Increasing diversity of the biomedical workforce through community engagement: The University of Utah Native American Summer Research Internship.

An engaged diverse biomedical workforce is essential for the health of a nation. Diversity fosters a more creative work environment and is associated with a more accomplished workforce and higher scientific impact. These attributes are particularly important in the fields of biomedical research and healthcare that rely on innovation. Our nation faces unprecedented challenges and opportunities to develop and translate new knowledge into improved health for all individuals through better understanding of disease mechanisms, improved diagnostics and therapeutics, prevention strategies, and evidence-based health policy that can contribute to sustainable models for healthcare delivery and eliminate health disparities. Reaching these ambitious goals will require the identification, recruitment, education, and training of the most talented scientists in the US. Unfortunately, data indicate that we are not currently benefitting from the talents of all citizens.1-4 This is particularly true for the American Indian/Alaska Native (AI/AN) population.1 AI/ANs represent only 0.6% of the biomedical work force; 0.3% of physicians and medical school faculty and 0.3% of the science and engineering workforce are AI/AN.1-4 Barriers for AI/ANs choosing biomedical careers include poorly funded tribal schools, lack of mentorship, culture barriers, or rural geography. For example, the University of Utah School of Medicine has had active summer research programs for undergraduates for more than 30 years, but has failed to recruit a single AI/AN student. This failure may have been due to cultural differences between majority and minority populations that were not recognized during program development. Our objective was to create a culturally relevant research experience that attracts and nurtures AI/AN students interested in pursuing biomedical careers. We have created the Native American Research Internship (NARI), which is an NIH-funded program that has been recognized with the University of Utah “Beacons of Excellence Award” in 2012, and the “Diversity Award” in 2013. These awards recognize excellence in creating and offering a transformational experience to undergraduate students and the enhancement of diversity on campus. We provide a description of the development and outcomes of the NARI program. Community Engagement To address the disparity of AI/AN students’ inclusion in undergraduate research programs, the University of Utah Department of Pediatrics and the Utah Center for Clinical and Translational Science (CCTS) proposed developing an undergraduate research experience to support AI/AN students based on the principles of community engagement (Table 1). The principal investigators began a dialogue with AI/AN elders and eventually formed partnerships with the AI/AN community. Partners included tribal elders from the Navajo Nation, Community Faces of Utah that is a CCTS organization that supports diverse communities, the Urban Indian Center of Salt Lake City, and Primary Children's Hospital. These groups helped to develop the Native American Summer Research Internship (NARI) program and have provided guidance over the last 5 years that has enhanced and supported the programs. Table 1 Principles of Community Engagement and Development of the NARI Program Development of a Culturally Relevant Summer Research and Career Development Experience The NARI summer programs include a number of cultural adaptations designed to promote trust, recruitment of students, and retention in scientific disciplines. Tribal elders felt that the most effective way to eliminate health disparities among AI/AN people was to increase their representation in the biomedical workforce. Elders stated that the Native communities wanted access to AI/AN health care providers and wanted to participate in clinical research conducted by AI/AN scientists. They believed AI/AN undergraduates could benefit from exposure the biomedical professions by participating in summer research and career development experiences that respected the Native heritage of the students. In response, tribal elders, AI/AN community and faculty members, other faculty, staff, and students built a trusting partnership and participated in the design and development of a 10-week NARI Program for undergraduate AI/AN students interested in pursuing a biomedical career. The NARI program provides a residential experience on the University of Utah campus and students receive a stipend, meal plans, and access to campus amenities. Students are housed together to avoid social isolation and participate in an orientation that includes both training and social events that provide opportunities for the creation of supportive peer and mentored relationships. Students are then assigned to scientific mentors and participate in rigorous hands-on research. Research experiences span the translational spectrum from basic laboratory science through clinical trials and health services research. Students are able to select the type of research project that they would like to experience. The program directors work to identify investigators working in scientific areas that are of related to the health priorities of AI/AN communities such as diabetes, heart disease, lung disease, and cancer. All research experiences support AI/AN cultural values. Students, mentors, and program directors engage in dialogue about the selection of a research project and include topics such as participation in research that involves animals and the sacred nature of animals in the Native communities. Critical and unique to the NARI program is the continued role of community partners during the summer experience and in the months between. This includes employing a member of the Dine (Navajo) community who serves as the program coordinator. The placement of a member of the AI community in this role facilitates the recruitment of students through trusted individuals from tribes, tribal colleges, and AI programs at institutions outside of the University of Utah and the state. The AI/AN community is also involved in the selection of students for the program. Another unique element of the NARI program is the assignment of an AI/AN cultural mentor to each student. These mentors come from the campus and local community and most work in scientific disciplines. The cultural mentors are available for continued support of the student's cultural identity in and out of the classroom and they serve as an important translator for students as they immerse themselves in in the new culture of biomedical research. During the summer experience, we host weekly “talking circles” at the lunch hour. Talking circles consist of research presentations, discussion of AI/AN health issues, and topics related to professional development. Scientific and cultural mentors attend and support students as they reflect on their academic, career, and personal development. Students share their experiences and challenges. Scientific, cultural, and peer mentors presence enables students to grow in confidence in many domains. Research mentors, cultural mentors, and program staff also meet individually with NARI students during the internship. Students complete a self-assessment, which then serves as a framework and structure to identify interests, opportunities, and gaps early in the internship. NARI students are able to participate in the internship for two summer sessions and we offer the ability to serve as a teaching assistant for experienced students. The program also extends support beyond the internship. Mentors and program staff assist students throughout the year and provide advising, letters of recommendation, notices of research and academic opportunities, networking, and job references. We use social media and maintain a NARI Facebook page to enhance our communication with interns and to foster communication between former interns and mentors.