Pathology Grand Rounds: April 20, 2023 - Alisha D. Ware, MD

April 26, 2023

Information

Using Holistic Review and Other Strategies to Promote Diversity, Equity and Inclusion in Pathology - Alisha D. Ware, MD

ID9874

To CiteDCA Citation Guide

00:00Welcome everybody.
00:01This is Department of Pathology grant rounds.
00:07On behalf of the our Diversity,
00:10Inclusion, Climate and Equity Committee.
00:13I'm very pleased to welcome Doctor
00:15Alicia Ware from University of
00:16North Carolina as today's speaker.
00:20She's
00:24one of The Pioneers in trying
00:26to increase diversity in.
00:28In pathology departments,
00:30starting with her role in training
00:33at Hopkins and now at UNC.
00:35If you guys recall,
00:37we had her partner in crime
00:40doctor Marissa White last year
00:42and together they pioneered some
00:45really innovative programs to
00:48bring in trainees within the
00:52Hopkins training environment that.
00:54Led directly to an increase in their,
00:59the amount of diversity they had in
01:01the department, which is something
01:02we're trying to do as well.
01:03So she's been here sharing her experience
01:07and the things that worked and
01:08things that didn't for our committee.
01:10So very pleased. Thank you for that.
01:13So a little bit of background at least.
01:15I got her bachelor's of science from
01:17Howard University and then her medical
01:20degree from the University of Virginia
01:22and then subsequently went to Hopkins for.
01:25Residency and and fellowship
01:27training in Hemato
01:28pathology, is that correct?
01:30She was also for those who are residents,
01:32she was chief resident and then
01:34also we served that associate
01:36director for the residency program
01:38for two years and after that she
01:43maybe to 2022 you moved to UNC
01:45to University of North Carolina.
01:47That's right. Yeah.
01:48Where she's now assistant
01:50professor of pathology and.
01:52Trying to establish similar programs
01:53that she did at at at Hopkins.
01:57So I'm not going to monopolize
01:59any more of her time.
02:00She received numerous awards,
02:02published, etcetera, etcetera,
02:03like any good academic scientists.
02:06So she's on a great career path,
02:09but today she'll tell us more about
02:12her efforts in improving equity
02:14and and diversity in pathology.
02:16Thank you for being here.
02:20Thank you all for having me.
02:24Thanks so much for having me.
02:25I'm really honored to be here and
02:27I've enjoyed meeting everyone so
02:28far that I've spent some time with.
02:31Please feel free if you have questions
02:33to stop me or we have some time
02:35at the end for questions as well.
02:36So today I'll be focusing on
02:39holistic review for applicants,
02:41which is something that I focused on
02:43while I was Associate Program Director,
02:45but I will be talking about some of the
02:47other initiatives and some things that I
02:49hope to work on in the future as well.
02:51So here are objectives for the day.
02:53So we will discuss the importance of
02:56DEI within the field of pathology,
02:58discuss the impact briefly of DEI on
03:01overall well-being in the medical workforce.
03:05Discuss holistic applicant review
03:07and we'll spend a large portion
03:09of the of the discussion on this
03:11topic as a means to deliberately
03:14increase diversity in our field.
03:16And then discuss the ways that a
03:18dedicated task force or what we would
03:20call a diversity committee can help
03:22to promote equity and inclusion.
03:25So once you work toward and start to
03:28achieve the diversity within the department,
03:31how we can make people feel included
03:33and sort of level the playing field?
03:35I don't have any relevant disclosures
03:38for today. OK, so why am I here?
03:41Why does diversity matter?
03:42And I this part will be a little
03:44bit boring and historical,
03:46so I apologize,
03:47but this is really an issue in
03:50medicine and in general.
03:51So here I have the active MD graduates who
03:55are in ACG ME programs for 2021 to 2022.
03:59And here I just have the the ethnicity
04:03and racial background breakdown.
04:06So as we can see,
04:08residents who are Hispanic make up about
04:128% or who self identifies Hispanic make
04:15up about 8% of all A/C GME residents.
04:18Black and African American
04:20residents make up about 6%,
04:22American Indian and Alaskan
04:24native residents about .6%.
04:26And then Native Hawaiian and
04:29Pacific Islanders, about .2%.
04:31And then I put the most recent census data
04:34here on the right just as a comparison.
04:37So for these these demographics,
04:40these groups,
04:41these are groups that have been
04:44identified as the AM C it's quote UN
04:46quote underrepresented in medicine.
04:48Historically that has been Blacks,
04:50Mexican Americans, Native Americans,
04:53including American Indians,
04:54Alaskan Natives and Native Hawaiians.
04:57And mainland Puerto Rican persons as well,
05:01but this is sort of an evolving
05:05definition as you can imagine.
05:08So the AM C also has recognized
05:10you know that diversity looks
05:12different in different places.
05:14So we need to approach it depending
05:16on our environment and just look
05:18at things through a whole lens,
05:21so we can sort of start to shift
05:24our focus from.
05:25Saying we need, you know,
05:26this number of these types of people
05:29versus those types of people and
05:31really just work on incorporating
05:32diversity of thought,
05:34diversity of backgrounds and just
05:36really evolving as time goes
05:39on. So this is really important
05:42when we're looking at the ways
05:43that we approach diversity,
05:44especially with some of the
05:47different climates that are evolving
05:49throughout our country as well.
05:52So here I have just the number of US medical
05:57graduates who are going into pathology.
05:59So I think this chart gives me a little
06:01bit of hope because as you can see,
06:04back in 2018, we started to experience
06:07a steep decline in medical students
06:10who were interested in pathology.
06:12And then since the pandemic,
06:14we've had some incremental improvements in
06:16the number of resident of applicants who are
06:20applying to pathology residency programs.
06:22So we are now at about, so sorry,
06:27we went from about like 500 a little almost
06:31580 applicants in 2018 down to 500 in 2019.
06:37So that's a pretty steep drop and
06:39now we're about at like the 5:30
06:42ish range for the last match.
06:44So we're getting there,
06:46but this also emphasizes an
06:48opportunity for us to improve our
06:50outreach to these medical students.
06:52And so if there is maybe an
06:54increased interest in pathology,
06:56we can start to really invest some
06:58time and strategies and recruiting
07:00these students to our field.
07:02But this also emphasizes, like,
07:04even though this is an improvement,
07:06these are pretty small numbers compared
07:07to a lot of other specialties.
07:09So a lot of the information that I'll
07:12present today is actually extrapolated
07:13from other specialties because we just
07:16don't have the research behind a lot
07:18of the pathology training programs.
07:22And then just to bring it all together,
07:24So I put the data from the pie
07:27chart in light blue.
07:28And then the data from our pathology
07:31training programs in dark blue.
07:34So as you can see,
07:34I won't go number by number here,
07:36but essentially most demographics are
07:40less represented in pathology than
07:43they are in the general A/C GME pool.
07:46There is, as you can see on the far right,
07:49the residents who are.
07:50Falling into the quote UN quote,
07:52other or unknown category are increased
07:57comparatively compared to other A/C,
07:59GME specialties.
08:00Part of this is due to the fact
08:02that a lot of pathology residents
08:04are graduating from international
08:07medical schools,
08:08which is great because that gives us a
08:09lot of diversity of thought and background.
08:12But it's also something just to keep
08:14in mind as we're going through these
08:16numbers and the diversity is not
08:18necessarily A1 size fits all. OK.
08:21So now we'll go way back into history.
08:23So one of the reasons why this is really
08:26important and where these strategies
08:28and projects really are coming from
08:31is that the US healthcare system really
08:34was built on segregation tactics.
08:37So this is a picture from
08:401963 of members of the NAACP.
08:45Protesting at the American
08:47Medical Association.
08:48And if you look back at the history of a
08:50lot of these larger medical institutions,
08:52you'll see that they didn't necessarily
08:55have the entire populations while
08:58being in mind when they were
09:00developing a lot of the.
09:02Rules with healthcare.
09:03Who can receive healthcare,
09:05where you can receive healthcare
09:08and I also included in the very
09:10bottom corner just an image from the
09:131619 podcast. So this is a project
09:16that was established by Doctor Nicole
09:19Hannah Jones who was a Professor at UNC.
09:23Our diversity committee at UNC actually
09:26listened to a an episode of her podcast
09:29that goes over sort of the history
09:32of segregation in the medical field.
09:35And we found it very useful for
09:38stimulating discussion as just part of
09:40our efforts to open discussion around some
09:43of these harder topics to talk about.
09:45So I just wanted to include this
09:47because it this is something that has
09:49been going on for a long time and
09:51while we don't necessarily have overt
09:53segregation in our wards anymore,
09:55there is still,
09:57there are still the remnants of
09:59these sort of established medical,
10:02medical practices, yes. Documentary.
10:06It's also Netflix. Yes, it is.
10:09It's Hulu. Yes, it is.
10:13Yes, I haven't had an
10:14opportunity to watch it yet,
10:15but it's on my 2 watch list.
10:18Thank you for adding that.
10:20OK, so now we're going fast
10:23forwarding a little bit in history.
10:25So now we're dealing with these recent
10:27events that are sort of emphasizing
10:30and highlighting some of the
10:32inequalities that exist in our society.
10:34So this is a photo from Johns Hopkins.
10:37We have our Dome, which.
10:39Like way in the back here,
10:41I don't know if you guys can see my arrow,
10:42but it's it's sort of at the middle center
10:45which is one of the original buildings
10:48of the Johns Hopkins Medical Center.
10:51And here we have our our physicians,
10:55our healthcare practitioners who are
10:57helping to have a sort of a silent
11:00white coats for black lives protest.
11:03And this was brought about because
11:05of the Black Lives Matter movement.
11:07This was during the pandemic.
11:08So you can see,
11:09maybe notice that some of the people,
11:11most of the people are wearing
11:12masks in the photo.
11:14But this was just an example of
11:17how much the recent events have
11:19really sparked discussion and
11:21stimulated proactive outreach
11:25with within our medical community.
11:28And also the importance of DEI
11:31has been emphasized by some of
11:33the larger bodies like the NIH and
11:36who are starting to emphasize the
11:39importance for DEI and biomedical
11:41research for our patients as well.
11:44And then of course the pandemic
11:46brought about a lot of.
11:48It's sort of shined a light on a lot
11:52of the inequalities in healthcare and
11:55also sort of just highlighted the
11:56fact that a lot of our population just
11:59doesn't have access to healthcare.
12:01So all of these things that I've
12:03presented right now are sort of
12:06historical reasons why DEI is important.
12:09And we can think of it as OK,
12:10we're pathologists,
12:11we're not seeing the patients
12:13in the clinic or on the wards,
12:15but we still have a really important
12:17role to play in our patient.
12:19Care as part of the multidisciplinary team,
12:23so these are just some recent articles.
12:27The top article came out actually
12:30from University of Virginia,
12:31and as a medical student I
12:34participated in this survey.
12:36So these are a couple of articles
12:38just emphasizing that even today
12:40physicians are treating patients
12:42pain differently based on their
12:45demographics and that a lot of
12:46physicians who are highly trained,
12:48highly educated individuals still
12:50hold these false beliefs about
12:52people based on their ethnicity.
12:55So This is why we really need to
12:57start early in improving diversity,
12:59improving the way that we
13:01teach medical education,
13:02so that our patients.
13:03Are getting the treatment that they need
13:08okay and then so one of the
13:10other areas that I'm very,
13:12very interested in is wellbeing.
13:14So there are studies out there that
13:17show that diversity actually positively
13:19impacts the wellbeing not only of trainees
13:22who are underrepresented in medicine,
13:24but also of all of the trainees
13:27and of the programs at large.
13:29And then in the converse,
13:31a lack of diversity can actually.
13:34Due to a lack of perceived
13:37inclusion amongst peers,
13:38higher attrition rates for the UIM
13:41faculty and increase training burnout
13:43as well because they're not feeling
13:45incorporated into their training setting.
13:50OK, so I've I've talked about a lot
13:52of things that are maybe not so happy,
13:54but there are ways that we can improve
13:56and things that we're working on.
13:58So how can we work to to
14:01increase DEI in pathology?
14:04So these are some strategies that
14:07I've worked on to help work,
14:09help promote DEI.
14:10So we'll go through this list.
14:13We'll start with increasing exposure
14:15in undergraduate medical education.
14:17And I will add that I'm passionate about
14:20increasing exposure even earlier than
14:21that and like grade school students.
14:24So we can talk about that a little bit later.
14:26But also holistic review of applicants,
14:29which is something I was very involved
14:30in as an associate program director.
14:32Promoting unconscious bias and bias,
14:34literacy training and awareness
14:36and we are going to talk about some
14:39nuances with that as well and then
14:42establishing an inclusive environment.
14:44So it's one thing to actually
14:47diversify your workforce,
14:48but then when people get there
14:50you want them to feel included and
14:52part of the the larger workforce
14:56still we'll talk about this.
14:57So we'll start about start talking
15:00about increasing exposure.
15:01So there are several ways that
15:03have been established to increase
15:05exposure to pathology.
15:06So the post sophomore fellowship
15:09year has been really instrumental
15:12in in increasing pathology exposure.
15:15So there are studies that show
15:17that institutions that have the PSF
15:20program actually increase the number
15:22of medical students who go into
15:25pathology for those of you who.
15:27Not familiar.
15:28The Post sophomore fellowship is a
15:31year long fellowship essentially
15:33where the medical student usually
15:36there it's between second and third year.
15:39They actually act as an intern,
15:41so they go through their pathology rotations.
15:44They have a lot of hands on experience.
15:46We have a PSF at UNC and we have
15:51students who come through their
15:53extremely enthusiastic and just
15:54really like you can't even differentiate
15:56them from.
15:57The interns,
15:58it's very impressive and it's it's
15:59great to see that passion so early
16:02on in medical school at a time when
16:04a lot of us like,
16:05don't even know what pathologists
16:07actually do other than teach us
16:10basic Histology.
16:11Another great way to increase
16:14exposure is through funded rotations.
16:16And I had a very.
16:18Integral role in the funded rotation
16:21at Hopkins for students who are
16:24underrepresented in medicine.
16:25So our rotation we would start off
16:28by giving outreach presentations
16:30to groups and schools for students
16:34underrepresented in medicine.
16:36For example, Howard University,
16:38Meharry Medical College,
16:40Morehouse Medical College.
16:43In other student groups,
16:45for students underrepresented in medicine,
16:48we would give a basic careers in
16:51pathology presentation.
16:52So very basic like this is what we
16:54do day-to-day.
16:56We, you know, look at slides,
16:57these are the subspecialties,
16:59these are our practice settings, etc.
17:01And then allow for a handson or sorry,
17:04a QA experience.
17:06QA session after the presentation.
17:10So that was a lot of us traveling
17:12to other institutions.
17:13But also we would invite students
17:16to apply for our
17:18rotation. So if they applied,
17:21the students would receive essentially
17:24free travel to Baltimore City and
17:26housing through our student housing.
17:29And we had a coordinator
17:31who was extremely helpful.
17:33In getting all of the little details
17:36about travel and and housing situated.
17:39And then we would really ask the
17:41students what they were interested in.
17:44So we had some students who were
17:46interested in forensics and wanted to
17:48go to the medical examiner's office,
17:49some who were interested in neuropathology
17:52and rotated with our neuro faculty
17:55and we integrated them into the
17:58daytoday runnings of the rotation.
18:00So they had a really handson experience,
18:03they were.
18:03Sort of amongst the residents as
18:06well and they really enjoyed it.
18:08And I will say so we had maybe about
18:10like 40 to 50% of our students actually
18:14go into pathology training programs,
18:16which is a pretty decent number.
18:17We had about 20 students overall
18:20when I was there who rotated
18:23and they're doing really well.
18:26I saw a couple of them at use cap last month.
18:28So it was really exciting to see them there.
18:30They were preparing to take boards.
18:33So they're like you know at the
18:34end of their training and it was
18:36really cool just to see like how the
18:39impact that we had with just this,
18:41you know they spent four weeks with us
18:43and rotated through different fields.
18:45So that can be really impactful.
18:47And it's you know, it's small numbers.
18:49So we had one or two students at a time,
18:51which doesn't seem like a lot,
18:53but it's baby steps.
18:54So you can you reach those students,
18:56they tell their colleagues etcetera and
18:59the programs that they go to as well.
19:02Some of the other tactics are
19:05increasing visibility,
19:05so having the UIM faculty and trainees
19:10present during the interview process,
19:13that can be harder when you don't
19:16have many UIM faculty or trainees.
19:17But if not,
19:18then having faculty and trainees who
19:20are passionate about the career,
19:22who are very inclusive and help
19:24to contribute to the inclusive
19:27environment of the training program.
19:30And that also can help people feel
19:32like it's a place where they can
19:34see themselves in training and
19:36then medical school lectures,
19:38which we have discussed now with
19:40several faculty as we're changing
19:43the medical school curricula.
19:45It's very.
19:48It's it can be an uphill battle getting
19:50pathologists to give the lectures and
19:53have an actual chunk of the curriculum.
19:56But as much as possible and I think
19:58this is even more motivation for us
20:00to sort of say hey like we belong here
20:03too even though we're not clinical
20:05faculty like we still can contribute
20:08to the medical student education
20:11and that can really help students
20:13see themselves in your shoes and.
20:15Have them be interested to rotate
20:17during their elective time if possible.
20:20Okay.
20:20Great,
20:23okay. So I'll talk a little bit
20:25about the DEI initiatives at UNC,
20:27and I will admit a lot of these
20:29predated me coming there last year.
20:31So in 2016 the School of Medicine
20:36established a dedicated DEI,
20:38or Diversity and Inclusion Council.
20:40And then in 2019,
20:42they established DEI priorities
20:43for the school strategic plan.
20:45So these are really this is support coming
20:49from higher up in the School of Medicine.
20:52So the missions are to build a diverse
20:55community that reflects those that we serve,
20:57to cultivate an inclusive environment
20:59and culture and strengthen the
21:02institutional infrastructure and
21:04systems that support DEI efforts.
21:07And then, starting in 2019,
21:09the School of Medicine has
21:11administered an annual climate survey.
21:13And then we have someone.
21:14So our DI officer for the School of
21:17Medicine comes to our department and
21:19presents the results of the climate
21:22survey for our specific department
21:24compared to other departments.
21:26We also at UNC have a dedicated
21:29PATHO pathology and laboratory
21:31medicine DEI committee that's very
21:35active and our committee actually
21:38established a pathobiology course.
21:41For students at our at
21:43two of our local HBC US.
21:46So they established this Introduction
21:48to Pathology of Disease course
21:51and have UNC faculty teaching the
21:54undergraduate students at North
21:56Carolina A and T University,
21:58which is in Greensboro and North
22:00Carolina Central University.
22:01So it's been virtual since COVID which
22:04helps a lot actually to reach students
22:06at two different campuses at the same time.
22:09But this has been really a
22:12really well received course.
22:14It's been led by Doctor Andrew
22:16Gladden and Dr.
22:17Buddy Weissman at UNC.
22:19And then we have two great supports, Dr.
22:22Baines and Dr.
22:24Rory at AT A and T&amp;NCCU who've helped
22:27us to get the word out and recruit
22:30students to the pathology course.
22:34And then more recently,
22:36actually this past Saturday,
22:38some of our smaller outreach initiatives
22:40are starting to get off the ground at UNC.
22:42So this is something that I
22:44worked on with Dr.
22:46Mariana Evans, who is the third person.
22:49And I don't know if you all can see my mouth,
22:51but she's.
22:52The third person from the left and then Dr.
22:55Stacy Keen is sitting sort of in the middle.
22:58So they are my new UNC partners in
23:01crime for our DEI outreach initiatives.
23:05But we established this day
23:06in the life of a pathologist,
23:08so we reached out to the Ant
23:13and NCCU students.
23:15And just offered them an
23:17opportunity to come on a Saturday,
23:19which happened last Saturday,
23:21to see what we do.
23:22So the students came to our campus.
23:25We started the day with just our
23:28Intro to Pathology PowerPoint,
23:29similar to what I did at the
23:32Hopkins Outreach presentations.
23:35Doctor Keene also does autopsy pathology,
23:37so she brought autopsy specimens for
23:40the students to look at just showing
23:43more basic like MI and lung diseases.
23:48We had organ models and the diabetes
23:50model for the students as well.
23:52These are all undergraduate
23:54students so they had varying levels
23:56of exposure to pathology.
23:57We had one student the the student
23:59standing on the far right side who was
24:02like I'm going into forensic pathology and.
24:05He was like very gung ho about that.
24:07We had some who were interested
24:10in historic technology careers
24:12and then some who were just like
24:13we aren't sure what pathology is,
24:15but we thought this would be interesting,
24:17so we had the full gamut.
24:19We also took them on a tour of the
24:21department and we went through
24:22a couple of case studies at the
24:24microscope with them as well,
24:25just to give them an example of what we do.
24:28We had really great responses.
24:30As you can see,
24:31it's a small group,
24:31so we had ten students come on Saturday,
24:34but they were really enthusiastic
24:36and excited and asked us if we would
24:38be doing something similar soon.
24:40So there is interest out there,
24:42even if it seems like the impact
24:44is really small.
24:47And then I feel like I can't give this
24:49presentation without talking about
24:50some of the work that I did at Hopkins,
24:52because it was really how I
24:54became established in this field.
24:56So in Hopkins, similar to UNC2016A,
25:01pathology diversity committee was created.
25:04And likewise, this was
25:06a very active committee.
25:07So we established an outreach program
25:09that I helped, worked with Dr.
25:12White on and sort of helped
25:15to helped us to advertise.
25:17More rotation,
25:18but also really just to meet students
25:20and give them more information
25:21about careers and pathology.
25:23So we went to different institutions
25:25and like I stated before,
25:27we delivered the careers and
25:29pathology presentation, this was me.
25:30I'm not sure where I was,
25:32but it was me giving one of the
25:35presentations between those years.
25:38Our active outreach sort of came
25:40to a halt with the pandemic,
25:43but Doctor Marissa White did a
25:45really excellent job of creating
25:47a virtual rotation for students.
25:49So continuing that outreach,
25:51even though we didn't,
25:53we have the ability to go in person.
25:56Our committee members also participated
25:58in local and national residency fair,
26:00so that's something that you
26:01all can do as well.
26:03One of the really great local fairs is
26:06the Howard University Residency Fair.
26:09It happens usually in February.
26:13February to March and it takes
26:14place in DC and they have students
26:16really from like the Northeast,
26:18like as far as New York,
26:19I think I met the last time I
26:21was there down to like Georgia,
26:23like the Carolinas.
26:25So they have a pretty large
26:27catchment area in students.
26:28And it again, it's, you know,
26:30you're out of booth with.
26:32Next to the internal medicine
26:34in the surgical, you know,
26:36residency program.
26:36So you're not going to get
26:38everybody that comes through,
26:40but there are usually a few students
26:41who are interested and you can at
26:43least like bring demonstrations,
26:44bring pamphlets and information that
26:47you can share with the students and
26:50you do get interest that way as well.
26:55So next we'll talk a little
26:57bit about holistic review.
26:59So the AMC has developed these sort
27:02of core principles of holistic review.
27:05So having a broad mission aligned
27:08selection criteria for applicants,
27:09having equitable,
27:11equitable consideration of experiences,
27:13attributes and academic performance,
27:15So not placing all of the
27:18emphasis on the numerical data.
27:20Having diversity in the consideration
27:22of an applicant's future impact on
27:24the field and on the institution,
27:26and also having a mission aligned
27:28and thoughtful consideration of race,
27:30ethnicity and other personal
27:32attributes or demographics.
27:34So something that we talked about last
27:36night was sort of the distance traveled.
27:38So incorporating all of that information
27:40when you're looking at applicants.
27:44OK, so when we're thinking about
27:46the need for holistic review,
27:48we have to take a step back and say,
27:50well, why do we actually need this?
27:53Is there implicit bias in the
27:55way that we review applicants?
27:57So there is.
27:59So traditional screening metrics use
28:02mostly numerical data and some like
28:05Honor Society letters of recommendation,
28:08so you and some Elise fours AOA status,
28:11especially in the more competitive.
28:14Specialties in medicine,
28:15floor chip grades and evaluations,
28:18research experiences and letters
28:20of recommendation.
28:21And definitely looking at this list,
28:23you're like, OK, well,
28:24if we take away our, you know,
28:26evaluation of all of these things,
28:28what are we left with?
28:29It's not saying to get rid of the way
28:32that we evaluate students in the past,
28:34but also to consider other things
28:36that they might bring to the table.
28:38And also, if one of these areas is maybe
28:42not as outstanding as another area,
28:44to not let that fact really deter from
28:48inviting the applicant for an interview.
28:51So first we'll focus on Usmly scores.
28:54So as you all may know,
28:57Usmly scores have not been.
29:00Correlated with success,
29:02necessarily.
29:02Studies have looked at US SIMILE and also
29:06MCAT scores and other standardized tests,
29:08and they found that they're not accurate
29:11predictors of a student's ability to
29:13provide high quality patient care.
29:14They don't really predict at all
29:18interpersonal communication skills,
29:20faculty evaluations during
29:22training or professionalism.
29:24And eliminating the requirement
29:25for a minimum score,
29:27which a lot of programs do as a means
29:30to sort of decrease the applicant
29:32pool that they're reviewing,
29:34or lowering the required score
29:36can increase the number of UIM
29:39applicants who are invited.
29:41And this is because of the opportunity
29:43bias that's out there, so.
29:47When we're looking at diversity in
29:50the way that scores impact diversity,
29:53there are studies that show that
29:56as a whole UIM students may score
29:59lower than non UIM counterparts.
30:01This is not a hard and fast rule,
30:04and I'm not by any means saying that all.
30:07UIM students do bad on their
30:08boards and all non UIM students
30:09do really well on their boards.
30:11But it's just a trend in the data and you
30:14can look at this at face value and say OK,
30:16well maybe they're just not good test takers,
30:19but that's not necessarily true.
30:21It really comes down to more of an
30:24equity issue in a lot of the cases.
30:25So students might not be able to
30:28take time off to prepare or pay
30:31for really expensive preparatory
30:33course or private tutor for the UI.
30:37SMLE exam and also they might be at
30:40a school that maybe prepares them
30:43less toward taking the test and more
30:45toward taking care of the patient.
30:48So you have to think about all of those
30:51factors when we're evaluating scores.
30:54But there is data to show that it can,
30:58if you focus on a cutoff for USMLE,
31:01it can negatively impact diversity.
31:04So.
31:04Most of us probably know now
31:07Usmile step one
31:08is pass fail as of July of January 2022.
31:12So I put this data here because I think
31:15it's interesting and I'm not quite sure
31:17how it will impact us going forward.
31:19I have spoken with a few program directors,
31:23particularly in non pathology
31:24specialties who say, OK,
31:26we'll just focus on the Step 2
31:28score and so it's like sort of
31:30kicking the can down the road.
31:32But what we do know is that since 2021,
31:35so that was the year before
31:37they made this switch,
31:38the pass rate has actually gone down for
31:42USMLE set one since they made it pass fail.
31:45So some of the conjecture
31:47is maybe students aren't.
31:50Prep with preparing well enough as they used
31:53to because they think I just need to pass.
31:55But I think a lot more focus needs to
31:58be placed on this and we need to follow
32:00the trends to see what really happens.
32:03But I just thought it was interesting.
32:05It was part of the reason they went
32:08this route was to help improve the,
32:11you know, pass rate and put less
32:13stress on the number itself.
32:15So we'll see Okay.
32:17So next we'll talk about a OA status.
32:20So the AOA as we know it's
32:23a medical Honor Society,
32:25it's one of the oldest if not the
32:27oldest in the country and a lot of
32:30the more competitive programs use
32:32a OA status as sort of A at least
32:36a Gold Star on the application.
32:38So it's specialties like orthopedics
32:40and dermatology and these are
32:42specialties that historically also have.
32:45Some of the lower numbers of diversity
32:48within their training programs.
32:51The issue really comes down to how
32:54schools elect members to the AOA.
32:56I'm so the AOA actually gives
32:59schools a lot of leeway in the way
33:02that they can elect students.
33:04So for my medical school class at UVA,
33:08and I'm not sure if this has
33:09changed since I graduated,
33:10but you were elected by your
33:13peers like peers would vote.
33:15On who would be up for
33:19consideration for AOA you.
33:21They do give schools leeway in terms of how
33:24much emphasis they put on certain aspects.
33:27So they use aspects of like academic
33:29achievement, research, education,
33:31leadership, professionalism,
33:33professionalism, humanism and service.
33:35But schools can place any
33:37amount of emphasis on any.
33:39The area that they want.
33:40So it's really not standardized and
33:42that can cause a lot of discrepancies
33:45in representation in a OA.
33:47And then some studies have looked at
33:50the representation in a OA and then
33:54correlated that with representation in
33:57the more competitive subspecialties.
33:59So even when accounting for grades.
34:03Students who are underrepresented in
34:05medicine have less AOA representation
34:07than those that are not underrepresented.
34:10So it's just something to keep in
34:12mind when we're evaluating based
34:13on these more traditional metrics.
34:15And then again,
34:16it may be due to the election process.
34:20This is something that the AOA actually has.
34:24Addressed So they recently put
34:26out this article saying that
34:29they are committed to DEI and they
34:32acknowledge that historically there may
34:35have been a lack of diversity in their.
34:38And their nominees, and they was elected.
34:41They also recently established an
34:43award for Excellence in Inclusion,
34:45Diversity and Equity,
34:47and Medical Education and
34:49Patient Care starting in 2019.
34:51Of the recipients of the first year,
34:53Meharry Medical College,
34:55SUNY Upstate Johns Hopkins and the
34:58University of North Dakota School of
35:00Medicine were the recipients in 2019.
35:05So next we'll move to clerkship
35:08grades and evaluations.
35:09So this is something that we sort of
35:14look at as a student's commitment
35:16to hard work and dedication.
35:19Some studies suggest that
35:20there can be some racial,
35:21racial and ethnic disparities
35:24amongst clerkship grading.
35:27So these two studies that I've
35:28listed here looked at the Medical
35:30student performance evaluation,
35:32the MSPE for underrepresented and
35:35non underrepresented students.
35:37This is sort of a narrative of
35:40the students overall performance
35:41from year one to year four.
35:43They can include shelf exam scores as well,
35:47but specialties like pathology don't
35:49necessarily have a shelf exam so
35:52it doesn't always help us in that
35:54way as pathologists to evaluate.
35:57But there's an objective proportion as well,
36:01and it's usually about usually based at
36:04least partly on the evaluations that
36:07students received during their rotations.
36:09But studies have looked at how the
36:13students are discussed in their MSP
36:16and what they found that few of fewer
36:19of the outstanding summary words or
36:22higher marks were received by UIM students.
36:26Another study by Lee showed that
36:2980% of the UIM students had lower
36:32clerkship grades even when adjusting
36:35for step one scores.
36:36These disparities still persist.
36:38And there are also some studies
36:41that show that Asian students
36:42or students of Asian background
36:45have disparities in their MSP or
36:47their overall evaluations as well.
36:49So I think this is something that
36:52we should look into more and.
36:54So it it's a little bit limited in
36:56pathology just because not every
36:58student rotates through pathology,
37:00but I I do think that it's important
37:02to it to at least address it and know
37:05that when we're evaluating these,
37:07this could be an area of bias as well.
37:12So something that we especially
37:14in pathology value is research.
37:17So residency programs in general often
37:20will value research when they're evaluating
37:23students to invite for interview.
37:26So in the most recent match
37:28data or this is 2021, sorry,
37:31they showed that almost half,
37:3441% of all residency training programs.
37:37And more, even more pathology
37:39training programs thought that
37:41research experience was valuable,
37:44or at least played some role in the
37:48applicants that they invited to interview.
37:51And this is important because there's
37:54not as much the opportunity for
37:57research is not evenly distributed.
38:00So overall, and again,
38:02this is not a hard and fast rule,
38:05it's just general numbers.
38:06But UIM students are less likely to attend
38:10a research intensive medical school,
38:13people from disadvantaged backgrounds.
38:16Might not be able to attend,
38:18you know, a private medical school.
38:19They might need to attend the
38:21state medical school that it's
38:23has less emphasis on research,
38:25and they may be less likely to
38:27participate in research electives to take
38:30dedicated research years or time off.
38:32And they are also less likely to
38:34graduate from an MD PhD program,
38:36which we've discussed them with Dr.
38:37Katz earlier.
38:38But a lot of it is just exposure,
38:40knowing the opportunities are out there,
38:41being at a place that offers
38:44that opportunity as well.
38:46So it's more of an access issue than a
38:49reflection on the students themselves.
38:51And then lastly, in this section,
38:53we'll talk about letters of recommendation.
38:54And a lot of this is extrapolated
38:57from other other specialties.
39:00So this paper here by Hoffman and all
39:03was in a surgical residency program.
39:06So they evaluated letters of
39:08recommendation for males versus females.
39:10So they didn't look at racial
39:12bias in this study.
39:13But they found that letters for males
39:15often have a more authentic tone.
39:17They use more achievement,
39:19or what they call a gentic
39:21words like ambitious, direct,
39:23assertive, intellectual,
39:24influential,
39:25or a go getter to describe the applicant.
39:29They use more possessive language when
39:31talking about the applicant's interaction
39:34with patients or interaction on service,
39:36and we're more likely to contain words
39:39like future leader or future success.
39:41And references to drive,
39:43knowledge, leadership and power.
39:47And when they compared this
39:48to the female applicants,
39:49there were more terms like hardworking
39:53and compassionate teacher,
39:54more communal phrases like how
39:56good of a teamworker they were
39:58or how helpful on service.
40:00Also,
40:00which I found interesting,
40:02they were more likely to reference
40:03the applicant's spouse or the
40:06spouse's accomplishments.
40:08And they were less likely to describe
40:10the applicants as bright when compared
40:12to the male applicants that they evaluated.
40:15And then also unfortunately,
40:17we're more likely to contain comments
40:19on the applicants appearance,
40:20which shouldn't really have anything to
40:22do with how well they can perform surgery.
40:26So this was a surgery program again,
40:28but it's important to think about
40:29the way that we're describing
40:31people and then as you as trainees
40:33get further on in your career and
40:35are asked to write these
40:36letters, it's really it's.
40:38Interesting to sort of think about your
40:40own biases and the way that you approach,
40:43you know, letter writing etcetera.
40:46And it's important to just be mindful
40:48of the way that we're describing
40:51our our students are trainees.
40:54OK, so then this the knowledge of the
40:57gender or sex bias makes us wonder
41:00whether there's racial or ethnic
41:02bias and letters of recommendation.
41:05So there are very limited studies about this,
41:09but one such study found that again,
41:11fewer agentic descriptors were used for
41:14letters from UAM for UAM applicants.
41:18Versus white and Asian applicants.
41:20But this is really limited again.
41:22So I think it's another area
41:24where we just need more research.
41:26We need to look into it more
41:28and see what the specifics are,
41:30not only for race and ethnicity,
41:31but also for pathology.
41:35OK, so back to our our big
41:38table of contents here.
41:39So unconscious bias and bias literacy
41:41training and awareness is really important
41:43and I think this is something that
41:45is sort of come to light or come to
41:48popularity and more recent times as well.
41:50I know a lot of programs have like
41:53unconscious bias training and bias literacy,
41:56so. We all have unconscious biases.
42:00I was listening to a dei lecture
42:04yesterday morning, actually,
42:05and they said if you have a brain,
42:07you have bias.
42:07And I was like,
42:08that's team that goes perfectly with the
42:10image that I have in my presentation.
42:12But it's true, you know,
42:14and a lot of this is just our human nature.
42:16Like we know if we see a lion or a bear,
42:19like we need to get out of theirs or a word,
42:21you know, lunch.
42:23But we have to be mindful about
42:26how this affects our interactions
42:29with with people in the workplace
42:31or in our everyday life.
42:35So bias literacy workshops
42:39can be really useful.
42:42It's it's one of those things
42:43where like the more interactive,
42:45the better in a lot of ways.
42:48But these interventions can help people
42:50bring to light any discriminatory actions,
42:54their personal biases and can help engage the
43:00community and equity promoting behaviors.
43:03It can be an adjunct, excuse me,
43:06to Implicit Association testing and the
43:10So the Implicit Association Test was
43:12something developed by Harvard researchers
43:14in conjunction with some researchers
43:16at UVA and the University of Washington.
43:19They have Iet's available for various biases.
43:23So gender, sexuality,
43:25race and ethnicity,
43:27religion, age, weight,
43:28tons more You can like.
43:31It's literally a menu if you visit the.
43:33Website.
43:33You can click and take the test,
43:36but there are some There is some
43:38evidence that doing the test
43:40alone it's enough to say like hi.
43:42I didn't realize that I was biased,
43:44but it doesn't really give the
43:46participant the tools that they need
43:48to actually modify their behavior.
43:50So it's good as an adjunct,
43:53but it might not be so great
43:56as a standalone tool.
43:58But it could be better than
43:59just the online learning model.
44:00So we I I think that as more
44:05programs emphasize the implicit
44:07bias or unconscious bias training,
44:10we can learn a little bit more from that.
44:12But it's it's really important to
44:14just open the discussion because these
44:16are really hard topics to talk about
44:18and they make people uncomfortable.
44:20But the more that we talk about it
44:21and get comfortable talking about it,
44:23the more change that we can make.
44:27OK. And then lastly,
44:29we will talk about establishing
44:31an overall inclusive environment.
44:35So it's really important I I
44:37think that sometimes this can
44:39get sort of lost in the weeds,
44:41but once you establish a DEI committee,
44:44once you are have these outreach
44:47efforts and you're improving the
44:49representation in your department.
44:50Establishing an inclusive environment
44:52is a really important next step.
44:55So having a dedicated committee that is,
44:58you know, that focuses on ensuring
45:01that this environment is inclusive,
45:03highlighting to applicants the
45:06department's diversity initiatives.
45:08So we have staff, diversity committees,
45:11and faculty and training committees.
45:15On at both Hopkins and UNC,
45:18there's a DEI website that sort
45:20of delineates all of the efforts
45:22within the department.
45:24You can also use departmental newsletters
45:27or institutional newsletters.
45:28At UNC also Doctor Weissman,
45:31who is currently chairing the DI committee.
45:35He makes an effort to send out
45:37a monthly newsletter,
45:39especially if it's like a month of
45:41representation for a specific group,
45:42to give a little bit of historical
45:45information about why we're celebrating or
45:47focusing on that group for that that month.
45:51Also celebrating training and
45:54faculty and staff culture.
45:56So we as pathology,
45:57we are a pretty diverse field.
45:59We have people from all across the globe and
46:02sort of emphasizing and celebrating that.
46:04I know it's a little bit
46:05different now with the climate,
46:07but having like a potluck or having like.
46:10There was a board of just like flags
46:13of countries that everyone was from.
46:15So like having just a little bit
46:16of that to say, hey, we're all,
46:18you know,
46:19even though we're from different places,
46:20we all have this common,
46:22common goal and common.
46:26Emphasis also outreach.
46:28So outreach is my one of my
46:31favorite things to do.
46:33But outreach to local communities.
46:35So here in New Haven, you,
46:39you're in the middle of the city.
46:42It's same thing with Baltimore.
46:44Chapel Hill is a little
46:45bit of a smaller town,
46:46but it's very close to larger cities as well.
46:49And I'm just getting to know
46:51the people in the community,
46:53educating people in the community.
46:55So one of the.
46:56Other things that our DEI committee
46:58does is they had a group that
47:00spoke with like a local church
47:02at UNC in North Carolina to
47:05emphasize just like general health,
47:08you know,
47:09like health maintenance and the
47:10importance of having a PCP and just like
47:14warning signs for like MI or stroke.
47:16So those are little things that
47:18can really go a long way and it's
47:21also really rewarding to have that
47:23connection with the community.
47:25And then inviting a diverse
47:27group of speakers.
47:28So I love doing talks about DEI,
47:31and I think it's really great.
47:32But also inviting people from diverse
47:35backgrounds who are giving scientific talks,
47:38talking about their research.
47:40You know,
47:41people who have established careers,
47:43talking about their career paths.
47:45Giving slide sessions to the residents etc.
47:48So I think these are all ways
47:51that we can help show that we are
47:54really dedicated to inclusivity and
47:57equity. And then when we're going
47:59through the interview process,
48:00which is one of also one of
48:02my favorite parts of the year,
48:03just making sure that we're emphasizing
48:05perceived fit and inclusion.
48:07So it seems, you know like the
48:09trainees here seem very close,
48:11very comfortable with each other
48:13and that'll shine through and the
48:15the applicants are coming through
48:17trying to choose their programs.
48:19And then just emphasizing again
48:21like the diversity efforts that
48:23are ongoing within the department,
48:25the inclusive environment because
48:28the opposite.
48:29So if a trainee comes through and
48:31sort of gets the sense that there
48:33might not be as much diversity,
48:35it can negatively impact their
48:37impression of the program even if
48:39otherwise the program was was perfect.
48:45So different ways to increase inclusion
48:47during the interview process or to
48:49increase the visibility of the UAM
48:51trainees and faculty while also
48:53being mindful that you don't want
48:54to over tax the UAM trainees and
48:57faculty but just inviting them like if
48:59there is a lunch session or if they
49:02would like to interview applicants.
49:04And it doesn't necessarily only
49:06have to be like.
49:07UIM faculty interviews the UIM
49:09applicants that can be, you know,
49:12exposure to all of the applicants,
49:15but also stressing the commitment to DEI,
49:18which is something that I can see
49:21is evident from my visit here.
49:23And describing the DEI efforts
49:24within the department, again,
49:26to all of the applicants,
49:27not necessarily just those who
49:30are underrepresented in medicine.
49:31And this is a photo from our visit to UVA,
49:35my medical school alma mater,
49:38where we gave one of our outreach
49:41presentations.
49:42And yeah,
49:42and Doctor White is standing right
49:44next to me in the middle there,
49:46our terror the chair.
49:48Hopkins Pathology, Dr.
49:49Rubin and is on the far right and then Dr.
49:53Troncoso is 1 in on the left,
49:56who is one of our neuropathology
49:59faculty at Hopkins. OK.
50:01So how do we move forward?
50:02I think this is a really heavy topic and
50:05it it highlights a lot of the issues without,
50:08you know,
50:09it can seem like there are so many issues,
50:10it can be really hard to overcome,
50:13but there are ways that we can
50:16overcome and work toward a more
50:18inclusive and equitable environment.
50:20So like I mentioned,
50:21one of the things I'm really
50:23passionate about is outreach efforts
50:25and pathway or pipeline programs.
50:28So I think starting at the
50:30really early student levels,
50:32grade school, undergraduate is great.
50:35I'm getting students before they
50:36go to medical school and decide
50:38they're going into internal medicine.
50:40We can sort of expose them to pathology.
50:42But even starting earlier than that,
50:44high school, middle school,
50:46even elementary school,
50:48I did an outreach program at Hopkins
50:50where we went to our elementary school.
50:53I mean, I showed this with a couple
50:54of people last night,
50:55but one of the.
50:57Group members had the really great
50:59idea to like put blue and or sorry.
51:02She put lotion and glitter
51:04on the students hands.
51:05They were like 4th graders and
51:08they went around touching things
51:09and that was how we taught them
51:11about the transfer of germs and
51:13how they should wash their hands.
51:14So you know it doesn't have to be
51:16really high level stuff, but you're.
51:18Getting them excited about science.
51:20We brought Petri dishes for them
51:22to look at under the microscope
51:23and things like that.
51:24So you can start really small,
51:27really basic,
51:28but just making that outreach
51:31effort can make a huge impact again,
51:34continuing to invite diverse speakers
51:36and create an inclusive environment.
51:39And then one of the things,
51:41so I will go back to that point
51:42for one second.
51:43So I think our brand rounds committee
51:46at UNC does an excellent job of
51:48inviting diverse speakers to speak on
51:51both DEI topics and scientific topics.
51:53And so I think that's something that
51:56we can do to help just emphasize you
51:59know that scientists look you know
52:02all different ways and can produce
52:05really impactful research as well.
52:08And then another thing that I'm
52:10also passionate about is just
52:11the impact of DEI on wellbeing,
52:13pathologists specific.
52:14So I've worked with a couple of my
52:19colleagues at Hopkins to develop wellbeing
52:22curricula for the residents and fellows.
52:25So that's something I'm
52:27very passionate about,
52:28but also showing how that interaction
52:30between DEI and wellbeing exists and
52:33how it helps to mold our experience
52:36through training and beyond.
52:38So that's pretty much it.
52:41So in summary,
52:43outreach efforts can increase early
52:46exposure to pathology and subsequently
52:48increase those going into our field.
52:51Dedicated funding for DEI initiatives can
52:53lead to expansion of the outreach efforts,
52:55so having a funded rotation or
52:57funding for students who are
52:59coming through the department.
53:01DEI committees are really essential
53:03at working together and producing
53:06the inclusive environment within the
53:08department and then holistic review of
53:11applicants can help increase DEI and
53:13training programs and then subsequently
53:15in the practicing field of pathology as well.
53:19So I have just a few acknowledgments.
53:21I cannot give this presentation
53:22without thanking Dr.
53:24Marissa White,
53:25who I've worked very closely with for several
53:28years now on all of these DEI efforts.
53:31She's a great friend and colleague of mine.
53:34Doctor Lauren Flax helped to produce
53:35a lot of the figures that I presented
53:38throughout the presentation.
53:39She is currently a pathology
53:42resident at Walter Reed.
53:44Doctor Stacy Keane and Mariana
53:45Evans for the work that I'm doing at
53:48UNC and for them going along with
53:50some of my somewhat far fetched
53:53plans and then the UNC and Hopkins
53:55Pathology Diversity Committees who
53:57both have been really essential
53:59at establishing establishing an
54:01inclusive environment and helping
54:03to promote a lot of this work as well.
54:07So that is all that I have.
54:08I'm happy to take any questions
54:11or comments or anything.
54:20There's
54:23one chat,
54:27OK, it's about seeming
54:32Can you tell us more about the
54:36decision to make the use and relief
54:39as failed? Maybe. Perhaps it?
54:44Yeah. So I I'm not sure,
54:47so I'm not sure how close we are
54:50to eliminating it completely.
54:52But as you all probably know,
54:53like a lot of schools don't,
54:56Oh my gosh, they don't,
54:58they don't require the GRE anymore.
55:01I had a fine blank for a second.
55:03Yeah. So it it's possible in
55:05the near future and maybe this.
55:08Declining password,
55:09it might help get us there.
55:11I think it's so it's hard
55:14because we it's something that
55:16has been really ingrained in
55:19the medical training over time.
55:22So I think that I think the intention
55:26behind it was good and there was a lot of.
55:30Like students would stress out and be
55:33in really poor states of wellbeing,
55:35just studying for step one
55:37and thinking about how it will
55:39make or break their careers.
55:41But now I think this is sort
55:43of an unfortunate consequence
55:45that failing up front,
55:47the higher fail rate might actually
55:49further impact their careers than
55:51a low passing score would have.
55:53So I think that I.
55:56I'm interested to see how it
55:59evolves overtime for sure.
56:00Sorry comments for a second time in
56:04when I graduated previous years pre
56:07pandemic they asked this question
56:09and the people there said would be possible
56:12the value of student without basically
56:14the risk that we just said the pandemic
56:18happened and they decided to suspend it.
56:22The students were having a
56:24hard time access to the task.
56:26I haven't got it back yet,
56:27and this is OK Without it, Yeah.
56:30So it would be interesting to
56:32blind resident evaluation without.
56:35Yeah. See how that's a great.
56:39That would be a great experiment.
57:08So I will. Oh, sorry. Keep going. Sure.
57:25Experience,
57:31right.
57:34Yes. So I will say that I think
57:38that there are differing schools
57:40of thought in this for sure.
57:42But I think that one of the things is it's
57:45really that distance traveled aspect.
57:48So I know from. For my involvement
57:52in residency selection committees,
57:54we have a lot of students who apply
57:56who come from a really small school,
57:58like a school that has like.
58:00Two residency programs for the entire school,
58:03they have no pathologists,
58:05like even at the the hospital and they
58:08have really had to go out of their way
58:11to rotate with the local pathologist,
58:14with the local medical examiner and like
58:16become friends with that person because
58:18it's really like just the two of them.
58:20And I when I look at those students,
58:22I say wow,
58:23this person really is passionate and
58:25made a point to go out of their way.
58:28So I will weigh that more heavily.
58:31You know, then just to say, well,
58:32we can't grade them because they didn't have,
58:34you know, didn't rotate through
58:35pathology in their medical school.
58:37But they've made a concerted effort to
58:39show that they're really passionate.
58:41And I think that those are some of
58:44the people that it's almost like a
58:46miracle they even found pathology
58:48because they don't really have
58:50exposure through medical school.
58:51So I do think that that is really important.
58:54I do if I come across a student
58:57who a lot of times.
58:59Students don't realize the power that
59:01they have when they're applying.
59:02Like, if you have that type of experience,
59:04emphasize that,
59:05talk about that in your personal
59:07statement because it does make
59:08a difference and it shows how
59:09passionate you are.
59:10So I think those are really important.
59:12And there are actually a
59:13lot of students out there.
59:14I've seen a lot of do students
59:15as well come through.
59:16They often don't have pathology emphasizes
59:19as much as we do in medical school,
59:22which of course is shrinking as well,
59:24but it's even less and they also
59:26go out of their way to make sure.
59:28Where they're getting exposure to
59:30pathology and I think that's really
59:32important and they make some of the
59:33best residents because they are so
59:35passionate and dedicated to making it work.
59:37And then I will circle back to
59:39the US Emily for one.
59:41So I I have noticed in later later
59:45selection like the more recent
59:47selection committees that I've sat
59:49on that there will be an effort
59:51to not show the USMLA score.
59:52So this is a little bit pre
59:55pass fail but like.
59:56Historically,
59:57you know we we sit in our in the room,
01:00:00the conference room,
01:00:01we have the applicants in the PowerPoint
01:00:04and there's like the picture,
01:00:05the school, the board scores.
01:00:08And there has been a more of an effort
01:00:10to not put those board scores there.
01:00:12And sometimes even there's,
01:00:13there are arguments about not
01:00:15putting this school there.
01:00:16Because it can be,
01:00:17you know,
01:00:17a grade A applicant from a lesser
01:00:20known school.
01:00:20And there unfortunately are some
01:00:22people in the committee who say,
01:00:24well, I've never heard that school,
01:00:26you know, and that doesn't.
01:00:28It's not important if
01:00:29the person is committed,
01:00:30if they've shown effort and
01:00:32they've really taken the steps
01:00:33to show that they're dedicated,
01:00:37yes.
01:00:50Yes, there are a lot of Med schools
01:00:52that don't have a chapter. Yes,
01:01:04it is included in the application.
01:01:06So what will happen is
01:01:08they can select like yes,
01:01:10they're in AOA, they're not in AOA,
01:01:11or their school doesn't have a chapter, so.
01:01:14In theory it shouldn't negatively
01:01:17impact their application,
01:01:19but sometimes like it's not.
01:01:23If they had, yes, I was in a OA,
01:01:25especially for like the more
01:01:27competitive specialties.
01:01:28I won't say so much for pathology,
01:01:31but that might be just my own bias.
01:01:33But. If they had like, yes,
01:01:36I was an AOA versus no, I don't have
01:01:39a chapter at my school like that.
01:01:40Yes, I'm in AOA student might
01:01:42be in a different specialty,
01:01:44might be higher ranked than the
01:01:46student who didn't have a chapter.
01:01:48But I agree it's not,
01:01:49it's not a level playing field at all.
01:01:52And a lot of the smaller schools,
01:01:53a lot of the HBC US don't have AOA chapters.
01:01:57So then it's like, well you know,
01:01:59if that's part of your selection criteria,
01:02:01then how are you going to
01:02:04evaluate those students?
01:02:05Sure, Yeah.
01:02:13Yes. So, yes. So when I was at Hopkins,
01:02:17we had in our chair.
01:02:19I will say like I give him all of
01:02:22the credit to Doctor Ruben because he
01:02:25had a really great connections with.
01:02:28Philanthropic donors.
01:02:28So a lot of the funding
01:02:31actually came from there.
01:02:32And I will say so I It seems like it takes
01:02:37a lot to get the program up and running,
01:02:40but it doesn't necessarily have to,
01:02:42especially if you are,
01:02:45you know, doing students like
01:02:46one or two students at a time.
01:02:48But also there are a lot of
01:02:50grants out there as well.
01:02:51So the NIH has training grants.
01:02:54That can help fund rotations
01:02:55and outreach like this as well.
01:03:00Oh yeah. So overall, from about 2016 to 2020,
01:03:05we had about 20 students.
01:03:07Usually we didn't have more
01:03:08than two rotate at a time.
01:03:10And there were some years where we had
01:03:12like one and some years we had five.
01:03:14It it sort of ebbed and flowed.
01:03:16Yeah, Yeah.
01:03:18And then did you have a question?
01:03:39I haven't heard that, but I
01:03:41wouldn't be surprised. Yeah,
01:03:50sure.
01:03:59Yes,
01:04:03yes,
01:04:06yes. Yeah,
01:04:17I agree.
01:04:20Yes. So I agree completely.
01:04:22I'm so mentorship has been really
01:04:24vital for me just in progressing
01:04:27through my career and I've had
01:04:29mentors who are UIM who are not
01:04:31UIM like it's the runs, the gamut.
01:04:33I also think having support,
01:04:35so like having your chair who says
01:04:37like hey I saw this opportunity come
01:04:39up I think you'd be great for this
01:04:42whether it's DEI focused or not.
01:04:43It could be like an education
01:04:45committee at use CAP or with the APC
01:04:48something like that but just having.
01:04:50Somebody who's sort of funneling those
01:04:52opportunities along or saying like,
01:04:54oh, somebody asked it,
01:04:55but if we could give a talk on this,
01:04:57I think you'd be great like promoting the
01:05:00faculty at a more equitable playing field,
01:05:03I think it's really important.
01:05:04And then just having like the
01:05:06ongoing support like annual meetings,
01:05:08etc, going over promotions,
01:05:11requirements and criteria and all
01:05:14those things because promotion.
01:05:18That's a place where a lot of people can
01:05:20get stuck in one position for a long time.
01:05:22And if you don't have that support
01:05:24or if you don't have other faculty
01:05:27who are who are saying like,
01:05:29hey, you should do this,
01:05:30you know this and the other will help you.
01:05:33I think that it can really be a struggle
01:05:35if you're not getting that support.
01:05:37And I think too, like for me,
01:05:39I my research is not.
01:05:41Traditional by any means.
01:05:44But having chairs and other faculty members
01:05:47who recognize like this is still important.
01:05:49Working.
01:05:49You're still doing research.
01:05:51It just looks a little different.
01:05:52So let's help you find those
01:05:54resources that can help.
01:05:56So I think all of that
01:05:57combined is really important.
01:06:06Yeah, no chats.
01:06:10Right. Thank you so much.
01:06:12Thank you for having me.