As the summer season of 2020 peaked, amidst a swelling pandemic and the murder of George Floyd, a team of physicians and staff within the Yale Department of Internal Medicine’s Section of Infectious Diseases banded together with university historians and experts from the Poorvu Center for Teaching and Learning to create a space to address diversity, equity, and anti-racism. Initially spearheaded by Lydia Aoun-Barakat, MD, associate professor of medicine (infectious diseases), and Gerald Friedland, MD, professor emeritus (infectious diseases), the section established the Infectious Diseases Diversity, Equity, and Antiracism (ID2EA) consortium, which aims to address systemic racism, promote diversity, and promote equity within the infectious disease space both at Yale and beyond via interactive learning sessions.
Marjorie Golden, MD, associate professor of clinical medicine (infectious diseases), points to an article in the New Haven Register as an important initial impetus for the creation of ID2EA. In his article, James Walker, a freelance columnist who is Black, describes how negative interactions with medical professionals led him to be skeptical about receiving the COVID-19 vaccine. Walker was later invited to speak as a community panelist for an ID2EA session.
Golden states, “It was very disheartening to see that this was the message being carried in the community. It made us realize that there was a lot of work we had to do within our section to understand issues of racism. Quickly, the interest ballooned from faculty to trainees.”
The motivated group, comprising primarily faculty from Yale’s Section of Infectious Diseases, banded together and focused on diversity, equity, and inclusion initiatives for the section.
“We were driven by the fact that many of our patients in infectious diseases face significant health disparities,” states Jaimie Meyer, MD, associate professor of medicine (infectious diseases), Yale School of Medicine, and public health (chronic disease epidemiology), Yale School of Public Health. “We take care of patients with HIV, substance use disorders, social barriers to health, structural barriers to care. It was our goal to leverage our collective expertise and transform the culture of the section, from the inside-out.”
Development of Curriculum
Following a needs assessment, the program morphed into a curriculum for professional development within the section. The team designed a dynamic roadmap, a path towards a culture shift within the section. As of December 2022, there have been eleven “roadmap stops,” detailing topics from medical experimentation, geographic racism, medical mistrust, COVID-19 and the Latinx population, transgender experiences within the medical system, and the gender tax.
Over time, these initial stand-alone sessions have become integrated into the infectious disease training curriculum and the usual schedule of section activities.
Golden states, “One of the most tangible things that has changed is that now, in our weekly case conferences, our fellows incorporate a slide on the social determinants of health related to their presentation topics. We have seen them pull in social determinants of health in the journal clubs as well. We can really see that our trainees are paying attention to this.”
Shifting the Culture From Within
Further culture shifts within the section have become apparent. Within the fellowship recruitment process, for example, there is a greater push to recruit a diverse set of trainees. Factors that were previously not considered, such as socioeconomic or personal “distance traveled” to medicine, are now being carefully evaluated in the recruitment process.
“We have learned that our colleagues are also going through many issues that are paralleled in the community, despite the white coat, despite the attending title,” states Meyer, “People experience racism, sexism, discrimination, and misogyny in our workplace. We need to be able to talk about these issues with transparency and do something about them.”
With Golden and Meyer now serving as co-chairs, and in partnership with Mahalia Desruisseaux, MD, as the section’s DEI vice chief, the ID2EA curriculum continues to develop with ever-growing momentum. Future sessions are planned for spring and include a presentation on medication cost as a barrier to healthcare access and a discussion on experiences of the Asian American and Pacific Islander community. In addition to presenting the ID2EA experience at national conferences and publicizing them in academic journals, the group is undergoing digitization of their work in order to further disseminate this knowledge. They are looking for more ways to engage community members to understand their experiences within the healthcare system, and are in the process of forming a community advisory board.
Golden states, “People are really hungry for concrete ideas for how to change their behavior.” The team continues to develop curriculum content for those interested in learning more. For more information, visit the ID2EA website.
The Department of Internal Medicine’s Section of Infectious Diseases engages in comprehensive and innovative patient care, research, and educational activities for a broad range of infectious diseases. Learn more at Infectious Diseases.