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