Expert: Black Students Face Unique Challenges When Entering, Considering Pharmacy Residency Programs

Pharmacy Times interviewed Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, and Tyler M. Kiles, PharmD, BC-ADM, on their presentations on addressing diversity, equity, and inclusion (DEI) in pharmacy at the 2023 American College of Clinical Pharmacy (ACCP) Annual Meeting. Abdul-Mutakabbir and Kiles underscore actionable recommendations for addressing DEI, including promoting education on inequities, identifying, and addressing disparities, implementing interventions, and advocating for the continued diversification of the pharmacy profession. Abdul-Mutakabbir and Kiles express how exposing and addressing barriers for the most vulnerable helps to create a more inclusive and equitable environment for everyone.

Pharmacy Times: What are some of the key factors in addressing DEI in pharmacy discussed in your presentation at the 2023 ACCP Annual Meeting?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: With our presentation, it will be focused on really assessing DEI, or diversity, equity, and inclusion, across the pharmacy profession, but we'll be doing it from many different standpoints. So, for me, my presentation will really lead out on describing just incorporating inclusive practices into post-graduate recruitment. So, for my presentation, specifically—we have 2 other presenters, so, Dr. Kiles, who's on with us, and then another doctor who will be talking—but I'm going to set the stage for them by really just going through and describing just the overall landscape of what we see in terms of just diversity one in the United States, but then two, the health disparities that exist or coexist with that increasing diversity. And then finally, how we as pharmacists are well positioned to address these things, and really talk about why it is that there are these systems of oppression, but because the pharmacy profession also lacks diversity, equity, and inclusion just amongst itself, which still makes how we confront these issues so hard.

So, I will, of course, really interrogate those issues. But more importantly, I really hope to just go through and talk about cultural competency, and then patient-provider concordance, and what that looks like. So, if we don't have cultural competency, then we won't have providers that look like their patients, and how that can really just detract from what it is that we see in terms of patient outcomes, and then the lack of just diversity and inclusion across the profession, but how that looks in the overall workforce and enrollment in pharmacy programs.

And finally, to wrap that up, job placement post-degree completion—one interesting thing that I found was that pharmacists who identify as Black and then those that identify as female are less likely to be employed following graduation. I thought that was just so interesting to consider. Then I thought about just the intersectionality that exists, God forbid, if you're someone that is Black and female. So, I mean, what does that even look like? Me being a woman that identifies as both, it really scared me to consider what this looks like, but more importantly, what it looks like for people that look like me.

"Then I thought about just the intersectionality that exists, God forbid, if you're someone that is Black and female. So, I mean, what does that even look like? Me being a woman that identifies as both, it really scared me to consider what this looks like, but more importantly, what it looks like for people that look like me." Image Credit: © C.D./peopleimages.com - stock.adobe.com

Then of course, I'll do a focus on pharmacy postgraduate training, and just the disparities that we see there in terms of recruitment and just the actual attainment of a postgraduate position and how we can see that—and I think one interesting thing that we saw with the recent release of the match rates was that there was a 15.8% increase match rate for non-minoritized applicants when compared to minoritized applicants, I think that is honestly astronomical. So, I think, I'm really excited to be able to get into that.

Then to talk about just the limitations that do exist, and just our barriers to diversifying the clinical pipeline. So, the trauma that minoritized students experience, the minimal faculty and leadership diversity, and we can link that all the way back to the jobs post-degree and then just the lack of diversity across the profession in general, limited financial resources, and just that limited support, because we are once again, not only looking at just per patient provider concordance, but educator to student concordance. Sometimes it can be hard to find a sponsor or mentor that looks like you and understands your experiences, or when people don't look like you but are willing to really just lean into and be empathetic to your experience.

So, finally I have some actionable recommendations that I'll provide. So promoting education on inequities, or just systems of oppression that exists because I think first we have to start with educating folks and getting on the same page about the fact that biases exist, implicit and explicit biases, systems of oppression exist, and we have to address them. And then identifying inequities—one thing I always say is to address something, you got to have data that shows that it exists. So that's our first step. And that's when I'll be toggle to the second step here, but first step in life. So, I'll be talking about that.

And then of course, implementing interventions after we do that data collection, measuring the success, we have to be comfortable with [the idea that] we maybe didn't hit the target the first time, but being able to recalibrate it a second time, or third time or fourth time, and then finally advocating for the continued diversification of the profession. Because at the end of the day, we have to have advocates in those that are willing to stand in the gap and amplify the disparities that we do see, so that we can ensure that they don't continue to be perpetuated across the profession.

So then, after I do all that, Dr. Kiles will go over her original research and really tell what she sees on the ground in terms of disparities—and it’s amazing research. So, I'm really happy to be able to set up—what is it, the volley?

Tyler M. Kiles, PharmD, BC-ADM: The alley-oop.

Abdul-Mutakabbir: Okay, okay.

Kiles: And I'll just add that after Dr. Abdul-Mutakabbir sets up the “why” this is so important, I'll talk a little bit more about the “how do we get there,” and some of the structures and systems that are in place that prevent minority pharmacy students from pursuing postgraduate training, and being able to become these advanced clinicians in the communities that they are needed in. And there's a lot of, I think, maybe I want to say confidence in the in the current system of residency recruitment and residency attainment, and I think a lot of people haven't looked at it through the lens of a minority applicant. So that's what I'm really bringing to the table is I had an original research study, a qualitative focus group study with African American students. I asked them about their perceptions of pursuing residency, and we had some really great discussions about what barriers they perceived, what attitudes they perceived, what sort of messaging they were getting about residency, and how they interpreted that. And I think it's pretty revealing. I won't give all away all the secrets here. But I think it'll set the stage for people to understand that the system as it is currently is inherently inequitable. It privileges those who already have privilege and does nothing to disrupt sort of the status quo that exists among all the other rungs of academia and society, if you will. So, I'm excited to you to share those results.

Then after both of us talk, we'll pass it over to Dr. Sally Arif, and she'll talk a little bit more about some of the structures that residency programs can do to encourage more Black students to apply or to educate their people who are involved in their programs or ways that they can sort of self-reflect and challenge the way that they've always done things. So, I think it'll be a really informative session, it'll have hopefully sparked some conversations or some self-reflection among these pharmacy clinicians who are involved in training postgraduates, or recruiting postgraduates, in really shaping the future of clinical pharmacy.

Pharmacy Times: What did the results of your research on the qualitative impact of DEI issues on the pursuit of residencies show?

Kiles: I basically asked the students to tell me what you think about residency, and I asked them about the applying to residency, interviewing for residencies, even just considering whether they wanted to do a residency at all. And through some qualitative evaluation, we really found some themes and some key things that they were considering.

The overarching theme was that they really felt this sense that they needed to balance their wellbeing with their desire to pursue professional advancement. And I know that that's something that, you know, nowadays, the kids are into, right, is thinking about their wellbeing. But by talking to these Black students, we talked more about how diversity, equity, and inclusion impacts their wellbeing disproportionately than other students. So, all students in pharmacy school are going to be stressed, but there's extra layers of stress for Black students. All students who are considering pursuing residency might be worried about not making enough money as a resident, but particularly for students from minoritized backgrounds, there's an extra layer of that financial consideration—interviews, applications, all of that, and the way that they felt this duality of not only do I need to be striving to be better, but I also need to be able to protect myself in that environment.

So, I guess 2 overarching themes was the sense of balance that they needed to consider their wellbeing, as they were considering residency, but then I got a lot of little themes and sub themes of if they were considering residency, what was their perception of the current environment and whether they felt that they would be successful or could be successful? What were the things that they were looking for within residency to feel welcome or to feel included?

Pharmacy Times: Closing thoughts?

Abdul-Mutakabbir: I think honestly, I got chills when I heard Tyler's say, like these systems are set up to provide privilege to those that are already privileged. And I think that I will sum it up with saying exactly that. And I hope that our session really unveils that, you know, and like Dr. Kiles said, the current structures just don't work. It's very easy to help those that have no barriers—or low barriers—but it is harder to really interrogate and inspect the barriers that do exist for those that are marginalized. So, I think it is our job to really expose them, and to really hold the scientific or the pharmacy community accountable, because now that you do have the knowledge that they exist, we can't continue to pull the veil over our eyes and say, “Oh, every student has an equal opportunity.” No, they don't, let's be honest about that. And there are significant limitations that exist. And honestly, if you address that person that has the most limitations, everyone else will be served. Because when you address the major barrier, you're inevitably going to address the small ones.

So, I think we have to keep that mindset that we address that person that is most underserved, and we're going to provide just a different change and a whole new momentum, in my opinion, for those people that for everyone that's pursuing a residency or postgraduate training, or honestly just wants to feel like they are they have a voice and that they're seen in the profession. I think everyone sitting in a pharmacy program deserves to feel that when they leave, they deserve to feel that they have a voice in this profession, they deserve to feel that they have an equal opportunity for success, like everyone else that's sitting next to them.

So, I think I hinge my career on that I want for the next generation to have an easier go at it or easier, like Dr. Kiles say the kids love their wellbeing, I want them to be able to say, you know that being a part of this profession doesn't compromise how their wellbeing or how they feel about themselves. So, I hope that this session just pushes us a little bit, a little bit more into that direction.

Kiles: No, I just would say it's going to be a great session, we're going to share lots of data, like real data to prove these things that that we sort of just inherently know. So, I'm looking forward to sharing that with the community. And seeing hopefully this serves as a launch point for further discussion and real change.