Holistic Review and Admission Processes

A holistic review and admission process occurs when universities aim to assess the “whole” applicant inclusive of contextual factors that may inform their likelihood of program success [Reference Scott and Zerwic14]. Holistic review and admission processes have been proven effective in identifying the strengths and skills of URM applicants that may be overlooked in traditional review processes [Reference Scott and Zerwic14]. Specifically, holistic admission procedures weigh indicators of leadership abilities, persistence to achieving long-term goals, and community engagement that are outside of the traditional academic measures of success [Reference Scott and Zerwic14]. The ultimate desired outcomes of holistic reviews and admissions processes are to identify applicants who have the ability to succeed in the training program and who add to the diversity of backgrounds reflected in the student body. Research studies have shown that holistic admissions review practices increase the diversity of students without negatively impacting academic program success (i.e., graduate point averages and graduation rates) [Reference Zerwic, Scott, McCreary and Corte15]. However, the key to the successful implementation of holistic admissions is that members of the selection committee be fully committed to the process. Onboarding and continuing education activities among all faculty, staff, and students involved in the admissions process are instrumental in maintaining fidelity to the principles of holistic admissions [Reference Zerwic, Scott, McCreary and Corte15].

Cohort Admissions and Cluster Hiring

Promoting a sense of community by creating a cohort of URM students with similar backgrounds can be effective in reducing social isolation [Reference Davis, Reese and Griswold16]. One example of cohort admissions is the Posse Program [Reference Oguntoyinbo17]. In this program, the staff and mentors use non-traditional strategies to identify and train public high school students with strong leadership potential and send the students to college together as a “Posse.” The Posse Program has been shown to be successful in increasing the diversity and success of URM students that enter higher education [Reference Kosinski-Collins, Godsoe, Epstein, Nelson and Cheng18]. Further, research also suggests that such cohort approaches can contribute to interdependent and mutually supportive relationships [Reference Brandon, Collins-McNeil, Onsomu and Powell26] and reduce feelings of anxiety resulting from social isolation [Reference Ali, Kohun and Levy19]. Similar to cohort student admissions, cluster hiring of URM faculty is an initiative that seeks to increase the workforce diversity by hiring more than one URM faculty at the same time [Reference Ponjuan20]. Cluster faculty hiring could be in the same department, inter-departmental, or across schools. Cluster hiring can help to minimize feelings of social isolation among URM faculty while promoting collaboration, social support, and peer mentorship. In turn, a higher representation of URM faculty can help to reduce feelings of social isolation, provide role models, and can increase graduation rates of URM students in those same institutions [Reference Page, Castillo-Page and Wright21].

Inter-group Contact and Dialogue

In addition to increasing the representation of URM students in higher education (i.e., the quantity of URM students), it is also important to encourage engagement among URM and non-URM students to improve the quality of the experience in the training program. The contact hypothesis [Reference Allport22] suggests that increasing inter-group contact by reducing social distance and encouraging inter-group communication is beneficial in reducing social isolation and facilitating effective interactions across diverse groups [Reference Stathi, Crisp and Hogg23]. Inter-group dialogue is one approach for increasing knowledge, understanding, and social contact between students. Such dialogue seeks to facilitate collaboratively structured group conversation characterized by participants’ willingness to “listen for understanding.” This method has been employed frequently with student participants reporting increased self-reflection, awareness of self as a member of a social group, knowledge about structural group inequality, perspective-taking, and motivation and actions to bridge differences [Reference Thakral, Vasquez, Bottoms, Matthews, Hudson and Whitley24]. Additionally, Puchalska-Wasyl [Reference Puchalska25] found that inter-group contact reduced confrontational attitudes and made participants less inclined to gain an advantage over outgroup members, increased mutual openness to different viewpoints, and enhanced readiness to consider the arguments of others. By reducing social distance and encouraging inter-group contact, pipeline programs may be able to reduce social isolation experienced by URM students.

Highlighting the Contributions of URM Researchers

The contributions of URM researchers have expanded and enhanced our understanding of health disparities. URM researchers can bring about different perspectives concerning theory and practice, which effectively challenge existing views on health inequality. For example, Crooks et al., 2019 [Reference Crooks, King, Tluczek and Sales28] has developed a framework, grounded in the sexual experiences of Black girls and women, to inform Black female sexual development and STI/HIV risk. Research guided by this framework has helped to identify socio-cultural conditions including the lack of protection (i.e., trauma-related factors and absence of parents due to systemic factors) and stereotype messaging that contribute to disproportionate sexual health disparities in this population. Crooks’ framework also has relevance to the development of effective and culturally tailored programming and interventions.

Despite the recognized importance of diversity in the health sciences, there is a lack of literature that focuses on the contributions of URM scholars [Reference Hassouneh, Lutz and Beckett29] in reducing health inequalities. One study conducted by Bauer-Dantoin and Ritch [Reference Bauer-Dantoin and Ritch30] designed a class to examine the contributions of URM researchers in science. The course focused on the life histories of URM in science (i.e., Percy Julian) and the barriers they faced (i.e., racial discrimination and low SES). In addition, the class focused on the factors that helped URM in science overcome barriers to success [Reference Bauer-Dantoin and Ritch30]. Additionally, many URM researchers, often use qualitative methods including grounded theory, ethnography, community-based participatory research (CBPR) to elicit stories and experiences to better understand health disparities and participate in social justice [Reference Lyons, Bike, Ojeda, Johnson, Rosales and Flores31]. Highlighting the importance of CBPR activities to increase community involvement can help to underscore the importance of community-informed research conducted by URM faculty in improving community health and promoting social justice [Reference Holkup, Tripp-Reimer, Salois and Weinert32].

Expanded Theoretical Frameworks

Pipeline development programs in the health sciences should also seek to expand the training curriculum to focus on non-biological drivers of health inequalities. The extent to which individual behaviors are embedded in external context is now well documented in the social determinants of health literature [Reference Page-Reeves, Niforatos, Mishra, Regino, Gingrich and Bulten33], with the Social Determinants of Health Model [Reference Shokouh, Mohammad, Emamgholipour, Rashidian, Montazeri and Zaboli34] now a leading framework endorsed by the NIH. Additional theoretical frameworks have been developed to highlight the role of contextual factors such as structural violence and racism on health and health inequalities. For example, the minority stress theory emphasizes how external events such as discrimination can increase stress and negatively affect physical and mental health outcomes [Reference Meyer35]. Geronimus’s Weathering hypothesis relates to Black women experiencing racism-related stress across the life course and that racism-related stress can lead to preterm births and low birth weight [Reference Geronimus, Andersen and Bound36]. The Socioecological Model [Reference Bronfenbrenner37] incorporates multi-level social factors to guide health equity research. Critical race theory, which is grounded in social justice and race equity, encourages scholars to look beyond proximal factors of physical health and to consider housing, employment, and other social factors that affect health and well-being [Reference Ford and Airhihenbuwa38]. These theories can inform the type of research that URM students may be more interested in conducting and should be presented along with other established theoretical approaches.

Service Learning Experiences

Lastly, the inclusion of community-based service-learning (CBSL) CBSL opportunities is recommended along with other traditional forms of research training. CBSL training gives students the opportunity to learn applied research skills. A growing body of literature suggests that CBSL provides a means by which the community and students mutually benefit through an exchange of knowledge [Reference Hamner, Wilder and Byrd39]. CBSL is essential for practice-based disciplines such as public health, nursing, and medicine [Reference Hamner, Wilder and Byrd39] and can have a long-term impact on under-resourced communities. CBSL can also be a useful means to learn about the importance of research interventions in “real world” community contexts. Additionally, CBSL can help bridge the gap and support partnerships between communities and universities.

Social Closure Perspective

The issue with the “leaky pipeline” indicates URM scholars are less likely to enter into higher education academic careers, which then continues to be “leaky” at all stages of academic education, training, promotion, and leadership development. One of the frameworks explaining the causes of such leaky pipeline is the idea that the practices of already privileged groups promote maintaining their status and limiting opportunities for outsiders. This process of drawing boundaries and constructing identities around the social boundaries is called social closure. The main purpose of social closure is to control resources.

Concerning racial/ethnic inequality in higher education, social closure is a mechanism through which URM scholars are often excluded from resources and opportunities relations. Practices of closure could work in evaluation, resource distribution, and promotion. In particular, evaluation often works against URM scholars). While the academy is viewed as an institution of meritocracy, organizational decisions are influenced by implicit biases and stereotypes against minority scholars, which disadvantages URM in hiring and promotion. Social closure also limits access to resources and opportunities. This “opportunity hoarding” ensures the members of the privileged monopolizes resources and opportunities, while excluding the other. In the academy, URMs often experience limited access to resources, know-hows, and social networks that are critical to successful socialization and promotion due to implicit and explicit practices of social closure.

These discriminatory practices become institutionalized, in part because organizational leadership often lacks minority representation, thus privileged preferences and stereotypes are reflected in URM evaluation, resource distribution, and social relations including mentorship and training opportunities. At the same time, because social closure prevents URMs from leadership roles, such practices are not challenged.

Detracking

Detracking in education is an argument against the practice of grouping students based on their academic ability levels, instead, detracking aims to create mixed classes with students of different abilities. In the tracking system, teacher’s expectations often differ for high track and low-track students. Furthermore, more resources are directed to high-track classes, while low-track classes tend to be low-income disadvantaged students in the first place, resulting in wider gaps between high and low performing students. Such a segregationist model of education may not reflect how students learn and interact with others. Detracking also challenges how people think about intelligence and stereotypes about race.