The first general issue raised by interviewees was the meaning and relative utility of the “pipeline” metaphor as a starting point for discussion. Examples of interviewee
comments in this regard include:
“There are a bunch of pipes, but no pipeline. There are a large number of different programs aimed at increasing the number of UR students who may someday become a health professional, but they lack coordination.” “The pipeline isn’t actually a pipeline, but more like a funnel that is meant to weed people out rather than get people through.”
“The pipeline has ‘clogs’ in it at certain key points. The goal is to
determine where the flow is getting clogged up, figure out why the clog is occurring, and resolve the problem so that the people will “flow” in greater numbers.”
A few interviewees questioned the utility of the metaphor, which suggests there is a prescribed route that carries one from whatever background they have to a final
‘collection point’ of matriculation into a HPEI. One respondent suggested that the use of a “river” metaphor might be more appropriate, reflecting a flow that can be diverted, redirected, pooled, drained, infused, etc.:
“…we’ve been talking about this for the last three decades and in medicine, the idea was to get to 3,000 historically underrepresented minorities by the year 2000. Didn't even get close. And that was with a lot of very well intentioned people. There’s a wonderful book out called “The Shape of the River,” which is much more accurate in the sense there’s so many obstacles or potential obstacles to derail a young person who might succeed and end up in a professional school like medicine, dentistry, pharmacy, nursing. And you really have to be there at the time of the obstacle to help with that. And it means the coaches, after school, parenting and especially we’re a port of entry here so we’ve got a very dynamic population. If we could change the numbers from one to two percent to ten percent, just that much, it would be remarkable.”
27 There are numerous pipeline programs documented in the CTD report ”Profiles in Leadership: A review of Exemplary Practices to Increase Health Professions Workforce Diversity in California.”
A key determinant of whether HPEIs invest in expanding the pipeline is whether senior leaders view it as within their purview. While all acknowledged it as a problem, some viewed it as a larger societal challenge to be addressed by others. For many, however, it is viewed as a shared responsibility in which HPEIs can play an important role. As stated by one chancellor:
“I became convinced that I have to do something actively as a leader. You can't just hope something happens, you have to make some inroads from actually working hard to try to bring under-represented minorities into the system, so that's led to a whole myriad of different operations.”
An HPEI dean also spoke to the importance of leadership from HPEIs in opening up doors to efforts that may already be ongoing in the community in this way:
“I'm very interested in looking at why pipeline efforts have failed because I would like to see - and one of my guesses is that you can have the pipeline working very well in the community but if the doors aren’t open on the - at the institutional level, you know, that pipeline’s going to run up against a wall there.”
Another general theme that emerged in interviews was the importance of collaboration in pipeline efforts. In order to try to influence the factors that will affect whether or not UR students can successfully navigate through to be able to seek training at HPEIs, our interviewees noted that there is a need for far greater joint planning among a range of actors including programs at different educational levels and health organizations. Some collaborative arrangements are vertical within regions, linking schools and students at all levels:
“…we have a vision, and we try to get funding for it, and we work with partners in our local area to create a sequential path of support from the intermediate school, high school, undergraduate, and graduate school, and having exposure, experience, mentoring, academic support, psycho-social support, along the way…The vision of people at involved is to link them so that there is continuity of support from one level [to the next].”
Other HPEI pipeline collaborations can be horizontal--across similar schools from the same health profession. One dental school dean involved in the Dental Pipeline Initiative talked about it this way:
“I think that the trust that has developed, particularly in admissions [among different schools], to say that we’re not stealing students, we’re really are working together to nurture this individual. And we count success as an individual who enrolls in dental school. They may not come to xxx and they may not come to yyy, but if we have had any work with that individual, we count that as success if they end up in a dental school.”
Some interviewees also identified the need to improve collaboration and coordination within their own campuses:
“These are the five colleges here on campus, and twenty-three of our departments are represented on this [pipeline] effort because frankly they all exactly [are working on] the same issues at hand--a lack of diversity in the student body, a lack of diversity in the faculty, a lack of ability to retain students after their first year or two in any of those disciplines, as well as placing those students after they leave here. … So we're trying to really bring everybody to the table, discuss what we have that works, discuss what our limitations and the real challenges are, and try to really overcome them in a coordinated fashion so that frankly the left hand knows what the right hand is doing.”
One interviewee spoke to the role of foundations, and the need to make funding decisions in a way that fosters collaboration:
“I would say that they [foundations] need to have a holistic program, and it does need to include middle school, high school, community college, the CSUs, the UCs, the medical schools. And there really needs to be a
partnership, not a ‘I'm greater than you so I get a bigger piece of the money, and then what's leftover y'all go over there and do that when all we really want from you is your numbers’; no one wants to work in that kind of atmosphere.”
In addition to working across organizations, one general challenge raised by interviewees was the lack of student tracking in pipeline efforts. As stated succinctly by one
interviewee:
“…we'd like to have a way to follow people, you know, across the levels, and if they fall off to be able help them and bring them back. We don't really have the funding and the infrastructure to kind of make that happen.”
Some interviewees cited tracking as a way to sustain faculty interest in pipeline efforts: “…the other study that we’re proposing is taking all students who
matriculated to [different] campuses and tracking their progress and, you know, how did they do. Again, we’re trying to drive data back to faculty to say you know what, these students do just as well, or we’ll find out that they don’t, in which case we can feed that back and maybe there is
something in how they’re being taught.”
Finally, a few of our interviewees noted that some of the primary beneficiaries of pipeline efforts are current HPEI students. One interviewee cited the cultural competency
“We have two hundred students in the thing, and many medical students, that are spending a couple of hours a week tutoring kids in the
neighborhood. But it’s doing two things: the students, our students of course, think that they’re helping these young people succeed in school, and I think that it is providing role modeling assistance that I think is very powerful. That is happening. But equally important, in my view is it's also making my students comfortable working cross-culturally and working cross-economically. That's incredibly important because then as they go out as professionals, then they're going to be willing to have those kinds of people in their practice, because they’ll feel comfortable with them.”
Another interviewee noted that participation in pipeline activities has contributed to the development of a broader, public health worldview among medical students:
“The most significant contribution of (Program A) is that it has focused the medical school into an area that is critically important in California, and up to now was really not being on the radar screen at all. For instance, we had a group of students wanting to take medical Spanish courses and (that led to) ... a group of students and faculty, saying, “Wait a second, we have other important issues to address [beyond medical care] and if you want to move Healthy People 2010 [forward], you can not leave behind 35 percent of the population.”