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Health Equity Workforce Research Center
Director: Patricia Pittman, PhD
Deputy Director: Clese Erikson, MPAff
The Health Equity Workforce Research Center was housed at the Fitzhugh Mullan Institute for Health Workforce Equity from 2019-2022. The Equity HWRC research portfolio looked across the continuum of education and training opportunities for all health professions and assess them in relation to social mission outcomes. We focused on developing and enhancing new metrics and tools for measuring health equity in health professions education, and partnering with health professions associations to analyze pipeline and school characteristics effects on health equity.
Previous Research Studies
Increasing Degree Requirements Decreased Diversity of Physician Assistants and Physical Therapist Graduates
On average, health professions that require a higher level of education have lower levels of underrepresented minorities. There has been little if any research as to whether the diversity of new entrants to a health profession falls when degree requirements are increased (e.g., from a master’s to a doctoral degree). This information could inform current debates about whether to increase the minimum entry degrees further, for example, for from the masters to doctoral level for physician assistants and nurse practitioners. This study addresses this gap.
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For questions about this study, contact Edward Salsberg.
The Role of Community Colleges in Health Professions Diversity
Community colleges (CCs) have long been noted as an important pathway for increasing the diversity of health professions as they are an important entry point to post-secondary education for low-income, minority and rural students. This study built on prior work to examine the contribution of community colleges to diversity other health professions that require advanced degrees, including occupational therapy (OT), physical therapy (PT), pharmacy, and dentistry. The study also examined associations between state investments in community colleges and cost of attending CCs and the diversity of health professions graduates in the state.
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For questions about this study, contact Clese Erikson or Leah Masselink.
Public Health Workforce Diversity: The Role of Academic Institutions
COVID-19 brought to the surface existing structural racism that has left gaps in access to care and health outcomes, disproportionately affecting racial and ethnic minority groups. To address racial and ethnic disparities in health outcomes, it is important to have a racially and ethnically diverse workforce that can address such public health issues. This study was designed to understand the relationship between school characteristics and the diversity of the public health workforce pipeline. Findings will create transparency through an evidence-driven analysis of the current state of public health education and identify opportunities for public health schools and programs to reflect upon their roles in contributing toward a diverse and equitable public health workforce.
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- Research Abstract
- Research Report
- Vichare A, Park YH, Plepys CM. 2023. Diversity of the US Public Health Workforce Pipeline (2016–2020): Role of Academic Institutions. American Journal of Public Health.doi.org/10.2105/AJPH.2023.307352.
For questions about this study, contact Anushree Vichare.
Predicting Systems-Based Practice Performance: Correlations Between Medical School Social Mission Scores and Competency Assessments in Residency
Since 2013, the Accreditation Council for Graduate Medical Education (ACGME) has used Systems-Based Practice (SBP) Milestones across medical specialties to measure resident physicians’ competence in working within health systems, including understanding and addressing health disparities and upstream factors that impact health. Ensuring resident competency in SBP is integral to HRSA’s goal of fostering a health care workforce to address current and emerging needs. Many medical schools are increasing their uptake of social mission, which includes preparing their graduates to address health equity and incorporating health systems science curricula and programs. However, little is known about how these factors impact graduates applied skills in systems-based practice once they graduate. This exploratory study aimed to assess whether the social mission-orientation of a medical school predicts its graduates’ performance on systems-based practice milestones in residency.
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Developing a Systems-Oriented Theory of Change for the Social Mission of Health Professions Education
A prior HRSA-funded study on advancing social mission research found a lack of a clear definition around what constitutes social mission in health professions education, wide heterogeneity in outcomes and metrics, and little specificity on how the expected impact of social mission-related activities would advance health equity. A social mission logic model could address these limitations by clearly illustrating consensus-based social mission inputs, outcomes, and the pathways by which health professions education may contribute to health equity. We believe its development is a necessary step toward accelerating and aligning stakeholders and resources to advance social mission research and lead toward a better understanding of how social mission activities contribute to the creation of a health workforce primed to advance health equity.
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For questions about this study, contact Clese Erikson.
The Association of Medical Education with Primary Care Physicians’ Medicaid Participation: Exploring the 2016 Medicaid Claims
The health workforce is a critical component of healthcare delivery, where the type of providers, their distribution, and their practice behaviors, including acceptance of patient’s health insurance, affect access and quality of care. Acceptance of Medicaid patients has remained a challenge, further widening existing inequities in access to care in a vulnerable population. These stark disparities are even more concerning amidst the COVID-19 pandemic as inequitable access may further exacerbate health and social disparities. This underscores the importance of maintaining a robust supply of the Medicaid health workforce to provide timely access to care for the low-income. The study’s objective was to examine the association between the role of medical schools and their graduates’ participation in Medicaid.
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For questions about this study, contact Anushree Vichare.
Promoting Equity in Emergency Preparedness & Disaster Response for Medical Students: A Qualitative Exploration
The purpose of this study was to document the range of emergency health workforce policies and public payment waivers issued in response to the COVID-19 public health emergency and to begin to understand their perceived impact on specific health professions, in specific settings, by specific stakeholders. Once these policies and stakeholder reactions are mapped, we propose to follow up in the fiscal year 2021-2022 cycle with the second phase of this study that would assess which policies modified the supply of clinicians and their practice patterns.
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For questions about this study, contact Patricia Pittman.
Pipeline Programs During COVID-19
Pipeline programs refer to initiatives at all levels of education intended to attract and retain underrepresented students, including minority, low income, and women, to increase representation in health professions fields. Enhancing diversity among health professionals is important to improving health care access and effectively serve minority and medically underserved communities. The Liaison Committee on Medical Education (LCME) requires that medical schools engage in pipeline programs and partnerships to enhance diversity, making them ubiquitous across medical schools accredited by the LCME.
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- Research Abstract
- Batra S, Orban J, Raichur S, et al. Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs. JAMA Netw Open. 2022;5(8):e222908.
Identifying School-Level Factors Associated with Diversity in Dental Education
This study involved 3 components. (1) Using institutional and student demographic characteristics from the Integrated Postsecondary Education Data System (IPEDS) and population statistics from the American Community Survey (ACS), we compared the diversity of dental school graduates to the diversity of the U.S. population between the ages of 20 to 35, the general age of graduates of health professions programs. Using this Diversity Index, we ranked schools according to program-to-population diversity and identify programs with the greatest improvements in diversity over time. (2) We conducted quantitative analyses to determine which institutional factors are associated with higher levels of diversity. (3) We conducted case studies of 5 select dental programs to understand how they have been able to increase diversity over time.
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- Research Abstract
- Health Workforce Diversity Tracker
- Salsberg E, Brantley E, Westergaard S, Farrell J, Rosenthal C. Limited, Uneven Progress in Increasing Racial and Ethnic Diversity of Dental School Graduates. J Dent Educ. 2021;86(1):107-116.
For questions about this study, contact Edward Salsberg.
Social Mission in Health Professions Accreditation
Accreditation in health professions education influences institutions’ practices and policies, ever-evolving to ensure high-quality education that meets the needs of patients and society. Health professions institutions are beginning to examine their approach to educating health care leaders to advance health equity through their social mission commitments. Social mission is the contribution of the school in its mission, programs, and the performance of its graduates, faculty, and leadership in advancing health equity and addressing the health disparities of the society in which it exists.” This study examined the scope of social mission content in major U.S. and Canadian health professions accreditation standards.
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- Research Abstract
- Orban J, Xue C, Raichur S, Misak M, Nobles A, Casimir J, Batra S. 2021. The Scope of Social Mission Content in Health Professions Education Accreditation Standards. Academic Medicine. doi: 10.1097/ACM.0000000000004437.
Residency Training in Community Health Centers: Implications for Staffing, Service, Quality of Care, and Provider Productivity
Community-based residency programs are an important strategy to address rural and underserved primary care shortages. Health centers engaged in residency programs report both benefits and challenges to training. This study aimed to understand the impact of the new Teaching Health Center (THC) residency programs on health center provider staffing, patient service, quality of care, and provider productivity.
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- Research Abstract
- Chen C, Chong N, Luo Q, Park J. 2021. Community Health Center Residency Training: Improving Staffing, Service, and Quality. Family Medicine. 53(8):689-696. doi: 10.22454/FamMed.2021.843335.
Effects of Completing a Postgraduate Residency or Fellowship Program on Primary Care Nurse Practitioners’ Transition to Practice
This study sought to examine the effect of completing a postgraduate residency or fellowship program on role perception, practice autonomy, team collaboration, job satisfaction, and intent to leave among primary care nurse practitioners (PCNPs).
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- Research Abstract
- Park J, Faraz Covelli A, Pittman P. 2021. Effects of Completing a Postgraduate Residency or Fellowship Program on Primary Care Nurse Practitioners’ Transition to Practice. Journal of the American Association of Nurse Practitioners. 34(1):32-41. doi: 10.1097/JXX.0000000000000563.
For questions about this study, contact Patricia Pittman.
Does Variation in State Nursing Education Regulations Matter?
This study aimed to identify policies states can adopt to improve nursing licensure pass rates by examining the relationships among state policies and nursing program-level characteristics to educational quality outcomes.
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- Research Abstract
- Pittman P, Zieman M, Pillai D, Bass E. Variation in State Education Regulations for RNs. Journal of Nursing Education. 2022;61(5):242-249.
For questions about this study, contact Patricia Pittman.
Building a Social Mission Research Agenda: Reviewing the Literature, Identifying Gaps, & Planning Ahead
The purpose of this study was to summarize the research on social mission in health professions education, identify evidence gaps and areas for additional inquiry, and discuss the resources and strategies needed to catalyze the advancement of a social mission research agenda and infrastructure.
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- Research Abstract
- Erikson C, Ziemann M. 2021. Advancing Social Mission Research: A Call to Action. Academic Medicine. doi: 10.1097/ACM.0000000000004427.
For questions about this study, contact Clese Erikson.
A Website Assessment of Interprofessional Education at Newly Established Medical School
Consensus guidance recommends that IPE in health professions education should be required, longitudinal, involve learning opportunities with other health professions students, and include real-world, experiential elements. The objective of this study was to assess IPE at newly established medical schools within the context of these recommendations, based on publicly available information published on schools’ websites.
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For questions about this study, contact Margaret Ziemann.
Social Mission Metrics Priorities II Survey
The overall objective of the Social Mission Metrics Initiative (SMMI) is to develop, disseminate and institutionalize a valid and usable instrument through which health professions schools can assess their success in advancing the social mission of their institutions. In 2018-19 this initiative obtained completed surveys from over 240 U.S. dental, nursing and medical schools. The Social Mission Metrics Priorities II Survey is designed to address an additional challenge in the continuing development of this instrument: how should specific indicators be weighted to accurately reflect their relative importance in contributing to Social Mission?
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- Research Abstract
- Research Brief
- Research Report
- Batra S, Orban J, Zhang H, et.al. Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US. JAMA Network Open. 2022;5(5):e2210900.
Program Attributes and Perceived Effects of the Interprofessional Student Hotspotting Learning Collaborative
The purpose of this study was to qualitatively examine: 1) the student hotspotting program model attributes that contribute to self-reported learning outcomes and experiences, 2) the lasting effects of program participation on alumni’s professional practice, and 3) the programmatic or curricular impacts program participation may have on the universities that host them.
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For questions about this study, contact Clese Erikson.
Does Prior Community College Attendance Predict Diversity in Health Professions Schools? The Case of Physician Assistants
This study explores whether applicants with a community college (CC) background contribute to the diversity of matriculants in Physician Assistant (PA) programs and if CC applicants are less likely to matriculate in PA programs.
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- Research Abstract
- Research Brief
- Luo Q, Erikson C, Chitwood R, Yuen C. 2020. Does Community College Attendance Affect Matriculation to a Physician Assistant Program? A Pathway to Increase Diversity in the Health Professions. Academic Medicine. doi: 10.1097/ACM.0000000000003860.
For questions about this study, contact Eric Luo.
Dental Education and Factors Associated with Medicaid Pediatric Dental Participation
While access to dental care for children enrolled in Medicaid has grown steadily, Medicaid children still face greater access barriers than privately-insured children. It is important to understand factors associated with whether dentists participate in Medicaid, including factors associated with their dental school training.
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- Research Abstract
- Research Brief
- Ku L, Han X, Chen C, Vujicic M. 2020. The Association of Dental Education with Pediatric Medicaid Participation. Journal of Dental Education, 85: 69-77.
For questions about this study, contact Leighton Ku.
Peer-Reviewed Publications
- Pittman P, Zieman M, Pillai D, Bass E. 2022. Variation in State Education Regulations for RNs. Journal of Nursing Education. DOI: 10.3928/01484834-20220303-06.
- Batra S, Orban J, Raichur S, et al. 2022. Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs. JAMA Netw Open. doi:10.1001/jamanetworkopen.2022.29086.
- Batra S, Orban J, Zhang H, et.al. 2022. Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US. JAMA Network Open. doi:10.1001/jamanetworkopen.2022.10900.
- Park J, Faraz Covelli A, Pittman P. 2021. Effects of Completing a Postgraduate Residency or Fellowship Program on Primary Care Nurse Practitioners’ Transition to Practice. Journal of the American Association of Nurse Practitioners. doi: 10.1097/JXX.0000000000000563.
- Chen C, Chong N, Luo Q, Park J. 2021. Community Health Center Residency Training: Improving Staffing, Service, and Quality. Family Medicine. doi: 10.22454/FamMed.2021.843335.
- Pittman P, et al. 2021. Health Workforce for Health Equity. Medical Care. doi: 10.1097/MLR.0000000000001609.
- Armstrong D, Moore J, Ziemann M, Strasser J, Westfall N, Krips M. State Responses to Address Workforce Needs in the Initial Wave of the Pandemic. Health Workforce Technical Assistance Center: NY. March 2021.
- Erikson C, Ziemann M. 2021. Advancing Social Mission Research: A Call to Action. Academic Medicine. doi: 10.1097/ACM.0000000000004427.
- Salsberg E, Brantley E, Westergaard S, Farrell J, Rosenthal C. 2021. Limited, Uneven Progress in Increasing Racial and Ethnic Diversity of Dental School Graduates. J Dent Educ. doi: 10.1002/jdd.12793
- Orban J, et al. 2021. The Scope of Social Mission Content in Health Professions Education Accreditation Standards. Academic Medicine. doi: 10.1097/ACM.0000000000004437.
- Luo Q, Erikson C, Chitwood R, Yuen C. 2020. Does Community College Attendance Affect Matriculation to a Physician Assistant Program? A Pathway to Increase Diversity in the Health Professions. Academic Medicine. doi: 10.1097/ACM.0000000000003860.
- Ku L, Han X, Chen C, Vujicic M. 2020. The Association of Dental Education with Pediatric Medicaid Participation. Journal of Dental Education. doi: 10.1002/jdd.12390