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Balancing Two Cultures: American Indian/Alaska Native Medical Students’ Perceptions of Academic Medicine Careers

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Abstract

American Indians and Alaska Natives (AI/AN) remain underrepresented in the academic medicine workforce and little is known about cultivating AI/AN medical students’ interest in academic medicine careers. Five structured focus groups were conducted including 20 medical students and 18 physicians. The discussion guide explored factors influencing AI/AN trainees’ academic medicine career interest and recommended approaches to increase their pursuit of academia. Consensual qualitative research was employed to analyze transcripts. Our research revealed six facilitating factors, nine dissuading factors, and five recommendations towards cultivating AI/AN pursuit of academia. Facilitators included the opportunity to teach, serving as a role model/mentor, enhancing the AI/AN medical education pipeline, opportunities to influence institution, collegiality, and financial stability. Dissuading factors included limited information on academic career paths, politics, lack of credit for teaching and community service, isolation, self-doubt, lower salary, lack of positions in rural areas, lack of focus on clinical care for AI/AN communities, and research obligations. Recommendations included heighten career awareness, recognize the challenges in balancing AI/AN and academic cultures, collaborate with IHS on faculty recruitment strategies, identify concordant role models/mentors, and identify loan forgiveness programs. Similar to other diverse medical students’, raising awareness of academic career opportunities especially regarding teaching and community scholarship, access to concordant role models/mentors, and supportive institutional climates can also foster AI/AN medical students’ pursuit of academia. Unique strategies for AI/AN trainees include learning how to balance AI/AN and academic cultures, collaborating with IHS on faculty recruitment strategies, and increasing faculty opportunities in rural areas.

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Acknowledgments

We would like to thank the members, staff, and leadership of the 2012 Association of American Indian Physicians Annual Conference, Anchorage, Alaska for assistance with the implementation of the study. A special thank you to Juan Amador and Linda Don for assistance with the conduct of the focus groups and coding of the transcripts, respectively.

Funding/Support

This study was supported by the Association of American Indian Physicians, Diversity Policy and Programs of the Association of American Medical Colleges, and the Building the Next Generation of Academic Physicians.

Author information

Authors and Affiliations

  1. Rutgers New Jersey Medical School, Newark, NJ, USA

    John Paul Sánchez MD, MPH

  2. Human Capital Initiatives, Diversity and Policy Programs, Association of American Medical Colleges, Washington, DC, USA

    Norma Poll-Hunter PhD

  3. Association of American Indian Physicians, Oklahoma City, OK, USA

    Nicole Stern MD

  4. Sansum Clinic, Santa Barbara, CA, USA

    Nicole Stern MD

  5. California Department of Public Health, Sacramento, CA, USA

    Andrea N. Garcia MD, MS

  6. Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA

    Cheryl Brewster EdD

  7. 9 Legendary Circle, Rye Brook, NY, 10573, USA

    John Paul Sánchez MD, MPH

Authors
  1. John Paul Sánchez MD, MPH
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  2. Norma Poll-Hunter PhD
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  3. Nicole Stern MD
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  4. Andrea N. Garcia MD, MS
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Corresponding author

Correspondence to John Paul Sánchez MD, MPH.

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Ethical Approval

This study was approved by the institutional review board of Montefiore Medical Center, Bronx, New York.

Appendix

Appendix

Focus Group Questions Posed to 20 AI/AN Medical Students, 2012

How do you define a career in academic medicine?

Tell us what has interested you about pursuing a career in academic medicine?

What experiences influenced your decision to or not to pursue a career in academic medicine?

As you are in the process of considering an academic medicine career, describe any challenges that you are currently facing?

What has helped you prepare for/pursue a career in academic medicine?

What helped you in the process of considering an academic medicine career?

Are there any additional factors you would like to share about your decision to pursue academic medicine and your efforts to prepare for this career?

Is there anything you would have done differently prior to medical school or during medical school to better prepare for a career in academic medicine?

What do you believe can be done to increase American Indian and Alaska Native representation in the academic medicine workforce?

Is there anything else related to this topic that we didn’t discuss that you would like to share with us?

Focus Group Questions Posed to 18 AI/AN Physicians, 2012

Can you tell me briefly about yourself: What is your current position, role(s), and responsibilities?

How do you define a career in academic medicine?

Tell us what has interested you about pursuing a career in academic medicine?

What experiences influenced your decision to or not to pursue a career in academic medicine?

In the process of considering an academic medicine career, describe any challenges you had and are currently facing?

What helped you in the process of considering an academic medicine career?

If applicable, are there any additional factors you would like to share about your decision to pursue academic medicine and your efforts to prepare for this career?

Is there anything you would have done differently prior to or during medical school, or during residency to better prepare for a career in academic medicine?

What do you believe can be done to increase American Indian and Alaska Native representation in the academic medicine workforce?

Is there anything else related to this topic that we didn’t discuss that you would like to share with us?

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Sánchez, J.P., Poll-Hunter, N., Stern, N. et al. Balancing Two Cultures: American Indian/Alaska Native Medical Students’ Perceptions of Academic Medicine Careers. J Community Health 41, 871–880 (2016). https://doi.org/10.1007/s10900-016-0166-x

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