school of medicine office of diversity and multicultural affairs rafael ortega, md
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School of Medicine Office of Diversity and Multicultural Affairs
Rafael Ortega, MD
Objectives:
• Explain the Mission and Vision of the Office of Diversity
• Describe the evolution of Diversity at BU School of Medicine
• Emphasize the importance of Diversity in education and health care
• Discuss how you can help us achieve our goals
Underrepresented in Medicine
Health Care Disparities
Diversity andMulticultural Affairs
INTERRELATED OBJECTIVES
Larry Chin
Doug Hughes
Samantha Kaplan
AlexNorbash
RafaelOrtega
http://www.bumc.bu.edu/oma/
Office of Diversity and Multicultural Affairs
• Monitors and promotes diversity at BUSM and BUMC including statistics on students, faculty and trainees.
• Reports on diversity issues to the Dean and Executive Committee.
• Collaborates with Departments in BUSM to identify and achieve diversity goals.
• Works with OSA to monitor progress of students.
• Mentors students, faculty and trainees.
• Provides support for medical student cultural and ethnic groups on campus.
• Explores new funding and grant support for diversity efforts.
• Manages EMSSP including recruitment, retention and academic preparation and assessment of students. Maintains collaboration with partner colleges and universities and seeks opportunities to expand affiliations.
• Monitors and promotes diversity at BUSM and BUMC including statistics on students, faculty and trainees.
• Reports on diversity issues to the Dean and Executive Committee.
• Collaborates with Departments in BUSM to identify and achieve diversity goals.
• Works with OSA to monitor progress of students.
• Mentors students, faculty and trainees.
• Provides support for medical student cultural and ethnic groups on campus.
• Explores new funding and grant support for diversity efforts.
• Manages EMSSP including recruitment, retention and academic preparation and assessment of students. Maintains collaboration with partner colleges and universities and seeks opportunities to expand affiliations.
Boston University School of Medicine will lead medical schools in diversity of faculty, students, staff and trainees, by development of innovative programs that educate,
recruit and retain a multicultural constituency. We will create a culture and climate that demonstrates BUSM belief that diversity adds value to intellectual development,
academic discourse, patient care and research. We believe that diversity is essential to the development of future leaders in healthcare and research to serve our community,
nation and world.
The Boston University School of Medicine Office of Diversity and Multicultural Affairs serves as the Dean’s proponent for diversity and cultural competence among students
faculty and staff. The Office of Diversity will accomplish this mission through collaboration with all departments to develop model recruitment and retention
strategies and for curriculum and faculty development.
MissionThe Boston University School of Medicine Office of Diversity and Multicultural Affairs
serves as the Dean’s proponent for diversity and cultural competence among students faculty and staff. The Office of Diversity will accomplish this mission through
collaboration with all departments to develop model recruitment and retention strategies and for curriculum and faculty development.
VisionBoston University School of Medicine will lead medical schools in diversity of faculty, students, staff and trainees, by development of innovative programs that educate,
recruit and retain a multicultural constituency. We will create a culture and climate that demonstrates BUSM belief that diversity adds value to intellectual development,
academic discourse, patient care and research. We believe that diversity is essential to the development of future leaders in healthcare and research to serve our community,
nation and world.
RaceEthnicityGender
Sexual OrientationGender Identity
Socio-economic StatusImmigration Status
AgeDisabilities
Religious BeliefsPolitical Beliefs
The Expanding Definition of Diversity
Military ServiceMarital Status
Same Sex MarriageChildren
NationalityEducational Attainment
LanguageHealth Care Disparities
Interracial MarriageIntercultural Marriage
Urban vs. Rural
Examples of Diversity Organizations on Campus
• AMERICAN ASSOCIATION OF PHYSICIANS FOR INDIAN ORIGIN (AAPI) • ASIAN PACIFIC AMERICAN MEDICAL STUDENT ASSOCIATION (APAMSA)• CHRISTIAN MEDICAL DENTAL ASSOCIATION (CMDA) • IRANIAN HEALTH CARE STUDENTS ASSOCIATION • MAIMONIDES SOCIETY• MEDICAL GAY AND LESBIAN ORGANIZATION (MedGLO) • MEDICAL STUDENTS FOR CHOICE (MSFC) • PHYSICIAN FOR HUMAN RIGHTS (PHR) • SOUTH ASIAN MEDICAL STUDENT ASSOCIATION (SAMSA) • STUDENT NATIONAL MEDICAL ASSOCIATION (SNMA)• OTHER
MD Physicians by Race and Ethnicity
Black 12%
Latino 15%
AAMC Data
2003 2004 2005 2006 2007 2008 2009
0
20
40
60
80
100
120
140
URM House Officers in BMC Residency Programs
12% 12% 14%
17%
21%
11%8%
TOTAL: 632
Anesthesiology 17 29Dermatology 2 14Cardiology 4 18Emergency Medicine 4 48Family Medicine 6 19GI 4 9Infectious Disease 3 6Internal Medicine 22 150Neurology 2 18Obstetrics & Gynecology 4 16Opthalmology 5 12Orthopedics 4 29Otolaryngology 0 14Pathology 4 12Pediatrics * 21 124PM&R 0 12Psychiatry 13 29Radiology 4 35Surgery (General) 8 39Urology 3 8Total 134 641
*Combined program
Number of URM House Officers in BMC Residency Programs
Internal
Medicin
e
Pediat
rics *
Emerg
ency
Medicin
e
Surge
ry (G
enera
l)
Radiology
Anesthesi
ology
Psychiat
ry
Orthoped
ics
Family
Med
icine
Cardiology
Neuro
logy
Obstetri
cs & Gyn
ecology
Dermato
logy
Otolaryn
gology
Opthalmology
Pathology
PM&R GI
Urology
Infectious D
isease
0
20
40
60
80
100
120
140
160 150
124
48
3935
29 29 29
19 18 18 16 14 14 12 12 12 9 8 611%
59%45%
14% 32% 22% 11% 14% 0% 42% 33%
15% 17%
8% 21% 25% 0% 44% 38% 50%
Percentage of URM House Officers in BMC Residency Programs
44%56%
WomenMen
2010 BUSM Total Full Time Faculty: 1,191
2010 BUSM Total Medical Students: 728
53.3%
46.7%
WomenMen
582
703 73
N-URMBlackAm Indian / AlaskaHispanic
2010 BUSM Total Medical Students: 728
80%
10%0.4%10%
Instructor Assistant Associate Professor0
50
100
150
200
250
300
58
263
168 177
128
265
8052
MenWomen
2010 BUSM Full Time Gender Faculty Distribution by Rank
Instructor Assistant Associate Professor0
100
200
300
400
500
600
186
528
248 229
2036
13 9
N-URMURM
2010 BUSM Full Time URM Faculty Distribution by Rank
Searching for Excellence & Diversity: A Guide for Search Committee Chairs, a guide developed by the Women in Science & Engineering Leadership Institute (WISELI) at the University of Wisconsin Madison
http://www.bu.edu/apfd/recruitment/fsm/
• “I am in favor of diversity, but I don’t want to sacrifice quality.”
• “We have to focus on hiring the ‘best.’”
• “We are so focused on diversity that white males have no chance”
• “There are no women or minorities in our field.”
• “There are few available, they are in high demand – we can’t compete.”
• “Minority candidates would not want to come to our campus.”
Common Arguments and Comments
http://www.bu.edu/apfd/recruitment/fsm/
November 18, 1993
U.S. Foreign Born Population / Top Ten
Korea
Canada
Dominican Rep
El Salvador
Cuba
Vietnam
India
Philipines
China
Mexico
0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000
Data from 2000 U.S. Census and 2004 Yearbook of Immigrant Statistics (projected for 2010)
Total: 33 million
December, 2008
Direct Services(Interpreters, Linguistic Competency in
Health Education Materials)
Cultural Homophilly(Using Staff of Similar Background,
Understanding Folk Remedies and Traditional Healers)
Institutional Accommodation(Clinic Location, Hours of Operation, Cultural
Competency and Training)
Institutional Resources
PATIENT
EthnicityGender
AgeSocial Class
LiteracyHealth Status
PHYSICIAN
EthnicityGender
AgeSocial Class
PATIENT – PROVIDERCOMMUNICATION
Expectations
Bias
Stereotypes
ExpectationsBias
Stereotypes
Patient evaluations and judgments / Physician cognitions and decision-making
Outcomes, Satisfaction, Adherence, Functional Status, Quality of Life
The Effect of Race and Ethnicity on Patient-Physician Communication(adapted from Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. 2004
PATIENT -PROVIDERCOMMUNICATION
PATIENT – PROVIDERCOMMUNICATION
PATIENT – PROVIDERCOMMUNICATION
PATIENT – PROVIDERCOMMUNICATION
What Caught My Attention?
Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia
Todd K H et al.JAMA 1993;269(12):1537-1539
“Hispanics with isolated long bone fractures are twice as likely as non-Hispanic whites to receive no pain medication
in the UCLA Emergency Medicine Center.”
The Effect of Ethnicity on Physician Estimates of Pain Severity
in Patients with Isolated Extremity TraumaTodd K H et al.
JAMA 1994;271(12):925-928
“Physician ability to assess pain severity does not differfor Hispanic and non-Hispanic white patients.”
The Language Barrier and PCA
• Whites received significantly more analgesics than Hispanics after limb fractures.
• Blacks also received less analgesia than did whites.
• Language was not the reason.
• The self-administered narcotics (PCA), including self- administered and self-administered plus infusion, were not significantly different across the ethnic groups.
Bernardo Ng et al: The effect of ethnicity on prescriptions for patient-controlledanalgesia for post-operative pain. Pain 66 (1996)9-12
Am J Anesthesiology 1999;26(9):429-432
Obstetrical AnalgesiaObstetrical Analgesia
Anesthesiology and Disparity
Relevant Today?
Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments
Pletcher et al. JAMA. 2008;299(1):70-78.
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 20050
5
10
15
20
25
30
35
40
45
WhiteNon-White
Percentage of Emergency Department Pain-Related Visits at Which an Opioid Was Prescribed, White vs. Non-White
Adapted from: Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency DepartmentsPletcher et al. JAMA 2008;299:70-78.
%
Reason and Countermeasures
• Physicians & nurses underestimate & undertreat pain
• Different verbal & physical expression of pain
• Lack of understanding of different ethnic groups
• Anecdotal information
• Stereotypes
• Portrayal of various ethnic groups by the media
• Patients react differently based on physician’s ethnicity
• Subtle prejudice
Pain Intensity Scales
PCA
Cultural Competency
Evidence-Based Medicine
Avoid oversimplification
Beware of Hollywood
Situational Awareness
Self Awareness
COUNTERMEASURES
Recommended Reading
National Academies Press 2003
Disparities in Health & Health Care: Definitions
– Disparities in health – differences between two or more population groups in health outcomes and in the prevalence, incidence, or burden of disease, disability, injury, or death.
– Disparities in health care – differences between two or more population groups in health care access, coverage, and quality of care, including differences in preventive, diagnostic, and treatment services.
Other Examples of Disparities Among Some Minorities
• Higher rates of death from cancer.
• Less screening and treatment for cardiac risk factors.
• Less childhood immunizations.
• Less immunizations for influenza
• Higher incidence of AIDS in Black and Latino children
• Less preventative care individuals with disabilities
• Poorer health in rural residents
Source: US Department of Health and Human Services
A Recipe for Medical Schools to Produce Primary Care PhysiciansN Engl J Med 2011; 364:496-497February 10, 2011
Leveling the Field — Ensuring Equity through National Health Care ReformN Engl J Med 2009; 361:2401-2403December 17, 2009
Payment Reform and the Mission of Academic Medical CentersN Engl J Med 2010; 363:1784-1786November 4, 2010
Eliminating Healthcare Disparities in America: Beyond the IOM ReportN Engl J Med 358:1081, March 6, 2008
Assessing Race, Ethnicity, and Gender in HealthN Engl J Med 356:1279, March 22, 2007
Dissecting Racial and Ethnic DifferencesN Engl J Med 354:408, January 26, 2006 Editorial
Racial Trends in the Use of Major Procedures among the ElderlyN Engl J Med 353:683, August 18, 2005
Health Care in America — Still Too Separate, Not Yet EqualN Engl J Med 351:603, August 5, 2004
Racial Disparities — The Need for Research and ActionN Engl J Med 349:1379, October 2, 2003
Racial Disparities in Clinical TrialsN Engl J Med 346:1400, May 2, 2002
Relevant Today?Keyword “Disparity”
• Less education -- more likely to have report poor communication with their physicians.
• More problems with some aspects of the patient-provider relationships.
• Lower income patients report more difficult patient-provider relationships.
• Less access to health care information, including information on prescription drugs.
Examples of Reasons for Disparities(in many racial and ethnic groups, the poor, and less educated patients)
Source: US Department of Health and Human Services
Access to health careQuality of care
Insurance coverageGenetics
Personal behavior
Disparities in Health & Health Care Interrelated Factors
Cross Cultural Education: A Requirement
• Diversity:
challenges assumptions broadens perspectives enhances socialization triggers intellectual and cognitive gains improves treatment of individuals from different backgrounds
• Minority physicians are more likely to treat minority patients, and more likely to practice in underserved communities.
• Diversity in the health professions workforce is key to eliminating health care disparities.
• The U.S. is still producing too few racial and ethnic minority physicians to assure quality health care for all.
• Diversity:
challenges assumptions broadens perspectives enhances socialization triggers intellectual and cognitive gains improves treatment of individuals from different backgrounds
• Minority physicians are more likely to treat minority patients, and more likely to practice in underserved communities.
• Diversity in the health professions workforce is key to eliminating health care disparities.
• The U.S. is still producing too few racial and ethnic minority physicians to assure quality health care for all.
“Diversity is Essential for Promoting Excellence in Education and Health Care”
LCME
FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree
(Standard IS 16)
“An institution that offers a medical education program must have policies and practices to achieve appropriate diversity among its students, faculty, staff, and other
members of its academic community, and must engage in ongoing, systematic, and focused efforts to attract and retain students, faculty, staff, and others from
demographically diverse backgrounds.”
LCME
• Teach basic principles of culturally competent health care.
• Recognize health care disparities and develop of solutions to such burdens.
• Meet the health care needs of medically underserved populations.
• Development of core professional attributes (e.g., altruism, social accountability) needed to provide effective care in a multi-dimensionally diverse society.
How Does Diversity Influence Education?
• Students’ assumptions are challenged
• Perspectives are broadened
• Greater socialization across racial and ethnic groups
• Demonstrated intellectual and cognitive benefits
• Improved ability to treat all patients
• More likely to treat racial and ethnic minorities
Health Resources and Services Administration, Bureau of Health Professions. The Rationale for Diversity in the Health Professions: A Review of the Evidence. Rockville, MD: U.S. Dept. of Health and Human Services; 2006.
Joint Commission
• Published in 2008: Meeting the HealthCare Needs of Diverse Populations
• Published in 2010: Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
• Will evaluate compliance with the Patient-Centered Communication standards: beginning January 1, 2011
Cultural competence requires organizations and their personnel to do the following:
value diversity assess themselves manage the dynamics of difference acquire and institutionalize cultural knowledge adapt to diversity and the cultural contexts of
individuals and communities served
Joint Commission
http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf
2008
http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf
2010
National Center on Minority Health and Health Disparities
• NIH Institute created by the passage of the Minority Health and Health Disparities Research and Education Act of 2000
• NIH has made health disparities a priority
• Enhance minority health disparities research
• Increase underrepresented minority students and students from health disparity groups with an interest in careers in biomedical research.
Need to Expand Data
• The data on diversity in health care and outcomes are limited.
• Most of the data focuses on race and ethnicity.
• Data needed on other aspects of diversity.
Grants.gov - central storehouse for information on over 1,000 grant programs and provides access to approximately $500 billion in annual awards.
Funding Opportunities
Toward a Deeper Understanding of the Diversity RationaleMichele S. Moses and Mitchell J. Chang
Educational Researcher, Vol. 35, No. 1, pp. 6–11, Jan 2006
• How did “diversity” come to occupy a key position in education policy?
• Is there a philosophical orientation that informs applying diversity to education?
• What is gained and lost by focusing on the diversity rationale?
Diversity?
• Increases affective conflict - interpersonal issues/clashes • Increases anger, fear, distrust, frustration• Problems greater with race and gender, than with age• Increases turnover• Less likely to communicate than less diverse groups• Tendency to drive out diversity• Lower levels of member satisfaction than more homogeneous• Organizations that value diversity must develop mechanisms
to counteract this
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
Statement on Inclusion
“At Walmart, we are committed to unlocking the full potential of our global workforce by giving every
associate the opportunity to learn, grow and advance.”
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“Diversity and inclusion are key competitive strengths – critical tomaintaining our position as the
world’s leading energy and petrochemical company.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“We value and demonstrate respect for the uniqueness of individuals and the varied perspectives and talents they provide. We have an inclusive
work environment and actively embrace a diversity of people, ideas,
talents and experiences.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“When companies recruit and retain individuals with diverse backgrounds, it drives innovation in their processes,
products and solutions. Diversity brings innovative approaches to a
company, while positively influencingthe way the company makes
decisions.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“Above all, we are about people. A philosophy of inclusion drives our
organization every day and helps us win in a diverse, global marketplace”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“We strive to represent and reflect the global communities in which we live
and work. To deliver superior performance, we create an
environment of inclusion that respects the contributions and differences of
every individual.
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“A diverse workforce and inclusive culture are essential to AT&T. They
allow us to attract and retain the best and the brightest to develop the most innovative products and solutions to
meet our customers' needs.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
"What is the business case for diversity?" Successful companies are
ones that satisfy their customer's wants, needs and desires. The only
way to satisfy diverse customers is to include their perspectives
inside the company.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
“Diversity is a cornerstone of our global corporate culture.
Nothing is more vital to the long-term growth of JPMorgan Chase
than our ability to attract and retain talented and dedicated employees.”
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
“Putting all our differences to work across the world is a continuous journey fueled by
personal leadership from everyone in our company. Our aspiration is that the behaviors
and actions that support diversity and inclusion will come from the conviction of every HP
employee - making diversity and inclusion a conscious part of how we run our business
throughout the world.”
Wal-Mart Stores
Exxon Mobil
Chevron
General Electric
Bank of America Corp.
ConocoPhillips
AT&T
Ford Motor
J.P. Morgan Chase
Hewlett-Packard
Statement on Inclusion
Top 10 Fortune 500 Corporations (2010)
A partnership between BUSM and 14 undergraduate colleges emphasizingearly admissions and curriculum coordination
The Early Medical School Selection Program (EMSSP)
Boston University Clark/Atlanta University
Morehouse CollegeSpelman College
Hampton UniversityThe University of the Virgin Islands
North Carolina Central UniversityMorgan State University
Dillard UniversityTougaloo College and
Virginia Union UniversityPembroke State University in North Carolina
University of the Incarnate Word in TexasUniversity of Texas at El Paso
.
Historically Black
Hispanic
American Indian
The Academies’ March Toward MediocrityBy BRUCE FLEMING
Published: May 20, 2010
“Another program that is placing strain on the academies is an unofficial affirmative-action
preference in admissions. While we can debate the merits of universities making diversity a priority in
deciding which students to admit, how can one defend the use of race as a factor at taxpayer-financed academies — especially those whose
purpose is to defend the Constitution?”
Diversity Goals in our Medical Campus
• Specify timelines. • Recruit minority faculty and residents for the various disciplines.• Educate students, faculty and staff the benefits of diversity. • Seek out outstanding minorities and provide opportunities for success.• Recognize outstanding minority graduates of BUSM and invite them back to campus.• Refine existing efforts to attract more minorities into the various schools and residencies.• Strengthen networking among the existing minority students, residents, and faculty.• Enhance and monitor mentoring opportunities in each department.• Encourage the participation of existing minority staff in recruiting other diverse individuals.• Prioritize leadership development for the next generation of diversity proponents. • Dispel the notion that diversity is primarily concerned with recruiting minority physicians.
Diversity Faculty Database
• To include “Diversity” faculty
• To include faculty with “Diversity-related” interests
• Voluntary
• Digital Social Network