LMSA Faculty/Physician Advisors: A Critical Partner in Supporting LHS+ Medical Students

Abstract

LSH+ physicians and faculty have had the dual role of advising LHS+ medical students and assisting them in the initiation, maintenance, and growth of LHS+ medical student groups at medical school campuses and leadership on the regional and national levels. This chapter describes the historical and emerging role and challenges, faced by LHS+ physicians and faculty, in supporting a primarily student-led medical association while ensuring their own promotion to senior academic health center positions.

Introduction

All medical schools have physician and faculty advisors that supplement administrative staff (e.g. Dean of Student Affairs or Dean for Diversity, Equity, and Inclusion) to successfully guide trainees through medical school. Medical student advisors have the complex task of understanding their students holistically and managing their academic, personal and professional needs. Advisors to LMSA chapters have the added responsibility to handle the cultural aspects that influence their members’ self-efficacy and success. As LHS+ medical students manage the interplay of their LHS+ culture and the culture of medicine, advisors must be ready to help trainees reflect on new experiences, adapt to a new culture, and achieve a new identity as self-assured and competent LHS+ physicians.

With the support of advisors, LMSA chapters and their preceding groups (e.g. BHO, CMSA, etc.) arose on medical school campuses to address the unmet developmental needs of LHS+ trainees and non-LHS+ trainees interested in serving LHS+ communities. There is a common expectation, and often a mandate at many medical schools, that medical student chapters have a faculty/physician advisor. Physicians and faculty typically assist students in understanding the policies and procedures to navigate the process of initiating, instituting, and funding chapters. Emilio Carrillo, MD, MPH, co-founder of the Boricua Health Organization (BHO), credited faculty advisors Dr. Poussaint, Dr. Einsenburg, Dr. Furshpan, and Dr. Kravitz for providing guidance and support in instituting BHO at Harvard Medical School and Dr. Rodriguez-Trias in building a regional presence.

The relationship between chapter leaders and advisors is mutually beneficial and necessary. An effective relationship can simultaneously meet the mission and goals of LMSA and fulfill the mission areas of the medical school. Trainees can achieve various scholarly outcomes such as receiving individual financial scholarships, applying for project grants, and presenting oral or poster presentations. They can also achieve leadership outcomes by serving in chapter, regional and national roles. Similar opportunities exist for faculty/physicians. When students and faculty collaborate, the aforementioned scholarly outcomes are more feasible and can allow for greater recognition of ‘two-fers/three-fers’ - the opportunity to achieve multiple outcomes from one primary activity. For example, successful chapters can apply for LMSA Chapter of the Year and faculty/physician advisors can apply for LMSA Regional or National Mentor of the Year. Students and advisors can write letters of recommendation for each other for promotion purposes. For medical students, this can increase their competitiveness for residency and for faculty to increase their promotion potential along a faculty (e.g. Assistant to Associate Professor) or administrative track (e.g. Director to Dean).

There are several factors that influence the success of the chapter and student-advisor relationship. Prior and new chapter leaders must spend time discussing transition. Chapter leaders usually serve one term in a position (e.g. chapter president) and have a short period to adapt. Advisors must ensure that there are transition meetings so new leaders understand facilitators of chapter success, mistakes to avoid, and build on lessons learned. Less is more. It is critical for student leaders and faculty to consider what is realistic over an academic year regarding a feasible number of quality projects and events. These events must be properly advertised and documented, in order to showcase the chapter’s successes to LMSA at large and to the medical school itself. Activities should align with the mission/strategic plan of the medical school and the LMSA organization. Focus on members’ needs. Taking inventory of members’ interests helps to ensure a greater level of engagement by members. Aim for value-based alignment. Advisors should help students appreciate how their efforts can meet personal passion, professional interests, institutional mission/objectives, and community needs and disparities [1]. Advisors and chapter leaders can maximize success through frequent, open communication; understanding each other’s vision, goals, interests, and responsibilities; strategic planning; monitoring progress; and aiming for agreed-upon core deliverables.

The Weight of Being an Advisor

Beyond serving chapter members, LMSA advisors must also manage their own professional success within the environment of a medical school. Medical schools have a social mission to graduate a diverse physician workforce; however, graduating and maximizing the potential of trainees are not synonymous. LMSA advisors, many of who are congruent in LHS+ identity, possess the aptitude to serve as credible role models, mentors, and champions, and can help trainees reach their full potential. However, for many advisors, based on their contract and the medical school culture, this level of activity and investment towards LHS+ medical students may be characterized as a “minority tax” rather than Full-Time Equivalent (FTE) or promotion capital [2]. Dependent on their faculty track, their chair’s expectations, and appointment and promotion guidelines, their LMSA-related work may or may not be routinely documented and substantially valued. Advisors must proactively reflect on how their LMSA activities align with their contractual responsibilities and discuss with their departmental Chair or medical school Dean how the work is mutually valuable and credited.

The Role of Advisor as Defined by LMSA Bylaws and Constitution

LHS+ medical student organizations have been championed and led by students. Although advisors have always been present and have helped guide the movement, their defined roles and responsibilities have slowly emerged in the distinct LMSA National and various regional constitutions and bylaws. Furthermore, across constitutions and bylaws, there has been considerable variation in positions (and titles) for faculty/physicians, associated responsibilities, and extent of influence. FPAC advisors must be physicians, healthcare professionals, and/or established faculty or staff at a medical school accredited by the United States - (U.S.) based Liaison Committee on Medical Education (LCME) or the American Osteopathic Association’s Commission on Osteopathic College Accreditation (AOA COCA). The LMSA National Constitution specifies that a chapter must have “A signed attestation by at least ONE (1) faculty member or senior administrator…to serve as the Chapter Advisor (4.3.2)”.

In terms of advisory groups, LMSA’s National constitution and bylaws allow for a Corporate Advisory Council, whereas LMSA West, LMSA Midwest, and LMSA Southwest have Advisory Boards [3,4,5,6]. LMSA National and LMSA West documents allow for the appointment of an Executive Director [4, 7]. Advisors have had some recognition in LMSA governing documents but not in the totality of what they have been called or expected to do by chapters, regional or national entities.

Illuminating and Defining the Role of Faculty/Physician Advisors

In the Fall of 2017, Co-Executive Director J.P. Sánchez, MD, MPH, and LMSA National President Eric Molina met to consider ‘low-hanging’ approaches to addressing the concept of ‘minority tax’ for LMSA advisors. Of particular concern was the negative impact the ‘minority tax’ would have on the current pool and future pool of Hispanic/Latino-identified LMSA advisors; in 2021, 5.9% of faculty at allopathic medical schools identified as Hispanic/Latino [8] and in 2016–2017 1.7% of faculty at osteopathic medical schools identified as Hispanic/Latino [9]. Hispanic/Latino and other underrepresented in medicine (UiM) faculty, overwhelmed by the ‘minority tax’, may inadvertently discourage LHS+ students from entering academia and limit the future pool of LMSA advisors [10]. In response, LMSA National Co-Executive Director Dr. Sánchez drafted a proposal (10/2017) and Eric Molina obtained approval by the LMSA National Board for a detailed description of the responsibilities of chapter advisors and of a new National Physician Advisory Council (PAC), elections of individuals to PAC, and structured metrics for the evaluation of advisors. In 2018, to recognize non-physician advisors the name was changed to Faculty/Physician Advisory Council.

Based on the approved proposal, chapter-level faculty/physician advisors, in advising the LMSA chapters, were responsible for:

• 1. The development, implementation, and evaluation of an annual strategic plan that aligns with the mission and strategic plan of LMSA National;

• 2. Discussing ongoing and emerging Latino/Hispanic related health issues;

• 3. Helping chapters be engaged in LMSA National and Regional activities; and

• 4. Helping chapters determine the personal and professional interests of their members and work towards cultivating the next generation of Latino leaders

In addition, chapter-level faculty advisors were expected to:

• 1. Attend the LMSA regional or national conference;

• 2. Participate in the LMSA National Faculty orientation (offered via webinar quarterly or at the LMSA National Conference); and

• 3. Meet with LMSA Chapter Leaders monthly

A National FPAC was organized to advise the LMSA National Board on organizational challenges (e.g. legal or financial issues), current challenges in health care related issues (e.g. enhancing care for undocumented populations), and best practices in cultivating the personal and professional development of LMSA members (e.g. the impact of AOA).

Based on the approved proposal, National FPAC members were to:

• 1. Provide written updates on current trends and challenges, and best practices in cultivating the personal and professional development of LMSA members to the executive LMSA National board

• 2. Serve as advisor to at least one member of the LMSA national board

• 3. Raise $1000 of capital for LMSA National (achieved through registration fees, purchasing tables at conference events, donating to scholarships, etc.)

• 4. Participate in 75% of 8 meetings per year (conference call or in person)

• 5. Co-present 1 faculty advisor training (for webinars or at the national conference)

• 6. Assist with the development of the faculty advisor evaluation letters

In 2019, to better support the activities of the LMSA FPAC, in particular, in improving the response rates for the annual directory of LMSA chapter advisors, submission of chapter strategic plans, and evaluation of chapter advisors, Dr. Sanchez asked for each current and future National FPAC member to donate $1250 to support the first paid staff member in the history of LMSA. In April 2020, Louis Francisco Morales-Shnaider, MSc, BS, OSC, President, Latino Medical School Association, University of Colorado Graduate School was hired as the first Part-Time Coordinator to support the work of the FPAC (Fig. 9.1). Louis was followed by Donald Rodriguez, PhD, MD Candidate at Pritzker College of Medicine between July 2021–April 2022 who also served in a part-time role. The success of the National Center for LMSA Leadership and Advancement in fundraising allowed Deion Ellis MD, MMS to become the first full-time staff member in May 2022 for LMSA FPAC.

Fig. 9.1

LMSA FPAC National Coordinators and Director

Election of FPAC Members

Similar to the structure of the LMSA National Executive Board, the initial plan of National FPAC was to have representatives from across the country, with expertise to support LMSA leaders and members. FPAC was set to have up to 10 members with 2 individuals from each region (1 recommended by chapter presidents and 1 recommended by faculty advisors). Nominations were expected approximately 1–2 months prior to the LMSA National Conference. The final selection was based on approval by the Executive Director(s) and the National LMSA President. Terms were to be 1-year with subsequent terms of 1 year approved on a yearly basis after every LMSA National Conference (Table 9.1).

Table 9.1 Founding LMSA National FPAC members

The Founding Council members (2017) were chosen because of their distinguished history in supporting Hispanic students. Dr. Homan-Sandoval brought historical expertise of NNLAMS and LMSA National as past Executive Director and past LMSA National Board Member; Associate Dean Lucio brought legal and diversity & inclusion expertise [11,12,13]; Associate Dean Martinez brought expertise in pre-medical pipeline/pathway programs and diversity and inclusion [14, 15]; Associate Dean Nakae brought expertise in admissions and support for DACA students [16,17,18,19,20,21,22,23,24,25,26,27]; Dr. Sola brought expertise of health policy as the founder of the LMSA Health Policy Summit [28,29,30]; Associate Dean Vela brought expertise in Hispanic health, cultural competency and faculty development [25, 31,32,33,34]; and Dr. Sánchez brought expertise in diversifying academic medicine, in particular pre-faculty development through Building the Next Generation of Academic Physicians (BNGAP Inc.) [1, 10, 15, 21, 22, 24, 28, 30, 34,35,36,37,38,39,40,41,42,43]. In 2020, two new Board Members joined – Dr. Hector Rasgado-Flores, who brought expertise in research, and basic sciences. and student success [44,45,46,47] and Dr. Pedro Mancias, who brought senior leadership experience (e.g. endowed full professor and fellowship director) and greater engagement of the south [43].

Giving Credit Where Credit Is Deserved

To maintain and support advisor engagement and strengthen a network of LHS+ leaders, an evaluation system was created to document and validate their contributions. On an annual basis, chapter leaders have been expected to evaluate their advisors and national student leaders have been expected to evaluate their advisory council. The LMSA National President and National Executive Director (or designee) provide the Faculty/Physician National and Regional Advisors and the Chapter Advisors with a letter describing their level and quality of advisement to their LMSA chapter, regional leaders, or national leaders. The letter aims to help advisors improve their skill set through feedback from LMSA members. Ultimately this assists the advisors to succeed in their own personal and professional growth. The letter can be simply added to promotion portfolios and facilitate faculty or senior leadership promotion.

Metrics included on the evaluation form include:

• 1. Participation in faculty advisor orientation.

• 2. Level of participation in faculty advisor trainings (monthly webinars or during the national conference).

• 3. Chapter submission of a strategic plan.

• 4. Level of participation in regional or national activities (e.g. Regional or National Conference; LMSA Policy Summit).

• 5. Evaluation by chapter leadership based on the above criteria of faculty advisor responsibilities (using a Likert scale and free text).

Characteristics of LMSA Chapter Advisors

Since 2018, the FPAC has worked to create a directory of chapter advisors to build a stronger national network of support for LMSA members, to enhance communication among advisors, and facilitate advisor training and promotion. In December 2019, a survey was conducted among advisors to collect contact information to support a directory and identify advisors’ personal and professional characteristics information to better support congruence for members. Between December 2019 and May 2020, data was collected from at least one advisor for 71% (96/136) of the LMSA chapters. The data collected was voluntary and limited by the responsiveness of the chapters’ advisors.

Among the 96 chapters, that had at least one advisor respond to the survey, 66 reported one advisor, 20 had two, 8 had three, 1 had four, and 1 had five advisors - for a total of 139 advisors; 66 had at least one advisor with an MD or DO degree; and 70 had at least one advisor who identified as LHS+. A goal of the FPAC is that 100% of chapters have at least one advisor who is MD or DO degree bearing and 100% of chapters have at least one advisor that is Hispanic-identified.

Among the 139 advisors, 127 completed the survey and provided personal and professional information. Of the 127 advisors, 65 (52%) were men and 62 (48%) were women. In terms of sexual orientation, 105 identified as straight, 7 as gay, 4 as bisexual and 11 did not respond to the question.

Figure 9.2 shows the ethnicity and race reported by the advisors. Not surprising, the majority 92/127 (72%) were Hispanic, followed by 20 (16%) African-American/Black, 14 (11%) White, 4 (3%) Asian and 3 (2%) American Indian.

Fig. 9.2

Ethnicity and race of LMSA chapter advisors, 2020. (©LMSA)

Of the 92 advisors identifying as LHS+, the five most prevalent nationalities were: Mexican - 36, Puerto Rican - 13, U.S. - 11, Colombian - 7, and Peruvian - 7, Ecuadorian – 4, Dominican – 4, Argentine - 3, Brazilian – 3, Cuban – 3, Salvadorean – 3, Chilean - 2, Panamanian – 2, Spanish – 2, Venezuelan – 2, Bolivian – 1, Uruguayan – 1, and Guatemalan – 1. This question was framed to assess ancestry and not birthplace.

45 of the 127 advisors were alumni of LMSA or one of the preceding regional groups that formed LMSA National (e.g. NBLHO, BHO, LMSA West, CMSA, LaRAMA, HAMSA, TAMSA, etc.). Among the 45 alumni, 42 were involved on the chapter level, 25 on the regional level, and 22 on the national level.

Figure 9.3 shows the number of years served by chapter advisors. The largest proportion 47 (37%) had served 2–4 years, followed by 27 (21%) serving <1 year, 16 (13%) serving 5–9 years, 15 (12%) serving 1 year, and 10 (8%) serving 10 or more years. Nearly one-third had served 1 year or less, an important group to mentor for longitudinal involvement.

Fig. 9.3

Length of Time Serving as Chapter Advisor (©LMSA)

Of the 127 advisors, 104 were faculty. In terms of rank, 7 were adjunct/volunteer, 7 instructor level, 37 assistant professors, 35 associate professors, and 18 full professors. In terms of tracks, 59 were on the educator track, 29 on the clinical track, 8 on the research track, 6 grouped as other, and 4 reported being administrators. In considering how many years advisors have before being ready for submission of their promotion credentials, 40 responded that it would be a period of 1 to 2 years, 19 reported 3–4 years, and 20 reported 5 or more years. Based on these proportions there is an ongoing need for FPAC to provide on-going, longitudinal support and professional development to ensure advisors succeed in the promotion process.

Table 9.2 highlights the affiliation (e.g. administrative, non-clinical and clinical) of advisors. Despite the wide variety of clinical departments represented, there were no advisors from the departments of emergency medicine, anesthesiology, radiology, or orthopedics; specialties shown to be in the top ten practice areas of the intent of all graduates of allopathic medical schools in 2019.

Table 9.2 Advisor Administrative/Non-Clinical/Clinical Affiliation and Top Ten Practice Areas of Intent reported by Graduates of Allopathic Medical Schools, 2019

When asked “What are the benefits of serving as an LMSA advisor?” the most common themes were supporting the academic, personal, and/or professional development of members (25 respondents); mentoring trainees (21); networking with students and colleagues (17); learning about the unique challenges for LHS+ students in the MD/DO pipeline and/or health issues of LHS+ communities (7); personal fulfillment from serving the LHS+ community (6); increasing LHS+ diversity in the medical workforce (6); and leadership development of trainees (3).

In 2022 the survey was re-launched to attain updated information, as well as account for the growth in the number of LMSA chapter advisors. The re-launching of the survey resulted in new and updated data for over 200 advisors across the nation. This was done in conjunction with a survey for all LMSA alumni, which combined with the advisor respondents, increased the LMSA Alumni and Advisor Directory to nearly 500 individuals.

LMSA is fortunate to have attracted a talented, driven and diverse group of advisors eager to serve their communities. The great majority of these mentors are still in the relatively early stages of their careers. As they serve LMSA members, FPAC is responsible for enhancing their professional development and academic advancement.

LMSA FPAC Accomplishments, 2017–2022

Since 2017, FPAC has created novel scaffolding for LHS+ faculty/physicians to serve as chapter-, regional-, and national-level leadership and programming to develop them personally and professionally. Opportunities have included leadership roles on the regional and national levels which supports their promotion potential; training on promising and best practices to support LHS+ and other minoritized pre-medical and medical students holistically; instruction on and how to convert their work to scholarship as a means of reducing taxation and building capital. The hiring of the first (and subsequent) LMSA FPAC consultant and eventual full-time staff member as FPAC Coordinators has helped to build and maintain communication and achieve objectives among a national network of advisors.

Part of the vision of LMSA has been to create unity among students, advisors, healthcare professionals and alumni with the goal of promoting the recruitment, retention, and promotion of LHS+ identified individuals in clinical and academic medicine. As part of this vision, it has been imperative to ensure our advisors are prepared and trained, on an annual basis, to effectively guide future physicians and leaders of medicine. Interestingly, there are few standardized programs to enhance the knowledge, skills, and competence of advisors. One nationally recognized standardized program is the AAMC Careers in Medicine Program (CiM) [49]. Through CiM, advisors can receive training to help trainees (a) assess their interests, values, personality, and skills to choose specialties that best fit their attributes; (b) learn about characteristics of various specialties; and (c) land the most favorable residency [49]. As such, CiM focuses on specialty choice and does not offer expansive information on overall career opportunities. Moreover, it does not tailor content for diverse groups who have remained underrepresented in highly competitive specialties. Without proper training, advisors may miss opportunities to distinctly enhance LHS+ medical students’ assets (e.g. build medical Spanish proficiency) and reduce deficits (e.g. build their limited professional network). With the evolution of FPAC, current LMSA members have submitted written complaints to National LMSA FPAC of experiencing microaggressions, discrimination, and sexual advances from LMSA and non-LMSA advisors and witnessing inappropriate conduct by advisors (e.g. excessive intoxication). Students have also commented about non-faculty advisors, especially of other partner organizations, lacking an understanding of LMSA history, policies, and procedures and knowledge and skills to help guide them about up-to-date medical education challenges and changes (e.g. racial/ethnic inequities with AOA designation; Step 1 scoring changed to Pass/Fail).

To address the lack of training for LMSA Advisors Dr. Sanchez created the LMSA Advisor Orientation and Training in 2017. The programming was first implemented at the 2017 LMSA National Conference at the Donald Zucker School of Medicine. The purpose of the training has been to bring together former and current advisors to (1) build a sense of an advisor community; (2) review with them the history, vision, and strategic plan of LMSA National; and (3) reflect and learn how to address on-going and emerging issues in promoting Latino representation in the medical and academic medicine workforces. From 2017 onward, to further promote professional development and scholarly productivity, advisors were encouraged to submit abstracts to be considered for workshop presentations during the training. This has provided advisors with an opportunity to present a workshop on a national level, which can support their academic promotion. Additionally, the training has served as an opportunity for advisors of junior rank to meet senior-rank advisors who can advise them on the promotion process or write them a letter of recommendation for their promotion package.

Core curricular content has included Orientation to LMSA and Prior Year Accomplishments (e.g. Review organizational history, structure, constitution, election procedures, and updated procedures); Faculty/Physician Advisory Council Structure, Function, Strategic Plan; Hispanic/Latino Students Needs and Assets and AAMC Resources; Effective Mentoring and Advising of LMSA Chapters; LMSA Opportunities: Achieving Scholarship and Promotion.

Invited topics have typically included new innovations in promoting Hispanic presence in the medical or academic medicine workforces, such as:

• “Office for Diversity and Inclusion: Engagement and Leadership Opportunities for Medical Students, Residents, Fellows” The workshop promoted Hispanic trainees’ effectiveness in leading change within medical schools by becoming better acquainted with office policies and procedures. Presented by Cheryl Brewster, EdD, Herbert Wertheim College of Medicine [15].

• “Teaching Medical Students Cultural Humility by Creating Mentoring Programs in Partnership with the Hispanic Community”. The workshop highlighted how LMSA members can complete scholarly work through community engagement activities. Presented by Claudio Cortes, DVM, PhD, Oakland University William Beaumont School of Medicine.

• “Jump Start Your Academic Career through Educational Scholarship: Publishing in AAMC MedEdPORTAL and Academic Medicine” The workshop encouraged advisors to publish their work in peer-reviewed journals to support promotion. Presented by Grace Huang MD, Editor in Chief, MedEdPORTAL, Dean, Faculty Affairs, Harvard Medical School.

• “Hispanic Applicants and Matriculants and Legal Concerns” The workshop summarized the prior and current legal challenges faced by Hispanic students in applying and matriculating to medical school, with a focus on Deferred Action for Childhood Arrivals (DACA) and undocumented status. Presented by Sunny Nakae PhD, MSW, and Francisco Lucio JD [12].

• “Getting Promoted as a Hispanic Faculty Member: Instructor/Assistant to Associate and Associate to Full Professor” The workshop detailed the current representation of Hispanics in academia and facilitators and challenges for Hispanics in the promotion process. Monica Vela, MD, FACP.

In 2021, Donald Rodriguez created a new catchy acronym for the program - LISTOS (LMSA Instruction, Support, Training & Orientation Session for Advisors). LMSA offers two LISTOS seminars annually, each seminar provides updated data points and often new sessions. As continuous training, improvement, and growth are necessary for LMSA’s success, all those serving in an advisory capacity to LMSA students are expected to attend at least one LISTOS seminar each year to remain in good standing with the organization. As NHMA, HSHPS and other partner organizations have striven to have access and advise LMSA pre-medical and medical students, their members are expected to also complete this training on annual basis. Since its inception, LISTOS has averaged 200 advisors in attendance annually.

National Center for LMSA Leadership and Advancement

In 2021 FPAC launched the National Center for LMSA Leadership and Advancement to respond to the paucity of LHS+-identified faculty and senior administrative leaders. For example, in 2021, there was only one LHS+ identified Dean of an accredited allopathic or osteopathic medical school on the mainland USA, Interim Dean Juan C. Cendán MD of Herbert Wertheim College of Medicine. Pedro “Joe” Greer, Jr. MD, Dean was selected to lead Roseman University College of Medicine in seeking accreditation by the LCME. The four medical schools in Puerto Rico were led by LHS+-identified Deans (Olga Rodríguez de Arzola MD, Dean, Ponce Health Sciences University School of Medicine Ponce, Puerto Rico; Yocasta Brugal MD, Dean, San Juan Bautista, School of Medicine, Caguas, Puerto Rico; José A. Capriles-Quirós, M.D., M.H.S.A., Dean of the School of Medicine, Universidad Central Del Caribe; and Agustín Rodríguez González MD, Dean, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico.)

The purpose of the center has been to provide LMSA faculty/physicians with the knowledge and skills to: (a) successfully support the academic, personal, and professional development needs of LMSA members and non-LMSA diverse trainees; (b) enhance discussion of Latina/o/x/e, Hispanic, or of Spanish Origin+ (LHS+) health-related discussions on their campus (e.g. equity, inclusion, bias); (c) understand how to utilize their LMSA work for promotion purposes and; (d) understand how to develop themselves to serve as senior leaders at academic health centers (e.g. Chairs, Dean, Chancellors, etc.) The model for this new national center was based on the successful model of the BNGAP National Center for Pre-Faculty Development [50]. Similar to the BNGAP Center, the LMSA Center has been situated within a diversity-related national organization rather than an academic health center, reducing overhead costs and political manipulation by a host institution. It has been financially supported by institutional/organizational memberships rather than solely by periodic state, federal, or private grant funding. Institutions could select from several membership tiers; each tier with its own set of benefits and annual fee. It exists in a virtual space and supported primarily by volunteer or part-time faculty/learners and a Center Director to reduce overhead costs. However similar to other Centers across the country it has been structured to produce scholarship, both research and education, affording diverse faculty/learners a further opportunity to advance.

Center offerings have included:

• 1. Heightened visibility of Center members’ efforts to promote LHS+ inclusion in medicine and academic medicine through the LMSA FPAC El Informe: A National Newsletter to Guide, Develop & Honor LMSA Advisors Newsletter, web-site, listserv, Facebook and Twitter accounts Center members were highlighted among the larger LMSA community.

• 2. Heightened networking opportunities for their institutional members through the LMSA network the constituents of Center members have had the opportunity to meet successful diverse faculty and collaborate on service, educational, and research endeavors on a local, regional, or national level.

• 3. Academic Medicine Medical Spanish Fellowship to promote medical Spanish publications

  • (a) This on-line 1–2 year fellowship introduces a medical student/resident/fellow/faculty member to opportunities to publish in medical education journals; components and best practices to submitting a project to MedEdPORTAL; and work in a team to submit a Medical Spanish project to MedEdPORTAL. The fellowship closely aligns with the new MedEdPORTAL Collection, Language-Appropriate Health Care and Medical Language Education Collection, led by Collection Editors Pilar Ortega, MD, MGM and Débora H. Silva, MD, FAAP, MEd and supported by MedEdPORTAL Editorial Board Member Anibelky Almanzar, MD, MA.

• 4. Sponsored registrations to LMSA Chapter Advisor Orientation and Update on Promising Practices (currently known as LISTOS: The LMSA Instruction, Support, Training & Orientation Session for Advisors)

  • (a) The CME-based one-day training helps chapter advisors and faculty mentors become knowledgeable and well prepared regarding LMSA history, policies, and practices to effectively guide LMSA members.

• 5. Sponsored registrations to LIDEReS: The LHS+ Identity, Development, Empowerment, and Resources Seminar

  • (a) The CME-based two-day seminar brings together faculty and physician advisors from across the United States and provides participants with inspirational and practical guidance and tools for pursuing career advancement in academic medicine. The seminar also helps participants develop key professional competencies that build self-efficacy, communication skills, and leadership while expanding their network of colleagues, role models, advisors, and champions.

• 6. El Informe: A National Newsletter to Guide, Develop & Honor LMSA Advisors

  • (a) Members are subscribed to receive a quarterly newsletter which includes LMSA FPAC activities, career and funding opportunities, upcoming events, and spotlights faculty members and trainees who are leaders of LHS+ health. The newsletter is disseminated to 3000+ diverse trainees, physicians, and faculty quarterly.

• 7. Access to nationally recognized speakers for Hispanic Heritage Month activities

  • (a) A distinguished Faculty/Physician Advisory Council (FPAC) or Chapter Member of the National Latino Medical Student Association Inc. (LMSA) presents a zoom-based Grand Rounds on Hispanic health, policies, and/or practices such as:

    • Latina/o/x/e, Hispanic or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership

    • Best practices in the recruitment and matriculation of Hispanic trainees to medical school, residency, and fellowship programs (e.g. DACA, holistic review, Step 1 scoring change)

    • Best practices in supporting the academic, personal and professional development of Hispanic medical students, residents, and fellows

    • Best practices in the recruitment, retention and promotion of Hispanic faculty

    • Hispanic presence and engagement in medical school leadership.

In July 2021, there were 16 inaugural institutional members of the center (Table 9.3).

Table 9.3 National Center Members

It was through the membership of these center members that the first full-time staff member was funded. Dr. Deion Ellis, a recent medical school graduate, was selected as the inaugural full-time Director of the National Center for LMSA Leadership & Advancement. Through his concerted efforts in this position, and by the start of the 2023 academic year, the center grew to include 22 medical institutions and organizations, including the American Association of Colleges of Osteopathic Medicine (AACOM).

Having Dr. Ellis as a staff member enhanced productivity and extended the outreach of LMSA initiatives. In addition, he expanded the online LMSA alumni directory; expanded the LMSA Specialty Sections; increased the number of LMSA chapters across the nation (allopathic and Osteopathic); coordinated the implementation of the 2nd annual trip to Puerto Rico for residency recruitment and Spanish curriculum exchange; helped to facilitate the creation, dissemination, and analysis of needs assessment data on the unique forms of discrimination faced by LHS+ identified medical students during the residency application process; and managed the planning of the Virtual LMSA 50th Anniversary Reunion. Since starting in his position, Dr. Ellis has contributed significantly to the advancement of LMSA National, LMSA FPAC and the National Center.

El Informe: A National Newsletter to Guide, Develop & Honor LMSA Advisors

Despite the investment of student advisors and faculty to ensuring LHS+ inclusion in medicine, there has been a historical lack of media outlets to guide their practices, provide on-going professional development, and honor their contributions and accomplishments. In 2021, National FPAC leaders, with the support of Donald Rodriguez, launched a new e-newsletter, El Informe, for the continued growth and edification of current and future faculty advisors. The e-newsletter has been developed on a quarterly basis (January, April, July and October) every year since its inception. Issues have highlighted alumni/faculty advisors’ work, publications, promotions; institutional position opportunities/announcements; and general updates. Since its inception Dr. Orlando Sola has served as a managing editor of El Informe.

Hispanic Heritage Month Lecture Series

Frequently, medical students and residents have raised concerns to LMSA leaders that there has been a lack of educational content on LHS+ health equity taught in college, medical school, and during residency. LHS+ identified learners have struggled to find LHS+ identified presenters and educators or non-LHS+ identified faculty/advisors with expertise in LHS+ health equity. Although this material has been sought for the standing UME and GME curriculum, student leaders and senior administrators have struggled to identify inspirational and knowledgeable speakers for Hispanic Heritage Month (HHM), which occurs between September 15th and October 15th of each calendar year, and uniquely galvanizes LHS+ community members. In response, the National Center for LMSA Leadership and Advancement has identified LMSA alumni and current faculty/physician advisors, and clarified their content expertise, to serve as distinguished HHM distinguished speakers for zoom-based Grand Rounds on LHS+ health, policies, and/or practices across the country. The majority of speakers have donated their honorarium to support the center. In 2021, five potential presentation topics were offered to institutions and by 2022 the directory had expanded to nearly 40 topics.

LMSA FPAC Specialty Sections

The LMSA FPAC Specialty Sections were created in 2021 to provide a space for LHS+ pre-medical, medical students, alumni, and FPAC (e.g. faculty and physicians), who are interested in the same specialty, to network and discuss personal, professional, and academic-related concerns and opportunities. The chairs selected were LHS+ identified faculty physicians that held the rank of Associate Professor or higher and/or served as a Department Chair. The Specialty Sections initially began with four specialties being represented in 2021–2022 but with the work of National and Regional FPAC, it was expanded to include 10 specialties for 2022–2023 (Table 9.4). During the winter of 2023, 4 additional specialty chairs were added (https://fpac.lmsa.net/lmsa-fpac-specialty-sections) including Rolando De Leon MD for Obstetrics and Gynecology; Orlando Ortiz MD, MBA for Radiology; Marcelino Rivera MD for Urology; and Shirley Sharp DO, MS, FACOFP for Family Medicine.

Table 9.4 Specialties included in specialty sections by year

LIDEReS: The LHS+ Identity, Development, Empowerment, and Resources Seminar

The on-going underrepresentation of LHS+ identified faculty in the higher faculty ranks (e.g. associate professor, full professor, tenure) and in senior administrative positions (e.g. Assistant and Associate Deans, Dean of the Medical School) was the primary impetus for the development of LIDEReS. In 2021, only 5.9% of faculty in allopathic medical schools were Hispanic, Latino, or of Spanish Origin, with less LHS+ representation in the advanced ranks of the professoriate - 5.4% of associate professors, 4.3% of full professors, and only 5 medical school deans [51]. Similar trends exist for LHS+ faculty/senior administrators at osteopathic medical schools [9]. Although other professional development programs have existed for racial and ethnic minoritized faculty (e.g. AAMC Minority Faculty Leadership Development Seminar and AAMC Mid-Career Minority Faculty Leadership Seminar) and women (e.g. AAMC Early Career Women Faculty Leadership Development Seminar), there has never been a professional development program designed and implemented by LHS+ identified faculty/senior administrative faculty for LHS+ identified residents and fellows with an academic contract in hand and junior, mid-career, and senior faculty/senior administrators, to help them progress to the next professional opportunity [52, 53]. LIDEReS was launched in July 2021, to provide LHS+ identified faculty members, physicians, senior staff members, advisors, and residents and fellows with a contract in hand, from across the United States, with inspirational and practical guidance and tools for pursuing career advancement in academic medicine. The multi-day seminar has been hosted annually, helping hundreds of participants develop key professional competencies that build self-efficacy, communication skills, and leadership while expanding their network of colleagues, role models, advisors, and champions. Since July 2021, there have been a total of 78 distinguished moderators and speakers and over 260 participants.

The inaugural LIDEReS served as the first forum for junior and senior LHS+ identified faculty and leaders to convene with AAMC President Skorton and discuss the historical, on-going, and emerging challenges of building LHS+ inclusion in medicine and academic medicine. During the session, entitled A National Perspective on LHS+ Leadership in US Medical Schools, several questions were posed about LHS+ senior leadership at the AAMC. Many had noted great pride in the leadership of Dr. David Acosta as the first ever LHS+ identified AAMC Chief Diversity and Inclusion Officer but were unaware of any other senior AAMC leaders of LHS+ identity. In addition, the participants raised concerns of the lack of LHS+ identified AAMC Board of Director (BOD) Members, a lack of prior BOD LHS+ identified members, and a lack of transparency of the selection process to serve as a board member. At the conclusion of the session Dr. Skorton invited participants to formally submit concerns and suggestions to him. On December 15, 2021, LMSA FPAC penned a letter to the AAMC as an invitation to collaborate to achieve LHS+ inclusion and equity in academic medicine and healthcare. The letter outlined 10 recommended action steps. The letter was signed by 53 distinguished LHS+ academic medicine faculty and leaders across the nation (Figs. 9.4 and 9.5).

Fig. 9.4

Letter to the AAMC (©LMSA)

Fig. 9.5

AAMC Response (©LMSA)

On January 20, 2022, The AAMC responded with a letter from Dr. Skorton. Both letters were shared and discussed, through several meetings, with LMSA National student and faculty/administrative leaders and letter signatories. For some of the FPAC leaders the response was considered ‘generic’ and ‘lacking commitment to real change’ while others felt it was the beginning of many future conversations. The vast majority of discussants advocated for a larger coalition to consider and be responsive not only to the 10 recommended action steps outlined in the letter but to on-going issues. In May 2022, the first meeting of the LMSA FPAC Collaborator Council was held with leaders of American Association of Colleges of Osteopathic Medicine (AACOM) (President Robert Cain), Association of American Medical Colleges (AAMC) (Dr. Norma Poll-Hunter and Dr. David Acosta), Accreditation Council for Graduate Medical Education (ACGME) (Dr. William McDade), American Medical Association (AMA) (Mr. Craig Johnson), American Osteopathic Association (AOA) (President Kevin Klauer), National Hispanic Medical Association (NHMA) (Dr. Elena Rios), and LMSA National/LMSA FPAC. The Council was created for LHS+ community representatives and stakeholders, consisting of members from within and external to these organizations, to advocate for, guide, and promote LHS+ initiatives and strategies at these organizations. Since its inception, members of this group have met bi-annually to collaborate on LHS + -identified students’, faculty and physicians’ concerns.

The 50th Anniversary of the first LMSA chapter afforded a unique opportunity to maintain attention on LHS+ inclusion in medicine/academic medicine and bring together organizational leaders to discuss the 10 recommendations. In addition to student led programming, FPAC organized three educational tracks – LIDEReS, LISTOS, and Alumni/Professional Track. As a part of the LIDEReS seminar organizational leaders including David Acosta MD, Robert Cain DO, and Bobby Mukkamala, MD (Chair of the AMA Board of Trustees) were in attendance. In addition, for the first time at the LMSA National Conference, LHS+ identified authors participated in a book signing and provided free copies to attendees.

LMSA 50th Anniversary

Cincuenta Años de Comunidad: Fostering Service, Health Equity, and Leadership (All Images and artwork property of LMSA) (©LMSA)

Recommendation 6. Commit to an action plan to address the ongoing microaggressions and overt discrimination towards students who attend the 4 LCME-accredited medical schools in Puerto Rico, especially as they apply for residency and fellowship programs.

After the 50th Anniversary, FPAC and the Collaborator Council attention shifted to work on the 10 recommendations especially recommendation 6 after the AAMC emailed the following correspondence to community members:

• The four medical schools in Puerto Rico are fully accredited by the Liaison Committee on Medical Education (LCME). Residents of Puerto Rico are U.S. citizens who carry U.S. passports, and graduates from these medical schools are graduates of a U.S. medical school, not international graduates.

  • AAMC Announcements and Information – May 9, 2022

For many in the LHS+ community an email alone, especially similar to prior emails, would inadequately address the on-going problem. For many students, alumni, faculty, and administrators it was neglectful, during calls for anti-racism/anti-ethnoracism, for LHS+ identified matriculants of the LCME-accredited medical schools on the U.S. mainland and in Puerto Rico to be mislabeled as “international”, “non-U.S. citizens” or “non-English speakers” and endure an inequitable burden as they apply for residency positions and strive to become physicians for our U.S. population.

In response, members of the Collaborator Council, LMSA National student leaders, and the Deans of the four medical schools in Puerto Rico met to design and implement a needs assessment to quantify and further illustrate the frequency and burden of discrimination faced by LHS+ identified medical students when applying to residency programs, especially students matriculated at the four LCME-accredited medical schools in Puerto Rico.

The needs assessment was disseminated between July 19 and August 22, 2022. A snapshot of the data is seen below:

After the data was collected, several webinars were hosted to share the results as well as a press release disseminated broadly across the nation. Subsequently, additional presentations were given to the Accreditation Council for Graduate Medical Education (ACGME) DEI Officer Forum, The AACOM Dean’s Forum and Retreat, several residency programs and GME offices. A follow-up study has been planned for February–March 2023.

Advancing Inclusion and Equity for the Osteopathic Community

Osteoapthic and allopathic students, faculty, physicians and administrators are equally valuable in advancing LHS+ health equity. As of December 2022, approximately 25% of LMSA student members and 20% of FPAC members have identified as a part of the osteopathic community. Only one LMSA National President, Lucas Warton, DO Candidate at Philadelphia College of Osteopathic. Medicine, has been from an osteopathic medical school. With osteopathic medical students representing nearly 1 in 4 medical students, it was critical for FPAC to enhance outreach to osteopathic medical school leadership. In the summer of 2022, LMSA FPAC and LMSA National entered into formal agreements with the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) through the leadership of AOA President Dr. Kevin Klauer and AACOM President & CEO Dr. Robert Cain. The AOA and AACOM have had representatives serving on the LMSA FPAC Collaborator Council. Since the beginning of the partnerships with AOA and AACOM, as of December 2022, LMSA has increased the overall percentage of chapters at osteopathic medical schools from 36% to 77%. Through engagement with AACOM, LMSA has come to learn of 2 LHS+ identified AOA Board of Trustees (Dr. Sonia Rivera-Martinez and Dr. David Garza) who are vested in supporting greater representation of LHS+ identified individuals across organizations.

Increasing LMSA Chapters at Allopathic and Osteopathic Institutions

In celebration of LMSA’s 50th Anniversary, LMSA FPAC subsequently began an initiative to fulfill the words stated by Dr. Sanchez at the gala, “No LHS+ identified medical student, anywhere in the U.S., should feel alone in medical school. By the end of 2022, we must aim to have a LMSA chapter at every osteopathic and allopathic medical school”. Since then, Center Director Dr. Ellis worked in conjunction with LMSA National President Roxie Gonzales, LMSA National CDO Santos Acosta, and all the LMSA Regional Co-Directors (Larissa De Souza, Kimberly Flores, Claudia Torres, Jordan Juarez, Christopher Vazquez, Darisel Ventura Rodriguez, Sierra Sossamon, Luis Valdez, Robert Olmeda-Barrientos and Vanessa Nuñez) to achieve the goal of 100% of osteopathic and allopathic medical schools with a LMSA chapter. For schools unable to mobilize a new chapter by the end of 2022, LMSA worked to link students and faculty with a neighboring medical school with an LMSA chapter. A neighboring chapter can serve as a sponsor for LHS+ students without a chapter and provide support and inclusion so none of them feel isolated. The hope is that the additional neighboring support provides the guidance and resources necessary to have that institution start its own chapter in the near future. As of December 2022, 97% of allopathic medical schools had a LMSA chapter (up from 88% in June 2022), 2% were connected with an established neighboring chapter, and 1% were in contact with LMSA FPAC to connect with a neighboring chapter. In terms of osteopathic medical schools, as of December 2022, 77% of had a LMSA chapter (up from 34% in June 2022) and 3% were connected with an established neighboring chapter.

Snapshot of LMSA FPAC Accomplishments

2017–2018

• 1st Advisor Orientation and Training

• Approval of FPAC

2018–2019

• 2nd Annual Advisor Orientation and Training

• Increase applicants for National Mentor of the Year and honor nominees

• Build directory of LMSA Chapter Advisor

• Provide guidance to LMSA National Executive Board on AOA response and Step 1 Pass/Fail response [34]

2019–2020

• 3rd Annual Advisor Orientation and Training

• Publish Content on Hispanic Health

• Respond to New ACGME Diversity Standard

• Recruit co-authors and contributors for new book on Latina/o/x/e, Hispanic or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership

2020–2021

• 4th Annual Advisor Orientation and Training + Midyear session

• Expanded number of LMSA National FPAC Advisors

• Instituted National FPAC Advisor contribution of $1250 to hire FPAC Coordinator

• Created aligned regional advisory councils/boards

• Build alumni database

• Drafted book on Latina/o/x/e, Hispanic or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership

• Launched El Informe: A National Newsletter to Guide, Develop & Honor LMSA Advisors

2021–2022

• 5th Annual LISTOS (formerly known as Advisor Orientation & Training)

• LIDEReS Training

• Maintain alumni base

• Build specialty groups

• Launch National Center for LMSA Leadership & Advancement

• Raise capital for LMSA staff member(s) through celebration of 50th Anniversary of LMSA Chapters

• Revise book on Latina/o/x/e, Hispanic or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership

• Continue Hispanic Heritage Month lecture series (with video recordings) for 2021

2022–2023

• 6th Annual LSITOS

• 2nd Annual LIDEReS Training

• Hired 1st full-time LMSA Staff Member

• Increased Institutional Members of the National Center for LMSA Leadership & Advancement

• Expanded Online Alumni Directory

• Expanded Specialty Sections

• 2nd Annual Trip to Puerto Rico for Residency Recruitment and Spanish Curriculum Exchange

• Created, Disseminated and Analyzed Data on the Unique Forms of Discrimination Faced by the Medical Students of Puerto Rico

• Continued Hispanic Heritage Month lecture series (with video recordings) for 2022

• Hosted LMSA 50th Anniversary

• Hosted LMSA 50th Anniversary Reunion - Planning for the Next 50 Years

• Revised and Published Book: Latina/o/x/e, Hispanic or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 years of Presence, Activism, and Leadership

• Drafted LIDEReS Book

• Increased Percentage of Medical Institutions with an LMSA Chapter to 95% (Allopathic & Osteopathic Combined)

• Launched Collaborative Group Comprised of AACOM, AAMC, ACGME, AMA, AOA, HSHPS, NHMA, LMSA National and LMSA FPAC

• Supporting Endowed Awards for LHS+ Identified Academic Medicine Leaders (Valerie-Romero Leggott MD, Diversity, Equity, and Inclusion Excellence Award, Health Sciences Center, University of New Mexico; Nilda Soto MSEd, Diversity, Equity, and Inclusion Excellence Award, Albert Einstein College of Medicine; Nelson Felix Sánchez, MD LGBTQ+ Excellence Award at Weill Cornell Medicine)

• Launch LMSA FPAC LHS+ Health Equity Medical Education Project

• Launch LMSA FPAC Medical School Fund Campaign for the first mainland bilingual, bicultural medical school

Looking Ahead

With the LHS+ population representing the largest non-white racial/ethnic group in the U.S., the current proportion of LHS+ faculty is insufficient to advise current LHS+ medical students and prepare the entire workforce to address unique LHS+ health issues and disparities. FPAC will be well positioned to recruit, train, and support LHS+ physicians and faculty as they assume leadership roles on the local/institutional, regional or national level. In doing so, LHS+ physicians and faculty can be supported to break through the LHS+ glass ceiling and assume senior administrative positions within academic medicine, as Residency Directors, Deans, Chairs, and other positions. LHS+ medical students will then have a larger cohort of congruent role models, mentors, and champions to support their development.

1st Annual LMSA National Orientation and Advisor Training, 2017 (©LMSA)

2nd Annual LMSA National Orientation and Advisor Training, 2018 (©LMSA)

4th Annual LMSA National Orientation and Advisor Training, 2020 (©LMSA)

LISTOS, 2022 (Philadelphia, PA) (©LMSA)