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 recent study published by Rollins et al in Blood Advances.

Background

The ASH Minority Recruitment Initiative—established in 2003 following a report from the Institute of Medicine that called for greater workforce diversity—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 was also established for doctoral scientists, beginning during graduate school and ending with a postdoctoral award.

“Patients feel more confident in their physician if it’s someone they can relate to,” explained co–study author Belinda R. Avalos, MD, President-Elect of ASH. “Previous literature has shown that patients and physicians from the same race or ethnicity have better relationships and stronger health outcomes,” she continued.

However, Black and Hispanic individuals, who constitute a respective 13.6% 18.9% of the U.S. population, make up only 4.1% and 5.7% of hematology-oncology trainees.

Study Methods and Results

In the 20-year retrospective analysis of the program, researchers evaluated its short- and long-term impacts. From 2004 to 2022, there were 405 participants across the six awards programs on the longitudinal career pathway.

Between 2004 and 2018, medical school attrition of 181 program participants was 2.2% compared with the national minority medical school attrition of 5.6%, whereas graduate school attrition of 32 participants between 2011 and 2017 was 0%—significantly lower than the 36% attrition rate among minority doctoral students in science and engineering fields. Additionally, among the 77 participants who received two or more program awards, about 32% (n = 25) of them 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,” emphasized senior 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,” she highlighted.

The researchers discovered that the program participants were more likely to pursue hematology-oncology and remain in the field. Among the 97 participants who received a medical school award from 2004 to 2014, 14.4% of them were board-eligible or board-certified in hematology-oncology. Additionally, most of the recipients of the early career award (n = 25/26) remained in academia, with 88.5% of them practicing in hematology. These percentages were significantly greater than the 5.7% underrepresented minority faculty in medical oncology—including in hematology-oncology—reported in 2019 national estimates.

The majority of the 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. Among all of the awards, with the exclusion of the early career award, most of the recipients self-identified as female.

Further, the ASH Minority Recruitment Initiative participants were highly involved at ASH even after completing the program. For instance, 45 alumni served in 353 leadership roles at ASH and from 2004 to 2022, 59% (n = 225/353) of the participants were authors on 1,105 abstracts presented at an ASH annual meeting.

Conclusions

“Participants who stayed in hematology are now the voices driving changes in other parts of ASH. We now have more diverse voices in the ASH ecosystem, whether in the executive committee, guidelines process, or editorial teams,” underscored Dr. Avalos.

As a result of 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 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,” Dr. Terrell underlined. 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,” she concluded.

Disclosure: For full disclosures of the study authors, visit ashpublications.org.