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Quality
Competence
Diversity
Health Benefits
Care
Diversity in Academic Medicine: Supporting Faculty Advancing Diversity and Excellence in Science and EngineeringUniversity of Michigan – Ann Arbor, MIJanuary 18 - 19, 2007Jeannette E. South-Paul, M.D.University of Pittsburgh
NationalityNationalityNationalityNationality CultureCultureCultureCulture
Class/Class/StatusStatusClass/Class/StatusStatus
GeographicGeographicLocationLocation
GeographicGeographicLocationLocation
MaritalMaritalStatusStatusMaritalMaritalStatusStatus
ReligiousReligiousBeliefsBeliefs
ReligiousReligiousBeliefsBeliefsEducationEducationEducationEducation
ProfessionalProfessionalExperienceExperience
ProfessionalProfessionalExperienceExperience
FamilyFamilyRespon-Respon-sibilitiessibilities
FamilyFamilyRespon-Respon-sibilitiessibilities
SexualSexualOrientationOrientation
SexualSexualOrientationOrientation
AgeAgeAgeAgePhysicalPhysicalAbilitiesAbilitiesPhysicalPhysicalAbilitiesAbilities
RaceRaceRaceRace
GenderGenderGenderGender
Physical Physical AbilitiesAbilities
Physical Physical AbilitiesAbilities
NEOUCOM
Diversity Kaleidoscope
8
10
12
14
90 92 94 96 98 '00
A Sagging Bridge to Diversity in Academic Medicine
0
5
10
15
20
25
50 62 74 86 95
Year
%
% URMs in
US Population
% URM Matriculants
2022 URMMatriculants
1786 URMMatriculants
Jordan Cohen, AAMC
Quality
Competence
Diversity
Health Benefits
Care
Enriching the Pipeline
Generational Issues
Silent Generation (1925 – 1944) Boomers (1945 – 1962) Generation X (1963 – 1981) Millennials (1982 – )
Generational Issues
Silent Generation (1925 – 1944) Boomers (1945 – 1962)
Work hard out of loyalty Expect long-term job Pay dues Self-sacrifice is a virtue Respect authority
Generation X (1963 – 1981) Millennials (1982 – )
Generational Issues
Generation X (1963 – 1981) Work hard if balance is allowed Expect many job searches Paying dues is not relevant Self-sacrifice may have to be endured, occasionally Question authority
Generation X (1963 – 1981) Millennials (1982 – )
Handling Generational Issues
Improving mentoring Redefine the ideal worker Enhance faculty career and leadership
development
Bickel J, Brown AJ., “Generation X: Implications for Faculty Recruitment and Development in AHCs,Acad Med., 1005, 80:205-210
Shifting Paradigms in Medical Education
The individual Cure of disease Episodic care Physician provider Paternalism Provider-centered Anecdotal care Inpatient-focused Individual accountability
The communityPreservation of healthContinuous careTeams of providersPartnership with patientsPatient/family-centeredEvidence-based medicineAmbulatory/home-centeredSystem accountability
Quality
Competence
Diversity
Health Benefits
Care
Enriching the PipelineMentoring – to include diverse mentorsDynamic curriculaFinancial support
Quality
Competence
Diversity
Health Benefits
Care
Creating a Welcoming Organization
Organizational Cultural Competency
Set of behaviors, attitudes, and policies that come together in a system, agency, or among professionals to enable work in cross-cultural situations
Destructive
Incapacity
Blindness
Pre-competence
Competence
Proficiency
Continuum Of Cultural Competence
Hayes M. Cultural Competency Continuum, 1991
Creating Inclusive Communities
Know Your InstitutionLeadership priorities Influence of NIH Promotion record Strengths/weaknesses
Explanatory Model: Clinical Setting
What do you call your problem? What name does it have? What do you think has caused the problem? Why do you think it started when it did? What does you the sickness do to you? How does it work? How severe is the sickness? Will it have a short or long course? What are the chief problems that your sickness has caused for
you? What kind of treatment do you think you should receive? What are the most important results you hope to receive from
the treatment?
Kleinman, Arthur, Patients and Healers in the Context of Culture. Berkley University Press, 1980
Explanatory Model: Managerial Setting
What is the problem? Who owns the problem? Is it defined differently by others? What are the varying perspectives?
What precipitated the problem? What is the impact of the problem? How severe is the problem? Will it resolve itself or evolve into a bigger problem? What are the consequences of intervening or not
intervening? What is the desired outcome? What is the best solution?
Maximizing the Benefits of Diversity
Diversity should permeate policy in all areas of campus life Institutions should recruit, support, and retain diverse student bodies Institutions should commit to hiring diverse faculty Diversity efforts should have as their goal development of a positive
campus climate Diversity efforts should provide safe cultural spaces Diversity efforts should encourage and foster interracial contact Institutions should assess the effectiveness of their diversity efforts
and compile evidence that indicates their approaches are working Institutions should implement, reward, and support pedagogical
practices to achieve diversity Milem JF, Chang MJ, Antonio AL (2005). Making Diversity Work on Campus: A Research-
Based Perspective. Wash, DC. Association of American Colleges and Universities.
The Consequences of PrematureAbandonment of Affirmative Action Admissions
Cohen JJ. JAMA 2003;289:1143-1149
Preserving diversity in medical schools is important -
Student and faculty diversity is indispensable for quality medical education
Diversity of the physician workforce improves access to care for underserved populations
Diversity of the research workforce can accelerate advances in medical and public health research
Diversity among managers of health care is good business sense
Cohen JJ. JAMA 2003;289:1143-1149
Has affirmative action been effective in medical school admission?
Minorities in Medicine
0
2
4
6
8
10
12
URM StudentsURM Faculty
Percentage of URM Participants in Allopathic Medical Schools
Minority Medical School Faculty
URM faculty increase from 2.6% to 3.7% between 1980 and 1995
A/PI faculty rose from 6.6% to 8.6% during the same period
URM faculty typically promoted to Associate Professor3 – 7 years later than Whites
Petersdorf RG, Turner KS, Nickens HW, Ready T. Minorities in medicine: past, present, and future. Acad Med 1990;65:663-670
Creating Inclusive Communities
Know Your Institution Leadership priorities
Influence of NIH Promotion record Strengths/weaknesses
Core of NIH Roadmap Vision
At core of this vision is the need to develop new research partnerships with organized patient communities, community-based health care providers, and academic researchers.
Creating Inclusive Communities
Know Your Institution Leadership priorities NIH Roadmap
Promotion requirements Strengths/weaknesses
Minority Faculty and Academic Rank
National survey of medical school faculty, n=344 Self-report data MDs and other degrees Adjusted for age and productivity URM faculty less likely to be promoted to senior
rank than white faculty
Palepu A, Carr PL et al. Minority faculty and academic rank in medicine. JAMA 1998;280:767-771.
Minority Faculty Promotions
Minority faculty more likely to Be IMGs or affiliated with other clinical science
departments Less likely to be tenured or tenure track Less likely to be recipients of RO1 or other NIH awards More likely to have appointments in private medical
schools More likely to be women (API/URM)
Fang D, Moy E, Colburn L. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA 2000;284(9):1085-92.
Predictors of Physicians Who Care for Underserved Populations
Being a member of an underserved ethnic or minority group
Having participated in the National Health Service Corps
Having a strong interest in practicing in an underserved area prior to attending medical school
Growing up in an underserved area
Rabinowitz HK, Diamond JJ, et al. The impact of multiple predictors on generalist physicians’ care of underserved populations. Am J Public Health 2000;90:1225-8
Challenges to Achieving Diversity in Academic Medicine
Minority physicians are more likely to choose underserved areas in which to practice Komaromy M, Grumbach K, Drake M. The role of black and Hispanic physicians in
providing health care for underserved populations. N Engl J Med 1996;334:1305-1310 Gray B, Stoddard JJ. Patient-physician pairing: does and ethnic congruity influence
selection of a regular physician? J Community Health 1997;22:247-59
Low numbers of minority faculty limit the number of minority mentors available and disadvantage at time of recruitment for faculty positions Giardino AP, Cooper MC. Perceptions of pediatric chief residents on minority
housestaff recruitment and retention in large pediatric residency programs. J Natl Med Assoc 1999;91:459-65
Challenges to Achieving Diversity in Academic Medicine
Assault on affirmative action reduces the percentage of minority matriculants from current 12% to 3% (less than before the Civil Rights movement in the 60’s Cohen JJ. The consequences of premature abandonment of affirmative action in
medical school admissions. JAMA 2003;289:1143-9
Disparities in promotion rates for minority faculty Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion
in academic medicine. JAMA 2000;284:1085-92.
Minority faculty are less satisfied with their academic careers even when they receive comparable financial compensation Palepu A, Carr PL, Friedman RH, et al. Specialty choices, compensation, and career
satisfaction of underrepresented minority faculty in academic medicine. Acad Med 2000;75:157-60.
Retaining Diverse Faculty
Give your post-doc’s and fellows a reason to stay Begin mentoring them during the recruitment
process Provide specific skills for success as academic
faculty Have visible leaders and administrative bodies that
respond to the needs of trainees
University of Pittsburgh – Office of Academic Career Development – Joan Lakoski, PhD
Maximizing Your Postdoctoral Success: An Orientation to a Full Academic and Social Life in Pittsburgh
NIH Career Development Award Workshop: Pathway to Independence: K-99/ROO
Health Sciences Professional Development Workshop for Faculty & Postdocs: Publishing with Integrity in Academic Journals
Health Sciences Faculty Professional Development Series: Managing Your Personnel
NIH Career Development Award Workshop: Awards for Basic Scientists
NIH Career Development Award Workshop: Life After Your K Award: Making Career Transitions
Quality
Competence
Diversity
Health Benefits
Care
Creating a Welcoming OrganizationSupporting young facultyAssuring a supportive environmentEngaging the promotion mechanism
Quality
Competence
Diversity
Health Benefits
Care
Embracing Your Community
Creating Inclusive Communities
Know Your Customers Know health status indicators Partner with your community Address community needs
Kaiser Family Foundation
People of color more likely than whites to live in neighborhoods that lack adequate health care resources
28% of Latinos and 22% of African Americans report having little or no choice in where they seek care as compared to 15% of whites experiencing this difficulty
Kaiser Family Foundation, March 2005 Policy Brief
Academic Health Centers
Must prioritize communication with the community To remain in touch with community concerns To keep community abreast of new discoveries To inform the community regarding results of
research
Strategies to Create Inclusive Communities
Medical Education Clinical Care Research Advocacy
Strategies for Inclusivity – Medical Education
Curricular reform Cultural competence training Mentoring Electives
Strategies for Inclusivity – Clinical Care
Community health center network Alliance with federally-qualified health
centers Community advisory groups
Strategies for Achieving a Culturally Competent Organization
Environmental assessment Institutional team to monitor the environment Case-by-case counseling Public health assessment of the community Team building activities
Institutionalize Cultural Knowledge
Educate staff on the cultural groups that the organization serves History, traditions, language, values, family systems
Incorporate cultural knowledge into service delivery Training in and development of systems to manage
medical and social issues Female interpreters for Muslim women
Provide language appropriate resources, referrals
Quality
Competence
Diversity
Health Benefits
Care
Research and Diversity
Clinical Research at the University of Pittsburgh
Dean/Sr Vice Chancellor for the Health Sciences Arthur Levine proscribes internal competition and encourages collaboration
UPSOM Office of Clinical Research Community Research Advisory Board – Center for Minority
Health, Graduate School of Public Health Center for Health Equity Research – Pittsburgh VA and
Division of GIM Center for Primary Care Community Based Research –
Dept of Family Medicine
CRABCommunity Research Advisory Board
Vision of Stephen B. Thomas, PhD, Philip Hallen Chair in Community Health and Social Justice.
Director for the Center for Minority Health in the Graduate School of Public Health
Chaired by Jeannette E. South-Paul, MD and Stephen Thomas, PhD
CRAB Membership –
Faculty, staff and individuals from academic, health related and community settings – stakeholders from various ‘walks of life’ – coming together on a monthly basis for the purpose of:
Increasing the members’ awareness of various aspects of research and its implications in underserved communities.
Providing feedback, based on diverse perspectives, to investigators about their proposed or on-going research.
CRAB
o Building both the academic and community capacity to: conduct culturally competent research in partnership to share knowledge and transfer information to improve health outcomes o Creating opportunities for further collaboration and partnership between research investigators and the communities/individuals most impacted by racial and ethnic disparities in health.
Center for Primary Care Community Based Research
Committed to issues of medically underserved communities
Based within FM-Pittnet – a PBRN in community health centers
Epidemiologic focus Research registry Vision of Janine E. Janosky, PhD – Research
Director
Quality
Competence
Diversity
Health Benefits
Care
Important National EffortsELAM ProgramAAMC Programs
ELAM Program – 10th Year
Executive Leadership in Academic Medicine for Women MCP-Hahnemann – then Drexel University College of
Medicine sponsored and administered 40 fellows annually from medical, dental and public health
schools 5 weeks annually to include attendance at the Association
of American Medical Colleges meeting Administrative, financial, diversity, mentoring, political,
media, governmental relations training Page Morahan, PhD, Rosalyn Richman leaders
Association of American Medical Colleges Programs
Women’s Professional Development Seminars for Junior Faculty and Senior Faculty
Minority Faculty Professional Development Seminar
Inclusion of women and minorities at the senior leadership professional development seminars
The Tribal Wisdom of the Dakota Indians, passed on from one generation to the next, says that when you discover that you are riding a dead horse, the best strategy is to dismount.
:
But in modern business including educational institutions, and government, because heavy investment factors are taken into consideration, other strategies are often tried with dead horses, such as the following
1. Buying a stronger whip.
2. Changing riders.
3. Threatening the horse with termination
4. Appointing a committee to study the horse.
5. Arranging to visit other sites to see how they ride dead horses.
6. Lowering the standards so that dead horses can be included.
7. Reclassifying the dead horse as "living-impaired."
8. Hiring outside contractors to ride the dead horse.
9. Harnessing several dead horses together to increase speed.
10. Providing additional funding and/or training to increase the dead horse's performance.
11. Doing a productivity study to see if lighter riders would improve the dead horse's performance.
12. Declaring that the dead horse carries lower overhead and therefore contributes more to the bottom line then some other horses.
13. Rewriting the expected performance requirements for all horses.
And, as a final strategy:
14. Promoting the dead horse to a supervisory position.
Quality
Competence
Diversity
Health Benefits
Care
Questions