III. Mission Statement
The Texas A&M University System Health Science Center is committed to preparing a health workforce to meet the needs of Texas. Graduates of Health Science Center programs should possess the competencies vital to understanding the health care needs of the increasingly diverse population of Texas, and they should be qualified and prepared to design, and staff, programs to meet those needs. In support of this mission, the Health Science Center utilizes Goals supporting the Mission Statement. (Appendix I)
The Goal is supported with eight objectives or strategies.
It is the intent of the Health Science Center to establish and implement the objectives and strategies within the parameters of federal and state law.
This goal and supporting objectives are based upon the following findings.
A. Diversity enhances the educational environment.
The benefits occurring to students in class environments which are ethnically and racially diverse have been articulated and summarized by Dr. Patricia Gurin in her expert testimony in the Grutter case. Dr. Gurin's testimony includes an extensive bibliography of the most pertinent and relevant findings which support the conclusion that diversity of a student body results in recognizable and substantial benefits. Such benefits include informed and lively discussion which is critical to mastery of content in formal course presentations. Complete discussion and comprehension of the different approaches to health and disease by ethnically diverse populations is critical to understanding their health care needs. Diversity serves to break down ethnic and racial stereotypes which is important to understanding both patients and the disease process. Participation of students from racial and ethnically diverse backgrounds in the educational process is of prime importance in ensuring that every student, minority or non-minority, receives the maximum benefit of class presentations. HSC learning environments include not only standard classroom lectures, to an entire class, but also small group study sessions and small group clinical teams. The presence of ethnically and racially diverse students becomes even more important when the entire class is divided into much smaller sections, often containing not more than four or five students. If the number of racial and ethnically diverse students in a class is small, there are few or no minorities in many of the small discussion groups or clinical teams. The result is that students are denied the benefits of the viewpoint, experiences, and personal dynamics of a diverse group of fellow students (Note: the accrediting agencies for HSC programs, the Liaison Committee on Medical Education, (LCME) and the Council on Dental Accreditation (CODA) mandate small group discussions as an essential element of accreditation. The Association of Schools of Public Health strongly encourage small discussion groups and field based experience in their guidelines for curriculum).
Recognizing the importance of cultural competence to practice in the health professions, the American Medical Association published a Cultural Competence Compendium, in 1999. This work stresses the importance of the cultural milieu and special needs of patients as women, men, children, seniors, African Americans, Hispanics, Asians, Whites, people with disabilities, and those facing chronic illness, and socioeconomic constraints.
Increasing racial and ethnic diversity of HSC classes will improve the educational environment.
B. Cultural competence prepares graduates to address society's problems.
Cultural competence is the ability to understand, and to make decisions based on, ethnic, racial, and cultural differences in risk factors, in presentation of symptoms, patient understanding of instruction and in patient compliance. (Cohen and Goode; 1999) Cultural competence is obtained from personal experience and interaction and cannot be obtained solely from textbooks or other traditional didactic sources. Cultural competence will prepare graduates of the Medical and Dental curricula to meet the needs of a diverse patient base. Cultural competence is equally important for students in the Public Health and Graduate School of Biomedical Sciences programs. Public health focuses on populations. The recommendations of public health officials depend critically on an understanding of the public's attitude toward and understanding of the problem, and their willingness to participate in its solutions. Classroom discussions of various public health problems benefit significantly from participation of students who can express the views of various ethnic constituencies of a population, including their roles in and attitudes toward public health matters. Students in the graduate programs ultimately gravitate to careers in health related research. Research in Texas into health disparities has been neglected for sometime and significant disparities persist. The existence of an ethnically diverse student body participating in the many formal and informal exchanges among students and between students and faculty is likely to result in increased numbers of graduate students electing to choose careers in research in health disparities or in diseases which evidence a higher prevalence among minority populations. (Cohen; 2003)
Increasing racial and ethnic diversity of HSC classes will promote attainment of cultural competence by all students.
C. Health disparities between minority and non-minority populations exist in Texas.
That disease prevalence, access to care, and clinical outcomes differ significantly among racial and ethnic groups is not debatable. Increasing the diversity of health professions classes as a strategy to address health disparities in the increasingly diverse population in the U.S. was suggested as early as 1910 in the "Flexner Report on Medical Education in the United States and Canada." Neighborhoods composed predominately of ethnic minorities experience shortages in physicians, and are confronted with reduced access to care when compared to non-minority neighborhoods. Increasing the supply of minority physicians is one means to help ameliorate these disparities. HSC President Dr. Nancy W. Dickey, former president of the American Medical Association, has discussed some of the factors underlying the existence of health disparities. (Dickey; 2003) In minority populations poverty, vestiges of past unequal treatment, distrust of non-minority providers, and failure to master cultural competence on the part of providers are all contributing factors. (Kingston, Tisnado and Carlisle; 2001) Failure to seek prenatal or preventive care, or to comply with medical direction due to mistrust or misunderstanding, coupled with poor understanding of public and personal health information, contribute to a societal financial burden of significant proportions. Because of lack of providers in whom minority patients have confidence, care is often delayed until a visit to the emergency room (the most expensive form of treatment) is the only remaining option. And, lacking health insurance, the cost of emergency room treatment is often transferred to state and local government.
Increasing the racial and ethnic composition of HSC programs will contribute to the elimination of health disparities in minority and non-minority populations.
D. Practice type and location is influenced by the race and ethnicity of graduates.
A social contract exists between the public and Health Related Institutions supported with public funds. The public, through government resources, provides funding for the institution and, in turn, rightfully expects the institution to confront the health related problems of society. Among the causes of health disparities, discussed in "C" above, are shortages of not only minority providers, but also non-minority providers in minority dense populations, urban inner cities, and rural areas. There is a strong correlation between minority population concentrations and designation as a medically underserved area. (Komoramy; 1996) Medical and dental schools have sought to address the shortage of providers in medically underserved areas by attempting to select students who have a high probability of ultimately selecting a location for practice in those areas. One of the best predictors of practice location is hometown origin or hometown origin of spouse. The evidence is equally strong for the influence of race and ethnicity on selection of practice location. (Thurmond; 1999) Statistics demonstrate that racial and ethnic minority healthcare professionals select practice locations in minority, rural, and/or urban inner-city areas in a percentage greater than their non-minority counterparts. Dr. Eric Solomon, HSC Baylor College of Dentistry, has shown that this is equally true for dentists as for physicians by providing evidence of the relationship between race and ethnicity of the provider and the provider's choice of practice location in Texas. (Solomon; 2001) Additionally, research shows that minority patients tend to select minority healthcare providers in a percentage higher than their selection of non-minority providers. Evidence suggests that patient satisfaction is enhanced when there is a concordant relationship between the patient and the provider than when there is a non-concordant relationship between the patient and provider. (Saha; 1999)
Use of race and ethnicity in admission to HSC programs is intended to address the shortage of providers in medically underserved areas by graduation of health professionals who will choose to practice in medically underserved, minority-dense population areas.