A Conceptual Framework for Exploring the Experiences of Underrepresented Racial Minorities in Pharmacy School

Antonio A. Bush, PhD

Disclosures

Am J Pharm Educ. 2020;84(1):7544 

In This Article

Abstract and Introduction

Abstract

Objective: To explore the social and academic experiences of students identifying as underrepresented racial minorities (URMs) in a pharmacy school, how they made meaning of their experiences, and the strategic actions they took to navigate towards degree completion.

Methods: Twenty students from a school of pharmacy within a research-intensive institution participated in semi-structured interviews. Data were analyzed through several rounds of coding. Trustworthiness procedures included the use of multiple coders, a dependability audit, and analytic memos to promote reflexivity.

Results: The study yields a conceptual model. Pre-pharmacy school factors such as pipeline programs, work experiences, family, and URM health professionals impacted students' interest in and encouragement to attend pharmacy school. Students reported experiences including a lack of diversity, feeling unwelcomed, and concerns about cultural competency and group work challenges. Students were motivated by URM faculty members, self-efficacy, and a sense of purpose. Students were inhibited by the mental impact of sociopolitical events, the pressures of representing their race/ethnicity, and feeling inferior. Students took several actions to navigate the school including "code-switching," finding solace and support with other URMs, seeking cultural competence-related experiences to complement the curriculum, and strategically remaining silent or speaking up during group work conflicts.

Conclusion: This exploratory study provides a roadmap to better understand URM students' journey to pharmacy school and experiences therein. Findings could be used by pharmacy schools to create a more inclusive environment for URM students and provide future directions for scholars pursing diversity-related research agendas in health professions education.

Introduction

If we are determined to reduce existing healthcare disparities among racial, ethnic, and socioeconomic groups, then we must be determined to diversify the healthcare workforce. Racial and ethnic diversity among healthcare providers is fundamental to academic institutional advancement, the preparation of health science professionals, and the provision of safe and effective patient care.[1] While there has been progress towards increased racial and ethnic diversity more work is needed. For example, as shown in Table 1, the racial/ethnic makeup of most healthcare diagnosis and treating occupations such as pharmacists, physicians, nurses, and dentists remain primarily White while healthcare support roles such as dental assistants, medical assistants, and personal care aides are more diverse.[2] Racial and ethnic diversity must be improved on all levels of the healthcare workforce, not only in support roles, to decrease disparities and enhance patient care.

Compounding this concern is that the United States is projected to become increasingly diverse in the coming decades. This has led to calls from various healthcare professions, including pharmacy, to examine the diversity of the workforce and educational preparation of future practitioners.[3–9] Most notably, the American Association of Colleges of Pharmacy's (AACP) Argus Commission explored the following question: How can we more effectively address and serve the diversity in our membership at both the institutional and individual level and prepare our learners to serve an increasingly diverse population of consumers?[6] Their special report, Diversity and Inclusion in Pharmacy Education, explored diversity and inclusion from five key perspectives: diversity in the society, application pipeline, current students, pharmacy faculty, and the AACP and the organization's member institutions.[6] The special report concluded that more work must be done to demonstrate the profession's commitment to diversity.[6]

There have been several aligning calls to action in addition to the 2013–2014 Argus Commission Report.[1,9] For example, an editorial written by Hayes provides compelling data reporting the rapid racial and ethnic diversification of the United States, accentuates the lack of minorities in healthcare, and suggests that though progress has been made, there remain opportunities to increase the recruitment and graduation rates for underrepresented minorities in pharmacy.[9] Hayes's piece concludes with a call to action: "The pharmacy academy must take ownership of the [underrepresented minority] issue and lead the transformation of the pharmacy workforce."[9]

A limitation to progress in diversifying pharmacy is that existing pharmacy literature on diversity consists primarily of reports and editorials. A 2017 study reviewing contemporary diversity-related literature in pharmacy revealed the scarcity of educational research in this area.[10] With only 12 research articles meeting the inclusion criteria (eg, quantitative and/or qualitative data were collected and analyzed; focused exclusively within the field of pharmacy; published between 1990 and 2016), the study provided great insight into why manuscripts examining diversity in pharmacy education often rely on other fields such as medicine and nursing for perspectives, thereby amplifying the apparent need to increase research concerning the experiences of diverse individuals within pharmacy. Overall, this research highlighted the need to continue exploring this important topic as there are too few empirical studies to form clear, actionable trends. While there has been some progress on studying diversity in pharmacy, overall scholarship in this area frequently relies on other health professions to better understand historically marginalized populations, despite a lack of scholarship in other fields as well. In fact, while there is more scholarship devoted to understanding historically marginalized groups such as racial minorities in other health professions,[11–15] much of this dialogue has consisted of seminal reviews, commentaries, and reports.[2,3,16–25]

The limited research articles published tend to emphasize quantifiable measures of diversity and inclusion and impacts of admissions processes on minority candidates. There is a significant gap, however, in areas of qualitative study. For example, one valuable step towards improving the sense of belonging for students self-identifying as underrepresented racial minorities (URMs) (ie, Alaska Natives, Native Americans, Black or African Americans, Hispanics, Native Hawaiians and other Pacific Islanders) in pharmacy is to understand the lived experiences of those currently pursuing education to become pharmacists.

By studying the current landscape of pharmacy and health professions education as experienced by underrepresented populations, we can gain important insight into how we can develop intentional practices and policies needed to better recruit and retain students self-identifying as URMs and enhance their experiences. This could positively impact the diversity of the healthcare workforce, enhance patient care, and decrease health disparities. Accordingly, this work explores the social and academic experiences of students self-identifying as URMs in pharmacy at a predominantly and historically White institution, how they made meaning of their experiences, and the strategic actions they took to navigate towards degree completion.[26–28] This study was informed by three theoretical perspectives including an anti-deficit approach, graduate and professional student socialization framework, and agency theory.

The first theoretical perspective guiding this work is the anti-deficit approach. When examining the scarcity of minority students in higher education and acknowledging the achievement gaps that exist, scholars have mostly presented their research by "amplify[ing] minority student failure and deficits instead of achievement."[28] Conversely, an anti-deficit perspective explores the lived experiences of students self-identifying as URMs in a more encouraging perspective by highlighting their successes despite challenging experiences they may encounter.[28] In this work the anti-deficit framework reverses questions that have generally been used to examine the deficiencies of higher education experiences of students self-identifying as URMs and the outcomes thereof and presents them in a more positive approach. For example, as opposed to asking why there are so few URM students in health professions, the anti-deficit focus of this study seeks to explore how URM students are successfully navigating health professions schools towards degree completion.

The next theoretical perspective framing this study is graduate and professional student socialization. Socialization is the process by which individuals "gain the knowledge, skills, and values necessary for successful entry into a professional career requiring an advanced level of specialized knowledge and skills."[27] The socialization framework suggests that students first enter professional school with a particular set of experiences and a perception of what is required to be successful. Students are then socialized through a variety of experiences.[27] Upon earning a degree, students should have gained the necessary skills valued within a given field through interaction with a variety of elements.[27] In this study, Weidman and colleagues' graduate and professional student socialization framework was specifically employed to understand the components influencing the experiences of URM students seeking pharmacy degrees, including their interactions with the professional communities (eg, practitioners and associations), personal communities (eg, family, friends, and employers), and the university (eg, institutional culture, academic program, peer and faculty interactions).[27]

The final theoretical perspective is agency. Agency is defined as "taking strategic and intentional views and actions toward goals that matter to oneself…[which] include perspectives or actions."[26] O'Meara and colleagues found that agency can be influenced on three levels: individual, organizational, and field and society. Individuals take these influences into consideration to make meaning of their experiences and take action to achieve a goal.[27] While research by O'Meara and colleagues focused primarily on faculty agency, their research has been previously employed to explore the strategic actions of URM doctoral students by incorporating the influences from Weidman and colleagues' graduate and professional socialization framework and the anti-deficit perspective.[26–29]

This study explored four central components: predispositions, experiences, perspectives, and actions. Predispositions (eg, identity and pre-pharmacy school experiences) included students' racial backgrounds and experiences prior to pharmacy school enrollment. Pharmacy school experiences included students' descriptions of their lived experiences of the phenomena under study, including their engagement on the university level and the pharmacy school level, as well as their engagement with peers, faculty members, and the curriculum.[27] Perspectives included the internal dialogue (ie, self-talk, self-reflection, inner conversations) occurring upon having those experiences.[26] Finally, actions included the behaviors students exhibited to navigate the experiences toward degree completion.[26] Together, these elements provide a comprehensive view of how URM pharmacy students make meaning of their experiences and provide critical insights into the actions taken to gain the skills, knowledge, and values needed to advance towards degree completion.

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