National Association of Minority Medical Educators NAMME, Northeast Regional Meeting

1. National Association of Minority Medical Educators NAMME, Northeast Regional Meeting San Juan, Puerto Rico “Recruit, Reclaim, Retain” América Facundo, PhD Professor, Internal Medicine Department University of Puerto Rico School of Medicine February 22, 2013 Embassy Suites Hotel, Isla Verde, PR

2. Objectives Examine the case of Puerto Rico as an example Explore how the social determinants of “life” influence, facilitate or hinder outcomes Explore the role of government agencies as obstacles in the education process Define the target

3. Who are we recruiting From what are we reclaiming How can we retain What outcomes can be expected

4. Who are we recruiting Focused on disadvantaged backgrounds Public high schools By current public school standards, low English proficiency 91 % of schools do not fulfill basic academic progress, according to the Puerto Rican academic proficiency exams and the “No child left behind” standards. Lack of an academic culture

5. Who are we recruiting Teachers: quality is too variable, number is too low, average salary $21,600 Hurry: between 2005 - 2011 > 17,574 students left school to take the high school equivalency exam Public high schools: low professional expectations Physical education and arts are non existent in most schools

6. Social determinants 45% of the population living under poverty level www.census.gov/prod/2011pubs/acsbr10-01.pdf 1,600,000 out of 3.7 million qualify for state-paid health services (43%) and close to 60% for food stamps 300,000 have no health insurance $16,300 average per capita salary in 2010 Unemployment: over 20% for most municipalities Sub-employment: unknown 385,000 “legally registered” firearms Average murders per year: 1,200

7. Social determinants Low educational level of parents and lack of motivation to get involved in children’s education Cell phones, social networks, electronic games Consumption as a high value

8. Social Determinants Violence and crime Drug dealing is estimated to produce $1,500 per week for adolescents

9. School Dropouts Estimated in over 48.2% by social scientists Department of Education claims not to have a “definition” of “school dropout” Allegedly impossible to determine due to transfer to low cost private schools and to emigration to the U.S. (the Island’s population: 200,000 less in the 2010 census compared to year 2000) Physical conditions of many of the public schools are deplorable (1,481 public schools)

10. Role of the Government Secretary of Education is often appointed on the basis of political party affiliation, not credentials. Budget: over $3.5 billion, for catastrophic results. Most of the budget is spent in payroll. No libraries, computers, or web access in most schools Excessive bureaucracy to justify the existence of excessive administrative employees.

11. Role of the Government Corruption Secretary of Education: Victor Fajardo(1994-2000) $4.3 million Illegally appropriated for his own profit and for his political party. Confessed his crime on February 2002. Sentenced on December 11, 2002. Currently in prison in Georgia, with a 12 year sentence and order to restitute the stolen money.

12. Reclaim from what to what? Reclaim from an adverse environment to provide orientation and motivation to continue studies, ideally in the health professions Approximately 19% of the 110 students admitted each year to the UPR School of Medicine are from disadvantaged backgrounds. Another 15% are on the verge, compared to the majority of the class. Literature indicates the same as for minorities in the U.S.: more willingness to serve communities similar to their own.

13. Strategies “Medicine and other Health Professions Clubs” Club initiation activities Recruitment Coordinator Selection of some schools specialized in Science and Math to increase success rate Study material with logos of the School of Medicine and the Campus as incentives and for a sense of belonging to the Clubs

14. University Gardens SchoolSpecialized in Math and Science

15. Strategies Visits to the Medical Sciences Campus Most are to be first generation university students, no previous exposure to higher education Establishment of networks with local primary care physicians and allied health professionals On-site “health clinics” Surveys of their health topics interests On-site interactive presentations by our campus students on the health topics selected Website Facebook

16. Strategies Orientation on: Orientation on health careers, accounting for length of time they take Financial aid Counseling on how to maintain a solid academic record Target are the University of Puerto Rico campuses…as opposed to the private colleges and universities Summer Program offered by the Medical Sciences Campus for high school students

17. Recruitment Allies Teachers of science, math, Spanish, English (and, if available, health) in the public school system Medical and other health professions students Faculty: medicine & other health professions

18. The Pledge to Become a Health Professional Ceremony

19. The Pledge to Become a Health Professional Ceremony

20. Target Increase the number of students from disadvantaged backgrounds that compete successfully for admision to medical or other health professions schools Delineate a Recruitment Program that would be useful to other institutions Increase the number of health professionals willing to serve the underserved

21. “Many small people, in small places, doing small things, may change the world.”