Effective Strategies to Improve Diversity, Equity and Inclusion in Pathology
January 30, 2022Information
January 27, 2022
Yale Pathology Grand Rounds
Marissa J. White, MD
ID7387
To CiteDCA Citation Guide
- 00:00Yes. At the end of our conversation today,
- 00:04hopefully you'll be able to recall
- 00:06the term underrepresented in medicine
- 00:07as defined by the Association
- 00:09of American Medical Colleges.
- 00:10Describe historical and current
- 00:12distribution of individuals
- 00:13underrepresented in medicine or UIM,
- 00:15both in training and practice,
- 00:16with an emphasis on pathology.
- 00:18Specific data.
- 00:19Recognize how barriers retaining
- 00:21individuals underrepresented in medicine
- 00:23evolve at each station or career,
- 00:25and then outline some key elements
- 00:27for an impactful DI initiative.
- 00:30Alright, but before we move forward,
- 00:32we want to recognize the past and better
- 00:35understand where we are coming from
- 00:37and understand the context in which the
- 00:39disparities that we currently see arose in.
- 00:42And for those of you who are
- 00:44readers or audiobook listeners,
- 00:45I have no stake in this book,
- 00:48but I think how the word is
- 00:50passed is a really nice book.
- 00:51For those of you to listen to,
- 00:53and I think it really
- 00:54emphasizes what I want to take.
- 00:56Drill home with this part
- 00:57of our conversation today,
- 00:59which is there is.
- 01:00The history that we know,
- 01:02the issue that we're taught,
- 01:03and then what actually happened and you know,
- 01:06it's important to be cognizant of
- 01:09what we thought we knew may not
- 01:12be reflective of the actuality
- 01:14of what we're seeing today.
- 01:16So I want to just pause and recognize our
- 01:18history in medicine and again of course,
- 01:20history.
- 01:20Medicine begins with segregation
- 01:22and medicine with ***** versus
- 01:24Ferguson upholding segregation.
- 01:26And I think there are a few of us
- 01:29that have some ties to Atlanta.
- 01:30So I'd just like to highlight the
- 01:32GREYDIS which is Grady Memorial
- 01:34Hospital is built in the shape of
- 01:36an age so that the white patients
- 01:37were on one side of the H and
- 01:39the colored patients are black.
- 01:41Patients were on the other side of the
- 01:43age and they had separate care teams.
- 01:45Matt Hopkins at Hopkins was segregated
- 01:48with the last inpatient unit being
- 01:50desegregated in about the mid 1970s.
- 01:53The first black pathology residents
- 01:55didn't resident did not enter our program
- 01:58until the year my brother was born,
- 02:00so again,
- 02:01segregation of medicine is a very real
- 02:04thing and this is the real history
- 02:06that we need to be cognizant of.
- 02:09Speaking of the history that we
- 02:10were taught and what you know the
- 02:12the other aspects of the history
- 02:13that we didn't necessarily know
- 02:14the Flexner report we all learned
- 02:16about the landmark Flexner report
- 02:18published by Abraham Flexner.
- 02:20Which is a comprehensive survey of
- 02:22the US and Canadian medical schools
- 02:24over the span of 18 or so months.
- 02:26This was commissioned by the American
- 02:29Medical Colleges Association Council
- 02:31medical education and it sought
- 02:33to reform and standardize medical
- 02:34education and bring it into what
- 02:36at the time was science and rigor
- 02:39providing medical students with
- 02:40an evidence based education and
- 02:43institutions such as you know,
- 02:45the Harverst the Hopkins stood
- 02:46out as the landmark institutions
- 02:48and that's what we were taught.
- 02:50That's what I was taught.
- 02:51I was taught that the Buckner port was.
- 02:52Instrumental in revolutionising
- 02:54medical education and really bringing
- 02:56us forward and bringing science and
- 02:58rigor again into medical education.
- 02:59What I didn't learn was that there are
- 03:02other chapters of the Flexner report.
- 03:03There was chapter 13,
- 03:04the medical education of women and
- 03:06then chapter 14 medical education of
- 03:08the ***** and learned about this.
- 03:10Anecdotally, I don't know what
- 03:12prompted me to just go look at
- 03:13the look up the facts and report,
- 03:15but I look I just decided to
- 03:17read it one day and I know these
- 03:19these these two chapters.
- 03:20So if you look at chapter 13.
- 03:23Medical education of women and it
- 03:25briefly outlining the status of medical
- 03:27education of women in early 20th century
- 03:29and while Flexner noted that female
- 03:32student enrollment was declining.
- 03:34Flexner did note that there was a
- 03:36clear role for women to be educated
- 03:39and medicine and become physicians.
- 03:41However,
- 03:41they flex or noted that they
- 03:43women had a decreased decreasing
- 03:46inclination to enter medical school,
- 03:48which was interesting.
- 03:51Now,
- 03:51as I mentioned,
- 03:52the flexing report was Brett Rose
- 03:53revolutionary in terms of.
- 03:55Bringing science and rigor into
- 03:56medical education,
- 03:57but the the consequences at the medical
- 04:01schools that Flexner felt did not have
- 04:04the adequate resources or the OR the
- 04:06whether they be physical resources.
- 04:09Faculty resources,
- 04:10whichever institutions that did
- 04:12not have the resources.
- 04:14Flexner spell all that out and
- 04:16then recommended whether they be
- 04:19closed or remain in existence.
- 04:21And So what?
- 04:21Flexner outlined in this Chapter
- 04:2313 is that none of the three women
- 04:25medical colleges at that time
- 04:26could be sufficiently strengthened
- 04:28without enormous select outlay,
- 04:30and recommended their closure where
- 04:31those medical school colleges was
- 04:33actually in Baltimore as well.
- 04:35Baltimore as well.
- 04:37So the implications on the flexing
- 04:39report for female medical education
- 04:40there is decreasing female
- 04:42enrollment with closure of medical
- 04:44schools with trained female,
- 04:45but also African American and
- 04:47working class or socio economically
- 04:49disadvantaged students.
- 04:50This also occurred in a time when medical
- 04:53schools still had some gender based
- 04:55quotas and so even though there was.
- 04:58Duckster was arguing that there needed
- 05:00to be females educated in medicine.
- 05:02The medical schools were not
- 05:04forced to have or to get rid
- 05:07of their gender based quotas.
- 05:09So what about medical education and
- 05:11the impact on African Americans?
- 05:13So out of these seven African
- 05:15American medical schools,
- 05:16which were in existence at the time,
- 05:18including Howard University College of
- 05:19Medicine and Meharry Medical College,
- 05:21Flexner argued that only two of
- 05:24those seven medical schools were
- 05:25able to provide a quality medical
- 05:27education at the standards that
- 05:29Flexner had argued were necessary.
- 05:32With that in mind, he did,
- 05:34however,
- 05:34outline a fundamental need for properly
- 05:37qualified education physicians.
- 05:38I'll be at what they narrowed.
- 05:39Scope of focus.
- 05:40I'm more so on public health and
- 05:43hygiene rather than subspecialty care.
- 05:46So what are the long term implications?
- 05:48Five of those seven medical colleges
- 05:51were closed with Howard and Meharry
- 05:53being the only two that were allowed to
- 05:57remain open. Morehouse School of
- 05:59Medicine didn't open until about the
- 06:01mid 70s and then secondarily with the.
- 06:05And fundamental need for qualified for
- 06:09qualified African American physicians
- 06:11outlined the the scope of practice was
- 06:14narrowed to again primary care and public
- 06:16health and hygiene with fewer African
- 06:18American physicians educated in medical
- 06:21specialties and the consequences that
- 06:23there is diminished or decreased access
- 06:25to subspecialty care for quite some time.
- 06:28And we still see those profound disparities
- 06:31in representation in subspecialties today,
- 06:33including orthopedic surgery,
- 06:35interventional radiology, cardiology, etc.
- 06:37So these are some of the
- 06:39long term implications,
- 06:41but another one that is,
- 06:42you know that that's the
- 06:44elephant in the proverbial room.
- 06:45Decrease exposure for diverse educational
- 06:47environments for all medical students.
- 06:49So not only are we talking about diminished
- 06:51access to education for African Americans or
- 06:54individuals underrepresented in medicine,
- 06:56particularly at the time
- 06:58indigenous Americans,
- 06:59would it be included in that as well?
- 07:01But then also,
- 07:02on the flip side,
- 07:04you had Caucasian students that were not,
- 07:06or white students that were not being.
- 07:08It educated an environment where
- 07:11there was diversity.
- 07:13But what about beyond education?
- 07:15We had patient segregation in the wards
- 07:17we talked about that with the greedies
- 07:19and we talked about that at Hopkins.
- 07:21But what about desegregation beyond awards?
- 07:23What about in pathology?
- 07:25So some of you historians may may
- 07:27remember that our blood supply
- 07:29was segregated for quite some time
- 07:31up until about the mid 1950s,
- 07:33or well into the mid 20th century.
- 07:36And this is what this is a an image
- 07:40published by Paul Hoxworth showing
- 07:42what the blood storage refrigeration
- 07:44units looked like,
- 07:45where you had it on one side,
- 07:46white blood and the other side colored blood.
- 07:48And these would be taken from white or.
- 07:51Brown donors and then stored in
- 07:53separate areas of the blood bank and
- 07:56only transfused to specific patients.
- 07:59And this is also in pathology again.
- 08:02So for those of you that have
- 08:04ties to Hopkins,
- 08:04this is our old original morgue and these
- 08:07little white tags on the doors are for
- 08:10white patients and colored patients.
- 08:13And this is from Doctor Ralph Rubin
- 08:15who shared this photo and I did touch
- 08:17base with Doctor John Boitnott.
- 08:20For those of you, again,
- 08:21have some Hopkins ties.
- 08:22Who confirmed that this was an
- 08:25actual this was. This was real.
- 08:27There were segregated storage,
- 08:30refrigeration, sorry there was.
- 08:33There was segregation in the morgue,
- 08:35although they did not necessarily
- 08:36always follow it.
- 08:37And you know that that take
- 08:39that for what it means.
- 08:41But it was built with segregated morgues.
- 08:45Alright, So what is the argument
- 08:48for diversity in pathology?
- 08:50Again, we talk about pathologists
- 08:52and you know we don't typically see
- 08:54our patients with the exception of
- 08:57those and of those of us in forensics
- 08:59or who those of us who do find
- 09:02utile aspirations as pathologists,
- 09:03we primarily look at,
- 09:04you know tissue under the slides or
- 09:06we look at blood and tubes and so
- 09:08we're not seeing our patients and
- 09:10so you could argue that I work we,
- 09:12as pathologists,
- 09:13work in a setting where bias doesn't have.
- 09:15He doesn't have impact on our
- 09:17clinical workflows.
- 09:18We are not impacted by bias.
- 09:21However,
- 09:21that couldn't be further from the
- 09:23truth and you don't necessarily need
- 09:24to be seeing your patients to be 1
- 09:27affected by bias or two to perpetuate
- 09:29and exacerbate health disparities.
- 09:31But beyond that, you know.
- 09:34Again, thinking classically about
- 09:35what workforce diversity does,
- 09:37we classically think of you
- 09:39know workforce diversity,
- 09:40providing improved patient care
- 09:41with patient provider, concordance,
- 09:43and the provision of cultural.
- 09:45Appropriate and patient centered care,
- 09:47which again might not be as relevant
- 09:49to most of us as pathologists,
- 09:50with the exception of those of us
- 09:52that do interact with patients.
- 09:53However,
- 09:54diversity has more has other ways
- 09:56on touching on how we provide
- 09:58care and how we can how it can
- 10:00improve the way we provide care.
- 10:03Not only does it help us
- 10:04provide higher quality care,
- 10:05but as well established that diversity in
- 10:07the workforce helps increase innovation.
- 10:09When you have diverse teams,
- 10:11diverse teams bring increased awareness
- 10:13of and emphasis on health and health care,
- 10:15disparities,
- 10:16diversification of clinical trials.
- 10:18I think that's a really hot button
- 10:19topic now that we're more aware of.
- 10:21But this is something that's been
- 10:23going on long for for quite some time,
- 10:25including the post NIH Revitalization Act,
- 10:28which mandates that the clinical
- 10:30trials and studies that are receiving.
- 10:32And age funds need to be thinking
- 10:35mindfully about diversity,
- 10:36increased workforce diversity
- 10:38and touches on all these aspects.
- 10:40Provision of high quality care,
- 10:42clinical child diversity help
- 10:43US verities focus innovation.
- 10:45So even though we as pathologists are
- 10:47not directly improving patient care
- 10:49by patient provider, concordance,
- 10:51or culturally appropriate and
- 10:52patient centered care,
- 10:53there are other ways that diversity
- 10:55adds value to the work that we do.
- 10:57And if you are,
- 10:59you know somewhat of a skeptic
- 11:01and you know disagree with those.
- 11:04You know things that I advocate for
- 11:06in terms of why diversity matters.
- 11:08Diversity does bring in higher
- 11:10financial performance with the
- 11:12McKinsey analysis.
- 11:13Looking at private sector companies
- 11:15and looking at financial performance.
- 11:17And they demonstrate that ethnically
- 11:20diverse companies were outperform
- 11:22or more likely to outperform their
- 11:24non diverse businesses.
- 11:25So even if there is a question of
- 11:28whether or not diversity increases
- 11:30innovation or increases emphasis
- 11:32and awareness on health disparities.
- 11:35Or improves the quality of care.
- 11:37Fundamentally it is financially
- 11:40beneficial to increase diversity.
- 11:43So now that we understand the
- 11:45framework for which we
- 11:47are building,
- 11:48our discussion on diversity upon,
- 11:50let's talk about what we currently
- 11:52observe the pathway into pathology,
- 11:54and we understand that you know,
- 11:55we as a as a medical as a
- 11:58medical institution had were
- 12:00segregated for quite some time,
- 12:02and with that segregation
- 12:04extending into a pathology space,
- 12:05we recognize that the long term
- 12:08impact of overt segregation and overt
- 12:10exclusion in medical education is
- 12:12still palpable today in terms of the
- 12:14representation that we do not see.
- 12:15In our medical specialties,
- 12:17so where are we now?
- 12:19So as it just pause and check in,
- 12:21here underrepresented is a term that I
- 12:23will be using for the remainder of the talk,
- 12:26which means those racial and ethnic
- 12:27populations that are that are
- 12:29underrepresented in the medical
- 12:30profession relative to the numbers
- 12:32in the general population and this
- 12:33represents a shift from the 2003
- 12:36term underrepresented minority which
- 12:39classically consists of blacks,
- 12:42individual black individuals
- 12:44on Mexican Americans,
- 12:46Native Americans mainland Puerto Ricans.
- 12:49And for those individuals we would use
- 12:52the term underrepresented minority.
- 12:53However,
- 12:54the AMC decided to shift and use
- 12:56the term underrepresented medicine
- 12:57because the old term underrepresented
- 13:00minority represents affixed,
- 13:01affixed aggregation of individuals where you,
- 13:03as UIM allows for an evolution of
- 13:06the individuals that we are looking
- 13:08at relative to their population
- 13:09within the United States and so the
- 13:11expectation or the hope is that at
- 13:13some point black individuals will
- 13:15no longer be underrepresented in
- 13:16medicine relative to the proportion
- 13:18of the United States population.
- 13:20And therefore we can shift the focus
- 13:23more appropriately to other individuals.
- 13:26OK,
- 13:26now again I just said I will be using you.
- 13:28I am for the remainder of the talk,
- 13:30but a lot of these data are coming
- 13:31are are are a little bit older
- 13:33and so they are priest.
- 13:35They they predate the ships to you.
- 13:36I am so URM will be synonymous
- 13:39and for these slides,
- 13:41but what I'd like to highlight is
- 13:42that when we look at when we look
- 13:44at the very beginning of the path,
- 13:46we're not the very beginning when
- 13:47we look at the middle of the pathway
- 13:48into a career in medicine with the
- 13:50beginning of the pathway starting
- 13:51and you know my sons pointed in
- 13:53kindergarten when we look at the
- 13:54midpoint in terms of applications.
- 13:56In medical school we do see that
- 13:58there have been slight increases
- 13:59in the number of applications the
- 14:01medical school over the past.
- 14:02I'd say since the past 2000s we can
- 14:04see that that there is an uptick.
- 14:06However,
- 14:07we need to be very deliberate in
- 14:09how we look at these data because
- 14:12applications are not the only.
- 14:13Point here, right?
- 14:14We want to look at how many students
- 14:16are matriculate ING successfully,
- 14:18and then how many are actually graduating
- 14:21applications are not sufficient,
- 14:23and they don't represent the
- 14:25entirety of the situation.
- 14:27So we look at individuals that
- 14:29are identified at self identify
- 14:31as black or African American.
- 14:33When we look at the number of
- 14:35applicants versus acceptes
- 14:36again, you see that upward trend
- 14:38in the number of applications.
- 14:39But when you look at the number of acceptes
- 14:42that has remained fairly stagnant and
- 14:44then it's important take home point,
- 14:46there is something going on here.
- 14:47Whether there are barriers to their
- 14:49acceptances or they're just not being
- 14:51accepted at increasing rates commensurate
- 14:53with the number of applications.
- 14:55Same similar trends seen
- 14:56in our Hispanic or Latino.
- 14:58Populations or Latin X populations.
- 15:00You see that there is an uptick
- 15:01in the number of applicants,
- 15:02but not the same rate of increase
- 15:05in the number of acceptance
- 15:07applicants versus acceptance.
- 15:10This deposit check in here are
- 15:11American Indian or Alaskan
- 15:13native or Indigenous American.
- 15:14Population has remained abysmally low
- 15:16in terms of the number of applicants
- 15:19versus acceptes and this is often
- 15:21the unspoken aspect of diversity.
- 15:24When we think about our Native American
- 15:26indigenous American population,
- 15:27profound under representation.
- 15:29Despite significant disparities in
- 15:31health and health care delivery.
- 15:34OK,
- 15:35so we talked about the midpoint in
- 15:37the pathway into query medicine,
- 15:39which is the application to medical school.
- 15:41We talked about that even though
- 15:42the numbers of applicants that are
- 15:44under record that self identify
- 15:46as underrepresented in medicine
- 15:47or underrepresented minority have
- 15:49increased the number of acceptes
- 15:51has remained stagnant.
- 15:52What we also see is that there
- 15:55is declining representation,
- 15:57so we have the US Census population
- 15:59which serves as our benchmark
- 16:01that is our representation in the
- 16:03total US population will meet.
- 16:05Look at the various milestones we
- 16:07look at the medical school graduates
- 16:09and then we look at the total GME
- 16:11pool and we look at the total
- 16:13physician pool we see attrition or
- 16:15loss of these individuals on the
- 16:18pathway to a career as a physician,
- 16:20and again highlighting reiterating
- 16:21the thing that we saw with the
- 16:23acceptance versus acceptance.
- 16:24There's attrition there,
- 16:25so at every node or every milestone
- 16:27in this pathway, there is attrition.
- 16:29There's attrition from application to
- 16:31acceptance, acceptance to matriculation,
- 16:33which circulation to graduation.
- 16:35Graduation to residency residency
- 16:37to practicing physician.
- 16:41And. This trend continues so under
- 16:45representation increases at faculty ranks.
- 16:48So when you look at Mewis Medical
- 16:50school graduates and compare their
- 16:52numbers with full time US Medical
- 16:54school faculty again you see that
- 16:57attrition with declining representation
- 16:59down to about 3.5 three point 5% for
- 17:03black representation at faculty ranks,
- 17:06and three point 2% for Hispanic or Latino.
- 17:11But what an interesting trend here.
- 17:13However, though,
- 17:14is that these gender disparities that we
- 17:16all talk about gender disparities and
- 17:19feet and in female representation and
- 17:21hire faculty ranks and leadership roles.
- 17:23Those gender disparities persist independent
- 17:25of a self identified race Recognice city.
- 17:29So even though there are more female African
- 17:32American or black self identified physicians,
- 17:36there are more male,
- 17:37self identified black or African American
- 17:40faculty and leadership positions.
- 17:42Including department chairs and
- 17:44which is what we're looking at here.
- 17:47Same thing resonates true for Hispanic.
- 17:51And stepping outside of,
- 17:53you know the the MD pathway.
- 17:56Do these trends hold true for our
- 17:58PhD colleagues?
- 17:59And they do so when we look at
- 18:01data from the NIH,
- 18:02we see that there again is
- 18:04at trend of attrition.
- 18:05When you look at let's look at women,
- 18:07you look at women the there's
- 18:09attrition from associates to bachelors,
- 18:11bachelors, Masters, Masters,
- 18:13electoral etc etc.
- 18:14When you look at underrepresented again,
- 18:17there's attrition down to full professor.
- 18:20So these.
- 18:21These trends resonate and or these
- 18:24trends are persistent through not only
- 18:27the MD pathway but also PhD pathway.
- 18:31And I'd like to highlight something
- 18:33that was published by Ginther at all,
- 18:35where they noted that after controlling
- 18:37for applicant educational background,
- 18:39country of origin training,
- 18:40prior research experience,
- 18:42publication record,
- 18:43employer characteristics,
- 18:44they found that black were African
- 18:47American self identified faculty remain
- 18:50less likely than white than white
- 18:53individuals to be awarded NIH funding,
- 18:55which again represents a significant barrier,
- 18:57particularly for our PhD colleagues
- 18:59and their.
- 19:00Not only a fat successful
- 19:02faculty appointment,
- 19:03but then also successful untimely
- 19:05promotion from assistant to
- 19:07associate associate full professor.
- 19:09This is also somewhat true for MD's,
- 19:12but may not be necessarily as
- 19:14critical to successful promotion.
- 19:16To just highlighting that there are
- 19:19barriers to successful promotion for
- 19:21not only individuals underrepresented
- 19:23but also individuals that I self
- 19:26identify as female and these hold
- 19:28true not only for MD but also PhD.
- 19:31Pathways and I'm talking a lot
- 19:34about race and ethnicity,
- 19:36since that is the area that
- 19:37I am the most familiar with.
- 19:39However,
- 19:39I do want to pause again and
- 19:41check in and remind everyone that
- 19:43diversity is very diverse when we
- 19:45look at socioeconomic diversity,
- 19:47for example,
- 19:48there is significant and profound
- 19:51underrepresentation of individuals
- 19:53that have parents that have the that
- 19:56have income within the lowest quintile.
- 19:59Less than you know,
- 20:01less than 5% of our US medical students have.
- 20:03Parental incomes within the lowest quintile.
- 20:07But then when you look at the
- 20:09top 50% of the of the students,
- 20:11their parents have the top 5th
- 20:14and 80th to 95th
- 20:16percentile. Income just highlighting profound
- 20:19disparities in socioeconomic status using
- 20:21parental income as a surrogate marker,
- 20:24and this has remained relatively stagnant,
- 20:26and these socioeconomic barriers have been
- 20:29demonstrated to correlate with performance
- 20:31and success within medical school with
- 20:34students that come from that have parents
- 20:37that have again low socioeconomic
- 20:39income or socio economic status,
- 20:41those students are more likely to attrite
- 20:44within the first first, second, first,
- 20:46or second years of medical school.
- 20:48Independent of their emcat scores,
- 20:51so again, socioeconomic status impacts.
- 20:55Diversity and has an impact on the
- 20:58barriers that the students will face.
- 21:01So why don't we look at some pathology
- 21:04specific data that we looked at some broader
- 21:06overall trends and medical education,
- 21:08and we look at pathology and I again I I
- 21:12want to just remind everyone that these
- 21:14are all data that are obtained from AMC
- 21:17and historically AMC data collection
- 21:19methods have been somewhat reductive
- 21:21and exclusive of of of individuals.
- 21:24So for the up until recently I think is 2017.
- 21:29You could either identify as black
- 21:31or African American.
- 21:31However,
- 21:32there is incredible diversity
- 21:33within African diaspora.
- 21:35Same thing is true for Hispanic and
- 21:37then for for gender identity you
- 21:39can either self identify as female
- 21:41or male and that's it.
- 21:43So again a lot of these data.
- 21:44I apologize,
- 21:45I'm not using the correct the
- 21:47the most inclusive terminology,
- 21:49but these are the way that data have
- 21:51been presented and hopefully moving
- 21:52forward now that there are more,
- 21:53there's more inclusion in our
- 21:55data collection methods.
- 21:56We will we'll be able to present our
- 21:58data or the data in a more inclusive way.
- 22:01Well, let's look at.
- 22:02Look at some pathology specific data and
- 22:04my interest in this was sparked by a.
- 22:07Paper published by one of my
- 22:09colleagues here in radiation Oncology
- 22:10at Hopkins Cortlandville,
- 22:12who published that in 2012.
- 22:15GME trainee or pathology GME
- 22:18trainees were there are fewer black
- 22:22pathology trainees 11 compared
- 22:23to the overall Jamie Pool,
- 22:26and that's also in comparison to for example.
- 22:30Physical medicine and rehabilitation.
- 22:32Emergency medicine.
- 22:33Radiation oncology.
- 22:33So at that time we had worked
- 22:36we had lower representation of
- 22:38black students or black rice.
- 22:40I'm sorry black residents at
- 22:42that time in 2012 when compared
- 22:44to other medical specialties.
- 22:46Hispanics were also less represented,
- 22:49however that was not
- 22:50statistically significant,
- 22:51so I became interested in
- 22:53kind of looking at longer,
- 22:54longer trend,
- 22:55longer term themes and trends in
- 22:58terms of representation,
- 23:00and to and look more forward and
- 23:02see how the trends improve or
- 23:04if there is improvement.
- 23:06And So what I noted first was
- 23:08that pathology is a female,
- 23:10is a leader for female resident
- 23:12and fellow representation compared
- 23:13to other medical specialties,
- 23:14and that certainly is no secret.
- 23:16We in pathology reached near gender
- 23:18parity in the in the early 2000s,
- 23:20and that has been a sustained increase
- 23:22in female representation since then,
- 23:25and so it's we've made significant strides.
- 23:27So what it highlights is that
- 23:29we as a specialty
- 23:30or are are capable of doing it.
- 23:32We increase female representation
- 23:34and that increased female
- 23:35representation has been sustained.
- 23:37And so it's portant for us to keep that
- 23:39in mind when we think about how high the
- 23:41hurdle and amusing hurdle as an analogy.
- 23:43Since I was a hurdler in college,
- 23:44what we use, you know that that
- 23:46there is a high hurdle to overcome,
- 23:48but we can do it because we did
- 23:50it for female representation.
- 23:52With that in mind,
- 23:54there are still significant barriers to
- 23:56increasing female representation by fat
- 23:59***** particularly in faculty ranks,
- 24:01with which we note that about 39.56%
- 24:05of female faculty or faculty or female.
- 24:07So there are still some significant
- 24:10opportunities for improvement.
- 24:12But again, there is still sustained increase,
- 24:15and so we are on the right pathway forward.
- 24:20And when we look at the 2020 seventeen
- 24:22distribution of female sex by female sex
- 24:25Ben pathology compared to the US population,
- 24:28again, we are doing fantastic with
- 24:30our pathology residents almost at
- 24:32the same level of their female
- 24:35representation in the US Census.
- 24:37However, again are practicing
- 24:38pathologists is a little bit lower than
- 24:40female representation in US Census,
- 24:42so opportunities for improvement. But again,
- 24:44we're on the right pathway forward.
- 24:46So again, it highlights that we can do it.
- 24:49With that in mind,
- 24:50but there are some significant
- 24:51opportunities for us to do it.
- 24:52We have to increase racial and
- 24:55ethnic diversity in pathology.
- 24:57When we look at the distribution
- 24:58of pathology residents by race and
- 25:00ethnicity between 1995 and 2017,
- 25:02at that point in time 8% were Hispanic,
- 25:064.5% were black and point 1% were
- 25:10Indigenous American, American,
- 25:11American Indian, Native American,
- 25:15Pacific Islander.
- 25:17These have increased only slightly
- 25:19in pathology.
- 25:20For Hispanic, we're a little bit above eight,
- 25:238% were around 5% for black and.
- 25:27About the same for American
- 25:30Indian indigenous American.
- 25:31Why is this matter? Again,
- 25:33US census populations here in the top bar.
- 25:36Hispanic and yellow,
- 25:37black and blue.
- 25:39And and just Americans in in black.
- 25:43And we know again there is significant
- 25:47underrepresentation comparatively speaking,
- 25:48when we look at the number of faculty.
- 25:50We're at 5.2%,
- 25:51two point 2% and .2% respectively.
- 25:55So significant under representation.
- 25:58And when we look at longitudinal trends,
- 26:00there are none.
- 26:01The rate of increase in representation
- 26:04for black faculty and Native American
- 26:06faculty has not been increasing at a
- 26:09significant rate. Again, abysmally low.
- 26:12So there are significant opportunities,
- 26:15and there's no secret that when
- 26:16we look even at pathology,
- 26:18chair and leadership positions again,
- 26:21these disparities persist again with
- 26:23the gender diverse gender disparities
- 26:26persisting as well with data from AMC High.
- 26:29Highlighting that of our pathology
- 26:33department's 38% of our clinical
- 26:35pathology departments or pathology
- 26:36clinical departments have female chairs.
- 26:3833% of our basic science pathology
- 26:41apartments have female chairs.
- 26:42There are two female, one male,
- 26:45black or African American chill chair.
- 26:47Three female,
- 26:482 male Hispanic or Latin X or Latino
- 26:51no American Indian Alaska native oh
- 26:54ornate Hawaiian so again highlighting
- 26:57the overall trend of attrition.
- 26:59There's loss on this pathway into
- 27:02medicine and I just want to pause
- 27:04here again and think about the
- 27:06terms that we often use.
- 27:07We often say the pipeline and,
- 27:09and when we think about being
- 27:11in the space of the eye,
- 27:13we want to be more Cognizant that
- 27:15we always have room for improvement
- 27:16and this is an area where I was.
- 27:19Educated historically,
- 27:19I had been using the term pipeline
- 27:22and one of my, you know,
- 27:24in my studies I recognize and learned
- 27:26that pipeline is an inherently
- 27:28is inherently triggering term.
- 27:30For some individuals who identify
- 27:32as indigenous American with the
- 27:34with the with the connotation
- 27:36or correlation with the the oil
- 27:38pipelines in the in the Midwest,
- 27:40and then thinking about to
- 27:41our the black experience in
- 27:43America, they call it. You know,
- 27:44the pipeline into jail. So wanna be.
- 27:47I'm trying to be more inclusive there
- 27:48and and avoid using that terminology.
- 27:50I've been trying to involve
- 27:51myself and use a term pathway,
- 27:53but we are seeing attrition on
- 27:55this pathway into medicine and we
- 27:57want to be mindful of what that
- 27:58pathway into medicine may look like.
- 28:00You know, thinking about our
- 28:02colleagues and you know,
- 28:03those individuals that you work with.
- 28:04Some of them may have and assume you know
- 28:06may may have earned an associates degree.
- 28:08First took some time off,
- 28:10went back out of four year degree
- 28:11and then took some time off
- 28:12again and then came back to you.
- 28:14Know medicine now thinking about
- 28:16what that individual needs compared
- 28:18to a a student that goes straight
- 28:20from high school to medical school.
- 28:22Or high school to college to
- 28:23medical school residency.
- 28:24Their needs are distinctly different and
- 28:27unique and being inclusive of each person,
- 28:29lived experiences and what
- 28:31career supports or what personal
- 28:34support they need for them.
- 28:36So I'm going to share some of what I've
- 28:39learned in some of what we've learned
- 28:40here at Hopkins and our efforts to
- 28:43improve inclusion and equity in pathology.
- 28:46And we'll start with our rotation for
- 28:48students underrepresented in medicine
- 28:50and from disadvantaged backgrounds,
- 28:51and pre COVID.
- 28:52This was a one month rotation
- 28:54for students who self identify
- 28:56as underrepresented in medicine
- 28:57and at the time we were covering,
- 28:59housing and travel for students
- 29:01which rounded out to approximately
- 29:04$1500 excluding travel,
- 29:05which includes housing and then school of.
- 29:08Medicine registration fees and I'm
- 29:10highlighting this because these are,
- 29:11you know pre COVID.
- 29:12We thought a lot of we put a lot
- 29:15of weight into those, you know,
- 29:16external rotators, right?
- 29:17Like oh,
- 29:17this person did a rotation with
- 29:18us and they were pantastic,
- 29:20but we often didn't think about how and
- 29:22how inequitable of an experience that is.
- 29:24The students have to have the
- 29:26money to spend to stay in a certain
- 29:29location for an entire month.
- 29:31Essentially pay double rent,
- 29:33and then travel and pay registration fees.
- 29:35If you are a student,
- 29:36that is a perhaps, you know,
- 29:37first generation college graduate.
- 29:39Or a student that comes from a socio
- 29:43economically disadvantaged background.
- 29:44You know those experiences are
- 29:47exceedingly difficult to navigate
- 29:49because they are expensive,
- 29:50and so for us,
- 29:52that was why providing cover
- 29:54financial support is important.
- 29:57And in terms of increasing equity and access,
- 30:00we also aim to increase equity by tailoring
- 30:03the experience to the students and and,
- 30:05you know,
- 30:06checking in with them and finding out
- 30:07what are they actually interested in,
- 30:08not giving them the same
- 30:10cookie cutter rotation,
- 30:11because again,
- 30:12each student has different interests
- 30:14has different needs.
- 30:15We also provided one on one advising
- 30:17and mentoring with pathology,
- 30:18junior and senior faculty had the
- 30:20Met meet with our residency training
- 30:22program director and the director
- 30:23of Department of Pathology and then
- 30:25finally we have exit interviews
- 30:27to discuss
- 30:28their experiences and.
- 30:29And help us self reflect and process improve.
- 30:33And this is our team and I
- 30:35want to highlight that again,
- 30:36none of these efforts can be
- 30:38done in a silo by one person.
- 30:39It really does require a team effort and
- 30:42so here we have lisandra voltaggio myself,
- 30:46Ralph Ruben, Lara Weiquan,
- 30:47Junko Solonika, Wind and Sherry Reid.
- 30:50She's our administrator support.
- 30:51Who is fantastic.
- 30:52Trisha Murdock and Alicia,
- 30:53where again a team effort.
- 30:57So we had this rotation.
- 30:59It was established in 2013,
- 31:01but I didn't become actively involved
- 31:03with it in about until about 2016
- 31:05and my involvement was somewhat
- 31:07serendipitous because I graduated
- 31:09from moral High School of Medicine
- 31:10and Morehouse School Medicine has a
- 31:12pathology department that is fantastic,
- 31:14but they don't have any clinical
- 31:16services and so when I came
- 31:18to Hopkins for as a resident,
- 31:20I was really interested in just
- 31:21giving back to my alma mater and in
- 31:24speaking with Ralph, he said, well,
- 31:25oh, why don't you do an outreach?
- 31:27Presentation and we found that
- 31:28those out the outreach presentation
- 31:30resulted in students being more
- 31:32interested in rotating and so we
- 31:34developed an outreach and active
- 31:36outreach program targeting programs
- 31:38at either our historically black
- 31:40colleges or targeting specific
- 31:42affinity groups at non historically
- 31:45black universities and using
- 31:47those as opportunities to have one
- 31:49highlight pathology as a specialty.
- 31:51Because we need students to
- 31:54go in pathology and then two.
- 31:56Talk to him a little about what our
- 31:58rotation looks like and hopefully
- 32:00generate some interest in our experience.
- 32:02And so we did.
- 32:04Active outreach and we again went in with it.
- 32:07Went into these experiences trying
- 32:09to reach as many students as
- 32:11possible in the hopes that maybe
- 32:13we would get one student rotator,
- 32:15but again,
- 32:16it just highlighted pathology as a specialty
- 32:18to them and we even had students that said,
- 32:21you know,
- 32:21I quite frankly have no
- 32:22interest in pathology,
- 32:23but I want to go into OB GYN and I want
- 32:25to learn more about pathology and we
- 32:27have them rotate and that's totally fine.
- 32:29So what we do is we have the we give
- 32:31an overview of what pathologists do,
- 32:33so this is Alicia.
- 32:35We're giving a presentation on how our
- 32:37pathologists involved in this case,
- 32:38so we give the students a presentation.
- 32:41The presentation or case presentation
- 32:43in this in this talk was a
- 32:45real modular carcinoma,
- 32:46which hopefully most of the medical
- 32:48students as they prepare for step one
- 32:50would be familiar with and we show
- 32:51them some gross photos that that's
- 32:53myself and more hustle of medicine,
- 32:55pre renovations and then walk
- 32:56them through the case and talk
- 32:57about the different ways that
- 32:59pathologists were involved.
- 33:00Talk about not only the
- 33:02gross the frozen sections,
- 33:03but gross examination.
- 33:05Sign out with staging and diagnosis.
- 33:08Diagnosis of an occult hemoglobin.
- 33:11SC disease that clinically
- 33:13had been a cultured,
- 33:14not the clinicians had known about it.
- 33:16We talked about the clinical
- 33:18pathology and how the you
- 33:19know they had a type and screen before by
- 33:21the blood bank and how pathologists are
- 33:24medical direct medical laboratory directors.
- 33:26So again, talking with the
- 33:28different ways that pathologists
- 33:29are involved with patient care.
- 33:30So they hopefully walk out
- 33:32of these presentations,
- 33:33learning that pathologists are not just,
- 33:35you know in the doing autopsies which you
- 33:38know is a very important part of pathology,
- 33:41but you know we don't all
- 33:42do pathology autopsies.
- 33:43If that's certainly not
- 33:45your area of interest,
- 33:46but we also kind of reached back earlier,
- 33:49because, again,
- 33:50if you try if you start your
- 33:52outreach efforts that medical school,
- 33:55you're not going to reach as
- 33:56many students as possible.
- 33:57You thinking about the pipe
- 33:59or the pathway into medicine.
- 34:01There is significant attrition
- 34:02once you hit medical school,
- 34:04but there there is even greater
- 34:06loss before that.
- 34:08Think about when you started as
- 34:09an undergraduate and how many
- 34:11colleagues you had in your first
- 34:13biology class and how many students
- 34:14in your class at their pre Med and
- 34:17then by the time you graduated,
- 34:18at least in my experience,
- 34:19you know it dropped.
- 34:20It dropped down, you know, precipitously.
- 34:22You know once you hit that,
- 34:24you know or inorganic chemistry,
- 34:26organic chemistry class.
- 34:27How many students you know switch to
- 34:29a different major or decided that
- 34:30they no longer want to be pre Med.
- 34:32So what we did is we started
- 34:35reaching out earlier.
- 34:36I mentioned Doctor Trisha Murdock.
- 34:39She's Tuscarora Native American,
- 34:40and she has been a very fierce
- 34:43advocate for increasing representation
- 34:45for our indigenous Americans.
- 34:47And So what she did is looked.
- 34:49Hooked us up with the National
- 34:51Labor American Youth Initiative,
- 34:53which provides a summer intensive
- 34:55experience for students who self
- 34:58identify as Indigenous American.
- 35:00And what we did here is we
- 35:03brought some microscopes.
- 35:04Ralph Ruben packed him up in this
- 35:06car and drove them down to DC for us.
- 35:08And then we brought some plastinated
- 35:10or some some nherf lungs and then
- 35:13some formalin fixed specimens.
- 35:15But you know,
- 35:15we want to be mindful again of inclusion
- 35:17and thinking about the indigenous
- 35:19American experience and culture and values.
- 35:21Some indigenous Americans have
- 35:23concerns about touching tissues
- 35:25from decedent individuals,
- 35:27and so we were very explicit and told him,
- 35:30you know,
- 35:30these are tissues over here at the station.
- 35:32Do not come to the station.
- 35:34You know, you know we will
- 35:36offer you another experience.
- 35:37So again,
- 35:37Trisha,
- 35:38Trisha Murdock was instrumental
- 35:39in helping us provide an inclusive
- 35:41experience for those students.
- 35:43But then also increasing acts,
- 35:45increasing their access and
- 35:46their high school students.
- 35:47A lot of them just had questions
- 35:49about college, but again,
- 35:50just having those conversations with
- 35:51them and having them speak to you know,
- 35:53Trisha someone who had this similar
- 35:55experience growing up in a reservation
- 35:57and learning more about what you know,
- 35:59her pathway looked like so that
- 36:01they can see that it's possible.
- 36:04This summer we are fortunate in
- 36:06able to reset restart our active
- 36:08outreach with our local high school
- 36:11program and this is our summer
- 36:13program at Dunbar High School
- 36:15which is down the street from us.
- 36:17For some of you basketball fans,
- 36:19there are a couple of basketball
- 36:21players that are pretty famous
- 36:22from Dunbar High School,
- 36:23but we worked with them over the
- 36:25summer and again did the same
- 36:26thing where we bought the specimens
- 36:28in the bags and the nerve lungs
- 36:30and the microscopes and had them
- 36:31look at it and it was super cute.
- 36:33Because if you can see in in here,
- 36:35this student has herself one out,
- 36:36not because they're checking their phone,
- 36:38but because they were actually
- 36:39taking a picture like our residents
- 36:41doing like we do using their cell
- 36:42phones to their oculars and they
- 36:44figured this out all on their own.
- 36:45So really bright students.
- 36:47They're super interested and again,
- 36:49we just talked a lot about just college,
- 36:52and that's that's where they are
- 36:53at that point in their career.
- 36:54But just highlighting that,
- 36:56you know this is you can do it.
- 36:58These are the steps that you
- 36:59need to take and we also brought
- 37:01not only pathologist here,
- 37:02you can see my colleague Laura Wake,
- 37:03but then we also brought.
- 37:05Our Histology Histology lab lead.
- 37:09Yolanda Mitchell.
- 37:11And we talked to them who talked
- 37:12to the students about careers in
- 37:14laboratory medicine and gave them
- 37:15some more information about different,
- 37:17you know,
- 37:17a different way that you can
- 37:19get a career in pathology,
- 37:20and you don't necessarily have to
- 37:21be a physician to be in pathology.
- 37:23You can have a very fulfilling career
- 37:25as a lead laboratory technician and the
- 37:27different ways that you can get there.
- 37:30Alright, so.
- 37:30We focus a lot of our efforts on either,
- 37:34again, historically black medical
- 37:36schools or affinity groups or high schools,
- 37:39or undergraduate programs
- 37:40that have a greater,
- 37:41have greater representation,
- 37:43or of students underrepresented in medicine.
- 37:45And why do we do that?
- 37:46Because we want to reach as many
- 37:48students as possible at one moment,
- 37:49and this just highlights the point.
- 37:51So these are data again,
- 37:52from the AMA masterfile from AMC
- 37:54and I highlights the number of
- 37:56medical schools that graduated 300
- 37:58and 5050 or more black or American
- 38:01physicians between 1980 and 2012.
- 38:03And you can see Howard,
- 38:04Meharry and Morehouse are up there,
- 38:07and again,
- 38:08I'm noting Morehouse because Morehouse
- 38:10wasn't open until about the late 1970s,
- 38:13early 1980s.
- 38:14But yet it got in my time when I graduated,
- 38:18my class was around the size of 50,
- 38:20such as schools,
- 38:21to show you that, might you know,
- 38:23at the time,
- 38:24Tiny Morehouse School of Medicine had
- 38:26graduated more than some other medical
- 38:29schools that are notably missing here.
- 38:32Find included.
- 38:33Alright,
- 38:34so US medical student interest you
- 38:37know we talking a lot about reaching
- 38:39as many students as possible.
- 38:40When I reach as many UIM
- 38:43students as possible too.
- 38:44Create the most opportunities
- 38:46for capturing one student,
- 38:47but again pathology interest is declining.
- 38:50We all know that and so why not reach as
- 38:53many UIM students as possible just to
- 38:55generate greater interest in pathology?
- 38:57And so again, that's part of the
- 38:59reason why we try to go for as
- 39:01broad an audience as possible.
- 39:02So when we go back to Morehouse or
- 39:03when we speak with students at Meharry,
- 39:05we we try and talk to the whole
- 39:07class and not just, you know,
- 39:08the students that self identify
- 39:10as being interested in pathology
- 39:11because that may be one person we
- 39:13want to again generate as much
- 39:15interest and enthusiasm about.
- 39:16Our careers and pathology.
- 39:18And these are just prior data
- 39:21highlighting that on again US pathology.
- 39:24Allopathic senior interest
- 39:26is again declining,
- 39:27precipitously relative to all
- 39:29US senior interests and matching
- 39:32into careers in medicine in US.
- 39:35So what is the impact been out
- 39:36of all of this?
- 39:38So with once we initiate the active outreach,
- 39:40we noted a dramatic increase
- 39:42in rotation interest,
- 39:44so again,
- 39:45I mentioned that this experience
- 39:48was established in 2013.
- 39:50I mean at 1 rotator and then when
- 39:52I became involved,
- 39:53the number of rotators between
- 39:552016 and 2019 was 20 and today
- 39:59we've had a total of 26 rotators,
- 40:01some of whom have been virtual
- 40:04out of these rotators,
- 40:069 have been have matched into pathology.
- 40:10We have a few more that are matching that
- 40:12are applying for the match this year or next,
- 40:15and we're hopeful that they will
- 40:17match into pathology as well.
- 40:19To the former,
- 40:20rotators have either completed.
- 40:21Path, Jimmy or you me training at Hopkins.
- 40:25I'm sorry Pat Jamie,
- 40:26either residency or fellowship
- 40:28education or training at Hopkins,
- 40:30and so we're really proud,
- 40:31but again,
- 40:32we had some students that just flat
- 40:34out said I'm going again into LBGYN
- 40:36or or surgery or internal medicine.
- 40:38I don't really have an interest
- 40:40in and you know pathology,
- 40:41but I want to,
- 40:42you know,
- 40:43do this experience around out my
- 40:44experience and that's totally fine.
- 40:46We were thrilled to have them with us.
- 40:48Conversely,
- 40:48we had one student come in that was
- 40:50very passionate about a career in forensics.
- 40:53And then came in and then decided
- 40:56that pathology wasn't for them
- 40:57and that was fantastic.
- 40:58We were happy that we were able to
- 41:00help that student figure out that
- 41:03pathology was not the career for
- 41:04them and they ended up becoming a or
- 41:07matching into a vascular surgery program.
- 41:09And now that student,
- 41:11we're not that resident.
- 41:12Physician seeks to give back to her
- 41:15hometown by being a vascular surgeon and
- 41:19provide care for Indigenous Americans.
- 41:21Recognizing that there are profound.
- 41:23Disparities and diabetes and
- 41:26indigenous American populations,
- 41:27so again having impacts even in
- 41:29medical specialties is important,
- 41:31so we're happy that we've had
- 41:33an impact on these students.
- 41:35Our careers and lives.
- 41:37So that's the objective feedback.
- 41:39The subjective feedback has been positive.
- 41:42One of the best things that
- 41:45we hope to achieve.
- 41:46One of the things that we hope to
- 41:47achieve with this whole experience is
- 41:49not only introducing them to pathology,
- 41:50but then also introducing them to
- 41:52careers in academics and that.
- 41:54Crews and academics can be very diverse and
- 41:57don't necessarily need to be basic science,
- 41:59and you need to have a lab and a
- 42:01wet lab for example. So again that.
- 42:05That feedback has, you know,
- 42:07been fairly consistent and we're
- 42:08happy that we're able to introduce the
- 42:11students to what academics can look
- 42:13like and that a career in academics
- 42:15is not as unattainable as you know,
- 42:17the the perception maybe.
- 42:18And, and that certainly was my lived
- 42:20experience where when I was, you know, I.
- 42:22I certainly you know,
- 42:2420 something year old me wouldn't
- 42:25have imagined that I would have
- 42:27ended up in academics,
- 42:28and this is exactly why,
- 42:30because I didn't think a career
- 42:31in academics was accessible.
- 42:32And I thought academics was one
- 42:35career pathway.
- 42:36But unfortunately during the pandemic again,
- 42:39we had to think creatively.
- 42:42So what we did is create a virtual
- 42:44rotation for students underrepresented
- 42:46in medicine and it started as a rotation
- 42:50for our in-house internal Hopkins
- 42:52students who at the time only had one
- 42:54other rotation that was available to them.
- 42:56Virtually that was clinical,
- 42:57and that was radiology.
- 42:59And so we developed a asynchronous and
- 43:02synchronous work rotation that again
- 43:04was all virtual using digital scan slides.
- 43:07And the students were given again
- 43:09previewing assignments and were expected
- 43:11to render a complete diagnosis and
- 43:13then email their diagnosis to me.
- 43:16And then we would drive the
- 43:17slides together during sign out,
- 43:18and then I would have the students
- 43:20present the cases to either myself
- 43:22or my colleagues or other senior
- 43:23residents as they would if they
- 43:26were doing it in person experience.
- 43:28And all that content was supplemented
- 43:31by asynchronous independent content,
- 43:34including online learning modules
- 43:36and so with this experience created,
- 43:39we were able to we recognize that we
- 43:41were able to reach a broader number of
- 43:43students and overcome the equity issue of,
- 43:45you know that the the fees required
- 43:47to travel for rotations,
- 43:49and so we advocated to our School
- 43:52of Medicine leadership to open this
- 43:54experience up to UM students and
- 43:57all students outside of Hopkins.
- 43:59Recognizing that this election has
- 44:01been an important element for us to
- 44:04increase diversity and department.
- 44:06So with that in mind,
- 44:07we were able to get quite a few
- 44:09rotators virtually and we were quite
- 44:11proud that we were able to continue
- 44:12to have impact in and increasing
- 44:14our UM students experiences without
- 44:17having them travel.
- 44:20But that's the small picture, right?
- 44:22Initiating department and institution wide
- 44:25cultural change. That's the big picture.
- 44:27That's that's that's the other part of this.
- 44:30You can recruit, recruit,
- 44:31recruit as much as you want.
- 44:33But it means nothing if you haven't
- 44:35created in a culture of inclusion,
- 44:37a culture of equity within our department,
- 44:40because the students are going to
- 44:42come into your department and then
- 44:44see that diversity inclusion are not
- 44:45valued and they're going to walk right away.
- 44:48Or, even worse,
- 44:49you may.
- 44:49They may walk away from medicine entirely.
- 44:52If they feel that your department or your
- 44:55or their experience was representative
- 44:57of medicine at all as a whole,
- 44:59and so that's really a key part
- 45:01of this is how you initiate that
- 45:03cultural change to make sure that the
- 45:06environment that the students are coming
- 45:08into the residents are coming into.
- 45:10The faculty are coming into their
- 45:11underrepresented in medicine.
- 45:12The environments that they are
- 45:14coming into our inclusive,
- 45:15so they don't leave.
- 45:17And I'd like to highlight what
- 45:19Vanderbilt has done so Vanderbilt,
- 45:21their radiology program builds a
- 45:24diversity program at at a time
- 45:27when they had no underrepresented
- 45:29trainees in the residency program,
- 45:31so they took us a tiered and
- 45:34systematic approach to DEI to
- 45:35look at the whole applicant pool,
- 45:38their residency program proper,
- 45:39and then they created
- 45:41additional diversity program,
- 45:42specific activities,
- 45:43defined roles and responsibilities
- 45:45for their office of of DEI.
- 45:47Including personnel again,
- 45:48a team based approach not doing this
- 45:51in a silo and really dedicating the
- 45:53funds and the time to doing this.
- 45:56What they noted was that when they
- 45:58took this tiered approach and were
- 46:00I'm sorry my son is screaming it
- 46:01took a tiered approach to deny that
- 46:04the number of UAM trainees increased
- 46:06from zero in 2013 to 6 and 2019.
- 46:08So again being really deliberate
- 46:10and so modeling after that,
- 46:13Hopkins is again trying to foster
- 46:15a true cultural shift and a true
- 46:18culture of conclusion at at,
- 46:19at and within the entire hospital,
- 46:21but then also within our department.
- 46:23So there are departmental and
- 46:26institutional leadership structures so.
- 46:28Within our department again,
- 46:29I have myself who I advocated for a
- 46:32deputy director ship for myself and
- 46:34I we have a diversity committee.
- 46:36It not only for our faculty and trainees,
- 46:38but also for the staff and that is
- 46:41a part of a broader institutional
- 46:42DI structure which includes a
- 46:44senior associate Dean for DIA,
- 46:46Vice Vice President and Diversity
- 46:49Officer or Chief Diversity Officer,
- 46:51and then a vice Provost for DNI
- 46:54at the broader university level.
- 46:55We have DI specific activities.
- 46:58And this picture here is our
- 47:01house Staff Diversity Council.
- 47:03We pre COVID we're having
- 47:05what we're calling on.
- 47:07I forgot what they're calling.
- 47:08Network networking or activities and
- 47:11we would have them every couple of
- 47:13months and they'll be really informal.
- 47:15We would have food and then
- 47:17faculty and fellows.
- 47:18Residents could all join and just
- 47:21network and and and and and fellowship.
- 47:25Since then, they've expanded to include.
- 47:28Other groups,
- 47:29including our ELG,
- 47:30LGBTQI community and other
- 47:34individuals as well,
- 47:36and then again facilitating
- 47:38that working in fellowship.
- 47:39What else have we done?
- 47:41So at Hopkins we are trying
- 47:42to extend beyond implicit bias
- 47:44training and normalizing and
- 47:46expanding these conversations.
- 47:47You know,
- 47:48these conversations can always
- 47:49feel a little uncomfortable,
- 47:50but the more you have them
- 47:52and the more robust they are,
- 47:54the more comfortable they become and
- 47:55the more comfortable you become with,
- 47:57you know, educating each other.
- 47:59Again, I was educated on using the
- 48:01term pipeline and so you know I
- 48:03I was comfortable in having that
- 48:05conversation with a colleague.
- 48:07And so, using intergroup dialogues,
- 48:09open discussion listening session when
- 48:11briefings, professional development,
- 48:12programming, training, focus workshop.
- 48:15So this morning I did a training
- 48:16focus workshop with your residence
- 48:17and they were fantastic.
- 48:18I was really proud of the of the of
- 48:20the content that they came up with and
- 48:22then case and evidence based health
- 48:24HealthEquity grand Rounds is another example.
- 48:27What we did recently at Hopkins is
- 48:29did a micro aggressions workshop
- 48:31specific to pathology.
- 48:33So we use pathology specific
- 48:35cases for example.
- 48:36So one of them was.
- 48:37You know you're out,
- 48:38sign out and you overhear someone
- 48:40saying that the residents quality of
- 48:42English is poor and you're disappointed.
- 48:45Or something to that extent.
- 48:46And what do you do?
- 48:47As you observe that macro aggression?
- 48:49That's not even a micro aggression
- 48:51and the ways that you can
- 48:53interrupt the microaggressions
- 48:54triangle by either being by by,
- 48:56you know, being a bystander end,
- 48:58interrupting it.
- 48:59If you're the source,
- 49:00you know how you can assist.
- 49:02Or if you're the recipient,
- 49:03how you act upon it.
- 49:04How do you self advocate?
- 49:06And so we had that microaggressions workshop?
- 49:08And again it was interactive,
- 49:09so instead of it being one of
- 49:11those online learning modules
- 49:12or a video that you watched for
- 49:1310 minutes and it ends up being
- 49:15very interactive and a dialogue,
- 49:16and you learn more from each other.
- 49:19I'm just as you all are doing.
- 49:21We have increased the number of DI
- 49:23lectures and increase our speaker
- 49:24diversity so we also had doctor
- 49:26Andrew de Rep and Doctor Joseph
- 49:28Graves give a grand rounds to us
- 49:29and Doctor Lecia where I hope that
- 49:32you will invite her for a future
- 49:34grand rounds but she gave a really
- 49:36nice grand rounds on a holistic
- 49:38review and how we can utilize that.
- 49:41What the different elements of
- 49:42holistic review R and the data behind,
- 49:44why they're important,
- 49:46and we also instituted a health disparities.
- 49:50Curriculum and mini curriculum,
- 49:51which included health disparities and
- 49:53pathologists overview by myself and
- 49:55then looking at COVID-19 health disparities.
- 49:57From a microbiology perspective,
- 49:59doctor Hebel Mustafa gave a beautiful
- 50:02overview of how she advocated for text
- 50:04test access within the local Baltimore
- 50:06community and then Doctor Mark Mars
- 50:08Inky give a nice overview of health
- 50:10disparities in laboratory medicine.
- 50:12Touching on not only EGFR,
- 50:13but then also our reference ranges for
- 50:16for our transgender nonbinary patient
- 50:19population or community around us.
- 50:21We are providing more information
- 50:23to our internal Chinese.
- 50:25We have a dedicated path to EI website that
- 50:27was made beautiful by our path web team.
- 50:30I cannot even take credit for this
- 50:33beautiful tile that RJ made but just
- 50:36highlighting different resources
- 50:37that are available and and then
- 50:39just again using these different
- 50:41platforms to highlight the ongoing
- 50:43activities throughout the institution.
- 50:45Not only our house at Diversity Council
- 50:49but again grand rounds. Different events,
- 50:51including a little our conference
- 50:53series throughout the university,
- 50:55but that's the small picture.
- 50:57The big picture here and my son you know
- 50:59at the time was two when we took him to
- 51:01one of the museums at the Air and Space
- 51:03Museum down here and and Northern Virginia.
- 51:05And he totally didn't even see the
- 51:07space shuttle in the room because he's.
- 51:09He's like that all the space shuttle is
- 51:10like that big and he just truly missed him.
- 51:12So it was our what's what's the big
- 51:14picture that we're missing here?
- 51:15And our big picture here is national
- 51:18organizational leadership investment.
- 51:20And what does that look like?
- 51:21That means accountability and our
- 51:25national organizations holding
- 51:27our institutions accountable.
- 51:30So AMC is holding our institutions
- 51:32accountable by implementing holistic
- 51:34review and all these holistic review
- 51:36materials are available for free on
- 51:37their website and for those of you who
- 51:39are unfamiliar with holistic review,
- 51:41it's a mission, missions aligned
- 51:43admissions or selection process.
- 51:45It takes everything into consideration
- 51:47about now about an applicant,
- 51:48not only their academics or not
- 51:50only their research experience.
- 51:51But also.
- 51:53The value that they would add their
- 51:56lived experiences and diversity in
- 51:58the way that individuals and and in
- 52:00in individuals lived experiences.
- 52:02Again,
- 52:03lots of materials that are available
- 52:06for free on AMC.
- 52:08But going beyond that,
- 52:09so for the department chair for for
- 52:11department chairs and division directors,
- 52:13you may be quite familiar with the
- 52:15LC media accreditation process,
- 52:17but the standards include diversity pipeline.
- 52:20And again we want to be mindful
- 52:21term pipeline,
- 52:22but the way it's written right now,
- 52:23it's pipeline programs and partnerships,
- 52:26cultural competence and healthcare
- 52:28disparities.
- 52:28All of us that are in leadership
- 52:30positions are being required to
- 52:31now comment on what we are doing
- 52:33to contribute to diversity.
- 52:34So that's us being held accountable
- 52:36by our national organizations.
- 52:38Outside of pathology.
- 52:40But we have to Belgium milestones
- 52:42that touched on cultural competency
- 52:44for the record.
- 52:45And so these are things that we
- 52:47should be teaching our medical,
- 52:48our residents and we are.
- 52:50We should be holding ourselves
- 52:52accountable because they are milestones.
- 52:54And if we are going to check off that,
- 52:56you know,
- 52:57for interpersonal communication skills,
- 52:58one our our resident has reached Level 4,
- 53:01we should at least check in and
- 53:03make sure that they are able to
- 53:05provide culturally competent care.
- 53:06And how are we assessing that?
- 53:09Moreover, on the annual survey,
- 53:11there's an opportunity for you to
- 53:13comment on for for the residents
- 53:15to comment on whether or not they
- 53:16are being educated in health
- 53:18disparities so things are being
- 53:20held by accountable by the AC GME,
- 53:23it means holding each other
- 53:25as colleagues accountable.
- 53:26Some of you may be familiar with
- 53:28this publication that looked at
- 53:30representation in the cardiology workforce,
- 53:33and there were some misinterpretations
- 53:34of the data,
- 53:35and UPMC was fantastic and highlighting that.
- 53:39That there were opportunities to
- 53:41reeducate or improve education of
- 53:43the faculty members involved
- 53:45with this publication.
- 53:47So holding each other accountable
- 53:49and then the journal editor
- 53:51held themselves accountable.
- 53:52Doctor Francis Collins is holding us
- 53:55all accountable with ending the manual.
- 53:58Hannah Valentine is making lots of
- 54:00tools available so that we can.
- 54:01We have access to them so we have no.
- 54:03We no longer have an excuse to say
- 54:05I don't know how to do this but
- 54:07within pathology we're starting
- 54:09to see greater representation in
- 54:11our various publications and we
- 54:13had asked published a really nice
- 54:15DNI peace and at your conference
- 54:17is both use CAP and a SCP and CAP.
- 54:21We're seeing more.
- 54:23Content focusing on DNI and equity as well,
- 54:26so it's really important that our
- 54:28professional society start to hold
- 54:30us accountable by giving us the
- 54:32educational content and resources
- 54:33so we can take them back to
- 54:35our respective institutions.
- 54:38And and and our professional organization
- 54:40should be leading by example here.
- 54:43So in summary,
- 54:44diversity in pathology is critical
- 54:45as we all strive to innovate,
- 54:47increase awareness self and
- 54:48reduce health disparities.
- 54:49Diversify clinical trials and
- 54:51provide high quality care.
- 54:53There are extensive opportunities to
- 54:55retain female faculty at higher ranks,
- 54:57so we're on our way.
- 54:58But there's still more to do.
- 55:00There are significant barriers
- 55:02to recruiting and retaining
- 55:03individuals under representing
- 55:04underrepresented in medicine,
- 55:06and those barriers evolve at each
- 55:08stage in their education and careers.
- 55:10Be really mindful and sensitive to that.
- 55:12Then finally impactful DE&IDEI
- 55:15initiatives should include
- 55:16personalized outreach and mentoring,
- 55:18but they should also be component of a
- 55:20larger institution and or specialty.
- 55:21Wide cultural changes.
- 55:22And with that I'd like to
- 55:24acknowledge again Doctor Lecia,
- 55:26where my colleague she's been
- 55:28fantastic and instrumental and our
- 55:30work here realized in Kirtland Ville.
- 55:33Also colleagues at Hopkins.
- 55:35That helps put together the
- 55:37data that we published.
- 55:38Again our team at Hopkins and and
- 55:41our pathology photography support
- 55:42team for helping us put together
- 55:44the nice little pamphlet that we
- 55:46give to the residents or to the
- 55:48medical students so we do outreach
- 55:50initiatives and with that if only
- 55:52everything was as easy as looking
- 55:54at cars under the microscope.
- 55:56And hopefully we're not missing
- 55:57the big picture here,
- 55:59which again is is inclusion.
- 56:01So thank you for your time.
- 56:03I think we're right at the hour and I
- 56:04guess I'll hang on for any questions.
- 56:10Thank you so much to Doctor White
- 56:12for this excellent presentation.
- 56:15The floor is open for
- 56:16questions you can speak up.
- 56:17You can write him in the chat.
- 56:24To my son is screaming now. I'm sorry,
- 56:26I'll just say congratulatory comment.
- 56:30It's really impressive Marissa and I
- 56:32was so pleased that you and I had a
- 56:35moment to chat earlier in the day,
- 56:37but your YOUR programs that get both
- 56:41at diversity and in in younger people
- 56:45and and and and also the the problem
- 56:48we're having in recruiting a pathology.
- 56:49Are really exemplary and gosh really
- 56:52should be a model for all of us,
- 56:55including us here at Yale.
- 56:57So thank you for sharing that
- 56:59great success story. Thank you.
- 57:05So I this Dave Rim,
- 57:07I would echo Maurice comments.
- 57:09I think it was really terrific,
- 57:10but I'm in the world we live in today.
- 57:13Their audiences aren't so
- 57:15receptive as perhaps the one here.
- 57:17And do you have pointers for us as
- 57:19we try to spread this word to how?
- 57:22How you approach a non receptive audience?
- 57:25Yes, I'll I'll. I'll give you an,
- 57:27I'll share my experience soum.
- 57:32Mike, so I talked about the
- 57:34microaggressions workshop and
- 57:35initially there is, you know,
- 57:36push back and you know your conversation
- 57:38about well microaggressions don't
- 57:39really happen with us, right?
- 57:41Because we're pathologist.
- 57:43And then we said the microscope
- 57:45and we're not really. We
- 57:46look at our own shoes all the
- 57:48time. Yeah, yeah, exactly.
- 57:50Honestly, at some point
- 57:52you just have to do it up,
- 57:54and that's essentially what I did.
- 57:57I said you know, Ralph,
- 57:58you just need to do this and Mike,
- 58:00we need to do this and. Thanks.
- 58:04And I told him that we were having,
- 58:05you know, we had the the the team
- 58:08coming in and we did it and after the
- 58:10fact you know really positive feedback.
- 58:12So at some point.
- 58:13When you recognize that there is
- 58:16a significant opportunity for.
- 58:18You know a conversation,
- 58:20you just have to do it and they will all.
- 58:23There will always no matter,
- 58:24no matter what you do.
- 58:25I think Marie you mentioned this
- 58:26to me no matter what you do,
- 58:28there will always be a dissenting
- 58:30voice or voices in the crowd,
- 58:32and that's fine.
- 58:33But if you reach,
- 58:34at least if you reach one person,
- 58:37that's enough, right?
- 58:38Because in this space you just
- 58:41trying to build your your group,
- 58:43your your team,
- 58:44and as your team becomes larger
- 58:46you will have more voices that
- 58:48will all as a collective.
- 58:49Groups say you know this should
- 58:51be interrupted or we should
- 58:53be focusing on this as well.
- 58:55So again,
- 58:56I I I think.
- 58:58Building your team one person
- 59:00at a time and at some point
- 59:02you just have to just say it.
- 59:05It is what it is.
- 59:06We can't.
- 59:07There are certain things that
- 59:08should not be happening anymore,
- 59:10and when they do happen they
- 59:12need to stop and there needs to
- 59:14be an opportunity for education.
- 59:16It is what it is.
- 59:21I have a quick question. Related
- 59:24to what David asked you,
- 59:26what do you think as you look back and
- 59:28reflect on the experience so far with
- 59:31one or two of the most major obstacles?
- 59:35That you had to struggle with to
- 59:37get over some of these things.
- 59:39Was it financial? Was it other things?
- 59:42I think the human capital is
- 59:44the most challenging hurdle.
- 59:46You know, building the team and I'm
- 59:48happy to say that now there are a lot
- 59:51more individuals that are involved
- 59:52and and the lesson I learned is that
- 59:55I should have reached out and cast a
- 59:58broader net earlier because I think.
- 01:00:00There were a lot more individuals
- 01:00:03that were interested.
- 01:00:04But they had no reservations or
- 01:00:07were a little bit nervous about,
- 01:00:10you know, putting themselves forward.
- 01:00:12But if you actively seek out their support,
- 01:00:14they happily support,
- 01:00:15you know Mark Mars Inc has been
- 01:00:17a fierce advocate,
- 01:00:18and I I should have reached
- 01:00:20out to him a long time ago,
- 01:00:21so casting a broad net and and
- 01:00:24building that team or sooner rather
- 01:00:26than later is instrumental not only
- 01:00:28to the success of the activities,
- 01:00:30but then also their durability.
- 01:00:31You want to make sure that you know these.
- 01:00:34Initiatives don't fizzle away once they
- 01:00:38start. They should not end with me.
- 01:00:42Great thank you Lisa too.
- 01:00:46I think the other challenge.
- 01:00:50I'll think about it.
- 01:00:51I'll think about the second thing.
- 01:00:52I think building the team has been
- 01:00:54has been the most important thing.
- 01:00:55'cause you cannot do everything
- 01:00:57by yourself. Understood.
- 01:01:02Doctor Lu oh hi, you know thank
- 01:01:06you for this very you know,
- 01:01:08interesting seminar.
- 01:01:09I think you know, as as a you know,
- 01:01:13is really congratulate you for building
- 01:01:15this team together at Hopkins.
- 01:01:18You know you showed the data as well,
- 01:01:21so it seems like the US senior, yeah.
- 01:01:23I mean you are, you know US medical
- 01:01:26Graduate School graduate graduation,
- 01:01:28US medical school seniors.
- 01:01:30They are generally
- 01:01:31continued to have declining
- 01:01:33interest in pathology. So as I'm
- 01:01:36from your personal experience personal
- 01:01:39study I know have you identified some
- 01:01:42of the key factors you know,
- 01:01:44you know, affect that interest,
- 01:01:46affected that trend?
- 01:01:48So that's one question.
- 01:01:49The second question is,
- 01:01:51do you believe it is
- 01:01:53addressable from pathologist?
- 01:01:56Besides perspective,
- 01:01:56you know we certainly wanted to have
- 01:01:58more people coming into our field,
- 01:02:01but we do not know for sure whether
- 01:02:03or not it is because we haven't done
- 01:02:07enough to the students or this is just
- 01:02:11something really beyond our control.
- 01:02:13I think that's kind of the question
- 01:02:15people just trying to figure it out.
- 01:02:17So what do you want to hear?
- 01:02:18You know your perspective on that?
- 01:02:20Yeah, that's the $1,000,000 question.
- 01:02:22Right now my my personal.
- 01:02:25These are my personal opinion.
- 01:02:27'cause I think you know the
- 01:02:29integrated curriculum and the the
- 01:02:32condensation of the curriculum.
- 01:02:34Has really diminished the
- 01:02:36students exposure to pathology.
- 01:02:38Uhm, you know,
- 01:02:39for us we have a our first years
- 01:02:42condensed down into about six
- 01:02:44months and then second year is
- 01:02:46the next calendar year and then
- 01:02:48they begin the clerkships right
- 01:02:51after that in the in our in the
- 01:02:53in the abbreviated second year.
- 01:02:55Or I guess the the 2nd that starts later.
- 01:02:57Pathology is a component of
- 01:02:59each organ system block,
- 01:03:01but the students are more focused
- 01:03:03on learning the pharmacology.
- 01:03:04The more focused on learning.
- 01:03:05What they feel are the higher yield
- 01:03:08things that they will be tested on.
- 01:03:11With that said,
- 01:03:11I think there are opportunities
- 01:03:13for us as pathologists too.
- 01:03:17Advocate more strongly for better
- 01:03:20representation in the curriculum
- 01:03:22and for those of us that are either
- 01:03:25pathology block directors or involved
- 01:03:28with any of the courses for creating
- 01:03:31novel experiences to highlight
- 01:03:33how pathologists are a key member
- 01:03:35of the multidisciplinary team.
- 01:03:37So for example, I Co direct a short,
- 01:03:40very short three day course on
- 01:03:42neoplasia and one of the things
- 01:03:44that we do as a mock tumor board.
- 01:03:46And so I have myself I have Realogy.
- 01:03:48I have radiation oncology.
- 01:03:50I have surgery and medical oncology all
- 01:03:52represented in this mock Schumer board.
- 01:03:55We go through a mock case and we show
- 01:03:57we talk about the pathology just as if
- 01:04:00we would as a as a as at a tumor board.
- 01:04:03And so the students get an opportunity
- 01:04:04to see what we as the pathologists do,
- 01:04:06that they might not have normally
- 01:04:08had an opportunity to see.
- 01:04:10And at that point in their medical education.
- 01:04:15I think other institutions are doing
- 01:04:16similar novel things where they have
- 01:04:18like a transition to the wards.
- 01:04:20Courseware pathology is included
- 01:04:21as in a transition towards course,
- 01:04:23but I think that happens
- 01:04:24too late to be honest.
- 01:04:25So I think if you if for those of
- 01:04:27us that again are involved with you
- 01:04:29and me trying to think creatively
- 01:04:31about how you can incorporate,
- 01:04:33you know the pathologists you
- 01:04:35know told the clinical team that
- 01:04:38XYZ or something to that extent
- 01:04:40highlighting that pathologists were
- 01:04:42an instrumental role in the diagnosis
- 01:04:44and the subsequent care plan.
- 01:04:46Is really important,
- 01:04:49but in terms of,
- 01:04:49you know why we're seeing at the client.
- 01:04:51I think it is partially because of that
- 01:04:53where it is unclear to the students that we,
- 01:04:55as pathologists are critical to
- 01:04:57multidisciplinary care and there are
- 01:05:00different ways that you can contribute
- 01:05:02to patient care without you know doing
- 01:05:04an autopsy as a pathologist and that
- 01:05:06most of us don't do. People don't.
- 01:05:07Most of us don't do autopsies.
- 01:05:09Or if we do, do autopsies.
- 01:05:11Autopsies have very different applications
- 01:05:13now than they did historically,
- 01:05:15where we have rapid autopsy programs.
- 01:05:17Where you're.
- 01:05:17An instrumental member of Cancer Research.
- 01:05:20By doing rapid autopsies and harvesting
- 01:05:22tissue for our colleagues in basic sciences.
- 01:05:25I think again,
- 01:05:26highlighting the role of pathology
- 01:05:28at the roles of pathologists or as
- 01:05:30early as possible are important.
- 01:05:32And being that smiling face that
- 01:05:35they want to see so. Thank you.
- 01:05:42So that's it.
- 01:05:43Yes, doctor white.
- 01:05:44Thank you so much for your presentation.
- 01:05:47I really enjoyed it and I found it
- 01:05:49extremely educational and and and and
- 01:05:50one of the reasons for this is that I I
- 01:05:53trained in Morehouse School of Medicine,
- 01:05:55I was a postdoctoral fellow there.
- 01:05:58It's very interesting that till now I did not
- 01:06:01know that the greydis etch what that meant.
- 01:06:04Yeah, and it was for shocking that
- 01:06:06nobody actually ever ever told
- 01:06:07us what the Bradys ever meant.
- 01:06:09Yeah, so thank you so much.
- 01:06:11And for teaching us and telling us I have.
- 01:06:16I do have a question.
- 01:06:17I don't know whether you have an answer
- 01:06:19because you didn't write that paper,
- 01:06:20but that Ginther ET al paper graph.
- 01:06:26I think rather confusing.
- 01:06:27I don't know how they have crunched
- 01:06:30those numbers off the R 01.
- 01:06:32Success rates that shows between
- 01:06:35various racial groups.
- 01:06:37Yeah, the potential biases that
- 01:06:39exist in terms of success rates,
- 01:06:42because I don't know whether that
- 01:06:44shows whether that data really,
- 01:06:45truly represents what's actually
- 01:06:47going on in terms of biases.
- 01:06:49Because if you look at the graphs,
- 01:06:51you notice that the Hispanics have
- 01:06:54the same success rate as whites,
- 01:06:56and I wonder whether that is
- 01:06:59because of some sort of.
- 01:07:02Incorrect analysis,
- 01:07:03or whether there is truly
- 01:07:06a difference that exists,
- 01:07:07that many of the African American applicants,
- 01:07:10or perhaps from the HBC US like
- 01:07:14Morehouse and their environment,
- 01:07:16is judged perhaps in properly by
- 01:07:18certain reviewers as not appropriate.
- 01:07:21I wonder if you have any comments
- 01:07:23to elaborate on that.
- 01:07:25Maybe in your next presentation
- 01:07:26you could expound on that mode.
- 01:07:29Yeah,
- 01:07:29so I think that I'm linking.
- 01:07:32Proper number I think there there is
- 01:07:34a paper that looks at institutional
- 01:07:36bias in terms of granting the
- 01:07:39the the granting of grants.
- 01:07:43Use the same words in a sentence.
- 01:07:45There are institutional biases against
- 01:07:48institutions that you mentioned,
- 01:07:49like Morehouse or smaller institutions,
- 01:07:51which hopefully that is diminishing now
- 01:07:53now that especially during the pandemic,
- 01:07:55a lot of these institutions
- 01:07:57have gotten greater notoriety,
- 01:07:58but there were some biases,
- 01:07:59and so I think that may be a
- 01:08:01confounder as you mentioned,
- 01:08:02since that those institutions are
- 01:08:04enriched for black individuals or
- 01:08:06individuals help identify as black
- 01:08:08in terms of why there are not,
- 01:08:10why there are not significant
- 01:08:12disparities in Hispanic I.
- 01:08:13I will have to go back and look at the paper,
- 01:08:15but I will say that Hispanic
- 01:08:17representation has been increasing
- 01:08:19and that is the one subcategory
- 01:08:21within the URM category that has been
- 01:08:23increasing at a significant rate,
- 01:08:25at least in pathology.
- 01:08:27And then you know,
- 01:08:29looking at looking at that.
- 01:08:30So I, I, you wonder,
- 01:08:32I I'm not sure if again we're
- 01:08:36looking at aggregated data, right?
- 01:08:38So I'm not sure if these are.
- 01:08:40If we're looking at individuals
- 01:08:41that are also, you know, coming in.
- 01:08:44Internationally or what type or what exactly?
- 01:08:47Again,
- 01:08:48we need to look at disaggregated
- 01:08:49data you know.
- 01:08:50Looking at,
- 01:08:51you know the data for Black or
- 01:08:52African Americans when we look
- 01:08:54at the actual number of African
- 01:08:55American males in isolation,
- 01:08:57the number of African American
- 01:08:58males has not changed at all,
- 01:08:59but the overall number of African of
- 01:09:01individuals who identify as black
- 01:09:03or African American have increased
- 01:09:05the number of black or African
- 01:09:07American males has increased.
- 01:09:08When we look at African American males,
- 01:09:10it has not,
- 01:09:11and we're looking at African
- 01:09:12males from the African continent.
- 01:09:14Those numbers have increased,
- 01:09:15so again I have to be really careful,
- 01:09:18and so I agree with you.
- 01:09:19I I will go back and look more
- 01:09:20carefully at that,
- 01:09:21but I think there there have been data
- 01:09:24suggesting an institutional bias is yes.
- 01:09:28Thank you.
- 01:09:30They were really late on time,
- 01:09:32but I would assume are yeah.
- 01:09:36Yeah, if we have time, is it OK?
- 01:09:38Go ahead, go ahead last one so I'm
- 01:09:41one of the Apqp residents are pgy 3.
- 01:09:45I just want to say this is so amazing,
- 01:09:47especially your work in the community and
- 01:09:50I was wondering if you guys have and I'm
- 01:09:52sorry if you said this and I missed it.
- 01:09:54I did have to take a couple
- 01:09:55calls during your presentation,
- 01:09:56but do you guys have resident
- 01:09:58involvement in all of these programs
- 01:10:01and just how you implement that?
- 01:10:03Yeah, thanks for asking so when Doctor
- 01:10:06where was a resident she was involved.
- 01:10:10I asked residents if they're interested,
- 01:10:12but of course their work comes
- 01:10:13first and so I make it explicitly
- 01:10:16clear that their clinical service
- 01:10:18and they're studying comes first.
- 01:10:20We have some residents right now
- 01:10:22that have expressed interest,
- 01:10:23particularly first first year in
- 01:10:25the third year that are interested,
- 01:10:27but they are waiting until they
- 01:10:28have a little more time and things
- 01:10:30have been kind of unpaused.
- 01:10:31They have met one on one.
- 01:10:33With some of our students when asked,
- 01:10:36but those were again small.
- 01:10:37One on one meetings with one student at Hawk,
- 01:10:41but not formally in terms of the outreach,
- 01:10:43but it's mostly been just asking,
- 01:10:45asking the resident or asking the Chiefs
- 01:10:47to ask the residents if there's anyone
- 01:10:49that's interested, and then again,
- 01:10:51you clinical services come first.
- 01:10:54But yeah, thank you for your question
- 01:10:56and thank you for logging in.
- 01:10:57Yeah, thank you so much.
- 01:10:59This is also great.
- 01:11:01Thanks
- 01:11:02let's altogether thank Doctor. Right
- 01:11:03again. Thank you, thank you so much and
- 01:11:06you're going into a meeting
- 01:11:08with our chair, right?
- 01:11:11OK, do I leave this one or stay here.
- 01:11:13I have no idea in from a link
- 01:11:16I will come to the link again.
- 01:11:20Thank you. Thanks everybody.
- 01:11:22Thank you so much Tina,
- 01:11:23I really appreciate it. It's
- 01:11:24a pleasure. Thank you.
- 01:11:26Right, you know, thank you.