The Case for Inclusion and Diversity in PA Cohorts

“We Want to Tear Down Educational Stereotypes”

June 23, 2020

By Menerva Yole-Lobe, PA-S

Menerva Yole-Lobe
PA student Menerva Yole-Lobe

The University of Utah Physician Assistant Program (UPAP) is one of the original PA programs in the country, celebrating 50 years in PA education. Almost nine years ago, UPAP took the bold step of creating a full-time faculty position for inclusion and diversity, with the goal of addressing, increasing, maintaining, and ensuring the success of diversity within its cohorts. This commitment to inclusivity has not only enriched the curriculum at UPAP but has provided quality education to hundreds of PAs, including those from under-represented minority (URM) communities, who often return to work in their home communities. This commitment to inclusion and diversity is one of the many reasons UPAP is a top-ranked PA program in the United States.

How was such fervent commitment to inclusion and diversity birthed in a PA program in the mountain state of Utah, which some people can’t identify on a map? To answer this question and discuss the important topic of inclusion and diversity, I sat down for a discussion with the University of Utah PA Program’s Director of Inclusion and Diversity, Darin Ryujin, PA-C. First, Mr. Ryujin gives credit to some of UPAP’s foundational and current leaders who advocated for equity, inclusion, and diversity, including C. Hilmon Castle, MD, William M. Wilson, PhD, Don Pedersen, PhD, PA-C, Connie Goldgar, MS, PA-C, Dan Crouse, MPAS, PA-C, and Jared Spackman, MPAS, PA-C.

Darin Ryujin
UPAP Director of Inclusion and Diversity, Darin Ryujin, PA-C

Mr. Ryujin is a consistent participant and contributor to national PA education workgroups and gives talks on inclusion and diversity. Being from a working class family who first arrived in the United States 130 years ago, he’s no stranger to the adversity that can come from being a minority. Growing up, he was acutely aware that he was a minority and often found himself being an outsider in the small community in which he grew up. These encounters gave him first-hand experience in the struggles of URM students and fueled his desire to be an advocate and a champion for inclusion and diversity in the PA field.

He reminds us that inclusivity in PA education requires a paradigm shift that challenges us to move from safe spaces to brave spaces.

MYL: What percentage of your matriculants come from underrepresented backgrounds?

DR: Thirty five to 40 percent of the matriculants from the UPAP program come from underrepresented diverse communities of people from various racial, ethnic, geographic, age, gender identification, religions, military service, and abilities—all of which enhance the quality of UPAP’s cohorts. We don’t want a cohort of standardized students. We strongly believe that our students’ learning, experience, perspective, practice, and, subsequently, the PA profession is enriched when learning takes place in an environment of varied perspectives

MYL: What was the impetus/drive for making the director of inclusion and diversity a full-time position at UPAP?

DR: Being one of the original medical extender (MEDEX) programs in the country, the basis of our existence was to be able to extend medical care. From that foundation came our mission to train PAs who can provide competent and socially-conscious care to underserved populations. Statistically, we know that graduates from URM groups are more likely to return and practice in the communities from which they came. If we know these things, then it only makes sense that our cohorts should be representative of our communities. There has to be population parity. Prior to my position, we had always done a lot of outreach but needed more structure because we had incomplete pipelines. Our leadership at the time this position was established included Don Pedersen, PhD, PA-C, Dan Crouse, PA-C (former president, Utah Association of Physician Assistants), and Connie Goldgar, PA-C (former PAEA president). They knew that if you just talk the talk, it would not get done. They decided to put the resources, commitment, and money into it. They gave me the latitude to figure out how we create compositional diversity in our cohorts. I was entrusted with evaluating all aspects of diversity and developing plans that facilitate and support inclusion for our students. We believe in the inclusive excellence (IE) model and know our students are our greatest asset.

MYL: What diversity initiatives are currently at your program?

DR: One of our most powerful and rewarding initiatives is our holistic admissions process, developed by Doris Dalton, MPA. We don’t just look at GPA but take into consideration other factors that make a student an asset, not only to our program but to various communities and the PA profession. Using a holistic approach is one that requires intentionality and effort on our end and having a faculty that values these efforts.

Secondly, we remain engaged in pipeline and outreach work in our communities. One of the most effective ways we’ve found to do this is to get our student body involved. In 2010, we created a group called PA Students Supporting Equity and Diversity (PASSED. This group allows student involvement in our mentorship, outreach, and pipeline activities. By keeping our students involved in their communities and connected with future PA students while in school, we’re able to reiterate the importance of our mission, educate students who understand and appreciate inclusion and diversity in their education, and help in the development of people who can champion this cause in the future.

In 2013, with the associate vice president’s Office for Health Equity and Inclusion, we established the Charles James Nabors, PhD Patient Voices Panels. These panels are named after Charles J. Nabors, who was the first African-American professor at the University of Utah School of Medicine, a former anatomy professor and civil rights activist. It gives a platform to people from various communities to discuss their experiences in receiving healthcare and gives them a chance to offer insight on how the providers we’re training can deliver more equitable care to their communities. These panels allow our program and our students to engage with diverse communities, learn from each community, develop connections, foster relationships, build trust, and allow our mission to be experienced by a more diverse potential applicant pool.

Lastly, we strive to make sure that when we build a diverse cohort, we invest the time and resources to promote the success of each student.

MYL: What successes have you seen with these initiatives so far?

DR:

  • We have seen continued success with our holistic admissions process. We have a very low attrition rate in URM students—less than 1%.
  • We have developed and maintained a student-centered program.
  • Created a working functional mission.
  • Created a culture of bravery where difficult conversations around inclusion and diversity can take place.
  • Created a program where there’s a high degree of concordance between students and the program. 

“We want to tear down educational stereotypes and dismantle the perception that a URM student might not be as good a student or provider.” – UPAP Director of Inclusion and Diversity, Darin Ryujin, PA-C 

MYL: What have been the most significant barriers to implementing these initiatives?

DR:

  • Lack of in-depth knowledge about inclusion and diversity. “Diversity is inviting everyone to the party; inclusion is being asked to dance,” diversity advocate Vernā Myers explains.
  • Not understanding the difference between equality and equity. Equality is giving everyone a coat in the same size; equity is giving someone a coat that fits them.
  • Getting people to move away from metrics and use a true and comprehensive system of merit.
  • Tearing down educational stereotypes of diverse students—the perception that a URM student might not be as good a student or provider.
  • Making sure we can address individuality without compromising the educational piece.
  • Changing how student advising is done—creating more of a partnership between advisor and advisee and using a more individualized holistic approach.
  • Recognizing and addressing unconscious bias.

“Diversity is inviting everyone to the party; inclusion is being asked to dance.” – Diversity advocate Vernā Myers 

MYL: How do you create a successful environment for URM students?

DR:

  • Establish initiatives that narrow achievement gaps.
  • Set equity-based educational goals.
  • Establish identity-based student supports; people want to feel affinity.
  • Figure out ways to support students while fixing the system.
  • Maintain a close ratio of advisors to advisees.
  • Establish mentoring systems/programs.
  • Look at social determinants of education and how it affects each student’s success.
  • Provide in-house tutors for students who might need additional help.
  • Require committee meetings through our academic displinary system that evaluate the whole student and look at variables that could be implemented to enhance a student’s success.
  • Remind our students that they’re at UPAP because they earned it, based on their merit. They belong here.
  • Take responsibility for our students’ success. 

MYL: What lessons have you learned?

DR: When it comes to inclusion and diversity, you can’t just talk the talk, you have to put your resources, time, commitment, and money where your mouth is. It is an investment in your program. You can’t get comfortable or weary of putting in the work. The work doesn’t end when you accept URM students into a program, you have to make sure the experience is equitable and that everyone’s success is a priority. PA education, the PA profession, and communities are better when we value inclusion and diversity.

MYL: How do you get buy-in when trying to establish inclusion and diversity initiatives?

DR:

  • Find out what motivates the people you’re trying to persuade—what’s their economy?
  • Show them the data—the data speaks for itself…diversity improves education!
  • Show them what’s in it for them and the program—how will they benefit? 

MYL: What advice would you give other program directors implementing similar initiatives?

DR:

  • Just do it! Make a strong case for it; have your data and research to back it up.
  • Make sure you’re not just creating token positions for inclusion and diversity and appointing figureheads who have no real say, power, or resources to do the job well.
  • Look at the accreditation standards, proficiency standards, population parity, and the communities around you.
  • Make sure it is a priority and figure out how to leverage it.
  • Create the capacity in knowledge and resources to make it successful.
  • Look for allies in power positions who care about it.
  • Establish interdependence with various communities.
  • Look at the policies and recommendations of institutions that govern medical education.
  • Get training centered on equity, inclusion, and diversity and talk about it.
  • Look at internal and systemic barriers and develop plans to break them.
  • Set intentional organizational goals to recruit and retain URM faculty.
  • Understand the consequences of language. Using words like “probation” for students whose progress is under close monitoring can have unintended negative effects.
  • Recognize that impostor syndrome is often intensified in URM students and work to foster a supportive environment where URM students can be candid about their concerns and are supported.
  • Allow frank discussions where URM students can offer a counternarrative and not be silenced by group-think.
  • Create opportunities for URM students and all students to get involved in leadership and innovation. Give them the tools and support to be impactful leaders in school and in their communities.
  • Recognize that microaggressions, microinsults, and microinvalidations are a reality that impact URM students in the classroom and in clinic. Support students to have a voice, validation, and affirmation.
  • Keep students and their success the number one priority. 

MYL: How do PA programs get involved in their communities and engage with potential URM applicants to their programs?

DR:

  • Find community partners in local URM organizations, affinity, and social groups.
  • Establish relationships with high schools, community colleges, and universities in underserved areas.
  • Allow partners to tell you their needs and listen.
  • Get your cohorts involved in these partnerships.
  • Don’t go into communities and think you’re there to save them. Your program is benefiting from these relationships, sometimes more than the partners.
  • Don’t just do projects — build relationships, maintain engagement and continuity.

MYL: What is your vision for future efforts that you and/or other directors of inclusion and diversity can work on?
DR:

  • Advocate for efforts that can keep the cost of PA education down—the burden of educational debt tends to be higher for URMs.
  • Create PA-specific bridge programs/pipelines.
  • Develop a better understanding of how people learn and effectively use principles of epistemology.
  • Develop evaluations and assessments that are equitable.
  • Create standardized faculty development around diversity, inclusion, and multicultural education.
  • Increase participation from preceptors and clinical sites in discussions and solutions about inclusion and diversity and how to support our students in clinical settings.

Menerva Yole-Lobe is a second-year PA student at the University of Utah PA Program (UPAP). She is a member of the Student Board Leadership Committee. She can be reached at [email protected].

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