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. 2024 May 28;35(3):262–269. doi: 10.1097/JPA.0000000000000599

What Works? Fostering Inclusivity in Physician Assistant/Associate Education: The Retention, Outreach, Alignment, and Diversity (ROAD) Framework

Vanessa Bester 1,2,3,4,5,6, Ramona Dorough 1,2,3,4,5,6, Nicole Burwell 1,2,3,4,5,6, Sumihiro Suzuki 1,2,3,4,5,6, Gerald Kayingo 1,2,3,4,5,6, Carolyn Bradley-Guidry 1,2,3,4,5,6,✉
PMCID: PMC11332370  PMID: 38833273

Abstract

Introduction

There are well-known strategies to increase diversity in health professions education, evidence is sparse on how such strategies are practically implemented and longitudinally sustained. This study investigated the most widely used strategies across physician assistant/associate (PA) educational programs that have consistently demonstrated the ability to graduate racial and ethnic underrepresented students.

Methods

Following a grounded theory, qualitative interviews were conducted with 41 nationally accredited PA programs identified as top performers in consistently graduating racial and ethnic underrepresented students. Semistructured interviews were conducted with a program representative focused on ascertaining the characteristics and strategies attributable to the successful recruitment and retention of underrepresented PA matriculants. The interviews comprehensively explored program resources, efforts, and practices. Transcripts were coded, and themes were identified.

Results

The study revealed 4 overarching themes: (1) Pathways from the Community to the Program and Into Healthcare; (2) Dedication to Student Retention and Support; (3) Commitment to Diverse and Inclusive Learning Environments; and (4) Alignment of Mission, Inclusive Action, and Improving Diversity Outcomes. Based on these emerging themes, we propose a new diversity framework that hinges on Retention, Outreach, Alignment, and Diversity (ROAD Framework). This framework seeks to explain the overarching goals, high-impact behaviors, and actionable steps that can be effectively implemented across PA education to facilitate further diversification.

Discussion

This study illuminated on What Works to foster diversity in PA programs. By embracing and implementing the ROAD Framework, institutions can effectively address the persistent issue of underrepresentation and contribute to cultivating a more inclusive and representative healthcare workforce.

INTRODUCTION

Despite decades of evidence that diversity in the health care workforce is essential in reducing health care disparities, the proportion of students from underrepresented racial and ethnic minority groups continues to decline across health professions programs in the United States.1 Diversity-focused literature continues to emphasize and provide evidence that the lack of representation of individuals from underrepresented populations in the health professions is having a profound negative health effect in the United States.1-4 Inequities in the health workforce reduces availability and access to quality care, patient satisfaction, treatment adherence, and the likelihood of patients seeking and obtaining care.5-7 Higher education institutions continue to struggle to increase representation in their health professions programs.8 The broad implication is that maintaining the status quo of underrepresentation in the health professions education negatively affects the health care workforce, further perpetuating health inequity across the United States.

To understand What Works in diversifying the physician assistant/associate (PA) profession, it is important to recognize contemporary equity, diversity, and inclusion frameworks, including the American Psychological Association’s Equity, Diversity, and Inclusion Framework and the National Association of Diversity Officers in Higher Education Anti-Racism Framework.9,10 These systemic efforts at addressing disparities have been helpful, however, with each framework comes complexity which can overwhelm and limit practical implementation across the broad health professions education landscape. Furthermore, discipline-specific experts and smaller-scale initiatives have reaffirmed these frameworks and made great gains but leave educators unsure of the transferability or applicability of these practices to their own institutional contexts and goals.11-14

Combining the knowledge of current, small-scale, discipline-specific successes along with contemporary diversity frameworks provides this study a starting point from which to establish What Works. While there are well-known strategies to increase diversity in health professions education, evidence is sparse on how such strategies are practically implemented and longitudinally sustained.1,15 To our knowledge, there has not been a comprehensive study examining What Works; from conceptual theory and educational practice to the implementation of effective and sustainable efforts in increasing diversity in PA education. This is a critical aspect of ensuring that health care professions are representative of the diverse communities they serve. Building on the previous quantitative study, 61 accredited PA programs were identified as top-performing programs in consistently graduating students over a 5-year time span who self-identified as African American or Black, American Indian or Alaska Native, Asian, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander.16 This study further explores the practices of these successful programs to establish goals, behaviors, and actions to provide valuable insights that can be applied across PA education.

METHODS

Theoretical Framework

A qualitative, grounded theory research methodology was used as the theoretical framework to answer the research question: What characteristics and strategies do PA Programs attribute to their success in contributing to a diverse PA workforce? This study uses a constructivist design that incorporates Charmaz's17 exploratory research methods to gain insights into the phenomena and follows a systematic, qualitative procedure, as described by Creswell,18 to generate a theory that explains a broad conceptual understanding of a substantive topic, including the construction of predictive statements about the experiences of the phenomenon. Driven by a dedication to fostering inclusivity and comprehension, our research group prioritized the cultivation of continuous discussions pertaining to health equity within the broad spectrum of disciplines, races, and ethnicities. Thus, grounded theory assists in developing an epistemological underpinning encouraging our research team members who self-identify as African American or Black, Asian, and White to confront those issues rather than ignore or silence them.19,20 A grounded theory framework was chosen for its ability to help distinguish the relationships, behaviors, and practices common to the nation’s top-performing PA programs contributing to the profession's diversity. The themes developed through data analysis and comparison allowed for the generation of goal-oriented, diversity-focused practices, supported by and grounded in the data collected, that can be replicated across other PA programs.

Participant Sample

Through a previously published quantitative study, 61 of 139 accredited PA programs in the United States were identified as top performers. These programs consistently succeeded in graduating students who self-identified as African American or Black, American Indian or Alaska Native, Asian, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander over a 5-year span between 2014 and 2018.16 The programs that were successful in graduating students from the above underrepresented groups (URG) in the PA profession reflect educational institutions from every geographic region across the United States; were in rural, urban, and suburban locations; and were embedded in various forms of higher education institutions.

Data Collection

With Institutional Review Board approval, the top-performing PA programs were invited to participate in this qualitative study. Of the 61 programs, 41 program representatives were interviewed over a period of 12 months through remote video conferencing. Interviews were conducted with a program representative (most often the program director) in a semistructured format focusing on ascertaining the characteristics and strategies attributable to the successful recruitment and retention of diverse PA matriculants. The interview protocol and questions were developed by consensus of the research team through extensive literature review. Each interview was recorded, transcribed, and coded by at least 2 team members.

Data Analysis

The coding process included identifying causal conditions using a pre-established code book with definitions to facilitate consistency across the researcher’s first coding cycle. Additional codes were added to the codebook using inductive thematic saturation and identified as emergent codes through combined sampling, data collection, and data analysis.21,22 Second-cycle coding formed the overarching themes. Saturation was achieved when no new codes or themes emerged. All coding, intercoder reliability tests, data visualization, and analysis were completed using the Dedoose qualitative software system.23

The second cycle coding process also yielded descriptions encompassing the original codebook-defined and new emergent codes. The overarching themes were then linked through representative quotes to help illustrate reproducible action strategies. From the first cycle code frequency and occurrence across participating programs, second cycle codes were finalized, and descriptions were developed to encompass the original codebook-defined codes and new emergent codes together.

Trustworthiness

Methodological trustworthiness was assured through the use of a grounded theoretical framework and assembling a research team that represented diverse racial, ethnic, and professional backgrounds. The study design specifically addresses the credibility, reflexivity, dependability, confirmability, and transferability of the findings. Credibility and reflexivity were achieved through intentional dialogue surrounding the positionality of each research team member at the onset of this project, through the process of codebook creation and interinterviewer consensus meetings held bimonthly throughout the interview and first and second cycle coding process.24 The sheer number of participants and data lent to the dependability and confirmability of the results. The volume of interviews conducted was intentionally chosen to ensure saturation across the different types of PA programs, their geographic location, and any other unforeseen attributes to diversity success. The diversity of program/institutional type further adds to the relatability and transferability of the results to other health professions programs. Each interview was coded by at least 2 team members, facilitating triangulation and additional data clarification. The validity of the interpretations was achieved through member checking.

RESULTS

The study findings were used to create a framework from which PA programs can identify and implement diversity practices common across the most successful programs in the United States. We first present the results of our finalized codes to demonstrate our process of arriving at the overarching themes from the data (Table 1). Here, we present participants’ quotes to illustrate the concepts (values), educational practices, and implementation efforts found to be most representative of 4 overarching themes: (1) Pathways from the Community to the Program and Into Healthcare; (2) Dedication to Student Retention and Support; (3) Commitment to Diverse and Inclusive Learning Environments; and (4) Alignment of Mission, Inclusive Action, and Improving Diversity Outcomes.

Table 1.

Finalized Codes, Percent of Code Occurrence, and Overarching Themes

Finalized Codes % of Code Occurrence Across Programs (n = 41) Overarching Themes
Holistic admissions
Pathways programs
Funding and resources		 92%
92%
92%		 Top-performing programs demonstrate significant effort directly related to diverse community outreach and the PA pathway
Student retention
Progression policies		 97%
86%		 Top-performing programs demonstrate dedication to student retention and support
Curriculum
Clinical experiences		 78%
100%		 Top-performing programs demonstrate commitment to diverse and inclusive learning environments
Mission
Inclusive culture
Faculty, staff, and alumni		 100%
97%
92%		 Top-performing programs demonstrate alignment of mission, inclusive action, and are striving to improve program diversity outcomes
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PA, physician assistant/associate.

Pathways from the Community to the Program and Into Health Care

Top performers in our study spoke to the prioritization of activities that connected their prospective students, current students, faculty, staff, and alumni together. These activities ranged from the community, K-12 education, technical and community college engagement, to holistic admissions practices, and community service. The programs attributed their success in recruiting students of color to their longstanding efforts to engage the community at the student, faculty, and staff levels. Programs spoke about their intentional training and support from their academic administration and institution.

We have faculty development. We have a DEI committee. We just had a speaker series on how to speak to students on diversity and inclusivity and how to better leverage the resources that we have to maintain better retention… I credit my Dean because she fights for everything. We give suggestions, she fights for the funding and we are fortunate when we get it.

Furthermore, top performers often engaged their alumni in community outreach and pathway efforts. “We find opportunities to get involved with community health centers and afterschool programs. We’ve gotten our students involved in volunteering and they get really excited about that.” Another program outlined further details and roles:

We have an outreach chair and she coordinates with the students and alumni to go to the various colleges, including community colleges to hype up our program. And we're fairly cognizant about, depending on where we're going of taking an alumnus or a student of color that is like the program we're going to. So if we're going to the tribal college, I'm going to contact my Navajo students or alumni.

Overall, there was a clear commitment to creating connections with the community, the program, and its alumni.

Dedication to Student Retention and Support

The top-performing programs normalized and supported students experiencing struggles with external stressors and mental well-being. This was accomplished through focused mentorship and attention to each individual student. One program noted the importance of “Taking the time to get to know the needs of the students, especially the students who are struggling” and another program described a group effort to identifying student needs: “We meet as a body and we go through everything and we try to make sure they [students] have already met with their advisors too. So we can pinpoint if there's anything social that is contributing to the academics.” One program specifically described its holistic approach to support:

[Struggling students] are often offered resources our occupational therapy department has this really great lifestyle redesign program where they help students, they interview students and break down their daily routines and help them kind of focus on mind, body, spirit, nutrition, study techniques, time management. It's always hard for them to find time to get over there, but we're working on curriculum and some expansion of space so we can cut down our contact hours to provide more room for study and for wellness.

Furthermore, a keen and proactive effort toward more inclusive and “forgiving” progression and leave policies were apparent. “We grant leaves of absence and those can also be mental health type medical leaves of absence. And every year we have one or 2 students that avail themselves of that when it's necessary. It's not like when you're out, you're out.” The programs all commented on their belief that these approaches positively affect their student retention as well.

Commitment to Diverse and Inclusive Learning Environments

The results showed that successful programs emphasized the importance of diverse and inclusive learning environments for students from URG. In the classroom setting, one participant reflected on creating a safe environment in which a student could call out transgressions, assuring their voice would be heard and action to improve the environment would be taken: “Having open communication with your students, having them feel comfortable enough to come to you and say, ‘this is what happened’ [and] then doing something about it, that is very important.” Another program went further in considering the clinical, or experiential environment as well, trying their best to connect students with training in setting that align with their interests:

We meet with all of our students individually and talk about their goals for clinical placements and things like that. And so our students who express an interest in being in, uh, one of those settings where they're directly caring for patients who are underserved or under-insured, we try as hard as we can to meet that goal.

Programs also had intentional and ongoing processes to incorporate diversity, equity, and inclusion into the written and unwritten curriculum: One program explained, “Once we've set our diversity goals, we will look for ways that we can integrate those goals into the curriculum in some of the courses we teach… Even when we have something that works, it doesn't mean that it stays working and the environment changes” and another program highlighted the critical importance of unwritten curriculum and learning environment:

So we said, well, what else can we do in terms of creating an institutional and systematic way of making a welcoming environment that actually supports our students? I mean, that to us was like, well, we can talk the talk, but you know you better walk the walk and we better have the foundation here because it doesn't matter if you have a pathway or not, you gotta have the rest in place.

Alignment of Mission, Inclusive Action, and Improving Diversity Outcomes

All participating programs demonstrated alignment of their mission with their practices and improving their outcomes. Some illustrated straight-forward decisions about student choice of experiential learning settings: “We have a lot of really rural sites and they're great training sites for our students, and they also meet our mission very closely” while others spoke more broadly about intentionality and program administrative prioritization of the mission:

Programs have to be very intentional about making sure that they are reaching a diverse population of students. Under the leadership of the previous program director that was not a priority. And so of course we had a mission statement that had a lot of, um, inclusivity and diversity in the language, but we weren't really doing anything to take that from pen and paper to really, you know, do that in the community… And so now we are intentional about making sure that our diversity work is inclusive of everyone.

Other programs highlighted the greater institution’s role in creating inclusive action and positive diversity outcomes, noting “The institution has a values based culture and mission, and that has helped us to say, we've got an institution behind us that have these values, and we're gonna expect this from our behavior in the program.”

Many programs focused on action and the conscious choice to do the right thing rather than the easy thing. For example, one participant described a lack of inclusive climate, illustrating the challenges faculty face in creating an inclusive learning environment:

We utilized a lot of guest lectures and one said something very offensive. My gut instinct was, you know, oh, well, but it's difficult to find a person to come give that kind of lecture. But when the student called me on it and made it that clear, it helped me put in perspective how important it was, that it was very personal.

While tempting and often easier for a program to sweep unconscious and consciously biased behavior aside, these quotes illustrate what equity, inclusion, and engagement of the institution, faculty, staff, and students should look like when a program is truly living its diversity-focused mission.

Emergent Code: Future Plans

An emergent code, “future plans,” was not anticipated by the research team however striving to improve (despite established success) and pushing diversity goals forward was present across most participants. Acknowledging the need to increase the diversity of health professions and assessing program progress toward those goals is only the first step. Programs coded as having “future plans” demonstrated addressing structural barriers. One program noted:

We know that [diversity] is not very good in our whole university, particularly in our colleges of nursing and medicine, which is where the PA program is…We have one African American female on our faculty, in our PA program, and our goal, our mission, our future planning, I should say is to hire more diverse faculty.

While the research team did not initially anticipate this code, it quickly and consistently emerged across the participants, directly reflecting their mission, action, and outcomes.

Overall, the iterative process of first-cycle coding and code frequencies affirmed the research team-developed codebook. The overarching themes are further supported by representative quotes directly from the participants. We believe it is important to restate that the programs that are successful in graduating PAs from URG includes academic institutions from every geographic region across the United States; were in rural, urban, and suburban locations; and were embedded in all forms of higher education institutions. The diversity of the programs and their institutions adds to the relatability and transferability of the results. This leads us to our discussion, where we propose real-life, actionable strategies that can be reproduced across the country.

DISCUSSION

Over the course of several decades, significant efforts have been devoted to addressing the issue of underrepresentation within the health professions. However, there remains a scarcity of empirical evidence regarding the practical implementation and sustained effectiveness of these efforts. Using PA education in the United States as a model, this study investigated strategies and What Works for improving the diversity of the health care workforce. Specifically, we investigated top-performing PA programs that have consistently demonstrated the ability to graduate students from underrepresented populations. The key themes that emerged from this study were community outreach and health professional pathways; alignment of diversity-focused mission, action, and outcomes; commitment to diverse and inclusive learning environments; and dedication to student retention and support. Our findings are consistent with the established literature and narrows in on the practices that are consistently increasing and supporting diversity in the PA profession. The findings of this study provide specificity and illuminate tangible goals, with definable behaviors and actions that can be put into practice and can guide standards toward diversity efforts at every level of a PA training program. Taken all together, we propose a new framework focusing on Retention, Outreach, Alignment, and Diversity (ROAD) Framework (Figure 1).

Figure 1.

Figure 1.

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Retention, outreach, alignment, and diversity (ROAD) framework. This figure depicts a framework for enhancing diversity, through highlighting goals, high-impact behaviors, and actions under the domains of ROAD practices.

Pathways from the Community, to the Program, and Into Health Care

Community outreach and pathway programs have been implemented across the health professions for over 40 years. Despite these initiatives, educational institutions have been unable to systematically increase representation in the health care workforce. Beyond standard program information sessions and admissions procedures, top performers identified surrounding communities and leveraged student engagement and mentorship as a part of that process.25,26 Furthermore, top performers often engaged their alumni in community outreach and pathway efforts. Pathways that pull people from the community into health programs while continuing to loop in students, faculty, staff, and alumni have been shown to sustain efforts in diversifying the health care workforce.27-29 Programs engaging all members of the diversity pathway were successful in sustaining their recruitment and retention success.

Dedication to Student Retention and Support

There is strong evidence in the education literature that the demonstration of dedication to student retention and support improves underrepresented student experience, sense of belonging, and academic success.29-32 The results from this study confirm specific actions that top-performing programs demonstrate, including providing consistent, yet flexible policies that allow students experiencing academic difficulties time and space to continue in their studies and a one-to-one connection between faculty and students, promoting a supportive community. A collective effort by program personnel to assure students have access to institutional, academic, mental health, and counseling resources needed to succeed are factors that add to the retention of students. This can be accomplished both within the program, through individualized mentorship and coaching, or in collaboration with other institutional resources.28 While not all PA programs are embedded in resource-rich institutions, this study demonstrates that success in student support does not necessarily require specialized expertise or financial resources. It is, however, important to note that many of the participants cited increasing student retention and support resources in their discussions about goals and outcomes.

Commitment to Diverse and Inclusive Learning Environments

A diverse and inclusive learning environment was consistent across top-performing programs. It is critical to note that diversity does not imply inclusion and that inclusion does not always address bias.33 Most top-performing programs directly called out overt and covert bias, microaggressions, and exclusion while also engaging all people in the process of working through those situations.34 Top-performing programs focused on an inclusive environment in addition to curricular content. It is important to note that prioritization of inclusion did not affect the programs’ curricular rigor or student success on the national certifying board examination.16 While all the top performers acknowledged various curricular approaches and content surrounding diversity, equity, and inclusion (universal design, social determinants of health, critical conversation surrounding equity-based care, and epigenetics), the overarching commonality was on facilitating a safe environment.35 This finding is also supported by several studies, recognizing the importance of not only acknowledging the impact of bias, but providing space, and opportunity to address it.11,36,37

Alignment of Mission, Inclusive Action, and Improving Diversity Outcomes

The overarching idea of putting pen to paper emerged throughout most of the program interviews, reflecting the theme of mission alignment, inclusive action, and improving program outcomes. The widespread initiative from health education accreditation bodies for programs to develop mission-driven tactics to increase diversity has become a catalyst for change.38 However, declaring diversity as a value in a mission statement or increasing the number of diverse matriculants without also practicing inclusive action has been shown to cause more harm than good.39,40 The principles of equity are prioritized over resource constraints, additional work, and financial considerations both in word and practice.15,41 These actions cultivate a culture of trust within a program, affirming its stated mission and the importance of diversity.

Our findings also identified that top-performing programs focused on “future plans” and always looked forward to improving and expanding their diversity efforts. Furthermore, most programs prioritized plans to increase diverse faculty representation. These efforts are consistent with a diversity agenda, which focuses on organizational goals that facilitate continuous climate and culture shifts toward diversity, equity, and inclusion. While not all programs had a written diversity agenda or plan, the literature suggests the importance of written, measurable, and time-bound goals facilitated by dedicated leaders.42

Overall, the first 2 themes point toward activities that engage both individual students and individuals in the community. The behaviors and actions that defined and demonstrated a diversity pathway include dedicated community engagement and service, educational outreach inclusive of K-12, community colleges, and minority-serving institutions. In addition, programs often involved alumni in outreach activities specific to local demographics and disparities. The behaviors and actions that demonstrate student support include faculty coaching (as opposed to advising), proactive identification, and referral for social support, flexible, and reasonable academic policies.

The third and fourth overarching themes address more systemic approaches toward diversity and inclusion in a health professions program. Specifically, the third theme points toward a goal for prioritizing a safe and inclusive learning environment, exemplified by behaviors, and actions that acknowledge bias in the learning environment, facilitate dialogue promoting inclusion, and maintain established diversity-centered curricular standards. The fourth theme outlines a goal focused on mission alignment that underpins all other diversity practices described. The behaviors and actions that demonstrate mission alignment include institutional support of diversity, equity, and inclusion initiatives, directly acknowledging and addressing instances of bias, and establishing a written diversity agenda or plan.

The results from this study provide specific diversity and inclusion approaches that programs can prioritize and implement. Physician assistant/associate programs can make small or sweeping changes, based on data. The overarching themes provide diversity goals, while the representative quotes define the most common practices to reach those goals. Programs can then set their goals and choose the practices that best fit their communities, students, and overall goals. Furthermore, the actions and practices described are measurable thus enabling programs to drive continuous improvement and demonstrate compliance with accreditation standards. Established literature affirms the goals and practices from our study.10,13,14

Proposing the Retention, Outreach, Alignment, and Diversity Framework

The US population is becoming more diverse yet the number of health profession graduates from URG continues to decline. Health disparities, social determinants of health, and health inequity disproportionately affect marginalized and underserved communities. Improving health outcomes and reducing the health care burden of marginalized and underserved populations will require intentional efforts to improve workforce diversity.

Based on the study findings, we constructed a simplified and transferrable ROAD framework for diversity action in PA education (Figure 1). The ROAD framework provides empirical evidence of successful strategies used by 41 PA programs across the United States that consistently recruit, retain, and graduate students from underrepresented populations. Despite ample evidence of the need to improve health care workforce diversity, PA programs have failed to meet the nation’s health care workforce needs. The findings suggest the ROAD Framework can be used as the foundation for change in PA academic programs.

Limitations and Implications for Future Research

This extensive qualitative study focused on the practices of top-performing PA programs that consistently graduate diverse health care providers into the workforce. Some may argue that the study design was limited in that only top performers were interviewed and examining other programs could further validate or refute the practices identified. However, the research question sought to answer What Works rather than scrutinizing deficits. Differences between individual institutional resources and funding for diversity-focused activities varied across the participants in this study. It is important to acknowledge the impact of financial barriers on any one program’s ability to fund and staff pathway initiatives, outreach, student recruitment, and student support services. However, the data illustrate low-resource, high-impact practices many programs used. While this study focused on PA educational programs, the findings and recommendations are supported in the contemporary diversity and inclusion literature and we contend that they can be generalized to other health professions. Furthermore, this study is focused on individuals from underrepresented populations. However, it is likely that the themes resonate across other marginalized groups and can be applied more broadly. Future directions include analyzing the data using a mixed-methods approach to further delineate measures and benchmarks for the goals, behaviors, and actions identified.43 Having established effective strategies and introduced the ROAD framework, our next phase involves examining the implementation of this framework in various PA programs that have not yet achieved prominent levels of diversity success. This step will contribute to a comprehensive understanding of the framework's potential impact and applicability across a broader spectrum of educational contexts. Expanding our knowledge will allow for the improvement of diversity-focused efforts and guide educators and administrators toward diversity and inclusion transformation and excellence.

Conclusion

The health care workforce plays a pivotal role in improving population health, the patient experience, and reducing health disparities. The key findings and implications of this qualitative study revealed strategies and practices to enhance diversity and inclusion in health professions programs. Consistent with the current body of literature, the study underscores the importance of intentional “Retention, Outreach, Alignment, and Diversity (ROAD)” efforts. The findings provide a scaffolding as well as a comprehensive guide for institutions to align their resources and mission with their diversity goals.

This study's contribution, as one of the first large-scale nationwide investigations to interview PA Educators, underscores the importance of capturing the lived experiences and the perceived understanding of the key drivers for increasing underrepresented racial and ethnic groups, alongside efforts to improve equity and inclusion in educational spaces. In addition, the ROAD framework provides a roadmap for integrating institutional goals, high-impact behaviors, and actionable steps toward achieving health care workforce diversity.

While this particular study is representative of What Works for PA programs, we believe that the identified practices can be applied to other health professions. The broader applicability of the ROAD framework increases its relevance and impact. Moreover, the far-reaching implications of this study have the potential to ignite policy transformation in service of diversity and inclusion in the health professions, nationwide and beyond.

Acknowledgements

The authors express their appreciation to the PA Education Association for the funding support of the Faculty Generated Research Grant. The authors thank the study participants for sharing their experiences and for their commitment to diversifying the healthcare workforce through graduating PA students from underrepresented racial and ethnic groups. The authors would like to acknowledge and warmly thank Andrzej Kozikowski, PhD, Director of Research, at the National Commission on Certification of Physician Assistants for assistance in reviewing the manuscript.

Footnotes

The 2020 PA Education Association Faculty Generated Research Grant provided funding to support the scholarly activity for the completion of this manuscript. PAEA had no influence on the design, analysis, or writing of this article.

The authors declare no conflict of interest.

All data on which the results are based are available and can be obtained from the corresponding author on reasonable request.

All methods were carried out in accordance with relevant guidelines and regulations. The study was deemed exempt by the University of Texas Southwestern Medical Center Human Research Protection Program Institutional Review Board Protocol #STU2019-1249.

Contributor Information

Vanessa Bester, Email: besterva@augsburg.edu.

Ramona Dorough, Email: ramona.dorough@utsouthwestern.edu.

Nicole Burwell, Email: nbburwell@ncat.edu.

Sumihiro Suzuki, Email: sumihiro_suzuki@rush.edu.

Gerald Kayingo, Email: gkayingo@umaryland.edu.

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