National Association of Minority Medical EducatorsNAMME, Northeast Regional Meeting

San Juan, Puerto Rico

“Recruit, Reclaim, Retain”

América Facundo, PhDProfessor, Internal Medicine Department

University of Puerto Rico School of MedicineFebruary 22, 2013

Embassy Suites Hotel, Isla Verde, PR

Objectives

Examine the case of Puerto Rico as an example

Explore how the social determinants of “life” influence, facilitate or hinder outcomes

Explore the role of government agencies as obstacles in the education process

Define the target

Who are we recruiting

From what are we reclaiming

How can we retain

What outcomes can be expected

Who are we recruiting

Focused on disadvantaged backgrounds Public high schools By current public school standards, low English proficiency 91 % of schools do not fulfill basic academic

progress, according to the Puerto Rican academic proficiency exams and the

“No child left behind” standards. Lack of an academic culture

Who are we recruiting Teachers: quality is too variable, number is too

low, average salary $21,600 Hurry: between 2005 - 2011 > 17,574 students

left school to take the high school equivalency exam

Public high schools: low professional expectations

Physical education and arts are non existent in most schools

Social determinants 45% of the population living under poverty level

www.census.gov/prod/2011pubs/acsbr10-01.pdf

1,600,000 out of 3.7 million qualify for state-paid health services (43%) and close to 60% for food stamps

300,000 have no health insurance

$16,300 average per capita salary in 2010 Unemployment: over 20% for most municipalities Sub-employment: unknown

385,000 “legally registered” firearms

Average murders per year: 1,200

Social determinants

Low educational level of parents and lack of motivation to get involved in children’s

education

Cell phones, social networks, electronic games

Consumption as a high value

Social Determinants Violence and crime Drug dealing is estimated to produce $1,500 per week

for adolescents

School Dropouts

Estimated in over 48.2% by social scientists

Department of Education claims not to have a “definition” of “school dropout”

Allegedly impossible to determine due to transfer to low cost private schools and to emigration to the U.S. (the Island’s population: 200,000 less in the 2010 census compared to year 2000)

Physical conditions of many of the public schools are deplorable (1,481 public schools)

Role of the Government

Secretary of Education is often appointed on the basis of political party affiliation, not credentials.

Budget: over $3.5 billion, for catastrophic results. Most of the budget is spent in payroll.

No libraries, computers, or web access in most schools

Excessive bureaucracy to justify the existence of excessive administrative employees.

Role of the Government Corruption

Secretary of Education: Victor Fajardo (1994-2000)

$4.3 million Illegally appropriated for his own profit and for his political party.

Confessed his crime on February 2002. Sentenced on December 11, 2002. Currently in prison in Georgia, with a 12 year sentence and order to restitute the stolen money.

Reclaim from what to what?

Reclaim from an adverse environment to provide orientation and motivation to continue studies, ideally in the health professions

Approximately 19% of the 110 students admitted each year to the UPR School of Medicine are from disadvantaged backgrounds. Another 15% are on the verge, compared to the majority of the class.

Literature indicates the same as for minorities in the U.S.: more willingness to serve communities similar to their own.

Strategies “Medicine and other Health Professions Clubs”

Club initiation activities

Recruitment Coordinator

Selection of some schools specialized in Science and Math to increase success rate

Study material with logos of the School of Medicine and the Campus as incentives and for a sense of belonging to the Clubs

University Gardens SchoolSpecialized in Math and Science

Strategies Visits to the Medical Sciences Campus

Most are to be first generation university students, no previous exposure to higher education

Establishment of networks with local primary care physicians and allied health professionals

On-site “health clinics” Surveys of their health topics interests On-site interactive presentations by our campus students on

the health topics selected Website Facebook

Strategies

Orientation on: Orientation on health careers, accounting for length of

time they take Financial aid

Counseling on how to maintain a solid academic record

Target are the University of Puerto Rico campuses…as opposed to the private colleges and universities

Summer Program offered by the Medical Sciences Campus for high school students

Recruitment Allies

Teachers of science, math, Spanish, English (and, if available, health) in the public school system

Medical and other health professions students

Faculty: medicine & other health professions

The Pledge to Become a Health Professional Ceremony

The Pledge to Become a Health Professional Ceremony

Target

Increase the number of students from disadvantaged backgrounds that compete successfully for admision to medical or other health professions schools

Delineate a Recruitment Program that would be useful to other institutions

Increase the number of health professionals willing to serve the underserved

“Many small people, in small places,

doing small things, may change the world.”