More underrepresented minority (URM) healthcare professionals are needed to improve health equity. Although holistic review in admissions has the potential to increase URM participation in health professions, recent data suggest that its impact varies substantially. The purpose of the dissertation research described here was to identify interventions to increase diversity among healthcare professionals and explore holistic review use in physician assistant (PA) program admissions to advance understanding of effective practices. PA programs were selected as an important prototype for exploratory studies since the extent of holistic review use in PA programs was unknown; at the same time, URM representation among PA students has decreased over the last 15 years.

A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes.

Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students.

Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs.

This paper addresses policy solutions for the continuing medical education of providers treating LGBTQ patients. As a population subject to significant health disparities, LGBTQ individuals are at risk of discrimination and harm when entering the medical context and, as such, require particular provider competence in approaches to care. This population is also vulnerable to distinctive medical needs which often position individuals as patients, making clinical interactions a key component of equality in social contexts. Through literature review and policy analysis, this paper addresses how systemic inequality has been propagated in the medical community and suggests an intervention in developing critical CME materials and requirements which seek to promote provider knowledge of best practices for the treatment of LGBTQ individuals. The ultimate policy suggestion incorporates existing policy promulgated at the state and professional organization level to fully respond to the challenges of informing providers of best practice in a meaningful, practicable manner. This policy specifies the importance of mandatory content-based learning hour requirements, in order to ensure that all providers meet a minimum level of competency in providing care to minority and at-risk populations, particularly the LGBTQ population. Moreover, it encompasses an understanding of the role and importance of outside organizations with subject-area expertise and endows such organizations with the power to interact with the policy and curriculum formation process. In so doing, it addresses many of the underlying gaps in provider education on this critical issue and promotes equity in health outcomes for all patients. Keywords: LGBTQ health, continuing medical education, health policy

Introduction: Health disparities for the Native American population in the United States have been well documented for years. Native Americans face many barriers to healthcare access, including low socioeconomic status, historical trauma, and lack of access to healthcare facilities. Barriers to healthcare and challenges associated with achieving optimal health among Native Americans contribute to health disparities within these populations. If these barriers are to be overcome, they must be understood and addressed. Purpose: The purpose of this review was to identify barriers to healthcare access for Native American populations as well as strategies to address barriers. Method: A preliminary scan of several online databases was conducted. Key terms used in the search included American Indians, Native American, healthcare, healthcare access, health disparities, barriers, and intervention. Articles were selected based on relevance, and data from each chosen article were extracted and categorized. Results: The initial search resulted in 272 articles of potential interest. Based on the abstract review, 32 were deemed relevant, and full text reviews were completed. Based on the full text review, an additional 10 articles were excluded, resulting in a final review of 22 articles. The articles addressed barriers related to various health conditions: cancer treatment, drug or alcohol use, maternal and child health, historical trauma, diabetes and chronic illnesses, and oral health. Conclusion: Native Americans face several barriers to healthcare access that are associated with social, physical, and mental health disparities. Successful efforts to address these barriers include patient-centered, culturally-competent interventions. Others include interventions which focus on community involvement.