10-26 MEDG: Diversifying the Healthcare Workforce: From Students and Beyond

October 26, 2023

ID10904

To CiteDCA Citation Guide

00:04My name is Jeanette Tetro.
00:05I currently serve as the Vice Chief
00:07for Education for the section of
00:10General Internal Medicine and our
00:11section Delighted to come back together
00:13with our friends from the Center for
00:16Medical Education for our first GIM,
00:18Center for Medical Education Co
00:21hosted Medical Education Discussion
00:23Group for the academic year.
00:26We're thrilled to welcome GIMS
00:29own Doctor Benjamin Imba who
00:32will be speaking with us today.
00:34Doctor Hoffler's going to give him a much
00:37more extensive interview or introduction.
00:39Excuse me,
00:39we could probably talk the whole time
00:41and all he's accomplished but he
00:43serves as the Vice Chair of Diversity,
00:45Equity and Inclusion for the Department
00:47of Internal Medicine and the Graduate
00:49Medical Education Director for Diversity,
00:52Equity and Inclusion as well
00:55as Associate DIO for our GME.
00:59So before I turn the podium over to
01:02Doctor Haffler just wanted for planning
01:04purposes make sure you mark your calendars.
01:07There will be another Med Ed
01:10discussion group which will take
01:11place on December 14th which is
01:13going to focus on ChatGPT and where
01:16it belongs in medical education.
01:18And then our next Co hosted session
01:21will be January 25th of 2024 led by
01:26Doctor Elizabeth Gaufberg from Harvard.
01:28And our last Co hosted session will
01:31be led by GIMS own Doctor Nathan
01:34Wood and that'll focus on culinary
01:37medicine and the future of nutrition
01:40education that will occur on March 28th.
01:43One last announcement,
01:44please don't forget to fill out
01:46your climate survey.
01:48I want to make sure we have
01:50great participation in that and
01:51that your voices are heard.
01:53So I'm going to turn it over
01:54to Doctor Hoffler.
01:57Hi, welcome everybody.
01:58I'm thrilled to be able to do
02:01the joint session together.
02:03Sorry if there's a little bit
02:04of noise in the background.
02:05I'm. I'm at a meeting.
02:06So Doctor Amba graduated from the College
02:09of Medicine of the University of Lagos,
02:11Nigeria and completed his internal
02:14medicine residency in the UK.
02:16But then he completed a second I
02:19am residency and served as chief
02:21resident at Cook County in Chicago.
02:24And before joining Yale, Dr.
02:27Amba was the associate chair of
02:29medicine for faculty development
02:30in medicine at Cook County,
02:31and he was a professor of medicine
02:34also at Rush Medical College.
02:36And when you look at what your
02:38career has contributed to the world,
02:40it's just been amazing.
02:41And I'm so thrilled that you're here
02:43at Yale with us because you really
02:46we talked about clinical education,
02:47diversity, equity,
02:48inclusion advocacy and it's
02:50mainly been in the GME space.
02:53And I really appreciate your
02:55work and residency program and
02:57faculty development Qi work.
03:00And now really what you're addressing
03:02today as we work together on this
03:05developmental longitudinal approach
03:07for our UME faculty and health
03:10professionals who teach medical
03:12students and PAS and are nursing
03:14all the way through the GME.
03:16So welcome and thank you so much and
03:20I'm thrilled to pass it over to you now,
03:22Ben.
03:23Yes, thank you, Janet,
03:24for the kind introduction and
03:26the opportunity to speak.
03:28I'm really glad to be here.
03:30And I'll just set about sharing my slides.
04:10OK Can you see my slides? Yes,
04:13Doctor Amba, but we're seeing
04:14your presenter view. OK
04:19Yes, go up to display settings,
04:22seeing the top row there.
04:27Yeah, it's not showing here.
04:29Not that. Again, One second.
04:52No, it's not one second.
04:54Let me see. Some reason it's
05:08OK. How's that?
05:11Can you share? You need to share your
05:13screen and then we'll see what you see.
05:35I'm not seeing your screen yet.
05:38It should come up in a second. OK
05:43And then the slideshow.
05:49Can you see the screen now? Yes.
05:54And is it the presenter
05:55view or the full view?
05:57It's still the presenter view.
06:00OK. So let let me just
06:02simply hide the presenter.
06:04How's that? There you are. OK,
06:06perfect. Perfect. Thank you. So,
06:09sure, no worries.
06:10So again, thank you, Janet, for the
06:13kind introduction and let's get started.
06:15So text the number on the screen to the
06:18number on the screen for your CME credit.
06:21And please don't forget to
06:23fill out your climate survey.
06:25So for today, I'll be talking about
06:29the scope of the I'll be covering
06:31the scope of the URM problem,
06:32challenges faced by URM faculty
06:35bottlenecks that URM medical students face,
06:38the importance of diversifying
06:40the healthcare workforce,
06:41visa visits, impact on healthcare
06:44outcomes and disparities,
06:45and strategies to increase the
06:47diversity of the healthcare workforce
06:49at the Yale School of Medicine.
06:50We should have time for questions
06:52and answers at the end.
06:55So the problem is the paucity of
06:58underrepresented in medicine,
06:59medical students, GME trainees,
07:02medical faculty, practising physicians
07:04and providers across the nation.
07:0720 years ago the AMC coined this
07:11definition to refer to those racial
07:13and ethnic populations that are
07:15underrepresented in the medical
07:17profession relative to their
07:18numbers in the general population.
07:20And so this refers to African American,
07:23Latino or Hispanic,
07:24Alaska Native or Native Americans,
07:26and Native Hawaiian populations.
07:28So though they find 20 years ago,
07:31it is important for us to remember that
07:33there there are other populations under
07:34represented in medicine such as low income,
07:37first generation to attend college,
07:39disabled and LGBTQ populations.
07:41If we just look a little bit
07:45more into the income situation,
07:48you find that the top 5% of US household
07:51household income quintiles account
07:53for 1/4 of all medical students.
07:56Basically,
07:57the top 20% of household income
07:59families account for more than
08:01half of all medical students,
08:03whereas the bottom 40% account
08:05for 15% of all medical students.
08:10Now when we look at the US population,
08:12we find that 34% of the US population
08:15comprises the underrepresented
08:17population base,
08:19while just 13% of medical students,
08:2410% of medical faculty and 13% of all
08:28active physicians are actually from
08:30the underrepresented population base.
08:32Half of the United States
08:35population is female,
08:3637% of active physicians are female.
08:41This is not just a medical doctor issued,
08:45this is a healthcare workforce issue.
08:47If you look at the breakdown
08:49of registered nurses you find
08:50that 80% are white and the same
08:53significant under representation of
08:55the groups exists amongst nurses.
08:57If you look at physician assistants,
08:59you find that 72% are white and the
09:03same significant under representation
09:05across the groups occurs there as well.
09:10So let's look closely at now the
09:13physician group and distribution
09:15Across the United States,
09:17Black or African American
09:21physicians make up just
09:236% of total physicians,
09:254% of medical school faculty and
09:277% of medical school graduates.
09:29Latino or Hispanic doctors
09:31make up 7% of all physicians,
09:336% of medical school faculty,
09:35and 6% of medical school graduates.
09:38The other underrepresented
09:40populations less than 0.5 across
09:43all all the domains and metrics.
09:47This is not a new problem.
09:49This is a decades long
09:50problem in the United States,
09:52just looking at the last 10 years.
09:54Unfortunately the four colours at
09:55the bottom of the graph represent
09:58the underrepresented group.
09:59This slide is for female faculty.
10:01Over the last 10 years,
10:02it's clear to see that there's
10:04been no significant progress
10:06in terms of representation.
10:07The same, unfortunately,
10:08is true for male faculty,
10:10where the four colours at the bottom
10:12represent the four underrepresented
10:15in medicine populations.
10:16So this is the last 10 years,
10:18and it goes on many more decades before that.
10:22So is change happening?
10:23Let's now look to our medical
10:25schools in the last five years and
10:27see if any change is happening.
10:29If you look at medical school
10:30matriculants in the last five years,
10:32unfortunately it's clear to see that
10:34there's been absolutely no significant
10:37change in the absolute numbers
10:39representation from this population base.
10:43Now if we look at medical schools,
10:48which is we are in the medical school
10:50system here and we look at rank
10:53and dice it by race and ethnicity,
10:55this is recent data.
10:56What you find is that of all the
10:59professors in medical schools,
11:01clinical and basics sciences departments,
11:04only 2% are black,
11:064% are Hispanic or Latino or
11:09the associate professors,
11:11just about 4% each for black or Latinos.
11:14And again,
11:14the other underrepresented groups
11:16are less than 0.5 across all ranks.
11:20Most of the professors and most of the
11:22associate professors as you can see,
11:23are white and then followed
11:25by Asian populations.
11:27So we have to ask ourselves then
11:31even why is there even worse
11:33representation amongst faculty
11:35from this underrepresented groups?
11:37And so at this point let's take a slight
11:41detail and look at the URM faculty
11:44experience from the URM faculty Lens.
11:47These authors looked at a longitudinal
11:49multi institutional study to look at
11:52race and ethnicity and how it correlates
11:54with success in academic medicine as is
11:57traditionally defined 17 year follow up.
12:00And what they found was significantly
12:03URM faculty had lower rates
12:05of peer review publications,
12:07lower rates of promotion to professor,
12:09and lower retention rates
12:11compared to white faculty.
12:13Interestingly,
12:13there was no difference in federal grants,
12:16senior leadership roles,
12:18career satisfaction and compensation
12:20between the URM and the and white faculty.
12:23So this this right here informs
12:27the need for deliberative
12:29programming to support productivity,
12:31academic productivity,
12:33and advancement for underrepresented
12:35in medicine faculty.
12:37Other authors from different institutions
12:39have looked at this problem,
12:42and I think these authors kind of
12:46captured the dissatisfaction and
12:48the disparities in their article
12:51titled Addressing Disparities
12:52in Academic Medicine.
12:54What of the Minority Tax?
12:56The minority tax has been defined
12:58as the tax of extra responsibilities
13:00placed on minority faculty in the
13:03name of efforts to achieve diversity.
13:05It's described as an under
13:08represented minority in medicine
13:10faculty responsibility disparity,
13:13which is evident in many areas,
13:16diversity efforts, racism,
13:17isolation, mentorship,
13:19clinical responsibility and promotion.
13:21I'll just go very briefly over
13:25each diversity at disparity realm.
13:29In terms of diversity efforts,
13:30more underrepresented faculty spend more
13:33time on DEI efforts and on community health,
13:37less time on research.
13:39And most times institutions
13:40do not acknowledge this for
13:43promotion racism disparity.
13:44URM faculty are exposed to
13:46systemic and individual racism,
13:48implicit and explicit,
13:50and racial difference in promotion,
13:54isolation, disparity.
13:55URM faculty often feel isolated culturally.
13:59This leads to reduce opportunities
14:01for collaboration or research
14:04outside of DI related matters,
14:06racial and gender concordant
14:08mentorship is lacking for URM faculty,
14:10who are then called upon to mentor
14:13URM mentees without having had the
14:16benefit of mentoring themselves or
14:19effective mentoring themselves.
14:22Clinical disparity.
14:23I've mentioned.
14:23URM faculty tend to spend more
14:26time doing community clinical
14:28work and engaging DEI efforts,
14:30and clearly there's a
14:32disparity in promotion rates.
14:33Less promotion equals to less
14:36salary in some institutions,
14:38and so we can start to understand why
14:42the specific challenges faced by URM
14:45faculty within the larger faculty body.
14:48So let's return to the scope of the problem.
14:52We left up here at academic
14:54rank and race and ethnicity.
14:56But if we actually look at
14:58this through a gender lens,
15:00what we find is that there's a
15:03significant male predominance,
15:04especially in the rank of professor,
15:06but also in the associate professor,
15:08with the exception of the
15:10black African American faculty.
15:11So on average,
15:13with the highest discrepancy actually
15:15being among white and Asian faculty,
15:17on average you have a 7 seven to
15:21three ratio of male professors
15:23to female professors.
15:26So with this understanding,
15:28this male discrepancy,
15:30what does actually medical school
15:34leadership look like across the country?
15:37Not surprisingly, it looks the same.
15:39If you look at all medical school
15:41Deans in the United States,
15:4373% are men, 23% are women,
15:45and only 13% are URM Deans.
15:48If you look at all medical school
15:51department chairs in the United States,
15:5377% are men.
15:54If you look at all,
15:55I'm an internist internal medicine
15:58and this is a collaboration
15:59with internal medicine.
16:00So if you look at all medical
16:02school internal medicine chairs
16:04in the United States,
16:0580% are men and 20% are women.
16:08The situation's actually worsen.
16:09Surgery, the surgery chairs,
16:1293% are men and 7% are are women.
16:16So what does leadership that the
16:18Yale School of Medicine look like?
16:21Of all the department chairs of
16:22the Yale School of Medicine,
16:2484% are men and 16% are women.
16:27The majority are are are white,
16:29with 10% Hispanic, Latino,
16:31and 10% black.
16:32So as the nation goes,
16:34unfortunately so does Yale go at this time.
16:38If we look at the Department
16:40of Medicine vice chairs,
16:4270% are men, 30% are women,
16:46majority white, 10% Hispanic or Latino
16:48and 10% black or African American.
16:50If you look at the Department of
16:53Medicine section chiefs, 82% are men,
16:5518% are women and 100% are are white.
16:59So what does the Yale Medical School
17:04medical student body look like actually,
17:06So this is matriculation
17:08data for the last five years.
17:10And actually what you find is that
17:12the medical school has 25 to 35%
17:15underrepresented in medicine minorities,
17:1710 to 15% first generation and 20
17:21to 30% international students.
17:26What does Connecticut and
17:27New Haven look like?
17:29So connect,
17:31the underrepresented in medicine
17:33population base comprises 31%
17:36of the Connecticut population,
17:38but it comprises 65% of the
17:42New Haven population.
17:46Now, we've talked about, we've defined
17:48the scope of the problem with with,
17:50we've defined the problem, we've defined
17:52the national scope of the problem.
17:53We've brought the looked at the numbers
17:56locally at Yale and the demographic
17:58distribution of New Haven and Connecticut.
18:01So what are the bottlenecks
18:03that URM medical students face?
18:05Well, bottlenecks are faced all along the
18:08spectrum of the medical education journey.
18:11I probably mistakenly left
18:13out kindergarten there.
18:14But it's fair to say that
18:16even before medical school,
18:18there's so many bottlenecks faced by
18:20underrepresented potential medical students.
18:22And there they are.
18:25There is the achievement gap.
18:26The achievement gap is the significant
18:30and sustained difference in reading and
18:34mathematics as tested from the 4th grade
18:38all the way to K12 and has remained for
18:41decades without significant change.
18:44Resource gap is self-explanatory.
18:46We have modern school segregation due to
18:50as a function of socioeconomic status.
18:52There's this stereotype threat.
18:54There's the implicit bias
18:56of educators and evaluators.
18:57There's the implicit bias of
18:59reference letter writers,
19:00implicit bias on the admission system itself.
19:03And this is all before we get
19:05to medical school.
19:06So what happens when we get
19:09to medical school?
19:10Now the AAMC started to look at this
19:12in the late 80s and early to mid 90s.
19:15This analysis in brief looked at
19:18the attrition rate due to academic
19:20reasons across racial groups in the
19:23matriculating classes from 8792
19:25and 95 for 10 years.
19:27And you can see they found a significant
19:30increased rate of attrition for all
19:32the minority groups compared to
19:34white and Asian medical students.
19:36In fact,
19:37the attrition rates due to academic
19:39reasons for all the URM students were
19:41more than four times that of white
19:44or Asian students over 10 years.
19:46So they're moving forward into the 2000s.
19:48Another AMC analysis in brief this
19:51time they looked at socio economic
19:53status and the rate of attrition in
19:56US medical matriculants in the 2000s.
19:59Just looking at the first two years,
20:01because 60% of attrition rates
20:03in medical school,
20:04at least 60% happened in the first
20:06two years of medical school.
20:08What they found was a low SES
20:10as defined by no parent having a
20:14college completed college.
20:15Those students had 1.4 times higher
20:18attrition rates than middle SES.
20:20For students in the low SES,
20:22they had more than two times.
20:24Higher attrition rates than those
20:26in the high SES,
20:27which is defined by at least one
20:29parent having a postgraduate degree.
20:32It is often stated that academic
20:34Rigo accounts for the difference
20:37in attrition rates between
20:39underrepresented and majority students.
20:41These are.
20:43This analysis looked at the different
20:46MCAT cohorts and found that the
20:49the disparity was still the same
20:51for socio economic status.
20:53So we've looked at how race
20:55impacts attrition.
20:56Now we've looked at how socio
20:58economic status impacts attrition.
20:59So now moving forward into the 2000
21:02and 10s and this study out of Yale
21:05by our illustrious MDPHD student,
21:08Matin looked at actually USMD
21:12matriculants for
21:142014, 2015, looked at them for
21:16six to seven years on adjusted
21:18significant attrition rates.
21:20Now they adjusted for MCAT scores and for
21:24sex and still found significant increase in
21:28the attrition rate for all the URM groups.
21:31Same for low economics families,
21:34low income families,
21:34and on the people who grew up
21:36in underserved neighbourhoods,
21:38defined as neighbourhoods with,
21:40that are underserved medically.
21:42In fact, on analysis,
21:44they found that the rate of attrition
21:46was greatest among students with
21:49three marginalized identities,
21:50which was almost four times higher
21:53than other students who had known,
21:55even when adjusted for the
21:57same MCAT scorings.
22:02Now the same. Our same student,
22:04MI 10 looked at the association of
22:07racial and ethnic identity with attrition
22:09rates from MDPHD training programs,
22:12physician scientists.
22:13They looked at close to 5000 students over
22:168 years and they found that 2% graduated
22:18with an MD only and 4% left medical school.
22:22Graduating with an MD only was highest for
22:25black students compared to all racial groups.
22:27More black than white MD matriculans
22:30left medical school. And in fact,
22:33after again adjusting for the MCAT,
22:35the odds of graduating with only
22:37an MD and leaving medical school
22:39were 50 and 83% higher.
22:41Percent higher for black
22:43than for white students.
22:45So, significant bottlenecks faced
22:48by students before medical school.
22:51In medical school,
22:52even adjusting for MCAT
22:55scores and academic rigour.
22:59Now you could ask the question,
23:01well, why diversify the healthcare
23:03workforce at all?
23:05The answer comes in two words.
23:07HealthEquity,
23:07HealthEquity,
23:08according to Cameron Jones,
23:11is the assurance of conditions for
23:13optimal health for all people.
23:14Achieving HealthEquity requires valuing
23:17all individuals and populations equally,
23:20recognizing and rectifying historic injustice
23:22and providing resources according to need.
23:26Health is a fundamental human right.
23:28HealthEquity is achieved when
23:30everyone can attain their full
23:32potential for health and well-being.
23:34Sadly, in this great country,
23:36perhaps the greatest country on the planet,
23:41HealthEquity has never been attained.
23:45We have never been free of health inequities.
23:49Now,
23:50the Institute of Medicine in about 2002
23:55commissioned an expert panel to review
23:58900 studies that controlled for poverty,
24:01education and social determinants of health.
24:04They tried to focus specifically on the
24:06impact of race on the quality of healthcare.
24:08It was published in 2003 and what
24:12they found was that minorities,
24:13especially black populations had
24:15worse outcomes for almost all cancers,
24:18HIV, pain control,
24:19maternal and infant mortality,
24:22cardiovascular disease,
24:23diabetic amputations, etcetera.
24:26And this is even adjusting
24:27for health insurance,
24:28education and socioeconomic status.
24:30So this was really jarring and
24:33shocking and obviously this is a
24:36complex problem and but part of the
24:38hypothesis that was that perhaps
24:40implicit bias in the system and in
24:43in providers contributed to this.
24:45And so there was a large opera
24:47to actually push to diversify the
24:50healthcare workforce, medical schools,
24:52GME training etcetera.
24:54And obviously as we have seen sadly
24:56there has been no significant
24:58shift in diversification.
24:59So it's not surprising that 20 years later,
25:02we are exactly at the same spot.
25:04Minorities, especially black populations,
25:06have the highest date for
25:08death rate for most cancers,
25:10lowest overall survival rates.
25:12Prostate cancer is horrible,
25:14has horrible outcomes in males,
25:16black males complete to any other group.
25:18Black women are 40 times more likely to
25:20die of breast cancer than white women,
25:22even though white women are
25:24likelier to get breast cancer.
25:26Black people are twice as likely
25:28to die from multiple myeloma,
25:30amputation, diabetic care.
25:31So we are nowhere,
25:32we haven't shifted the needle at all,
25:35so therefore the outcomes and
25:38health inequities have persisted.
25:40Now,
25:41how do we know that actually
25:43diversifying the healthcare
25:45workforce would make a difference?
25:47Well, this authors looked at patient,
25:50physician, racial concordance and the
25:52perceived quality and use of healthcare.
25:54So it's qualitative but
25:56by no means unimportant.
25:58And they served different racial groups.
26:02They found out black respondents
26:04with black physicians were likely
26:06that were likelier than those
26:07with non black physicians to rate
26:09their physicians as excellent.
26:11Black respondents reported receiving
26:12preventive and all the care that they
26:15needed in the prior year to the study
26:17and Hispanics with Hispanic physicians
26:19were likelier than none those with
26:21non Hispanic physicians to be very
26:23satisfied with their healthcare.
26:24So again qualitative but by
26:27no means unimportant.
26:28Moving a few years further along,
26:30this authors looked at patient centered
26:32communication ratings of care and
26:34concordance of patient and physician race.
26:36And again they found that race concordant
26:39visits were more extended and and had
26:41higher patient positive affect ratings.
26:43And patients in race concordant visits
26:45were more satisfied and rated their
26:47physicians as more participatory,
26:49qualitative but by no means unimportant.
26:52So then we start to shift
26:55into quantitative data.
26:56So this is sometimes referred
26:58to as the Oakland experiment.
27:01About 650 black men were recruited
27:03mostly from Barber shops and
27:05the subjects were given a coupon
27:07for free healthcare screening.
27:09A clinic was set up with black
27:11and non black doctors.
27:12All the doctors knew whether they
27:14were to do their best to encourage
27:16the participants to engage in the
27:18screening and get the flu shot.
27:20Visit was in two stages,
27:21pre consultation digital tablet and a
27:24post consultation with the doctor in person.
27:27The following health metrics were
27:30offered including a flu shot.
27:32What they found was that subjects who
27:34saw black doctors were 18 absolute
27:37percentage points more likely to
27:39accept invasive tests and flu shots.
27:41And based on the analysis,
27:43they found that black doctors could
27:45reduce the black white male gap in
27:48annual cardiovascular mortality by 20%.
27:50Now we're starting to shift to quantitative,
27:53albeit experimental and now.
27:57So this year,
27:58few months ago,
27:59these authors looked at black
28:01representation in the primary
28:03care physician workforce and its
28:06association with population,
28:07life expectancy and mortality rates.
28:10They look they identified 1600
28:12counties with at least one black
28:15physician as a matter of interest.
28:18There are 33 counties in the United States,
28:20which means that 60% of the
28:22counties in the United States do
28:24not have one single black PCP.
28:26They found that greater black workforce
28:29representation was associated with
28:31higher life expectancy and was
28:33inversely related to all cost black
28:35mortality and mortality disparities
28:37between black and white individuals.
28:39A 10% increase in black PCP
28:42representation was associated with a
28:44higher life expectancy of a month.
28:47So now we start to see an impact on
28:49a population basis quantitatively.
28:52Now interestingly,
28:53a few months later I find this
28:56quite interesting because this
28:58almost combines qualitative and
29:00quantitative analysis.
29:01These authors looked at social
29:03demographic disparities in queue
29:05jumping for emergency department care.
29:08So it is stated that they this they looked at
29:11Ed patient arrivals at two large
29:14Eds within a large northeast health
29:16system between 2017 and 2020.
29:20Large northeast health
29:22system that may be Yale.
29:24So they had 300,000 visits to the Ed,
29:2840% were white,
29:2930% were black and 20% were Hispanic.
29:31The third of all patients
29:33experienced an unexplained Q jump,
29:35defined as a patient being placed in
29:38a treatment space ahead of a patient
29:40of higher or equal acuity who actually
29:43arrived earlier than that patient.
29:46And what they found was that
29:47the Q jump was statistically
29:49more significant for non black,
29:51Hispanic, Hispanic or Latino.
29:53Sorry, non Hispanic,
29:54black Hispanic or Latino,
29:56Spanish speaking Medicaid patients.
29:57And patients who were jumped
29:59over had higher odds of being
30:01in the hallway bed placement and
30:03actually leaving before treatment.
30:05So you can imagine what happens
30:07in terms of healthcare outcomes.
30:10So we have looked at defined the problem,
30:13the scope of the problem nationally,
30:15scope of the problem locally,
30:18challenges faced by URM faculty,
30:20bottlenecks faced by URM medical students,
30:24impact of diversity on the
30:26healthcare workforce and outcomes
30:28qualitative and quantitative.
30:29So I think it's fair to say it
30:31is time for a paradigm shift.
30:33It is time because numerous studies
30:35have shown that physicians and
30:37healthcare provider diversity enables
30:38better access and quality of care to
30:41diverse and underserved communities.
30:43Greater Black health workforce
30:45representation may actually lead to
30:47higher life expectancy for Black
30:49patients and we have an obligation
30:51to provide representation of
30:53providers and staff to reflect
30:54the communities we serve.
30:56We are obliged to care for our community
30:58health and develop professionals from
31:00within the communities we serve.
31:02And so this brings us to Operation EB.
31:06Equity begins with everyone.
31:08Equality tries to measure or looks
31:13for equal opportunities and equity
31:18addresses outcomes and tries
31:20to look for equal outcomes.
31:23Most of the DEI work is in the
31:26realm of the domain of equity.
31:28And the blueprint basically is that
31:31if we have increased representation
31:33and outreach of minorities in faculty,
31:37medical students, nurses,
31:39physician assistants, etcetera,
31:41we will have be able to recruit
31:43more and retain more and we'll have
31:45the circle of equity for healthcare
31:47and medical education.
31:48It will have an impact on medical education.
31:51It will have an impact on patient outcomes,
31:53which is ultimately what we're all about.
31:57Now how do we get there?
31:59So operation EB The strategy is
32:03the verbs verbs so RRAR verbs,
32:07R for retain for recruit, R for retain,
32:11A for advance and R for relay.
32:14And this is recommended for all departments,
32:17all sections and all divisions.
32:21So let's start with the first
32:23action verb which is to recruit.
32:25Now the GME office in collaboration
32:29with the medical school and all
32:32departments actually coordinates
32:33outreach to medical student
32:35organizations like the Latin Medical
32:37Student Association and the Student
32:39National Medical Association at
32:41regional and national conferences.
32:43In September we went to the LMSA
32:45and this at this conferences we
32:47exhibit training opportunities at
32:49the medical school level because
32:51the medical school sends a sends
32:53representation and at the GME level
32:58Yale has held its this year in September
33:01its second annual virtual recruitment
33:04event fair for all HBCU medical students.
33:08We had over 100 students.
33:10Yale holds in person events
33:12at Howard and Meharry.
33:13So all departments at all sections
33:16are encouraged to engage with
33:18the DME office as GME office.
33:20As we coordinate all this,
33:23we offer second look,
33:24virtual and in person,
33:25for URM candidates and in
33:28collaboration with the University
33:30pipeline Programs and College summer
33:32programs for science and STEM.
33:34In terms of faculty,
33:36we recommend that all sections
33:37and departments include DEI
33:39representatives on search committees
33:41and panels for certain positions,
33:43like the instructor rank
33:44that has no search committee.
33:46We recommend advertising on the
33:48career centers digitally of the
33:50National Medical Medical Association,
33:52which is a predominant African black
33:54or African American physician group,
33:56and the National Hispanic
33:58Medical Association.
34:02Now, having affinity groups
34:05supported by an institution actually
34:08fosters recruitment and retention.
34:10The GME office and the Yale School of
34:13Medicine has the supports the Yale
34:15Minority House Staff Organization,
34:17the Yale Women's House Staff Organization,
34:19and just in last month was launched
34:22the Yale First Generation Low Income
34:25Longitudinal Mentorship Program.
34:26Shout out to Doctor Jamie Cavallo from the
34:30Department of Urology for leading this.
34:32Something else that that we
34:34are trying to establish,
34:36I'm trying to establish with my team
34:37in the Department of Medicine is a
34:39Minorities in Medicine mentorship program.
34:41Other departments and sections can do this.
34:44Our program will pair one URM faculty
34:46member with one to two URM trainees
34:48or students and the mentor will be
34:51part of each trainees mentor team.
34:53I use the word trainee for students
34:56and for GME Graduate trainees,
34:58and the mentor's role is to provide
35:00the trainee with the perspectives
35:02of a URM physician.
35:03It's a hybrid of a mentor and a
35:05coach guide through the training
35:07challenges and career challenges
35:09faced uniquely by URM physicians.
35:11And our hope is that this program will
35:14be longitudinal and will create a support
35:16structure that will foster trainee retention.
35:18As faculty members themselves with us now,
35:22after you recruit,
35:24you have to retain.
35:26It's recommended that all departments
35:28and sections create a structure
35:30for gender and ethnic concordant
35:32mentoring for junior faculty,
35:34Yale School of Medicine
35:35has the Moore program,
35:37which is the minority organization
35:39for retention and expansion
35:40at Yale School of Medicine.
35:42I would encourage section on
35:44department leaders to have their
35:47minority faculty engage with this.
35:50Every section department should
35:52have a visible commitment to DEI.
35:54Every section should have ADEI leader
35:57and create a specific DI curriculum
35:59which could include DI workshops,
36:01retreats, invited speakers,
36:03integration of diversity topics into
36:05all aspects of the clinical curriculum,
36:08ground rounds, etcetera.
36:12Departments and sections should provide
36:14support for clinician educators.
36:15A big chunk of faculty,
36:17URM and non URM faculty come to you because
36:21they want to thrive as clinician educators.
36:23We're all here now this session because
36:25of the center at the collaboration
36:27with the Center for Medical Education.
36:29And so it is very important that all
36:32departments and sections provide
36:34support for clinical educators to
36:36advance their educational skills.
36:37The Center for Medical Education offers
36:40a master's degree and a host of much
36:42more other things that are offered that
36:45can advance the clinician education career.
36:48This is where section leaders,
36:49department leaders should endeavour
36:51to protect some time so that junior
36:54faculty can advance their own careers.
36:56They will stay on and and this will
36:59lead to an increased retention and
37:01part where they should be created and
37:03defined to leadership opportunities
37:05for academic clinicians and clinician
37:08educators which are a very big chunk
37:10of faculty as opposed to traditional
37:12investigators or clinician scientists.
37:15So we need to have a big tent approach
37:18to advance all tracks and faculty
37:22as part of retain retention efforts.
37:24Every section should have a formal
37:26mentoring structure that assigns
37:28mentors to junior faculty.
37:29A promotion advisory committee that
37:32reviews faculty readiness for promotion
37:35annually for URM and for non URM and the
37:38F tax should inform and guide this process.
37:41It's important that we don't
37:43forget that section leaders,
37:45senior faculty on promotion committee
37:48may also benefit from ongoing workshops,
37:51mentorship and sponsorship workshop so
37:53that we are constantly embracing a culture
37:56of academic sponsorship and mentorship.
37:58And I I refer to Matt sponsorship and a
38:01sponsor as a person in an organization
38:03who is in a position of influence
38:05and power who actively supports the
38:07the career of a of prodigy protege.
38:12We recruit, we retain now we have to advance.
38:16We've talked about the minority
38:18tax and section leaders.
38:19Department leaders should facilitate
38:21URM faculty academic advancement
38:23by incorporating DDI efforts
38:25and activities and leadership,
38:27DDI activities, leadership,
38:29clinical service,
38:30scholarly creative activities,
38:32community engagement as a significant
38:35supporting criterion for promotion.
38:37Faculty development programs
38:38to advance scholarly skills for
38:40junior faculty like the Department
38:42of Medicine's Academic Clinician
38:44Educator Scholars Program,
38:45the Centre for Medical Education
38:47does offers a ton of faculty
38:50development training programs,
38:52hands on bedside, etcetera,
38:54how to be a better teacher.
38:56So section leaders and Division and
38:59Department Chiefs should encourage
39:00engagement by junior faculty,
39:02URM or otherwise,
39:03with the Centre for Medical Education
39:06and the OAPD office that offers
39:08a lot of faculty development.
39:11I just want to talk.
39:13So we talked about the the minority
39:15tax and how it's difficult to
39:18capture and measure DEI efforts and
39:20have that contribute to promotion.
39:23We, my team and I are piloting a a
39:25tool that captures and actually weights
39:28DEI activities into impact scores.
39:30We're calling it the Yield
39:32DEI Productivity Calculator.
39:33It's an online tool that you answer
39:36some questions and it actually
39:38generates and computes and spits
39:40out the DEI activity impact
39:42score to inform promotion.
39:44We're hoping to pilot this in medicine.
39:46We are going to pilot this in
39:47medicine and actually currently
39:49we are now doing this as part of
39:52a a nationwide study to calibrate
39:54activity impact scores and to
39:56give it meaning and relevance.
40:01Now we're here to the final final hour,
40:03which is the final verb, which is to relay.
40:05And the DE, the underrepresented
40:08problem is not just institutional,
40:11it's regional, it's national, and so every.
40:15Institution or system that comes up with this
40:18semi solution that can advance representation
40:21should share this with the larger community.
40:25And so the last verb is of the
40:27Aurora verbs is the relay,
40:29which is to share our strategies
40:31regionally and nationally.
40:32Conference workshops,
40:33invited lectures, grand rounds,
40:35media platforms, commentaries,
40:37articles in peer reviewed journals.
40:41We should join professional
40:42organizations that advocate for
40:43diverse and inclusive healthcare.
40:45So we can advocate locally,
40:47but we can also do it
40:50simultaneously regionally,
40:51SGIMACP, surgical groups,
40:53gynecology groups as well.
40:55And we can do it nationally.
40:57We can advocate for policy and legislative
40:59changes and we can participate in pipeline
41:02programs into the Community Schools.
41:05An example of successful
41:06relaying is for instance,
41:08the section of infectious diseases
41:10within the Department of Medicine
41:12during the pandemic created DEI
41:15inclusive and anti racism curriculum.
41:17It was very successful.
41:19We're trying to model other sections
41:20around it and they actually wrote about it.
41:23So this is not just advocating locally,
41:25but relaying it nationally.
41:27Dr.
41:28Sharon Austerfield Jones is a internist
41:31and a paediatrician in the section
41:34of in General medicine hospitalist.
41:37She worked towards incorporating
41:39DEI topics into existing curriculum
41:41into the pediatric ground grounds
41:43and then she wrote about it.
41:44So not just making an impact locally,
41:47but relaying it nationally.
41:48And then our, our colleagues in surgery,
41:52Doctor Paris Butler,
41:54worked on programs and then
41:55they share this nationally.
41:56So in conclusion,
41:58the four verbs we have to retain
42:00underrepresented minorities,
42:02we have, we have to recruit,
42:04outreach and recruit.
42:05We have to retain and support mentorship
42:09programs to support productivity.
42:13We have to advance academic
42:15careers and leadership positions.
42:16And then finally,
42:17we have to relay our best practices.
42:19And with that,
42:20I thank you for your time and your attention.
42:22Thank you very much.
42:27Thanks so much. Ben.
42:27You can take down your slides and we
42:29have a few minutes for discussion.
42:31And I I feel so grateful
42:33to have serve it here.
42:34And we've got, you know, Sharon,
42:36we have so many people here doing
42:38really excellent research in this area.
42:40My first question,
42:41I would love to hear, Ben,
42:43when you're talking about
42:44the DEI impact score,
42:45tell me a little bit more
42:47about that and would it be
42:49for every faculty member?
42:51Yes, thank you for the question.
42:53So this is, this has bothered
42:56everyone at academic centres.
42:57How do you actually capture DEI
42:59efforts and how do you make them count?
43:01And how do you, you know,
43:02people, If I say the h-index
43:05for publication, everyone's,
43:06everyone knows it and everyone's like,
43:08Oh my God, h-index, etcetera.
43:10So the idea, Janet,
43:11here is that it's for all faculty,
43:14yes, all specialities,
43:15all faculty can use this.
43:17And the idea is that that you
43:21will have we have an online tool
43:23that captures all activities.
43:25So let's say I'm a faculty
43:26going up for promotion.
43:27I go on this online tool and
43:29I answer several questions.
43:31And as I'm asking questions like for
43:33instance, it covers curriculum building,
43:36research community work,
43:37working with incarcerated,
43:38working with the homeless,
43:39mentoring students, recruiting students,
43:41recruiting trainees,
43:42recruiting faculty, recruit,
43:44diversifying research teams.
43:46And there is a weighted scoring
43:48system to every answer.
43:49And so automatically it comes out with the
43:52diversity Diverse DEI Activity impact score.
43:54And now to your question,
43:55Janet,
43:55is that what does that score mean?
43:58So This is why we're now nationally trying
44:00to calibrate it at this point as we speak,
44:03we have sent out with the Yale
44:06IRB exemption approval,
44:07we have sent out this survey to
44:10all the DEI champions across all
44:12academic centers in the United States.
44:15So we're starting to try to to to
44:18measure what is the kind of the
44:21high point by people who their
44:23job description includes this.
44:25And then so eventually what we hope
44:27to have is that when someone's going
44:29up for promotion that you can have
44:32a page that shows national metrics,
44:35regional, national and institutional.
44:37If if if institutions are engaged.
44:39And then you can have your candidates
44:41who's coming up for promotion,
44:43their own diversity impact score.
44:45And then you can make an informed judgement
44:48about how impactful their DEI work is,
44:51especially if it's done
44:53without protected time.
44:54Because then you're literally
44:56converting the the minority
44:58tax into academic credit.
45:00Now one thing I want to stress
45:02absolutely importantly is that this
45:04productivity calculator does not
45:07assign any points based on identity or race.
45:11It's only assigns points based on
45:14activities that promote DEI and inclusion.
45:20Very interesting because on CV Part 2,
45:23we do have a section where we are required
45:26to mention what we do in the DEI space.
45:30So it'll be interesting to see how
45:32this works together. Let's open it up.
45:34Do others have questions?
45:44Sandy has her hand raised.
45:45Janet. Oh, thanks. I thanks.
45:48Go ahead, Sandy. Thank you, Janet.
45:49Thank you, Dorothy.
45:51Benjamin, thank you so much.
45:52This is really important work and
45:55and very insightful and helpful
45:57in our work in both in the student
45:59realm as well as the faculty realm.
46:01I just want to, I don't have a question.
46:03I really just want to thank you
46:05for calling out and including
46:08physician assistants PAS.
46:10So this work definitely impacts
46:12the world of PAS and we're often
46:15not included in these studies.
46:17So thank you very much for that.
46:19Oh, thank you. We are all one, I mean we're
46:22all one healthcare team. Appreciate it,
46:27Jeanette.
46:29Yes, thank you so much for a
46:32tremendous talk. Doctor Emba,
46:35I'm interested you know the inclusion
46:37of kind of low income first generation
46:40in the DEI kind of definition.
46:45Do you see that becoming more widespread
46:48and national data including that measure,
46:52I just you know I think it's
46:54really important and I don't
46:55feel like it's always captured.
46:59Thank you for your question.
47:00It is actually I see it getting more
47:01and more involved in the discussion.
47:03So if you look at if you first generation,
47:0662% of the United States population,
47:09households, 62% of the US
47:12adults have not attended,
47:13completed a four year degree
47:15program or an associate's program.
47:17And so. So it is very important
47:20that and if you look at medical,
47:23most medical schools now,
47:25if you look over the last two
47:27decades it was in the single digits
47:29of medical school students that
47:31are actually first generation.
47:32And if you look at for instance Yale's
47:34data now and which is across national data,
47:37it correlates with national data
47:39is that about 14 to 15% of medical
47:42school intakes actually taking
47:45in first generation families.
47:47When you look at low socio economic
47:49status when it comes to the poverty level,
47:525 to 6% of all medical school
47:55students come from official
47:57poverty defined family households.
48:00So in short, yes,
48:01I do see more and more involved.
48:03I know that the initial definition
48:05was exclusively on race,
48:07but then there are other populations
48:09that as this this gathering momentum.
48:11For instance,
48:12the United States 13% of adults,
48:15approximately 13% of adults are actually
48:17registered as having a disability.
48:19And in terms of medical school,
48:21you only have about maybe 4% of
48:23of medical students are disabled.
48:26So clearly there's an on
48:28the representation as well.
48:29So so that's why it's as we push
48:32forward inclusion should broaden it
48:33shouldn't I don't think it should
48:36be narrowed down just to race and
48:38ethnicity but to all disadvantaged
48:40cohorts that in the country.
48:43There are also other I didn't
48:44talk about it but there are even
48:46with even the nuances within this.
48:47You know,
48:48a lot of my slides showed for
48:50instance that they're the Asian,
48:52Asian physicians are over represented
48:54in faculty,
48:54but there's a significant challenge
48:57faced by Asian American faculty members,
49:00which is that the pathway to leadership.
49:03They for the last 20 years when you
49:05look at the leadership Parity Index,
49:08which is the representation of of
49:12leaders from a racial group over
49:14the total number in faculty,
49:16the two two groups stand out,
49:18women overall and Asian Americans
49:20for the last 20 years have had a
49:23leadership parity Index of less than one.
49:26So there's so much,
49:28there's so much inequity within
49:29inequity within inequity.
49:31It's like a matrix, like, you know.
49:34So another question,
49:35I'd love to hear your thoughts on this.
49:37It's from Darren.
49:38Now that the Supreme Court has
49:40said race and ethnicity cannot
49:42be used in admission discussions,
49:44do you think they'll be more
49:47examining our SES and thinking
49:50about that with greater concern?
49:53I I think that I think there will
49:56be more attention paid to that.
49:58But I also caution that though there's
50:00an overlap, there's no it is not.
50:02It's not a perfect surrogate
50:04marker when it comes to race.
50:07So you could have.
50:10I definitely agree that both.
50:12So it's a it's not a 0 sum game.
50:14I think it's the the pie
50:16should be larger overall.
50:18What you find is that yes,
50:20people will start to look at SES
50:23parameters because unfortunately most
50:25SES lower SES families are also minority
50:27families or first generation families.
50:30So yes, that is an important
50:31metric to look at,
50:32but following the SCOTUS
50:34decision it is still.
50:36First of all,
50:37the decision does not have any impact
50:39for outreach currently and recruitment,
50:41recruitment efforts and
50:43additionally the SCOTUS decision
50:48it. It does not preclude obviously
50:52as everyone knows integrating,
50:55what attributes in individual's
50:58applicancy contributes to
51:00their overall lived experience.
51:01And of course it's
51:03impossible to separate race,
51:05socio, economic status,
51:06zip code from your overall,
51:12from you or your identity.
51:14So, but yes, I think Darren,
51:15there will be much more
51:16attention paid to that.
51:17But I just cautioned that it shouldn't
51:19just be a simple substitute.
51:21It's very complicated.
51:22It's very nuanced and we just have
51:25to keep making the effort to make
51:27sure that our inclusive strategy is
51:30as inclusive as possible and that
51:32we keep checking for the nuances
51:34of inequities within all all the
51:36strata that we are working on.
51:43Thank you. Other questions,
51:44I think we have time for one more
51:46and Please note that we have the
51:48evaluation which just takes a minute
51:50so you can even start doing it.
51:52It's really important for us to
51:54get your feedback so you can go
51:56into the chat and pick that up if
51:58there's any last couple of questions.
52:07And one thing I'm hoping for is
52:09that we get more and more data
52:12on on on clinical outcomes,
52:14on population impact of diversifying
52:17the healthcare workforce because
52:18so it moves from this qualitative
52:21metrics or outcomes or experience
52:24or quality and access to actually
52:28finding out that you know we
52:30actually impact life expectancy,
52:33mortality rates etcetera.
52:36And then we have Natasha has
52:38a important question for us.
52:40Are there any data on
52:42inter ethnic disparities,
52:43for example the black immigrants
52:46from Africa or Caribbean versus
52:49American descendants of slaves?
52:53OK, thank you for the question. So
52:57one thing that's unique to all the data
53:00presented and anywhere you get data
53:02on URM participants or or trainees,
53:06the data that I quote is restricted to
53:09the AAMC only reports demographic data on
53:14American citizens and green card holders.
53:18And as you all know the US census groups and
53:22most places that collect demographic data,
53:26it doesn't go granular.
53:28Like for instance if you check the box Asian,
53:31there are at least 31 nationalities
53:33cultures that could be Asian,
53:35if you check the box black or African
53:37American, you could be African,
53:38you could be African,
53:39multi generational, black American,
53:41you could be Caribbean and
53:42so on and so forth.
53:44So I don't think the data exists
53:47to at such a granular level.
53:51Is there some,
53:54Is there some angst or disagreements or
53:58discordance within all racial groups?
54:01I'm sure there are about how to
54:02capture it and what to make of it.
54:04It's, for now, remains unknown.
54:09I'm sure we're going to
54:10have people working on it.
54:11Well, please fill out the eval.
54:13And I really thank you, Ben,
54:15for this wonderful work and
54:17contributing to Yale and I'm
54:19thrilled that you're here.
54:20I'm sure we'll have many more discussions.
54:22Patrick has a big thumbs up also.
54:24So really appreciate everyone's time.
54:27Thank you very much.
54:28And just a reminder that equity
54:30begins with everyone. Thank you,
54:33Janet. Shelly has her hand raised.
54:36I don't know if there's time
54:38to address another quick.
54:39Oh, wait, I just meant to do that.
54:40Claps. I'm sorry, Ben.
54:42You are fantastic. Ben.
54:44Just wanted to acknowledge that.
54:45Sorry, I'll lower my hand. No worries.
54:48No worries. Great. Thank you.
54:53So are we staying? We're
54:54staying on. Right. OK. Yeah.