Collaboration seems to be a common theme among trailblazing health sciences center outreach programs aimed at increasing the student diversity in the health sciences and/or the diversity of the applicant pool for professional health sciences programs (i.e. medicine/pharmacy). For James et al who detail the Eastern Area Health Education Center (EAHEC or Eastern AHEC) which is housed at East Carolina University (ECU) “[a] key component of this form of collaboration is that together the agencies can overcome some obstacle or challenge that the individual agencies could not accomplish independently” (p. 33). Most programs I researched felt that their collaborations not only benefited teachers and students but also the outreach efforts themselves by expanding their capacity to reach more students. For the University of Hawaii this means that “any [K-12] school in Hawaii that requests involvement is visited” (p. 47) by the outreach program. This would be a good point to highlight that any proposed health sciences outreach program should be designed to have different levels of partnerships spanning from one-time campus visits (either at school or college campus) to formalized, on-going partnerships with state education offices, local school districts, schools or individual classrooms. The third outreach pipeline program is Project BioEYES at the University of Pennsylvania. The fourth is the nearly 20 year-old Partners is Health Sciences program at the University of Arkansas for Medical Sciences (UAMS).
Due to the fact that any such collaborative initiative will face challenges and barriers from the onset I will discuss those now. Knowing common challenges and barriers during the planning and implementation phases will aid in avoiding any such pitfalls. For James et al it is vital to begin developing health sciences outreach programming (East Carolina University) with the premise that “collaboration should not be expected to produce immediate successes due to the time it takes to build a faithful relationship” (p. 33). They go on to summarize the work of Russell & Flynn (2000) and Thorkilsdon & Stein (1996) to make the following suggestions:
“(a) the collaborations are [designed to be] sustainable [especially in schools with high teacher turnover]; (b) all agencies have an optimistic outlook; (c) all partners are given uniform voice and vote; and (d) [agreement that] common goals are achieved more efficiently through the partnership [rather] than individually. …partner commitment to participation, time, outside support for the program, distribution of information, and the presence of continuous assessment were also characteristics in successful collaborations" (p. 33).
Other barriers identified in other articles include the following: the objectives/outcomes must be clearly defined for all involved in the collaborative initiative; power relationships among core partners must be equalized (this can be difficult to achieve especially if one partner is a Research 1 institution’s teaching hospital or health sciences center); some resources [i.e. meeting space, presentation materials, evaluation tools] will need to be shared; restructuring of responsibilities may be required [i.e. writing the collaborative initiative into requisitions/job descriptions]; effective and flexible communication strategies across partnerships must be implemented; there must be sufficient resources: particularly time and money; poorly designed and implemented activities will have less impact on participants and therefore should be avoided; and the implementation of activities which are theoretically detached from the desired results of the collaborative initiative must be avoided. (Epstein & Sanders, 2000; Anderson et al., 2006; McLaughlin & Black-Hawkins, 2007). For example if you have a mission statement that identifies increasing diversity as part of an outreach office yet the events, programming and/or office personnel are informed by the guiding principles of colorblind meritocracy or neo-Social Darwinism this results in outreach that is theoretically detached from the mission statement.
The implementation of any advisory committee should be modeled on the concept of “horizontal expertise”. According to Anagnostopoulos et al horizontal expertise is necessary because:
“[a]chieving common goals requires professionals to cross organizational boundaries and combine the resources, norms, and values from their respective settings into new, hybrid solutions. Horizontal expertise emerges from these boundary crossings as professionals from different domains enrich and expand their practices through working together to recognize relations and coordinate their work" (p. 139).
For example, it would be vital to bring various units or stakeholders to the table like college prep programs, college/university recruitment/orientation, STEM advisors/professors, diversity offices, and even outreach programs in allied fields i.e. service learning. This might require, for example, health care practitioners stepping into the role of co-teacher/presenter for the outreach programming. Ideally, an advisory entity would identify any missing partners/stakeholders and be charged with overseeing the community asset-based assessment of the target communities as they relate to successfully navigating the health sciences preprofessional pipeline. While I am not a fan of traditional needs assessments because they are generally informed by deficit discourse in that the entire premise assumes that there is indeed a need or deficiency—in this case among communities who are underrepresented in the health sciences—and that the benevolent institution has the expertise and answers to remedy any identified needs while the target community is seen as lacking the wherewithal and agency to address the said needs without outside assistance (i.e. from the institution of higher education).
Community asset-based assessments borrow the concept of asset-mapping from Kretzman and McKnight and apply it to academic outreach/enrichment efforts. A community asset refers to something that makes a neighborhood/community/region a better place in which to live and learn. These can be tangible in nature such as individuals, organizations, businesses, and school or intangible such as social/cultural capital, culture, diversity, and close-knit interpersonal relationships. Kretzman and McKnight (1993) describe “asset mapping” as an:
“approach to community development … that work[s] from the principle that a community can be built only by focusing on the strengths and capacities of the citizens and associations that call a neighborhood, community or county ‘home.’”
I would also deploy this methodology to investigate the assets of underrepresented communities as to identify their self-identified assets versus their percieved deficiencie. The input of community-based organizations, K-12 schools and college/university units is paramount to creating and implementing well-planned health sciences outreach programming. I suggest employing an expanded definition of assets to include such things as programming, personnel, meeting space, office & A/V equipment, programming, students, networks/affiliations, and any other in-kind assets which can be mobilized to meet the shared goals of the pipeline program. The expected outcome would be to identify the target community’s strengths first and then weaknesses or barriers. Ideally, the advisory committee would also serve as a think tank that is convened to develop strategies to overcome the weaknesses and/or barriers by mobilizing the strengths or assets discovered through the asset-mapping process. In place of traditional needs assessments which ask-“What are you’re needs?”-I suggest employing a hybrid of surveys, focus groups, and interviews in order to assess the common barriers/community weaknesses preventing underrepresented students from attaining a higher education particularly in the health sciences. This might be accomplished by building upon or revisiting past community-based asset mapping or research pertinent to school-university-community partnerships focused on the target communities and its residents.
While it would be ideal to adhere to a co-constructivist model-where all key stakeholders have input into the construction of programming and/or prorgram ideology-throughout the planning and implementation stage I feel that it would be much more efficient to research the “best practices” of current outreach efforts of health sciences centers within institutions of higher education. I will offer up the common themes that are present in four nationally recognized health sciences outreach programs that share the common goal of increasing diversity in the health sciences professions. From my research I contend that the overarching shared goal of increasing diversity in the health sciences seems to be buttressed by other shared goals of providing: curriculum-based and age-appropriate outreach, teacher development, health sciences student training, and improved health care delivery in medically undeserved areas. While the geographic outreach boundaries would be a decision for the advisory committee I would contend that any such efforts focused on the Salt Lake Vally should be focused on the West Side of incorporated Salt Lake City which is extremely medically undeserved and offers a unique interest convergence in that they could be afforded access to diverse communities. Through this unique patient/community exposure health sciences students can become better trained to work with individuals and/or communities outside their comfort zone which would ideally translate into more culturally competent health care practitioners. It is important that this interest convergence not be exploited which can result in an unbalanced power dynamic and can create a sense of a community being used as a real-life research site/laboratory or its residents being seen as holders of cultural knowledge to be co-opted and translated versus viable research partners.
In order to implement the outreach which would be informed by the advisory committee it would be vital to organize a core health sciences outreach team charged with the coordinating the pipeline programing. This would most likely be limited to an entity within the partnering institutuion of higher educaton. It would be ideal if an office like that which was the University of Utah School of Medicine Diversity and Community Outreach could house and administer the program. It would also be ideal if each college, department or academic program of the partnering institution of higher education had a staff representative or liaison on the advisory committee of the health sciences outreach. This core group would focus on the shared goals of recruiting more diverse students into their academic programs and offering their current health professional students with access to diverse communities where they will be able to develop into culturally competent health care practitioners or researchers. The University of Hawaii encourages all their health professions students and social work students “to participate in rural training experiences either individually or as part of an interdisciplinary team.” It is not only important to provide health professional student training but professional development for in-service teachers as well.
All health science outreach programs which I examined have a K-12 teacher-development component. Through this teacher development the goal of offering age-appropriate, curriculum-based outreach is accomplished through close coordination with school administration and faculty. To supplement the input of teachers some health science outreach programs will need to specifically bring in school districts to be a core partner. For example, at East Carolina University “departmental faculty members also work with local school systems science coordinators to choose and align curriculum and plan professional development workshops to address the needs of the respective teachers” (p. 35). Again it would seem that you would have a core and periphery team dedicated to developing how this would be accomplished across the continuum. In Utah this would mean that the vested-interest and participation of the Utah State Office of Education, Health Science Education Specialist in the Career and Technical Education Office would be vital to the efforts outlined in this essay. I contend that yet another community asset-based assessment-again coupled with surveys, focus groups, and interviews-would be vital to achieve co-constructivism among key stakeholders and allow for input from the target communities.
Teacher development seemed to be the main focus of the successful outreach programs and the sole focus of one. While teacher development seems to be a small focus at the University of Hawaii, they do offer “teacher training in health education, [such as] how to make anatomy and microbiology fun [offered] to 200 teachers a year” (p. 47). For Project BioEYES the teacher development is coupled with co-teaching experiences with “trained university science consultants (Outreach Educators)” (p. 134). I feel this is a great way to prevent over-burdening both K-12 teachers and health science faculty, especially faculty of color who are generally more stretched thin than their white counterparts. For Project BioEYES this collaboration is achieved by having teachers attend “a half-day workshop held at one of our partner universities” in order to allow teachers to be “introduced to the curriculum by directly experiencing it” and when ready:
“The teacher then schedules co-teaching experiences with Project BioEYES Outreach Educators, collaborates with BioEYES staff to customize the unit for his/her individual class culture, and explores strategies to foster cooperative student research.”
Again you have a collaboration that naturally lends itself to the development of age-and-culturally-appropriate curriculum by utilizing the teachers as a resource for reciprocal benefit. Project BioEYES adopted an already-developed curriculum utilizing a zebra fish laboratory. See the Resources section for a link to this curriculum. This is a very inexpensive program that any teacher can implement without the need for extensive collaboration.
At East Carolina University in North Carolina they too use co-teaching experiences where “[d]epartmental faculty members also visit classrooms to assist or to model teaching science topics using an inquiry science approach” (p. 35). Such an approach here in Utah would enable any such program to meet the Utah Core Curriculum requirements. Within “these classroom lessons, university faculty members teach a portion of a grade level content goal” again making it pertinent to the core curriculum in North Carolina. Their professional development is also closely coordinated with local school districts. They are guided by the following principle: “Professional development for teachers is important for several reasons. One is that teachers are life-long learners, not only for certification requirements, but more importantly for expanding their own knowledge” (p. 36). Professional development for them not only includes teacher workshops but offering in-kind donations of equipment and personnel as to enhance or augment the equipment already available to teachers and students through the local schools. All the programs I researched maintain some inventory of equipment, tool-kits or the like which are provided to the program partners for check-out. One program makes in-kind donations and overall teacher professional development its primary modus operandi.
The nearly 20 year-old Partners is Health Sciences program at the University of Arkansas for Medical Sciences is entirely based on the teacher development philosophy coupled with a Public Health emphasis designed to ensure their health professions students are culturally compitent practitioners through enriching their technical knowledge with experiential knowledge: teaching students about the national health concerns articulated by Healthy People 2010 to give them “a better understanding of those factors that favor personal and, therefore, national health” (p. 181) coupled with exposure to patients and communities that are medically underserved and/or impacted by health disparities. They feel that the lack of understanding of these issues and their impact on society “effects the quantity and quality of students selecting a career in science or medicine” (p. 181). They focus on teacher development because they see their work as a responsibility to remedying the current problems with K-12 science teacher pre-service education and professional development which includes:
“(1) the barriers between schools of education and science on the same or dissimilar campuses (Summerfield, 1996), (2) the low quality of the teaching of science (Weaver, 1984) and (3) the low quantity of well-trained science teachers (Hudson, 1996). … Training (pre-service) and/or re-training (in-service) of the nation’s science teachers is an effective approach to solving this problem" (p. 182).
Any such programming in Utah, I contend, would require adopting a similar philosophy which would open doors for cross-disciplinary collaboration such as between the School of Medicine and the College of Education. However, the reasoning for the need of such cross-disciplenary collaboration given above seems to be a very condescending message to K-12 science teachers so I would suggest modifying how this is articulated. This UAMS outreach program also conducted a traditional needs assessment of Arkansas K-12 science teachers. Program administrators felt that the input of K-12 science teachers was vital “because K-12 teachers are (1) professionally trained educators; (2) well-versed in local, state, and national ‘standards/frameworks’ and (3) trained to design and implement lesson plans in the K-12 classroom” (p. 183). They offer teachers “a cafeteria of mini courses” lasting anywhere from one to three days, “telecommunication outreach for students” utilizing the UAMS “telemedicine network,” “computer-assisted instruction” modules; a science night at the “local science magnet high school” which they “adopted”; hosting “student field trips to the UAMS campus”; “community-requested presentations by program faculty”; and “college credit for participating pre-service and in-service teachers”. One area were this and the other aforementioned programs could improve is with their focus on health science/professional career exploration.
Career exploration should be an undergirding objective in most, if not all, the activities, events and programming of health science outreach designed to increase the diversity of the applicants in health sciences pipeline. Career exploration would be coupled with sending positive reinforcing messages to students underepresented in the health sciences as to counter any racialization or racial/ethnic academic stratification. This would be accomplished in many ways some of which are historical revisionism which disrupts the eurocentricism inherent in the STEM core curriculum. That is by revising the racial master narrative that indigineous groups are primitive and backwards with no contemporary connection to modern science with narratives of such things as Aztec surgeons and botonists or Mayan mathmaticians as to send the message that intellectual pursuits in the STEM subjects is part of underrepresented students’ history. This could possibly have a positive impact on underrepresented students’ academic self-esteem, self-efficacy, disposition and performance. It has been shown that there is a positive relationship between career development and educational development. According to a review of the literature concerning career/educational development conducted by Dr. David Blustein the popular discourse on the subject holds that:
“In sum, the findings that have been presented here provide empirical support for the proposition that students who are able to internalize the connection between school and career will be better prepared psychologically to engage fully in their educational lives" (no pg. #).
I contend that the same holds true if underrepresented students are also able to internalize the connection between their racial/ethnic identity and their career choice. Subsequently, the career exploration implemented must be buttressed by positive, reinforcing messages from people who can serve as positive role models and mentors. A cascading mentorship program might serve the purpose of positive reinforcement and enable the health science outreach program to send this message of historical revisionism and empowerment with some cohesion.
The model for career development would be that of “informed and considered career decision” development versus traditional career exploration. This will prevent the participants from being short-changed and enable students to make “informed and considered career” decisions. According to Gillie and Isenhour (2003):
“informed and considered career decisions are the product of a career development process that includes: creating awareness of options; exploring possible career pathways; reviewing available information; clarifying interests, values and skills through assessment; reflecting upon experiences; relating education and training options to occupational goals; experimenting through work sampling, volunteering or employment; consulting with knowledgeable people in the field of interest; formulating plans for education, training, career entry, and retraining; making decisions and refining plans, and; applying the career development process throughout the lifespan" (p. 2).
The authors point out that “[n]ot all people will engage in all steps and the sequence may vary” but this will most likely manifest or result in “informed and considered career decisions” for the target audience or students underrepresented in the health sciences. This will hopefully leave no allusions as to what health sciences careers (i.e. medicine) are all about. This will prevent students from making straw-man statements like, “I’ve always wanted to be a doctor since I was five” rather make statements like “Medicine is for me because since I was five I wanted to be a doctor and through this program I have informed my decision to pursue medicine with informed career development and fully understand what it will take for me to become a future physician.”
The limitations to a proposed collaborative initiative like this are great. I have already outlined some of the most prevalent structural, ideological and administrative barriers. I will now discuss the financial limitations. Most of the programs I examined were not institutionally funded, rather grant funded. While there are millions of grant funds available to start and sustain such aforementioned collaborative initiatives, the grant writing, application and reporting process is very labor-intensive and not a secure source of funding. An upside to such funding is that the ideological differences with the parent institution can usually be circum-navigated because they are not holding and manipulating the purse strings. Institutionally funded programs like the former University of Utah School of Medicine Office of Diversity and Community Outreach are subject to institutional reform which usually leans towards, race-neutral, equal opportunity philosophy.
Another limitation is what the institution is willing to provide in-kind. While this endeavor could be undertaken without institutional backing it would be hard to make inroads without being institutionally mandated or grounded. For some programs I have heard that the institution provides support in name only and all the rest is the responsibility of the program. Southern Utah University’s Rural Health Scholars is one such program. The best way to get a program like this in place would be to make it legislatively mandated. However, few states like Utah would back this with the current wave of anti-affirmative action legislation, cloaked as equal opportunity legislation, coming out of the Utah State Legislature.
Of course the ongoing evaluation and assessment of any such programming is essential to its sustainability. The impact of the programming and its perceived quality are vital to any outreach programming. What follows are my recommendations for program evaluation.
Pre-post surveys administered as to measure the following:
Participants/Students should be measured on the following:
Anticipated and actual satisfaction
change in attitudes towards health sciences/ health sciences careers
change in motivation to pursue a higher education and/or health sciences career
change in level of understanding of pathway to one or more health professions
change in understanding of the primary personal characteristics/attributes of a helath practitioner
change in career goals (either health sciences-specific or in general)
change in perception of the feasibility of becoming a health practitioner
change in academic self-esteem; academic performance; academic self-efficacy; academic disposition
change in knowledge of any specific health profession or health sciences in general
Methodology of assessment/evaluation
Paper or computer-based surveys distributed to target group wich employ a combination of Likert scale (i.e 1-5), True-False, and multiple choice questions. Surveys should be given out to as many participants before and after any event, program, school year etc. Avoid surveys which have leading questions or no room for clarification of answers. Also, the methodology should be culturally congruent, short and simple. Any statistical analysis should be handled by a third party (any college student looking to bolster resume could serve as a great low-cost or free resource).
Other recommendations for assessments/evaluations:
Evaluations should be program/event-specific and collected as close to actual program/event as possible
Evaluations should be age-appropriate as well as culturally and linguistically apporpriate
Different measures should be included in the surveys for teachers/counselors/staff/parents
In closing, I have provided my research which was conducted for a graduate course but which was initiated during my time working at the University of Utah School of Medicine which at the time included a collaborative initiative aimed at widening the pool of diverse students entering the health science professions. This blog post has been informed by much research into such programming. I have shown that multi-disciplinary collaboration is key to developing a program that seeks to provide age-appropriate, curriculum-based outreach to K-12 students and teacher development for K-12 educators. Career development would also be a key component of this outreach. I have discussed the barriers, the basic planning/implementation process, and overall outreach structure butressed by existing “best practices” at leading institutions of higher education. NOTE: IT IS MY PERSONAL BELIEF THAT “DIVERSITY” IS NOT A MEASURABLE OUTCOME (I.E. NUMBERS) OR AN END IN ITSELF, RATHER, A PROCESS BY WHICH MARGINALIZED AND DISENFRANCHIZED COMMUNITIES BECOME A LASTING/SUSTAINABLE PART OF AN INSTITUTION (I.E. HELATH SCIENCES). THE FOCUS SHOULD NOT BE ON DEMOGRAPHICS, RATHER, ON EQUITABLE OUTCOMES FOR ALL STUDENTS.
Resources on the web for K-12 teachers and/or health sciences outreach:
• Zebrafish in the classroom: http://www.zfic.org/index.html
• University of Texas, Teacher Enrichment Initiative’s Health Care Unit/Curriculum: http://teachhealthk-12.uthscsa.edu/curriculum/healthcare/healthcare.asp
• Kids Health Games Closet: http://kidshealth.org/kid/closet/?gclid=CLPt7f3V5aUCFQN7gwodIjyt2g
• NIH Curriculum Supplement Series: http://science-education.nih.gov/customers.nsf/WebPages/CSHome
Anderson, C. et al. (2006). Science Center Partnership: Outreach to Students and Teachers. The Rural Educator, Fall 2006 pp. 33-39.
Blustein, D. The Relationship between Career Development and Educational Development: A Selected Review of the Literature. Accessed on the Pennsylvania Department of Education website www.pacareerstandards.com/documents/RA-3_Career_Development.pdf on various dates.
Burns, E. R. (2002). Anatomy of a Successful K-12 Educational Outreach Program in the Health Sciences: Eleven Years Experience at One Medical Sciences Campus. The Anatomical Record (New Anat.), 269, pp. 183-193.
Epstein, J. and Mavis Sanders. (2000). Connecting Home, School, and Community: New Directions for Social Research. In Handbook of the Sociology of Education, Maureen T. Hallinan, ed. Academic/Plenum Publishers:New York.
James, L. et al. (2006). Science Center Partnership: Outreach to Students and Teachers. The Rural Educator, pp. 33-39.
McLachlan, J. (2005). Outreach is better than selection for increasing diversity. Medical Education, 39(2005), pp. 872-875.
McLaughlin, C. and Kristine Black-Hawkins. (2007). School-university partnerships for educational research—distinctions, dilemmas and challenges. The Curriculum Journal, 18(3), pp. 327-341.
Shuda, J. and Kearns-Sixsmith, D. (2009). Outreach: Empowering Students and Teachers to Fish Outside the Box. Zebrafish, 6(2), pp. 133-138.
Withy, K. M et al. (2006). Community Outreach, Training, and Research: The Hawai’i/Pacific Basin Area Health Education Center of the University of Hawai’i, John A. Burns School of Medicine. Hawai’i Medical Journal, 65(2006), pp. 46-49.