pittsburghb
20,000
20,000
Yes
Brandeisb
17,000
17,000
Yes
U Indiana
3,575
9,600
Occasionally
McGillb
3,000
8,000
Rarely
0
0
6,727
11,028
Sarah Lawrence b U Cincinnati U Texas
Mt Sinai Certificate c Mean tuition cost (degree only)
Yes
an = 17; this number represents all programs with first class beginning by Fall 1992.
b Private schools; all others are state institutions. CMt. Sinai offers a certificate in genetic counseling; only students who have a master's degree in another field are eligible for this program which offers payback service for tuition costs.
Strategies for recruitment are listed in Table VI. These strategies are very diverse; some are financial in nature while others involve a time commitment by practicing genetic counselors. Some of these strategies incorporate strategies utilized by other health care professions.
Minority Recruitment in Genetic Counseling
177
Table VI. Strategies for Minority Recruitment Identify minority colleges,a Participate in lectures, seminars, career day fairs at local colleges and high schools. Genetic Counseling Training Programs should find out how to be included in The Annual Guide to Graduate Studies (also known as Peterson's Guide). Provide career packets and speakers' bureau information to the National Association of Advisors of Health Professions (NAAHP). Genetic counselors could serve as assistant university minority recruitment officers and advisors, b Genetic counselors could serve as mentors to those already enrolled in a program or to high school and college students (e.g., invite them to clinics or NSGC meetings). Use SAT demographics for the purpose of recruitment. Establish minority student summer internships with genetic counselors, c Recruit students from non-biological majors, d Stimulate interest in students in junior or senior high school or by their first 2 years of undergraduate training. Target articles and advertising to publications appropriate for the population that you are trying to recruit (e.g., Black Collegiate MagazhTe, Essence, etc.). a Historically Black Colleges and Universities (HBCU) are in each state but the largest number are concentrated in the South. These institutions are composed of the 41 United Negro College Fund (UNCF) member colleges that are private and other predominately African-American state institutions. bThere is an abundance of students who are interested in pursuing a career in medicine but there are not enough slots for the applicant pool. If there is a relationship between a genetic counselor, recruitment officers, and advisors these students could be shown that their professional goals can be fulfilled by the profession of genetic counseling. c Either high school or college advisors can identify students. dMt. Sinai Medical School recruits humanities majors who have higher GPAs than pre-medicine majors. These students are then enrolled in science courses.
A l a r g e s e g m e n t o f t h e p a t i e n t p o p u l a t i o n is u n d e r s e r v e d . P e r h a p s o n e o f t h e r e a s o n s is t h e s h o r t a g e o f g e n e t i c c o u n s e l o r s . D a t a f r o m t h e NSGC Professional Issues Survey revealed that the same populations that a r e u n d e r s e r v e d a r e a l s o t h e s a m e o n e s w h o c o m p r i s e less t h a n 8 % o f t h e p r o f e s s i o n ( a c t u a l n u m b e r b a s e d u p o n t h e n u m b e r o f r e s p o n d e n t s is 7 . 4 % ) .
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Clarification of the definition of minorities is needed: a functional definition would be more flexible to include males and other groups (i.e., persons from India, Israel, etc.) that the legal definition would not identify as minorities. A joint effort between the NSGC and genetic counseling training program directors could be made to advance the recruitment of minorities. Practicing genetic counselors can also assist training programs in the recruitment of students. Last, the successful recruitment of minority students to undertake genetic counseling training is not the end of our responsibility. At both the training and postgraduate levels, mechanisms that encourage continued participation as a genetic counselor regardless of ethnicity need to be identified and/or created. Two ideas for consideration with minority students are: (1) introduce students to practicing minority genetic counselors who can then serve as mentors and guides, and (2) find ways to make financial assistance information available at the best time for potential applicants. APPENDIX. MINORITY RECRUITMENT: A REVIEW OF THE LITERATURE A review of articles pertaining to minority recruitment and retention in the health professions provided a number of potential strategies for planning minority recruitment in genetic counseling. Quintilian (1985) and Anderson (1991) examined a small number of minority student graduates' perceptions of the basis of their success in allied health and nursing programs. Quintilian found that exposure to college offerings through printed literature and exposure to the health care system through treatment at a health care facility were both very influential factors in recruitment. Friends, peers, and alumni were more successful recruiters than counselors and nursing faculty. Once recruited, these students stated that their retention in the programs was facilitated by flexible scheduling, peer contact, and contact with clinical personnel. Tysinger and Whiteside (1987) discuss minority recruitment and retention strategies that have been used historically. Summer enrichment programs for promising minority or disadvantaged freshmen or sophomore students were used in the late 1960s and early 1970s. Students were provided with science and academic instruction and information about health careers for recruitment to a particular institution. Prematriculation programs were developed to give students a head start and acquaint them with faculty and program components. Academic year programs, including freshman orientation, tutorial programs, and academic support services were retention strategies used.
Minority Recruitment in Genetic Counseling
179
Walker (1991) describes federal and non-federal programs designed to promote the number of Black scientists and raise their participation in scientific activities. The federally funded Minority Biomedical Research Support (MBRS) program focuses on institutions that traditionally graduate the largest number of minority students with NIH supported resources to expand the research capabilities of these academic programs. The federally funded Minority Access to Research Careers (MARC) program focuses on helping talented minority science majors make the transition from college to graduate school by supporting juniors and seniors research projects at minority institutions. MARC helps minority students look beyond their own institution by requiring that they leave their home institution and spend at least a summer in a major research laboratory in some other part of the country. The National Science Foundation (NSF) has several programs with the goal of decreasing attrition among minority students who have already shown interest in math, science, or engineering at any level of higher education. Non-federal initiatives have been initiated by the American Association for the Advancement of Science (AAAS) whose Linkage program involves community groups such as churches to improve science exposure for minority populations and other underrepresented groups. Walker's (1991) paper also details barriers to minority achievement in science, including difficulty in moving into top management positions and substantial economic differences between minority and White individuals due to working at lower degree levels, local labor market forces, job performance, and the size and strength of employers. Successful media-based recruitment strategies are described in several articles. Lappa (1989) describes recruitment of Black men and women into careers in the nursing profession by using culturally specific magazine advertisements. Fletcher and Himburg (1991) describe a minority recruitment program to increase the number of Blacks and Hispanics in dietetics by use of culturally specific slide tape recruitment presentation, on-site visits to provide exposure to the profession, and a summer orientation and tutorial program for enrolled minority students. Baker and Lyons (1989) describe recruitment to a school of Allied Health Sciences by utilizing flyers, posters, pamphlets, and brochures illustrating appropriate role models. They also used minority recruiters to visit areas of the state with a high proportion of minority populations. Garcia and Fowkes (1987) used the media to promote the role of physician assistants and a physician assistant training program. Their local newspapers featured special interest articles about minority physician assistants who practiced in their communities. Also, a faculty mentor system was available for all students with academic, financial, or personal problems.
180
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A number of articles discuss the need for preparation and support of minority students interested in the sciences at a young age, while in high school, so that minority applicants to college programs are academically competitive. Walker (1982) describes the need for academic enrichment programs including tutoring and counseling to prepare qualified minority students and to acquaint them with opportunities available in allied health. Davis and Davidson (1982) discuss use of enrichment courses in the sciences and field experiences in hospitals and laboratories to prepare high school students for health careers. Also described is a Saturday tutorial program for academic enrichment in math, science, English, and study skills, as well as a parent support network offering workshops on study skills, financial aid, careers, and college application processes for parents of minority high school students. A strategy used by Hill-Hogan (1990) to advance recruitment in dietetics program included visiting junior and senior high schools to conduct career awareness seminars. It is important that those individuals and programs making efforts to recruit minorities into genetic counseling be aware of recruitment experiences and strategies employed by other health professions. Many of these methods are probably adaptable to our field. In fact, there are a number of NSGC committees that are currently discussing development of some of the recruitment tools that have been used successfully by others. Finally, there is an excellent series of articles in Science (Vol. 258, 13 Nov. 1992) "Minorities in science: The Pipeline problem" that reviews the overall history of integrating minorities into science in general, talks about effectiveness of strategies, and offers many personal insights from minority individuals who have been influenced both positively and negatively by these strategies.
REFERENCES 1990 Census of Population (1991) U. S. Bureau of the Census Volume 1, Characteristics of the Population. Anderson J (1991) Nursing students: Minority recruitment and retention. Nurse Educ 16(5):38-39. Baker J, Lyons B (1989) The recruitment and retention of minority and disadvantaged allied health students. J Allied Health 18:389-401. Davis J, Davidson C (1982). The Med-COR Study: Preparing high school students for the health careers. J Med Educ 57:527-534. Garcia R, Fowkes V (1987). Recruitment and retention of minority students in a physician assistant program. J Med Educ 62:477-484. Fletcher S, Himburg S (1991). Providing access to Blacks and Hispanics in dietetics education. J A m Diet Assoc 91(8):966-969. Hill-Hogan C (1990). Minority recruitment and retention: A career ladder approach. J A m Diet Assoc 90(2):523-525. Lappa K (1989). New recruitment efforts target minorities. Hospitals 63(20):64.
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Quintilian E (1985) Influential factors in recruitment and retention of minority students in a community college. J Allied Health 14:63-70. Tysinger J, Whiteside M (1987). A review of recruitment and retention programs for minority and disadvantaged students in health professions education. J Allied Health 16:209-217. Uhlmann W (1992) Professional status survey results. Perspect Genet Couns 14(2)(Suppl):7-10. Walker B (1991) Environmental health and African Americans. A m J Public Health 81(11): 1395-1398. Walker P (1982) The need for support services for minority pre-allied health majors. JAUied Health 11:29-34.
Minority Recruitment into the Genetic Counseling Profession Stephanie C. Smith, 1,4 Nancy Steinberg Warren, 2 and Lavanya Misra 3
In the past, genetic counseling training programs have had an abundance of applicants for the number of slots available. They have, however, had a very limited pool of minority applicants. At the June 1992 meeting of the genetic counseling training programs directors the topic of minority recruitment was explored. The resources and recommendations that resulted from this discussion can be used by other medical training programs. KEY WORDS: minority recruitment; genetic counseling training.
For several years there has been a continuous discussion about the shortage of trained genetic counselors. Some institutions have positions that have been unfilled for months and were then filled by persons who are not trained genetic counselors. Other institutions, especially in areas where the patient population is primarily of one ethnic group, have created positions to assist the genetic counselors. (The job titles for these positions are diverse. Examples are genetic assistants and genetic aides.) As we discuss the shortage of professionals practicing in underserved areas (which are mainly in areas where the majority of the population in other settings are classified as minorities) we need to examine who are underserved, why they are underserved and ways that we can overcome this shortage. 1Department of Preventive Medicine, University of Mississippi School of Medicine, Jackson, Mississippi. 2Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio. 3St. Lukes/Roosevelt Hospital, New York, New York. 4Correspondence should be directed to Stephanie C. Smith, Department of Preventive Medicine, University Medical Center, 2500 North State St., Jackson, Mississippi 39216-4505~ 171 1059-7700/93/0900-0171507.00/19 ]993 NationalSocietyof GeneticCounselors,Inc.
172
Smith, Warren, and Misra
Table I. /dinorityDefined Ethnic group
U.S. government
Geneticcounseling
(African descent) Includes Caribbean, Black-Hispanics, Haitian-Americans, etc.
yes
yes
Hispanics
(Spanish descent) Includes Puerto-Ricans, Mexican-Americans, Central and South Americans
yes
yes
Native Amerleans Includes American Indians, Eskimos,or Aleut
yes
yes
Aslan or Pacific Islander
yes
yes
Only if of a defined
yes
African-American
Males
minority group
Data from the 1990 United States Census Bureau revealed that there was an overall 9.8% increase in the total population from 1980 to 1990. However, there have been reports that the Census missed a portion of the population. Groups that may have been underreported included minority populations and the homeless. Table I defines minority populations as declared by the U.S. Government. These are also the groups that have been identified as being underserved by existing health care programs. Not only was there a large increase in the total population there were also significant increases in minority populations (see Table II). It is important to look at the minority populations and how their growth impacted the data from the 1990 Census. Each group is examined in terms of the percentage increase in that group, the resulting percentage of the total population for each group, and the overall percentage impact on the increase in the total population. As reflected in Table II the growth rate of each minority group is different. Native-Americans who comprise only 0.8% of the total population had more of an increase within their group than the African-American group which is the largest (in terms of percent of the total population) minority group. Asian-Americans (or Pacific Islanders) had the most notable increase in the size of the population with a 107.8% increase comprising only 2.9% of the total population with a 0.3% increase in the total population. Those listed as "other" indicated an ethnic group different from those on the Census questionnaire and included persons from East
173
Minority Recruitment in Genetic Counseling Table II. Minority Populations and the 1990 Census Data
Racial group
Year 1980
Year 1990
Increase Total within racial population group (%) (%)
Increase in total population (%)
African-American
26,495,000 29,986,000
13.2
12.1
0.4
Hispanic
14,609,000
22,354,000
53.0
8.9
2.5
Native-American
1,420,000
1,959,000
37.9
0.8
0.2
Asian or Pacific Islanders
3,500,000
7,274,000
107.8
2.9
0.3
Other (East Indians, Israelis, Arabs, etc)
6,758,000
9,805,000
45.1
3.9
1.0
Indian and Arabic descent. In that group there was a 45.1% increase making up 3.9% of the total population with a 1.0% increase in the total population. By the time of the year 2000 census minorities could comprise as much as 40% of the total population. Information from the 1992 Professional Issues Survey of the National Society of Genetic Counselors (NSGC) revealed the ethnic diversity and gender of the membership (Table III). This is the first time that the NSGC attempted to identify the ethnicity of its membership. (Prior to this survey, persons who contacted the Executive Office about the ethnic diversity of the NSGC were instructed to call minority genetic counselors who may or may not have had the information.) The make-up of the membership reflects the ethnic diversity of the U.S. but it does not attain the percentage totals for each minority group in the total population. Of those responding to the Professional Issues Survey only 6% were males. For the field of genetic counseling the definition of minorities in the profession must be broadened to include males (Table I). A needs assessment questionnaire regarding the feasibility for a more concerted effort to recruit minorities was sent to the genetic counseling training programs. The programs were asked about the number and ethnicity of their students in the last 10 years. The total number of students accepted in the programs from 1982-92 was 730. The total number of minority students was 62 or 8.5% (Table IV). Of those 62 students accepted 56 (90.3%) completed their training. This was a comparable retention rate to that of other students. The number of male students was 50 (6.8%) of the total students. All of the minority students indicated that they had not been recruited by any of the programs.
174
Smith, Warren, and Misra Table IlL Ethnic Composition of the NSGC Survey Respondents (n = 500) a
Ethnic group Hispanic-American
Total
Membership (%)
10
2.0
Asian-American
7
1.4
African-American
3
0.6
Native American
1
0.2
Other (includes East Indians, Israelis, Arabs, etc)
5
1.0
11
2.2
463
93.5
Multiple responses b White
aThe information used to generate the above data was unpublished at the time the Table was created and was obtained from then President-Elect Betsy Gettig. Full survey data can be found in Perspectives in Genetic Counseling (Vol. 14(2), Summer 1992, pp 7-10). b Some respondents listed multiple ethnicities (i.e., African-Hispanic American).
Barriers that might prevent minorities from entering the profession are many and varied. Two barriers that were frequently cited in a telephone survey of other minority genetic counselors were: (1) the lack of available information about the field at their undergraduate institutions, and (2) tuition costs. At this workshop a preliminary survey of tuition costs at each of the 17 training programs was elicited. Directors were also questioned as to whether or not there was any type of financial assistance targeted for minority students and when students were made aware of such sources of support (i.e., whether or not this information was disclosed at the time applications and information were being sought by potential students and their college advisors or after a student had been accepted into the program). There is tremendous variability in tuition costs between institutions and accounting periods (i.e., semesters, quarters, annual, and the entire length of the training program). Public institutions were less costly than private. The training program directors were also polled about tuition costs for out of state students. This and other tuition data are summarized in Table V. Directors expressed a need for a mechanism to identify ethnocultural status of potential applicants so that financial assistance resources can be made available to those eligible. An exhaustive pre-workshop literature search did not reveal any articles regarding recruitment of minorities in genetics. There were, however, several articles on minority recruitment in other health care professions and these are reviewed in the Appendix.
175
Minority Recruitment in Genetic Counseling Table IV. Summary of Data on Minority Recruitment from 15 Master's Genetic Counseling Programs
Students accepted 1982-1992 Total minority students
Number of students
Percent
730
100
62
8.6
African-American
17
2.7
Asian-American
21
3.4
Hispanic-American
17
2.7
Native American
0
0.0
Others
7
1.1
Males
50
6.8
How recruited Self Other
All 2 (recruiting service)
Minority retention Completed training Retention rate
56 90.3
Any discussion of the necessity for more recruitment of minority students must take place in the context of appropriate strategies. For example, recruitment must be directed toward student populations containing the targeted ethnocultural groups. The Executive Director of the NSGC receives many calls from high school and college students who are exploring the field. Currently there is no mechanism to identify ethnicity of callers. If the caller's ethnicity could be identified and provided to program directors, the directors could then contact the student directly. However, a long discussion ensued about issues related to such an effort, such as consent, how to identify ethnicity sensitively when students contact the Executive Office, whether it was appropriate for the NSGC to take the lead in minority recruitment, how to provide the information to the training programs, should there be a fee for this service and, if so, who should pay for this information. The NSGC career packet for high school and college students has been recently updated, and the FY92 budget allocated funds for distribution of this packet to minority college science advisors.
176
Smith, Warren, and Misra Table V. Cost of Graduate Training Programs in Genetic Counseling a
Program Northwestern b
Tuition in-state/yr
Tuition out-of-state/yr
Assistantships
$15,075
$15,075
Yes
U Michigan
7,000
14,000
No
U So. Carolina
3,188
6,376
Yes
U California-Berkeley
3,400
11,000
No
Medical College of Virginia
4,501
10,871
Occasionally
U California-Irvine
3,036
9,454
Yes
U Minnesota
3,500
7,000
Occasionally
Howard
6,625
6,625
Few
10,000
10,000
Yes
5,247
10,320
Yes
912
6,156
No
U Colorado
2,300
7,000
No
U Wisconsin
6,000
19,000
No
U Pittsburghb
20,000
20,000
Yes
Brandeisb
17,000
17,000
Yes
U Indiana
3,575
9,600
Occasionally
McGillb
3,000
8,000
Rarely
0
0
6,727
11,028
Sarah Lawrence b U Cincinnati U Texas
Mt Sinai Certificate c Mean tuition cost (degree only)
Yes
an = 17; this number represents all programs with first class beginning by Fall 1992.
b Private schools; all others are state institutions. CMt. Sinai offers a certificate in genetic counseling; only students who have a master's degree in another field are eligible for this program which offers payback service for tuition costs.
Strategies for recruitment are listed in Table VI. These strategies are very diverse; some are financial in nature while others involve a time commitment by practicing genetic counselors. Some of these strategies incorporate strategies utilized by other health care professions.
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Table VI. Strategies for Minority Recruitment Identify minority colleges,a Participate in lectures, seminars, career day fairs at local colleges and high schools. Genetic Counseling Training Programs should find out how to be included in The Annual Guide to Graduate Studies (also known as Peterson's Guide). Provide career packets and speakers' bureau information to the National Association of Advisors of Health Professions (NAAHP). Genetic counselors could serve as assistant university minority recruitment officers and advisors, b Genetic counselors could serve as mentors to those already enrolled in a program or to high school and college students (e.g., invite them to clinics or NSGC meetings). Use SAT demographics for the purpose of recruitment. Establish minority student summer internships with genetic counselors, c Recruit students from non-biological majors, d Stimulate interest in students in junior or senior high school or by their first 2 years of undergraduate training. Target articles and advertising to publications appropriate for the population that you are trying to recruit (e.g., Black Collegiate MagazhTe, Essence, etc.). a Historically Black Colleges and Universities (HBCU) are in each state but the largest number are concentrated in the South. These institutions are composed of the 41 United Negro College Fund (UNCF) member colleges that are private and other predominately African-American state institutions. bThere is an abundance of students who are interested in pursuing a career in medicine but there are not enough slots for the applicant pool. If there is a relationship between a genetic counselor, recruitment officers, and advisors these students could be shown that their professional goals can be fulfilled by the profession of genetic counseling. c Either high school or college advisors can identify students. dMt. Sinai Medical School recruits humanities majors who have higher GPAs than pre-medicine majors. These students are then enrolled in science courses.
A l a r g e s e g m e n t o f t h e p a t i e n t p o p u l a t i o n is u n d e r s e r v e d . P e r h a p s o n e o f t h e r e a s o n s is t h e s h o r t a g e o f g e n e t i c c o u n s e l o r s . D a t a f r o m t h e NSGC Professional Issues Survey revealed that the same populations that a r e u n d e r s e r v e d a r e a l s o t h e s a m e o n e s w h o c o m p r i s e less t h a n 8 % o f t h e p r o f e s s i o n ( a c t u a l n u m b e r b a s e d u p o n t h e n u m b e r o f r e s p o n d e n t s is 7 . 4 % ) .
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Clarification of the definition of minorities is needed: a functional definition would be more flexible to include males and other groups (i.e., persons from India, Israel, etc.) that the legal definition would not identify as minorities. A joint effort between the NSGC and genetic counseling training program directors could be made to advance the recruitment of minorities. Practicing genetic counselors can also assist training programs in the recruitment of students. Last, the successful recruitment of minority students to undertake genetic counseling training is not the end of our responsibility. At both the training and postgraduate levels, mechanisms that encourage continued participation as a genetic counselor regardless of ethnicity need to be identified and/or created. Two ideas for consideration with minority students are: (1) introduce students to practicing minority genetic counselors who can then serve as mentors and guides, and (2) find ways to make financial assistance information available at the best time for potential applicants. APPENDIX. MINORITY RECRUITMENT: A REVIEW OF THE LITERATURE A review of articles pertaining to minority recruitment and retention in the health professions provided a number of potential strategies for planning minority recruitment in genetic counseling. Quintilian (1985) and Anderson (1991) examined a small number of minority student graduates' perceptions of the basis of their success in allied health and nursing programs. Quintilian found that exposure to college offerings through printed literature and exposure to the health care system through treatment at a health care facility were both very influential factors in recruitment. Friends, peers, and alumni were more successful recruiters than counselors and nursing faculty. Once recruited, these students stated that their retention in the programs was facilitated by flexible scheduling, peer contact, and contact with clinical personnel. Tysinger and Whiteside (1987) discuss minority recruitment and retention strategies that have been used historically. Summer enrichment programs for promising minority or disadvantaged freshmen or sophomore students were used in the late 1960s and early 1970s. Students were provided with science and academic instruction and information about health careers for recruitment to a particular institution. Prematriculation programs were developed to give students a head start and acquaint them with faculty and program components. Academic year programs, including freshman orientation, tutorial programs, and academic support services were retention strategies used.
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Walker (1991) describes federal and non-federal programs designed to promote the number of Black scientists and raise their participation in scientific activities. The federally funded Minority Biomedical Research Support (MBRS) program focuses on institutions that traditionally graduate the largest number of minority students with NIH supported resources to expand the research capabilities of these academic programs. The federally funded Minority Access to Research Careers (MARC) program focuses on helping talented minority science majors make the transition from college to graduate school by supporting juniors and seniors research projects at minority institutions. MARC helps minority students look beyond their own institution by requiring that they leave their home institution and spend at least a summer in a major research laboratory in some other part of the country. The National Science Foundation (NSF) has several programs with the goal of decreasing attrition among minority students who have already shown interest in math, science, or engineering at any level of higher education. Non-federal initiatives have been initiated by the American Association for the Advancement of Science (AAAS) whose Linkage program involves community groups such as churches to improve science exposure for minority populations and other underrepresented groups. Walker's (1991) paper also details barriers to minority achievement in science, including difficulty in moving into top management positions and substantial economic differences between minority and White individuals due to working at lower degree levels, local labor market forces, job performance, and the size and strength of employers. Successful media-based recruitment strategies are described in several articles. Lappa (1989) describes recruitment of Black men and women into careers in the nursing profession by using culturally specific magazine advertisements. Fletcher and Himburg (1991) describe a minority recruitment program to increase the number of Blacks and Hispanics in dietetics by use of culturally specific slide tape recruitment presentation, on-site visits to provide exposure to the profession, and a summer orientation and tutorial program for enrolled minority students. Baker and Lyons (1989) describe recruitment to a school of Allied Health Sciences by utilizing flyers, posters, pamphlets, and brochures illustrating appropriate role models. They also used minority recruiters to visit areas of the state with a high proportion of minority populations. Garcia and Fowkes (1987) used the media to promote the role of physician assistants and a physician assistant training program. Their local newspapers featured special interest articles about minority physician assistants who practiced in their communities. Also, a faculty mentor system was available for all students with academic, financial, or personal problems.
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A number of articles discuss the need for preparation and support of minority students interested in the sciences at a young age, while in high school, so that minority applicants to college programs are academically competitive. Walker (1982) describes the need for academic enrichment programs including tutoring and counseling to prepare qualified minority students and to acquaint them with opportunities available in allied health. Davis and Davidson (1982) discuss use of enrichment courses in the sciences and field experiences in hospitals and laboratories to prepare high school students for health careers. Also described is a Saturday tutorial program for academic enrichment in math, science, English, and study skills, as well as a parent support network offering workshops on study skills, financial aid, careers, and college application processes for parents of minority high school students. A strategy used by Hill-Hogan (1990) to advance recruitment in dietetics program included visiting junior and senior high schools to conduct career awareness seminars. It is important that those individuals and programs making efforts to recruit minorities into genetic counseling be aware of recruitment experiences and strategies employed by other health professions. Many of these methods are probably adaptable to our field. In fact, there are a number of NSGC committees that are currently discussing development of some of the recruitment tools that have been used successfully by others. Finally, there is an excellent series of articles in Science (Vol. 258, 13 Nov. 1992) "Minorities in science: The Pipeline problem" that reviews the overall history of integrating minorities into science in general, talks about effectiveness of strategies, and offers many personal insights from minority individuals who have been influenced both positively and negatively by these strategies.
REFERENCES 1990 Census of Population (1991) U. S. Bureau of the Census Volume 1, Characteristics of the Population. Anderson J (1991) Nursing students: Minority recruitment and retention. Nurse Educ 16(5):38-39. Baker J, Lyons B (1989) The recruitment and retention of minority and disadvantaged allied health students. J Allied Health 18:389-401. Davis J, Davidson C (1982). The Med-COR Study: Preparing high school students for the health careers. J Med Educ 57:527-534. Garcia R, Fowkes V (1987). Recruitment and retention of minority students in a physician assistant program. J Med Educ 62:477-484. Fletcher S, Himburg S (1991). Providing access to Blacks and Hispanics in dietetics education. J A m Diet Assoc 91(8):966-969. Hill-Hogan C (1990). Minority recruitment and retention: A career ladder approach. J A m Diet Assoc 90(2):523-525. Lappa K (1989). New recruitment efforts target minorities. Hospitals 63(20):64.
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Quintilian E (1985) Influential factors in recruitment and retention of minority students in a community college. J Allied Health 14:63-70. Tysinger J, Whiteside M (1987). A review of recruitment and retention programs for minority and disadvantaged students in health professions education. J Allied Health 16:209-217. Uhlmann W (1992) Professional status survey results. Perspect Genet Couns 14(2)(Suppl):7-10. Walker B (1991) Environmental health and African Americans. A m J Public Health 81(11): 1395-1398. Walker P (1982) The need for support services for minority pre-allied health majors. JAUied Health 11:29-34.
