In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there w... more In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collabora...
Journal of racial and ethnic health disparities, Apr 4, 2024
Academic medicine, and medicine in general, are less diverse than the general patient population.... more Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/ Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.
In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is... more In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is presented demonstrating a current “sense of urgency” that underscores the challenges of diversifying its academic workforce. The chapter will end with a general overview describing the array of pathways into academic medicine and a reflection activity for readers to consider when choosing a path that best aligns with their personal and professional interests.
In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is... more In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is presented demonstrating a current “sense of urgency” that underscores the challenges of diversifying its academic workforce. The chapter will end with a general overview describing the array of pathways into academic medicine and a reflection activity for readers to consider when choosing a path that best aligns with their personal and professional interests.
Reducing health care disparities among disenfranchised populations remains a major challenge in t... more Reducing health care disparities among disenfranchised populations remains a major challenge in the United States, and those affected are integral to better understanding causes and solutions. Community-based participatory research (CBPR) provides a process for obtaining input by partnering community members with academic researchers to jointly define issues needing study. The University of Washington (UW) School of Medicine Center for Equity, Diversity and Inclusion (CEDI) adopted and translated the principles/processes of CBPR to develop a new curriculum tool for medical educators—the community-based participatory curriculum development (CBPCD) tool - designed to partner community members with medical educators to jointly define issues to teach our future physician workforce. The critical elements are: (1) recognition that the community has important expertise; (2) partner community members with medical educators; (3) mutual sharing of knowledge, skills, resources and power; (4) p...
More than 15 years after two pivotal reports from the Institute of Medicine (now the National Aca... more More than 15 years after two pivotal reports from the Institute of Medicine (now the National Academy of Medicine) focused their attention on unequal access to healthcare and established health equity as a pillar of quality care, healthcare disparities persist. Some of this can be traced to overt discrimination against certain groups, but this chapter shines a light on a subtler form of prejudice: unconscious bias. The by-product of a normal—and often useful—human tendency to make associations and split-second judgements, unconscious bias, affects even people who believe strongly in equality and equal care. Left unaddressed, unconscious bias can influence relationships between providers and patients and among providers and their colleagues, affecting clinical interactions, workplace diversity, and even patient outcomes. Providers can mitigate unconscious biases by becoming more aware of them and resolving to overcome them through proven strategies for improving health equity and rev...
Introduction: Language concordance between patients and physicians is an important factor in prov... more Introduction: Language concordance between patients and physicians is an important factor in providing safe and effective health care, with Spanish as the predominant and fastest growing non-English language in the United Sates. However, despite increasing demand for medical Spanish education, valid concerns about inadvertently increasing provider use of limited Spanish with patients, lack of knowledge of best practice in education and assessment, and lack of institutional support still present barriers to medical Spanish education in medical schools. Methods: The authors conducted a narrative review of existing literature that evaluates the link between medical Spanish education of physicians and language concordance. Results: Medical Spanish educational efforts, although increasing, are not consistently linked to learner assessment. The literature to date supports that for medical Spanish education to improve patient outcomes, it should be linked to assessment methodology that demonstrates improvement in language concordance with Spanishspeaking patients, and should include safety measures to prevent inadvertent communication errors. The authors review data for published medical Spanish postcourse language assessment strategies and provide recommendations to ensure responsible and competent use of medical Spanish skills. Conclusion: The authors propose three structural elements that should be considered when incorporating or enhancing medical Spanish education in medical schools: institutional endorsement of the role of medical Spanish education within a national health disparities context; precourse proficiency testing to establish student starting level; and learner postcourse communications skills and limitations assessment to provide individualized recommendations and assure patient safety.
In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, me... more In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient-physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.
American journal of medical quality : the official journal of the American College of Medical Quality, 2017
Health care disparities have long existed for racial and ethnic minority populations who continue... more Health care disparities have long existed for racial and ethnic minority populations who continue to lag behind whites in several quality metrics, including quality of care, access to care, timeliness of care, and health outcomes. Effectively addressing these issues requires a health care workforce and leaders who represent the population they serve, and who are deeply committed to reducing health disparities by promoting equity, diversity, and inclusion. Women currently comprise half the population of the United States. Minority groups (any group other than non-Hispanic whites) make up approximately 40% of our population and are projected to comprise the majority of the population over the next 3 decades. 1 Patients report that they are more comfortable communicating with clinicians of the same sex, race/ethnicity, and social background. This enhanced comfort and trust may in turn result in improved health care quality, increased adherence to medical recommendations, and better patient experience of care. 2,3 Despite the imperative for diversity in high-performing teams and organizations, the academic health care pipeline remains more akin to a funnel because of attrition, especially for women and underrepresented minorities. 4,5 This attrition results in loss of diversity of thought and talent, so essential to the long-term success of academic health centers (AHCs). Diversity at the highest levels of leadership at AHCs contributes critical and innovative viewpoints and organizational-level changes that ensure excellent patient care, groundbreaking research, and serve as a model for health professions education. With the goal of identifying strategies to develop the next generation of diverse leaders, the University of California Davis (UC Davis) spearheaded the first University of California (UC) system-wide Health Sciences Leadership Development Conference, held in May 2016. This article summarizes best practices and themes from the conference.
The Journal of the American Board of Family Practice American Board of Family Practice, 1997
Background: Cervical pregnancy is a rare form of ectopic pregnancy that is associated with consid... more Background: Cervical pregnancy is a rare form of ectopic pregnancy that is associated with considerable maternal morbidity and a high mortality rate if early diagnosis and treatment are not carried out in a timely fashion. Alethods: The current medical literature was reviewed by searching MEDLINE files from 1985 to 1996, using the key words "ectopic pregnancy" and "cervical pregnancy." Older articles were accessed from cross-reference of the more recent publications. Results: The incidence of cervical pregnancy is 1 in 2400 deliveries and represents less than 1.0 percent of all ectopic pregnancies. No clear cause of cervical pregnancy has been described, and criteria for the clinical, pathologic, and sonographic diagnosis have been well established. The most common clinical complaint is painless vaginal bleeding. Routine transvaginal sonography early on allows for conservative management and avoids adverse outcomes. Methotrexate administered systemically and by intra-amniotic instillation are the therapeutic options of choice. Gestational age and the presence or absence of fetal cardiac activity are major prognostic factors for its success. Conclusion: Earlier diagnosis of cervical pregnancy using sonography and conservative management of this condition have reduced considerably the morbidity and mortality associated with this rare form of ectopic pregnancy and have helped preserve a woman's future fertility.
The Journal of the American Board of Family Practice / American Board of Family Practice
Internet has become an integral tool for modern physicians, and those not ready to embrace this n... more Internet has become an integral tool for modern physicians, and those not ready to embrace this new technology will be missing a valuable resource. This pilot study reviews rural physicians' usage patterns of the Internet as a medical resource and examines the barriers that might preclude rural providers from using this technology. We undertook a questionnaire survey of rural providers in Wyoming, Montana, and Idaho. Information was elicited about the physicians' Internet access, frequency of Internet use, the different Internet categories used, and the barriers they encountered to using the Internet. A background MEDLINE search was performed using the MeSH headings "Internet," "medical informatics," "and rural health." Eighty-five percent of providers had Internet access, and 75% of respondents reported using the Internet either daily or one to four times a week. E-mail was the most frequently used category. The next most frequent categories we...
From 1980 to 2010, the shortage of Latino physicians worsened despite the unique benefits that La... more From 1980 to 2010, the shortage of Latino physicians worsened despite the unique benefits that Latino physicians provide, especially in caring for the rapidly growing Latino patient population. The authors describe the expanding Latino population in the United States, discuss some health care issues specific to the Latino population, and briefly evaluate historical and ongoing issues to increase the Latino physician workforce. Developing the Latino physician workforce will require a multifaceted approach including, but not limited to, building the next generation of Latino medical school applicants and matriculants, cultivating more Latino residents, prioritizing Latino inclusion in the academic medicine workforce, expanding curricula and training on Latino health in both undergraduate and graduate medical education, rebuilding and reframing federally sponsored diversity initiatives, and fostering collaboration between Latino professional organizations and academic health centers.
Many inn0mtiz.e strategies ham been ahdoped OWT the p r s to imprm the recruitment and retention ... more Many inn0mtiz.e strategies ham been ahdoped OWT the p r s to imprm the recruitment and retention of physicians in the shortage areas of rural America. These strategies hazle met With mrying success. Postresldency education, or fillowship training, @ family physicians is y t another strategy that has been aheloped @ the same purpose. Most applicants ham been interested in obstetrical and rural health fillowship programs 11s a means jbr preparing@ rural practice. This paper descriies these programs (demographics, finding, applicant pool, curriculum) and reuiews their gr&ate outcomes (practice location after matriculation, clinical priuileges). Tmty-nine obstetrical and nine rural health fillowships are currently operational in the United States. Fellows who complete a rural health fellowship haue a higher tendency to bcate in rural settings. Almost all graduates from obstetrical nnd rural health programs attain general hospital priviIeses in family practice, including lawrisk obstetrics. A signijcant number ofgraduatesfrom both types of pgrams attain privileges in highrisk and operatiw obstetrics ILS mll. Fellowship training can p@ an integral role in the preparation of family physicians @ rural practice. M 'edical institutions that have been involved in the training of residents over the years have developed a number of different and innovative ,strategies to entice and prepare these trainees for rural practice These efforts have included rural practice rotations (both required and elective), rural training tracks (R'ITs) and rural satellite clinics
In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there w... more In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collabora...
Journal of racial and ethnic health disparities, Apr 4, 2024
Academic medicine, and medicine in general, are less diverse than the general patient population.... more Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/ Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.
In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is... more In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is presented demonstrating a current “sense of urgency” that underscores the challenges of diversifying its academic workforce. The chapter will end with a general overview describing the array of pathways into academic medicine and a reflection activity for readers to consider when choosing a path that best aligns with their personal and professional interests.
In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is... more In this chapter, we’ll explore the value of diversity and inclusion in academic medicine. Data is presented demonstrating a current “sense of urgency” that underscores the challenges of diversifying its academic workforce. The chapter will end with a general overview describing the array of pathways into academic medicine and a reflection activity for readers to consider when choosing a path that best aligns with their personal and professional interests.
Reducing health care disparities among disenfranchised populations remains a major challenge in t... more Reducing health care disparities among disenfranchised populations remains a major challenge in the United States, and those affected are integral to better understanding causes and solutions. Community-based participatory research (CBPR) provides a process for obtaining input by partnering community members with academic researchers to jointly define issues needing study. The University of Washington (UW) School of Medicine Center for Equity, Diversity and Inclusion (CEDI) adopted and translated the principles/processes of CBPR to develop a new curriculum tool for medical educators—the community-based participatory curriculum development (CBPCD) tool - designed to partner community members with medical educators to jointly define issues to teach our future physician workforce. The critical elements are: (1) recognition that the community has important expertise; (2) partner community members with medical educators; (3) mutual sharing of knowledge, skills, resources and power; (4) p...
More than 15 years after two pivotal reports from the Institute of Medicine (now the National Aca... more More than 15 years after two pivotal reports from the Institute of Medicine (now the National Academy of Medicine) focused their attention on unequal access to healthcare and established health equity as a pillar of quality care, healthcare disparities persist. Some of this can be traced to overt discrimination against certain groups, but this chapter shines a light on a subtler form of prejudice: unconscious bias. The by-product of a normal—and often useful—human tendency to make associations and split-second judgements, unconscious bias, affects even people who believe strongly in equality and equal care. Left unaddressed, unconscious bias can influence relationships between providers and patients and among providers and their colleagues, affecting clinical interactions, workplace diversity, and even patient outcomes. Providers can mitigate unconscious biases by becoming more aware of them and resolving to overcome them through proven strategies for improving health equity and rev...
Introduction: Language concordance between patients and physicians is an important factor in prov... more Introduction: Language concordance between patients and physicians is an important factor in providing safe and effective health care, with Spanish as the predominant and fastest growing non-English language in the United Sates. However, despite increasing demand for medical Spanish education, valid concerns about inadvertently increasing provider use of limited Spanish with patients, lack of knowledge of best practice in education and assessment, and lack of institutional support still present barriers to medical Spanish education in medical schools. Methods: The authors conducted a narrative review of existing literature that evaluates the link between medical Spanish education of physicians and language concordance. Results: Medical Spanish educational efforts, although increasing, are not consistently linked to learner assessment. The literature to date supports that for medical Spanish education to improve patient outcomes, it should be linked to assessment methodology that demonstrates improvement in language concordance with Spanishspeaking patients, and should include safety measures to prevent inadvertent communication errors. The authors review data for published medical Spanish postcourse language assessment strategies and provide recommendations to ensure responsible and competent use of medical Spanish skills. Conclusion: The authors propose three structural elements that should be considered when incorporating or enhancing medical Spanish education in medical schools: institutional endorsement of the role of medical Spanish education within a national health disparities context; precourse proficiency testing to establish student starting level; and learner postcourse communications skills and limitations assessment to provide individualized recommendations and assure patient safety.
In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, me... more In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient-physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.
American journal of medical quality : the official journal of the American College of Medical Quality, 2017
Health care disparities have long existed for racial and ethnic minority populations who continue... more Health care disparities have long existed for racial and ethnic minority populations who continue to lag behind whites in several quality metrics, including quality of care, access to care, timeliness of care, and health outcomes. Effectively addressing these issues requires a health care workforce and leaders who represent the population they serve, and who are deeply committed to reducing health disparities by promoting equity, diversity, and inclusion. Women currently comprise half the population of the United States. Minority groups (any group other than non-Hispanic whites) make up approximately 40% of our population and are projected to comprise the majority of the population over the next 3 decades. 1 Patients report that they are more comfortable communicating with clinicians of the same sex, race/ethnicity, and social background. This enhanced comfort and trust may in turn result in improved health care quality, increased adherence to medical recommendations, and better patient experience of care. 2,3 Despite the imperative for diversity in high-performing teams and organizations, the academic health care pipeline remains more akin to a funnel because of attrition, especially for women and underrepresented minorities. 4,5 This attrition results in loss of diversity of thought and talent, so essential to the long-term success of academic health centers (AHCs). Diversity at the highest levels of leadership at AHCs contributes critical and innovative viewpoints and organizational-level changes that ensure excellent patient care, groundbreaking research, and serve as a model for health professions education. With the goal of identifying strategies to develop the next generation of diverse leaders, the University of California Davis (UC Davis) spearheaded the first University of California (UC) system-wide Health Sciences Leadership Development Conference, held in May 2016. This article summarizes best practices and themes from the conference.
The Journal of the American Board of Family Practice American Board of Family Practice, 1997
Background: Cervical pregnancy is a rare form of ectopic pregnancy that is associated with consid... more Background: Cervical pregnancy is a rare form of ectopic pregnancy that is associated with considerable maternal morbidity and a high mortality rate if early diagnosis and treatment are not carried out in a timely fashion. Alethods: The current medical literature was reviewed by searching MEDLINE files from 1985 to 1996, using the key words "ectopic pregnancy" and "cervical pregnancy." Older articles were accessed from cross-reference of the more recent publications. Results: The incidence of cervical pregnancy is 1 in 2400 deliveries and represents less than 1.0 percent of all ectopic pregnancies. No clear cause of cervical pregnancy has been described, and criteria for the clinical, pathologic, and sonographic diagnosis have been well established. The most common clinical complaint is painless vaginal bleeding. Routine transvaginal sonography early on allows for conservative management and avoids adverse outcomes. Methotrexate administered systemically and by intra-amniotic instillation are the therapeutic options of choice. Gestational age and the presence or absence of fetal cardiac activity are major prognostic factors for its success. Conclusion: Earlier diagnosis of cervical pregnancy using sonography and conservative management of this condition have reduced considerably the morbidity and mortality associated with this rare form of ectopic pregnancy and have helped preserve a woman's future fertility.
The Journal of the American Board of Family Practice / American Board of Family Practice
Internet has become an integral tool for modern physicians, and those not ready to embrace this n... more Internet has become an integral tool for modern physicians, and those not ready to embrace this new technology will be missing a valuable resource. This pilot study reviews rural physicians' usage patterns of the Internet as a medical resource and examines the barriers that might preclude rural providers from using this technology. We undertook a questionnaire survey of rural providers in Wyoming, Montana, and Idaho. Information was elicited about the physicians' Internet access, frequency of Internet use, the different Internet categories used, and the barriers they encountered to using the Internet. A background MEDLINE search was performed using the MeSH headings "Internet," "medical informatics," "and rural health." Eighty-five percent of providers had Internet access, and 75% of respondents reported using the Internet either daily or one to four times a week. E-mail was the most frequently used category. The next most frequent categories we...
From 1980 to 2010, the shortage of Latino physicians worsened despite the unique benefits that La... more From 1980 to 2010, the shortage of Latino physicians worsened despite the unique benefits that Latino physicians provide, especially in caring for the rapidly growing Latino patient population. The authors describe the expanding Latino population in the United States, discuss some health care issues specific to the Latino population, and briefly evaluate historical and ongoing issues to increase the Latino physician workforce. Developing the Latino physician workforce will require a multifaceted approach including, but not limited to, building the next generation of Latino medical school applicants and matriculants, cultivating more Latino residents, prioritizing Latino inclusion in the academic medicine workforce, expanding curricula and training on Latino health in both undergraduate and graduate medical education, rebuilding and reframing federally sponsored diversity initiatives, and fostering collaboration between Latino professional organizations and academic health centers.
Many inn0mtiz.e strategies ham been ahdoped OWT the p r s to imprm the recruitment and retention ... more Many inn0mtiz.e strategies ham been ahdoped OWT the p r s to imprm the recruitment and retention of physicians in the shortage areas of rural America. These strategies hazle met With mrying success. Postresldency education, or fillowship training, @ family physicians is y t another strategy that has been aheloped @ the same purpose. Most applicants ham been interested in obstetrical and rural health fillowship programs 11s a means jbr preparing@ rural practice. This paper descriies these programs (demographics, finding, applicant pool, curriculum) and reuiews their gr&ate outcomes (practice location after matriculation, clinical priuileges). Tmty-nine obstetrical and nine rural health fillowships are currently operational in the United States. Fellows who complete a rural health fellowship haue a higher tendency to bcate in rural settings. Almost all graduates from obstetrical nnd rural health programs attain general hospital priviIeses in family practice, including lawrisk obstetrics. A signijcant number ofgraduatesfrom both types of pgrams attain privileges in highrisk and operatiw obstetrics ILS mll. Fellowship training can p@ an integral role in the preparation of family physicians @ rural practice. M 'edical institutions that have been involved in the training of residents over the years have developed a number of different and innovative ,strategies to entice and prepare these trainees for rural practice These efforts have included rural practice rotations (both required and elective), rural training tracks (R'ITs) and rural satellite clinics
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Papers by David Acosta