Participants of the American Society of Hematology (ASH) Minority Recruitment Initiative had lower attrition rates in graduate and medical programs, were more likely to pursue a career in hematology, and had high levels of engagement at ASH beyond their participation in the program, according to a study published today in Blood Advances .
The ASH Minority Recruitment Initiative was established in 2003 following a report from the Institute of Medicine that called for greater workforce diversity. The program aimed to recruit physicians and physician/scientists from communities underrepresented in hematology into the field through paid research opportunities and mentorship. Over the course of 20 years, the program grew to support prospective hematologists from medical school through fellowship and into early career, creating a longitudinal pathway of support. A longitudinal pathway also exists for doctoral scientists that begins during graduate school and ends with a post-doctoral award.
"Patients feel more confident in their physician if it's someone they can relate to," said study author Belinda R. Avalos, MD, ASH president-elect. "Previous literature has shown that patients and physicians from the same race or ethnicity have better relationships and stronger health outcomes."
Black individuals, who constitute 13.6% of the U.S. population, and individuals of Hispanic descent, who constitute 18.9% of the U.S. population, make up only 4.1% and 5.7% of hematology-oncology trainees, respectively.
In a 20-year retrospective analysis of the program, Dr. Avalos and her colleagues evaluated its short- and long-term impact. From 2004 to 2022, there were 405 participants across the six awards programs on the longitudinal career pathway.
From 2004 to 2018, medical school attrition of 181 program participants was 2.2% compared to the national minority medical school attrition of 5.6%, while graduate school attrition of 32 participants from 2011 to 2017 was 0%, significantly lower than the 36% attrition rate for minority doctoral students in science and engineering fields. Additionally, of the 77 participants who received two or more program awards, 25 received awards that directly progressed on the pathway.
"We were very intentional about including mentorship and peer connections early on in the program pathway so that participants were supported along their journey," said study author Deirdra R. Terrell, PhD, associate professor of epidemiology and assistant dean for sovereignty, opportunity, belonging, and engagement at the University of Oklahoma Health Sciences. "These lower attrition rates show that participants created their own networks – a group of people to connect with, text for advice, and gain empowerment from after hearing their stories."
Program participants were more likely to pursue hematology-oncology and remain in the field. Of the 97 participants who received a medical school award from 2004 to 2014, 14.4% were board-eligible or board-certified in hematology-oncology. Additionally, most recipients of the early career award (25 out of 26) remained in academia, with 88.5% practicing in hematology. These percentages are significantly greater than the 5.7% underrepresented minority faculty in medical oncology (which included hematology-oncology) reported in national estimates in 2019.
The majority of program participants received the medical student award (240 awards from 2004 to 2022), self-identified as Black or Hispanic, and attended or were faculty (early career award) at a U.S. academic institution. For all awards, except the early career award, most recipients self-identified as female.
The ASH Minority Recruitment Initiative participants were highly involved at ASH even after completing the program. Forty-five alumni served in 353 leadership roles at ASH and from 2004 to 2022, 59% (225 out of 353) of participants were authors on 1,105 abstracts presented at an ASH annual meeting.
"Participants who stayed in hematology are now the voices driving changes in other parts of ASH," said Dr. Avalos. "We now have more diverse voices in the ASH ecosystem, whether in the executive committee, guidelines process, or editorial teams."
Due to its retrospective nature, the study did have some limitations, including obtaining medical specialty outcomes through publicly available data, resulting in a conservative estimate of retention in hematology, and identifying an appropriate comparison group.
The researchers plan to further evaluate and bolster the program's impact by implementing a standard annual assessment tool for all awardees, including a formal mixed methods assessment to better understand the awards' impact on careers, and conducting more outreach through the ASH Ambassador Program in areas of the country that have not yet had an awardee.
"This program has built a community of people who want to do good science and good things in the world," said Dr. Terrell. She urged other institutions to consider this success as evidence that similar programs are worth the investment and commitment. "Programs like this work, make a difference, and are necessary. We need to continue making sure everyone is represented at the table."
ASH is continuing to foster and empower a diverse new generation of leaders in hematology through the Hematology Inclusion Pathway (HIP), the successor program to the Minority Recruitment Initiative. To learn more about ASH's HIP, visit hematology.org/awards/hematology-inclusion-pathway.
