Developing a Diverse EM Faculty by Thinking Strategically About the Pipeline That Leads From Student to Clinician

By Nancy Wood MPA, MS and Beau Abar PhD on behalf of the SAEM Grants Committee

Undergraduate emergency medicine (EM) research enroller programs have served as a pipeline to support students “the vision of the class model held by considering a career in medicine, engaging them in research and, in program leadership was to provide many cases, instilling a passion for EM. Many end up in EM residencies and become our colleagues in emergency underrepresented students of color with departments across the country. Recently, the societal unrest following experiences that would help them compete George Floyd’s death and the resulting attention to the Black Lives Matter with students experiencing privilege.” movement has prompted us to reflect on and intensify our division’s efforts to diversify the population of student after hiring. The proposed new model, to being hired into a parttime EDRA enrollers working in our emergency instead, first required students to take position. department (ED). Several years ago, we began considering changing the model of our ED Research Associate (EDRA) program to include classes for credit prior to hiring students into paid positions. In the past, we hired undergraduates into parttime positions and trained them a new four-credit public health class providing all of the initial training and field experience to prepare a student to work in ED research. Enrollment in the class was capped at 16 students per semester, with applications required for admittance. Successful completion of the class became a prerequisite There was initial hesitation about this idea, with team members arguing that under this system only the students who were financially stable could give up paid employment to work in the ED “for free,” as the class involved committing to time spent working in the ED as well as classroom instruction. There was

concern that this innovation, as initially planned, would result in the program becoming even less representative of our student and patient populations during a time when we were actively trying to diversify and make the enrollers more representative of our populations’ racial, ethnic, and socioeconomic diversity. In the end, we agreed to a trial of this change in program structure. While there would be more students than paid positions open, it was acknowledged that the class would broaden the number of students receiving invaluable experiences with direct patient interactions that would prepare them for medical school and beyond.

An important lesson learned in interviewing students for EDRA positions was that students who came with a long resume of clinical experience (including shadowing) and fantastic prior research experiences were more likely to be White and/or raised in a wealthy suburban family. They were hired because they arrived with more qualifications and were perceived as more ready for ED enrollment. As a result, the vision of the class model held by program leadership was to provide underrepresented students of color with experiences that would help them compete with students experiencing privilege. Not surprisingly, it didn’t happen overnight.

The University of Rochester student body is about 46 percent White, but we found our course applicants did not represent the 54 percent of nonWhite students. Much to our dismay, we didn’t have an “if we build it, they will come” situation. Over time, we partnered with first generation student outreach groups, student organizations that supported students of color, and the campus group that supported students of color seeking internship experiences. We learned that many of the students we sought were unable to take an extra class and still work enough to pay expenses, so we modified the class so that it would not be considered “extra.” We enhanced our writing assignments so that students could use the EDRA internship to satisfy undergraduate writing requirements and eliminate a class taken solely for this requirement. We reached out and, most importantly, tried to listen. As a result, our recent EDRA internship classes have been substantially more racially and ethnically diverse than in previous semesters, and this is an accomplishment we’re very proud of.

Our vision is that by playing a small part in increasing the number of underrepresented students who apply to medical school, who have competitive experience on their resumes and compelling stories about patients in the ED to talk about in interviews, and who go on to EM residencies based on a passion sparked as an undergraduate, our EM faculty will eventually look a bit more like the patients they serve. We encourage everyone to think strategically about the pipeline that leads from student to clinician as a way to make meaningful changes that can grow over time.

ABOUT THE AUTHORS Nancy Wood is a faculty member in Emergency Medicine at the University of Rochester Medical Center (URMC) and the administrative director of the University of Rochester Emergency Department Research Associates program. She also serves as the primary instructor of the above discussed EDRA internship class.

Dr. Abar is an associate professor of Emergency Medicine, Psychiatry, and Public Health Sciences and is the faculty director of the EDRA program at URMC.