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Optometric Education

The Journal of the Association of Schools and Colleges of Optometry

Optometric Education: Volume 47 Number 3 (Summer 2022)

PEER REVIEWED

Use of a Town Hall Focus Group to Assess Mentorship, Sense of Belonging and Self-Efficacy
in Black Students in Optometry School

Ruth Y. Shoge, OD, MPH, FAAO, James M. Caldwell, OD, EdM, EdD, and Anne Frankel, PhD

Abstract

Background: Education institutions need to better understand the experiences of their current students to recruit and retain more under-represented minority prospects. This study surveyed the social experiences of Black optometry students. Methods: A town hall-style focus group was used to explore experiences with mentorship, sense of belonging and self-efficacy. Results: There were 18 participants and all identified as Black. Facilitators to success included peer mentorship, and barriers included cost and lack of study strategies. Conclusion: Pairing incoming students with peer mentors, timely discussions about financial obligations and study strategies may increase positive experiences for Black students and likely students at large.

Key Words: optometry, Black, student, belonging, mentorship

Background

The term under-represented minority (URM) refers specifically to Black, Hispanic/Latino and Native groups that remain under-represented in education attainment and the science and engineering workforce.1 Research has demonstrated that when a critical mass of URM students is present within an education setting, the civic, cultural and intellectual development of all students benefits due to the racially and ethnically diverse learning environment.2 Also, students who are educated within a diverse student population find it easier to relate to patients from diverse populations.3 This relating, contemporarily described as empathy in the health and social care professions, has been shown to enable healthcare providers to better understand the needs of their patients and more effectively and efficiently elicit therapeutic change.17 To increase the recruitment and retention of URM students, education institutions need to better understand the perceptions and experiences of their current students. In a study by Formicola et al., URM students who wanted to attend dental school cited three perceived barriers to their success: taking on a high level of education debt, lack of social support from peers, friends, teachers and family members, and little promotion of the profession during their undergraduate education.3 Snyder et al.4 found several barriers that prevented a more diverse health workforce, including financial concerns, academic preparation, unwelcoming campus climate and lack of social and emotional support. The purpose of this study was to assess the social experiences of URM students in optometry school along the themes of mentorship, sense of belonging and self-efficacy. Mentorship was loosely defined as a more senior person offering guidance and advice to a less experienced person. Sense of belonging was described as feeling secure, supported, accepted and included. Self-efficacy was defined as one’s belief in one’s ability to succeed in specific situations or accomplish a task.

The lack of access to knowledge, accomplished individuals, formal and informal relationships and networks limits social capital.5 Social capital are those intangible resources provided by interpersonal relationships, (e.g., immediate and extended family, peers, teachers, religious leaders, neighborhood businesses) that educate, influence and support students’ decision-making in their education and occupation pursuits.18 Fortunately, education institutions can enhance social capital through their ability to serve as an alternate network of diverse, learned individuals who can provide access to information, resources and shared norms affording opportunities to students who otherwise lack the requisite knowledge to advance in the education system.6 Stanton-Salazar7 supports this theory of social capital development, noting that meaningful social ties within an education community between students and staff can advance both individual and group goals. The role of mentorship cannot adequately be underscored when considering the needs and success of URMs in optometry school specifically and health professional school in general. Cascading mentorship, which starts with faculty mentoring more senior students who in turn mentor their peers or more junior students (near-peer), was built upon the demonstrated effectiveness of near-peer mentoring for learning and teaching.8 Successful outcomes were attributed to active participation of student mentors in the design and implementation of the overall program. Researchers concluded that failure within URM groups is less likely to occur among those students who are positively oriented to both the dominant culture and their own without feeling alienated from their personal values. Students empowered by their school in this manner develop the motivation, confidence and ability to academically succeed. Having confidence in their cultural identity and a command of appropriate school-based knowledge allows them to fully participate in instructional activities.8

A profession greatly benefits from enhancing the diversity of its graduates because they are likely to serve as mentors who will play an important role in welcoming other URM students and future providers into the healthcare environment where there may be a limited number of role models.9

Study Design/Methods

A town hall focus group (THFG) was used to collect information from current students about their experiences on campus. A THFG is a hybrid style first described by Zuckerman-Parker and Shank10 as a way to have larger groups form into smaller teams (two to three people) to allow each person to contribute within the framework of their team and then each team contribute to the larger group discussion. The THFG was recorded and later transcribed and thematically coded to look for emerging themes. Thirty students were invited to participate via their student leaders. They were told in advance the purpose of the survey and THFG and that participation was voluntary. The THFG asked participants questions (Appendix A) about their social experiences on campus, including mentorship and its quality, sense of belonging (did they feel part of their education community), if they have felt supported academically and socially, and their perception of self-efficacy (did they have the tools/skills to execute what is needed to be academically successful).

Questions for the THFG were created based on a literature review for instruments measuring self-efficacy and sense of belonging. Only questions that were found to be relevant to the purpose of the interview were selected, modified and included. Table 1 lists the variables and categories of questions that were asked in the THFG. Appendix A contains the open-ended questions that were asked. Thematic coding and analysis were used for the THFG based on the thematic variables presented in Table 1: mentorship, sense of belonging, self-efficacy and demographic information.

Results

Eighteen students participated in the town hall focus group. Fourteen (77.8%) of the participants identified as female and four (22.2%) identified as male. The average age was 26.06 years (SD 3.5 years) with the youngest being 22 and the oldest being 35. All participants identified as Black.

During the THFG participants were asked questions about barriers and facilitators to their academic success and social well-being along the themes of mentorship, sense of belonging and self-efficacy. These pre-determined themes included subthemes: mentorship – mentors past and present, preparation for optometry school, and participation in a pipeline or a summer preparatory program; sense of belonging – feeling welcomed on campus, comfort with asking questions in class, ways to increase sense of belonging or comfort on campus; self-efficacy – class attendance and study habits, academic distress, motivation to succeed, and the use of counseling services. Table 2 lists themes and corresponding questions.

Theme 1: mentorship. What are the perceptions and experiences of current optometry students regarding mentorship?

During the THFG, participants were asked about who mentored them, and many reported they benefited from peer mentorship. One participant mentioned faculty as a source of mentorship, and one mentioned a parent. Participants were asked what would have helped them feel better prepared for optometry school, and a large portion of the discussion centered around two subthemes – money and faculty involvement in effective study strategies. Participants reported that lack of money was a major issue and not worrying about it would make a huge difference. Much of the stress about money reportedly came from having to purchase mandatory equipment for their coursework – the timing, amount and expectations. Several participants mentioned they were given short notice to purchase expensive equipment and were not given the opportunity to shop for more cost-effective alternatives. One participant stated: “They give us an estimate for cost-of-living, equipment, but they divide the amount [loan reimbursement] equally over three semesters whereas they may ask for all of it [equipment purchase] in the Fall, so where is the rest of the money coming from?”

Regarding faculty involvement in effective study strategies, there was a general consensus that faculty should do more than say “graduate school is not like undergrad.” Faculty should provide tangible suggestions on how best to approach mastering the material for each course. When asked about participation in pipeline or summer preparatory programs, many of the respondents mentioned they had participated in pipeline programs, with one respondent mentioning being involved in them since middle school. Several respondents said they had participated in summer programs offered by other optometry schools and commented on the strengths and weaknesses of them. Didactic simulation and workshops in which prospective students met with financial aid advisors and had mock interviews were seen as strengths because they provided the opportunity to “know what it’s like to be a student in optometry school.” Others commented that other programs only gave tours of the school, which were not beneficial if one did not end up going to that school.

Theme 2: sense of belonging. What are the perceptions and experiences of current optometry students regarding sense of belonging?

The questions used to examine sense of belonging during the THFG were modified from Hoffman et al.’s Sense of Belonging Survey.11 Participants were asked about whether they felt welcome on campus, their comfort with asking questions in class, and ways to increase sense of belonging or comfort on campus. They mentioned that while they initially felt welcomed on campus, particularly during the interview process, the feeling wasn’t sustained, and they felt their classes were segmented into “cliques and clusters.” While participants responded that they felt comfortable asking their teachers questions, most said their preferred method of communication was email or during office hours. When asked about ways to increase the sense of belonging on campus, participants said having more Black and Latino faculty would help as well as more awareness about issues that affect the student body. Race and ethnicity weren’t the only social identifiers that affected sense of belonging; rather, the intersectionality of many cultural and social identifiers impacted experience. One participant mentioned the following as an example of lack of awareness: “There are a few tone-deaf things with LGBT issues. Earlier today they gave a prize, a Chick-fil-A gift certificate, to a gay student as a prize for a contest. There’s been a very tenuous [relationship] between the LGBT community and Chick-fil-A because they support groups that want you to lose rights, and that’s a reminder, when given to a gay person, that there’s a huge section of people that, for religious reasons, don’t want you here.”

Theme 3: self-efficacy. What are the perceptions and experiences of current optometry students regarding self-efficacy?

The questions used to examine self-efficacy during the THFG were modified from Zimmerman et al.12 and Chemers et al.13 Academic Self-Efficacy and Efficacy for Self-Regulated Learning Survey. Participants were asked about their class attendance and study habits, what they did and who they turned to in times of academic distress, what motivated them to succeed, and the use of counseling services on campus. Some participants mentioned they did go to class, while others said they did not, preferring other methods of review such as watching the lectures as recordings. When it came to study habits, most said a combination of studying by oneself and then studying with a group was efficacious as well as studying in the library. When in academic distress, participants responded that they would seek the help and counsel of their peers first and then go to their teacher if needed. When asked about the use of the counseling services, particularly during time of academic distress, some said they had used it and found it helpful, while others had used it and did not find it helpful. Many of the participants were not aware of this service on campus. When asked what motivated them to succeed in this program, participants gave a variety of responses including “graduating,” “lifestyle” and “for the youth.”

Discussion

Formicola et al.3 and Snyder et al.4 reported that URM students cited several perceived barriers to their success, including the high level of education debt, lack of social support, academic preparation and an unwelcoming campus climate. The results of these studies support what participants in this study reported as facilitators to success, which were the importance of pairing incoming students with peer mentors, timely discussions about financial obligations, and discussing and implementing study strategies to help students succeed.

The role of mentorship cannot be underscored adequately when considering the needs and success of URM students. Cascading mentorship, which starts with faculty mentoring more senior students who in turn mentor their peers or more junior students (near-peer), was built upon the demonstrated effectiveness of near-peer mentoring for learning and teaching.8 During the THFG, participants were asked about who mentored them, and many reported that they benefited the most from peer mentorship, while only one participant mentioned faculty as a source of mentorship, and one mentioned a parent. Participants mentioned that they were matched with a near-peer mentor based on shared personalities, gender, geographic location or a combination of factors. Those who chose to participate in near-peer mentorship found the process easy and successful. There was no mention of a similar process for faculty-student mentorship, and perhaps a more formal structure for faculty mentorship would help facilitate faculty-student mentorship.

Participants were asked what would have helped them feel better prepared for optometry school, and one of the main factors discussed was money and financial security. Minority students have often cited concern over how they would fund their education as an obstacle to their success in becoming a healthcare provider.14 Participants reported that lack of money was a major issue and not worrying about it would make a huge difference. Much of the stress about money reportedly came from the timing, cost and expectations of having to purchase mandatory and expensive equipment for coursework with little warning and no opportunity to shop for more cost-effective alternatives. The direct (tuition) and indirect (room, board, equipment) costs of higher education are prohibitive for many students, particularly minority and underserved students. Students from under-represented backgrounds are more sensitive to tuition increases and indirect costs of education, which can negatively influence their enrollment and attendance decisions.15 Ensuring that URM students have access to optometry schools and the health profession in general is important, and robust evidence indicates exposure to diversity and diverse peer interaction on campuses leads to positive psychosocial and education outcomes.15 Thus, the demand for college students from diverse sociodemographic backgrounds only heightens the need to provide cost-effective ways to educate students because it would not only benefit URM students, but also the student body at large.

Another major concern that emerged from the THFG was faculty involvement in effective study strategies and exam preparation. There was a general consensus that faculty should do more than say “graduate school is not like undergrad” and they should provide tangible suggestions on how best to approach mastering the material for each course. This goes against historical assumptions about a professor’s role in the classroom. In the old paradigm, professors expected to transmit a body of knowledge for which they are a content expert, students were expected to absorb the information, and if the students failed it was their fault.16 Those assumptions and paradigms are shifting to student-centered teaching, or learner-centered teaching (the former term has been found to create resistance among faculty who worry about coddling students). Faculty members are now expected to become “guides on the side instead of sages on stage.”16 It was accurately predicted that by 2020 a true paradigm shift would occur as more senior faculty retired from academic life and junior faculty became responsible for the bulk of the lecturing.

Strengths and limitations

One of the major strengths of this study included its sampling of first-, second- and third-year students, which created good representation of experiences as well as robust conversation about near-peer mentorship. The data were collected, transcribed and analyzed by one reviewer, which provided benefit on two counts. The reviewer felt confident that information shared by students was accurate and unfiltered, and there was limited variability in interpretation of the qualitative data.

One major limitation was that only Black students participated in the study. Future studies should include a diverse representation of URM students as well as non-URM students to provide insight about differences in perception of social experiences and differences in strategies used to achieve academic and social success. Additionally, more in-depth questions should be asked about faculty mentorship to better understand the existing disconnect between students and faculty.

Conclusion

The findings of the town hall focus group support current knowledge regarding the effects of money, mentorship and academic support for URM students in graduate school. Preparation for the future success of URM students in a health professional setting should begin well before they apply to optometry school, and perhaps before they are in college. Changes in mentorship, financial support and appropriate pre-emptive academic support may improve academic success as well as cultivate better social experiences for students as they adapt to their environment and find appropriate faculty and near-peer mentors to help guide them through their new environment.

References

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  13. Chemers MM, Hu LT, Garcia BF. Academic self-efficacy and first year college student performance and adjustment. Journal of Educational Psychology. 2001;93(1):55-64.
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  15. Allen D, Wolniak GC. Exploring the effects of tuition increases on racial/ethnic diversity at public colleges and universities. Research in Higher Education. 2019;60;18-43.
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Appendix A. Click to enlarge

Dr. Shoge [rshoge@berkeley.edu] is an Associate Clinical Professor and the Director of Diversity, Equity, Inclusion, and Belonging at the University of California Berkeley School of Optometry in Berkeley, CA. She earned her Doctor of Optometry degree from the Pennsylvania College of Optometry and her MPH from the Department of Social and Behavioral Sciences, College of Public Health at Temple University. In addition to her clinical expertise in pediatric care and binocular vision, her research interests include mentorship and social experiences of under-represented minority students, bias awareness and cultural competence training, recruitment and retention strategies and curriculum reform.

Dr. Caldwell is the Dean of Student Affairs and an Assistant Professor at Salus University in Elkins Park, PA. He earned his Doctor of Optometry degree from the Pennsylvania College of Optometry and his EdM and EdD from the Department of Policy, Organizational and Leadership Studies, College of Education and Human Development at Temple University. In addition to primary care optometry, his interests include strategic planning, assessment of institutional effectiveness and student learning and understanding the lived experiences of students in their education program.

Dr. Frankel is an Associate Professor in the Department of Social and Behavioral Sciences, College of Public Health at Temple University in Philadelphia, PA. She earned her PhD in public health at Florida International University. Her research interests include the scholarship of teaching and learning, particularly in online settings, and how classroom-based community-building can contribute to positive social, emotional and environmental outcomes.

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