PROMOTINGDIVERSITYINTHEPIPELINEOFPHYSICIANSStephanieDewar,MDPatriciaPoitevien,MDAldaMariaGonzaga,MD

Objectives• Stimulateadiscussionandanassessmentofdiversityeffortsinyourtrainingprogram• Considerthecomponentsthataremissingandpracticehavingconversationsaboutthechallengesfaceenhancingand/ormaintainingthediversityinyourprogram.• Discussapproachestorecruitingandsupportingamorediverseresidencyapplicantpool• Holisticreviewofresidencyapplicants• Enhancementorshipactivitiesinyourprogram

Outline

• Whyisthisimportant?• Disparities inthePhysicianWorkforce

• Whatarethebarrierstooursuccess?• ProgramDirectorRoleinChange• Bootsonthegroundstrategies

• Recruitment• Mentorship

• Howdowetalktoadministration/leadershipaboutthis?• MonitoringProgress

Diversity

• “ thestateofhavingpeoplewhoaredifferentracesorwhohavedifferentculturesinagroupororganization”

Source:Merriam-Webster'sLearner'sDictionary

Diversityinpediatricpatients

• In2010,50.4%ofinfantsintheUSwereminorities• 1in4USchildrenliveinanimmigrantfamily• AsianAmericanandLatinogroupsaccountfor75%ofthegrowthoftheUSchildpopulationoverthepast2decades

Mendoza,Pediatrics2015

USCensusfutureestimates

• By2020,44.5%ofallchildrenwillbeminorities• By2050,1in3childrenwillliveinanimmigrantfamily• TheproportionofLatinochildrenintheUSwillequaltheproportionofnonHispanicwhitechildren,each36%

Mendoza,Pediatrics2015

RacialandEthnicDisparityinHealthCare

• Anydifferencesbypatients’raceorethnicitynotrelatedtopatientpreferencesorclinicalappropriateness

RacialandEthnicDisparitiesexistinthecareofourpatients

§ Cancer§ Prematurebirth§ HIV§ Obesity§ Sicklecelldisease§ Autismspectrum§ Downsyndrome§ Painmanagement§ Cerebralpalsy

§ Asthma§ Cysticfibrosis§ ADHD§ Diabetes§ Endoflifediscussions§ MentalIllness§ Traumaticbraininjury

PowerShuffle• Honorconfidentiality.• Unconditionallyrespectyourselfandothers.• Speakforyourselfonly.• Activelylisten:considerotherpeople'swordsasgifts.• Noput-downsorhostileanalysis.Avoidinterpretingotherpeople'sexperience.• Givecaringfeedback.

• Thisexercisewillincludeadialogue,notadebate.Therearenolosersorwinners.• Agreetodisagree.• Everyonehastherighttopass.• Itisokaytoexpressyouremotions.• No"rescuing."• Takeresponsibilityforyouownlearning- askforwhatyouneed.

Questionstoconsiderduringthedebrief

1. Howdiditfeeltobeinthegroupwhichhadtowalkacross?2. Howdiditfeeltobeinthemaingroupandwatchotherscross?3. Whatsurprisedyouduringthisexercise?4. Whatisthesignificanceofwhatyouexperiencedduringthis

exercise…foryourschool(department/division/program)?Foryourownpracticeofmedicine?Forhealthcareingeneral?

5. Howwouldyoufeelifyourdoctorbelongedtooneofthegroupsmentionedinthisexercise(notyourown)?

6. Howdoesthisactivitybuildcommunityandindividualcourage?

ProgramSelf-Assessment

Makingtheargumentfordiversity

• Alignwiththestrategicgoalsofyourinstitution• Makethemoralargument• Linkdiversitygoalswithqualitymeasures,safetymeasures,patientsatisfaction,employeesatisfaction• Createobjective,measurablegoals – defineyourROI• Bepreparedtodiscardineffectivediversitytoolsforbetterones

RecruitmentEfforts

MissionDriven

ThemissionofthePediatricResidencyatChildren'sHospitalofPittsburghofUPMCistoeducateandsupportadiversegroupofresidentsinaninnovativeandcollaborativeenvironment.Ourgraduatesareexceptionalpediatriciansequippedtosucceedintheiruniquecareerpathspromotingthehealthandwellnessofchildrenandcommunities.

Preparation

AssessYourProgram

• Trackthenumbersof• URMapplicants• URMinterviewees• URMcandidatesranked“tomatch”• URMphysiciansjoiningyourprogram

• Knowyourfacultydata• DepartmentstatisticsofURMfaculty

• Knowyourcultureofdiversity

AskforanExternalLook

• Currentresidentsofunder-representedbackgrounds(ifyouhaveany)• Medicalstudents• Faculty• Anotherprogramdirector• Staffmembers

Ourexternallook

• Website• Diversitycorner• Mission• Faces• Faculty

• Openconversation• ItokaythePDisn’tanURM• Askquestionsaboutwhatit’slike• Bepreparedfortheanswer

Whatwedid(everythingtheytoldus)• Diversityandinclusioncommittee• Websiteupdates• Recruitmentefforts• Residentconversations• MeetingswithUPSOMstudents• Outreachtootherschools• GMEoffice,FacultyGrandRounds,Societymeetings

Prepareyourpartners

• Showyourfacultythatthisisimportant• SelectionCommittee• Facultydevelopmentonunconsciousbias• HaveeveryonedotheIAT

• Interviewers• Bestpracticesonhowtotalkaboutdiversity(evenifyou’renotfromanURMbackground)• Howtoopenthedoortotalkingwiththecandidateabouttheirbackground

RecruitmentSeason

StepOne

• Examinetheapplicantpool• LookatschoolswhotraditionallytrainURMphysicians• Askyourselfwhycertainstudentsmightnotbeapplying• TrackURMapplicantsseparately• Invite“risky”applicants

HolisticReview

• Flexible,highly-individualizedprocess• Balancedconsideration• Multiplewaysapplicantsprepareforanddemonstratesuitability

• Underthisframework,candidatesareevaluatedbycriteriathatare• Institution-specific• Broad-based• Mission-driven• Thatareappliedequitablyacrossentireapplicantpool

AAMCRoadmaptoDiversity:IntegratingHolisticReviewPracticesintoMedicalSchoolAdmissionProcesses,2010

ApplicationReview

• EAM• Experiences• Attributes• Metrics

• Weareprettycomfortablewithmetrics

AAMCRoadmaptoDiversity:IntegratingHolisticReviewPracticesintoMedicalSchoolAdmissionProcesses,2010

Experiences

• Howdidthisapplicantgethere?• Highlightsoflife’sstory

• Examples• Careforafamilymember• Employmenthistory• Geographydistance• Research• Volunteerism

Attributes

• Skillsandabilities• Personalandprofessionalcharacteristics• Demographics• Examples:• Listeningskills• Multilingualabilities• Intellectualcuriosity• Socioeconomicstatus• Parentaleducationlevels

Wheredowefindthese?

• MSPE• Openingparagraphs• Comments

• CV• Volunteerism• Leadership

• Personalstatement• Letters• Perseverance,leadership,resilience,communication

ReviewthesampleERASapplication

Assignsroles:PD,APD,selectioncommitteemember

InterviewDay

• ConsiderofferingaURMfocusedday• Gatherfacultyandresidentstogetherfora“pre-”event

• Plantyourresidentswithaninterestindiversityatkeymoments• Lunch,tour,morningreport

• Matchfacultyandapplicants• Addressdiversityinyourremarks

AddressDiversityinYourRemarks

• DiversityandInclusionCommittee• Activities/successes

• Mentoringprogram• Mentortraining?

• FacultyDevelopment• Integrationintonoonconferenceseries

TheInterview

• Facultymatchisimportant• Consideraddingamemberofyourdiversitycommitteetotheitinerary• Askaboutattributesthatarestrengths• Allowapplicantstoaddressstrugglestheymayhavehad• Lowerboardscores,repeatcoursework,timeoff

• Beexplicitaboutprogramcommitmenttodiversity

FollowThrough

• Makesurecandidatereceiveanemailfromyouaftertheinterviewday• Followuponquestionstheymayhaveraised• AskaURMfacultymemberorresidenttoreachouttothembyphone

• Addressconcernsaboutneighborhoods,housesofworship,family,institutionaldiversity• Considera“secondlook”

RankMeeting

• AssignanadvocatefortheURMapplicants• Diversitycommitteemember

• Includeseparatespreadsheet• Spendtimeaddressingexperiencesandattributesatmorelength

• Knowthesecandidatesbetterthantherest• Doyourhomework• CalltheDeanofStudentsorletterwriters

SealingtheDeal

• Emailagainandoffertoanswerquestions• Askyourresidentstocallandfollowup• Ifyoudoasecondlookday• Addabreakfast/lunchwithURMfaculty

• Inquireaboutopportunitiesforsignificantothers

OnboardingandResidencyTraining

PostMatch

• ReachouttomatchedURMresidentstopersonallyaddressconcernsaboutthemove• Includequestionsabouttheinterviewenvironmentinyourpostmatchsurvey• Debriefwithyourteamaboutthebarriersthatmighthaveoccurredwitheachoftheseapplicantsyoudidnotcatch

CheckinEarly

• ConsiderpairingthemwithaURMseniorresidentearlyintheyear• Haveresourcesavailableforpersonalneeds• Housing,restaurants,housesofworship

• Advisorassignment• Layeredmentorship

• Personalemailsandanearlymeeting

AdvisingandMentorshipPrograms

• Mentorshipisthemostpowerfulinterventiontoimprovesuccessofresidentsfromdiversebackgrounds• ConsideraURMmentor(ifavailable• Supportthelivedexperienceofbeingaminorityinmedicine

• Earlyandspecialattentiontosupporttheirweaknesses• Efficiency• EMR/notewriting• Preparationforintrainingexam

“IamhonoredtostandundertheshadeofatreeIdidnotplant.”

Dr.ValerieMontgomery-Rice

SetTheStage

• Beclearaboutyourcommitmenttotheirsuccess• Beclearthatyouaretheretosupportthemthroughanydifficultiestheymayface• Maywanttoexplicitlyacknowledgethattheymaybetreateddifferentlythantheirmajoritycolleaguesandthatyouareavailabletotalkwiththematanytime

• YouarementoringthefutureURMleadersinacademicmedicine

ResidentRetentionandSupport

• Addressfellowshipplansearly• Askabout(encourage)planstostayinarea• Inquirefrequencyinsmallgroupsaboutthecultureofdiversity• Bespecific:whatdoweneedtodotokeepyouhere?

SocialNetworking

• Encouragethemtogetinvolvedwithprofessionalgroups:• StudentNationalMedicalAssociation(SNMA)/NationalMedicalAssociation

• GatewaySociety• LatinoMedicalStudentAssociation(LMSA)• MinorityHousestaff Association• PrideHealth

BreaktheSilence:TimetoTalkaboutRaceandRacism• Facultyneednotonlytheabilitytorecognizeprejudiceanddiscriminationbutalsothetoolstospeakupagainstitwhentheywitnessit

• Don’tavoiddiscussions– befearless• Don’tpretenddiscriminatoryincidentsdon’thappen• Silenceinthefaceofinjusticenotonlykillsanyspaceforproductiveconversations,butalsoallowscancerousideastogrow

Acosta&Ackerman-Barger.Acad Med2016Sep20ePub aheadofprint

CelebrateDiversity

• Advocatefordiversity• Students,residents,faculty

• Advocatefordiscussionsaboutdiversity• Roundtablediscussion• Meettheprofessorsessions

• Theseexpressionsofastrongcommitmenttodiversitygoalongwayandcanhaveahugeimpactonyourinstitution’sculture

CrucialConversations

CrucialConversations

• Whatmakesaconversation“crucial”vs.typical?• First,opinionsvary• Second,thestakesarehigh• Third,emotionsrunstrong

CrucialConversations

• Whydon’tcrucialconversationstendtogowell?• Emotionstendtorule• Yourbodyphysicallyreacts• Weareunderpressure• Wearestumped• Weactinselfdefeatingways

TypicalResponsesinaHeatedDiscussion

• Masking,Avoiding,Disengaging=SILENCE• Controlling/coercing,Labeling,Attacking/Belittling=VIOLENCE

8CorePrinciplesofCrucialConversations

1. Begintorecognizetheconversationsthathaveyoustuck2. StartwiththeHeart:Focusingonwhatyoureallywant3. LearntoLook:HowtoNoticeWhenSafetyIsAtRisk4. MakeitSafe5. Master[yourown]stories6. Learnhowtoeffectivelyshareyourownviews:[STATEyourPath]7. Howtoencourageotherswhentheygetemotionaltosharetheir

ownviewsandgetbacktothefacts[AMPP]8. MovetoAction

#1Recognizeacrucialconversation

• Stuckconversation• Stuckissues• Feelingsof• Anxiety• Fear• Judgement• Anger

#2StartwiththeHeart

• WhatdoIreallywantformyself?Andothers?Therelationship?• HowwouldIbehaveifIreallywantedtheseresults?• Refusethe“sucker’schoice”

#3LearntoLook

• Inthemidstoftheconversation,learntorecognizewhenthingsarenotgoingwell• Stepoutofthecontentoftheconversationandobservehowtheconversationisgoing

#4MakeitSafe

• ConditionsofSafetyMutualPurposeandMutualRespect• Apologize• ContrasttoRepairMisunderstandings• UseCRIB

• Committoseekmutualpurpose• Recognizethepurposebehindstrategy• Inventamutualpurpose• Brainstormnewstrategies

#5MasterYourOwnStories

Seeandhear

TellaStory Feel Act

IncitingEvent

Facts Interpretation Emotion Behavior

#6LearnhowtoEffectivelyShareYourViews

• Shareyourfacts• Tellyourstory• Askforotherspath• Talktentatively• Encouragetesting

#7EncourageOthersWhenTheyGetEmotional• Asktogetthingsrolling• Mirrortoconfirmfeelings• Paraphrasetoacknowledgethestory• Primewhenyouaregettingnowhere

#8MovetoAction

• Decidehowyou’lldecide• Documentdecisionsandfollowup

RolePlay

• Breakintogroupsof3• IdentifyRoles(A,B,C)• A=yourself• B=Chair/Administrator/FacultyMember• C=Observer

• Reviewhandoutdescribingroles• Conversation5mins• Debrief5mins• Changeroles