Yale Psychiatry Grand Rounds: September 22, 2023

Transcript

• 00:00For this,
• 00:03for the kind introduction,
• 00:05it's a real honor to be here and
• 00:07to get to talk to all of you.
• 00:09I'm sorry I can't be there in person,
• 00:12but I'm delighted to see it.
• 00:13So many of your faces here on the screen
• 00:16as well as in that room over there also.
• 00:20So I'm going to share my
• 00:22screen now and bear with me.
• 00:24OK, so folks can see that.
• 00:28Yes, Okay. All right, excellent.
• 00:31So I'm going to get started.
• 00:32So as Doctor Diaz told you all,
• 00:35I'm going to be talking about
• 00:37the UCSF Arches program,
• 00:39which is advancing the research careers
• 00:40of historically excluded scholars.
• 00:42This is actually a program across
• 00:44all of the University of California,
• 00:45San Francisco,
• 00:46which is a Health Sciences university.
• 00:48But to set the stage,
• 00:50I'm going to be giving you some
• 00:52background about other work that I've
• 00:54done in addition to the Arches program.
• 00:58So I want to make it very clear
• 01:00that the work that I'm going to be
• 01:02discussing today is not just mine,
• 01:04It's the work of many, many others.
• 01:06It's possible through strong collaborations
• 01:08and partnerships with dedicated faculty,
• 01:11trainees,
• 01:11and staff inside of UCSF and outside UCSF.
• 01:15I've been mentored and mentored others
• 01:18and have received a lot of sponsorship
• 01:21and tried to sponsor others as well.
• 01:23This over here is kind of shows
• 01:25you a little bit about how I see
• 01:28some of the research that I do.
• 01:29So one of my mentors and somebody
• 01:31who I really admire a lot is
• 01:34Kirsten Bibbins Domingo.
• 01:35She was on faculty here at UCSF and
• 01:37is now the editor in chief at JAMA.
• 01:39And she taught me that,
• 01:41you know,
• 01:42scientists create the stones
• 01:44for policymakers to throw.
• 01:47And so I like shining spotlights on
• 01:49areas of growth within academic medicine.
• 01:52I create a stone and then I
• 01:54hope to create some ripples in
• 01:56the system to promote equity.
• 01:57I'm hoping today I give you all
• 02:01some ideas and some pearls to make
• 02:04changes in the university and and
• 02:06you're setting or nationally that you
• 02:08think are necessary to make it a more
• 02:11equitable climate for all of us so
• 02:13we can do the best work that we can.
• 02:15Some disclosures.
• 02:16So here are my financial disclosures
• 02:18and some of the people that I admire.
• 02:21I'd be remiss during Hispanic
• 02:23Heritage Month not to disclose
• 02:25some part of my identity.
• 02:27So from my last name,
• 02:28many of you probably think I'm
• 02:30Armenian and I am 1/4 Armenian.
• 02:33I'm also 1/4 daughter of
• 02:35the American Revolution.
• 02:36But the biggest part of me or the
• 02:39part that I identify the most
• 02:41with is related to my mother.
• 02:43My mother's from Ecuador.
• 02:44She's an immigrant from Ecuador.
• 02:45My father was a my grandfather
• 02:48was a physician there.
• 02:49And I love these two.
• 02:51I'm an only child and my parents
• 02:55and my other now family,
• 02:57my husband and child children
• 03:00mean the world to me.
• 03:01So.
• 03:01But this is part,
• 03:02a big part of my identity.
• 03:05All right, So today, today,
• 03:07we're going to be just,
• 03:08I'm going to be describing some of
• 03:10the problem related to diversity and
• 03:13research faculty and academic medicine
• 03:14to get us all on the same page.
• 03:17Some of you know a lot about
• 03:18this information, some know less.
• 03:20I'm going to be going through
• 03:23some of this relatively quickly,
• 03:25but I'm providing you with some QR codes
• 03:28so if you're interested in some of it,
• 03:31you can take pictures and afterwards I'm
• 03:33happy to make these slides available to you.
• 03:37I'm also going to including
• 03:39these national reports.
• 03:40Then I'm going to go over the arches
• 03:42program itself as well as some
• 03:44work that I did when I was in the
• 03:46Department of Psychiatry as the Vice
• 03:47Chair for Diversity and HealthEquity.
• 03:49And then I want to leave with each
• 03:53of you having a future direction
• 03:56that you could take or action item
• 03:58that you can take in your space.
• 04:00So that's that's really the wish that I have.
• 04:02I hope that some of you listen to
• 04:05what I'm saying and think, oh,
• 04:07I could do that part of it or that
• 04:09part really resonates with me.
• 04:11Now,
• 04:11something that's been hard for all
• 04:13of us in academic medicine has been
• 04:15the recent recent Supreme Court
• 04:17decision about affirmative action.
• 04:19And these are some statements that
• 04:21we've had as part of the Arches program.
• 04:23And I'm sure Yale has similar
• 04:27statements that it's made about
• 04:29the dedication to diversity,
• 04:30equity and inclusion.
• 04:31I will highlight this article
• 04:33that a colleague of mine scholar,
• 04:36a legal scholar at UC Law San Francisco,
• 04:40Joan Williams, wrote.
• 04:41And it has some information,
• 04:44really important information,
• 04:46about how it doesn't make our work illegal.
• 04:49Especially out here in California
• 04:51where we've been dealing with
• 04:53Proposition 209 prohibiting affirmative
• 04:54action for many years.
• 04:56And it's really continue doing what
• 04:59we're doing to make our climate
• 05:01more diverse so that we do the
• 05:04best science we can possibly do,
• 05:06deliver the best education,
• 05:08deliver the best clinical care
• 05:10and make our communities healthy.
• 05:14So here's where I'm going to frame some
• 05:16of the problem and tell you some of
• 05:18the work that I and others have done.
• 05:20This first slide should be a
• 05:22little bit of a tongue in cheek
• 05:24now this was in the
• 05:27BMGA Christmas issue.
• 05:28Can I see a raise of hands for folks
• 05:31who know the Christmas issue A/B, MJ?
• 05:34It's kind of a funny issue.
• 05:36And so a colleague of mine, Eleni Linos,
• 05:40who's at Stanford did this where
• 05:43she she looked at a cross-sectional
• 05:46study of School of Medicine chairs
• 05:48at the top 50 NIH funded institution.
• 05:51And she found that there were more
• 05:55mustaches than there were women
• 05:58at the institution is chairs.
• 06:01So it's tongue in cheek.
• 06:02But it told, you know, and it says, you know,
• 06:04maybe women should consider having mustaches.
• 06:07You know, maybe that will increase
• 06:08their likelihood of becoming chairs.
• 06:09It's tongue in cheek.
• 06:10But what it did was kind of highlight we
• 06:13got a problem, you know, what can we do?
• 06:15What can we do about this?
• 06:17And then you look at Deans.
• 06:19Now this is from the AM C you'll see
• 06:22the data here. This is by gender.
• 06:25These are the men.
• 06:27This is by URIM versus non URIM status.
• 06:31This is non URIM.
• 06:33As you can see there's not equity
• 06:36in terms of by gender yet and the
• 06:40portion that are URIM is low.
• 06:43Now a colleague of of mine and
• 06:46I wrote about this and we did a
• 06:49very simple graph showing, OK,
• 06:52well we're we're making some inroads.
• 06:55You know what would happen if we project out.
• 06:58So this is years in the X axis
• 07:00and this is the percent women,
• 07:03this is 1966, this is 2070.
• 07:06If we continue,
• 07:07these are the orange or the
• 07:10Deans and the blue is the chairs.
• 07:13If we keep doing what we're doing,
• 07:14this is great, right?
• 07:16We're going up. This is awesome.
• 07:18It's not going to achieve equity until 2070.
• 07:23That's not in my my career lifespan.
• 07:27It might not be till the end
• 07:29of my daughter's lifespan,
• 07:30You know, her career lifespan.
• 07:33This isn't good enough.
• 07:34I think we can all agree.
• 07:36Now with Hispanic Heritage Month,
• 07:39You know,
• 07:40I'm going to talk about what
• 07:42about Latinx faculty.
• 07:43There's actually not data available about
• 07:45this issue right now at the Dean's level.
• 07:48I think many of you know that despite
• 07:50the fact that the Hispanic population
• 07:52in the United States is growing,
• 07:5418% of the population,
• 07:56less than 7% are active physicians.
• 07:59And when you drill down and look at
• 08:02physicians like me or Esperanza,
• 08:04we're part of the coveted 2%,
• 08:07right, only 2% of the US physician
• 08:11population or Latina women.
• 08:13I'll get back into this in a few.
• 08:16Now I'm going to get into some
• 08:19of the reports.
• 08:21OK, This is again just level setting.
• 08:23So the National Academies of Science,
• 08:25Engineering and Medicine have produced
• 08:27multiple reports and I'll notice the time.
• 08:31So back in 2011 they started and
• 08:33there's been reports every year.
• 08:35So you know,
• 08:36almost every year since 2020
• 08:38I'll get into each of these,
• 08:40but there's excellent work about
• 08:43expanding underrepresented minority
• 08:45participation is for women the
• 08:48impact of COVID anti racism.
• 08:50A AM C has similar reports.
• 08:54If you can see here,
• 08:55what they've been really focused on
• 08:58recently is really on salary equity
• 09:01and based on gender as well as race
• 09:06ethnicity and looking at salary equity
• 09:09among medical student leadership.
• 09:11I'll say that at UCSF and I'm
• 09:13sure at Yale has a similar thing.
• 09:14We conduct A faculty salary
• 09:17equity review every year.
• 09:19My office is now responsible for a part,
• 09:22for a large part,
• 09:24of that review in the School of Medicine
• 09:26and we're adding in an evaluation of
• 09:29URM women into our evaluation to see
• 09:31whether there's disparities in that.
• 09:34And so really the devil's in the
• 09:36details here and it's it's challenging,
• 09:38but it's important for all of us
• 09:41to achieve equity in compensation.
• 09:45So again,
• 09:46this is the part where I said
• 09:47I was going to show you a lot
• 09:49of these reports with QR codes.
• 09:51You can take some pictures of this.
• 09:52I'll send this to you.
• 09:54This is mostly to say that this
• 09:56problem has been going on for a while.
• 09:59The National Academies of Sciences
• 10:01has been thinking about this
• 10:03of the under representation of
• 10:05historically excluded faculty in STEM.
• 10:09There are.
• 10:10They kind of describe promising
• 10:13practices for women in medicine
• 10:17and sciences and engineering,
• 10:19and actually they kind of show
• 10:22these sad photographs or graphs.
• 10:25Here is looking at Biological Sciences,
• 10:29physical sciences, computer science,
• 10:32engineering, math and chemistry.
• 10:34And this is the representation
• 10:36of women compared to men.
• 10:38And the, you know,
• 10:40you just look at this goes down as
• 10:43people advance in their careers.
• 10:45I'm sure the data is similar at Yale.
• 10:48It's at UCSF, it's it's everywhere.
• 10:53They have several recommendations
• 10:55to deal with this.
• 10:57A lot of this are for those
• 11:00implementation scientists out there.
• 11:02I'm an implementation scientist.
• 11:04It requires top leadership support.
• 11:06These are these are kind of key factors
• 11:08to implement programs and have and happen.
• 11:11Top leadership support dedicated financial
• 11:13and human resources to this issue.
• 11:16Often equity and diversity are
• 11:20underfunded or are issues that
• 11:23people expect are going to get done,
• 11:24just as the kindness of people's
• 11:28hearts are and that it needs money.
• 11:31You need to really have a deep
• 11:34understanding of the context of
• 11:35the university and then data
• 11:37collection and really adopting an
• 11:39intersectional approach is important.
• 11:41And so this was back in 2020.
• 11:42This was part of NASA.
• 11:45NASIM also has put out several
• 11:49reports about COVID-19,
• 11:50the impact on the careers and women
• 11:53and their academic productivity,
• 11:56work, life balance,
• 11:58mental health and wellbeing.
• 12:00I was part of the UCSF effort to
• 12:04promote wellbeing of our people
• 12:08that you see us have during COVID-19
• 12:10and I know that this hadn't a
• 12:13real impact on everybody.
• 12:14I'm sure everybody here
• 12:16knows and felt that as well.
• 12:18And the challenges with the pandemic
• 12:21that continue to this day because
• 12:23we're not over with with it quite yet,
• 12:26The effects of COVID on on
• 12:28effectiveness of women,
• 12:30they have these different graphs.
• 12:32These are just showing the same things
• 12:34that negative impacts that it's had on women,
• 12:39the challenges related to child care at home.
• 12:43There's been a lot of data on the
• 12:45amount of work that women do both
• 12:48office housework and more work doing
• 12:51domestic activities still to this day.
• 12:54And this includes, you know, women,
• 12:57faculty, trainees, and staff.
• 13:02And then Nassim also created
• 13:04a really important report as
• 13:06well on advancing anti racism,
• 13:09diversity, equity and inclusion.
• 13:12Again, they talk about, you know,
• 13:15how racism impedes careers and come up
• 13:18with important guidelines for doing this.
• 13:21So I urge you all to look into some
• 13:23of these if you haven't already.
• 13:25I imagine many of your leaders have already
• 13:27looked at these really important pieces.
• 13:32These are the ones that are from
• 13:34the AM C Again, as I mentioned,
• 13:36a lot of these are on salary equity,
• 13:39so here's some of the QR codes.
• 13:41Here again, same story over and over again.
• 13:46Women are earning less than
• 13:49men and room for improvement.
• 13:51This is talking about how you really
• 13:54need salary equity to attract and retain
• 13:57faculty and how how important that is.
• 14:02And then this actually was
• 14:04looking even among leadership.
• 14:06And I I did a publication on
• 14:09this with Michael Mensa looking
• 14:11at public medical school chairs.
• 14:15And even among public medical school chairs,
• 14:18there were gender disparities in
• 14:21compensation between men and women.
• 14:26I'm really proud of the work that's done
• 14:28by the AM CG Women's Steering Committee.
• 14:30This is a group on women in
• 14:32medicine and sciences.
• 14:33I actually have the honor of being on that
• 14:36steering committee as of late last year.
• 14:39This is led by Amy Gottlieb who
• 14:42is a scholar in compensation and
• 14:45academic medicine is now taking the
• 14:49role in faculty affairs at USC.
• 14:52They have developed a lot of really
• 14:55important toolkits through the
• 14:57AM C and issues related to women
• 14:59that you could should check out.
• 15:01I think something that I touched on
• 15:04very briefly was intersectionality
• 15:06and they actually,
• 15:07the AM C has a women of faculty of
• 15:10color toolkits that are I think,
• 15:13interesting for folks to look at that
• 15:15again have strategies for what you can do.
• 15:19I wrote a piece with some of my colleagues
• 15:22and many of you may know Carolyn Rodriguez.
• 15:25She's actually one of my best friends.
• 15:28We went to Columbia together
• 15:30and she's now at Stanford.
• 15:31She's an associate Dean for faculty
• 15:34and academic affairs in Stanford.
• 15:36And we wrote a commentary to that
• 15:38piece that I was talking about before
• 15:40by Doctor Ayana about the fact that
• 15:43only 2.4% of US physicians are Latina.
• 15:47Again said the same thing that I've
• 15:48been repeating over and over again
• 15:50about the bias of discrimination.
• 15:52You know that there are
• 15:54structural barriers in place,
• 15:55but what are our recommendations?
• 15:57Our recommendations are really increasing
• 15:59leadership opportunities for women of color.
• 16:02I think institutions to start thinking about
• 16:05centering their efforts on women of color,
• 16:07meaning looking at all their policies
• 16:10and procedures through that lens about
• 16:13how that might impact those people,
• 16:15those individuals.
• 16:15And if you do that,
• 16:17it actually lifts everybody.
• 16:20I think there's importance
• 16:21to reducing isolation,
• 16:22building community and of course
• 16:25data-driven accountability.
• 16:28Another portion of in our part of
• 16:31intersectionality that we don't
• 16:33talk about a lot is caregiving.
• 16:36Now, I think we talked about caregiving
• 16:39in terms of women having babies,
• 16:42right.
• 16:42And UCSF,
• 16:43and I'll give some data
• 16:45about what I've done here.
• 16:46UCSF has made great strides and increasing
• 16:49the amount of paid family leave for anybody,
• 16:52regardless of gender to 12 weeks paid leave.
• 16:55And so we think a lot about how
• 16:57are we going to support people,
• 16:59you know, people having children.
• 17:00But we don't talk a lot about is that
• 17:03a lot of people are also taking care
• 17:06of ill family members and many of your
• 17:09faculty as they advanced in their careers,
• 17:12especially the women faculty are
• 17:15taking care of elderly parents.
• 17:17This is coming up more and more.
• 17:20And so I was very,
• 17:21very pleased that NASIM has started
• 17:24a a work group on supporting family
• 17:27caregivers working in science,
• 17:28engineering and medicine.
• 17:29And I was very,
• 17:30very honored to be the inaugural speaker,
• 17:33talking about my experiences not only
• 17:35with my father, who now has Alzheimer's.
• 17:37I showed you his picture earlier.
• 17:39I'm an only child.
• 17:41This does fall on me.
• 17:43But also when even before that,
• 17:45my, my youngest son,
• 17:46who's now very healthy,
• 17:48had a very serious medical condition,
• 17:51required a bone marrow transplant
• 17:53when he was a baby.
• 17:54That was part of my that was
• 17:56something that happened in my life.
• 17:58Women that are in our,
• 18:00that are in our society tend to provide
• 18:03more of these kinds of caregiving needs,
• 18:05not only at the workplace where you're
• 18:07caring for our patients and maybe even
• 18:10the other people within the institution,
• 18:12but you're also at home caring for the
• 18:14family, including when they're sick.
• 18:17So I've given you a lot of kind
• 18:20of depressing information, right?
• 18:21Like, Oh my gosh, you know,
• 18:24here there's so much,
• 18:25so many problems.
• 18:26Sometimes it can feel hard to
• 18:29figure out what can I do,
• 18:32especially what can I do as an individual.
• 18:33This is too overwhelming, right?
• 18:36So I'm going to give you some stories.
• 18:37I'm going to show you some
• 18:39things that I've done and again,
• 18:41some things that you can hopefully pick up
• 18:44and take with you to try to do as you move,
• 18:47you know, in your institution or your
• 18:48little sphere of influence, right.
• 18:51So I'm showing part of a talk that I gave
• 18:54where I become the inaugural Vicechair
• 18:57for diversity and HealthEquity in the
• 18:59Department of Psychiatry from 2015 to 2022.
• 19:02So I'm going to tell you about some
• 19:04of the things that I did in that role.
• 19:07So and I'm looking at John.
• 19:09John, you may recognize this
• 19:10guy up here on the left.
• 19:11This is Andy Crystal,
• 19:13his brother who is the vice
• 19:15chair for research here who
• 19:16is an active partner with me.
• 19:18So something that I did was I focused
• 19:22on women faculty and increasing
• 19:25and advancing women faculty.
• 19:27So I was very much,
• 19:29because I'm a scientist, focus on the data.
• 19:32So I targeted our advancement strategy.
• 19:36I looked at our how we go about
• 19:38in our search committees,
• 19:40what we do in an appointment and advancement,
• 19:45how we're moving people forward.
• 19:47I actually would write the
• 19:49division chiefs to say hey so and
• 19:51so's an associate professor.
• 19:53Have you thought about them going up
• 19:55for full professor what are you doing?
• 19:57And I have some pretty impressive outcomes.
• 20:01We went up for an increase in our
• 20:04full professors from 30 to 50%.
• 20:05We increased our overall women faculty
• 20:08in the department up to close to 58%,
• 20:11which is higher than the AM CI can
• 20:14talk about specific strategies
• 20:15that we did to do this.
• 20:16I created Mom Pods during the
• 20:19pandemic to help some people who
• 20:22felt isolated be together.
• 20:23I'd actually created groups of
• 20:27women earlier in my career when
• 20:29I was an assistant professor.
• 20:30I'd gone to the AM C Early Career
• 20:33Workshop for women and I noticed
• 20:35that I learned a lot from my peers.
• 20:37And so I just created a women's
• 20:39group and it's going on to this day,
• 20:41and they have all sorts of different events.
• 20:44It was called warm hearts and this was
• 20:46I I think these peer groups are very
• 20:49important to reduce isolation and also
• 20:52can be really advocates for change.
• 20:55And so I encourage you all to
• 20:58think about community building.
• 21:00I had some listening tours.
• 21:01I developed reports, I focused on research.
• 21:06So I was fortunate with Christine
• 21:09Yaffe to get one of the Doris Duke
• 21:11funds to retain clinical scientists.
• 21:13This was funds to actually give small
• 21:16grants to informal caregivers like I
• 21:20mentioned to fact to research faculty
• 21:22who were caring for ill loved ones.
• 21:24I believe GAIL has one of these doors
• 21:27to FRCS grants, grant mechanisms.
• 21:30I created a URM Research Mentorship Award.
• 21:34We created a gender equity work in progress.
• 21:38We were looking at the data in
• 21:40our department.
• 21:41We created several high impact papers
• 21:45and I also created a mid career
• 21:48program across the university.
• 21:50This is Kirsten, this is me.
• 21:51These are our three first fellows.
• 21:53And so I felt like there was
• 21:55a gap in providing mentorship
• 21:57and support for our mentors.
• 21:59So created this program for extraordinary
• 22:02mentors at UCSF and they actually
• 22:05get some funding and a sponsorship
• 22:08and mentorship from us through this.
• 22:11I mentioned the family leave.
• 22:13I'm really proud of this work that I did.
• 22:16And you see my chair here,
• 22:17Matt, Matt Gold, Matt State,
• 22:20as well as Brian and his who's who's
• 22:22from Yale, as many of you know,
• 22:24a friend of many and Brian Aldridge.
• 22:27And I remember Matt saying to me, hey,
• 22:29let let's, let's let's do this together.
• 22:31We should, we should increase our paid leave.
• 22:33And then I spoke to Brian Aldridge and he
• 22:35said, you know what would really help me?
• 22:37Brian Aldridge is our vice Provost.
• 22:39He said, you know,
• 22:40if you collected data on all on some of
• 22:43our peer institutions and their family leave.
• 22:46So I collected this data and
• 22:48then I published on this data.
• 22:51So this is something that I suggest to
• 22:53those of you who are doing diversity work.
• 22:56Make sure you're publishing some
• 22:58of your work so that the work gets
• 23:02gets out to others to try to use,
• 23:05but also advances your career.
• 23:07So I certainly suggest publishing the work.
• 23:09So I published the work kind of
• 23:11against shining the spotlight.
• 23:13There's a gap in our paid lead
• 23:15policies at the leading institutions.
• 23:17I looked at that UCSF expanded
• 23:19to after after that piece,
• 23:21along with decades of work by others.
• 23:24This is kind of the last straw on it
• 23:26And because of really strong leaders,
• 23:28we were able to get 12 weeks of
• 23:31paid leave from a CGME and A/B Ms.
• 23:33thanks to Kirsten here,
• 23:35we were able to actually increase based
• 23:37on some of our data looking at residents
• 23:40increase resident paid leave to six weeks,
• 23:42now I wanted 12.
• 23:43You can look at some of the pieces,
• 23:45a piece that we have in the New
• 23:47England Journal where there's talk of
• 23:4812 because I really want 12 weeks,
• 23:50but that's it's incremental steps
• 23:53are important and then there's been
• 23:56some really important policies that
• 23:58have been made on dependent care.
• 24:02I had a big focus on sponsorship.
• 24:04Now this is actually the wrong word,
• 24:06is the word we use in medicine is
• 24:09sponsorship and the business in business
• 24:12they use access to opportunities.
• 24:14I'm using sponsorship because more of,
• 24:15you know what sponsorship is.
• 24:17It's different from mentorship.
• 24:19It's when somebody's talking about you
• 24:22in high settings and also in a position
• 24:24of power to actually be able to give you
• 24:27resources or give you access to people.
• 24:29And so I focused a lot on sponsorship
• 24:32and in getting people into the
• 24:34right rooms and getting them awards
• 24:37to increase their visibility and
• 24:39increase their access to funds.
• 24:41And so I I definitely put up many
• 24:44individuals for Chancellor awards.
• 24:46Watson Fellows,
• 24:46which is at UCSF,
• 24:48gives $75,000 a year to this prestigious
• 24:50program and sponsor people for the
• 24:55SMMA. At the same time,
• 24:56I had been asked to be the chair of
• 24:59the Council of Minority Mental Health
• 25:01and Health Disparities in the APAI
• 25:04did some things I I brought people
• 25:06together on the two sides of the house.
• 25:08So I don't know how many
• 25:09of you know about the APA,
• 25:11but the APA has caucuses and
• 25:13then they have these councils.
• 25:15It's almost like the House of
• 25:17Representatives in the Senate.
• 25:19And they're not really supposed
• 25:20to always get together.
• 25:21And in this case,
• 25:23I was bringing folks together to
• 25:25formally so that we could attend to our
• 25:28shared goals to diversify our profession.
• 25:32I also created many APA position position
• 25:36statements and then had created this
• 25:39what's called Fierce sister could
• 25:42and this is a group of diversity
• 25:45leaders across psychiatry nationally.
• 25:48You'll recognize many of them
• 25:49including Ayanna Jordan who was
• 25:51there at Yale for many years and
• 25:53this group still meets to this day.
• 25:55We provide support to one another
• 25:58and the work that we do and and have
• 26:02written about our work including
• 26:04diversity leader guidelines in academic
• 26:07medicine that was published in a JP.
• 26:10Now for the main thing that I was the billing
• 26:14here was about the UCSF Arches program.
• 26:17So what is the Arches program?
• 26:21Okay the Arches is a career
• 26:24development program designed for the
• 26:26historically excluded research faculty.
• 26:29Recognizing the diversity is
• 26:31critical to institutional success
• 26:33and scientific progress.
• 26:35Now,
• 26:36historically excluded individuals are
• 26:38individuals who have historically
• 26:40faced discrimination,
• 26:42prejudice and systemic barriers that
• 26:44prevented them from achieving equal
• 26:46opportunities and access to resources.
• 26:48That's the definition that we used.
• 26:50Now this was stimulated by the 1st grant.
• 26:53Can I see a show of hands?
• 26:54How many people know what the first grant is?
• 26:58OKI see one of couple in the audience there.
• 27:00I don't see any in the OKA few in this.
• 27:03OK, great.
• 27:04OK, so a couple,
• 27:05but not many of you know about it.
• 27:07Oops, it took me forward. OK.
• 27:10So the first grant is an NIA.
• 27:13It was basically Hannah Valentine's baby.
• 27:15Hannah Valentine was the Chief
• 27:18diversity officer and NIH.
• 27:20And she created this award,
• 27:21which was a $20 million award to
• 27:24institutions to recruit faculty,
• 27:26diverse faculty to their institution.
• 27:28So every institution under the sun
• 27:30was applying for this because this
• 27:32was dollars to bring people in.
• 27:34UCSF applied as well.
• 27:36Now, UCSF history,
• 27:38we were applying with Dan Lowenstein,
• 27:40who was our Executive Vice
• 27:41Chancellor and Provost at the time,
• 27:43and Kirsten Bibbins Domingo,
• 27:44who was, as I mentioned before,
• 27:46she was the one of the vice teams for
• 27:49HealthEquity at UC or the inaugural
• 27:51vice team for HealthEquity at UCSF.
• 27:53So they were both the MPI's on the grants or,
• 27:58you know,
• 27:58work and work at UCSF that many
• 28:00of you may or may not know is,
• 28:02you know, we've had really impressive
• 28:04DEI efforts over the years.
• 28:05Yeah,
• 28:06Our climate survey still identifies gaps,
• 28:09making people feel like they belong.
• 28:11It's not Nirvana.
• 28:12There's lots and lots of opportunities still.
• 28:15We've written this grant intending to
• 28:19create institutional transformation and we
• 28:22did not receive the grant despite trying.
• 28:24But then we just were like we're
• 28:26just going to do this anyway.
• 28:27So we initially called it the first light
• 28:30program and it was built just you know
• 28:32about a year and a half ago in March,
• 28:34the end of March of 2022.
• 28:36So what have we done?
• 28:38So because and the reason why I was
• 28:39chosen in is I was the head of the
• 28:42faculty development core for the program.
• 28:43So I had built this the the grant,
• 28:47the, the section of the grant.
• 28:49And so I was going to be
• 28:52launching this program component.
• 28:55Now the team was very important to me that
• 29:00we had diversity in terms of not just gender,
• 29:04race, ethnicity, types of science,
• 29:07types of school,
• 29:08that we had the right people here.
• 29:11People often think of it as,
• 29:13you know, where their MD's and
• 29:15PHD's who who is at the table,
• 29:16do we have diversity and representation.
• 29:19We also had to have people who are able
• 29:21to be in the administrative assistants,
• 29:22the program manager.
• 29:23To help us run this,
• 29:25I created a group of advisors.
• 29:28So this is what I call
• 29:30the changemaker circle.
• 29:31So these are top senior leaders at the
• 29:35university who are also women of color.
• 29:37So wanted to have this group of leaders
• 29:41who could advise us as we move forward.
• 29:44I had continued to have advisors
• 29:47where we had an Advisory Board.
• 29:49So I put together the folks who are in,
• 29:52you know, this is the Vice Executive,
• 29:54Vice Chancellor and Provost.
• 29:56This is our Dean.
• 29:57This is the Vice Chancellor
• 29:58for diversity and outreach.
• 30:00This is the Associate Vice Chancellor
• 30:02for research in diversity.
• 30:04I was bringing together all the top
• 30:07leaders and had the sponsors and actually
• 30:09had other ad hoc advisors to guide the work.
• 30:12And many of you will recognize Kamara Jones,
• 30:14who's obviously an incredible
• 30:17scholar in this space.
• 30:20I also wanted to develop
• 30:22the target population.
• 30:24So you might not have heard it,
• 30:26but with the first grant,
• 30:27what they were focused on
• 30:29was bringing in individuals.
• 30:31So they wanted to bring in like
• 30:3312 people and dump all the
• 30:35resources into these 12 people.
• 30:38And that's important.
• 30:39I think it's important to bring
• 30:41people in like this and and various
• 30:44places including Sinai and Yu
• 30:46others have developed these cohorts,
• 30:48right that they bring in cohort
• 30:50models are incredible bringing in
• 30:52cohorts be together form a group.
• 30:54However,
• 30:54it leaves out the masses who
• 30:57are already there, right?
• 30:59And there's a lot more people
• 31:01who are already here.
• 31:03So rather than selecting a few faculty,
• 31:06recruits 12 we you know we have 3500 faculty,
• 31:09let's look at all UCSF historically excluded
• 31:13research faculty across all schools.
• 31:15That's our target.
• 31:17And So what our goal was,
• 31:19was to build activities in response
• 31:21to what our people
• 31:22said. They needed specific skills,
• 31:24sponsorship and community,
• 31:26and we would know we'd succeeded.
• 31:28I remember asking Kirsten and Dan about this.
• 31:30We know. So you succeeded.
• 31:32If people knew about the program,
• 31:34and I'll just tell you as a teaser,
• 31:36they definitely know about the program now.
• 31:39And now our next goal for this year is
• 31:41that people feel part of the program,
• 31:44feel like they're part of the program,
• 31:45not just and they trust the arches program.
• 31:48So here I'm going to tell you about
• 31:50building the different program components.
• 31:53As usual we've we've done a
• 31:55listening tour and talked to folks.
• 31:57We all also had our own experience
• 32:00as historically excluded faculty,
• 32:02but it came in in areas that were
• 32:05predictable, right We when people
• 32:07wanted community and mentorship,
• 32:10they wanted, you know,
• 32:11working to support, you know,
• 32:13needed advocacy from us and working
• 32:15to train all people regardless of
• 32:18where you were early to mid and senior
• 32:21folks and building infrastructure,
• 32:24they also wanted skills, right?
• 32:26So we wanted we developed an
• 32:28early career development program,
• 32:30program seminar series.
• 32:31So this we've had several of these,
• 32:34these are quarterly,
• 32:36we had a mentoring panel discussion,
• 32:39we had a discussion focused on your
• 32:42advancement and optimizing your CV
• 32:45because this is focused on research
• 32:48faculty and we define research
• 32:50broadly as any kind of scholarship.
• 32:52We talked about building your research team.
• 32:55And then the one that's been really
• 32:58concerning and important I think
• 33:00is how little a lot of the faculty
• 33:03knew about their finances and making
• 33:05sure that the that they understood
• 33:08the research support they should
• 33:10be getting from the institution
• 33:12and get some kind of finance 101.
• 33:14So that they really start looking
• 33:16at their budget status reports,
• 33:18understand those status reports,
• 33:19understand the projections so that
• 33:21they can manage their resources well.
• 33:23We also created online resources.
• 33:27I mentioned that I created this program.
• 33:30I brought this program into arches.
• 33:33This was our next group of faculty
• 33:35that we were able to recruit.
• 33:37Thanks to the Chan Zuckerberg Bio Hub,
• 33:41I was able to expand our group to four.
• 33:44We also have some funding from Genentech
• 33:47to get this work off the ground.
• 33:49And this is just a quote from one of
• 33:52the people who took the program and
• 33:54just how much it meant to them and
• 33:57how career changing it was for them.
• 34:01We, I said this before,
• 34:03but we provided flexible funds,
• 34:06$75,000 a year to each of them.
• 34:08And the impact is there's been over $10
• 34:11million in new funds and we've been,
• 34:14as I said, we've been able to
• 34:16leverage efforts across the campus.
• 34:18Here's another quote.
• 34:19My mentees and I've been impacted in more
• 34:22ways than count than I can describe or count.
• 34:24My confidence has great has improved greatly,
• 34:27making me a better leader,
• 34:28mentor and sponsor.
• 34:29I'm able to ask for what I need and advocate
• 34:32on my on behalf of my mentees in new ways,
• 34:35and it was amazing what
• 34:36they did for their people.
• 34:37So it had not only an impact on them,
• 34:40but because they were selected for
• 34:42how extraordinary mentors they were,
• 34:43it trickled down and really had
• 34:45an impact on their trainees.
• 34:47We will have more data on the impact
• 34:49of this and comparing to those who
• 34:51are not able to enter the program.
• 34:53I'll get into that a little bit later.
• 34:57We also have done a lot of
• 34:58community building.
• 34:59This is led by Ryan and Steve,
• 35:02Ryan Hernandez and Steve Mack.
• 35:04We have a we had a little social.
• 35:06This is some part of the
• 35:08people at the social.
• 35:09We created a listserv so arches,
• 35:11faculty receive information from us.
• 35:15We have an online landscape
• 35:17of community affinity groups,
• 35:19so people can find different groups
• 35:21that they might want to join.
• 35:23And we have developed peer mentorship groups.
• 35:26These are not funded,
• 35:27meaning people don't receive
• 35:29funds to go to this,
• 35:30but they just receive some
• 35:32of the administrative support
• 35:33to put the groups together.
• 35:35And we also built what's called arches,
• 35:37coins.
• 35:38And So what this is,
• 35:39is actually money for people
• 35:42to go out together.
• 35:44And so all all you have to do is
• 35:46just organize a community activity,
• 35:49going out to dinner and then take
• 35:51a picture of yourself and then
• 35:53send it to us And you, you know,
• 35:55you you get the funds for for for doing that.
• 35:58And so mostly it's just to build community.
• 36:00It's just to build community.
• 36:02So this has been launched very
• 36:04effectively in the Department of Medicine.
• 36:06So we borrowed it for arches.
• 36:08Here's some of our products.
• 36:09This is our, this is our website.
• 36:12You can look that up.
• 36:13Here is a picture of that website and
• 36:16here's a picture of our newsletter,
• 36:19what it looks like. This was the first one.
• 36:21And what we do within the newsletter is
• 36:24very intentionally spotlight individuals
• 36:26and we track who are we spotlighting,
• 36:29who are we sponsoring.
• 36:30So that we make sure that we have
• 36:34representation again across schools,
• 36:36across divisions,
• 36:37across types of science.
• 36:39That we're not just doing basic sciences,
• 36:41just doing physician scientists that
• 36:43we're really paying attention to making
• 36:46sure everybody feels included and seen.
• 36:49Now we also had as part of my grant,
• 36:52I had a change maker portion of
• 36:54the grant now that was much bigger
• 36:57within the grant and I have,
• 36:59I've still got this in my back pocket.
• 37:01I'm doing little elements of this and maybe
• 37:03in the Q&A we can talk more about this.
• 37:05But what I what I feel happens and
• 37:09many of you who maybe are in this
• 37:12diversity space or are historically
• 37:14excluded identifies historically
• 37:15excluded yourself often you know you're
• 37:18doing your research and you're doing
• 37:21some of this work at the same time.
• 37:23And So what I really wanted to do
• 37:26with changemakers was give people
• 37:28the resources they needed to do that
• 37:31extra work given funding and or people
• 37:34support and or access to sponsors.
• 37:37So what I did is I partnered with our
• 37:40institutional resource allocation program
• 37:42which gives these anti racism awards.
• 37:45So these are different scientists who
• 37:47won these awards and I met with them and
• 37:50connected them with different sponsors
• 37:52at the institution to amplify their work
• 37:54and make their work have even a higher reach.
• 37:58So not just giving the money
• 38:00went out to them,
• 38:01but then connect with them,
• 38:03get them connected to high level
• 38:05individuals and also sponsor them by
• 38:07showing their work in our newsletter.
• 38:09I've also been developing key
• 38:11partnerships with other folks across
• 38:13the university and exploring giving
• 38:17consultation to other investigators
• 38:20throughout the university who are
• 38:23doing NIH funded DEI focused awards.
• 38:26Finally, I also have been working,
• 38:28I mentioned Joan Williams before
• 38:31I recently received,
• 38:33you see an NSF Advanced Partnership Grant.
• 38:36This is a grant focused on
• 38:38interrupting bias in medicine.
• 38:40And so I've been working closely with
• 38:42Joan and what we're trying to do is
• 38:45increase access to opportunities for all
• 38:48faculty across the School of Medicine,
• 38:51focusing in on the research faculty
• 38:53and by doing this really delving into
• 38:56where bias occurs in the workplace.
• 39:01And then these are two women,
• 39:04Claire Brenda's is a Latina.
• 39:06You can't tell by her name either.
• 39:09So I'll I'll sponsor her
• 39:10and let you know about her.
• 39:11She is an incredible woman in the net.
• 39:14She was the director of the
• 39:15Institute for Health Policy Studies,
• 39:16nationally recognized for her work
• 39:19and family planning and is a member of
• 39:23the National Academies of Medicine.
• 39:24And this is Elizabeth Ozer,
• 39:26who's currently one of the
• 39:27Associate vice Provost for faculty.
• 39:29And they are leading the engagement,
• 39:33the evaluation portion of Arches.
• 39:37And they actually have new hot
• 39:39off the press late yesterday.
• 39:41So I didn't include this in here
• 39:44survey of our people and just how
• 39:47much the faculty really feel like
• 39:49they really like the arches program
• 39:52we had submitted as a survey.
• 39:54And they even if they're not
• 39:58attending the program,
• 39:59even having the newsletter
• 40:00components of the program,
• 40:02even having the newsletter was something
• 40:04that was very meaningful for for them,
• 40:06which was very surprising for us.
• 40:07So here's this.
• 40:08You know very high click rates
• 40:10and open rates.
• 40:11They did this survey and many
• 40:13of them felt like the work was
• 40:16there's wonderful qualitative
• 40:17and quantitative work that I'll
• 40:19be able to share more later when
• 40:21I when I have it all condensed.
• 40:23But but it's people are engaging.
• 40:25I told you some of the outcomes
• 40:27from the mid career program.
• 40:30I didn't mention that I have a had
• 40:33a sponsorship component to it and I
• 40:35had kind of targeted their division
• 40:37chiefs and all of the scholarships
• 40:40were nominated that scholars that
• 40:41were nominated for awards received
• 40:43awards and half of them were invited
• 40:46to speak grand at grand rounds.
• 40:48And there were other opportunities
• 40:50as well here,
• 40:52let's see there's all all people
• 40:55are attending these seminars and
• 40:57there's a high degree unsatisfaction
• 40:59from attending the seminars and
• 41:02the people want them.
• 41:03We kind of afterwards write up
• 41:05the pearls from the seminar and
• 41:07post those on our website.
• 41:09And so actually folks at Yale
• 41:10can go look at our Arches website
• 41:12if you want to and see some of
• 41:15the information that we post.
• 41:16So then this is the last part,
• 41:18is just some pearls to take home.
• 41:21So my recommendations for you
• 41:24all and what you can do.
• 41:26So my thought a lot of institutions
• 41:32are focusing on recruitment now.
• 41:36Recruitment is important.
• 41:37I'm not saying a recruitment isn't important,
• 41:40but it really needs to go
• 41:42hand in hand with retention.
• 41:45I think there needs to be increased
• 41:48efforts focused on retaining the
• 41:51outstanding historically excluded
• 41:53faculty and trainees that enter
• 41:55and then faculty that we have,
• 41:58so keeping people here.
• 41:59So some of the ways that I think
• 42:03that you can do this are focused
• 42:06on improving the mentorship and
• 42:09sponsorship at your institution.
• 42:11So as I mentioned before,
• 42:13consider centering efforts around
• 42:15the idea of women of color.
• 42:19So for example,
• 42:19a lot of things that people are
• 42:21wondering about today is return to work.
• 42:22How many people are going to get
• 42:24come to work Now it looks in there,
• 42:25there's a big group of people together.
• 42:27But I know what UCSF sometimes there's
• 42:29big groups of people together and
• 42:30sometimes some buildings are empty,
• 42:32like a lot of people aren't
• 42:34in some of the buildings.
• 42:35And so when you're thinking about what is
• 42:38our return to work policy going to be,
• 42:40think about it and think about, well,
• 42:42how might this impact a woman of color?
• 42:44How might this impact her ability to
• 42:46get the kid into her kids into school?
• 42:49How might it impact her experiences
• 42:51of discrimination at work?
• 42:53What are we going to do to make sure
• 42:55that some of the policies that we put in
• 42:56place don't have these adverse effects?
• 42:58So it's not saying we're going to make
• 43:00something special for women of color.
• 43:01It's that we're thinking about that
• 43:04population when we're developing
• 43:06policies and procedures.
• 43:07I'm obviously biased to offer research
• 43:10support for family caregivers.
• 43:11I think especially in medicine we
• 43:14can learn a lot from people who are
• 43:17caregivers themselves lot about
• 43:19how we can improve our system.
• 43:22I think you should increase peer
• 43:25mentoring starting groups if
• 43:26you don't already have them,
• 43:28of identity groups or community affinity
• 43:31groups in the department and facilitate
• 43:35sponsorship for Latin eggs and or women.
• 43:38And think about specifically like looking
• 43:40at the population and saying oh are we
• 43:43are we distributing opportunities equally?
• 43:44How can we do this in a way
• 43:47that really lifts everybody?
• 43:49I don't know like couple more slides,
• 43:53use data to shine the spotlight
• 43:56on these issues.
• 43:58So sometimes what will happen
• 44:00is you'll look at like, no,
• 44:02we've got equal representation
• 44:04of women and men.
• 44:05There's no problem here.
• 44:07But I would separate out the
• 44:10data into what series are these.
• 44:13Let's say if I'm using faculty,
• 44:15what series are they in?
• 44:16Are they in clinical series?
• 44:17Are they in research series?
• 44:20What series are they in?
• 44:21What rank are they in?
• 44:25Are they in the,
• 44:26are they in leadership roles?
• 44:28And what you'll find,
• 44:29which is what we find everywhere,
• 44:31is that there are gaps and
• 44:33opportunities and that can target our,
• 44:35you know,
• 44:35that can help us to figure out
• 44:37where our efforts should be.
• 44:39I do think it's important to gather
• 44:42data on salaries and endowed
• 44:44chairs and to look at these things
• 44:47and be transparent about this.
• 44:49Where UCSF had been doing,
• 44:51I I published many pieces on
• 44:54endowed professorships and the
• 44:56differences in distribution of these.
• 44:58I'm particularly interested now in
• 45:00the size and finding out the size of
• 45:03these endowed professorships and I'm
• 45:05looking at our data internally at UCSF,
• 45:07those those with more Gray hairs like mine,
• 45:10which you can't see mine,
• 45:11but that's because of their dyed,
• 45:13you know,
• 45:14know that there's a difference
• 45:15between the baby endowed chairs
• 45:18and a distinguished professorship.
• 45:20So who has what are there differences?
• 45:24Can should they be like that?
• 45:27How are we distributing these these these
• 45:30are major resources that have impacts.
• 45:33And then focus on his
• 45:36policies and procedures.
• 45:37You know, these are accountability
• 45:39metrics with leadership reviews,
• 45:41salary transparency, paid family leave.
• 45:44I have a paper that's coming
• 45:46out around lactation policies.
• 45:48I think those are something else that is
• 45:50important for us to be thinking about,
• 45:52to encourage people who've had
• 45:54their children to be continuing to
• 45:57encourage and and allow there to be
• 45:59policies and procedures to allow them
• 46:00to continue to nurse their children.
• 46:03Given the strong evidence for health
• 46:05of of the baby and the mother.
• 46:07I also think around elder care,
• 46:11perhaps Yale is different,
• 46:12but most institutions do not
• 46:14have a specific elder care paid
• 46:16leave policy and this is going
• 46:18to increasingly become a problem.
• 46:20And then I think targeting recruitment
• 46:22for leadership roles and really thinking
• 46:23about making sure we have as diverse
• 46:28candidates as possible and that we have
• 46:30checks and balance for when you are
• 46:33selecting people so that our biases don't
• 46:36take over and select the majority group.
• 46:41I want to thank all of these people.
• 46:43These are mentors and sponsors that I've
• 46:46had over the years inside UCSF and outside
• 46:51of UCSFI did not get here on my own.
• 46:56These are people who have lifted me
• 46:58my career, served as role models,
• 47:00giving me sage advice and putting
• 47:03me in the room where it happens so
• 47:05I can make an impact. And I'm just
• 47:08extremely grateful to all of them.
• 47:10And there's actually many,
• 47:11many more peers and mentees that aren't
• 47:14even on this slide who've impacted
• 47:17my career and made it fulfilling.
• 47:19I'll leave you with this last slide.
• 47:22I I really like this quote.
• 47:24I changed it a little bit.
• 47:25It's from RFK, Bobby Kennedy.
• 47:29Each time a person stands up for an ideal,
• 47:34or acts to improve the lot of others,
• 47:37or strikes out against injustice,
• 47:39they send forth a tiny ripple of hope.
• 47:43And those ripples can be a current
• 47:47that can sweep down the mightiest
• 47:49walls of oppression.
• 47:50And
• 47:53I really believe that.
• 47:54So I really believe that
• 47:56little things that you do,
• 47:57it doesn't need to be big,
• 48:00can make a huge difference and
• 48:03help make our our home better.
• 48:07So that's it. Thank you so much.