The Work Ahead

To the YSM Community:

During my first State of the School presentation, I committed to working with you to address discrimination and racism, promote diversity and inclusion, and eliminate inequities in health care. Yale School of Medicine should be an academic home where women and underrepresented in medicine (URiM) faculty, staff, and students thrive, and where diversity and excellence are inextricably linked.

Since the first week in June, 16 departments and centers have held listening sessions and workshops, many facilitated by Deputy Dean Darin Latimore, and five additional sessions have been scheduled to take place over the next several weeks. I have had the privilege to be part of several of these frank conversations. For the last several months, Dean Latimore has led the development of a strategic plan for the Office of Diversity, Equity & Inclusion. While still a work in progress, I can share that this plan will include education in unconscious bias, micro-aggressions, ally-ship and bystander training, crucial conversations/dialogues, and leading across differences; provide strategies to enhance recruitment, retention, and inclusion; delineate goals and measurable outcomes; and hold us accountable to achieving these outcomes. This work cannot fall to one office, but requires our commitment as a school and as members of a community. Our actions must be real and sustained. I would like to elaborate on this vision.

To address behaviors such as racism, gender discrimination and harassment, and bullying, we must hold people accountable, regardless of rank or position. Accountability requires a system for confidential reporting, tracking patterns (either at the individual or unit level), and a standardized approach to behavior. This approach should include both counseling and behavioral interventions but also consequences for repeated and egregious offenses. In February, we developed such a standardized approach, and Deputy Dean for Professionalism and Leadership Linda Mayes has presented this process to department chairs and other members of senior leadership, FAC, SWIM, and MORE. Since February, we have completed climate reviews of seven departments, sections, or labs where there were perceived patterns of concern and have developed plans for intervention. We are also working with YNHHS to develop processes for sharing information to enhance pattern recognition. Our efforts to address racism and promote diversity and inclusion must span not just the medical school but also the hospitals and clinics where residents and fellows train, and the communities where our faculty, staff, and students live.

Accountability also requires that we select value-driven leaders and that we provide them with the training and tools to hold others accountable. In the last four months, we have revised our search processes for senior leadership. Importantly, this includes the constitution of search committees that are inclusive. We are developing onboarding tools and have expanded leadership coaching for new chairs and directors.

We must measure and report desired outcomes regularly. In the State of the School, I presented data on the proportion of URiM and women faculty by rank. In 2019, 9.4%, 6.2%, and 5% of assistant professors, associate professors, and professors, identified as URiM. While these numbers are unfortunately typical of our peers, Yale School of Medicine should lead in this area. Forty-seven percent, 41%, and 26% of assistant professors, associate professors, and professors were women. The proportion of faculty in these groups is a “lagging indicator,” but we must also track and report “leading indicators,” such as the proportion of candidates interviewed who come from these groups. Only by moving leading indicators will we move lagging indicators.

We must continue to build the pipeline. Today, approximately 28% of our students are URiM. Increasing the representation of these groups among our residents, fellows, and faculty requires that we nurture the career development of our students. We have opportunities to enhance the recruitment of URiM candidates in our graduate medical education programs. Similarly, we must continue to invest in programs that expose K-12 students and undergraduates to careers in STEM and medicine in particular.

In order to retain our best and brightest, we must develop a strong culture of mentorship and work proactively. A recurring theme in my listening meetings with faculty and staff is the need for career development. In March, I appointed a task force to make recommendations about an institutional infrastructure for career development for physician-scientists. At the same time, Deputy Dean Linda Bockenstedt has tasked Associate Deans Samuel Ball and Jonathan Grauer with surveying our departments to develop best practices for career development for clinicians. It is our intention to create centralized resources. In my experience, attention to career development and mentorship particularly benefits women and URiM faculty. For example, the observation that faculty of color carry a disproportionate share of citizenship duties (committee membership, etc.) reflects a failure of mentorship. We have begun to conduct exit interviews of faculty who have left Yale in the last three years. Going forward, we must also conduct “stay interviews” in which we identify the needs of our faculty proactively. In our Strategic Plan for Diversity, Equity and Inclusion, we will propose the creation of modules within our career development programs that address the unique challenges faced by URiM faculty. With the support of the YSM Office of Diversity, Equity & Inclusion, Professor Valentina Greco has created similar resources for women. We will measure the outcomes of these programs.

We must address inequities in health care in partnership with our community. The COVID-19 pandemic has highlighted yet again the effect of inequities in health care. In response to COVID-19, we developed coordinated collaborations across the university and health care system. We can leverage these collaborations to address health inequities. Together with Tesheia Johnson, deputy director and chief operating officer of YCCI, and Marcella Nunez-Smith, founding director of the Equity Research and Innovation Center, as well as other leaders of YCCI and colleagues in the Department of Sociology, we have expanded conversations with leaders of the Connecticut AME Zion Churches, Junta for Progressive Action, and local community-based organizations to prioritize and address health inequities and the needs of our community, including those areas where more research is needed. These conversations and others will serve as the basis for strategic planning and investment in community-engaged research.

We have much to do. Every member of our community has a role to play in changing our culture, and I ask you to consider what role you will play. I look forward to working together with you on this important undertaking.

Sincerely,

Nancy J. Brown, MD
Jean and David W. Wallace Dean of Medicine
C.N.H. Long Professor of Internal Medicine