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New Distinction Pathway Focuses on Health Disparities, Racism, Bias

July 01, 2021
by Julie Parry

The new Race, Bias, and Advocacy in Medicine (RBAM) Distinction Pathway officially launches for the 2021 fall semester. Interested residents should apply for the two-year program in the fall of their PGY-2 year.

Created by former chief residents Jana Christian, MD, and Rachel Schrier, MD, the new pathway offers residents a rigorous and comprehensive curriculum, arming them with tools to understand, combat, and reflect on racism and structural / cultural bias experienced through the healthcare system, medical education, and physician practice. Residents will partner with the greater New Haven community to better understand disparities in access, intensity, and quality of healthcare and improve healthcare delivery.

Christian recalled the origination of the pathway as part of her April 22, 2021 Medical Grand Rounds. She shared the devastation and outrage she felt after the murder of George Floyd in Minnesota. “And with George Floyd and the horror of that video, it felt like enough was enough. And so over the summer of 2020, my co-chiefs and I attended protests, spoke openly with each other about race and racism, and brainstormed together about what we could do to contribute to being anti-racists and bringing these principles into the medical sphere. And what I wanted so desperately was to create a space for our residents to discuss, process, and develop an understanding of the pervasive nature of racism and bias, and brainstorm ways to combat it as physicians. So I led a working group of dedicated residents, interested in talking about racism in our own medical system, education, and practice. And my co-chiefs and I met with experts on race and medicine throughout our own department and in other departments throughout our medical center,” she explained. Watch her Medical Grand Rounds on the website.

Christian, and four other residents approached Department Chair Gary V. Desir, MD; Associate Chair for Diversity, Equity, and Inclusion Inginia Genao, MD, FACP; Traditional Residency Program Director Mark D. Siegel, MD; and others, and were given full support, which led to the creation of RBAM.

“Jana and other residents reaching out to Dr. [Gary] Desir and I with the excellent idea of a distinction pathway on anti-racism is music to our ears and undoubtedly have our full support,” said Genao. “With the support of Dr. [Vincent] Quagliarello, the resources were made available and restructured to benefit not only RBAM, but all the distinction pathways in our residency programs. We are thrilled to see our future physicians leading the way to break the cycle of racism and other forms of discrimination.”

Aba Black, MD, MHS, assistant professor (general medicine); and vice chief for diversity & inclusion (general medicine) will serve as co-director of RBAM. She met with the residents early in the process and helped frame the coursework.

“I have a background in Sociology and African-American studies, so I tend to think about things in that framework, and so we chatted about some ideas for moving forward, people to get involved, and how to move forward with leadership to make sure that this is something that sticks,” said Black. “But this was the chiefs' initiative, and they did a lot of great work talking to a lot of key players in our department at the institution to make sure that this is something that can work.”

“The overarching goal is to engage a select group of residents more deeply in issues surrounding diversity, equity and inclusion. I always think of these issues in a number of different ways; there's certainly direct community engagement. One of the goals is to enhance our awareness of issues at pertain to the greater New Haven community. And then thinking about some of the larger social injustices that exist, whether we are thinking about the criminal justice system, education, healthcare. There are a number of different ways that we can take those issues and then intersect them with race and identity,” Black continued.

Stephen Holt, MD, MS, FACP, co-director, was a founder and core faculty member for the Clinician Educator Distinction Pathway and felt compelled to participate in RBAM.

“I wanted to be a part of something new, something that was forward-thinking, and something that I felt I could contribute in some meaningful way, simply by virtue of the fact that I had run a distinction for seven years, and so I know the like the mechanics of it,” said Holt. “And Aba, who I have been an admirer of since she arrived as an intern seven or so years ago, was going be the faculty lead for this? I was compelled to send her and Inginia [Genao] an email saying that I wanted to help out.”

Christian, Schrier, and their fellow chief residents outlined how credits would be earned, and what didactics would be available for learners. Five department faculty members have signed on thus far, and the curriculum is being outlined for the fall 2021 start. Resident leaders for the pathway are Ashley Demory, MD; Zina Huxley-Reicher, MD; Raksha Madhavan, MD; and William Santiago, MD.

“This pathway will provide a highly visible and sustainable infrastructure by which our residents can discuss and unpack issues of race, racism, and bias, especially as it interacts with our own healthcare system,” said Christian.

While Christian has returned to her home state of Maryland to work as a hospitalist at The Johns Hopkins Hospital, she was impressed with Yale School of Medicine’s commitment to the project. “It’s been a privilege to be able to see an idea come to fruition as something that has been embraced by a full Internal Medicine Department at your institution, that feels amazing. It says a lot about Yale as an institution, that they are so willing to listen to good ideas, and willing to then put resources in a good idea too. The fact that our leadership, Dr. Genao and Dr. Desir, were so quick and eager, and followed through on their statements, so they would support us with resources, it's just incredibly meaningful, because that is what will allow it to be sustained,” she said.

RBAM is the fifth Distinction Pathway available within the Department of Internal Medicine. Learn more about the core pillars and requirements on their website. Other pathways include Clinician Educator; Global Health & Equity; Investigation; and Quality Improvement & Physician Leadership.

The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.

Submitted by Julie Parry on June 30, 2021