Reposted: Our Ancestors’ Wildest Dreams: From Slave & Immigrant Families to Ivy League Residents

Updated and reposted from the April 21, 2023 issue of the Transformational Times

Our Ancestors’ Wildest Dreams: From Slave & Immigrant Families to Ivy League Residents  

British Fields, MD and Adriana Perez, MD 

 

Drs. Fields and Perez are two first-generation, underrepresented in medicine (URiM) physicians who navigated a system that once didn’t accept people that looked like them. They describe creating a space of advocacy for patients and future generations of Black and Brown medical students ...

 

“No, I’m not the interpreter. No, I’m not the cleaning staff. I’m a student doctor.” These phrases became all too familiar to us as we embarked on the journey to becoming physicians. We had gone from being praised for being the first doctors in our families, to countless encounters with patients and medical staff assuming we weren't the student doctor because of the color of our skin.  

 

The Culture Shock 

Being first-generation medical students came with a lot more struggles than we anticipated. One of the hardest challenges to overcome was that of being financially disadvantaged. Who knew there would be a whole hidden curriculum requirement? Spending money to get on an equal footing seemed like an impossible task as our families didn’t understand that there was much to becoming a doctor than what was taught in lectures.  

We both soon realized we weren’t in Kansas anymore. The rigor of medical school was something we did not fully grasp until we both failed the first quiz after two weeks of nonstop studying. After many failed exams, we spiraled into four years of secret self-doubt, self-loathing, and imposter syndrome.   

Although these feelings became ingrained in us, we knew that there was a bigger purpose at play here as our patients said “¡Si se puede hermanita, necesitamos mas doctores como tu!” (You can do it little sister; we need more doctors like you!). 

 

Our Commitment to Changing Culture 

While we knew coming into medical school that we were not in the majority, the differences in our identities and background were further amplified. Although these feelings initially weighed us down, we learned to harness and use them as fuel to support each other and other students throughout our journey. We quickly became involved with different organizations at MCW that shared goals of supporting students who are racially/ethnically and economically disadvantaged at the institution, in the community, and eventually at a national level through the Student National Medical Association (SNMA), Latinx Medical Student Association (LMSA), and White Coats for Black Lives (WC4BL).  

 It didn’t always feel like we were having an impact, but we were reminded to continue our work when we heard comments like, “Your story inspired me to take a gap year to retake the MCAT and apply next year!” 

We also sought ways to increase our involvement in caring for historically marginalized and vulnerable communities in Milwaukee. Through the Saturday Clinic for the Uninsured (SCU) and Walker’s Point Community Clinic (WPCC), we were reinvigorated to solidify our place in medicine as patients told us, “You’re the first doctor I’ve had that looks like me.” These were the times that inspired us to keep pushing in moments of self-doubt on patient rounds or failed exams.  

  

The Light at the End of the Tunnel 

At MCW, we found the things that we are most passionate about, mentors who believed in us, and served as role models. We gained the exposure and the tools necessary to continue to pursue our work in addressing healthcare disparities through research and within medical education through teaching and mentoring students at all levels of training.  

No, we are not just future physicians. We are advocates, teachers, mentors, change agents, and hermanas (sisters).  

 

British Fields, MD graduated from MCW in 2023 and is now a Pediatric resident at Harvard University’s Boston Combined Residency Program in the Leadership in Equity and Advocacy Track. 

Adriana Perez, MD graduated from MCW in 2023 and is now a resident in the Yale University School of Medicine Department of Anesthesiology. 

Building a Culture of Health in Health Care and our Community

From the August 4, 2023 issue of the Transformational Times

 

Building a Culture of Health in Health Care and our Community 

Kajua Lor, PharmD, BCACP 

 

We as healthcare professionals and leaders need to recognize that to build a culture of health, we must take off our white coats and meet the community… The neighborhoods we live in, the places we work and play, impact the health of our community…

George Floyd. A Black man who died on May 25, 2020, as a white police officer in Minneapolis knelt on his neck for nearly nine minutes. A name that goes does down in history as a flashpoint of inequities faced by people of color and vulnerable communities. A death captured by a bystander on a video that went viral and sparked one of the largest protest movements in U.S. history, as well as a movement within health care.   

Together, George Floyd and the COVID-19 pandemic revealed the true colors of our broken healthcare systems and the inequities faced by people of color and people disadvantaged by the system.   

 

 

My experience as a Hmong American refugee 

 

As a Hmong American refugee growing up here in Wisconsin, I was oftentimes the only person of color in the room, the only woman in the room, the only pharmacist in the room. I struggled with my identities and many times would feel like I was “lucky,” and I was the “underdog” in many of the spaces that I was in personally and professionally. 

 

Being the “first” and or the “only” person made me question if I could be my own authentic self in the spaces that I was in. Early on in my professional career, I would hide myself and my identities as I felt that showing any vulnerability would mean that I may not be good enough.  

 

Since the COVID-19 pandemic, I’ve learned that life is so precious, that there are so many things to be grateful for, that I can show up as my own authentic self and that I need to know my allies, people who support and are able to create positive influences around me.    

 

When I saw the video of George Floyd’s death, I was shocked, angry and, then, sad. I felt disappointed in humanity. How can I influence change? Where is the love for humankind? What can I do to make things better where I live, work, and play? 

 

I remember a white coworker who said to me, “I don’t understand why those Black people are so angry.” And I thought about my own privilege as an Asian American. Why did they feel comfortable speaking with me? Was it because I was Asian American?

 

I remember being part of a virtual listening circle to create safe spaces to hear from others from the MCW community after the death of George Floyd. I volunteered to participate as a note taker for the circle. I appreciated being a part of this circle as I learned from others in the room about their stories. As the only person of color, I realized that this was a safe space with many allies, raised my “virtual” hand, and said, “As an Asian American woman and leader, I experience microaggressions almost every day at MCW. There hasn’t been one week that I have not had a microaggression.”  

 

Microaggressions happen and are real. Psychologist Derald Wing Sue, who has written two books on microaggressions, defines the term: "The everyday slights, indignities, put-downs, and insults that people of color, women, LGBT populations, or those who are marginalized experience in their day-to-day interactions with people.” 

 

Research has shown that microaggressions, although seemingly small and sometimes innocent offenses, can take a real psychological toll on the mental health of their recipients. This toll can lead to anger and depression and can even lower work productivity and problem-solving abilities. 

 

Some microaggressions I have experienced:  

 

• Patients asking me “Where are you from?”  
• Direct reports seeking recognition from male leadership as my recognition as a woman leader was not “good enough.” 
• After returning from maternity leave, a coworker stated, “hope you had a nice vacation.” 
• A staff member referring to Asian Americans as “Oriental.”  
• After sharing that I was attending a blessing ceremony over the weekend, a colleague saying, “Oooooo! Spooky”  
• A staff member’s written comment about a candidate that they “didn’t speak English good enough.” 

 

Mountain or mole hill? I’ve learned to pick my battles. Will I be working with them in the long term? Is it worth it to say anything?  

 

I learned that one of the officers in the video who was a bystander, watching the death of George Floyd, was Hmong. I remember the hatred toward the Hmong community for letting George Floyd’s death happen. Many Hmong were targeted with death threats. It seemed that there was a perception the inaction by one member of the Hmong community reflected the entire Hmong community. 

 

How do we create change with people who “don’t see color?” How do we change when there are differences in opinion on the approach to building inclusion and belonging? How do we learn from one another and embrace our differences? How can we move forward when we remain behind in the work that we do? 

 

Race was created as a social construct, not a biological construct. 

 

We as healthcare professionals and leaders need to recognize that to build a culture of health, we must take off our white coats and meet the community. 

 

According to the Robert Wood Johnson Foundation, “Building a Culture of Health means working together to dismantle structural racism and other barriers so that everyone has the chance to live the healthiest life possible.” 

 

The neighborhoods we live in, the places we work and play, impact the health of our community.  

 

I’ve learned over the years, working with community, that I can be my own authentic self in the spaces that I’m in and that I need to show up when times get tough as an ally for others. 

 

Each of us has a different story and a different walk of life. We need to embrace each other as humans to be able to “see” one another and develop a deeper understanding -- to learn from one another to be able to move forward.  

 

 

Take action: Practice inclusive leadership  

 

Has the needle moved? Progress has been made; however, the journey has just begun and will continue to be a long one. Many hospitals and healthcare systems have expanded positions and resources to support health equity efforts. Many organizations have provided more budgetary resources and infrastructure in efforts to build health equity.   

 

At MCW, the Office of Diversity and Inclusion developed the Inclusive Excellence Framework. This framework showcases how we all can create communities of safe spaces for others to ensure all feel they belong.   

 

We must develop inclusive leadership skills. Inclusive leadership is defined as “leadership that assures that all community members feel they are treated respectfully and fairly, are valued and sense that they belong, and are confident and inspired.” (“Workplace Inclusion Network – Reflections from our Virtual Roundtables ...”) 

 

Strategies to practice inclusive leadership:  

• Take time to make a personal connection with your team and your patients (if applicable). 
• Develop topic discussions with your team that incorporate inclusive leadership principles. 
• Describe resources for health and well-being. 
• Address fears – listen with empathy. 
• Cultivate compassion for yourself and others.  

 

Spend some time to reflect on equity, diversity, and inclusion:  

• What does diversity mean to me?  
• "When have I or someone else been treated equally, but should have been treated equitably?" (“Discussion Guide DEI: The Basics – Part 1”)  
• Think of a time when you felt excluded. What were your feelings? How did they impact you?  
• Think of a time when you felt included. What were your feelings? How did they impact you?  
• How can I help others to be/feel included? Valued? 

 

Take action:  

In the next month, what one action will I commit to that promotes diversity, equity, and/or inclusion? (i.e., “I will engage in a conversation with someone whose opinions differ from my own.”) (“Discussion Guide DEI: The Basics – Part 1”)  

 

For further exploration: 

 

• This Day in History: George Floyd is Killed by a Police Officer
• Robert Wood Johnson Foundation: Why Build a Culture of Health?

Resources from the MCW Office of Diversity and Inclusion: 

• MCW Office of Community Engagement Introduction and "Quick Links"
• Inclusive Excellence Resources
• Resources to Read and Watch
• MCW Anti-Racism, Equity, Diversity, & Inclusion Glossary

Videos: 

• Reggie Jackson: A History of Race 

Kajua Lor, PharmD, BCACP, is Founding Chair/Associate Professor in the Department of Clinical Sciences at MCW School of Pharmacy. She is a clinical pharmacist at Sixteenth Street Clinic, a federally qualified healthcare center serving Spanish-speaking communities one day per week. Dr. Lor was a fellow of the Robert Wood Johnson Foundation Clinical Scholars Program from 2017 – 2020, a leadership program to build healthier and equitable communities. She is a community-engaged researcher building a culture of health with Hmong refugees.  

 

 

 

 

 

A Reflection on the Impact of George Floyd at MCW

From the July 28, 2023 issue of the Transformational Times

Perspective/Opinion

Has Anything Changed? A Reflection on the Impact of George Floyd at MCW

Precious Anyanwu & Chiemerie Ogbonnaya, Class of 2026

Three years after the murder of George Floyd, medical students Anyanwu and Ogbonnaya offer their perspective on the shortcomings of the American healthcare system, and the racial and ethnic injustices that perpetuate them...

NOTE: Tear gas can be neutralized with about three tablespoons of baking soda mixed with eight ounces of water. It is important to have this mixture in hand before you arrive at a protest because when the gas hits, there will be no time to waste. Remember to carry enough to help wash the eyes of your peers. But most importantly, get out immediately.

This simple recipe has spread from crowds of protestors in Hong Kong to civil activists in Washington DC, all fighting for the preservation of their people.

In the wake of the unjust murder of George Floyd, protesters sought justice at the steps of our government. Instead, they were met with controlled violence in the form of tear gas and police batons. Even with the gas burning their throats, protesters continued to scream for justice. The pain they experienced in that moment was incomparable to the agony of watching yet another Black man lose his life to institutional injustice.

Long before the shocking event that transpired on May 25, 2020, the lives of persons in Black and Brown communities were undervalued and endangered in America. The death of George Floyd, combined with the simultaneous COVID-19 pandemic, amplified how deeply ethnic discrimination and racial inequities are rooted in key American structures. The pandemic disproportionately impacted marginalized communities because of longstanding, systemic inequalities.

Numerous studies have proven that the American healthcare system does not prioritize cultural understanding for ethnic communities. This neglect contributes to an overall decrease in the standard of care and a notable increase in poor health outcomes. Justified mistrust of the healthcare system by these communities is ingrained in history. America’s past is riddled with medical exploitations of racially marginalized communities; recall the Tuskegee experiments and Henrietta Lacks.

The cycle of medical abuse and healthcare avoidance perpetuates chronic illness and shortened lifespans in Black and Brown communities. If American institutions continue to discriminate against marginalized populations under the guise of extenuating circumstances, they will never restore faith in the system and America will remain tainted by its sordid history.

Change starts at the grassroots

Although we have a substantial amount of progress to make as a country, it is important to acknowledge that change starts at the grassroots. In response to George Floyd’s death, the Medical College of Wisconsin implemented several changes to its surgery department centered around prioritizing the principles of diversity, equity, and inclusion.

These changes brought the opinions of marginalized groups to the forefront, introducing pertinent cultural topics that may not have been considered otherwise.

With this seemingly minor adjustment, disadvantaged communities now have advocates speaking on their behalf in spaces that can implement true change. Some cities also chose to pursue action after George Floyd’s passing. For example, Minneapolis reallocated $8 million from its police department to expand mental health crisis response services and Boston chose to invest $12 million into expanding public and social health services.

White Coats for Black Lives

White Coats for Black Lives originated from the national outcry for justice in response to the murder of George Floyd. We aim to safeguard the well-being of our future patients by advocating for the elimination of racialized medicine.

Our ultimate goal is for government officials and civilians across the country to recognize the need for restructuring how America operates fundamentally.

Tangible action against racial inequities is needed. History cannot be rewritten, and the lives lost from injustice cannot be resurrected, but the future can be changed. 

For further reading: 

1. MCW’s Department of Surgery’s response to George Floyd’s death. https://www.mcw.edu/- /media/MCW/Departments/Surgery/DOS-Statement-Racism-Disparities-DSiversity-6-12- 2020.pdf

2. Vasquez Reyes M. The Disproportional Impact of COVID-19 on African Americans. Health Hum Rights. 2020 Dec;22(2):299-307. PMID: 33390715; PMCID: PMC7762908. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762908/

3. Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror- 2021-reflecting- poorly#:~:text=The%20U.S.%20ranks%20last%20on,on%20measures%20of%20care%20process

Precious Anyanwu and Chiemerie Ogbonnaya are in their second year of medical school at the Medical College of Wisconsin. They are currently serving as Co-Presidents of the White Coats for Black Lives organization. Their work emphasizes the importance of outreach and intervention to provide a lifelong space for Black and Brown communities in healthcare.

The Right to Breathe

From the July 28, 2023 issue of the Transformational Times

The Right to Breathe

Michael N. Levas, MD, MS

A pediatric emergency medicine physician advocates for comprehensive and compassionate care in the broader context that health is more than biology – that it encompasses people’s lived experience, their trials, their strengths. As a leader of several diversity, equity, and inclusion initiatives at Medical College of Wisconsin, he also reflects on recent shifts he has observed in institutional culture, and reminds health care providers to be mindful of the social pressures that burden patients and colleagues...

“I can’t breathe.”

These were some of George Floyd’s final words, captured in a bystander video. Through this video, we as a nation also witnessed a dying man call out for his mother.

I often see youth who are scared, and some who feel like they are dying, as a pediatric emergency medicine physician who practices at Children’s Wisconsin. They say, “I can’t breathe” and they ask for their mothers. Watching the video of George Floyd, I felt powerless. But in the emergency room, there are situations where I can do something — I can help their difficulty breathing, we can find their mothers and get them to their bedside.

The risk of becoming numb to social injustices is real. It can lead to harmful health outcomes, even death. The continued traumas our nation experiences are seemingly endless.

Mobilization and hope

There has been a movement within MCW to increase advocacy addressing diversity, equity, and inclusion, including the development of DEI councils within residency programs and clinical departments.

For the first time since I was a medical student at MCW (many moons ago), I feel that it is okay to talk about biases, microaggressions, social determinants of health, and health equity.

In fact, health equity has become a theme of many clinical, educational, research and community efforts at MCW. More grand rounds across campus focus on racism’s impact on healthcare outcomes. Trainees are demanding health equity be woven into curricula. There is more acknowledgement that

health is much more than biology – that health encompasses people’s lived experience, their trials, their strengths.

Within the Department of Pediatrics, over 500 faculty and staff have participated in Implicit Bias Training. Other departments have requested this training, including Psychiatry and Behavioral Medicine, Anesthesiology, Physical Medicine & Rehab, the Admissions Committee, the Joint Fellowship Council, among others.

The Comprehensive Injury Center and Department of Pediatrics recently adopted policies recognizing MLK and Juneteenth as holidays by not scheduling recruitment, training, or lectures during those days.

Barriers are real

But two things are clear: inertia is real, and not everyone is happy with such activism. For every stride we make fighting for equity in health outcomes and health education, a counter narrative is threatened by change.

While we are deliberating about what efforts to implement or back as institutions, youth are dying from firearms, families are losing their homes, and transgender youth are losing faith in the healthcare community.

Some changes that need to be made do not require repeated meetings or committees to implement. Unfortunately, our current healthcare environment has become accustomed to that approach, driven by fear of retribution rather than focus on doing what is right.

“The time is always right to do the right thing,” is my favorite quote from Dr. Martin Luther King Jr. We cannot become numb to the trials that our patients face. We cannot ignore the social pressures that burden our patients and colleagues.

Despite continued barriers and bureaucracy, as health care professionals we must continue to model comprehensive and compassionate care. We need to have the courage to use our privilege as health care providers to speak out against social injustices and our expertise to show the evidence-based approaches that lead to less disparities.

Every living human has the right to breathe.

We need to breathe to stay alive.

We need to breathe life into policies that strive for health equity.

We need to help others to pause and breathe before they are threatened by ideas that lean towards justice.

We need to breathe for those who no longer can.

Dr. Michael N. Levas, MD, MS, is a professor of Pediatric Emergency Medicine, Vice Chair of Diversity, Equity, and Inclusion for the Department of Pediatrics, Medical Director of Project Ujima, Associate Director of the Comprehensive Injury Center, Faculty Advisor for the Latino Medical Student Association, and MCW Faculty Advisor for White Coats for Black Lives.

On Inclusion, Diversity, and Why Black Lives Matter, Too

 From the July 21, 2023 issue of the Transformational Times - "A Look Back"

On Inclusion, Diversity, and Why Black Lives Matter, Too: What our MCW Community BLM Protests Mean to our Colleagues of Color

Leroy J. Seymour, MD, MS

Editor’s Note: Dr. Seymour, currently an incoming Chief Resident in Internal Medicine, was an intern at MCW when he wrote this essay for the Sept 11, 2020 issue of the Transformational Times following Black Lives Matter protests on campus in response to the shooting of Jacob Blake in Kenosha, WI. In giving permission for us to re-publish his essay today, he also shared reflections on what has changed, which are captured in a footnote.

On Wednesday, September 2, 2020 at 5:11pm, members of the Medical College of Wisconsin community held a Black Lives Matter protest to help shine a light on the frequent propensity for violence against people of color. This latest protest is one of hundreds of protests against police brutality and racial injustice that have been occurring in various cities, states, and countries, most recently triggered by the murder of George Floyd on May 25th 2020, in Minneapolis, MN.

So many people have demonstrated peacefully and expressed their voices, all vying for the same dream Martin Luther King Jr. expressed to the world. Almost every aspect of the world’s population has provided an overwhelming outpouring of support of the Black Lives Matter movement; taking the baton and relaying the message that “Black Lives Matter, too” to widespread media coverage and the political stage.

MCW faculty, residents, and medical students alike raised their voices in support of the Black Lives Matter movement. This stance informed the world that MCW and the Froedtert medical community will not tolerate racism, and that racism itself is a pandemic that needs to be eradicated. The Sept. 2nd protest involved holding seven minutes of sustained silence, each minute representing every bullet aimed at the back of Jacob Blake, an African-American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer.

Mere seconds after violence left a man paralyzed, the world responded with outrage and exhaustion, yet another example of the unfair mistreatment of people of color when interacting with those with a perceived position of authority.

Many of us have protested these injustices before. I've protested it before. Our parents protested it before. Our grandparents protested it before. Our ancestors survived and protested it. I’ve stood face to face with the Ku Klux Klan, neo-Nazis, and individuals who have all decided that racial slurs and anger were the best response when asked why they hate people of color or different sexual orientation.

Nobody should have to be afraid to walk outside or live in their own homes. People should not be judged by the color of their skin or their sexual orientation, but by the content of their character. People of every ethnicity, background, or creed, should not have to be afraid for their lives when interacting with police.

With the many communities, committees, social circles, and groups that I belong to, I can single-handedly attest to the importance of diversity, the inclusive nature of MCW, and why having people of varying backgrounds, experiences, and cultures is so critically important to both the health of a community and a medicine brain trust.

As a new internal medicine resident and as an African American, I have witnessed firsthand the most beautiful sides of humanity, and the darkest corners of vitriol. I have cared for patients who have been incredibly appreciative and receptive of my presence, feeling more at ease with talking about their privileged information because I am a person of color. I have also had patients turn me away for the exact same reason.

When I wanted to become a physician, I made a lifelong commitment to improving and protecting my community. I’ve vowed to provide a safe haven for those without a voice, to be a vanguard in the face of hatred, to be the lighthouse in someone else's storm. But when it is you, your family, your friends, or your community who is being harmed, harassed, and violently mistreated, it takes that community to heal the hurt.

It is hard to sustain a thriving and supportive community if that same community refuses to break bread with a particular subset of the population, even when everyone shares the same table.

I am proud to belong to a program and institution that takes a hard stance against institutionalized racism and is incrementally rolling out educational opportunities for those interested in, and in need of, anti-racism education. It is comforting to know that my colleagues and peers support the Black Lives Matter movement and understand the deeper inclusive meaning behind the statement.

However, supporting the movement is only the first step of a marathon many have been running for years. With many cities in various countries now protesting the same cause, only time will tell if our collective voices have resonated, and what changes will result from our collective stance against institutionalized racism and racist ideology.

Myself, my colleagues, and my peers at MCW have already decided which path we will walk, and that is hand in hand with our flourishing, diverse, and inclusive community.

July 21, 2023: I can look back at this essay with pride, as much as it saddens me that it came out of such intense anger for someone else’s suffering. It has been important to my healing to be part of many Diversity and Inclusion efforts at MCW since this was written. Much has been done, but our community isn’t perfect, and there is still much more to do. I am very proud to have been part of organizing events at the American Black Holocaust Museum in Milwaukee for incoming interns a few short weeks ago, and also attended and supported medical students there last fall, during programs that helped others better understand the experience of this historically under-represented population, and how this can frame our approach to providing better medical care. I think it is also remarkable that Juneteenth is now a National holiday, this is progress – Leroy J. Seymour, MD MS

Leroy J. Seymour, MD, MS, is a chief resident in the Department of Medicine at MCW. 

Using Data to Drive Equity in the Learning Environment

From the July 7, 2023 issue of the Transformational Times - Summit on Advancing Equity in the Learning Environment

Using Data to Drive Equity in the Learning Environment: A Discussion of How MCW is Working to Understand our Data 

 

Leon J. Gilman, Tavinder K. Ark, PhD, Michael N. Levas, MD, MS, Karen Mann, and Jerel Ballard, Malika L. Siker, MD 

 

 

The authors were panelists in the Second Annual Summit on Advancing Equity in the Learning Environment on April 20, 2023. The following article summarizes what was presented and discussed, and provides next steps we should take for all students to thrive…  

 

Every student deserves to learn in an environment where they are respected and valued. Unfortunately, data from multiple sources over the last few years reveal that our health science students who identify with groups historically underrepresented in medicine (URiM) experience the learning environment as less supportive and inclusive. Consistent with findings from many other health science schools, these results are not unique to MCW.  As part of our institutional effort to examine how the learning environment may be contributing to these differences, we have been designing data-based strategies to better understand root causes, design tools and strategies to mitigate areas of concern, and monitor changes.  The panelists were tasked with sharing and discussing examples of how we are using data to inform sustainable changes needed to ensure all students and trainees have a learning environment that supports their academic excellence. 

 

Looking at National Residency Matching Program (NRMP) Data (presented by Leon J. Gilman) 

  

Through a partnership with the Office of the Dean from the Medical School, Medical College of Wisconsin Affiliated Hospitals, and the Office of Diversity and Inclusion, data was collected from all residency programs shortly after the 2022 National Resident Matching Program (NRMP) and linked with the Electronic Residency Application Service (ERAS) to better understand how MCW students perceive and are perceived by MCW residency programs through the selection process.  

 

This unique dataset linkage enabled demographics and interview information to be connected to the ranked ordered list of applicants to residency programs. Outcomes of the selection process for female, URiM as a combined group, Black and Hispanic applicants, MCW as unique groups, and non-MCW applicants. The residency selection process was divided into five stages: applications, interview invitations, interviews, being ranked by a program, and matching to a MCWAH residency. 

  

Figure 1 shows overall results for all groups across all stages. Results for 2022 showed an ever-increasing percentage of female, URiM, and Black applications as applicants went through the process. One interpretation of these results suggests that female and Black applications to our graduate medical programs were more likely to be ranked highly. Analyses exploring MCW compared with non-MCW applications showed that female and URiM MCW applications - applicants more likely to be well known to the programs - were more likely to be ranked more highly than their non-MCW counterparts.

Although, in general, Black applicants were likely to be ranked relatively highly, MCW Black applicants were less likely to match to MCWAH residencies (Figure 2). This could indicate that the applicants who are MCW students did not rank MCW programs highly on their own ranking lists because they preferred to train elsewhere. Following this data trend in future years and using other methods (e.g., surveys, interviews and focus groups) will help us understand the underlying explanations and implications of this phenomena.   

 

The Role of Individuals in Advancing Equity in the Learning Environment (Presented by Malika Siker, MD) 

 

As unique individuals who play a role in the learning environment, we can each be intentional in addressing equity by following these 3 steps: 1. Remember; 2. Recognize; and 3. React. 

 

As educators, we must remember that our students may face challenges outside the classroom, clinic, or lab that impact their ability to flourish in the learning environment.  The impact of racism, sexism, violence, prejudice, discrimination, socioeconomic challenges, and more can produce inequities, including access to resources, dedicated time for studying, and attention to mental health. We must cultivate an environment where challenges that impede our students’ success are reduced when possible so that students can focus on becoming excellent health professionals. 

 

Data can expose the systemic contributions to inequities in education and how each of us, as individuals, may be contributing to this.  We should recognize and productively examine our own individual biases, faults, and imperfections.  While these should not define us as educators, what we do to mitigate them will.  There are many tools to assist us in doing this work. One research-based tool that has been used to better understand individual unconscious biases and build curricula to mitigate the negative impacts of such biases on educational programs is the  implicit association test through Harvard University and other sites. Other individual data to monitor and explore include the diversity of the students we mentor, evaluating the language used in letters of support for bias, and considering which businesses we support. 

 

Finally, we each need to react by seeking ways to have an impact within our circle of control and by expanding our circle of influence while advocating for those who may not have the same privileges or power. In the spirit of continuous improvement and lifelong learning, we can check in with ourselves and hold ourselves accountable by tracking our own data.   

 

We have an individual responsibility to remember the importance of addressing equity, recognize how our individual behaviors can reveal bias or prejudice -- either implicit or otherwise -- and react to mitigate our shortcomings.   

 

Individual data is a powerful tool for understanding the scope of these inequities, empowering change, and ensuring accountability so that our community is a place where all students have the opportunity to thrive.  

 

How Clinical Departments use Data to Ensure Equity (Presented by Michael Levas, MD) 

 

The Department of Pediatrics (DOP) uses data in diversity, equity, and inclusion (DEI) efforts at the department level in many ways. Recently, the DOP fielded an anonymous survey of the entire faculty and staff. Much was learned through this process about the various identities held by members of the department and the range of opinions on DEI efforts. Of the over 250 responses (45% response rate), over 95% supported continued DEI efforts. This finding suggests that while our current efforts align with the majority of the DOP, input from those who are less supportive of the DEI efforts will be considered to tailor future practices and tactics intended to enhance our institutional culture. The DOP also follows participation in DEI trainings actively within each section and uses that data to offer targeted solutions for increased participation.   

 

Acknowledging both the need to address well established inequities based on national historical data and the imperfection of current data tracking systems, the DOP is moving forward with tactics intended to increase diversity and representation while striving to continually improve the data collection. 

 

What data are we missing? (Discussion among panelists and audience) 

 

We need to understand the context of what and why we see the data we do see. National data gives us one perspective. But local data is needed to round out the picture and address local issues. There is so much we do not yet know. For instance, what is the percentage of URiM applicants that apply to our residency programs?  Is MCW above or below those averages? Who is being accepted for interviews? Of those that do match and decide not to stay at MCW, is this a success story or something to be concerned about? 

 

The Panel Discussion 

Through the panel discussion, we learned that many participants demonstrated curiosity about the data and potential underlying root causes for the trends that emerged.  We sought to provide transparency and opportunities for discussion with the diverse group of stakeholders present in the audience. As panelists, we presented the data so that the audience could see what is available to us, including the data’s strengths and limitations, what we are discovering through integrating data from different sources, how we are approaching data analysis, and the potential these efforts have in informing our DEI work. 

 

After engaging with the probing questions from the moderators and panel audience members, a prevailing theme emerged.  We learned how important it is to clearly describe our data collection as well as our wrangling and analysis methodology in order to engage the community in interpreting the findings and refining the insights. In this way, we can ensure that our work provides tangible, valid and inspiring support for progress toward our institutional goals. 

 

Overall, there are several takeaways from our panel presentations and the community discussion that followed:   

 

• First, we should not let perfection become the enemy of progress, an all too easy trap to fall into. While the data is not perfect, we must continue to collect it and strive to improve the data quality and processes without stalling progress. 
• Second, advancing equity in the learning environment is not the responsibility of one office. Each one of us has a role in contributing to achieving equity. Collaboration is a powerful way to make impactful change.  
• We will strive to combine different data sources to get an ever more robust, meaningful, and complete picture of the learning environment. 
• It is essential to continue to collect data at all levels for the purpose of working to develop tools, strategies and interventions to mitigate the measured inequities.  

 

At every level of an institution, we can use data to help all students thrive in an equitable learning environment.  

 

 

Leon J. Gilman is a Data Analytics and Research Specialist in the Office of Diversity and Inclusion and the Center for the Advancement of Women in Science in Medicine at MCW.

Tavinder K. Ark, PhD, is the Director of the Data Science Lab at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Michael N. Levas, MD, MS, is an Associate Professor in the Department of Pediatrics at MCW. He is also the Vice Chair for Inclusion, Diversity, and Equity in the Department of Pediatrics.

Karen Mann is a Learning Specialist III in the Office of Diversity and Inclusion at MCW.

Jerel Ballard is a Communications Consultant for the Office of Diversity and Inclusion, the Center for the Advancement of Women in Science and Medicine, and the Office of Student Inclusion and Diversity at MCW. 

Malika Siker, MD, is an Associate Professor in the Department of Radiation Oncology at MCW. She is also the Associate Dean for Student Inclusion and Diversity.