Direct and Indirect Effects of Restrictive US Immigration Policies on Pharmacy Education

Keywords: immigration, cultural competency, policy, international students, international faculty INTRODUCTION Immigration policy and enforcement in the United States has experienced many ebbs and flows over our 244year history as an independent nation, with policies either supporting or opposing the influx ofnew citizens at different stages ofdevelopment.1 Nopoliticalparty can claimthe proverbial "high ground" when immigration policy is viewed through a greater historical lens, but the Trump Administration campaigned on a hardline anti-immigrant platform and effectively executed several actions to restrict immigration into the United States throughout his term in office.2 The nonpartisan Migration Policy Institute (MPI) cataloged more than 400 executive actions under the Trump AdministrationthateffectivelyreshapedtheUSimmigrationsystem, including actions on border protection, asylum case administration, immigration courts, and visa processes.3 While immigration policy changes in the United States have broad implications on the economy, culture, and everyday life of millions of people, leaders in pharmacy education may not always connect these larger policy actions to the specific needs of our more focused pharmacy education stakeholders (students, faculty, staff, etc). [...]whenImmigration and Customs Enforcement (ICE) announced in July 2020 that students who were enrolled in schools that were shifting to online-only educationbecause ofthe coronavirus identified in 2019 (COVID-19) pandemic would not be eligible to retain their student visas and could be subject to deportation procedures unless they were attending at least onein-personclass,immigrationpolicybecameamajorpriority for higher education leaders.4 While this rule was revoked shortly after, this action and the preceding pattern of immigration restriction raises concerns for those who are involved in pharmacy education and brings about the question of how future immigration policies could impact pharmacy schools. [...]from a patient care or public health perspective, retaining these graduates may have a positive impact on reducing health disparities in the United States, and we discuss this in more detail below under indirect effects.8-10 Another direct impact of changes in immigration policies involves the potential reduction in the number of international faculty employed by US schools of pharmacy. Considering that international faculty members are prime candidates to serve as mentors to international students, a lack of non-US-born faculty members would mean that there would be fewer mentors for international students that understand their background and may be better equippedto help guidethese students in anunfamiliar environment.12 The education of pharmacy students on cultural competency and sensitivity is an integral part of pharmacy school curriculums and is explicitly reviewed as part of the accreditation standards of the Accreditation Council for Pharmacy Education (ACPE).13 The American College of Clinical Pharmacy ' s(ACCP ' s) Task F orce on Cultural Competency developed a series of white papers in the early 2000s describing cultural competency for health professionals and how it should be viewed as a continuous process undertaken to ensure that care of diverse populations is delivered in an appropriate manner. 14 Further, the task force specifies that becoming culturally competent also requires a "conscious effort to reduce any ethnocentric biases" one may have.14 In other words, pharmacy students must demonstrate that they do not believe any one culture to be superior to another.