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.  

 

 

 

 

 

Reflecting on My Journey to Women’s Health Care a Year After Dobbs

From the July 14, 2023 issue of the Transformational Times - One Year post Dobbs

Reflecting on My Journey to Women’s Health Care a Year After Dobbs

Amy H Farkas, MD, MS

Dr. Farkas shares her longtime passion and perspective on the advances and freedoms in women’s health care, both locally and globally, as the nation marks one year since the Supreme Court ruling on Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion...

My path to women’s health care began in 9th grade world geography class. Mr. Nickels required us to report on a current world event each week, which meant I often found myself reading the world news section of the Kansas City Star. One day, as I read a story about the treatment of women by the Taliban in Afghanistan, I found myself wishing I could do more to help women around the world. Recognizing that I would not be traveling to Kabul any time soon, I decided to call my local Planned Parenthood to volunteer. I honestly can’t remember if I even knew what Planned Parenthood did, other than I had a vague understanding they were active in women’s health care and were a lot closer than Afghanistan.

My first job as a volunteer was to learn about local anti-abortion groups, specifically the Army of God, an organization known for acts of violence against abortion facilities and clinicians. I was shown pictures of known members in hopes that I could pick them out from the mostly peaceful protestors. Within a few weeks, I was the Saturday morning clinic escort. My main job was to stand opposite the protesters who showed up each Saturday and be a friendly face to women who were coming for care. Most Saturdays it was just me and the security guard standing across from five to fifteen protestors who were yelling and holding signs.

My time as a clinic escort was mostly uneventful. The police would frequently drive by and sometimes park across the street until everyone had gone home. But there were incidents of violence, real and threatened. One day, the clinic had to close when all its windows were shot out. Another day, it closed when someone committed suicide in the parking lot in protest. My fellow escort had a rock thrown at her head. Most staff at the facility had their pictures published on the internet by anti-abortion groups, and my picture might have been out there, too.

I remained a volunteer for Planned Parenthood throughout high school. In college, I founded a chapter of Planned Parenthood’s student advocacy organization. While I entered college as an international studies major, my time with the student advocacy organization grew my passion for women’s health care and specifically, reproductive care. It inspired me to pursue medicine.

I was fortunate in medical school to meet another educator, Dr. Melissa McNeil, a general internist, and leader in women’s health, who became my mentor. Throughout medical school, residency, and fellowship, she helped foster my knowledge and skills in clinical women’s health and the practice of academic medicine. She also connected me to the VA.

Since I began working at the VA in 2018, I have become convinced there is no other healthcare organization in the US more committed to serving women’s health care needs. You may find this surprising, given the military and VA's reputation for being male dominated.

Yet, women Veterans represent the fasting growing demographic group within VA, and the VA invests in their care across all its missions. It supports women’s health fellowships for physicians, researchers, psychologists, and nurses. This, in turn, helps grow the next generation leaders in academic medicine and women’s health. It funds research in contraception, maternal mortality, intimate partner violence, and breast cancer. It offers targeted educational programs for primary care teams, including physicians, APPs, and nurses to ensure they have the skills necessary to provide comprehensive, gender-specific care.

And in the post-Roe v. Wade world, the VA committed to ensuring women Veterans have access to the full range of reproductive health, including access to abortion care to “promote,preserve, or restore the health” of Veterans.

To achieve this goal, educators will be key to success. Educators will be the ones who translate government policy into clinical practice. They will teach clinicians who likely have never engaged in pregnancy options counseling and certainly not abortion care to provide compassionate and comprehensive reproductive health care. This change at VA will take time, and there are many pieces left to be figured out. But the VA's commitment to women’s health gives me hope that in the post-Roe world, medicine will not allow six justices to define health care.

The VA’s commitment to all aspects of women’s health care takes me back to my early passion to serve women’s health, both locally and globally. Thankfully, American women have far more options than were allowed to their counterparts living under the Taliban, both then and now. I am reminded that the advances and freedoms in women’s health remain only when we fight for them.

As a physician and educator, I can do my part in my clinic with my patients and in the classroom with students by helping to ensure the next generation of physicians have the necessary skills to provide comprehensive care to women. I’m grateful to have the VA as an ally in my own work to ensure health freedom for women.

Amy H Farkas, MD, MS, is an associate professor of Medicine at the Medical College of Wisconsin and works clinically as a women’s health primary care physician at the Milwaukee VA Medical Center. She also serves as faculty at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, where she is Director of the KICS program and part of the GME Pillar.

Navigating Difficult Terrain One Year After Dobbs

From the July 14, 2023 issue of the Transformational Times

As Predicted, Things Have Gotten More Complex: Navigating Difficult Terrain One Year After Dobbs

Adina Kalet, MD, MPH and Elizabeth (Libby) Ellinas, MD, MS

It has been a year since the US Supreme Court ruled in Dobbs vs. Jackson Women’s Health Organization. As director of an institute dedicated to the transformation of medical education with character, caring, and competence and the leader of our institution’s Center for the Advancement of Women in Science and Medicine, we are monitoring the cascade of consequences these changes are having. We continue to believe that robust discussion, dialogue, and debate surrounding this complex issue is essential. In this spirit, we once again invited a range of authors to share their perspectives with the Transformational Times ...

In the June 24, 2022 issue of the Transformational Times, anticipating that the US Supreme Court would overturn federal protections of access to abortion, we predicted that the healthcare landscape would become more complex. We have not been disappointed. This ruling has already had significant nationwide impact. The intended and unintended consequences continue to evolve.  

The legislative pot continues to roil. Abortion is now illegal in thirteen states with a few going as far as criminalizing health professionals for offering abortion care. Sixteen states have voted to affirm some sort of abortion rights, with Michigan, California, and Vermont making abortion access part of their constitutions. As of June 13, 2023, nearly 700 abortion bills had been introduced, split evenly between those that would expand and those that would restrict access. This has significant implications for medical education and the health of the public. 

The Dobbs decision is affecting where physicians train and work

Physicians, as a group, are strongly committed to preserving professional autonomy. Independent of party and religious affiliation, data demonstrate that we suport ensuring patients receive the best individualized care possible. To the extent that physicians see abortion bans as interfering with the doctor-patient relationship—which is built on the trust that there will be absolute respect for privacy, confidentiality, and a commitment to shared decision making—physicians may choose to practice in places where they can share with their patients all available reproductive healthcare options.

In a recent survey of physicians (Vinekar, 2023), 82% of respondents reported that they preferred to work or train in states with preserved access to abortion. Seventy-five percent of both physician and trainee respondents report that they would not even apply for a job in a state that imposed legal consequences for providing abortion care. Early data from this last national residency match show fewer applications to residencies in the most restrictive states (across all specialties), although the residency program “fill rates” remain stable. There has been 5% drop in the number of students applying for OB/Gyn residencies. While it will take years to see how these trends manifest, they are especially worrisome for underserved rural states and urban areas already at risk.  

In states with strict abortion bans, access to healthcare was falling prior to the Dobbs decision. These are states with the fewest physicians per capita and places where rural hospitals have been closing at alarming rates over the past decade. Wyoming, Mississippi, West Virginia, and Kansas already lose more than 40% of college graduates to other states. This “brain drain” is predicted to worsen if young people perceive that their personal autonomy is threatened. 

One in four women in America will need a pregnancy-related procedure during her lifetime. As of August 2022, 44.8% of accredited OB/Gyn residency programs are in states moving to ban abortions. This means that a significant number of physicians who are committed to providing OB/Gyn care will need to travel to learn to do routine procedures. This has implications for medical education and health care nationwide. 

Medical education and physician organizations are advocates

In June 2022, the AAMC released a statement regarding the Dobbs decision, predicting that it would “significantly limit access for so many and increase health inequities across the country, ultimately putting women’s lives at risk, at the very time that we should be redoubling our commitment to patient-centered, evidence-based care that promotes better health for all individuals and communities.” In the ensuing year, the AAMC’s Group on Women in Medicine and Science (GWIMS) and Medical Education Senior Leaders (MESL) have create a joint Reproductive-Health Task Force which produced a white paper (look for it soon on the AAMC Reproductive Health web page), and a series of webinars to discuss those consequences to reproductive health. You can access a recording of the first webinar here and sign up for the second webinar, which looks at the Dobbs’ decision’s effect on education here.  

The AAMC is taking a data-driven approach to the effects of Dobbs on medical students, residents, and residency selection. The Task Force is considering adding two questions to the Graduate Questionnaire that is completed by all students as they finish medical school; those questions would assess whether and how the Dobbs decision influenced their choice of specialty and location. The AAMC sees reproductive health under Dobbs as “complex and challenging for patients, providers, and learners” and will continue to provide support to the academic medicine community as we continue to navigate that complexity.

Jesse Ehrenfeld, MD, MPH, the newly-installed President of the American Medical Association and a member of the MCW faculty, reiterated in his inaugural speech and in an interview, the AMA’s position. “Let me state unequivocally that we oppose strongly the interference of government in the practice of medicine. And we oppose strongly any law that prohibits a physician from providing evidence-based medical care that is in the best interest of their patients.” 

In our essay one year ago in the Transformational Times, we acknowledged that our salaries and status would allow us to travel out of state if we or our families ever needed restricted care, a privilege to which many others do not have access. Many, including the American Bar Association attest to this “exacerbation of wealth disparity.” In addition, not all insurance policies pay for contraception or abortion. These potential out-of-pocket expenses—plus travel, childcare, hotels, and meals—add up, and are prohibitive for many, especially when emotionally-fraught decisions must be made quickly, work issues managed, and resources gathered. In response to this need, some companies now offer abortion travel coverage for employees in states with restrictive laws, decreasing the costs for employees at those companies. 

Preparing our students to be adaptable and engaged 

Times like these—defined by rapid change and complexity—can lead us to be both weary and wary. To care for our patients and educate our students, we need to monitor rapid changes in law, practice, and local regulation. This can make us weary. When the issue is as controversial as abortion, many of us become wary of being drawn into contentious, difficult conversations. However, we know that if physicians do not engage, the public will be worse off.  

Abortion is only one of many controversial, increasingly politicized concerns that will impact the practice of medicine over the coming era. To support our future healthcare professionals to flourish and lead, we will need to help them (and us) learn to adapt to—rather than simply comply with—rapidly evolving and challenging situations. 

Learning adaptive behavior requires intellectual skills best built through facilitated civil discourse. Woodruff (2023) at the Pritzker School of Medicine at the University of Chicago, developed a Growth Oriented Pedagogy aimed at enhancing adaption and based on a rigorous form of civil discourse. The curriculum prepares trainees to face complex real-world problems (such as well-being, career choices, and diversity, equity, and inclusion), and engages them as individuals in grappling with and learning to adapt to complex challenges. The pedagogy they have developed is both highly conceptual and pragmatic. It guides students to maintain their strong connections with the meaning and purpose in their chosen work, especially as the environment around them is undergoing rapid change. 

The Kern Institute’s Philosophies of Medical Education Transformation Lab (PMETaL), building on the work of Woodruff, is working to develop frameworks for, and faculty development to, support implementing such a growth oriented, civil discourse-based pedagogy for our new school of medicine curriculum.  

As healthcare providers, our opinions matter and we must communicate effectively to both policy makers and the public. In order to do so, our immediate work must include preparing students and physicians to engage in respectful and intellectually rigorous conversations that effectively cover difficult terrain. By doing so, we will improve the health of our communities, care for ourselves, and preserve the autonomy of the profession for future generations.  

For further reading:

Mengesha B, Zite N, Steinauer J. Implications of the Dobbs Decision for Medical Education: Inadequate Training and Moral Distress. JAMA 2022;328(17):1697–1698. doi:10.1001/jama.2022.19544

Grover A. A Physician Crisis in the Rural US May Be About to Get Worse. JAMA 2023;330(1):21–22. doi:10.1001/jama.2023.7138

Verma N, Grossman D. Obstacles to Care Mount 1 Year After Dobbs Decision. JAMA. Published online June 23, 2023. doi:10.1001/jama.2023.10151 

Vinekar, Kavita MD, MPH; Karlapudi, Aishwarya BS; Nathan, Lauren MD; Turk, Jema K. PhD, MPA; Rible, Radhika MD, MSc; Steinauer, Jody MD, PhD. Projected Implications of Overturning Roe v Wade on Abortion Training in U.S. Obstetrics and Gynecology Residency Programs. Obstetrics & Gynecology (August) 2022; 140(2):146-149. | DOI: 10.1097/AOG.0000000000004832

Woodruff, James N. MD1; Lee, Wei Wei MD, MPH2; Vela, Monica MD3; Davidson, Arnold I. PhD4. Beyond Compliance: Growth as the Guiding Value in Undergraduate Medical Education. Academic Medicine (June) 2023; 98(6S):S39-S45. | DOI: 10.1097/ACM.0000000000005190

Adina Kalet, MD MPH, is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Libby Ellinas, MD, MS, is Professor of Anesthesiology, Associate Dean for Women’s Leadership, and Director of the Center for the Advancement of Women in Science and Medicine (AWSM) at the Medical College of Wisconsin.

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.