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Research Reports |
AR Haskins, PT, EdD, is Associate Professor, Department of Physical Therapy, Florida International University, UP Campus, HLS 348, Miami, FL 33199 (USA)
N Kirk-Sanchez, PT, PhD, is Assistant Professor, Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Fla
(haskins{at}fiu.edu). Address all correspondence to Dr Haskins
Submitted November 2, 2004;
Accepted May 27, 2005
 | Abstract |
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Subjects. Seventy program directors of programs offering master’s or doctoral degrees in physical therapy responded to a survey.
Methods. The survey questionnaire requested information on program demographics, numbers of applicants, students and graduates from minority groups, and recruitment and retention strategies utilized. The most frequently used strategies were identified. Wilcoxon rank sum tests were performed to determine which strategies were associated with better recruitment and retention of students from minority groups.
Results. Fifty programs made a special effort to recruit and retain students from minority groups. Nine recruitment strategies and 3 retention activities were associated with programs having higher proportions of minority applicants, students, and graduates.
Discussion and Conclusion. The most frequently used strategies were incongruent with the strategies used by programs with higher proportions of applicants, students, and graduates from minority groups. This study provides information to help physical therapist educators determine which strategies help recruit and retain students from minority groups. [Haskins AR, Kirk-Sanchez N. Recruitment and retention of students from minority groups.]
Key Words: Black/African American • Diversity • Education • Hispanic/Latino • Recruitment • Retention
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According to US Census data, only 12.6% of physical therapists are members of minority groups, with only 5.6% self-identifying as black/African American, 3.2% as Asian, and 3.6% as Hispanic/Latino.3 Among members of the American Physical Therapy Association (APTA), members of minority groups, particularly those of Hispanic/Latino and black/African-American race or ethnicity are even more underrepresented than as reported by the US Census. Only 9.2% of all APTA physical therapist members self-identify as a member of a minority group, with 1.9% claiming to be Hispanic/Latino and 1.5% indicating that they are black/African American.4
The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,5 described evidence of racial and ethnic disparities in health care across a wide range of disease areas, clinical services, and clinical settings. Because these racial and ethnic disparities result in worse outcomes and higher mortality rates,5 they need to be identified and addressed. The report stated that many sources contribute to disparities in health care for racial and ethnic minority groups. One of those sources is health care provider prejudice or bias. Another source is patient mistrust and refusal. In order to counteract these sources, Recommendation 5-3 of the Institute of Medicine report was to increase the proportion of underrepresented members of minority groups in the health care professions, using affirmative action and other efforts to the extent legally permissible. Diversity in the health care professions would strengthen the patient-provider relationship and reduce health care disparities:
Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment. ... In addition, racial and ethnic minority providers are more likely than their non-minority colleagues to serve in minority and medically underserved communities ... the evidence of diversity in the health professions will accrue broadly, as this diversity helps to expand the disciplines’ ability to conceptualize and respond to the health needs of increasingly culturally and linguistically diverse populations.5(p186)
The APTA has developed and periodically revises a plan to foster minority representation and participation in physical therapy (BOD 11-98-06-12).6 Current activities include: sponsorship of a minority scholarship fund, maintaining a directory of minority members and minority speakers to increase representation at state and national meetings, support of the Advisory Panel for Minority Affairs, and creating workshops for physical therapy education faculty to learn about recruitment and retention strategies for minority students.6
Many studies7–11 have examined recruitment and retention of students from minority groups in medicine and allied health. Successful recruitment and retention activities identified in the literature include: partnerships with elementary, middle, and high schools; prematriculation academic enrichment courses; comprehensive orientation and advising programs; peer, alumni, professional, and faculty mentorship; study skills assistance and academic tutoring; reading and critical thinking enhancement; stress-reduction strategies; licensure examination preparation; and cultural diversity in the curriculum. Cultural diversity in the curriculum includes lectures on understanding and living in a diverse environment, cross-cultural communication courses, and clinical experiences and community partnerships with minority populations.10
Many recruitment and retention strategies have been proposed to increase the number of students applying to, enrolled in, and graduating from physical therapist education programs. However, previous work has demonstrated that many programs do not have a specific plan for recruiting and retaining students from minority groups.12,13 In 1994, Haskins and Rose-St Prix12 studied recruitment and retention strategies used by programs that were associated with success in recruiting and retaining students from minority groups. These strategies included talking to parent groups, staying in touch with minority students, and assisting students in completing admissions applications.12 Provision of external funding also seemed to be related to success in recruitment and retention of students from minority groups.12
However, much has changed in the physical therapist educational environment since the study by Haskins and Rose-St Prix12 was published, and thus it is anticipated that the strategies that are utilized in the recruitment and retention of minority students also have changed. There have been significant changes in the use of instructional technology, the demographics of physical therapist education programs, and the entry-level (professional) degree.
The use of instructional technology has increased rapidly in the last decade. In 1994, Kosmahl14 reported that only 29.9% of accredited entry-level physical therapist programs in the US used computer-assisted instruction. By 2003, however, 71.4% of accredited physical therapist education programs were using computer-assisted technology (CAT) in some or all courses, with 41.5% of the programs reporting courses taught at least partially online and an additional 77% of the programs planning on adding CAT within the next academic year.15
It is possible that the increased use of instructional technology could have an impact on the retention of students from minority groups. It has been found that minority students are less likely than nonminority students to own computers and that less than one third of minority students have had experience using a computer prior to attending college.16 Hispanic/Latino and black/African-American students are less likely than white students to report using a personal computer frequently.17 Internet use is less prevalent among members of minority groups than among whites.18
Other changes in the environment that justify examining what strategies are currently being used to recruit and retain students who are members of minority groups are the changes in the applicant pool, the number of students enrolled, and the proportion of students from minority groups in the applicant pool. In 1995, the mean number of applicants to physical therapist education programs was 342.19 In 2003, that number had dropped to 92.20 The mean number of students enrolled was 43 in 199519 and 32 in 2003.20 The proportion of applicants from minority groups increased from 9.8% in 1994 to 15.4% in 2000,21 and the proportion of students from minority groups increased from 6% in 1995 to 11.9% in 2000.19 Although the drop in applicants with a relatively constant class size has resulted in a higher proportion of applicants being admitted, students from minority groups are still underrepresented in the applicant pool as compared with the general population and among enrolled students as compared with both the applicant pool and the general population.
The most dramatic change in the environment that justifies examining what strategies are currently being used to recruit and retain students who are members of minority groups is the rapid advent of the Doctor of Physical Therapy (DPT) degree. In 1990, when data were collected for the 1994 study by Haskins and Rose-St Prix,12 82% of the programs studied were at the baccalaureate level. In 1990, there were no DPT programs and only about 45 entry-level master’s degree physical therapist programs.12 In the year 2000, there were 19 accredited and developing DPT programs and 184 accredited and developing master’s programs. By September 2004, there were 111 accredited and developing entry-level DPT programs and 98 accredited and developing master’s programs.20 The APTA projects that by 2008, approximately 82% of physical therapist professional education program graduates will earn a DPT.20
This rapid shift from bachelor’s degree entry level to master’s degree entry level to doctoral entry level must be accompanied by a close inspection of the impact on students who are members of minority groups. Disparities in educational attainment already exist. Although 28.1% of non-Hispanic white people in the 25-year-old and older population have a bachelor’s degree, only 10.6% of Hispanics have a bachelor’s degree.22 Among black men and women, the numbers are somewhat better than for Hispanics, but still only 17% of people aged 25 years and older have a bachelor’s degree.23 Given the disparity in educational attainment due to race, the increase in the number of DPT programs in the United States may be viewed as a barrier for students from minority groups to apply to and be more successful in physical therapist education, unless successful strategies are investigated and implemented to recruit and retain students from minority groups.
The purposes of this study were to examine current practice in recruiting and retaining students from minority groups and to identify strategies that are more frequently used by programs that are successful in attracting, enrolling, and graduating these students, particularly those from Hispanic and black groups. This study replicated the method used in a previous study by Haskins and Rose-St Prix12 in order to assess minority student recruitment and retention strategies in the current environment of physical therapist education. Some of the changes in the method addressed examining the increased use of computers and the Internet and the advent of the DPT as the preferred entry-level degree.
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Program characteristics and programs’ reported involvement in a special effort in recruitment and retention of minority students, as well as funding received for this purpose, are summarized in Tables 1 and 2. Several of the respondents did not supply information related to minority data for application, enrollment, and admission. The numbers of programs that provided minority data for application, enrollment, and graduation are summarized in Table 3. The medians, quartiles, and ranges of students from aggregate minority groups applying to, enrolling in, and graduating from the physical therapist education program are summarized in Table 4. Data are classified by those programs making a special effort to recruit and retain minority students (effort group) and those programs not making a special effort (no-effort group).
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Programs were asked to identify, for the class of 2001, the number of applicants for the year of admission, the number of students enrolled, and the number of students graduated from each of the following ethnic groups: black/African American, Hispanic/Latino, American Indian or Alaska Native, Asian, and Native Hawaiian/Pacific Islander.
Equity Scores
For all programs, equity scores for application, enrollment, and graduation were calculated as described by Richardson and Skinner24 and used previously by Haskins and Rose-St Prix.12 Equity scores describe the success of programs in recruiting and retaining students from minority groups in proportions similar to the age-stratified proportion of people from minority groups in the home state population. Minority equity scores (MES) describe the extent to which programs are successful in recruiting and retaining students from any minority group as an aggregate score that is a weighted representation of the different minority groups. Hispanic/Latino equity scores (HES) and black/African-American equity scores (BES) also were calculated to describe the success of programs in recruiting students from these minority groups.
Minority equity scores for application (MESA, HESA, BESA) were calculated as the ratio of the proportion of minority group members applying to the program to the proportion of minority group members between the ages of 18 and 29 years in the state’s population. We chose to use the 18- to 29-year-old age range reported by the US Census Bureau because, although the largest percentage of applicants to physical therapist programs is between the ages of 21 and 25 years, 16.6% are 20 years of age or less and 10.7% are 26 to 29 years of age.21 In addition, the average age of students for classes admitted in 2001 was 24.2 years, ranging from 20 to 30.7 years (personal correspondence with Mary Jane Harris, Director, APTA Department of Accreditation, 2004).
Minority equity scores for enrollment (MESE, HESE, BESE) were calculated as the ratio of the proportion of minority group members enrolling in the program to the proportion of minority group members between the ages of 18 and 29 years in the state’s population. We chose to compare the enrollment with the population rather than with the applicant pool because we wanted to measure a program’s ability to reflect the population rather than its success in enrolling applicants, particularly as the applicant pool, as previously discussed, may not be diverse. In addition, many programs, while able to identify the race or ethnicity of students in the program, are unable to identify this information for people in the applicant pool. Minority equity scores for graduation (MESG, HESG, BESG) were calculated as the ratio of the proportion of minority group members graduating from the professional program to the proportion of minority group members enrolled in the first year of professional education.
For each case, the higher the program’s equity score, the more successful the program is in recruiting or retaining students from minority groups at proportions similar to or higher than the age-stratified proportion of people from minority groups in the home state population. For equity scores for enrollment and application, an equity score of 100 indicates that there is an equal proportion of minority group members recruited as the age-stratified proportion in the population. An equity score below 100 indicates that the proportion of students recruited is less than that of the state’s population, and an equity score above 100 indicates that the proportion of students recruited is higher than that of the state’s population.
For equity scores for graduation, a score of 100 means that the proportion of minority students graduated is the same as the proportion of students enrolled in the first year of the program. An equity score below 100 indicates that the proportion of minority students graduating from the program is less than the proportion of minority students enrolled in the first year of the program. An equity score above 100 indicates that the proportion of students graduating from the program is higher than the proportion of students enrolled in the first year.
Programs making a special effort to recruit or retain students from minority groups (n=50) also were asked to identify, from a list of recruitment and retention activities, the activities in which the program was involved. This list of 43 recruitment and 32 retention activities had been developed and utilized previously by Haskins25 and Haskins and Rose-St Prix12 with the addition of a few activities to reflect current educational practices such as the use of computer technology.
Data Analysis
Data were analyzed using SAS software program, version 9.1.* Program characteristics were analyzed using medians, quartiles, ranges, and frequency counts. The number of programs responding to minority data for application, enrollment, and graduation also was calculated. The median number of program applicants, students, and graduates and the median number of minority applicants, students, and graduates also were calculated and classified by whether or not programs were engaged in a special effort to recruit and retain students from minority groups. The median aggregate MES, BES, and HES were calculated. For each recruitment and retention strategy, the percentage of respondents reporting utilization of the strategy was calculated.
The Wilcoxon rank sum test was used to compare equity scores between groups using and not using each strategy. The Wilcoxon rank sum test is a nonparametric test that is equivalent to the Mann-Whitney U test and is used to compare 2 independent samples.26 For each recruitment strategy, the Wilcoxon rank sum test was performed to determine the difference in MESA, MESE, BESA, BESE, HESA, and HESE between programs using and not using the strategy. For each retention strategy, the Wilcoxon rank sum test was performed to determine the difference in MESG, BESG, and HESG between programs using and not using the strategy. Wilcoxon rank sum tests also were performed to examine the differences in all equity scores between programs receiving or not receiving external funding and programs involved or not involved in a broader effort to recruit or retain students of minority groups. For strategies that showed differences in equity scores between programs using and not using the strategies, the median equity scores were calculated. Because of the multiple comparisons performed, alpha was set at .01 (rather than .05) in order to decrease the chance of a making in error in finding a difference between groups that was due to chance.
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| Discussion |
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TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
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In this study, we found aggregate minority student mean equity scores of 43, 52, and 88 for application, enrollment, and graduation. Although the ranges of the equity scores for application suggest that some programs had a higher proportion of applicants from all minority groups applying than were present in the local population, median scores less than 100 reflect that for most of the programs, minority students, particularly black/African-American and Hispanic/Latino students, were applying in a smaller proportion than were present in the local population. Median equity scores for application for the effort group and the no-effort group demonstrated that the effort group tended to have higher median equity scores than the no-effort group, but these differences were not statistically significant (
=.01).
Similarly, although some programs had a higher proportion of students from all minority groups enrolling than were present in the local population, most programs had minority students enrolling in a smaller proportion than were present in the local population. Similar to equity scores for application, median equity scores for enrollment for the effort group and the no-effort group demonstrated that the effort group tended to have higher median equity scores than the no-effort group, but these differences also were not statistically significant (=.01).
The equity scores for graduation indicated that, once enrolled in the education program, except for black/African-American students in the effort group, students from minority groups graduated in similar proportions as the proportion of students enrolled in the first year (Tab. 7). When comparing black/African-American students’ equity scores for graduation in the effort group versus the no-effort group, the effort group seemed to have less success in graduating black/African-American students, but this difference also was not statistically significant (=.01).
In order to correct the underrepresentation of minorities, many physical therapist education programs are implementing recruitment and retention activities. In this study, 71% of the respondents indicated that they made a special effort to recruit and retain minority students, but the equity scores demonstrated that those who were making a special effort were doing no better than those who did not make a special effort at recruiting students from minority groups at proportions higher than the proportion of the home state population. It seems that, once enrolled, students from minority groups have graduation rates similar to those of students who are not from minority groups, except for black/African-American students. Perhaps the lower graduation equity scores for black/African-American students in the effort group was the impetus for the special effort, although these efforts did not appear to be successful in this case.
Strategies Used by Programs With Higher Equity Scores
The current study demonstrated that certain strategies seem to be associated with higher equity scores in some groups, but not in others. Programs that provided preprofessional enrichment courses, for example, had higher median black/African-American equity scores for application and higher median Hispanic/Latino equity scores for application. Likewise, programs that disseminated financial aid information to potential students had higher Hispanic/Latino equity scores for enrollment, but not higher aggregate minority or black/African-American equity scores for enrollment. Although none of the retention activities were related to the equity score for graduation for the aggregate minority student group or for Hispanic/Latino students, there were a few strategies related to the black/African-American equity scores for graduation.
Given that the Hispanic/Latino and black/African-American groups are the most severely underrepresented groups in physical therapy, it would be in the best interest of physical therapist education to pay particular attention to those strategies that target these groups. The results of this study suggest that different strategies should be used for students of different minority groups.
Of particular interest is the finding that programs that used computer skills education had higher black/African-American equity scores for graduation than those programs that did not use computer skills education. This finding is consistent with the findings of Poock and Berryhill,27 who found that race and ethnicity were related to a preference for using online applications. Hollander28 found that students entering medical school lacked the requisite skills for using computer-assisted instructional programs.28 Chisholm et al16 found that all students in their study, regardless of ethnicity, did not feel well prepared in the use of technology. We found that most physical therapist education programs were not providing computer skills education, but that programs with higher retention rates for black/African-American students were providing computer skills education.
Most Frequently Used Strategies
The most frequently used recruitment and retention strategies identified in this study were, for the most part, consistent with the most frequently used recruitment and retention practices identified by Splenser et al.13 There was a divergence between the strategies most frequently used and the strategies used by programs with the higher equity scores. Only 3 of the most frequently used strategies for recruitment were associated with higher equity scores for enrollment, and none of the most frequently used strategies for retention were associated with higher equity scores for graduation.
Limitations
There are several limitations to this study. Of primary concern is the use of the equity score approach. The equity scores are based on the proportion of members of minority groups in the state in which the program is housed. This does not take into consideration the fact that many programs attract applicants from outside of the home state.
Another problem with the use of the equity scores is that they do not allow for the fact that more than one program from the same state is drawing from the same applicant pool. A candidate from a minority group may be applying to more than one program in more than one state. This is a difficult factor to control given the method used in this study.
Another limitation is that only 41% of usable survey questionnaires were returned. It is possible that programs that did not return the questionnaires either did not utilize recruitment and retention strategies or had very low numbers of students from minority groups.
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It is possible that the minority student recruitment and retention strategies most often used by physical therapist educators are not related to improvements in recruitment and retention of students from minority groups. This study attempted to describe patterns of recruitment and retention of students from minority groups, to identify strategies most frequently used by programs, and to determine which strategies are related to higher proportions of minority students applying to, enrolling in, and graduating from physical therapist education programs.
The most frequently used strategies and the strategies related to recruitment and retention of minority students are incongruent. Implementing recruitment and retention strategies can be costly and time-consuming. Information about which strategies are associated with better recruitment and retention of students from minority groups can help educators allocate resources more efficiently and effectively.
Although the underrepresentation of students from minority groups has been addressed by APTA, there is still very little research in this area. Future studies should address the effectiveness of implementation of specific strategies in recruiting and retaining students from minority groups. Physical therapist education programs that are making a special effort to recruit and retain students from minority groups should collect data and analyze their outcomes in order to build evidence in this area.
According to the Institute of Medicine,5 the underrepresentation of racial and ethnic minorities in the health care professions contributes to racial and ethnic disparities in health care. Biases, prejudices, stereotyping, and uncertainty in clinical communication and decision making by health care providers result in lower quality and intensity of health care and diagnostic services across a wide range of procedures and disease areas.5 In addition to placing a higher burden of disease and mortality on members of minority groups, inequities in care are a threat to the quality of care for all Americans.5 The Institute of Medicine recommends an increase in the proportion of racial and ethnic minorities among health care professionals.5 Physical therapist educators at all levels need to be responsive to the increasingly diverse nation in which we live and take positive steps to ensure that the graduates of our accredited programs reflect the face of America.
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This study was approved by the Institutional Review Board of Florida International University.
* SAS Institute Inc, PO Box 8000, Cary, NC 27511. 
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