Pathology Grand Rounds: April 20, 2023 - Alisha D. Ware, MD
April 26, 2023Information
Using Holistic Review and Other Strategies to Promote Diversity, Equity and Inclusion in Pathology - Alisha D. Ware, MD
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- 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&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.