Urban Universities: Developing a Health Workforce that Meets Community Needs
-
Upload
jmichaels1984 -
Category
Documents
-
view
213 -
download
0
Transcript of Urban Universities: Developing a Health Workforce that Meets Community Needs
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
1/36
Urban Universitiesdeveloping a health workforce
that meets community needs
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
2/36
the coalition of urban serving universities
Te Coalition o Urban Serving Universities (USU) is a president-led organizationcommitted to escalating urban university engagement to increase prosperityand opportunity in the nations cities, and to tackling key urban challenges. TeCoalition includes 42 public urban research universities representing all U.S.geographic regions. Te USU agenda ocuses on creating a competitive workorce,building strong communities, and improving the health o a diverse population.Te Coalition o Urban Universities (USU) has partnered with the Association
o Public and Land-grant Universities (A
P
L
U) to establish an Oce o UrbanInitiatives, housed at APLU, to jointly lead an urban agenda or the nationspublic universities.
the association of public and land-grant universities
Te Association o Public and Land-grant Universities (APLU) is a researchand advocacy organization o public research universities, land-grant institutions,and state university systems with member campuses in all 50 states, U.S. territoriesand the District o Columbia. APLU is the nations oldest higher educationassociation, with 218 members, including 76 land-grant institutions, and
18 historically black institutions. In addition, APLU represents the interests othe nations 33 American-Indian land-grant colleges through the American IndianHigher Education Consortium. APLU is dedicated to advancing learning,discovery and engagement. Te association provides a orum or the discussionand development o policies and programs afecting higher education and thepublic interest.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
3/36
Urban Universitiesdeveloping a health workforce
that meets community needs
By Jennifer Danek, M.D. anD evelin Borrayo, Ph.D.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
4/36
USU MeMBerS
Arizona State University
Boise State University
California State University, East Bay
California State University, Fresno State University
California State University, Fullerton
California State University, Long Beach
California State University, Northridge
Cleveland State University
Florida International University
Georgia State University
Indiana University-Purdue University Indianapolis
Morgan State University
Portland State University
San Francisco State University
San Jose State University
Temple University
Texas Tech Universi ty
The Ohio State University
The State University of New York System
Stony Brook University
SUNY College of Environmental Science and Forestry
SUNY Downstate Medical Center
SUNY Upstate Medical University
University of Akron
University of Albany
University at Buffalo
University of Central Florida
University of Cincinnati
University of Colorado-Denver
University of Houston
University of Illinois at Chicago
University of Louisville
University of Massachusetts Boston
University of Memphis
University of Minnesota
University of Missouri-Kansas City
University of New Mexico
University of North Carolina at Charlotte
University of Washington, Tacoma
University of Wisconsin-Milwaukee
Virginia Commonwealth University
Wayne State University
Wichita State University
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
5/36
Table of Contents
p
a
i 1
d s: i h
d, ub p 2
t f h w:
t r ub u 6
r r s ub u 7
r 18
e 22
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
6/36
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
7/36
v
Urban
Universities
Preface
Te Coalition o Urban Serving Universities (USU) is a president-led organization
o public urban research universities committed to improving the economic
prosperity and quality o lie and place in cities and metropolitan regions. As part
o their health initiative, members o the Coalition work together to increase the
numbers, diversity, and cultural competence o the health workorce to improve
health and reduce disparities in their communities.
Tis report is the product o the USU Urban Health Initiative. Principal authors
o the report are Jennier Danek, Director o USU Health, and Evelinn Borrayo,
Executive Director o the Latino Research and Policy Center at University o
Colorado Denver. Members o the Steering Committee include: Betty Drees, Dean
o the School o Medicine, University o Missouri Kansas City; Greer Glazer,
Dean o the College o Nursing, University o Cincinnati; Kevin Harris, Assistant
Vice President or Health Sciences Academic and Diversity Aairs, Virginia
Commonwealth University; Roderick Nairn, Provost, University o Colorado
Denver; and John Finnegan, Dean o the School o Public Health, University o
Minnesota.
As Chair o the Coalition and Co-Chairs o the Urban Health Initiative, we are
proud to present this report to our USU colleagues and the broader university
community. Te USU Health Workorce Study is our rst step to better understandthe health workorce eorts o our membershow they are currently engaging,
what is considered to be most eective, and where greater eort is needed.
While this report is directed to university presidents and health leaders, its
insights will be useul or ederal agencies and national associations working with
our institutions toward the shared goal o preparing the uture health workorce
or cities.
Wim Wiewel
President, Portland
State University
Chair, USU
Mark P. Becker
President, Georgia
State University
Presidential Co-Chair,
USU Urban Health
Michael Rao
President, Virginia
Commonwealth University
Presidential Co-Chair,
USU Urban Health
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
8/36
vi
Urban
Universities
Acknowledgements
USU would like to thank the many universities and individuals who contributed to
this report. Te USU Health Steering Committee was instrumental in the projects
design and implementation. We extend our gratitude to current and past members:
Betty Drees, Roderick Nairn, Sheryl Garland, Kevin Harris, Greer Glazer, Carole
Anderson, Alan Noonan, and John Finnegan. A special thanks to Jennier Danek
or leading the project, and to Evelinn Borrayo and the research team at University
o Colorado Denver, including Jenny Nguyen, Ava Drennen and Shi-Ming Shi, who
helped developed the survey and analyzed the data.
Tis project beneted rom the broad participation o USU member institutions,
including administrators, deans, aculty, and sta who coordinated the collection
o data and provided valuable input into the reports recommendations. We would
like to recognize Shari Garmise, Vice President o USU/APLU Oce o Urban
Initiatives, or her extensive input and assistance and Larry Van Dyne or his
editorial assistance.
We owe a special debt o gratitude to M. Roy Wilson, who got this work o
the ground as the ormer Chair o the USU Health Initiative and Chancellor o
University o Colorado Denver. His dedication to this project was critical to its
success. Wed also like to recognize the current USU Health Co-Chairs, Mark
Becker, President o Georgia State University, and Michael Rao, President oVirginia Commonwealth University or their leadership ensuring the projects
successul completion. Finally, we acknowledge the coalitions leadersthe board,
and the member presidentswho support these recommendations and whose
steadast commitment to an evidence-based agenda has kept the coalition ocused
on data and on advancing what works.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
9/36
1
Urban
Universities
Introduction
iMProving health eqUity throUgh
Workforce innovation
Health Care Reorm has invigorated eorts to reconsider how our nations health
system should evolve to better meet the health needs o all. Broadening access
to care through insurance coverage or millions o Americans is but one solution
or a system encumbered by health workorce shortages, shiting population
demographics in the United States, and persistent health inequities. Our ability
to resolve health workorce gaps, in particular, will impact a multitude o other
initiatives to reorm the healthcare system and improve the publics health.Ensuring high-quality care and broader access hinges on our uture talentthe
clinicians, researchers, and health leaders who will serve in and shape the uture
health system.
Universities and their academic medical centers have an important role to play.
Tese institutions oten serve as anchors or local communities, possessing an
unparalleled scale and breadth o resources in education, research, and patient care.
Tis makes them well positioned to drive local innovations in health workorce
development and to improve health and health equity in their communities.
Tis report provides an account o how urban universities are tackling this goal by
enhancing and expanding a diverse, culturally sensitive, and well-prepared health
workorce to improve health and reduce disparities in our nations cities. Te report
contains recommendations on what universities need to urther increase their
capacity and eectiveness and to improve the knowledge base or university leaders
and policymakers making critical investments in our uture health workorce.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
10/36
2
Urban
Universities
Demographic Shift: Improving
the Health of Diverse, Urban
Populations
According to the National Healthcare Disparities Report, disparities in
health status or minority and poor populations persist, and access to care is on
the decline across urban and rural populations. In U.S. cities, minorities are more
likely than whites to report cost barriers to care, such as lack o health insurance.
Tey are less likely to report they have a personal doctor and more likely to report
air to poor health. Te persistence o health disparities is particularly worrisome
in light o changing demographics. By the year , no one race wil l constitute a
majority. Moreover, population growth and cultural diversity is greatest in U.S.
cities and surrounding areas, where nearly percent o the population now lives.
increaSing DiverSity in health ProfeSSionS
o ensure that the health care needs o diverse populations are met, it is crucial
to prepare a diverse, culturally and linguistically competent health workorce.
Numerous reports, including those by the Institute o Medicine7 and the Sullivan
Commission in , identiy the lack o minorities in the health workorce ascontributing to unequal access and quality o care. Policymakers and education
leaders recognize the need or large-scale changes in health proessions education
and training, and over the past decade, they have sought to broaden the pipeline to
health proessions, increase awareness and accountability among universities, and
improve education nancing.
Yet progress in diversiying the health workorce has been slow. Arican-
Americans, Hispanic-Americans, and Native Americans comprise more than one-
third o the U.S. population. Yet, they account or only percent o physicians, 7
percent o dentists, percent o pharmacists, and percent o registered nurses.
Over the last decade, the proportion o minority graduates has increased in some
elds, such as public health and nursing. Others, such as medicine, have seen
virtually no change (see Figure ).
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
11/36
3
Urban
Universities
figure 1. health workforce diversity
Percentage of Degrees Conferred to Underrepresented
Minorities by Health Field (2000 to 2009)
2000 2009 change in Percentage
Medical Doctor (M.D.) 13.0% 12.0% -1.0%
Dentistry 9.0% 11.3% 2.3%
Pharmacy 11.9% 10.7% -1.2%
Nursing1 13.6% 15.1% 1.5%
Public Health1 16.5% 22.6% 6.1%
1 Includes bachelors, masters, and doctoral degrees
Source: U.S. Department of Education, Integrated Postsecondary Education Data System (IPEDS) ,
IPEDS Data Center, 2000, 20 09. http:// nces.ed.gov/ipeds/datacenter/.
Plans to increase coverage or the uninsured will intensiy current gaps in our
health workorce. Among the estimated million uninsured individuals, nearly
hal are minorities, and the vast majority live in urban environments. Te entry
o these individuals into the health system will require an expanded and equally
diverse set o health proessionals to care or them.
eDUcating More health ProfeSSionalS anDDePloying theM Where they are neeDeD
Te national shortage o health workers is well-documented. Fully percent o
the U.S. population mill ion peoplereside in communities where access
to primary health care providers is limited. Forty ve percent o these Health
Proession Shortage Areas (HPSAs) are in metropolitan areas, including inner city
neighborhoods that oten lack other critical resources needed or good health, like
sae areas to play or quality schools.
In addition to existing shortages, demand or health workers is expected toincrease as an elderly population expands and current health proessionals retire.
In response, most o the major health proessions associations have recommended
an increase in education and training.
he Association o American o Medical Colleges (AAMC) predicts that 91,000
more physicians will be needed by 2020 and has recommended a 30 percent
increase in medical school enrollment by 2015.13
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
12/36
4
Urban
Universities
he American Association o Colleges o Nursing (AACN) projects that 260,000
more registered nurses will be needed by 202514 and calls or an increase in
nurses with baccalaureate degrees by 80 percent and the doubling o nurses
with doctorates.15
he Association o Schools o Public Health (ASPH) estimates that 250,000
more public health workers will be needed by 2020 and recommends training
three times the current number o graduates over the next 11 years.16
Expanding the numbers o health proessionals alone wont solve the access
problem. Greater attention is needed to coordinate the growth and deployment
o the health workorce in order to ensure the right types o proessionals are
practicing in the communities where they are needed. From to , the
number o health graduates increased signicantly, but the growth was uneven:
pharmacy more than doubled, nursing and public health both increased by
percent, dentistry grew only by percent, and medicine was stagnant (see
Figure ).7 Now that more medical schools are opening and existing schools are
expanding, the supply o physicians is expected to increase or the rst time in two
decades. But unless more o these students choose primary care or start practicing
in high-need communities regardless o specialty, access to the health system is
likely to be worse in seven to ten years when these people join the workorce.
figure 2. growth in health professions
Percentage Change in Total U.S. Degrees
Conferred by Health Field (2000 2009)
0
10
20
30
40
50
60
70
80
90
100
Public
Health
Nursing
Percent
Pharmacy Dentistry Medicine
82% 83%
106%
19%
< 1%
1 Include Bachelors, Masters, and Doctorate degrees
Source: U.S. Department of Education, Integrated Postsecondary Education Data S ystem (IPEDS),
IPEDS Data Center, 2000, 20 09. http:/ /nces.ed.gov/ipeds/datacenter/.
1 1
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
13/36
5
Urban
Universities
Te need to anticipate demand and plan across health elds was part o the
rationale or creating a National Center or Health Workorce Analysis and the
National Health Workorce Commission. Te latter entity was legislated by the
Aordable Care Act, but is yet to be unded.
PreParing 21St centUry health ProfeSSionalS
As cities grow in size and density, and as they become more cultural ly diverse,
urban health systems will need to adapt. In , the percentage o the oreign-
born population reached percent, and more than 7 million people now speak
a language other than English at home. In certain cities, such as Louisville,
Jackson, and Indianapolis, the number o oreign-born persons doubled in the
past decade. As health systems evolve to
better deliver care or dierent urban-based
populations, they will require a new brand ohealth workers and leadersones who are
more collaborative and who have both technical
competence and the ability to understand and
address complex social issues.
Increasing attention is being placed on cultural
competence. Nearly all experts agree that
improving cultural awareness and providing
students with skills to work eectively with
patients o dierent cultural backgrounds
is crucial to maintaining individual and
community health. Studies on cultural competence interventions are promising.
Expectations or cultural competence are now built into accreditation standards
or health proessions schools. At the same time, theres little agreement on what
constitutes cultural competence, how to attract students who have or will be able
to develop these skil ls, and how health proessions schools develop or measure this
in the students they train. As more health employers demand cultural competence,
universities and health proessions schools will need to gure this out.
i s, su
s lus, Js,
d idps,
umb -
b pss dubd
ps dd.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
14/36
6
Urban
Universities
Transforming the Future
Health Workforce: The Role
of Urban Universities
Urban universities have a unique capacity and responsibility to respond to health
workorce needs in their locales.Urban universities produce a large share o thenations health proessionals, educating percent o physicians and dentists and
percent o nurses and public health proessionals. Tese universities are oten
a gateway to higher education or urban students and to advanced training in
health proessions.
Addressing the ailing K education pipeline, particularly or urban and minority
students, must be a priority. oo many urban studentsmany rom high-need or
underserved communitiesdrop out beore they can even consider a health career.
A study by Americas Promise Alliance conrmed the dramatic high school
graduation gap between urban and suburban public school students in major
cities. Students who drop out o high school, in turn, are more likely to suer
rom poor health themselves, as educational attainment and health disparities are
closely linked.
Needed change within the health workorce can be attained i training institutions
make it a core priority and commit the resources required to achieve it. One o
the most important steps toward achieving diversity goals is the commitment
rom university leaders.7 Tey have the power to transorm institutional policies
and procedures and collaborate with other educational institutions to strengthen
the pipeline rom preschool to graduate school. By aligning admission practices
with broader institutional goals, health proessions leaders shape the incoming
student body and aect the infux o proessionals entering health proessions.
Universities also are primary innovators in health proessions education and
can leverage existing linkages with urban sites, clinics, and hospitals to increase
cultural competence and train health proessionals in those venues where they are
needed to practice.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
15/36
7
Urban
Universities
Research Results from a
Study of Urban Universities
Te Coalition o Urban Serving Universities (USU) is a president-led organization
o public urban research universities committed to improving the economic
prosperity and quality o lie and place in cities and metropolitan regions. As part
o their health initiative, members o the Coalition work together to increase the
numbers, diversity, and cultural competence o the health workorce to improve
health and reduce disparities in their communities.
In the winter o , the coalition collected data rom member institutions
and public sources to better understand existing eorts and the needs o urban
universities in preparing an adequate, diverse, and ully prepared health workorce.
Te USU survey included both quantitative and qualitative data analysis related
to the ollowing areas: institutional priority and capacity, admissions practices,
pipeline programs, and innovative education eorts. Te survey response rate
was greater than percent, including institutions and o their health
proessions schools.
USUs study is a rst step to better understand the workorce eorts o its
membershow they are currently engaging, what is considered to be most
eective, and where greater eort is needed. Te survey provides baseline data and
identies areas or uture research. While this report is directed to USU presidents
and health leaders, its insights will be useul or ederal agencies and national
associations working with our institutions toward the shared goal o preparing the
uture health workorce or cities.
i. leaDerShiP: BUilDing caPacity to MeaSUre reSUltS
Preparing a more diverse and culturally competent health workorce is a stated goal
in the strategic plans o nearly all institutions. Presidents and health proessionsdeans consider it a very high priority. Institutional leaders are taking steps to
enact change, and a multitude o educational innovations and partnerships target
the issue.
Even with a stated high priority, many universities lack the capacity to execute and
measure progress on their health workorce goals. Nearly al l have eorts underway,
but ewer institutions have mechanisms to track institutional progress or report on
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
16/36
8
Urban
Universities
outcomes to leaders. In the strategic plans o health proessions schools, diversity
and cultural competence is oten identied as a core value, but is not always
accompanied by specic goals and objectives, responsible agents, or metrics (see
Figure ).
figure 3. survey results: institutional capacity
Preparing a More Diverse and Culturally Competent Health Workplace
so urs ce
0
20
40
60
80
100
120
In Strategic
Plans
Percent
Core
Value
Taking
Actions
Goals &
Objectives
Responsible
Agents
Metrics
19%
57%
76%
97%100%
34%
Source: 2011 USU Member Survey, includes data from 32 universities and 85 of their health
professions schools.
Te results o the study make clear that top leadership commitment is crucial
to meeting health workorce goals. University boards, presidents, and health
proessions deans set expectations, al locate resources, and hold themselves and
others accountable. Several institutions cited a clear message rom leaders as
enabling more substantive planning and collaboration across the dierent health
proessions schools and units o the university. Such a process was noted at
University o Colorado Denver, Ohio State University, and Georgia State, among others.
Many institutions are expanding senior leadership positions or diversity. Several,
including Portland State University and the State University o New York (SUNY)
Albany, have appointed chie diversity ocers. Indiana University-Purdue University
Indianapolis (IUPUI) credits three new leadership positions as advancing its eorts:
an Assistant Chancellor or Diversity, Equity, and Inclusion and two ull-time
associate deans o diversity aairs in medicine and dentistry. Te University o
Houston System hired an associate vice president to oversee the Urban Health
Initiative, a signature eort to prepare more o its diverse student body to become
uture health proessionals in Houston communities.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
17/36
9
Urban
Universities
Unortunately, the data collected and used to measure progress on health
workorce goals is largely inadequate. Te lack o evidence and a data eedback
loop to inorm eorts and investments is a barrier or leaders. Box presents the
survey ndings on the use o data.
BoX 1. use of data
Student Tracking and Program Evaluation
Nearly all health professions schools collect data on underrepresented students
who apply and enroll, using the data to inform policies on diversity.
Sixty-four percent of these schools report tracking graduates to determine
if they practice in underserved communities, though data is often difficult to
obtain.
Universities frequently evaluate pipeline programs, but few have the capability
to track long-term outcomes of participating students.
Challenges to improving data collection and analysis include a lack of
infrastructure, cost, and definitional issues (e.g., defining such terms as
underrepresented, economically disadvantaged, and diversity).
Eorts to strengthen data systems oten stem rom leadership priority and
desire or greater accountability. As part o a highly visible Graduation Initiative,
the Caliornia State University (CSU) System improved its tracking o studentoutcomes and reporting across campuses. Campus leaders requently cited
the system-wide initiative as helping to align and better organize their work. Te
recent strategic plan or the SUNY System makes a commitment to develop the
right health proessionals or the right places, and will be tracking its metrics in
an annual report card to the public. Another example is the University o New
Mexicos Vision , the rst academic health center strategic plan that ocuses
on improving the health and health equity o a states population as a measure o
the institutions success. All o the colleges, schools, departments, and programs at
UNM Health Sciences Campus have incorporated into their annual perormance
plans how their education, service, and research enterprises will measurablyimprove the health o New Mexicos population.
Sustained institutional unding is requently cited as important. Virginia
Commonwealth University allocates permanent unding to support core
inrastructure or pipeline programs within the Division or Health Sciences
Diversity. Others point to the impact on diversity o declining resources. As one
institution explained, We created a dean-level position to promote, monitor, and
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
18/36
10
Urban
Universities
BoX 2. how urBan universities are
eXpanding the talent pipeline
k12 anD UnDergraDUate PrograMS
The University of Missouri, KansasCityoffers the Summer Scholars Program,
an academic enrichment program for underrepresented minority undergraduate
students who have interest in and aptitude for health careers. Of the 1,265
participants to date, 69 percent have enrolled in a health careers degree program,including 25 percent in medical school.
PoSt-BaccalaUreate PrograMS
The Ohio State UniversitysMeDPath is a one-year post-baccalaureate academic
enrichment program. Participants receive conditional acceptance into the College
of Medicine and matriculate once they complete the program. The program
doubled the number of underrepresented minority medical students in the School of
Medicine. In addition, 68 percent of MEDPATH graduates provide substantial care
to underserved populations, compared to 33 percent of non-MEDPATH graduates
from Ohio State.*
SySteMic effortS
University of Illinois at ChicagoUb h Pm is a preschool through
graduate level program that recruits and supports students from underserved
communities interested in pursuing health careers. The program is integrated
across the six health sciences colleges and includes both undergraduate and pre-
undergraduate initiatives. In 34 years, the university has graduated more than 6,000
African American, Latino, and Native American health care providers and health-
related researchers.
Virginia Commonwealth Universityrecently has consolidated its 21 health sciences
and research pipeline programs into a comprehensive model to increase access
and success in health careers for diverse students. Centralizing the programsenables the university to consolidate resources, improve linkages with the
community, create a connected experience for students, and track common data
and outcomes.
* L. McDougle, D.P. Way and Y.L. Rucker. Survey of Care for the Underserved: A Control
Group Study of Practicing Physicians who were Graduates of The Ohio State University
College of Medicine premedical Post Baccalaureate Training Program. Academic
Medicine. 85 (1) (2010): 3640.
measure progress on diversity. However, due to the budget crisis, the position was
temporarily eliminated.
ii. reaching More StUDentS: the talent PiPeline
Teres good evidence that pipeline programs work. Evaluation studies on pipelineinterventions demonstrate a range o positive outcomes, including improved
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
19/36
11
Urban
Universities
0
10
20
30
40
50
60
70
80
Outreach
& Information
Mentoring Academic
Enrichment
Test
Preparation
Scholarships
Undergraduate Students
Percent
K12 Students
academic success and increased enrollment in health proessions schools. USU
leaders also cite pipeline programs as one o their most eective strategies or
increasing and diversiying the workorce. About hal o USU member institutions
cite programs that are innovative or have documented success (See Box ).
Universities make signicant investments in their pipeline programs. At most
institutions, the principal source o unding comes rom the university and
health proessions school. At the same time, nearly all count on some ederal
support, particularly or K activities. Te ederal Health Resources and Services
Administrations itle VII programs, particularly the Area Health Education
Centers, the Centers o Excellence and Health Career Opportunity Programs,
are particularly instrumental to sustaining university health workorce diversity
eorts. On more than one occasion, programs got o the ground through these
ederal programs, and then were continued by the institutions themselves.
Te types o pipeline interventions being deployed by urban universities varytremendously. Te breadth and diversity o programs, as well as the overlap with
science, technology, engineering, and mathematics (SEM) programs and general
student services, make it dicult to characterize a standard health careers
pipeline program or to determine what types o activities are needed to yield
positive outcomes. Figure summarizes the requency o activities oered by
Source: 2011 USU Member Survey, includes data from 32 universities and 85 of their health
professions schools.
figure 4. survey results: eXpanding the talent pipeline
Activities for K12 and Undergraduate Students
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
20/36
12
Urban
Universities
BoX 3. regional pipeline partnerships
University of New Mexicoand New Mexico StateUniversityrecently have formed
a cooperative pharmacy program to increase educational opportunities and
the supply of pharmacists to areas of high need. High school students from
underserved counties are accepted into the program, complete two years of
undergraduate work at New Mexico State, and then matriculate to the University of
New Mexicos School of Pharmacy. Graduates have incentives to return to these
communities to practice.
The University of Houstonparticipates in a pre-health professions agreement with
Baylor College of Medicinecalled the h Psss adm. The program
targets students from DeBakey High School, a highly diverse school in Houston
focused on health professions. Students receive tuition assistance and academic
supports all the way to medical school. Since its founding in 1996, 147 Debakey
students have entered the program, and 75 of 76 University of Houston program
graduates (99 percent) have matriculated into medical school.
Cleveland State Universityhas launched a new partnership with Northeast Ohio
Medical University. The aim is to prepare diverse primary care doctors for urban
underserved communities. Several pathways to the medical degree are available
to Cleveland State students, including direct entry, a post-baccalaureate to M.D.
program, and a baccalaureate to M.D. pipeline.
urban universities. Outreach, such as health career airs and websites, are most
requent while academic and nancial support are less common.
Short-term pipeline interventions, such as pre-matriculation and post-
baccalaureate programs, are common among urban universities. Tese programs
have substantial and growing evidence to support their eectiveness. Studies show
they increase academic readiness and enrollment o underrepresented minorities
in health proessions schools. Participants in these programs are also more likely
to plan on working with underserved populations upon graduation.
Among urban universities, the use o pre-matriculation and post-baccalaureate
programs varies by health proession. Post-baccalaureate programs are oered at
percent o medical schools surveyed, compared to 7 percent o public health
schools, percent o dental schools, percent o nursing schools, and none o
the pharmacy schools. Te data are similar or pre-matriculation programs.
While most pipeline activities ocus on undergraduates, about hal o health
proessions schools oer pipeline programs or K students. Several institutions
have developed more in-depth partnerships with specialized urban high schools
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
21/36
13
Urban
Universities
ocused on health careers. IUPUIworks with Crispus Attacks Medical Magnet School;
San Francisco State University has the Metro Health Academy; University o Houston
works with Debakey High School or Health Proessions; and the University o Illinois
at Chicago has a partnership with UIC College Prep, a charter high school whose
curriculum is co-developed by aculty in the universitys six health sciences colleges.
Aside rom discrete pipeline programs, urban universities are developing more
systematic approaches to improve educational transitions to health careers.
Examples include combined or accelerated degree programs, regional cooperative
partnerships among educational institutions targeting high-need communities,
new undergraduate majors, and improved articulation agreements with
community colleges (see Box ).
Bridging programs are particularly common among schools o nursing. Tese
programs encourage nursing students to advance to higher levels o education.
San Jose State University (SJSU) ormed a partnership with the Evergreen Valley
Community College to enable second-year associate degree nursing students
to cross-enroll at SJSU, taking one higher level course each semester. Te pilot
partnership streamlines the educational transition and allows students to complete
their bachelors degree in nursing within months o ull-time enrollment.
SUNY Downstate has developed a -month accelerated nursing program serving
Brooklyn, Queens, and Staten Island in New York City. Other bridging programs
address the shortage o nursing aculty or the lack o diversity among nursing
leaders. BothArizona State University and University o Minnesota have successul
M.S. to Ph.D. nursing programs or Native Americans.
Only one third o urban universities cite institutional partnerships with minority-
serving institutions. Many o these partnerships target biomedical research
careers, and are supported in part by NIH. Such programs are in place at CSU-Los
Angeles, IUPUI, and University o Minnesota.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
22/36
14
Urban
Universities
iii. recrUitMent anD aDMiSSionS
Nearly all health proessions schools consider diversity goals in admitting students,
but promising admission practices are not being used to the extent suggested in
the literature. Te most common admission strategies include using holistic
review or broadening the composition o the admission committee to refect
greater diversity and perspectives. De-emphasis on test scores or elimination o
screening algorithms are used less requently, although some have advocated that
approach, particularly where testing has low correlation with long-term academic
perormance (see Figure ).
figure 5. survey results: current admissions practices
0
10
20
30
40
50
60
7059%
53%
18%11%
Use holistic
review
Percent
Broaden
composition
of admissions
committee
De-emphasize
standardized
test scores
Eliminate
screening
algorithms
Tere are some dierences in admission practices among the health proessions.
Extending conditional or guaranteed admissions is more requent among schools
o medicine and pharmacy then among schools o public health, nursing, or
dentistry. Te majority o medical schools surveyed require mandatory training
or the admissions committee, a practice that is inrequent among other health
proessions schools. Consideration o cultural competence within the admissions
process also is more requent among medical schools (See Figure ).
Source: USU 2011 Member Survey, includes data from 85 health professions schools.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
23/36
15
Urban
Universities
figure 6. survey results: variation in admission
practices By health profession school
0
10
20
30
40
50
60
70
80
90
Conditionaladmissions
Percent
Mandatorytraining of
admissionscommittee
Culturalcompetence
considered
Dentistry Medicine Nursing Pharmacy Public Health
Source: USU 2 011 Member Survey, includes data from 85 health professions schools.
Slightly more than hal o health proessions schools report evaluating their
admissions strategies and outcomes. Several schools pointed to innovative
approaches that improved their ability to attract and matriculate a more diverse
class. University o Minnesotas School o Public Health cites its core concepts
certicate as a way to both train more people in public health and enable students
who didnt initially gain acceptance to demonstrate academic competence while
making progress toward the masters degree. Many institutions identied
recruitment strategies as increasing their eectiveness (e.g. outreach to diverse
campus and national groups, online eorts, and hiring multicultural recruiters).
For one institution, the decisive actor in attracting the students it seeks was
oering more scholarships.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
24/36
16
Urban
Universities
BoX 4. spotlight on innovation and success
h Psss edu fd i Us
neW aMericanS in nUrSingThrough a regional collaboration of area hospitals, FIU has created the rst
Foreign Doctor to Nurses program in the nation. nw ams nus is
an accelerated Bachelor of Science program with specialized courses to transition
foreign-born doctors to become practicing nurses. The idea was suggested to the
former dean, Divina Grossman, by a group of Cuban doctors in Miami who were
working outside their eldas cab drivers, at produce stands, or as security guards.
The impact, published in a 2008 article in the Journal of Nursing Education, is
unassailable.* The program taps an unmet need (the initial class had over 450
applicants), increases the supply of nurses, and on measures of nursing quality
and employer satisfaction, graduates outperform expectations. Since its rst class
in 2002, more than 500 graduates have entered the nursing workforce. The school
is partnering with the Hospital Corporation of America to expand the program
remotely to Tampa.
neighBorhooD helP PrograM
FIUs medical school, which opened in 2009, is similarly committed to improving
community health. The schools curriculum is designed around the g fm
fud nbd helP pm, an interdisciplinary approach
where teams of students from medicine, nursing, social work, and law work in
Miamis poorest and most diverse communities. The students, now exceeding 400,
visit with families in their homes over four years. They identify concerns and work
with family members to improve them. In addition to training culturally competentphysicians, Neighborhood HELP intends to impact health disparities directly. Initial
data shows participating families already have lower emergency room utilization
rates, and additional measures of health outcomes will be collected over time.
* D. Grossman and M.L. Jorda. Transitioning Foreign-educated Physicians to Nurses: The
New American in Nursing Accelerated Program. Journal of Nursing Education47 (12)
(2008): 54451
iv. innovationS in health ProfeSSionS eDUcation
raining in underserved communities is an important strategy or increasing
the cultural competence o health graduates. Nearly percent o urban health
proessions schools have community partnerships to increase student exposure
to, and understanding o, culturally diverse populations. Schools also are adaptingtheir ormal education, with 7 percent o health proessions schools reporting
they have integrated cultural competency into their curriculum.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
25/36
17
Urban
Universities
Only about one quarter o schools, however, have either done a ormal needs
assessment o cultural competency within curricular oerings and training or
assessed cultural competency in students. Te lack o student assessment largely
refects the newness o the eld, varying denitions o what constitutes cultural
competence, and questions o how cultural competence can be measured.
Many institutions are expanding clinical sites or community-based education
to train students in venues where they are needed. Students rom health-
related schools at the University o Akron are assigned as part o their clinical
experience to work in the College o Health Proessions Nurse Managed Center
or Community Health, which has six clinics serving vulnerable and uninsured
individuals in Akron. Tis includes a womens and childrens homeless shelter, a
mens homeless shelter, a ederally unded housing complex, and a clinic serving
individuals with severe and persistent mental i llness. Florida International
University has several innovative programs to improve the workorce or South
Floridas diverse and underserved communities (see Box ).
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
26/36
18
Urban
Universities
Recommendations
i. high-level coMMitMent
Campus-wide planning to meet goals or increasing the size and quality o the
healthcare workorce should encompass both the initiatives o universities and
their health proessions schools. Only some o the eorts o universities to target
workorce improvements are coordinated currently, and this can lead to duplication
and diculties assessing critical gaps. Lack o coordination also hampers the
ability o university leaders and health proessions deans to collect reliable and
compatible data across all their health proessions schools and programs, which
makes it dicult to track progress on diversity, cultural competence, and othergoals.
Heres what top leaders can do:
Make their commitment visible. Where this has occurred, universities and health
leaders are better able to coordinate eorts, measure eectiveness, and partner
with their communities. he University o New Mexicos Vision 2020 is a good
example o how a visible commitment to improve health equity at the highest
level can galvanize both a campus and community to work together.
Ensure that what is valued is measured, monitored, and reported. hough improved
health and reduced health disparities in communities is diicult to measure,
other workorce outcomesaccess to health proessions, student diversity, the
location and practices o graduatesare more easily quantiied. Universities
should establish big-picture health workorce goals and be diligent about
tracking and reporting their outcomes.
Design health workorce programs based on local needs and outcomes. University
leaders should ensure that decision-makingparticularly expansion or
development o new health proessions schoolsis responsive to local need.
In turn, universities need national and state-level agencies and planners to
provide more reliable and appropriate health workorce data. his helps leaders
to better anticipate demand and plan across health ields.
Engage leaders across health proessions. Some o the most eective programs,
such as the University o Illinois Chicago Urban Health Program, are integrated
across the university and health proessions and beneit rom shared leadership
commitment and ownership. University presidents and health leaders should
create mechanisms that break down silos among the health proessions and
ensure greater collaboration.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
27/36
19
Urban
Universities
Reine metrics by which institutions can assess progress and drive urther
health workorce improvements. Universities should identiy a set o measures
where data are already available and work with others to improve data and
inormation systems that enable even better measures.
Inventory programs that impact the health workorce to better assess and
coordinate existing services and identiy gaps.
Improve and harmonize data relevant to health workorce goals. Universities should
establish deinitions or relevant terms (e.g. disadvantaged students) and
identiy common data to be collected across university programs and health
proessions schools.
ii. the talent PiPeline
Crucial to the eort to recruit, train, and graduate more students in the health
proessions is improving the fow o students into health proession schools by
encouraging and preparing them rom a young age.
Urban universities should:
Identiy high-impact interventions. Evidence or pipeline programs is generally
strong, but less is known about the relative value o speciic interventions.
Universities should work with ederal agenciesincluding the National
Institutes o Health, the Health Resources and Services Administration, and
the National Science Foundationto reine and disseminate knowledge that
helps leaders to improve programs and direct resources appropriately.
Build on what works. Universities should be rigorous in deploying ev idence-basedstrategies or improving the pipeline to health proessions. Interventions that
are proven eectiveor example, post-baccalaureate programs in medicine
should be scaled-up or piloted in other ields where there is similar need.
Collaborate regionally. Some o the more innovative and promising health
workorce models are regional collaborationswith other universities,
K-12 systems, community colleges, local government, hospitals, and other
employers.
Partner with minority-serving institutions. Universities should consider speciic
strategies to link students at minority-serving institutions with advanced
health proessions education and training. While some are already engaged in
such partnerships, much more can and should be done.
Develop mechanisms to track pipeline participants longitudinally, and identiy
common measures to evaluate pipeline programs.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
28/36
20
Urban
Universities
iii. recrUitMent anD aDMiSSionS
Institutions currently consider diversity and cultural competence in their
recruitment and admission strategies, but practices dier across health proessions
schools and are not consistently evaluated.
Urban universities should:
Align admissions practices with institutional goals. Health proessions leaders
should collaborate to provide consistency in support o an overarching vision,
to learn rom each others practices, and to optimize eorts across the board.
Consider adopting promising practices in admissions to promote diversity, including
holistic review, broadening the composition o admissions committees, and
requiring mandatory training o committee members.
Evaluate health proessions admission strategies and outcomes to make certain they
are eective and aligned with goals.
iv. cUltUral coMPetency
Universities are developing a number o innovations to attract and prepare
individuals with the background, qualities, and skills to improve health and
eliminate disparities. Nearly all are integrating cultural competence into their
programs, but they lack consistent denitions and ways to measure this trait or the
skill-sets associated with it.
Universities should:
Establish expectations or cultural competence that encompass campus climate,
institutional practices and policies, and education programs. o do so,
universities will need to deine cultural competence appropriate to their
mission and to identiy the results they seek.
Identiy learning outcomes or students and develop ways to measure the transer
o knowledge that enables graduates to eectively care or diverse populations.
Educate more students romand inthe communities where they are needed.
Evidence that health proessionals will more likely serve the communities they
come rom or the places where they train supports a place-based approach toworkorce development. A number o places where this is occurring, such as the
partnership between Cleveland State University and Northeast Ohio Medical
University, should be closely ollowed and their outcomes evaluated.
Work with local healthcare employers to improve the supply o culturally
competent graduates. he FIU oreign doctors to nurses program is a great
example o a local partnership that improved university oerings, while
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
29/36
21
Urban
Universities
meeting the needs o local employers and communities or health workers that
understand and can eectively serve South Floridas diverse communities.
v. gathering eviDence
Urban universities are creating and implementing solutions to develop a health
workorce that ameliorates health disparities. Tey have leveraged diverse
undingincluding their ownto sustain these eorts. In an environment
o increasingly tight budgets and accountability, better data is needed by both
institutions and policymakers to direct resources and investments to what works.
Members o the Coalition o Urban Serving Universities are well-positioned to
make headway in this area. Tey should:
Encourage well-designed evaluation studies to inorm health workorce eorts.
Federal partners should work with universities to und high-quality researchon health workorce interventions and disseminate the results. Institutions, or
their part, should publish more o their data so it can inorm the ield.
Partner with state workorce planners and others to ensure that a regular,
comprehensive analysis o local health workorce needs is available to guide
and evaluate university eorts.
Improve university data and inormation systems. Data collected and used to
measure progress on health workorce goals are largely inadequate. his lack o
evidence and a data eedback loop are barriers or leaders. Strengthening the
data inrastructure and processes to provide leaders with this capability should
be a top priority.
Develop learning communities.Eorts to improve data systems or to deine
common metrics would beneit rom a broader cooperative eort among
universities and health proessions schools. Similarly, universities and
policymakers should work together to identiy and target crucial areas where
evidence is lacking and can be improved.
I urban universities and their national partners work together we can make
greater progress in developing a health workorce that meets community needs.
Its imperative that our shared eorts evolvethat innovation becomes knowledgeand that this knowledge is translated into better and more strategic programs. In
the words o one university president: Our aim is to do whats important, better.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
30/36
22
Urban
Universities
enDnoteS
Coalition o Urban Serving Universities, Urban Universities: Anchors GeneratingProsperity or Americas Cities () Retrieved rom http://www.usucoalition.org/
downloads/part/USU_White_Paper_Report_.pd
U.S. Department o Health and Human Services Agency or Healthcare Research and
Quality,National Healthcare Disparities Report: (AHRQ Publication No. -),(). Retrieved rom http://www.ahrq.gov/qual/nhdr/nhdr.pd
K.J. Bennett, B. Olatosi, and J.C. Probst, Health Disparities: A Rural-Urban Chartbook.(South Carolina Rural Health Research Center. ). Retrieved rom http://rhr.sph.sc.edu/report/(7-) percentHealth percentDisparities percentA percentRural
percentUrban percentChartbook percent- percentDistributionpercentCopy.pd
U.S. Census Bureau,An Older and More Diverse Nation by Midcentury ().Retrieved rom http://www.census.gov/Press-Release/www/releases/archives/population/.html
U.S. Census Bureau, Statistical Abstract o the United States, Population (). Retrieved
rom http://www.census.gov/prod/pubs/statab/pop.pd K. Grumbach and M. Rosalina, Disparities in Human Resources: Addressing
the Lack o Diversity in the Health Proessions, Health Afairs 27() ():-
; and . Goode et al., Te Evidence Base or Cultural and Linguistic Competencyin Health Care. (Washington, DC: National Center or Cultural Competence,
Georgetown University, ) available at http://www.cmw.org/usr_doc/Goode_evidencebasecultlinguisticcomp_.pd
7 B. Smedley, A. Butler, and A. Bristow, eds. In the Nations Compelling Interest: Ensuring
Diversity in the Nations Health Care Workorce (Washington, DC: National AcademiesPress, ).
Sullivan Commission,Missing Persons: Minorities in the Health Proessions. A Report othe Sullivan Commission on Diversity in the Healthcare Workorce (Durham, NC: Sullivan
Commission, ).
L. Sullivan and I. Suez Mittman, Te State o Diversity in the Health Proessions
a Century Ater Flexner.Academic Medicine () (February ). Retrieved romhttp://journals.lww.com/academicmedicine/Fulltext///Te_State_o_Diversity_in_the_Health_Proessions_a..aspx#P
U.S. Department o Health and Human Services, Improving Data Collectionto Reduce Health Disparities,(January , ). Retrieved rom http://www.
healthcare.gov/news/actsheets///disparitiesa.html; U.S. CensusBureau ().
D.J. Derksen and E. Whelan, Closing the Health Care Workorce Gap: Reorming Federal
Health Care Workorce Policies to Meet the Needs in the 21st Century. (Washington,D.C.: Te Center or American Progress. ) Retrieved rom http://www.
americanprogress.org/issues///pd/health_care_workorce.pd; and U.S.Department o Health & Human Services, Shortage Designation: Health ProessionalShortage Areas, Medically Underserved Areas/Populations. (). Retrieved rom http://bhpr.hrsa.gov/shortage/
U.S. Department o Health and Human Services. Designated Health Proessional
Shortage Areas Statistics. (June , ). Retrieved rom http://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR_
Smry&rs:Format=HML.
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
31/36
23
Urban
Universities
Association o American o Medical Colleges, Physician Shortages to Worsen Without
Increases in Residency raining(). Retrieved rom: https://www.aamc.org/newsroom/newsreleases//7/.html; and M.J. Dill and E.S. Salsberg.Te Complexities o Physician Supply and Demand: Projections through 2025 (Washington,DC: National Association o Social Workers Center or Workorce Studies, )Retrieved rom http://www.tht.org/education/resources/AAMC.pd
American Association o Colleges o Nursing,Nursing Shortage Fact Sheet ()Retrieved rom http://www.aacn.nche.edu/media/pd/NrsgShortageFS.pd
Institute o Medicine, Te Future o Nursing: Leading Change, Advancing Health ().Retrieved rom: http://www.theutureonursing.org/sites/deault/les/Future
percento percentNursing percentReport_.pd
Association o Schools o Public Health, Conronting the Public Health Workorce Crisis
() Retrieved rom http://www.asph.org/document.cm?page=
7 U.S. Department o Education (, ).
Health Reorm GPS.National Workorce Development Policy. () Retrieved romhttp://healthreormgps.org/resources/national-workorce-policy-development/
Grantmakers in Health, In the Right Words: Addressing Language and Culture in Providing
Health Care. () Retrieved rom http://www.gih.org/usr_doc/in_the_right_words_issue_brie.pd
J. H. Wilson and A. Singer, Immigrants in 2010 Metropolitan America: A Decade oChange. (Washington, DC: Metropolitan Policy Program at Brookings, ). Retrieved
rom http://www.brookings.edu/~/media/research/les/papers///%immigration%wilson%singer/_immigration_wilson_singer.pd
J. Betancourt, A. Green, et al. Dening Cultural Competence: A Practical Frameworkor Addressing Racial/Ethnic Disparities in Health and Health Care. Public HealthReports, ().
. Goode, et al. Te Evidence Base or Cultural and Linguistic Competency in HealthCare. (Washington, D.C.: National Center or Cultural Competence, Georgetown
University, ). Retrieved rom http://www.cmw.org/usr_doc/Goode_evidencebasecultlinguisticcomp_.pd
Coalition o Urban Serving Universities. American Urban Research Universities.(Washington, DC: USU, ).
K. Grumbach and M. Rosalina, Disparities in Human Resources: Addressing the Lacko Diversity in the Health Proessions, Health Afairs 27() ():-.
EPE Research Center, Cities in Crisis 2009: Closing the Graduation Gap: Educational andEconomic Conditions in Americas Largest Cities. (Washington, DC: Americas PromiseAlliance, ). Retrieved rom http://www.americaspromise.org/Our-Work/
Dropout-Prevention/Cities-in-Crisis.aspx
N. Freudenberg and J.Ruglis, Reraming School Dropout as a Public Health Issue,
Preventing Chronic Disease, 4() (7). Retrieved rom http://www.cdc.gov/pcd/issues/7/oct/7_.htm
7 Smedley et al. (); Sullivan Commission ()
M.R. Wilson, Administration and Leadership o the Health Proessions Partnership
Initiative: A Medical School Administrators PerspectiveAcademic Medicine, 81()(): -7; and C.L. Gilliss, D.L. Powell, and B. Carter, Recruiting andRetaining a Diverse Workorce in Nursing: From Evidence to Best Practices, Policy
Politics Nursing Practice, ():.
Smedley et al. (); Sullivan Commission ().
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
32/36
24
Urban
Universities
U.S. Department o Health and Human Services, Health Resources and Service
Administration, Bureau o Health Proessions, et al., Pipeline Programs to ImproveRacial and Ethnic Diversity in the Health Proessions: An Inventory o Federal Programs,Assessment o Evaluation Approaches, and Critical Review o the Research Literature.()
Retrieved rom: http://bhpr.hrsa.gov/healthworkorce/reports/RecruitReport.pd
K. Grumbach and E. Chen. Eectiveness o University o Caliornia Post-baccalaureate Premedical Programs in Increasing Medical School Matriculation orMinority and Disadvantaged Students. Journal o the American Medical Association,
() (): 7-; and D.A. Andriole and D.B. Jee. Characteristics o MedicalSchool Matriculants who Participated in Post-baccalaureate Premedical Programs.Academic Medicine. () (): .
K. Lupton, C. Vercammen-Grandjean, E. Wilson, and K. Grumbach. Specialty Choiceand Practice Location o Physician Alumni o the University o Caliornia. Academic
Medicine. 7()(): .
Sullivan Commission ().
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
33/36
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
34/36
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
35/36
-
7/29/2019 Urban Universities: Developing a Health Workforce that Meets Community Needs
36/36