RISE: Promoting Diversity Among Public Health Professionals Harolyn M. E. Belcher, MD, MHS; Jenese McFadden, DM, MS, MBA rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Context: Public health education and research training of underrepresented populations is an important component of a comprehensive approach to promote health equity. Objective: To describe student outcomes following participation in an innovative public health training cooperative agreement program funded by the Centers of Disease Control and Prevention. Participants: Sixty-six graduate, professional, and recent baccalaureate degree students participated in the Research Initiatives for Student Enhancement program. The majority of the students were from underrepresented populations (95%) and female (80%). Intervention: The Research Initiatives for Student Enhancement program, a collaboration between a university-affiliated Institute and Historically Black Colleges and Universities, provided public health educational and research experiences during the summer and academic year. Main Outcome Measure: Student presentations at national meetings, publications, and completion of degree programs. Results: The acceptance rate for student presentations at national scientific meetings was 89%. Almost 14 percent of the students were authors of peer-reviewed articles. More than one-third of the students (36%) completed their master’s degree and 33% completed doctoral degrees during the 5 years of the program. Students used their Research Initiatives for Student Enhancement program research to complete master’s theses, practicum requirements, and dissertations. Ninety-five percent of the students pursued education or careers in public health and health care. KEY WORDS: diversity, health equity, public health education,
underrepresented populations
Two major overarching goals of Healthy People 2020 are (1) to achieve health equity and (2) eliminate preventable disease, disability, and premature death.1 Increasing the number of individuals from underrepresented racial and ethnic populations (ie, African Americans, Hispanic/Latino persons, American Indians, Alaskan Natives, Pacific Islanders, and certain Asian populations) who work in health care and research professions is especially important to promote health equity given recent reports estimating that by the year 2050, the number of individuals from underrepresented racial and ethnic groups will increase to nearly half.2 Of concern, however, is current US census trends that do not project a burgeoning of a diverse scientific workforce that reflects the projected diversity of the US population. Without intentional and sustained efforts to recruit and retain well-qualified individuals from underrepresented populations into the science workforce, there will be a shortage of scientists and engineers that will have a negative impact on the US economy and general health of its citizenry.3-6 National Academy of Sciences recognized distinct barriers to and recommendations for the participation
Author Affiliations: The Family Center at Kennedy Krieger Institute, Baltimore, Maryland (Drs Belcher and McFadden); Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Belcher); and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Belcher). The authors thank and acknowledge the students and mentors who participated in the RISE Program. The RISE Program was supported by the Cooperative Agreement CDC, U50 MN325127. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Data from this paper were presented as a poster at the 2011 American Public Health Association Annual Meeting in Washington, District of Columbia, and the 2012 National Institutes of Health Summit on the Science of Eliminating Health Disparities: Building a Healthier Society Integrating Science, Policy and Practice, December 17-19, 2012, National Harbor, Maryland. Data from this paper were discussed during a platform presentation at the 2010 International Conference on Education Research. The authors declare no conflicts of interest.
J Public Health Management Practice, 2015, 21(4), 384–391 C 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright
Correspondence: Harolyn M. E. Belcher, MD, MHS, The Family Center at Kennedy Krieger Institute, 2901 East Biddle St, Baltimore MD 21213 ([email protected]). DOI: 10.1097/PHH.0000000000000052
384 Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Promoting Diversity Among Public Health Professionals
of underrepresented populations in the science field.7 Barriers include low expectations, lack of science career information and vigorous recruitment into the sciences, weak academic preparation, and inadequate financial resources. Priority recommendations to improve the number of underrepresented students in the sciences were to (1) develop strong educational programs from preschool through 12th grade, (2) provide social and financial support for underrepresented undergraduate students, (3) support teacher preparation and advanced training, and (4) develop programs that support the transition from undergraduate to graduate and professional schools. In 2005, a cooperative agreement was awarded to the Kennedy Krieger Institute by the Centers for Disease Control and Prevention (CDC), Office of Minority Health and Health Equity. The cooperative agreement resulted in the establishment of the Research Initiatives for Student Enhancement (RISE) Program. The ultimate goal of the RISE program was to increase the diversity of the public health workforce and reduce health disparities. Specifically, the RISE program goals were threefold: first, provide a mentored public health research experience for underrepresented racial and ethnic graduate students, targeting the student population attending Historically Black Colleges and Universities (HBCUs); second, increase collaboration and community outreach among 3 local HBCUs, the Kennedy Krieger Institute, and Johns Hopkins Bloomberg School of Public Health to expand awareness of physical and mental health disparities; and third, increase the enrollment of underrepresented populations in public health graduate and health-related graduate and professional programs. This article describes the development, activities, and evaluation of this innovative partnership between a nonprofit institution, that is, the Kennedy Krieger Institute, HBCUs, and the Johns Hopkins Medical Institutions.
● Methods Setting Kennedy Krieger Institute: The Kennedy Krieger Institute is a nonprofit, multispecialty institution, which is a Johns Hopkins University–affiliated program. Located in Baltimore City, the Kennedy Krieger Institute’s mission is to improve, through treatment, research, and education, the lives of children affected by disorders of the neurological system. The Kennedy Krieger Institute is within proximity to major HBCUs and majority institutions in the Baltimore-Washington, District of Columbia, area and annually has more than $25 million in research support facilitated by the Kennedy
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Krieger Institute’s grants management administration. The Kennedy Krieger Institute has the oldest and largest Leadership Education in Neurodevelopmental Disabilities training program in the United States. The infrastructure provided by the Leadership Education in Neurodevelopmental Disabilities program, with existing university training affiliation agreements and distance and technical learning capacities, provided an ideal environment for the development of a research training program to promote student diversity in public health research. Centers for Disease Control and Prevention Initiative: In 2005, the CDC funded the RISE program at the Kennedy Krieger Institute to formalize the partnership among the Kennedy Krieger Institute, HBCUs, and the Johns Hopkins Medical Institutions, addressing RISE Goals 1 and 2 to provide mentored research experiences and increase collaborations and community outreach among HBCUs, the Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, Johns Hopkins School of Nursing, and Johns Hopkins Bloomberg School of Public Health.
Program description Research Training Consortium: To address Goal 2 of the RISE program, a graduate Research Training Consortium with faculty from 3 urban HBCUs, namely (1) Coppin State University Department of Applied Psychology and School of Nursing, (2) Howard University Departments of Psychology and Biology, School of Social Work and School of Medicine, and (3) Morgan State University Department of Psychology, School of Computer Science, Mathematics, and Natural Sciences, School of Community Health and Policy, was developed. Faculty reviewed program initiatives and curricula, collaborated on manuscripts and grant proposals, and informed and recruited students for the RISE program. The Kennedy Krieger Institute established training affiliation agreements with the aforementioned universities and other universities interested in sending students to participate in the RISE program. Research Training Consortium members met quarterly to discuss program activities, student recruitment strategies, and grant collaborations. Student recruitment: Student recruitment depended on several strategies. The RISE Web site contained program description, eligibility requirements, online application, student testimonial videos, and contact information for RISE and HBCU faculty collaborators. Bookmark and shareware capabilities linked RISE Web site to numerous social media outlets. The RISE Web site linked to the CDC and National Institute of Allergy and Infectious Diseases at the National Institutes of Health Web sites. In addition to the RISE
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386 ❘ Journal of Public Health Management and Practice Web site, program staff attended college seminars and career fairs, contacted academic program directors via phone and e-mail, encouraged student peerto-peer recruitment, and directed mail recruitment outreach. Recruitment of research mentors: Volunteer research mentors were recruited through presentations and collaborations with deans, chairpersons, and research faculty at the Kennedy Krieger Institute and Johns Hopkins Medical Institutions. One-third of RISE researchers were from underrepresented populations. RISE research mentors received guidelines detailing program activities, objectives, and the expectation to interact closely with the students and guide and support the students’ research experience and success. The number of research opportunities available for the students increased each year of the RISE program, from 28 to 48. Applicant review and selection: Students were required to complete an application with 2 public health– focused essays and 2 academic letters of recommendation. Eligibility criteria for students also included a grade point average of at least 3.0 on a 4.0 scale. Objective criteria based on student academic achievement and community leadership, essays, and recommendations were created to rank application packets. The highest ranked students were interviewed by at least 2 members of the RISE program team. Interviewers included RISE administrative staff, faculty at The Johns Hopkins University School of Medicine, and current and past RISE students. Standardized forms were used to rank interviews. Interview scores were then added to the scores obtained from the paper application review to determine the final student ranking. The actual number of students selected each year was based on available funding and the housing and transportation funding support needed by the students. RISE research externships: Three types of mentored research experiences were developed to address Goal 1 of the RISE program, namely, to create a mentored research experience for the students. Students participated in (1) full-time 9-week summer research program (primarily for medical and out-of-state students), (2) extended graduate student research experience (full time during the summer and 10 hours per week during the academic year), or (3) full-time 1-year postbaccalaureate Bridge program to prepare students to enter graduate or professional school (Table 1). All students worked full time on their research projects during the summer. Following the summer program, extended graduate students worked for 10 h/wk during the academic year. Students received a prorated stipend on the basis of the National Institutes of Health trainee salary scale.
Students were required to have health insurance. Grant funds were used to support the cost of health insurance if a student was uninsured. Housing and round-trip transportation were provided for out-of-state students for the summer program. The RISE learning experience: Students in the RISE program completed the human subjects protection, confidentiality, and conflict of interest online training courses before beginning the RISE program. The RISE orientation provided the foundation for program. Orientation lectures covered the epidemiology of and research on health disparities, urban health issues (eg, obesity, human immunodeficiency virus, cancer disparities, community violence, substance abuse), mental health, developmental disabilities, research design, biostatistics, abstract and article development, Access database classes, advanced PubMed, and Reference Manager training. Students received an orientation notebook containing the orientation schedule, lecture objectives, PowerPoint presentations and related research articles, lecture evaluations, lecture quizzes, maps of the Kennedy Krieger Institute and Johns Hopkins Medical Institutions, conduct and dress code guidelines, confidentiality guidelines, descriptions of research opportunities, a research ranking form, and universal precautions information. Students completed quizzes after lectures to reinforce the material presented. At the end of the orientation week, students selected their top 3 research choices and were matched according to the students’ interest and the researchers’ availability. Students could work on up to 2 research projects. When students worked on 2 research projects, 1 research project was usually in the early stages of development and the other project had data ready for analysis. This gave students a broad experience with research design, implementation, and analysis. Weekly seminars were held to discuss active public health projects, review and critique journal articles, and explore public health career opportunities. All students self-selected a public health topic of interest to investigate. The public health topic was presented, using an epidemiologic rubric8 developed by Dr James Anthony, Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, to their mentors and peers during the closing seminar at the end of the summer. Students who were in the extended graduate student and Bridge programs participated in monthly journal clubs during the academic year. Students led the journal clubs during the spring semester. All students were registered as student members of the American Public Health Association (APHA) and received the American Journal of Public Health. Students were encouraged to submit their research to the APHA
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Promoting Diversity Among Public Health Professionals
annual meeting. Students who submitted their research to the APHA or other scientific meetings were sponsored to attend the scientific meeting (as CDC funding allowed). In addition to the activities mentioned previously, students in the Bridge program participated in grantfunded Graduate Record Examination (or equivalent examination) preparatory courses and received guidance with graduate school application process, curriculum vitae, and personal statement support development by the RISE program director. Extended graduate and Bridge students presented their public health topics to community members at local Baltimore
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City health fairs. In preparation for annual community health fairs, students revised their public health topic to be relevant for community members. Over the course of the RISE program, a successful distance-learning component was developed for out-of-state graduate students who wanted to continue doing research with their mentors. RISE Facebook: Students developed and maintained a RISE Facebook page to continue to network, encourage, and support each other following graduation from the RISE program. RISE program evaluation: Structured questionnaires were used for research faculty to evaluate their
TABLE 1 ● Description of RISE Research Experience and Student Enrollment (N = 66)
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Research Experience Summer graduate
Student Characteristics Out-of-state graduate students
Number of Students per Year 2006
2007
2008
2009
2010
3
5
8
6
5
7
8
4
2
7
2
4
2
2
1
Medical students
Extended graduate
Postbaccalaureate (Bridge)
Local graduate students Graduate students with identified collaborative research mentor at their home school Baccalaureate degree received within 6 mo of the RISE orientation
RISE Research Experience Description Summer program (9 wk) Human Subjects Protection and Research Ethics compliance certification RISE orientation 40 h worked per week on research project Weekly meetings with mentor Weekly public health seminars One day Mental Health Prevention course at the Bloomberg Summer Institute Select and present a public health topic to colleagues and program mentors Summer program (9 wk) as described previously, and during academic year 10 h worked per week during on research project Weekly meeting with mentor Monthly public health seminars Develop and submit abstract to a scientific conference Present public health topic to community members Full-time employment for 1 y as Bridge student prepares for graduate or professional school (includes Summer program activities as described previously) Weekly meeting with RISE program director to create time line for graduate/professional school applications, prepare personal statements and resume Public health seminars (monthly during academic year) Take GRE/MCAT test prep course (financial reimbursement provided) Complete and submit graduate school applications Develop and submit abstract to a scientific conference Present public health topic to community members
Abbreviations: Graduate Record Examination (GRE)/Medical College Admission Test (MCAT).
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388 ❘ Journal of Public Health Management and Practice students’ performance and students to evaluate their research mentors. Questionnaires used a 5-point Likert scale, with 5 being the highest rating. Scores were reported as percentages of the possible highest score. Total Cronbach α for the Student Evaluation Measure was .94. Subscales on the Student Evaluation Measure were Knowledge (Cronbach α = 0.87), Accuracy (Cronbach α = 0.78), Efficiency (Cronbach α = 0.75), Attitude (Cronbach α = 0.47), Professionalism (Cronbach α = 0.88), and Research Skills (Cronbach α = 0.70). The Mentor Performance Questionnaire’s Cronbach α was 0.91. Mentor Performance Questionnaire included the following subscales: Intellectual Growth and Development (Cronbach α = 0.87), Professional Career Development (Cronbach α = 0.76), Skill Development (Cronbach α = 0.68), Personal Communication (Cronbach α = 0.83), and Role Model (Cronbach α = 0.69). Evaluations were conducted at least twice during the student’s research experience, including at the conclusion of the student’s RISE research experience. At the end of the summer session, students gave a talk to peers and mentors on a self-selected public health topic. Students’ public health presentations were videotaped and objectively evaluated by faculty and peers using a standardized format. Copies of the videotaped presentations were given to the students. Students’ accomplishments were recognized during a closing graduation ceremony. A Microsoft Access database was created and used to track the students’ demographic information, program participation (eg, journal club attendance, research placement, and research hours), professional and academic activities during and after the RISE program, and evaluations. Contact forms were sent annually to all students for academic and professional updates. Students often e-mailed RISE administrative staff to update them on their accomplishments. The protocols for the database and analysis strategy were reviewed and approved by the Johns Hopkins Medical Institutional Review Board.
● Results Student description The majority of the students (95%) were African American and female (80%). Mean age of participants was 27 years (SD: 11 years; median: 25 years) (Table 2). Eightytwo percent of the students attended HBCUs. Students came from 7 different HBCUs, with the majority of students attending Howard University (41%) and Morgan State University (14%). Students who participated in the RISE program attended 7 different majority schools.
TABLE 2 ● Student Demographics (N = 66)
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Characteristic Age (y) Race Black Gender Female Institution type HBCU Majority Degree completed (n = 60) MD MD/MPH PhD, Psychology PhD, Leadership DSW DrPH MPH MSW MS Nursing
n (%)
Mean (SD)
Median
27 (11)
25
63 (95) 52 (80) 54 (82) 12 (18) 12 (20.0) 1 (1.7) 5 (8.3) 1 (1.7) 3 (5.0) 5 (8.3) 19 (31.7) 7 (11.6) 6 (10.0) 1 (1.7)
Abbreviation: HBCU, Historically Black Colleges and Universities.
Students were enrolled in master’s and doctoral degree programs including public health, medicine, psychology (applied, clinical, and developmental), social work, anthropology, and leadership.
RISE Program Goals 1, 2, and 3: Students’ accomplishments and outcomes Goal 1: Sixty-six students trained (100% retention rate) in the RISE program over 5 years (Table 3). All Bridge students were accepted into postbaccalaureate, graduate, or doctoral programs. Students presented a wide range of topics related to urban health and health disparities to their peers and the community. Examples of topics that students discussed included human immunodeficiency virus/AIDS, obesity, shaken baby syndrome, youth violence, stroke, cardiovascular disease, depression, maternal substance abuse, child maltreatment, attention deficit hyperactivity disorder, and comparison of health behaviors by race and ethnicity. More than 80% of the students submitted their research to scientific meetings, with an 89% (n = 47) acceptance rate. Presentations were accepted at national (eg, annual APHA and Society for Adolescent Health and Medicine) and international professional conferences (ie, International Congress of Autoimmunity Meeting in Portugal). To date, students were coauthors on 9 peer-reviewed manuscripts and 1 book chapter (Table 3).
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Promoting Diversity Among Public Health Professionals
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TABLE 3 ● RISE Student Accomplishments (N = 66)
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Accomplishments Completed masters MPH MSW MS Nursing Currently enrolled in doctoral degree programs Completed doctoral/MD degree programs MD PhD DSW DrPH Public health presentationa Poster Platform Chapter Community Manuscript Career Statusb Physician Nurse Research Mental health Public health Faculty Student
Summer Graduate n = 27, n (%)
Extended Graduate n = 28, n (%)
Bridge n = 11, n (%)
12 (44.4) 12 (44.4) ... ...
11 (39.3) 3 (10.7) 5 (17.9) 3 (10.7)
6 (22.2)
7 (25.0)
9 (81.1) 4 (36.4) 2 (18.2) 3 (27.3) 1 (9.1) 1 (9.1)
15 (55.5)
12 (42.9)
...
13 (48.1) 1 (3.7) ... 1 (3.7) 21 11 (40.7) 5 (18.5)
... ... ... ... 21 6 (54.5) 4 (36.4)
2 (7.4) 3 (11.1)
... 5 (17.9) 3 (10.7) 4 (14.3) 37 14 (50.0) 9 (32.1) 1 (3.6) 10 (35.7) 3 (10.7)
12 (44.4) ... 1 (3.7) 1 (3.7) 5 (18.5) ... 7 (25.9)
... ... 5 (17.9) 8 (28.6) 10 (35.7) 2 (7.1) 7 (25.0)
8 (72.7) 3 (27.3) ... 1 (9.1) 2 (18.2) 3 (27.3) 2 (18.2) ... 3 (27.3) (postbaccalaureate medical school programs)
a Some students were coauthors on presentations. b Student careers may include more than 1 area.
Goal 2: Twenty students revised their public health lectures for presentations at community health fairs in Baltimore City. Goal 3: By November 2013, 32 students obtained masters’ degrees, 13 students completed medical degrees, 14 students obtained doctoral degrees, and 1 student earned her nursing degree. Fourteen students continue in doctoral studies, and 1 student did not complete an MPH degree program. The majority of the RISE program students (95%) who graduated are working in public health or health-related fields.
ranged from 75 (SD: 19.9) for Research Skills to 92.6 (SD: 11.5) for Attitude. Specifically, mean scores for student were as follows: Professionalism 90.7 (SD: 11.7), Knowledge 89.0 (SD: 13.3), Accuracy 87.3 (SD: 14.9), and Efficiency 83.2 (SD: 17.6). In a survey of the mentors, all of the respondents reported that they found mentoring RISE students very or highly rewarding and stated that they would mentor a RISE student again (average rating 4.8 of 5 on both questions). Mentors felt that students valued their research experience (average rating 3.4 of 5 total score).
Mentors’ evaluation and reflections about students’ performance and mentoring experience
● Discussion
Mean mentors’ ratings of students’ performance were above average. Mean subscale scores for the students
Health equity is a long-standing achievable challenge for the United States. Increasing the diversity of the
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390 ❘ Journal of Public Health Management and Practice public health workforce is one strategy to reduce health disparities and promote health equity. By accomplishing the 3 proposed RISE program goals, namely, providing mentored research experiences; fostering collaborations among HBCUs, nonprofit institutions, and research universities; and increasing the enrollment of underrepresented students in public health and healthrelated graduate studies, the RISE program works to address this public health challenge. Ongoing support for comprehensive and innovative programs to promote public health clinical and research careers among underrepresented racial and ethnic populations, however, continues to be of utmost importance in the effort to eliminate health disparities. A recent study by Ginther et al9 published in Science highlights the lower likelihood of National Institutes of Health funding for African American researchers than that for white researchers. Increased research training of graduate and medical students from underrepresented populations will improve the probability of successful funding and expand the pool of knowledgeable and committed professionals needed to conduct research studies that inform social and health policy. Applying the methods suggested in the National Academy of Sciences 2011 report “Expanding Underrepresented Minority Participation: America’s Science and Technology Talent at the Crossroads,” the RISE program endeavored to create a supportive environment with high expectations for enrolled students.7 The RISE program at the Kennedy Krieger Institute was funded by the CDC to introduce graduate and baccalaureate degree students to opportunities in the public health research field. Creating partnerships with HBCU faculty fostered successful recruitment of students into the RISE program who were from traditionally underrepresented populations. The students’ accomplishments, highlighted by national presentations and peer-reviewed publications, reinforce their confidence to succeed in advanced academic settings. Students also improved their communication skills through presentation of public health topics to their mentors and peers. They gained further expertise as they “gave back” to the community through participation and speaking at community health fairs. The RISE program complemented the graduate education by providing mentored research experiences that applied didactic classroom-based learning. In addition to national presentations, publications, and book chapters, students used their RISE research projects to fulfill academic requirements for master’s theses, practicum courses, and dissertations. The RISE research experience facilitated completion of academic requirements, often reducing the time needed to complete dissertation research. An added benefit for the Kennedy Krieger
Institute and Johns Hopkins Medical Institutions was the ability to attract and recruit talented and diverse students for predoctoral, postdoctoral, and residency training programs.
Limitations The RISE program is a new initiative with a maximum of 8 years of follow-up student outcome data. Although current student achievement is positive, long-term outcomes are still forthcoming.
● Conclusion and Future Directions The support and development of young professionals in academic, policy, and research arenas is of significant public health importance. Many students desire funded research opportunities; however, there are too few opportunities for talented students. Nonprofit institutions, as well as universities, can effectively work to promote diversity among future public health leaders. Nonprofit institutions may provide a smaller, well-resourced and focused environment in which the student can learn and thrive. To our knowledge, the Kennedy Krieger Institute is one of the only nonprofit subacute health care institutions that sought out and provided a program to attract students from underrepresented populations to public health research careers. Importantly, the RISE program is a model public health program that may be disseminated for use in other nonprofit health and research institutions desiring to build collaborations between underrepresented students, communities, and institutions of higher learning. Future directions for programs designed to promote health equity should focus on attracting students throughout their educational careers beginning in secondary school. Cost analysis, comparison of student populations, and longitudinal follow-up after graduation would also enhance the ability of policy makers to calculate the value of such programs. Partnerships between HBCUs, majority institutions, public schools, and community youth centers may enhance the pipeline of eligible students. Through collaborations with nonprofit health agencies, state and federal health care providers may expand training and job opportunities and promote program sustainability. Further outreach and support need to be focused on underrepresented male students, which made up 20% of the RISE program. This is an area of continued challenge and need. Scholarship and mentoring programs provided by universities may benefit by partnering with nonprofit institutions, creating synergy and expansion of
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education and research focusing on areas that bridge health care gaps in urban communities. Increased and sustained efforts will be necessary, in this time a fiscal constraint, to continue to address the projected shortage of public health workers, especially those from underrepresented populations.
REFERENCES 1. Office of Disease Prevention and Promotion. Healthy People 2020. Washington, DC: U. S. Department of Health & Human Services; 2010 November. Report No.: ODPHP Publication No. B0132. 2. Passel JS, Cohn D. U.S. Population Projections: 2005-2015. Washington, DC: Pew Research Center; 2008. 3. Smedley BD, Stith AY, Colburn L, Evans CH. The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity in the Health Profession. Washington, DC: The National Academies Press; 2001.
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4. Jeste DV, Twamley EW, Cardenas V, Lebowitz B, Reynolds CF III. A call for training the trainers: focus on mentoring to enhance diversity in mental health research. Am J Public Health. 2009;99(suppl 1):S31-S37. 5. Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Public Health. 2008; 98(9 suppl):S8-S11. 6. Satcher D. Embracing culture, enhancing diversity, and strengthening research. Am J Public Health. 2009;99(suppl 1): S4. 7. Committee on Underrepresented Groups and the Expansion of the Science and Engineering Workforce Pipeline, Committee on Science Engineering, and Public Policy and Global Affairs. Expanding Underrepresented Minority Participation: America’s Science and Technology Talent at the Crossroads. Washington, DC: The National Academies Press; 2011. 8. Anthony JC, Van Etten ML. Epidemiology and its rubrics. In: Bellack AS, Hersen M, eds. Comprehensive Clinical Psychology. New York, NY: Pergamon; 1998:355-390. 9. Ginther DK, Schaffer WT, Schnell J, et al. Race, ethnicity, and NIH research awards. Science. 2011;333(6045):1015-1019.
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Context: Public health education and research training of underrepresented populations is an important component of a comprehensive approach to promote health equity. Objective: To describe student outcomes following participation in an innovative public health training cooperative agreement program funded by the Centers of Disease Control and Prevention. Participants: Sixty-six graduate, professional, and recent baccalaureate degree students participated in the Research Initiatives for Student Enhancement program. The majority of the students were from underrepresented populations (95%) and female (80%). Intervention: The Research Initiatives for Student Enhancement program, a collaboration between a university-affiliated Institute and Historically Black Colleges and Universities, provided public health educational and research experiences during the summer and academic year. Main Outcome Measure: Student presentations at national meetings, publications, and completion of degree programs. Results: The acceptance rate for student presentations at national scientific meetings was 89%. Almost 14 percent of the students were authors of peer-reviewed articles. More than one-third of the students (36%) completed their master’s degree and 33% completed doctoral degrees during the 5 years of the program. Students used their Research Initiatives for Student Enhancement program research to complete master’s theses, practicum requirements, and dissertations. Ninety-five percent of the students pursued education or careers in public health and health care. KEY WORDS: diversity, health equity, public health education,
underrepresented populations
Two major overarching goals of Healthy People 2020 are (1) to achieve health equity and (2) eliminate preventable disease, disability, and premature death.1 Increasing the number of individuals from underrepresented racial and ethnic populations (ie, African Americans, Hispanic/Latino persons, American Indians, Alaskan Natives, Pacific Islanders, and certain Asian populations) who work in health care and research professions is especially important to promote health equity given recent reports estimating that by the year 2050, the number of individuals from underrepresented racial and ethnic groups will increase to nearly half.2 Of concern, however, is current US census trends that do not project a burgeoning of a diverse scientific workforce that reflects the projected diversity of the US population. Without intentional and sustained efforts to recruit and retain well-qualified individuals from underrepresented populations into the science workforce, there will be a shortage of scientists and engineers that will have a negative impact on the US economy and general health of its citizenry.3-6 National Academy of Sciences recognized distinct barriers to and recommendations for the participation
Author Affiliations: The Family Center at Kennedy Krieger Institute, Baltimore, Maryland (Drs Belcher and McFadden); Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Belcher); and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Belcher). The authors thank and acknowledge the students and mentors who participated in the RISE Program. The RISE Program was supported by the Cooperative Agreement CDC, U50 MN325127. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Data from this paper were presented as a poster at the 2011 American Public Health Association Annual Meeting in Washington, District of Columbia, and the 2012 National Institutes of Health Summit on the Science of Eliminating Health Disparities: Building a Healthier Society Integrating Science, Policy and Practice, December 17-19, 2012, National Harbor, Maryland. Data from this paper were discussed during a platform presentation at the 2010 International Conference on Education Research. The authors declare no conflicts of interest.
J Public Health Management Practice, 2015, 21(4), 384–391 C 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright
Correspondence: Harolyn M. E. Belcher, MD, MHS, The Family Center at Kennedy Krieger Institute, 2901 East Biddle St, Baltimore MD 21213 ([email protected]). DOI: 10.1097/PHH.0000000000000052
384 Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Promoting Diversity Among Public Health Professionals
of underrepresented populations in the science field.7 Barriers include low expectations, lack of science career information and vigorous recruitment into the sciences, weak academic preparation, and inadequate financial resources. Priority recommendations to improve the number of underrepresented students in the sciences were to (1) develop strong educational programs from preschool through 12th grade, (2) provide social and financial support for underrepresented undergraduate students, (3) support teacher preparation and advanced training, and (4) develop programs that support the transition from undergraduate to graduate and professional schools. In 2005, a cooperative agreement was awarded to the Kennedy Krieger Institute by the Centers for Disease Control and Prevention (CDC), Office of Minority Health and Health Equity. The cooperative agreement resulted in the establishment of the Research Initiatives for Student Enhancement (RISE) Program. The ultimate goal of the RISE program was to increase the diversity of the public health workforce and reduce health disparities. Specifically, the RISE program goals were threefold: first, provide a mentored public health research experience for underrepresented racial and ethnic graduate students, targeting the student population attending Historically Black Colleges and Universities (HBCUs); second, increase collaboration and community outreach among 3 local HBCUs, the Kennedy Krieger Institute, and Johns Hopkins Bloomberg School of Public Health to expand awareness of physical and mental health disparities; and third, increase the enrollment of underrepresented populations in public health graduate and health-related graduate and professional programs. This article describes the development, activities, and evaluation of this innovative partnership between a nonprofit institution, that is, the Kennedy Krieger Institute, HBCUs, and the Johns Hopkins Medical Institutions.
● Methods Setting Kennedy Krieger Institute: The Kennedy Krieger Institute is a nonprofit, multispecialty institution, which is a Johns Hopkins University–affiliated program. Located in Baltimore City, the Kennedy Krieger Institute’s mission is to improve, through treatment, research, and education, the lives of children affected by disorders of the neurological system. The Kennedy Krieger Institute is within proximity to major HBCUs and majority institutions in the Baltimore-Washington, District of Columbia, area and annually has more than $25 million in research support facilitated by the Kennedy
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Krieger Institute’s grants management administration. The Kennedy Krieger Institute has the oldest and largest Leadership Education in Neurodevelopmental Disabilities training program in the United States. The infrastructure provided by the Leadership Education in Neurodevelopmental Disabilities program, with existing university training affiliation agreements and distance and technical learning capacities, provided an ideal environment for the development of a research training program to promote student diversity in public health research. Centers for Disease Control and Prevention Initiative: In 2005, the CDC funded the RISE program at the Kennedy Krieger Institute to formalize the partnership among the Kennedy Krieger Institute, HBCUs, and the Johns Hopkins Medical Institutions, addressing RISE Goals 1 and 2 to provide mentored research experiences and increase collaborations and community outreach among HBCUs, the Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, Johns Hopkins School of Nursing, and Johns Hopkins Bloomberg School of Public Health.
Program description Research Training Consortium: To address Goal 2 of the RISE program, a graduate Research Training Consortium with faculty from 3 urban HBCUs, namely (1) Coppin State University Department of Applied Psychology and School of Nursing, (2) Howard University Departments of Psychology and Biology, School of Social Work and School of Medicine, and (3) Morgan State University Department of Psychology, School of Computer Science, Mathematics, and Natural Sciences, School of Community Health and Policy, was developed. Faculty reviewed program initiatives and curricula, collaborated on manuscripts and grant proposals, and informed and recruited students for the RISE program. The Kennedy Krieger Institute established training affiliation agreements with the aforementioned universities and other universities interested in sending students to participate in the RISE program. Research Training Consortium members met quarterly to discuss program activities, student recruitment strategies, and grant collaborations. Student recruitment: Student recruitment depended on several strategies. The RISE Web site contained program description, eligibility requirements, online application, student testimonial videos, and contact information for RISE and HBCU faculty collaborators. Bookmark and shareware capabilities linked RISE Web site to numerous social media outlets. The RISE Web site linked to the CDC and National Institute of Allergy and Infectious Diseases at the National Institutes of Health Web sites. In addition to the RISE
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386 ❘ Journal of Public Health Management and Practice Web site, program staff attended college seminars and career fairs, contacted academic program directors via phone and e-mail, encouraged student peerto-peer recruitment, and directed mail recruitment outreach. Recruitment of research mentors: Volunteer research mentors were recruited through presentations and collaborations with deans, chairpersons, and research faculty at the Kennedy Krieger Institute and Johns Hopkins Medical Institutions. One-third of RISE researchers were from underrepresented populations. RISE research mentors received guidelines detailing program activities, objectives, and the expectation to interact closely with the students and guide and support the students’ research experience and success. The number of research opportunities available for the students increased each year of the RISE program, from 28 to 48. Applicant review and selection: Students were required to complete an application with 2 public health– focused essays and 2 academic letters of recommendation. Eligibility criteria for students also included a grade point average of at least 3.0 on a 4.0 scale. Objective criteria based on student academic achievement and community leadership, essays, and recommendations were created to rank application packets. The highest ranked students were interviewed by at least 2 members of the RISE program team. Interviewers included RISE administrative staff, faculty at The Johns Hopkins University School of Medicine, and current and past RISE students. Standardized forms were used to rank interviews. Interview scores were then added to the scores obtained from the paper application review to determine the final student ranking. The actual number of students selected each year was based on available funding and the housing and transportation funding support needed by the students. RISE research externships: Three types of mentored research experiences were developed to address Goal 1 of the RISE program, namely, to create a mentored research experience for the students. Students participated in (1) full-time 9-week summer research program (primarily for medical and out-of-state students), (2) extended graduate student research experience (full time during the summer and 10 hours per week during the academic year), or (3) full-time 1-year postbaccalaureate Bridge program to prepare students to enter graduate or professional school (Table 1). All students worked full time on their research projects during the summer. Following the summer program, extended graduate students worked for 10 h/wk during the academic year. Students received a prorated stipend on the basis of the National Institutes of Health trainee salary scale.
Students were required to have health insurance. Grant funds were used to support the cost of health insurance if a student was uninsured. Housing and round-trip transportation were provided for out-of-state students for the summer program. The RISE learning experience: Students in the RISE program completed the human subjects protection, confidentiality, and conflict of interest online training courses before beginning the RISE program. The RISE orientation provided the foundation for program. Orientation lectures covered the epidemiology of and research on health disparities, urban health issues (eg, obesity, human immunodeficiency virus, cancer disparities, community violence, substance abuse), mental health, developmental disabilities, research design, biostatistics, abstract and article development, Access database classes, advanced PubMed, and Reference Manager training. Students received an orientation notebook containing the orientation schedule, lecture objectives, PowerPoint presentations and related research articles, lecture evaluations, lecture quizzes, maps of the Kennedy Krieger Institute and Johns Hopkins Medical Institutions, conduct and dress code guidelines, confidentiality guidelines, descriptions of research opportunities, a research ranking form, and universal precautions information. Students completed quizzes after lectures to reinforce the material presented. At the end of the orientation week, students selected their top 3 research choices and were matched according to the students’ interest and the researchers’ availability. Students could work on up to 2 research projects. When students worked on 2 research projects, 1 research project was usually in the early stages of development and the other project had data ready for analysis. This gave students a broad experience with research design, implementation, and analysis. Weekly seminars were held to discuss active public health projects, review and critique journal articles, and explore public health career opportunities. All students self-selected a public health topic of interest to investigate. The public health topic was presented, using an epidemiologic rubric8 developed by Dr James Anthony, Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, to their mentors and peers during the closing seminar at the end of the summer. Students who were in the extended graduate student and Bridge programs participated in monthly journal clubs during the academic year. Students led the journal clubs during the spring semester. All students were registered as student members of the American Public Health Association (APHA) and received the American Journal of Public Health. Students were encouraged to submit their research to the APHA
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annual meeting. Students who submitted their research to the APHA or other scientific meetings were sponsored to attend the scientific meeting (as CDC funding allowed). In addition to the activities mentioned previously, students in the Bridge program participated in grantfunded Graduate Record Examination (or equivalent examination) preparatory courses and received guidance with graduate school application process, curriculum vitae, and personal statement support development by the RISE program director. Extended graduate and Bridge students presented their public health topics to community members at local Baltimore
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City health fairs. In preparation for annual community health fairs, students revised their public health topic to be relevant for community members. Over the course of the RISE program, a successful distance-learning component was developed for out-of-state graduate students who wanted to continue doing research with their mentors. RISE Facebook: Students developed and maintained a RISE Facebook page to continue to network, encourage, and support each other following graduation from the RISE program. RISE program evaluation: Structured questionnaires were used for research faculty to evaluate their
TABLE 1 ● Description of RISE Research Experience and Student Enrollment (N = 66)
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Research Experience Summer graduate
Student Characteristics Out-of-state graduate students
Number of Students per Year 2006
2007
2008
2009
2010
3
5
8
6
5
7
8
4
2
7
2
4
2
2
1
Medical students
Extended graduate
Postbaccalaureate (Bridge)
Local graduate students Graduate students with identified collaborative research mentor at their home school Baccalaureate degree received within 6 mo of the RISE orientation
RISE Research Experience Description Summer program (9 wk) Human Subjects Protection and Research Ethics compliance certification RISE orientation 40 h worked per week on research project Weekly meetings with mentor Weekly public health seminars One day Mental Health Prevention course at the Bloomberg Summer Institute Select and present a public health topic to colleagues and program mentors Summer program (9 wk) as described previously, and during academic year 10 h worked per week during on research project Weekly meeting with mentor Monthly public health seminars Develop and submit abstract to a scientific conference Present public health topic to community members Full-time employment for 1 y as Bridge student prepares for graduate or professional school (includes Summer program activities as described previously) Weekly meeting with RISE program director to create time line for graduate/professional school applications, prepare personal statements and resume Public health seminars (monthly during academic year) Take GRE/MCAT test prep course (financial reimbursement provided) Complete and submit graduate school applications Develop and submit abstract to a scientific conference Present public health topic to community members
Abbreviations: Graduate Record Examination (GRE)/Medical College Admission Test (MCAT).
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388 ❘ Journal of Public Health Management and Practice students’ performance and students to evaluate their research mentors. Questionnaires used a 5-point Likert scale, with 5 being the highest rating. Scores were reported as percentages of the possible highest score. Total Cronbach α for the Student Evaluation Measure was .94. Subscales on the Student Evaluation Measure were Knowledge (Cronbach α = 0.87), Accuracy (Cronbach α = 0.78), Efficiency (Cronbach α = 0.75), Attitude (Cronbach α = 0.47), Professionalism (Cronbach α = 0.88), and Research Skills (Cronbach α = 0.70). The Mentor Performance Questionnaire’s Cronbach α was 0.91. Mentor Performance Questionnaire included the following subscales: Intellectual Growth and Development (Cronbach α = 0.87), Professional Career Development (Cronbach α = 0.76), Skill Development (Cronbach α = 0.68), Personal Communication (Cronbach α = 0.83), and Role Model (Cronbach α = 0.69). Evaluations were conducted at least twice during the student’s research experience, including at the conclusion of the student’s RISE research experience. At the end of the summer session, students gave a talk to peers and mentors on a self-selected public health topic. Students’ public health presentations were videotaped and objectively evaluated by faculty and peers using a standardized format. Copies of the videotaped presentations were given to the students. Students’ accomplishments were recognized during a closing graduation ceremony. A Microsoft Access database was created and used to track the students’ demographic information, program participation (eg, journal club attendance, research placement, and research hours), professional and academic activities during and after the RISE program, and evaluations. Contact forms were sent annually to all students for academic and professional updates. Students often e-mailed RISE administrative staff to update them on their accomplishments. The protocols for the database and analysis strategy were reviewed and approved by the Johns Hopkins Medical Institutional Review Board.
● Results Student description The majority of the students (95%) were African American and female (80%). Mean age of participants was 27 years (SD: 11 years; median: 25 years) (Table 2). Eightytwo percent of the students attended HBCUs. Students came from 7 different HBCUs, with the majority of students attending Howard University (41%) and Morgan State University (14%). Students who participated in the RISE program attended 7 different majority schools.
TABLE 2 ● Student Demographics (N = 66)
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Characteristic Age (y) Race Black Gender Female Institution type HBCU Majority Degree completed (n = 60) MD MD/MPH PhD, Psychology PhD, Leadership DSW DrPH MPH MSW MS Nursing
n (%)
Mean (SD)
Median
27 (11)
25
63 (95) 52 (80) 54 (82) 12 (18) 12 (20.0) 1 (1.7) 5 (8.3) 1 (1.7) 3 (5.0) 5 (8.3) 19 (31.7) 7 (11.6) 6 (10.0) 1 (1.7)
Abbreviation: HBCU, Historically Black Colleges and Universities.
Students were enrolled in master’s and doctoral degree programs including public health, medicine, psychology (applied, clinical, and developmental), social work, anthropology, and leadership.
RISE Program Goals 1, 2, and 3: Students’ accomplishments and outcomes Goal 1: Sixty-six students trained (100% retention rate) in the RISE program over 5 years (Table 3). All Bridge students were accepted into postbaccalaureate, graduate, or doctoral programs. Students presented a wide range of topics related to urban health and health disparities to their peers and the community. Examples of topics that students discussed included human immunodeficiency virus/AIDS, obesity, shaken baby syndrome, youth violence, stroke, cardiovascular disease, depression, maternal substance abuse, child maltreatment, attention deficit hyperactivity disorder, and comparison of health behaviors by race and ethnicity. More than 80% of the students submitted their research to scientific meetings, with an 89% (n = 47) acceptance rate. Presentations were accepted at national (eg, annual APHA and Society for Adolescent Health and Medicine) and international professional conferences (ie, International Congress of Autoimmunity Meeting in Portugal). To date, students were coauthors on 9 peer-reviewed manuscripts and 1 book chapter (Table 3).
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Promoting Diversity Among Public Health Professionals
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TABLE 3 ● RISE Student Accomplishments (N = 66)
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Accomplishments Completed masters MPH MSW MS Nursing Currently enrolled in doctoral degree programs Completed doctoral/MD degree programs MD PhD DSW DrPH Public health presentationa Poster Platform Chapter Community Manuscript Career Statusb Physician Nurse Research Mental health Public health Faculty Student
Summer Graduate n = 27, n (%)
Extended Graduate n = 28, n (%)
Bridge n = 11, n (%)
12 (44.4) 12 (44.4) ... ...
11 (39.3) 3 (10.7) 5 (17.9) 3 (10.7)
6 (22.2)
7 (25.0)
9 (81.1) 4 (36.4) 2 (18.2) 3 (27.3) 1 (9.1) 1 (9.1)
15 (55.5)
12 (42.9)
...
13 (48.1) 1 (3.7) ... 1 (3.7) 21 11 (40.7) 5 (18.5)
... ... ... ... 21 6 (54.5) 4 (36.4)
2 (7.4) 3 (11.1)
... 5 (17.9) 3 (10.7) 4 (14.3) 37 14 (50.0) 9 (32.1) 1 (3.6) 10 (35.7) 3 (10.7)
12 (44.4) ... 1 (3.7) 1 (3.7) 5 (18.5) ... 7 (25.9)
... ... 5 (17.9) 8 (28.6) 10 (35.7) 2 (7.1) 7 (25.0)
8 (72.7) 3 (27.3) ... 1 (9.1) 2 (18.2) 3 (27.3) 2 (18.2) ... 3 (27.3) (postbaccalaureate medical school programs)
a Some students were coauthors on presentations. b Student careers may include more than 1 area.
Goal 2: Twenty students revised their public health lectures for presentations at community health fairs in Baltimore City. Goal 3: By November 2013, 32 students obtained masters’ degrees, 13 students completed medical degrees, 14 students obtained doctoral degrees, and 1 student earned her nursing degree. Fourteen students continue in doctoral studies, and 1 student did not complete an MPH degree program. The majority of the RISE program students (95%) who graduated are working in public health or health-related fields.
ranged from 75 (SD: 19.9) for Research Skills to 92.6 (SD: 11.5) for Attitude. Specifically, mean scores for student were as follows: Professionalism 90.7 (SD: 11.7), Knowledge 89.0 (SD: 13.3), Accuracy 87.3 (SD: 14.9), and Efficiency 83.2 (SD: 17.6). In a survey of the mentors, all of the respondents reported that they found mentoring RISE students very or highly rewarding and stated that they would mentor a RISE student again (average rating 4.8 of 5 on both questions). Mentors felt that students valued their research experience (average rating 3.4 of 5 total score).
Mentors’ evaluation and reflections about students’ performance and mentoring experience
● Discussion
Mean mentors’ ratings of students’ performance were above average. Mean subscale scores for the students
Health equity is a long-standing achievable challenge for the United States. Increasing the diversity of the
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390 ❘ Journal of Public Health Management and Practice public health workforce is one strategy to reduce health disparities and promote health equity. By accomplishing the 3 proposed RISE program goals, namely, providing mentored research experiences; fostering collaborations among HBCUs, nonprofit institutions, and research universities; and increasing the enrollment of underrepresented students in public health and healthrelated graduate studies, the RISE program works to address this public health challenge. Ongoing support for comprehensive and innovative programs to promote public health clinical and research careers among underrepresented racial and ethnic populations, however, continues to be of utmost importance in the effort to eliminate health disparities. A recent study by Ginther et al9 published in Science highlights the lower likelihood of National Institutes of Health funding for African American researchers than that for white researchers. Increased research training of graduate and medical students from underrepresented populations will improve the probability of successful funding and expand the pool of knowledgeable and committed professionals needed to conduct research studies that inform social and health policy. Applying the methods suggested in the National Academy of Sciences 2011 report “Expanding Underrepresented Minority Participation: America’s Science and Technology Talent at the Crossroads,” the RISE program endeavored to create a supportive environment with high expectations for enrolled students.7 The RISE program at the Kennedy Krieger Institute was funded by the CDC to introduce graduate and baccalaureate degree students to opportunities in the public health research field. Creating partnerships with HBCU faculty fostered successful recruitment of students into the RISE program who were from traditionally underrepresented populations. The students’ accomplishments, highlighted by national presentations and peer-reviewed publications, reinforce their confidence to succeed in advanced academic settings. Students also improved their communication skills through presentation of public health topics to their mentors and peers. They gained further expertise as they “gave back” to the community through participation and speaking at community health fairs. The RISE program complemented the graduate education by providing mentored research experiences that applied didactic classroom-based learning. In addition to national presentations, publications, and book chapters, students used their RISE research projects to fulfill academic requirements for master’s theses, practicum courses, and dissertations. The RISE research experience facilitated completion of academic requirements, often reducing the time needed to complete dissertation research. An added benefit for the Kennedy Krieger
Institute and Johns Hopkins Medical Institutions was the ability to attract and recruit talented and diverse students for predoctoral, postdoctoral, and residency training programs.
Limitations The RISE program is a new initiative with a maximum of 8 years of follow-up student outcome data. Although current student achievement is positive, long-term outcomes are still forthcoming.
● Conclusion and Future Directions The support and development of young professionals in academic, policy, and research arenas is of significant public health importance. Many students desire funded research opportunities; however, there are too few opportunities for talented students. Nonprofit institutions, as well as universities, can effectively work to promote diversity among future public health leaders. Nonprofit institutions may provide a smaller, well-resourced and focused environment in which the student can learn and thrive. To our knowledge, the Kennedy Krieger Institute is one of the only nonprofit subacute health care institutions that sought out and provided a program to attract students from underrepresented populations to public health research careers. Importantly, the RISE program is a model public health program that may be disseminated for use in other nonprofit health and research institutions desiring to build collaborations between underrepresented students, communities, and institutions of higher learning. Future directions for programs designed to promote health equity should focus on attracting students throughout their educational careers beginning in secondary school. Cost analysis, comparison of student populations, and longitudinal follow-up after graduation would also enhance the ability of policy makers to calculate the value of such programs. Partnerships between HBCUs, majority institutions, public schools, and community youth centers may enhance the pipeline of eligible students. Through collaborations with nonprofit health agencies, state and federal health care providers may expand training and job opportunities and promote program sustainability. Further outreach and support need to be focused on underrepresented male students, which made up 20% of the RISE program. This is an area of continued challenge and need. Scholarship and mentoring programs provided by universities may benefit by partnering with nonprofit institutions, creating synergy and expansion of
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education and research focusing on areas that bridge health care gaps in urban communities. Increased and sustained efforts will be necessary, in this time a fiscal constraint, to continue to address the projected shortage of public health workers, especially those from underrepresented populations.
REFERENCES 1. Office of Disease Prevention and Promotion. Healthy People 2020. Washington, DC: U. S. Department of Health & Human Services; 2010 November. Report No.: ODPHP Publication No. B0132. 2. Passel JS, Cohn D. U.S. Population Projections: 2005-2015. Washington, DC: Pew Research Center; 2008. 3. Smedley BD, Stith AY, Colburn L, Evans CH. The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity in the Health Profession. Washington, DC: The National Academies Press; 2001.
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4. Jeste DV, Twamley EW, Cardenas V, Lebowitz B, Reynolds CF III. A call for training the trainers: focus on mentoring to enhance diversity in mental health research. Am J Public Health. 2009;99(suppl 1):S31-S37. 5. Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Public Health. 2008; 98(9 suppl):S8-S11. 6. Satcher D. Embracing culture, enhancing diversity, and strengthening research. Am J Public Health. 2009;99(suppl 1): S4. 7. Committee on Underrepresented Groups and the Expansion of the Science and Engineering Workforce Pipeline, Committee on Science Engineering, and Public Policy and Global Affairs. Expanding Underrepresented Minority Participation: America’s Science and Technology Talent at the Crossroads. Washington, DC: The National Academies Press; 2011. 8. Anthony JC, Van Etten ML. Epidemiology and its rubrics. In: Bellack AS, Hersen M, eds. Comprehensive Clinical Psychology. New York, NY: Pergamon; 1998:355-390. 9. Ginther DK, Schaffer WT, Schnell J, et al. Race, ethnicity, and NIH research awards. Science. 2011;333(6045):1015-1019.
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