COLUMBIA — The MU School of Medicine's problem is a common one: It wants and needs to improve diversity, but has to compete against every other school with the same goal.
On top of that, the school's self-imposed policy of recruiting almost exclusively from Missouri makes the potential applicant pool even less diverse, according to data from the Association of American Medical Colleges.
And still, Warren Lockette, the school's senior associate dean for diversity and inclusion, says he wants the school to be No. 1 in the nation in diversity one year from now.
This goal might sound pretty far-fetched. In fact, when Lockette said it recently in front of School of Medicine Dean Patrice Delafontaine, his boss questioned whether it was realistic in the short term.
After all, last year only 5 percent of students enrolled in the medical school were underrepresented ethnic minorities. But Lockette is serious.
“I would like to have every dean of every medical school sending me an email saying, ‘How did you do it?’” Lockette said. “I want us to be a leader. I’m just not happy with slow incremental improvements.”
Whether changes are slow or drastic, the school has to improve its diversity in order to keep its full accreditation status from the Liaison Committee on Medical Education, which accredits medical schools. The committee flagged diversity and three other areas, including student mistreatment, as noncompliant in its June 2016 evaluation of the medical school.
The school must send the committee a detailed plan for improvement by December. If the committee decides that there hasn't been enough improvement, the school could be put on probation.
The committee’s findings weren’t a surprise, Delafontaine said. But he doesn’t think there’s any realistic chance MU will be put on probation. He sees the accreditation report as highlighting what the school can do better. Since receiving the report in June, he’s created task forces of faculty, staff and students for each piece of the action plan.
"We really are a top school, so to get citations like this is really the norm," Delafontaine said. "I don't know of any LCME accreditation visit where there's not a citation. The chance of this going to probation or loss of accreditation is extremely low."
The school’s lack of diversity stems from multiple sources, and there’s no simple solution. Medical schools across the nation have long been competing to attract the same underrepresented students, according to a study in the Journal of the National Medical Association. Once they get them to enroll, the school environment must be inclusive and comfortable enough for them to remain.
A historic problem
The school has lacked diversity in its student body for years. The committee identified student and faculty diversity as a problem in its 2008 evaluation, noting that there were no black students in the first-year class. There wasn’t an administrator leading diversity efforts or a strategic plan to address the issue.
Following the evaluation, the school hired Lockette’s predecessor, Ellis Ingram, and enhanced programs meant to encourage underrepresented students to enter the medical field. Black and Hispanic faculty increased, as well as rural and low-income students, but the numbers of students from underrepresented ethnic minorities largely remained stagnant.
The school also hired Traci Wilson-Kleekamp as its diversity coordinator with a special focus on recruiting underrepresented students. She said she believed the school wasn't serious about increasing diversity and had no infrastructure to support her efforts.
"They have a cultural ideology about equality or inclusion that is antithetical to having a more diverse environment," Wilson-Kleekamp said. "A lot of them think if you have diversity, the person you're interested in is automatically unqualified."
She said MU rejected almost all the students she recruited in the five years she was there, even though she was promoted to director of diversity and outreach initiatives. Frustrated with the lack of support, she quit in 2013 and said she felt like she was forced out.
School of Medicine spokeswoman Mary Jenkins said it was the school's policy not to discuss personnel matters so she declined to comment on Wilson-Kleekamp's remarks.
Delafontaine and Lockette weren't at MU for the last LCME visit. Delafontaine became the school's dean at the end of 2014, and Lockette was hired shortly after when Ingram retired. But they're the ones tasked with finding a solution when the committee determined in this year's evaluation that the school hadn't improved enough.
Recruiting underrepresented minorities is challenging for any medical school because of a limited applicant pool. But MU has another barrier to increasing diversity: its focus on applicants from Missouri, which has an even less diverse applicant pool than the national average, according to the Association of American Medical Colleges.
Delafontaine said the school focuses on in-state applicants because Missouri is facing a significant physician shortage, especially in rural areas.
According to Association of American Colleges data, 76 percent of MU’s 2015 entering class was from Missouri. Out-of-state applicants are unlikely to be admitted unless there’s a “compelling reason” for the admissions committee to make an exception, such as a strong tie to the state of Missouri, according to the admissions website.
The policy is meant to keep graduating physicians in the state of Missouri, and it has worked: More Missouri physicians come from MU’s medical school than all other medical schools in the state combined, according to the Association of American Colleges.
However, the focus on admitting Missouri students also works against the school’s diversity efforts. Few Missouri applicants are from underrepresented ethnic minority groups, which include black, Hispanic and American Indian students.
In 2015, 9.3 percent of Missouri’s applicants were from one of these underrepresented groups, according to Assocation of American Colleges data. Nationally, underrepresented minorities made up 14 percent of the applicant pool.
Just 19 underrepresented minority students from Missouri enrolled in medical school in 2015: 16 black students, two Hispanic and one American Indian. Underrepresented minorities made up 13 percent of the national first-year class, but only 7 percent of Missouri’s.
Delafontaine knows the school’s diversity is limited by its focus on in-state students. He said the school tries to compensate by placing high value on diversity for the out-of-state students it does admit.
More underrepresented students applied and were accepted to the school in 2016, Delafontaine said, likely because of an increase in scholarship support.
"We're very happy with that," Delafontaine said. "I think it's a good start, but I want to see our school more diverse overall. I don't want to be near the average in that area. I really don't."
Seven of the 129 scholarships listed on the school’s website give preference to underrepresented ethnic minorities. In the future, Delafontaine also hopes to partner with historically black universities or those with higher proportions of minority students to increase recruitment.
But these small improvements aren’t enough for Lockette. He wants a medical school class that represents the demographics of the United States, which he knows would take significant work. However, he believes the school’s leadership has the right mindset to make that wish a reality.
Mentoring and faculty
Improving diversity and inclusion isn’t just about recruiting, Lockette said. It’s also about creating an inclusive environment and making students feel welcome once they’ve enrolled.
Connecting with faculty and older students as mentors is an important part of that environment. Dale Okorodudu, who graduated from the School of Medicine in 2010, knows that firsthand. He's now an assistant professor of internal medicine at the University of Texas Southwestern Medical Center and a physician at the Dallas VA Medical Center.
Okorodudu said he was an undergraduate when longtime faculty member Ellis Ingram sought to persuade him to attend MU’s medical school.
"He was instrumental in terms of finding students he saw potential in and mentoring them," Okorodudu said. "He went out of his way to make sure we were doing what was necessary to succeed."
The mentoring he received inspired Okorodudu to participate in the CALEB science club, a program Ingram created to connect younger students in the community with the health professions.
“It was ingrained that this is what we’re supposed to do,” Okorodudu said. “This is how to make society better: Find people who have great potential, be there for them and help them succeed.”
Okorodudu wanted to keep helping these students when he left MU for his residency at Duke University, but long-distance communication was a challenge. The desire to maintain those relationships led him to create Diverse Medicine, an online community for underrepresented medical students and professionals. The network now includes more than 2,000 members. He also founded Black Men in White Coats, a video series which aims to increase the number of black men in the medical field by featuring black physicians.
The pool of underrepresented minorities applying for faculty positions is also limited. Only 4.6 percent of the School of Medicine's 569 full-time faculty came from underrepresented minorities as of 2013, according to the LCME report.
Lockette wants to change that so more MU students can create connections with mentors from similar backgrounds. He said Delafontaine has made efforts to attract more underrepresented faculty, such as creating a diversity lecture series with successful speakers who are minorities.
“It’s important for students to have ideal role models,” Lockette said. “Students live up to the perceptions and expectations you have of them. When you have accomplished faculty that are minorities, it sends an implicitly strong message to minority students.”
No simple solutions
School of Medicine assistant professor Camila Manrique has learned that improving race relations is slow, steady work. She’s been examining the racial climate across MU for the past year and a half as a member of the Faculty Council Race Relations Committee.
Manrique said the committee openly discussed issues of race in a respectful environment, and she found that was effective in opening members’ minds to views and experiences outside their own. Now, their goal is to seed similar discussion groups within individual schools and departments across campus.
Manrique has connected with other professors in the medical school who she said are willing to listen and engage. She’s hopeful that there’s a will to make changes among faculty and administrators.
Medical students have also taken the initiative to start discussions about the school’s climate. After graduate student Jonathan Butler began a hunger strike last fall calling for UM System President Tim Wolfe’s resignation, a group of students set up roundtable discussions about diversity, second-year medical student Benjamin Vega said.
While starting discussions is one important step, increasing diversity in the school isn’t a simple or easy process, Manrique said. She believes it will take years of investing in local communities to widen the pipeline of underrepresented students going to medical school.
“We need to do more,” Manrique said. “It’s a joint effort of everyone involved in the medical school to create a more diverse environment.”
Supervising editor is Katherine Reed.