key: cord-0709372-bs2p0tr4 authors: Batra, Sonal; Orban, Julie; Zhang, Hexuan; Guterbock, Thomas M.; Butler, Leigh Anne; Bogucki, Colleen; Chen, Candice title: Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US date: 2022-05-09 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2022.10900 sha: 88da33477f65794f0fe9090783d56a5efab80a3a doc_id: 709372 cord_uid: bs2p0tr4 IMPORTANCE: The COVID-19 pandemic and calls for racial justice have highlighted the need for schools to promote social mission. Measuring social mission engagement and performance in health professions education may encourage institutional efforts to advance health equity and social justice commitments. OBJECTIVE: To describe the current state of social mission commitment within dental, medical, and nursing schools in the US and to examine how social mission performance compares across school types. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study invited all US dental and medical schools and a subset of baccalaureate- and master’s degree–conferring nursing schools to participate in a self-assessment to measure their school’s social mission commitment from January 29 through October 9, 2019. The survey measured 79 indicators (with indicators defined as responses to specific scored questions that indicated the state or level of social mission commitment) across 18 areas in 6 domains of school functioning (educational program, community engagement, governance, diversity and inclusion, institutional culture and climate, and research) that have potential to enhance social mission engagement and performance. Individual health professions schools were the unit of analysis, and 689 dental, medical, and nursing schools were invited to participate. School deans and program directors were the primary target respondents because of their broad insight into their school’s programs and policies and their ability to request data from various internal sources. Demographic information from respondents was not collected because multiple respondents from an institution could complete different sections of the survey. MAIN OUTCOMES AND MEASURES: Survey responses were analyzed to create indicator scores, standardized area scores, and an overall social mission score for each school. Using descriptive analyses, frequency and contingency tables of specific indicators within each area were created, and schools were compared based on ownership status (private or public), Carnegie Classification of Institutions of Higher Education research classification group (doctoral university with very high research activity [R1], doctoral university with high [R2] or moderate [R3] research activity, baccalaureate or master’s nursing college or university, or special focus institution), and discipline group (dental school, medical school granting doctor of osteopathic medicine [DO] degrees, medical school granting doctor of medicine [MD] degrees, nursing school granting baccalaureate-level degrees, or nursing school granting master’s-level degrees). RESULTS: Among 689 invited schools, 242 schools (35.1%) completed the self-assessment survey. Of those, 133 (55.0%) were nursing schools, 83 (34.3%) were medical schools, and 26 (10.7%) were dental schools. Response rates ranged from 133 of 420 invited nursing schools (31.7%) to 83 of 203 invited medical schools (40.9%). Most schools included social determinants of health in their curriculum in either required courses (233 of 242 schools [96.3%]) or elective courses (4 of 242 schools [1.7%]), but only 116 of 235 schools (49.4%) integrated social determinants of health across all years of study. Most schools also included health disparities in either their required courses (232 of 242 [95.9%]) or elective courses (6 of 242 [2.5%]); however, only 118 of 235 schools (50.2%) integrated health disparities across all years of study. In several areas of social mission, public schools performed better than private schools (eg, curriculum: mean [SE] standardized area score, 0.13 [0.07] points vs −0.14 [0.09] points, respectively), and R1 doctoral universities and special focus institutions performed better than R2 and R3 doctoral universities and baccalaureate and master’s nursing colleges and universities (eg, extracurricular activities: mean [SE] standardized area score, 0.25 [0.09] points for R1 doctoral universities and 0.20 [0.12] points for special focus institutions vs −0.05 [0.12] points for R2 and R3 doctoral universities and – 0.30 [0.12] points for baccalaureate and master’s nursing colleges and universities. Different areas of strength emerged for dental, medical, and nursing schools. For example, in the curriculum area, MD-granting medical schools had a mean (SE) standardized area score of 0.38 (0.08) points, which was significantly higher than the standardized area scores of dental schools (mean [SE], −0.21 [0.14] points), DO-granting medical schools (mean [SE], −0.22 [0.13] points), graduate nursing schools (mean [SE], −0.21 [0.19] points), and undergraduate nursing schools (mean [SE], −0.05 [0.10] points). CONCLUSIONS AND RELEVANCE: In this study, there was widespread interest from health professions educational leaders in understanding and enhancing social mission commitment. Future work may focus on identifying and promoting best practices using the framework described, providing schools with continued opportunities for self-assessment, and further validating the self-assessment survey. Thank you for participating in the self-assessment process by filling out this questionnaire about your school. This questionnaire aims to assess the social mission of your school, defined as the contribution of the school in its mission, programs, and the performance of its graduates, faculty and leadership to addressing the health disparities of the society in which it exists. The Social Mission Self-Assessment aims to measure the social mission engagement of a health professions school, track it over time, and compare it to national norms. The questionnaire is based on pre-existing tools to assess aspects of social mission, literature review, and expert opinion. It was created with the guidance of a national multidisciplinary Advisory Committee. It has been field tested at 65 dental, medical, and nursing schools and revised based on this fielding process. All dental and medical school deans in the United States are invited to participate in the selfassessment process. Given the large number of nursing schools in the U.S., compared to the other disciplines, a randomly selected sample of 400 nursing school deans will also get this invitation. Nursing schools that were not randomly selected to receive an invitation to participate may elect to participate by contacting the study team. The research team will provide a confidential summary report to the primary respondent at the school. This will include a summary of the responses of your school compared to aggregated data of all participating schools within your discipline. The summary report may be used to further engage in self-analysis and reflection of their baseline performance to establish performance-improving changes. Your responses will only be shared with the study team. You will NOT receive any information on the responses of other schools, and no other schools will receive information on the responses of your school. No information on a particular school's standing will be shared or published without explicit consent from that school. We've sent this survey to you as someone who has insight into your school's programs and is in a position to request data from various internal sources. We don't expect that you'll have all the answers at your fingertips, so we encourage you to look at databases at your institution and to consult with people in other departments or units who might have some of the information requested. You may delegate a primary respondent other than yourself to take responsibility for aggregating the required information. In field tests of the survey, the following departments were typically consulted by the primary participant: Please select the answer choice "Don't Know/Information Not Available" or leave the question blank if the "Don't Know" option is not there. Participation is voluntary and for your own self-reflection, so we encourage schools to answer all questions if possible. If there is any requested information that you or your school does not wish to share, please leave the item blank or note that you decline to answer that item. If you are willing, we would be interested in understanding why you may not be interested in sharing the information as it will assist us in better refining the questionnaire. Your participation will help examine 1) the status of your school's social mission activities; 2) current strengths and areas for improvement in these activities; and 3) your school's proficiency in social mission in comparison to similar schools. In addition to the confidential summary report, the data from the self-assessment will enable the research team to further develop performance measures in the field of social mission. This project is funded by a research grant from the Robert Wood Johnson Foundation. Please About how many of your students participate in these experiences? 1 All or nearly all (91% or more) 2 Most (51-90%) 3 Some (10-50%) 4 Just a few (less than 10%) 9 Don't know What is the average duration of the experience? 1 < 2 weeks 2 2-4 weeks 3 > 4 weeks Definition: Community of commitment is the term we are using to indicate a medically or socially underserved communitythis could be an underserved geographic area (local or regional), demographic group, or category of patient that your school has explicitly targeted as a focus for your work. IF YES: Does your school's mission statement specifically mention any of the following terms (select all that apply): ❑ Social determinants of health ❑ Underserved/underrepresented/disadvantaged populations ❑ Health equity or health disparities IF YES: Does your school's mission statement identify a specific "community of commitment" as defined above? If you're not sure, please send us your mission statement or give us the Web address (URL) where we can locate it and we will attempt to make a determination. 1 Yes 2 No 9 Don't know URL: IF YES: Please specify your school's community or communities of commitment: IF YES: Does your school's strategic plan specifically mention any of the following terms (select all that apply): ❑ Social determinants of health ❑ Underserved/underrepresented/disadvantaged populations ❑ Health equity or health disparities IF YES: Does your strategic plan identify a specific "community of commitment" as defined above? If you're not sure, please send us your strategic plan and we will attempt to make a determination. Definition: A Community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. 4 1 Yes, as a matter of written policy 2 Yes, as a matter of informal practice 3 No 9 Don't know Total number of students: ______ This rate represents the percentage of students who graduated within _____ years. Percent of students: _____% ❑ Information not available Percent of students who were first-generation college students: _____% ❑ Information not available Considering only first-generation college students in your primary degree program, what is their average graduation rate? Note: This rate should be calculated over the same time period as the questions above. Graduation rate for first-generation college students: _____% ❑ Information not available H8. Please consider all the scholarship and grant dollars awarded by your school in the last academic year. What percentage of the scholarship and grant dollars were awarded based on financial need? (Do not count student loans or student wages.) Since definitions and abbreviations are evolving, we may have omitted some letters from the LGBTQ abbreviation. Please apply your schools practice to the next section as you feel appropriate. H9. Does your school collect information from each student on his or her self-reported sexual orientation and/or preferred gender identity? 1 Yes 2 No IF YES: What percentage of students in your primary degree program self-identify as LGBTQ? Percent of students identifying as LGBTQ: _____% ❑ Information not available The following questions ask about the composition of your faculty. Please include all full-time faculty members in your school, regardless of rank or tenure status. Faculty members on joint appointments with other schools should be included if the appointment in your school is considered to be their primary appointment. Adjunct faculty should be included if their work commitment to the school is considered to be full-time. Other than one-time contacts with students, what is the number of K-12 students who participate in your pipeline programs each year? Other than one-time contacts with students, what is the number of undergraduate students who participate in your pipeline programs each year? Approximately what percentage of the participating students are from underrepresented racial/ethnic minority groups? Approximately what percentage of the participating students are the first in their family to go to college? Approximately what percentage of the participating students ultimately enter education for one of the health professions? (Note: Do not include students enrolled in prematriculation who have already been admitted to a health professions school.) Percent of participating students who enter health profession education: _____% eFigure 3. Standardized Area Scores by Health Professions Discipline From the Social Mission Metrics National Self-Assessment for Areas 13 to 18, 2019 a,b a (1)(2)(3)(4)(5) number indicate the five health profession groups. Numbers above the x axis indicate the groups whose means are significantly LOWER than this group's mean, based on pairwise t-tests with a finite population correction and Fisher's LSD correction. For example, in Area 15 (Student Activism), group 2 (DO medical schools) and group 3 (MD medical schools) scores significantly higher than each of the three other groups. b There were 26 dental schools, 25 DO Medical schools, 58 MD Medical schools, 31 graduate nursing schools, and 102 undergraduate nursing schools included in the analysis. (1)(2)(3)(4)(5) number indicate the four Carnegie classification groups. Numbers in parentheses above the x axis indicate the groups whose means are significantly LOWER than this group's mean, based on pairwise t-tests with a finite population correction and Fisher's LSD correction. For example, in Area 15 (Student Activism), groups 1 (R1 Doctoral), and 4 (Special Focus) score significantly higher than groups 2 (R2 &R3 Doctoral), and 3 (Masters and Baccalaureate). Community Engagement in Research: Frameworks for Education and Peer Review Health equity National Institutes of Health website World Health Organization website L2. How many of your current students have taken any of the following types of training? N1. Other than time given to student-run health clinics, about how many of your students are actively involved in community-based programs or organizations that address health disparities or social determinants of health? 1 All or nearly all (91% or more) 2 Most (51-90%) 3 Some (10-50%) 4 Just a few (less than 10%) 5 None 9 Don't know N2. Does your school provide any regular financial support for community-oriented student activities outside of the curriculum (not including student-run health clinics)? 1 Yes 2 No 9 Don't know N3. Consider your students who are from under-represented groups in the health professions. About how many of these students are active in minority professional associations and societies? 1 All or nearly all (91% or more) 2 Most (51-90%) 3 Some (10-50%) 4 Just a few (less than 10%) 5 None 9 Don't know P. Faculty activism P1. Other than time given to student-run health clinics, about how many of your faculty are actively involved in community-based programs or organizations that address health or issues related to health? 1 All or nearly all (91% or more) 2 Most (51-90%) 3 Some (10-50%) 4 Just a few (less than 10%) 5 None 9 Don't know P2. About how many of your faculty members are actively involved in advocating for change in issues related to health or its social determinants? (Include regional, state, national or international advocacy organizations.) 1 All or nearly all (91% or more) 2 Most (51-90%) 3 Some (10-50%) 4 Just a few (less than 10%) 5 None 9 Don't know P3. Does your school recognize or reward faculty participation in the activities in P1 or P2? e. Health or research needs assessment in your school's local community or communities of commitmentR2. Approximately what percentage of your school's total research portfolio is focused on research in all of the above categories combined (community engaged research, health equity/disparity research, health promotion/disease prevention research, social determinants of health, community health needs assessment) 1 0-10% 2 11-25% 3 26-50% 4 > 50% THANK YOU for sharing so much information about your school's programs and efforts to advance the social mission in health professions education. Your responses are invaluable to our research and our efforts to advance these areas in the education of our nation's health professionals.We would like to hear more from you about what your school is doing in the area of social mission. Please take a moment to answer the following question: Thanks again for completing the assessment.© 2022 Batra S et al. JAMA Network Open. Community based participatory research is a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community and has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.Community engaged research is a process of inclusive participation that supports mutual respect of values, strategies, and actions for authentic partnership of people affiliated with or self-identified by geographic proximity, special interest, or similar situations to address issues affecting the well-being of the community of focus.Community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis.Community of commitment is the term we are using to indicate a medically or socially underserved community -a health disparity community -that could be a geographic area (local or regional), demographic group, or category of patient that your school has explicitly targeted as a focus for your work.Disease prevention research is research designed to yield results directly applicable to identifying and assessing risk, and to developing interventions for preventing or ameliorating the occurrence of a disease or the progression of detectable but asymptomatic disease.Health equity research is research that aims to eliminate health disparities and achieve optimal health for all.Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.Health disparity research includes basic, clinical and social sciences studies that focus on identifying, understanding, preventing, diagnosing, and treating health conditions such as diseases, disorders, and other conditions that are unique to, more serious, or more prevalent in subpopulations in socioeconomically disadvantaged (i.e., low education level, live in poverty) and medically underserved, rural, and urban communities.Health promotion research is research that promotes the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.Holistic review is a university admissions strategy that assesses an applicant's unique experiences alongside traditional measures of academic achievement such as grades and test scores. It is designed tohelp universities consider a broad range of factors reflecting the applicant's academic readiness, contribution to the incoming class, and potential for success both in school and later as a professional. Holistic Review has been described by the Supreme Court as a highly individualized review of each applicant's file, giving serious consideration to all the ways an applicant might contribute to a diverse educational environment.LGBTQ is an acronym for lesbian, gay, bisexual, transgender, and queer.Social determinants of health are the complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors.Student-run health clinics are community clinics where students (with faculty supervision) provide health care services at no cost or low-cost to underserved populations. IV III II I