The Changing Face of Osteopathic Medical Education
By Kathleen Louden
If Norman Rockwell were still painting pictures of physicians, they probably would look different from the white men that mirrored the artist’s view of America in the 1920s and 1930s.
Today, more than one-third of DOs are women, and osteopathic physicians are more varied in race, not unlike the United States itself. Minority racial and ethnic groups now make up 37 percent of the U.S. population, and the U.S. Census Bureau projects that they will be in the majority by 2043.
Like other forward-thinking educational institutions, Philadelphia College of Osteopathic Medicine is not waiting for the country’s demographics to change before increasing the diversity of its student body, says Lisa McBride, PhD, the College’s inaugural chief diversity officer. “We’re planting the seeds for success now,” Dr. McBride says. “PCOM and other osteopathic medical schools are responsible for educating our students to serve an increasingly diverse society.”
The Association of American Medical Colleges defines diversity as acceptance and respect of differences, including in race, ethnicity, sexual orientation, gender, age, abilities, religion, native language and culture.
Dr. McBride says that among PCOM students, “diversity includes single parents, international students, students having experienced other cultures, veterans, individuals from different geographical and socioeconomic backgrounds, and others with unique backgrounds and life experiences.”
PCOM’s admissions policy states: “We actively recruit under-represented minority students and non-traditional students who often offer exceptional potential for becoming outstanding physicians.”
Minorities remain under-represented in medicine, however. A 2006 study from the U.S. Department of Health and Human Services shows that minority physicians are more likely to work in areas that are medically underserved. Yet African Americans, Hispanics and Native Americans represented only about 6 percent of practicing physicians nationwide in 2004, despite constituting 25 percent of the U.S. population, according to the Sullivan Commission, a group charged with studying workforce diversity in the health profession.
In its 2004 report, the Sullivan Commission called for an increase in racial and ethnic diversity among health professionals. The commission cited “compelling evidence” that benefits of racial-ethnic diversity include improved access to health care for minority patients, greater patient satisfaction and better educational experiences for students in the health professions.
Greater racial and ethnic diversity among osteopathic physicians is critical to eliminating the racial-ethnic disparities that exist in the quality and availability of health care for underserved populations, Dr. McBride and other experts say.
Sources: American Association of Colleges of Osteopathic Medicine, March 23, 2013 (DO graduates nationwide, 1985 and 2012); C. B. Perloff, To Secure Merit: A Century of Philadelphia College of Osteopathic Medicine 1899–1999, chapter 14 (1986 data); Philadelphia College of Osteopathic Medicine registrar report, September 27, 2013 (class of 2014).
Sources: American Association of Colleges of Osteopathic Medicine, March 23, 2013 (DO graduates nationwide, 1988 and 2012); C. B. Perloff, To Secure Merit: A Century of Philadelphia College of Osteopathic Medicine 1899–1999, chapter 14 (1988 data); Philadelphia College of Osteopathic Medicine registrar report, September 27, 2013 (class of 2014).
Sources: American Association of Colleges of Osteopathic Medicine, March 23, 2013 (DO graduates nationwide, 2012); Philadelphia College of Osteopathic Medicine registrar report, September 27, 2013 (class of 2014).
A history of diversity
Many medical schools are working to enhance an environment of diversity, but diversity is nothing new to osteopathic medical colleges. Osteopathic medicine—itself a minority in the medical field—was an early supporter of bringing women and racial minorities into the profession.
Historically, PCOM has embraced diversity. One of the first two graduates of the College—then named the Philadelphia College and Infirmary of Osteopathy—was a woman, and a female physician was on the new College’s faculty in 1900.
Later, female graduates of PCOM pioneered in traditionally male-dominated areas of medicine. Among them was Vivian Barsky, DO ’67, one of only two women in a class of approximately 100 medical students. Now retired and living in Venice, Florida, Dr. Barsky says, “I never felt discriminated against in class because of being a woman. The education was excellent.”
Although it seemed to Dr. Barsky that most physicians at the time thought that women should become general practitioners or obstetrician/gynecologists, she received offers for residencies in multiple specialties. She chose the male dominated field of surgery and became PCOM’s first female graduate to be board-certified in general surgery.
A woman in the class after Dr. Barsky, Elizabeth Bomheuer, DO, graduated in 1968 at the age of 52, showing the College’s openness to accepting older students.
The first African-American graduate of PCOM was a woman, Meta Christy, DO, in 1921. Although the College graduated only four African Americans in its first 50 years, by 1978 it was pro-actively recruiting students from under-represented minorities, including African Americans, Hispanics and Native Americans.
The College’s early efforts at recruiting minority students earned it a recommendation from the American Association of Colleges of Osteopathic Medicine as a model program. Initiatives included outreach programs to Philadelphia high school students from socioeconomically disadvantaged backgrounds as well as to colleges with high minority enrollment. PCOM also began awarding scholarships to minority students in the 1980s.
Even before the institution’s commitment to supporting programs that would aid in successful student outcomes, minority students were committed to helping each other succeed, says Marsha Williams, PCOM associate director of admissions. For example, third- and fourth-year minority students formed peer partnerships to emotionally encourage and academically assist students.
Commitment to diversity
Since the 1980s, the College has become more diverse (see figures 1-3 above). Of the current DO student body at both College campuses (Philadelphia and Georgia), one third are minorities or multiracial, and more than half of students are women.
PCOM’s minority student enrollment fluctuates from year to year. At osteopathic medical schools nationwide, the percentage of enrolled African American students dropped from 4.1 percent in 2006 to 3.0 percent in 2010, according to a January 4, 2012, article in The DO. That decrease, despite a 35 percent increase in overall enrollment at osteopathic medical colleges during the same period, may be a sign of the economic recession, the article reports.
The College uses various methods to matriculate minority students. For instance, recruitment trips to historically black colleges and regional educational meetings geared toward minority recruitment in other parts of the country, such as the Southern Regional Education Board Institute on Teaching and Mentoring, help develop relationships between under-represented minority students and PCOM. Strategies for recruiting minority students to PCOM are dynamic, as staff members constantly look for ways of improvement, according to Ms. Williams.
For the past two years, PCOM has given high school students from under-represented populations in Philadelphia firsthand experience of osteopathic medicine as a possible career by hosting them monthly throughout the academic year. Known as the Health Professions Recruitment and Exposure Program (HPREP), this educational “pipeline” program is co-sponsored by the Office of Admissions and the Student National Medical Association (SNMA), a minority medical student organization. HPREP gives participants an opportunity to visit various areas of campus once a month and learn about different fields in medicine. Students also learn to suture and are required to complete a final project on what they would need for a successful career in medicine. Last year’s final project was designing a practice in an underserved area. Ms. Williams says she expects to have data in five or six years on the numbers of HPREP participants who choose to study osteopathic medicine.
For the past few summers, minority “whiz kids” have been mentored (on campus) by PCOM scientists through the Physician Scientist Training Program (PSTP). PSTP is a national program that supports aspiring minority physicians from 7th grade through their senior year of college. The program focuses on training physician scientists who will be capable of translating basic research advances from the laboratory to the clinic.
And each spring, PCOM hosts an open house for minority college students. This event introduces them to current medical students who come from similar socio-economic backgrounds and who are fulfilling their dreams of a medical career.
Another recent change, according to Ms. Williams, is to allow virtual appointments through a webcam with applicants and prospective students from other states who cannot afford to travel to Philadelphia. “Students want face-to-face interaction. In this way, I provide them with that opportunity at no expense to them,” she says.
An important part of diversity is building understanding of other cultures, called cultural competence.
Many African Americans who attend predominantly white undergraduate universities feel a lack of understanding about their culture from students of other races, and they fear losing their cultural identity, research published in 2013 in the journal Communication Education shows.
Helping students bridge the culture gap at PCOM campuses are national student organizations that focus on multicultural affairs. Such groups for medical students include the SNMA and the Asian Pacific American Medical Student Association.
PCOM goes further by including instruction about cultural and linguistic competence in its curriculum. The class on patient-centered skills for first- and second-year DO students this year introduced a lecture series about multicultural situations they likely will encounter in medical practice, including different religions, care of transgender patients, and care of children of lesbian and gay couples.
In Philadelphia, medical students work in a homeless shelter and at PCOM’s Healthcare Centers—four urban and one rural—that provide care to medically underserved communities. A major goal of the College is encouraging PCOM medical students at both campuses to provide care to underserved communities after graduation and to conduct research on healthcare disparities—conditions that disproportionately affect one race compared with another, Dr. McBride says.
The goal of cultural competence education is to foster the knowledge, skills and attitudes that allow future osteopathic medicine physicians to understand sociocultural differences and work effectively with patients, their families and other members of the medical team. “We encourage all potential physicians to have a culturally competent heart. It meshes with our mission of fostering civility and respect for each member of the PCOM family,” Dr. McBride says. “The world is changing, and we want to be a welcoming community.”
NOMA Promotes Diversity
Among the organizations promoting diversity in osteopathic medicine is the National Osteopathic Medical Association (NOMA). “Diversity is important because it’s a true reflection of the world we live in and the community we serve,” says Jennifer Caudle, DO, vice president of NOMA and an assistant professor of family medicine at Rowan University School of Osteopathic Medicine in Stratford, New Jersey.
The mission of NOMA is to facilitate the recruitment, admission, retention and graduation of minority osteopathic medical students, heighten awareness of the osteopathic profession in the minority community and promote initiatives designed to improve minority health issues globally, Dr. Caudle says.
NOMA was founded in 1992 to create a sense of community for minority osteopathic physicians and to address these issues. The association links osteopathic medical students and pre-med students with physician mentors, and it advocates on critical issues affecting minority physicians and their patients. NOMA also sponsors health fairs and other community service events that aim to improve minority health.