Leveraging Accreditation to Advance Diversity in Health Professions Education: Is Institutional Support the Missing Link?

Abstract

Background Shortages of underrepresented groups in the US health professions are widening, necessitating a diverse health workforce to increase access to quality care, patient satisfaction, and treatment adherence. Health workforce diversity is crucial for addressing health disparities and advancing health equity. However, in the physician assistant (PA) profession, over 80% of certified PAs are white, and only 3.3% are Black/African American. Accreditation, as a critical quality assurance mechanism, has the potential to ensure diversity, equity, and inclusion (DEI). In 2019, the Accreditation Review Commission-Physician Assistant (ARC-PA) introduced Standard A1.11, which required sponsoring institutions to demonstrate commitment to DEI. This qualitative study aims to examine the impact of this standard on diversity and inclusion in the PA profession and explore challenges faced by programs in compliance. Methods This three-phase exploratory qualitative study first collected and reviewed diversity standards in accreditation manuals across health professions; secondly, data on the frequency of ARC-PA citations related to diversity were gathered; lastly, participants were recruited through maximum variation sampling for semi-structured interviews. A sample of 56 individuals with diverse backgrounds were interviewed. Two research team members analyzed the transcription of interviews using common validation strategies to increase the trustworthiness of the findings, including peer debriefing, reflexivity, triangulation of researchers, and interviewing until saturation was reached. Results All six health professions organizations addressed DEI through at least one accreditation standard. Most institutions were already engaged in diversity efforts before the inception of standard A1.11. Interview participants were mainly female (52%), White (74%), and predominately program directors (65%). Participants were from various geographic regions and institution types, program affiliations, and differing accreditation statuses. Four major themes emerged from the data: institutional support, early pipeline development, increase faculty first or the students, and local context. Institutional support and focus on pipeline development were the most dominant themes. Between June 2020 and March 2023, 16 DEI citations on Standard A1.11 were levied on seven programs. Conclusions The inclusion of Standard A1.11 in the ARC-PA Standards and the focus on diversity by other accrediting bodies signifies the growing recognition of DEI in healthcare education. Institutions can advance DEI in the PA profession by leveraging accreditation-related activities through leadership, partnerships, and accountability measures.