Cleveland, Ella F. PhD
The case studies in this supplement of Academic Medicine describe eight highly successful Health Professions Partnership Initiative (HPPI) sites funded by the Robert Wood Johnson Foundation and the W. K. Kellogg Foundation. Additional funding came from the health professions schools and the school districts. As the deputy director of pipeline partnerships at the Association of American Medical Colleges (AAMC), I had the opportunity to visit most of the 26 HPPI sites. We soon learned of the importance of having a National Program Office (NPO) to evaluate, assist, and advise the HPPI sites. From these visits, through my work in the NPO, and by studying the annual reports from the sites, I was able to understand the mission of the HPPI sites, their academic results, their diversity in programs, and those educational and organizational matters that were common to all.
Universal to each HPPI site included in this supplement is that they were designed to address the challenges, barriers, and solutions to producing high-quality partnerships resulting in enhanced learning opportunities. They document how the pipeline partnerships were formed, what educational activities were implemented and institutionalized, and the lessons that they learned about extending the education of ethnic and racial minority students.
The editors for this special issue chose the case studies to be represented in the supplement, inviting six schools of medicine: University of Alabama School of Medicine; Creighton University School of Medicine; University of Connecticut School of Medicine; University of California, San Francisco, School of Medicine; University of Massachusetts Medical School; and Mt. Sinai School of Medicine of New York University. Also, two schools of public health—Emory University, Rollins School of Public Health, and the University of Illinois at Chicago School of Public Health—were invited to write case studies.
The sites chosen for this supplement are regionally distributed, as were the 26 HPPI projects. Most HPPI projects were led by medical schools, but in the last round of funding, five of the ten sites selected included schools of public health. While most HPPI projects were located in urban settings and served black students, the Fresno HPPI was an exception. It was located largely in a rural setting and, for the most part, served Latino students. A majority of HPPI projects began their efforts at the junior high school level and later intervened at the high school level. The University of Connecticut is an exception with its college-level programs.
Characteristics of Successful Programs
Once the member institutions of the HPPI were identified, faculty, staff, teachers, administrative personnel, parents, and members of the business community joined in developing the overarching trait of the successful HPPI sites documented in this supplement. They began with a thorough educational and health needs assessment of their community. Next the site members met to develop and articulate clear, measurable goals for their HPPI. It was while developing goals that the partners in the initiative came together and understood their educational mission. They moved from a silo mentality (i.e., seeing their education role with tunnel vision) to one of a true partnership and a broader vision of education.
All HPPI sites dealt with similar problems. Money was always in short supply and frequent staff turnover had to be addressed. All sites found ways to bring the educational institutions together in a meaningful fashion. At times, medical schools or public health institutions did not understand how to work with elementary and secondary schools. In turn, teachers and administrators had much to learn about the educational strategies used in health institutions. Deans of health profession schools became conversant and understanding about K–12 education. This institutional culture change is probably the largest contribution, or outcome, of HPPI.
The successful HPPI sites highlighted in this supplement were able to quickly overcome these barriers and they were soon functioning as a single united group dedicated to educating ethnic and racial minority students. They built partnerships that functioned in such as manner that the goals established early on in the funding cycle could be achieved. Once the goals were developed, successful HPPI sites started gathering data needed for evaluation of their project.
Best Practices of Successful HPPI
Soon after their funding cycle commenced, successful HPPI sites learned of the power of partnerships. Several quality institutions such as health professions schools, colleges and universities, school districts, and hospitals coming together became a powerful voice in the community in matters of education. They had access to business leaders, and some sites received funding from financial institutions. As an HPPI they had access to the leadership of the school districts, colleges, and universities, and to the health professions schools. The partners in the HPPI were able to present their case for support, both verbally and fiscally.
During their first year of funding, HPPI sites started planning on how to sustain their educational effort when foundation funding ended. Frequently this matter was on the agenda, and HPPI sites developed strategies to continue their HPPI efforts, and to make the HPPI concept part of their institutional fabric.
In addition to evaluation, successful HPPI sites learned early on to reduce the thrust of their programs and to trim their aspirations about how many children they could educate. These sites usually reduced the numbers of institutions involved in their partnership and narrowed and focused their goals. Clear yet flexible goals were the important structure here.
Successful HPPI sites had strong leadership from the top of the administration. Deans, vice-presidents, and school district superintendents were involved. They made it clear that the HPPI concept was important to their institutions and one that they valued. They encouraged their faculty and teachers to participate in HPPI activities, and this was seen as adding value to their resumes. The leadership from the medical school or the health profession school was visible as supporters of HPPI and they gave of their time and energy to participate in HPPI planning and education activities.
Making the Difference in Education
Soon after funding, successful HPPI sites developed and implemented a number of strategies that helped improve the quality of education that students received. For example:
▪ They recognized the importance of and utilized parental support and involvement in the education of their children. They soon understood that no child could progress in education without strong parental support.
▪ They understood the importance of raising expectations of children that they could learn and perhaps have a career in one of the health professions.
▪ They developed and utilized early learning interventions; applied innovative teaching techniques; sponsored Saturday Learning Academies, after-school mentoring and tutoring programs, and exposure to health careers to raise students’ motivation toward learning; and made learning for children a year-round activity.
There were program similarities among the successful HPPI sites. First, all of them raised awareness of children that they could learn and achieve. Second, without exception, these HPPI sites cared about enhancing the education of the children in their programs. Third, the participants in the high-quality HPPI sites worked together as a team and remained focused on their educational mission.
Programs That Faltered or Failed
Projects that faltered or failed did not take into account the issues facing public schools today, such as high mobility of the student population, the demands of the No Child Left Behind education act, or competing athletic or other program demands on students. Due to personality or cultural differences of the health professions schools and the public K–12 schools, some sites were never able to form true partnerships. Thus, it became the health professions representative trying to conduct programs or activities in the schools or community, without much success. Finally, many projects had goals that were much too lofty, broad, and definitely immeasurable.
However, every one of the 26 HPPIs succeeded in changing the cultures of their participating institutions. I submit that there is much to learn from these eight HPPI sites about preparing ethnic and racial minority students for entrance into the health fields. I believe that if one views these eight sites as one group, they present a powerful education model that might be used nationally to prepare racial and ethnic minority students for the health professions.