Abstract
Developing a diverse talent pool starting at the high-school level, while students are making future education and career decisions, should be a national priority, given the need to build a diverse health-care workforce. This article describes a 6-week immersive simulation-based summer program to introduce 20 junior high-school students (13–15 years old) to the range of health professions. Because precollege students typically receive limited exposure to clinical settings, high-fidelity simulation is an excellent surrogate for providing realistic experiences in health care. Students heard lectures on health careers, earned basic life support certification, learned to perform basic vital signs measurement, practiced the management of acute asthma, and received an introduction to the daily activities in the life of a nurse and an anesthesiologist. They researched, developed, and presented public service announcement videos about a health-care issue affecting their community. Participants reported being excited about health careers. Future programs will focus on longitudinal support and mentoring, essential for mitigating the higher rates of attrition from health professions among minoritized individuals.
Implications for Knowledge Translation
The Black and Latino/Hispanic populations make up the fastest-growing racial and ethnic groups in the US but are the most underrepresented in the health-care workforce. Health professions pathway programs offer a structured curriculum to students from traditionally underrepresented backgrounds to consider health-care careers. Students networked with members of various health professionals, earned cardiopulmonary resuscitation (CPR) certification, learned about health equity, studied in nursing and anesthesiology simulation labs, and created public service announcements (PSAs) about health-care issues affecting their community.
According to the U.S. Census Bureau, minoritized racial and ethnic groups make up 38% of the population, but only 19.2% of the nursing workforce (American Association of Colleges of Nursing [AACN], 2019). The Black and Latino/Hispanic populations make up the fastest-growing racial and ethnic groups in the US but are the most underrepresented in the health-care workforce (AACN, 2019; Jensen et al., 2021; Salsberg et al., 2021). Health profession accrediting bodies such as the AACN and the Accreditation Council for Graduate Medical Education recognize the urgent need to increase the diversity of the health-care workforce to reflect the rapidly changing demographics in the US, to ensure that health-care providers are prepared to address the needs of a diverse population and to address persistent racial and ethnic disparities in health outcomes (AACN, 2019; McDade, 2019; Salsberg et al., 2021). A key strategy is health profession pathway programs, which offer a structured curriculum to students from traditionally underrepresented backgrounds to consider health-care careers. These programs should be inclusive of immersive clinical experiences, exposure to different opportunities within the health-care system, college preparation, individualized mentoring, and community engagement.
Overview of Health Profession Pathways Programs
Although health profession pathway programs vary, most programs involve exploring multiple health disciplines (including nursing, dentistry, medicine, physical therapy, occupational therapy, and pharmacy) and provide academic support, clinical experiences, and mentorship. Exposure to the different health disciplines is accomplished through panel discussions, lectures, and/or immersive clinical experiences. Simulation provides an interactive, safe environment for students to receive hands-on learning about the various roles. Building networks and mentorships with health-care professionals can provide long-term benefits, including guidance in attaining acceptance into health-care education programs and in pursuing their first job after graduation.
Program outcomes include increased knowledge and understanding of various health professions, improved academic performance, enhanced critical thinking and problem-solving skills, increased confidence, and increased awareness of health disparities (Taylor et al., 2019).
Health profession pathway programs have an especially positive impact on underserved communities. Health professionals from underrepresented groups are more likely to work in underserved communities after graduation and are more likely to advocate for better quality care and services for those communities, which can lead to improved overall health of the community (Valentine et al., 2016). When health-care providers care for patients with similar cultural backgrounds, studies show improved patient–provider communication, enhanced sense of trust, and improved health outcomes (AACN, 2019; Alsan et al. 2019; Valentine et al., 2016).
Successful health profession pathway programs need a financial infrastructure to ensure sustainability, dedicated faculty and support staff, and integration with undergraduate and professional programs in the host institution (Vallejo et al., 2020). Limited diversity in the health professions has been attributed to multiple factors, including lower-quality secondary education, lack of academic preparation coupled with increasingly stringent admissions requirements, limited financial support, lack of mentorship and role models (especially racially concordant mentors), and limited exposure to health careers (Salsberg et al. 2021; Toretsky et al., 2018).
Health profession pathway programs should address these obstacles, for example, by providing information on obtaining financial assistance to attend college, and providing social support (Taylor et al., 2019). The expected outcome for pathway programs is to increase the number of students from underrepresented groups entering the health professions; however, data about long-term outcomes of the programs, such as attrition from health professions programs and college graduation rates, are difficult to obtain (Tombers et al., 2023). Evaluating the longitudinal effectiveness of these programs would require tracking students from high school through college graduation. Further research is needed.
Overview of Columbia University’s Summer High School Health Professions Pathway Program
Columbia University in New York City participates in several national health-care pathway programs, such as the Summer Health Profession Education Program and the Summer Health Public Scholars Program. However, very few of the programs specifically target high school students within Columbia's local Washington Heights/Harlem/South Bronx community. Students from these communities, which are largely Black and Hispanic, with high immigrant populations, face numerous obstacles to attending college, such as living in low-income households and attending underserved schools categorized as low performing.
In 2021, we received financial support from an “Addressing Racism Seed Grant Initiative,” which was sponsored by the office of the Vice Provost, for a program designed to attract students within the local community to the health professions, with the hope of contributing to diversifying the local health-care workforce. The budgetary requirements for implementing such a program are subject to variability and are contingent on several factors, including scale of the program, geographic location, and range of activities planned. Essential budget items often encompass public transportation fares for commuting to and from the program venue, meals, CPR certification courses, simulation equipment and associated supplies, and appreciation gift bags; a discretionary expenditure could involve offering participants a completion stipend.
Because of the barriers to obtaining access to clinical shadowing in patient care settings, simulation was proposed as a surrogate for observing and participating in clinical practice.
Program Description
The program was targeted to junior high school students’ ages 13–15 years old. Outreach to local schools inviting online applications for the program took place in collaboration with Columbia's Roger Lehecka Double Discovery Center (DDC). The DDC is a nonprofit organization affiliated with Columbia College, whose mission is to help prepare underserved community youth to be admitted and successfully graduate from college (Roger Lehecka Double Discovery Center at Columbia University, n.d.). The center has long-standing relationships with local schools, and we proposed a collaboration that would take advantage of their well-established networks and experience. Applicants were asked to explain the reason for their interest in the program, name their top three health-care fields of interest, report prior medical field experiences if any, and describe which health-care problem they would most like to solve.
Sixty-seven students from high schools across New York City applied for the program. Four program directors reviewed and ranked the quality of the applications and selected 20 students who were in at least their second year of junior high school, a point when they were likely to be making decisions about the direction of their education and career. The 6-week summer program took place every Monday from 9 am to 1 pm in two simulation centers located within the Columbia University Medical Center campus in Washington Heights. Grant funds were used to cover the cost of lunch, public transportation to and from campus, and gifts of a tote bag containing a stethoscope, manual sphygmomanometer, Columbia University T-shirt, pen and notebook, pulse oximeter, and an American Heart Association (AHA) Basic Life Support Manual.
Program Agenda
Week 1: Health Professions Career Expo
Faculty representatives from dentistry, medicine, physical therapy, occupation therapy, public health, social work, genetics, and nursing each provided a short presentation about their profession. After the presentations, students networked with the speakers and asked questions. Students were assigned to groups during this first session and received instructions about their group assignment, which was to create a 1-min PSA video addressing a health-care issue affecting their community. They were assigned 30 min to one hour at the end of the next two sessions to meet in person to work on their projects and were encouraged to work with each other on the projects outside of their time in the program.
Week 2: Basic Life Support Certification
Each student attended the AHA’s basic life support CPR class in the School of Nursing simulation center. Each student completed all requirements and received their AHA CPR certification card.
Week 3: Lectures on Health Equity and Social Determinants of Health
An interactive presentation and discussion provided a general overview of social determinants of health and their effects on health outcomes. A Hispanic nurse researcher spoke about cardiovascular health in the Hispanic community, and a Black obstetrician/gynecologist spoke about maternal health disparities among Black mothers in the US.
Week 4: A Day in the Life of a Nurse
Students spent this session in the School of Nursing's state-of-the-art simulation center. The day began with a didactic session on asthma, obtaining vital signs, auscultation of lung sounds, and administration of nebulized medications. After a hands-on lab experience, the students used the skills they learned to participate as providers in a pediatric asthma simulation scenario using a pediatric high-fidelity manikin.
Week 5: A Day in the Life of an Anesthesiologist
Students spent this session in the Department of Anesthesiology's Margaret Wood Center for Simulation and Education, where they were introduced to what a career in anesthesiology entails with presentations by a medical student, residents, a nurse anesthetist, and anesthesiology faculty members. This visit included a tour of the simulated operating room; hands-on experience with airway management, intravenous catheter placement, and suturing; and an introduction to transthoracic echocardiography (TTE), with a demonstration of the beating heart on a live model, followed by hands-on practice with a TTE simulator.
Week 6: Group Presentations and Graduation
Students presented their group projects comprising 1-min recorded PSAs. Topics included COVID-19, heart disease, stroke, breast cancer, prostate cancer, asthma, diabetes, and substance use disorder. After each presentation, students answered questions about why they selected their topic, how they worked within the team, and what they learned through the group project. After the presentations a fun escape room team competition was held, where students had to solve a series of puzzles, with the first team to solve all clues being declared the winner. A detailed description of the escape room can be found in the appendix at the end of this article. The session concluded with prizes for the escape room winners and distribution of certificates of completion to all students. Speakers from all the sessions were invited to attend the last session.
Results
Summary of Course Evaluations
Program evaluations were completed at the end of the last session. Of the 19 students who completed the program, 12 students (a 60% response rate) completed the online evaluation. The survey consisted of questions assessing their satisfaction with the program, the program increased their confidence to pursue career goals, and an evaluation of each weekly activity. Additional open-ended questions included identifying what they liked most and least about the program, suggested topics for future cohorts, and suggestions to improve the program. All students rated the program as excellent or good, and 11 of the 12 students reported significantly increased confidence in pursuing their career goals, with one reporting somewhat increased confidence.
The careers they were interested in before the program included nursing, dentistry, and medicine; on completing the program, some mentioned new interests in anesthesiology, physical therapy, and genetic counseling. There were ratings of highly satisfied or satisfied for most sessions, with the day in the life of a nurse, day in the life of an anesthesiologist, and CPR training rated the highest, respectively. These were the most interactive sessions.
Only 5 of the 12 respondents reported having identified a mentor by the end of the program. Suggestions from the written evaluations and verbal feedback included adding 1 or 2 additional days per week to the program and providing longitudinal guidance about additional opportunities for volunteering, clinical shadowing, and participation in research. Students stated they were least satisfied with the group project due to a lack of participation from some members of the group. All students stated they would recommend the program to a friend.
An unsolicited email from a parent told us that her daughter's reviews for the program were glowing! In her years of attending school, she had never felt this level of engagement, learning, organization, and personal attention to detail. She remarked how fun and engaging the CPR session was, giving her daughter a sense of affirmation that this is what she wants to do.
Lessons Learned
The interactive sessions were the most highly rated. Cardiopulmonary resuscitation certification was highly popular and should be prioritized—it is a valuable asset for résumé-building at the high school level and is a basic requirement for a wide range of occupations beyond health care. The escape room activity was thrilling for the students and allowed them to comprehensively apply the skills learned in the prior weeks and to compete with their peers. Escape rooms are growing in popularity in medical education because they allow engagement with learning material in a gamified context (Reinkemeyer et al., 2022).
Given the feedback about insufficient opportunities to connect with mentors, a more intentional effort should be made, proactively pairing individual students with mentors based on prestated interests, or else setting up deliberate “speed mentoring” events where students can have short conversations with all the available mentors, rather than wait for the relationships to develop organically. A more robust pre- and post-experience survey to assess more accurately for growth in levels of confidence and to document new skill acquisition is warranted.
Conclusion
Attracting students from traditionally underrepresented backgrounds in health care to the health professions, starting at least as early as the high school years, is crucial for building a diverse health-care workforce and promoting health equity. Utilizing engaging, hands-on simulation-based programs is an effective and replicable strategy that can be implemented in any health profession pathway program. These simulation activities provide an immersive opportunity for students to gain a better understanding of health profession roles. The provision of longitudinal support and mentoring along the health career pathway is essential for mitigating the higher rates of attrition seen among students who are members of racial and ethnic minorities. Dissemination of resources such as sharing the detailed curriculum for this successful pilot program may serve as a catalyst for this vital antiracist work.
Footnotes
Acknowledgments
We would like to achkowledge Yarisell Hernandez and David Wang for their contributions to this project.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This initative was funded by a Columbia University Office of the Provost's Addressing Racism: A Call to Action for Columbia Faculty Seed Grant.
Author Biographies