Building a Pathway for Diverse Leaders in Hematology

As a Latin woman, walking into a large medical conference can be a lonely experience. But Jacqueline C. Barrientos, MD, said that feeling faded away for her at the American Society of Hematology (ASH) Annual Meeting when she entered a room full of hematologists who were current or former recipients of research awards granted through the Society’s Minority Recruitment Initiative (MRI), a program that is reaching a milestone 20-year anniversary this year.

“There are so many prejudices and biases that affect minority physicians and people in training. Seeing successful people who went through the same or even worse things, it’s uplifting. It gives you a sense of power that you might not feel otherwise,” said Dr. Barrientos, who is chief of hematologic malignancies and director of oncology research at Mount Sinai Medical Center in Miami Beach, Florida.

She is also a 2014 recipient of the ASH-AMFDP Award, a partnership between ASH and the Harold Amos Medical Faculty Development Program (AMFDP) of the Robert Wood Johnson Foundation. Dr. Barrientos is one of more than 25 recipients of the ASH-AMFDP Award since it was first given in 2006.

The ASH-AMFDP Award is a mentored research training grant given to hematologists from backgrounds historically underrepresented in medicine who are early in their academic careers. The award serves as the capstone to an extended pathway of research awards under the ASH MRI. Launched in 2003 with one award for medical students, the ASH MRI now includes six research funding opportunities for trainees, PhD students, residents, fellows, and junior faculty.

“The ASH MRI is now established as a 13-year unbroken pathway that starts from the first year of medical school, goes through residency and fellowship, and then through [one’s] early academic career with the ASH-AMFDP Award,” said Christopher R. Flowers, MD, division head ad interim of the Division of Cancer Medicine at MD Anderson Cancer Center in Houston, Texas, and the first recipient of the ASH-AMFDP Award. “That pathway makes it very clear for those starting their careers in medical school that hematology is a field they can be successful in but also well supported in.”

ASH Clinical News spoke with hematologists involved in the creation of the MRI and the ASH-AMFDP Award, as well as past recipients of these grants, to find out how the programs have evolved and the effect they’ve had on the careers of hematologists from backgrounds underrepresented in medicine.

Starting With Med Students

The ASH MRI was launched 20 years ago as evidence continuously reinforced the fact that in order to improve access to care and quality of care for patients from minority backgrounds, more physicians and physician-scientists from underrepresented backgrounds were needed.¹ In 2003, a report from the National Academies’ Institute of Medicine highlighted the existence of health disparities among racial and ethnic minorities in the U.S., which persisted regardless of insurance status, income, age, and medical condition severity. The report also noted that increasing the number of minority health care providers had the potential to improve care since these providers were more likely to work in medically underserved communities.²

Building that workforce would require overcoming some of the barriers to recruiting and retaining physicians from underrepresented backgrounds. Thus, the Minority Medical Student Award Program (MMSAP) became the first piece of the MRI pathway. The program provides medical students from underrepresented backgrounds in medicine with the chance to conduct research under the supervision of an ASH research mentor, while also receiving career development guidance from a second mentor.³

Students have the option to pursue research for eight to 12 weeks in the summer or part time throughout the year or to take a year off and complete a year-long project. For each research track, ASH provides a stipend plus additional funding for research supplies. Awardees also receive funding to travel to the ASH annual meeting and present their research at the Promoting Minorities in Hematology event, in addition to ASH membership through residency.

Melody Smith, MD, an assistant professor of medicine in the Division of Blood and Marrow Transplantation and Cellular Therapy at Stanford University, said receiving the MMSAP in 2005 had a significant effect on her career path. As part of the program, she spent two summers working in the lab of Edmund “Ned” K. Waller, MD, PhD, at Emory University, where she investigated bone marrow transplant in mouse models under the mentorship of Dr. Flowers. The experience set her on a path toward research and she decided to pursue a career focused on bone marrow transplant.

“I enjoyed the translational implications of how the immune system could be harnessed to treat blood cancer, but I also had great mentors,” Dr. Smith said.

More than a decade after her first engagement with ASH, Dr. Smith stays in regular contact with her research mentor, Dr. Flowers, and her career development mentor, José López, MD, chief scientific officer at Bloodworks Northwest and professor of medicine in hematology at the University of Washington in Seattle. Dr. Smith has also stayed involved with ASH, serving on the ASH Committee on Diversity, Equity, and Inclusion (DEI); chairing the ASH Research Training Award for Fellows (RTAF) study section; and serving as a research mentor for a medical student through the MMSAP.

Creating Role Models

With the ASH MRI off the ground, ASH leaders began looking at ways to address the lack of diverse representation at the other end of the spectrum – among medical faculty.

Dr. López and Cage S. Johnson, MD, professor emeritus of medicine and of physiology and biophysics at the Keck School of Medicine at the University of Southern California, were the founding co-chairs of the ASH Committee on Promoting Diversity, now called the ASH Committee on DEI.⁴ They helped launch the MMSAP and considered how ASH could help promote the retention of underrepresented faculty. Dr. López, who was a recipient of the Robert Wood Johnson Foundation’s AMFDP Award in the 1980s, suggested partnering with the AMFDP to bring that opportunity to more early-career hematologists.

“That program left an impression on me in terms of the way it had been structured and also the success of it,” Dr. López said. “I kept pushing the idea that we should talk to them and that we didn’t have to reinvent the wheel.”

In partnering with the AMFDP, which was launched in 1983, ASH took advantage of the program’s existing infrastructure, including review panels. The AMFDP also gained representation on ASH’s Committee on DEI. Since the beginning of the partnership, ASH has provided funding for one to two hematology scholars each year through the ASH-AMFDP Award.

The ASH-AMFDP Award provides four years of postdoctoral research support to scholars from underrepresented backgrounds who are committed to careers in academic medicine. The award includes an annual stipend of up to $75,000 and an annual $30,000 supply budget to support research. Scholars are expected to spend at least 70% of their time on research activities with the support of a senior faculty member at their academic institution. Like the mentorship model of other MRI awards, ASH-AMFDP scholars receive research and career guidance from a mentor, but they are also assigned to a member of the program’s National Advisory Committee (NAC) for additional support. Scholars also receive a stipend to attend the ASH and AMFDP annual meetings for four years and complimentary ASH membership.⁵

To be eligible, candidates must have completed formal clinical training and be pursuing a career in academic medicine, be prepared to devote four consecutive years to research, and be committed to serving as role models for students and faculty from similar backgrounds.

“The return on investment has been high in the sense that most of the awardees are in academia, they are now mentors to others, and they continue to serve ASH and be very active within ASH,” said Arturo Molina, MD, a hematologist who has served on the AMFDP NAC since 2006. “This network of scholars is very close to each other, but also close to ASH, and they support ASH activities.”

The program boasts that more than three-quarters of AMFDP scholars across medicine remain in academic medicine, including eight alumni who are deans or presidents of schools of medicine or colleges. Additionally, two alumni are directors of institutes at the NIH and more than 20 have been elected to the National Academy of Medicine.⁶ Notably, one past recipient of the AMFDP Award, Alexis A. Thompson, MD, MPH, served as ASH president in 2018.

Influencing the Gatekeepers

While the AMFDP has enjoyed a long record of success, the program began because the Robert Wood Johnson Foundation was struggling in its efforts to increase the number of students from underrepresented backgrounds entering U.S. medical schools. James R. Gavin, III, MD, PhD, who is a past national program director for the AMFDP and sits on the NAC, was in charge of the initial medical school initiative in the 1980s. A few years into the program’s implementation, data revealed it hadn’t moved the needle much, despite identifying highly qualified students.

“The students who were getting into medical school looked a lot like students who were not,” Dr. Gavin said. “It turns out that the limiting factor was that admissions committees had no underrepresented minority faculty. The gatekeepers were cherry picking but not really moving the numbers because that was not a priority for them.”

Dr. Gavin and his colleagues took a step back and decided to focus on increasing diverse faculty representation at medical schools, with one of the goals being to create greater representation on admissions committees.

“We needed to enrich the pipeline, but what we needed to do first was have an influence on the gatekeepers,” he said.

With the ASH-AMFDP partnership going into its 18th year, other medical societies are taking notice. The American Society of Nephrology, the American Heart Association, the American Association for the Study of Liver Diseases, and a consortium of the American Thoracic Society, the American Lung Association, and the American College of Chest Physicians have all partnered with the AMFDP to address the lack of diversity among academic research positions.

“ASH has become the model for what we would hope to see across clinical and medical disciplines,” Dr. Gavin said.

The MRI grew over the years as the Society’s commitment deepened and an increasing number of external supporters allowed the number of programs funded to expand, according to Dr. Johnson. ASH added the Minority Graduate Student Abstract Achievement Award in 2011, the Minority Resident Hematology Award Program in 2017, and the Minority Hematology Fellow Award and the Minority Hematology Graduate Award in 2020.

“The growth and spread of the program have just been remarkable,” Dr. Johnson said.

Fostering Mentorship

 The MRI mentorship model, which provides research and career development mentors, is a critical part of all the programs within the MRI, including throughout the course of the ASH-AMFDP Award.

Mentors can be a “sounding board” for career decisions, assist in helping mentees find work-life balance, and even intervene when scholars aren’t getting the support they need, such as the protected research time that is central to the ASH-AMFDP Award, Dr. Molina said.

Dr. López said the intervention of his AMFDP career development mentor was what kept him from quitting academic medicine when he ran into obstacles early on.

“For me, that was key,” he said. “I don’t think I would be in academics if not for that help.”

His mentor traveled from Washington, DC, to Seattle to discuss the issue in person and help identify a solution. Dr. López ended up moving to a new lab that was a better fit for him, a change he said he couldn’t have negotiated on his own at that stage in his career.

“One thing that I don’t think is appreciated much is how vulnerable people are at that stage in their career because essentially it’s make it or break it,” Dr. López said.

He added that early career is an especially critical time for physicians from underrepresented backgrounds who may not have the same level of support as physicians from other backgrounds.

Dr. Johnson agreed, noting that mentorship is a key part of retaining these physicians.

“Making a career in academic medicine is very difficult if you’re by yourself,” he said. “If you don’t get promoted, if you’re not productive, then you’ll be eased out. Having the mentorship, the role models, and the support is what keeps you in the field so that you can develop your program and your status to its highest level. That is one of the most important aspects of these kinds of programs.”

Dr. Smith had a full circle mentoring moment at the 2022 ASH Annual Meeting when she attended the MRI dinner with both her MMSAP mentee and her research mentor, Dr. Flowers, who now serves as an ASH Councillor and was a 2022 recipient of the ASH Mentor Award. As a mentor herself now, Dr. Smith is sensitive to the worries that are unique to students from underrepresented backgrounds.

“When medical students from underrepresented backgrounds look around and see that few of their peers look like them, they may have concerns pertaining to the more subjective aspects of training. They may ask, ‘Am I being evaluated in a similar fashion to my peers from different backgrounds?’” Dr. Smith said. “Hence, I try to counsel my mentees to be proactive in seeking feedback to allay some of these concerns.”

Looking Ahead

While the accomplishments of past MRI recipients and continued interest in the program stand as measures of success, Dr. Smith said the ASH Committee on DEI, in conjunction with the MRI Programs Subcommittee, is also analyzing data on the various award programs to assess clear metrics for past awardees.

“We’re going to analyze all of the qualitative and quantitative data so that we can understand how we have progressed. This assessment will help us to understand where we are now and aid in the development of the next goals,” Dr. Smith said.

One area under discussion is whether there are ways for ASH to reach students earlier in their education, either at the college or high school level.

“That’s probably a bit more logistically challenging because those students are even more undifferentiated in terms of whether they will pursue a career in medicine, much less hematology,” Dr. Smith said. “Nonetheless, I do think that the [ASH MRI] has fostered tremendous progress in our field and pioneered a continuous pipeline, which I believe other professional societies and subspecialties could emulate.” 

References

1. American Society of Hematology. History of the ASH Minority Recruitment Initiative. Accessed Feb. 24, 2023. https://www.hematology.org/awards/minority-recruitment/history.
2. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.
3. American Society of Hematology. ASH Minority Medical Student Award Program. Accessed Feb. 25, 2023. https://www.hematology.org/awards/medical-student/minority-medical-student-award-program.
4. American Society of Hematology. The American Society of Hematology honors Cage S. Johnson, MD, and José A. López, MD, with the ASH Award for Leadership in Promoting Diversity. Published August 14, 2018. Accessed March 3, 2023. https://www.hematology.org/newsroom/press-releases/2018/ash-honors-cage-s-johnson-md-and-jose-a-lopez-md-with-award-for-leadership-in-promoting-diversity.
5. American Society of Hematology. ASH-AMFDP Accessed Feb. 25, 2023. https://www.hematology.org/awards/career-enhancement-and-training/amos-medical-faculty-development-program.
6. Harold Amos Medical Faculty Development Program. Program highlights. Accessed on Feb. 24, 2023. https://www.amfdp.org/about/history/program-highlights.