Assessing the Impact of ʻImi Hoʻōla: A Survey Analysis of 50 Years in Advancing Healthcare Equity in Hawaiʻi and the Pacific Basin

Introduction: ʻImi Hoʻōla (IH) is a 12-month post-baccalaureate program at the John A. Burns School of Medicine that provides educational opportunities to disadvantaged premedical students with ties to Hawaiʻi and the U.S. Affiliated Pacific Islands. Its mission is to increase the number of physicians who demonstrate a strong commitment to practice in underserved communities and primary care. Since its establishment in 1973, 306 participants have completed IH.

Objectives: To commemorate IH’s 50th anniversary, this study aimed to determine whether IH has worked towards its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by collecting feedback from alumni regarding the program’s impact on their careers.

Methods: An electronic survey was sent to 263 IH alumni by email from April 2023 to August 2023. The survey collected data on alumni demographics, current working status including specialty, location of practice, populations served, and their perceptions of working in underserved areas before and after completing IH based on a Likert scale. The data was summarized by descriptive statistics.

Results: The survey received responses from 100 IH alumni. The majority of IH alumni are practicing or training in primary care specialties such as internal medicine, family medicine, and pediatrics. For IH alumni who are current medical students, the most interested specialty is internal medicine. Before enrolling, a large number of alumni expressed a strong desire to practice in underserved communities in Hawaiʻi and the Pacific Basin. After completing IH, an even greater percentage expressed their dedication, with over 75% of practicing alumni serving in these areas of need. Furthermore, a majority of residents and medical students expressed a strong desire to practice in Hawaiʻi and the Pacific Basin. The top ethnic populations that practicing and retired IH alumni serve are Native Hawaiians and Pacific Islanders, Asians, and Whites.

Discussion: IH alumni’s choice of specialty shows that IH generates physicians who are willing to fill the primary care gap in Hawaiʻi and the Pacific Basin [1]. The alignment between IH alumni’s origins and choice of practice locations reflects the program's success in retaining current and future healthcare professionals in areas with underserved populations. Although IH is not ethnicity based, many participants come from ethnic minority groups, populations, and communities that are medically underserved. Physicians who come from underserved and minority communities are more likely to provide care to underserved populations [2]. The populations served by IH alumni support that IH is creating alumni who are providing greater access to healthcare in historically underserved populations.
This research is limited by a small sample size due to outdated contact information of alumni and collection of data through electronic surveys. The absence of investigation into other predictive factors on IH alumni’s specialty and location of practice limits the scope of the study. It can be concluded though, that IH has contributed to its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by increasing primary care physicians and healthcare access to underserved communities. The IH program’s infrastructure works in providing disadvantaged students an opportunity to attend medical school, and it can serve as a template for other medical schools interested in providing alternative pathways for disadvantaged students.

Target Audience: Medical Educators, University Administrators, Diversity Officers