Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

From the January 27, 2023 issue of the Transformational Times

Perspective/Opinion

Reflecting the Change You Want to See – The Importance of Involvement in Equity and Inclusion Initiatives

By Michael Stout, Ed.D. – Master of Science in Anesthesia Program Director

The importance of diversity and equity in our organization is demonstrated by our values. But how we invest our time is where real change is cultivated… 

Diversity, Equity, and Inclusion goals are often easier to design than they are to achieve. We value their importance, yet gaps persist. These issues were seldom mentioned when I first entered graduate school. More recently, I would be hard-pressed to find a college leader who does not support DEI initiatives. It appears we renewed interest and enthusiasm for addressing gaps and inequality wherever they exist, including our college campuses. Creating a thriving community built on principles of respect and inclusion remains an institutional priority, but how can we make it imperative? The benefits of participation in DEI initiatives can extend beyond individual growth and development and promote positive change beyond our role. 

Admittedly, I have struggled to find time to participate in development programs. There are countless instances when I have received an email and thought, “That sounds interesting. I would really like to attend that event” only to be pulled immediately back into the consuming list of my daily tasks. Inevitably, the date passes without consequence. While missing an opportunity is usually disappointing, the explanation that other activities were more pressing suffices to allay my concern. However, the impact my non-participation has on my team, and the larger organization, is often missed. A person’s priorities can be discerned by where they spend their most precious resource, their time. How could my faculty, staff, and students understand my support of DEI initiatives, if they do not see me participate? 

These programs are designed to help move our organization

The resources dedicated to them aim to transform our campus community and achieve outcomes that align with our values. As an academic leader, I wish for everyone in my unit to attend these events. I welcome the transformational ideas they bring back to our team. But if I choose not to participate, why would I expect that anyone else will? Therefore, my decisions have expanding ripple effects. These decisions not only impact my own development, but can also impact my team, and the larger organizational culture. 

There is growing evidence that improving diversity yields benefits in both private and public institutions. To this end, I pledge to attend an IWILL event to broaden my views on gender. These programs present opportunities to demonstrate our commitment to improving organizational culture. I am grateful for all the hard work, generously provided, by those who organize and attend them. 

While the demands upon our time are likely to remain unchanged, investing in these initiatives can help close the gap between the aspiration for change and its achievement. 

Michael Stout, EdD, is an Assistant Professor in the Department of Anesthesiology at MCW, a Certified Anesthesiologist Assistant, and Program Director for the Master of Science in Anesthesia Program at MCW.

Reflecting on medical school and residency

 From the 6/11/2021 newsletter

Perspective

Reflecting on medical school and residency

By Buba Marong, MD

Dr. Marong reflects on his journey of gratitude through MCW as a student and resident.  

It has been quite the journey, these past seven years. As I conclude what I considered to be the most meaningful endeavor of my adult life, I am filled with a range of emotions, but perhaps the sentiment that overshadows them all is GRATITUDE. I am eternally grateful for the opportunity and privilege to realize this childhood goal of mine in this faraway land. A land so far away from where I grew up, yet it never quite feels foreign to me. America always feels like home to me because I consider myself so lucky to have crossed paths with some amazing human beings; human beings whose impact on my growth - both personally and professionally – has been immeasurable. 

“Buba! Very nice to meet you.” That was how Jennifer Haluzak, then the admission coordinator at the Medical College of Wisconsin (MCW), greeted me during our first encounter when interviewing for a position in the Class of 2018. I usually remark that it doesn’t bother me at all when folks butcher my name, and I mean that. But there was something about how perfectly she pronounced my name that made me feel right at home. That sentiment of feeling right home would stay with me throughout medical school. I am painfully cognizant of race relations in America, and I must admit that I mentally prepared myself to tackle both the overt and covert issues in medical school and residency. Fortunately, it was preparation that I never needed, for all my interactions have been filled with genuine and mutual respectful curiosity and admiration. 

It should be no surprise then that residency selection was an easy choice for me. Medical College of Wisconsin Affiliated Hospitals (MCWAH) was my number one and only choice. I knew if I was willing to put in the work and time, I could garner the requisite skillset necessary to become the kind of physician that I knew I wanted to be. I was lucky to be surrounded by colleagues and educators who are just as passionate about their craft as I am. There is something special about the Internal Medicine residency class of 2021. As a function of my family obligations, I didn’t get to interact with folks that much outside of work, but there is an indescribable warmth about this class and an eagerness to be there for each other. I will greatly miss listening to Curren’s quiet wisdom, catching up with Kam in the hallways about family, and Matt giving me a hard time about that one award that he thought I stole from him.

When I look back at my residency, though, perhaps the turning point for me was formative feedback I received from my favorite attending and mentor, Dr. Jayshil Patel. I had solicited feedback at the end of a rotation, and he told me to be “comfortable with being uncomfortable.” He went on to elaborate that true growth only comes about through putting oneself through intellectually uncomfortable situations. I took that to heart and read the entire Annals of Internal Medicine Clinic Series (for example) to shore up my foundational knowledge. I re-read basic biochemistry again (at least the components with pertinent clinical applicability). I was appreciative of that formative feedback. At the time, I didn’t understand it as being “called out” for becoming complacent, and there was a reason for that, which brings me to my final point and a challenge to all my fellow educators. 

Giving trainees formative feedback should be considered a privilege. A privilege that is only earned after establishing with said trainee that you genuinely care for their personal and professional growth. Take some time to get to know your trainees. What drives them to do what they do? What are their biggest fears? What makes them happy and/or sad? Have they lost someone close to them recently or in the past? Is their family doing okay?  I am fervent believer that if the very first time that you have any meaningful non-work-related conversation with a trainee is to give them feedback, the chance that those tips will land on a receptive ear is slim to none. Instead, the sentiment you expressed will merely serve as a fodder for venting to the next willing listener that the trainee can find. 

To the graduating class of 2021, I challenge you all (myself included) to please use your new-found status and privilege in society for the common good.  Start with the simple things: Be the best friend, partner, son, daughter, parent that you can be and let your north star always be DOING THE RIGHT THING! 

Buba Marong, MD is a PGY3 Internal Medicine resident at MCW. He founded the Marong Health Group with the goal of establishing quality and affordable primary health care clinics in Gambia.  He will be practicing hospital medicine in the Milwaukee area.

Learners and Justice: Our Present and Future

From the 12/4/2020 newsletter


Learners and Justice: Our Present and Future


Joseph Kerschner, MD – Dean, EVP, and Provost of the Medical College of Wisconsin



In a Leadership Plenary Address as the Chair of the Board of Directors of the Association of American Medical Colleges (AAMC), Dr. Kerschner explains the importance of listening to our learners, creating culture change, focusing on diversity, committing to being anti-racist, and transforming medical education.


Dr. Kerschner gave his address on November 17th, 2020 and the video of his full address is available here and the complete transcript is available here.

The AAMC is a unique organization with a unique position to influence medical education, research, and our nation’s health. I have always tried during my leadership year on the AAMC Board to put learner topics front and center, because at the very core of the AAMC, our organization needs to be about our medical students and residents who, after all, represent – not only our future – but our present. And, when given a voice, they provide important insights and identify solutions to our current challenges. Below are three topics students identified as the most important areas for emphasis by our medical schools, academic health systems, and the AAMC.



The first area we must tackle is learner well-being

This is at the top of my list. We simply cannot be satisfied with the state of our overall learner well-being. Although there are encouraging trends, the level of depression and distress for physicians (and other health care professionals) remains enormously high, and difficulties become manifest early in one’s journey to becoming a physician. There is not a single one of us who does not have a personal responsibility to actively reduce barriers to mental health access and to remove the stigma for those seeking healing as they struggle with mental health, addiction, and other related concerns.


Changes to curricula and assessment are making a difference. We must improve learning environments and assess how we provide instruction and evaluation. I personally believe that the recent change to pass/fail for the Step 1 exam will have a positive impact.

But we must do more to explore access to mental health resources, financial support, and milestone-based curricula that will provide more flexibility to our learners as they progress in their development. I believe we must provide the ability for a student to finish medical school and residency in less time – or more time – than the “standard number of years,” depending upon her or his previous experiences and aptitude.


Changing the culture to address well-being

We can change our cultures, in part, simply by bringing the conversations forward and highlighting the importance of engaging in this manner. The currency of leadership is time — and, as leaders, if we do not spend time on this issue, we will devalue the importance of well-being. Have we stressed the importance of taking time for oneself and one’s loved ones with the same passion that we have stressed completion of the latest research project or preparation for the next presentation on rounds? Do we intentionally “clear the deck” to talk to our struggling colleagues to provide guidance, resources, and support?

Well-being and mental health are broad topics that demand systemic approaches, yet I believe that the most critical systems change we need — throughout medicine and education — is a change in our culture. Until we enable our culture to truly see those who are suffering, remove all negative connotations, and offer what is needed to support our colleagues, we will continue to risk our own and our colleagues’ mental health and wellness.

A favorite saying of mine is, “Our attitudes influence our perceptions, which in turn create our realities.” The message here is that we can change our culture so that the health and well-being of our learners — and, really, all who pursue health and science careers — will improve!



The second area we must tackle is student debt and transition to residency

Often linked to well-being for our learners is overall debt and residency opportunities — or competitiveness. I will focus here mostly on the overall debt of our learners.

The US is an anomaly in the world, in which those who have chosen to dedicate their lives to the practice of medicine are often asked to take on an enormous debt burden before they even begin to see patients. We have resisted solutions, because, the thought process goes, physicians are well-compensated and can afford to pay back loans. In addition, many medical students come from relatively privileged backgrounds. There is some truth in these assertions. However, if we seek to encourage diversity among our medical workforce, how many potential students from less advantaged socioeconomic backgrounds never even consider medicine because, early on, they learn of the overwhelming cost and debt?

I believe that if medical school debt could be limited through means-based support of those with fewer economic advantages, we would see progress in well-being and a more diverse workforce. A legislative solution would require a realization that medical students are a national treasure that deserves our support.



The third area we must tackle is student diversity

Our students view medical school diversity as a critical area to strengthen education, improve health outcomes, and bring much needed racial and social justice to our society. As a nation, we simply have not made enough progress in this regard. For example, the matriculation rate for Black and African American men has not made any appreciable progress in fifty years!

Racial concordance between patients and providers can contribute to better patient communication, satisfaction, and trust — and that these attributes and others can provide at least a part of the solution to the lack of equity in health outcomes. We must construct our admissions processes, pipeline programs, and support systems to enable this reality. I believe that our medical schools and institutions must become truly anti-racist. We must establish institution-wide practices that address unconscious bias in all faculty, staff, and learners.



How I learned a diversity lesson

When I became Dean nearly a decade ago, there were many who were willing to work on equity, diversity, and inclusion; enhanced structures to measure pay equity; changes in policies influencing the manner in which inequities were handled; and institution-wide unconscious bias training for every leader, student, staff member, and faculty. We doubled the number of underrepresented in medicine matriculants. We enhanced our pipeline programs, and students of color specifically shared with me their heightened feelings of inclusion at MCW. Leadership diversity improved, thanks to conscious efforts in faculty hiring and leadership searches. On the financial side, an annual process was instituted to rectify gender-based and other inequities. And we were in the early stages of developing the Center for the Advancement of Women in Science and Medicine, which would soon become a reality. We were gaining momentum.


Then, six years ago, a group of MCW medical students raised their concerns about police brutality, the Black Lives Matter movement, and racial injustice. They requested support from my office for a local “White Coat Die-In” — a national initiative in 2014 that many listening today will remember. My office was supportive and helped arrange for the most prominent location at MCW’s Milwaukee campus for this to occur — the entrance to our Medical Education Building.

The event took place and received some local media coverage. Although I was well aware that MCW still had a great distance to travel, I remember believing that this student-led “die-in” was yet another example of MCW’s progress on its journey to becoming an anti-racist institution.


Fast-forward to 2020: Like the rest of the world, we watched the coverage of George Floyd’s senseless, horrific, and tragic death and read about the ongoing issues of police accountability. We convened a Town Hall meeting and panel, including expert opinions on racial justice and steps to move forward. The conversation was honest and, at times, raw, but action-oriented — qualities that I believe embody a maturing, questioning, and vibrant organization.

One of the panelists, a person of color who had been a student at MCW during the 2014 “die-in,” provided her impressions of the event. She stated that she felt the event was an enormous disappointment. Why? Because of low turnout; the overall lack of dialogue about the event by leaders and the broader MCW community; and a general sense that this issue was not important at MCW.

And she was right.

Hers was the true story — not the one I had told to myself six years before. It was not the “comfortable” narrative which I had constructed at the time of the die-in that rewarded my need to see progress.

I logged off the Town Hall and reflected on the “uncomfortable” place where I now was — and what I should have done differently. I cannot say it any better than did Bryan Stevenson, author of Just Mercy, when he suggested that we must “get proximate” to the issues at hand. My own misinterpretations of student reactions following the “die-in” in 2014 were partly a result of my lack of proximity. I needed to acknowledge the former student’s story and engage in additional dialogue. But, more importantly, I needed to take concrete and meaningful steps forward to make MCW an anti-racist institution.



My challenges to you

My ask of you is threefold:

• First, if you are in an educational leader, always ask, “How will this decision impact our learners?” but, before answering, actually listen to some students to ensure that you have it right. 
• Second, if you are a learner who is worried about not being heard, find faculty allies. It might be hard, and might seem “risky,” but it is important. 
• Third, if you are neither a major decision-maker nor a learner, ask how you can be a better ally for our learners, because they do matter. 

How we listen and provide this support has the potential to change everything in medicine.

Every institution is trying to enhance social and racial justice. We still have a long way to go, and we have made far too little progress, but it is critical that we seize the moment now and not lose this momentum. If we hope to more rapidly “bend the arc of the moral universe toward justice,” as the Rev. Martin Luther King, Jr. so eloquently told us, we must all continue to engage in dialogue, thought, and action.


I would encourage us all to work to elevate the voices of others. We must increasingly see how the judgments we impart, the ways we consciously or unconsciously behave, and the decisions we make, will move us to make progress toward an inclusive, equitable, and healthy environment for all.







Joseph E Kerschner, MD is Dean, Executive Vice President, and Provost of the Medical College of Wisconsin. He is a Professor in the Departments of Otolaryngology & Communication Sciences and Microbiology & Immunology at MCW. These remarks are excerpted from a longer address delivered on November 17, 2020 at the 131st Association of American Medical Colleges (AAMC) meeting in his role as outgoing Chair of the Board of Directors.

Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

 From the 10/30/2020 newsletter

Student perspective

 

 Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

  

Morgan Lockhart, MCW-Milwaukee medical student

 

 Ms. Lockhart shares what she has discovered about research gaps, cultural microaggressions, and her vision as a medical student and descendent of the Cherokee Nation …

 

 Boozhoo MCW,

 A novel coronavirus swept the nation and, along with it, many standard summer research opportunities. As a member of the lowest socioeconomic status, unemployment was not an option for me. Since research is one of the forefront pillars of MCW, I decided to pursue research in a field of interest and passion: exploration of my Native American heritage and culture, as I had never had the opportunity to immerse myself previously. After weeks of networking, I found the Great Lakes Native American Research Center of Health (GLNARCH) and was accepted into a research internship created and funded by the Great Lakes Inter-Tribal Council (Glitc). I was the first school of medicine applicant, and I could not be more honored and elated.

 Throughout my life, procuring health insurance, let alone quality insurance, has been an ongoing struggle: I have always been enrolled in public low-income state insurance or been uninsured. This influenced my decision to develop a research project studying health care coverage rates among Native Americans. Based on interest and compatibility, I was partnered with a mentor, Margaret Noodin, MFA PhD, a member of the Ojibwe Tribe and Professor of English and American Indian Studies at the University of Wisconsin-Milwaukee. Due to SARS-CoV-2 disproportionately affecting residents on the reservations, my project needed to be based virtually. My research objectives evolved into a literature review to identify specific barriers that prevent access to and utilization of healthcare coverage and policies among Native Americans.

 In addition to mentoring my research, Dr. Noodin had several other students working on GLNARCH projects. We all convened weekly through virtual meetings. I had the opportunity to network and develop professionally and culturally with my peers. These relationships continue to prosper and we rely on one another, which I found paradoxical because of the importance our society places on egocentrism. The sense of community and proudness of one another goes beyond the individual; it is ethnorelativism, indicative of indigenous culture.

 From Kindergarten to M2 year, I have been one of few, if not the only, Native American in my entire education system. Microaggressions borne out of envy and ignorance have referred to me as a “Native token” or under the baseless accusation that my tuition is financed from “Native American-owned casino profits.” For the first time, I was surrounded by individuals that shared not only my heritage, but unnervingly similar life experiences. For the first time, I was a puzzle piece that was congruent with the edges of those around me.

 After reviewing the literature, I was disheartened to realize how few empirical research studies identified by the NIH National Library of Medicine have focused on the health of indigenous populations in the US. The few articles that have specifically studied indigenous people often amalgamate all tribes into one, despite each being a separate, sovereign nation. It is patronizing and disrespectful to assume the needs of one tribal organization are comparable with another; that is tantamount to claiming the needs of the United States are identical to that of a foreign country.

 Every barrier had a common denominator: profound mistrust that continues to be perpetuated by non-tribal members since 1492. Without a doubt, the most indisputable finding was not the lack of health care coverage illiteracy among Native Americans, but among non-tribal health care providers. The fault of incomprehension always appears to be placed on minorities, but the cultural ignorance should be shared by the majority. To exacerbate the burden imposed by the cultural gap, tribal members often feel invisible and unrecognized by non-tribal health care systems and often do not seek care outside of Indian Health Services and Urban Health Programs.

 Prior to starting medical school, I was optimistic that a culture of inclusivity and diversity would be at the forefront of medicine, but I find that it is still wading in the shallow waters of preliminary stages. As a second-year medical student, I, too, feel invisible and unrecognized; without representation in clinical vignettes, campus organizations, and the racial demographic of all four years of cohorts on all three campuses. In 2019, the AAMC reported that 0.3% of all actively practicing physicians identified as indigenous. According to the MCW Education 2018 – 2019 Report, 0.14% of students enrolled in any program at MCW were American Indian or Alaskan Native. Without indigenous or culturally competent non-tribal health care providers available, we cannot improve the poor health care encounters and outcomes experienced by indigenous people, including myself.

 

 Recently, I had the opportunity to present my findings to the GLNARCH council. My hope is to develop a study that determines the baseline knowledge of non-tribal healthcare providers on Native health care and policy. I aspire to collaborate with tribal leaders, healers, and members to most efficiently educate non-tribal members on the complexity of Native American health care and policy. My priority is to ensure the product of our efforts focuses on the gains that can be provided to tribal nations with education of non-tribal healthcare providers as an added benefit.

 I am now an advocate for the indigenous people, my people, but we are responsible and accountable for actively learning about the culture and needs of all our patients, and it is high time we direct our attention toward the needs of Native Americans. As an initial step, I challenge you to translate the Ojibwe greetings within this text and learn the names of the sovereign nations that reside within Wisconsin.

 Miigwech

 

 Morgan Lockhart is a medical student in the class of 2023 at MCW-Milwaukee.

What to do when it is your turn [and it is always your turn]

From the 10/23/2020 newsletter

Director’s Corner

 

What to do when it is your turn [and it is always your turn]

 

 Adina Kalet, MD MPH

 

 This week Dr. Kalet celebrates our focus on women in medicine by reflecting on what it has meant to be an underrepresented “minority” in medicine and what to do when it is your turn …

  

 "Women belong in all places where decisions are being made. It shouldn't be that women are the exception."

-Justice Ruth Bader Ginsburg

"There's a special place in hell for women who don't help each other!

-Former Secretary of State Madeleine Albright

 

One of my favorite things to do at MCW is study the class pictures lining the hallways of the ground floor of the medical school building. From the earliest days of the 20^th Century, MCW and its predecessor institutions created photographs of graduating classes – not surprisingly, all white men for decades – year after year – generation after generation. Starting about a quarter of the way along the length of the hallway, a few clusters of white women begin to appear, often wearing the habits of religious orders. Further down the hall, the first Black face, a man, in a sea of white male faces with a smattering of white women. Eventually there are Black female faces. And so, it goes, making starkly obvious that acceptance for women and people of color into the ranks of physicians is a very recent, evolving, and slow phenomenon.

I care deeply about our continued progress, which makes me ask: What was it like for those first women pioneers? How much better did they need to be? How fiercely defiant were they of low expectations for academic achievement? How much effort did it take to resist the pressure to conform to gender role expectations – to be considered “good enough”?

 

Being a pioneer

Over the course of my career, I have learned a great deal about being the “only one.” Early on, I ran the gauntlet daily. I regularly dodged being backed up against the wall while on rounds or touched inappropriately in the OR by male residents and attendings – all in “good fun.” I knew I risked being dismissed as the “bitch” when I insisted that junior teammates be accountable to me as they discharged their patient care duties. Being the “only one,” meant remaining appropriately humble as I informed patients, family members, and colleagues that I “was the doctor” and I “was in charge,” not the very tall, much older (he was an MD/PhD) intern standing behind me. To his credit, he regularly reinforced my leadership!

Once patients accepted that I was the doctor they, as often as not, expressed relief and delight. I had many experiences where men from religious traditions with strict rules against being in a room alone with a non-family member woman came to accept and respect me, allowing me special status as a “healer.” It was remarkable how much being a woman in medicine was a “superpower” my male peers didn’t have.  I thrived in the environments where I could work at my full capacity, and benefited from many “affirmative action” programs, aimed at correcting gender inequities,  focused on giving me – based on my gender – a “leg up”; for example, opportunities such as the Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM®) program. I have worked my whole career to be surrounded by respectful, kind, and loving peers and mentors of all gender and racial identities. 

 

Being a pioneer, again

Daily experiences of frank gender-based discrimination and micro- and macro-aggressions faded into the background until I first joined institutional leadership in mid-career.

When I finally had the privilege of being invited into the “C-suite Boardroom” of a private academic health center, it became clear to me who was in charge. The decision-making tables with opportunities for real change were surrounded by men in gray suits and ties. After years of working collaboratively with women and men, I was again the only one. What I was wearing, how my hair looked, and the age of my then young children were considered acceptable small talk at the beginning of each meeting. I was made to feel self-conscious of my gender and relative youth. In the guise of “complements,” I felt “put in my place,” even by those I had considered role models. This could occur immediately before we were to talk about important issues of educational policy and practice in our department or medical school. After the meetings, my assignments might be stereotyped. For example, when a top performing women medical student (whom I did not know personally) had a body piercing that everyone else (not I) agreed could “upset” patients, the task of calling her in for a conversation fell to me.

I recovered my “voice” and, in relatively short order, there were a few other women invited to these tables. And it has made all the difference. As we diversified, discussions were more substantive, less contentious and less autocratic, more pragmatic, and more creative. Not because women uniquely possess different “ways of being” (although some of us do), but purely as an impact of diversity of points of view and life experience. Diverse leadership in institutions is better. Period. Not just right, but good for us all.  

 

How do we make progress?

Progress has been slow in academic medicine. At MCW, as it is at most other medical schools in the US, there is a problem.  While women have been 50+% of the medical students since 2019 and 43% of MCW faculty are women only 29% of full professors and 17% of chairs identify as female.  Of the traditionally impactful leadership positions (chairs, deans, and other executives), the large majority are men.

Nationally, there have been calls to impose medical school department chair term limits to open up leadership roles to more diverse pools of candidates. While the pipeline is hardy and full of talent, we are not, as of yet, experiencing the value of a fully diversified leadership roster.

Having women leaders, is more important now than ever. I am a fan-girl  of the young Prime Ministers Jacinda Ardern of New Zealand and Sanna Marin of Finland, each of whom has demonstrated leadership leading to lower COVID-19 case and death rates in their countries. They are known to encourage and listen to both dissenting and expert voices. Although each situation is unique and complicated, I say having women and other underrepresented groups at the table is a good thing and accelerates transformation.

 

Linking gender and racial equity

White women, as members of a gender minority with life experiences of bias and discrimination, but also as part of the racial/ethnic majority, are finally in the position to exercise some power. As a result, white women are now over-represented in efforts to address injustices, inequities, and the care of the vulnerable. For example, the leadership of a large, multi-institutional, foundation-funded program to mentor women and URiM early career scientists is overwhelmingly white (79%) and female (87%). This is typical of many such activities. I am not naïve; clearly, some white women (like their male counterparts) have demonstrated shameless entitlement, privilege, and racism.  We are not a monolith, but we do have collective power which we can use for good.

Change is coming. Through the efforts of MCW’s Center for the Advancement of Women in Science and Medicine (AWSM) under the leadership of Libby Ellinas, MD and the Council for Women’s Advocacy (CWA), much has been accomplished and much more needs to be done to achieve and cultivate a diverse and vibrant culture at MCW and elsewhere.

As I walk down the hallway of class pictures, I always say out loud to those pioneers “Thanks, sisters!” They helped to change the “face” of the profession. We must reflect on what they did – and what we must do – to continue the progress. We must be at the forefront, increasing the diversity and inclusiveness of our profession and institution. We must enlist everyone to assume responsibility and play a role to ensure continued transformation.

Our work is not yet done.

 

 

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

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

 From the 9/11/2020 newsletter

Perspective
 
 
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 - Internal Medicine – PGY1
 
 
Dr. Seymour writes about the recent MCW Black Lives Matter protest and why it is important to create a flourishing, diverse, and inclusive community … 
 
 

On Wednesday, Sept. 2^nd, 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 25^th, 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. 2^nd protest involved holding 7 minutes of sustained silence, each minute representing every bullet maliciously aimed at the back of Jacob Blake, an unarmed African American man returning to his vehicle, by Rusten Sheskey, a Kenosha WI police officer. Mere seconds after an instinctive proclivity for violence towards nonaggression 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.
 
 
 
 
Leroy J. Seymour, MD MS is a first-year internal medicine resident at the Medical College of Wisconsin

Initiating MCW’s “Community Conversations” about Race and Racism

From the 8/7/2020 newsletter

Racial Injustice & Inequities Perspective 

Initiating MCW’s “Community Conversations” about Race and Racism 

David J. Cipriano, PhD Co-Chair Elect, MCW Diversity and Inclusion Action Committee 

Dr. Cipriano was on the team that launched MCW’s “Community Conversations.” In this essay, he shares the process of that launch and a bit of what the facilitators and note-takers learned …

In early June, soon after the killing of George Floyd and the unstoppable social movement that ensued to end racial injustice, MCW was preparing to address how these issues were impacting our institution. President Raymond committed himself to leading MCW to become an anti-racist institution. The Office of Diversity and Inclusion (ODI) together with the Diversity and Inclusion Action Committee (DIAC) developed Guiding Principles for combatting racism and also laid the groundwork for groups of individuals to get together to have these difficult conversations. These groups, eventually called “Community Conversations” developed out of a close partnership between Dr. Greer Jordan and ODI, the Kern Institute, DIAC, and the Center for the Advancement of Women in Science and Medicine (AWSM). 

Laying the Groundwork 

A rapid mobilization was required to train facilitators, schedule sessions, publicize the initiative and assemble the groups. Dr. Adina Kalet of the Kern Institute and I worked on developing training materials for the facilitators and began to recruit people for this role. Our team also included M. Paula Phillips from AWSM, Charlie Ann Rykwalder of DIAC, and Marina Thao, events specialist for the College. Within a week, we had 160 people signed up to participate. We had also recruited twenty-seven people, made up of faculty and staff, to be facilitators and note takers. We held two training sessions which turned into more of a time for self-reflection and gut check than skills-building sessions. 

Preparing the Facilitators and Note-Takers 

The purpose of the groups was to answer two key questions. The facilitators grappled with these questions, knowing that we needed to be clear on them before we could facilitate groups of our colleagues in a discussion. 

• The first question was, “What does it mean to be an anti-racist organization?” We shared definitions we had found in our reading and self-education. We grappled with the basics: What is the difference between systemic racism and structural racism? Some of us were unclear on the meaning of the term “anti-racist.” 

• The second question, “Where does structural racism exist at MCW?” led to an array of responses amongst the facilitators. I suppose we reflected the MCW community in general in our reactions: “Nowhere! We’re are an organization made up of well-intentioned people who adhere to laws and rules against discrimination” to “Everywhere! We are not aggressively recruiting and hiring people of color. We are not including black-owned businesses in our vendor lists. Our students of color are still getting poor performance evaluations for such subjective, and therefore open-to-bias issues as ‘attitude.’” Over and over, this humble group of facilitators, the great majority of whom were white, expressed concern over their unpreparedness for this task. 

And, what was to be our function as facilitators, to listen or to teach? Most of us are educators by profession or nature. After much discussion, we made the deliberate decision to listen and not teach. We decided to facilitate and not impose our beliefs or values on the group. After all, the purpose of the groups is to gather information to help our inclusion leaders understand where the enterprise is at on these issues, what the concerns are and what the needs are; all in the service of developing next steps. Dr. Jordan was adamant that the objective was not to change people and not to MAKE people learn anything about race and racism. 

We had to consider the language we were using – are we talking about antiBlack racism or racism that affects all people of color and marginalized groups? We were directed to assume good intentions. Even if we heard something difficult or challenging, people are still learning just like we are. They may be asking an honest question without meaning to hurt anyone. We may hear things that don’t align with our beliefs or with the institution’s goal of becoming an anti-racist organization. Implicit bias is the culprit here – it allows people with good intentions to occasionally operate from automatic, or unconscious stereotypes that they hold. 

What we Experienced and Noticed 

So, at times we bit our tongues. But really, all of our participants appeared to be there with the genuine motivation to listen, learn and figure out ways to contribute. 

 As the sessions occurred, the facilitators and note-takers began sharing their experiences in group emails. These became very valuable to all of us as we realized that this endeavor was having an impact on us as well as on the participants. Some of these emails were long, and were filled with heartfelt reactions, questions, and concerns. I believe we all read each and every one of these emails, judging by the number of responses which ranged from “Thanks for sharing,” to “Me, too!” 

We also shared major themes and questions that emerged: 

• Most participants want to be educated on the issues. 
• Why is it necessary to spend so much time educating white people about racism? 
• Do people in the majority culture stay stuck in intellectualizing and defining these issues? 
• Should one of the objectives simply be to learn to tolerate the discomfort of these conversations? 

We wondered why there were separate groups for African Americans to share their feelings. We lamented the fact that there was little diversity in our groups. Some felt that whites need to hear from Blacks about their experiences so that they can learn in a truly impactful way. Others thought that it is not the job of Black people to teach white people about racism. “They can learn about it themselves,” and, “they can consider their own race and all the baggage that it comes with.” These steps take self-reflection, and maybe that is what these groups will trigger. 

We really meant it when we told our participants that we were learning right along with them. We are all on our own journey of confronting our privilege in this unfair and biased system. We came away feeling troubled, nervous, and exalted – all at the same time. 

Next Steps 

When it came time to deal with the fact that over 200 more people from MCW had put themselves on a waiting list for our Community Conversations, every one of our facilitators and note-takers signed up to go another round. We are currently finishing up and waiting for next steps from the institution. We are eager to continue to learn and grow. 

David J. Cipriano, MS PhD is an Associate Professor in the MCW Department of Psychiatry and Behavioral Medicine, the Director of Student and Resident Behavioral Health, and the Co-Chair Elect, Diversity and Inclusion Action Committee. He is a Faculty Member of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

How to Be an Antiracist by Ibram X. Kendi Chosen as the MCW Common Read

 From the 8/7/2020 newsletter 

 

 

How to Be an Antiracist by Ibram X. Kendi Chosen as the MCW Common Read

 

Anna Janke, MCW Class of 2023

Associate Editor

 

Ms. Janke discusses the process and outcome of this year’s search for the book that will be the MCW Common Read…

 

It took us the entire school year to choose this upcoming year’s Common Read selection. Led by then-M4 Sophia Lindekugel, the Book Selection Committee read dozens of books suggested by MCW community members to pick a book that would be timely, readable for a wide audience, and actionable to spark meaningful change. As a lifelong reader and now a member of the Book Selection Committee, I really enjoyed reading books that opened my eyes to topics I had not explored in depth before, ranging from the opioid epidemic, to the Flint water crisis, to the individual and societal impacts of sexual assault.

However, after selecting a book with which we were all thrilled to announce, these plans were pivoted once we noticed, and joined in on, the outcry surrounding the deaths of George Floyd, Breonna Taylor, and far too many others. The MCW Common Read Leadership felt that it was necessary to shift this year’s Common Read to one that would center around race and race relations in America, shelving our previous selection for another year.

While the time allotted to select a book was now much shorter after the decision to pivot, many inspiring voices came forward to recommend titles that would spark discussions throughout the MCW community about race. It was humbling to realize that we have been late to join this movement; The MCW Office of Diversity and Inclusion (ODI), Student National Medical Association (SNMA), and the Center for the Advancement of Women in Science and Medicine (AWSM), among others, have been leading MCW for decades towards progress in health equity, workplace climate, and the dignity of every person.

In the end, we wanted as many community voices to be heard as possible for this year’s Common Read. We met with key stakeholders, including representatives from the aforementioned groups, to select three books from which MCW would vote. After 548 people weighed in, we are thrilled to have How to Be an Antiracist by Ibram X. Kendi as the 2020-2021 MCW Common Read.

While I am both elated and terrified to be a Co-Chair for this year’s programming, I am confident that the Common Read Leadership and the rest of the MCW community will come together to get our hands dirty and make mistakes so we can learn from those mistakes and take important steps forward in the lifelong journey that is Antiracism.

 

  

Anna Janke is an MD Candidate in the MCW Class of 2023. She serves as an Associate Editor of the Tranformational Times.

Racial Discrimination in Academic Surgery: A Webinar Presented by the Association for Academic Surgery

From the 7/24/2020 newsletter

Racial Discrimination in Academic Surgery: 

A Webinar Presented by the Association for Academic Surgery

Eileen Peterson, MD Candidate 2023

Associate Editor

Background

This webinar was one in a series of town halls with the goal of changing the landscape of academic surgery. The town hall was led by two session moderators, Callisia Clarke, MD of the Medical College of Wisconsin and Colin Martin, MD of the University of Alabama Birmingham, and five panelists from across the nation. As the chair of the Diversity, Equity, and Inclusion (DEI) Task Force for AAS, Dr. Clarke stated that the AAS is looking for “not just discussions but solutions” within the academic surgical workforce.

Speaker 1 – Yue-Yung Hu, MD

Dr. Yue-Yung Hu, a pediatric surgeon at Northwestern University, spoke on the prevalence of racial discrimination amongst surgical trainees. Dr. Hu discussed data published in JAMA Surgery in April 2020, which was collected from 6,956 resident surveys after the 2019 ABSITE exam with an 85.6% response rate. Of note, the study found that 41% of non-white general surgery residents reported racial or ethnic discrimination. Of those who reported discrimination, 71% were Black, 46% were Asian, and 25% were Hispanic. In addition, discrimination is associated with higher rates of burnout, thoughts of attrition, and suicidality.

Hu also discussed the SECOND Trial. This is a prospective randomized trial across 215 residency programs to assess diversity and resident well being while providing a toolkit of strategies to improve the learning environment for residents. The SECOND Trial is also currently compiling resources on implicit bias training.

Speaker 2 – Erika Adams Newman, MD 

“We will look back and our children will look back and say, ‘How did we respond, what did we do, what changes were we engaged in?’ both individually, within our institutions, and within our organizations.” Erika Adams Newman, MD, a pediatric surgeon at Michigan Medicine, discussed faculty-level racial discrimination as it leads to barriers to retention and promotion. When looking to improve equity and reduce discrimination, Dr. Newman encourages departments to look at their demographics and ask what message it sends by having only a few people of color and also fewer women within a department.

Newman suggested Grand Rounds as a great way to increase diversity, raise consciousness, and push the envelope. Through the introduction of The Michigan Promise in 2017, Michigan’s Department of Surgery has diversified their recruitment committee, increased mentorship, and implemented bias and cultural competence training in order to seek out sustained change. 

These are just a few ideas for programs. Dr. Newman stated that good intentions are not enough because “how can we achieve excellence without being diverse?”

Speaker 3 – Justin Brigham Dimick, MD, MPH

Justin Brigham Dimick, MD, MPH, the Department of Surgery Chair at Michigan Medicine, posed reflective questions for non-minority audience members on the topic of earning the title of bystander or ally.

1. Have you come to terms with your privilege? If you can see an event in the news and be complicit, returning to work and acting like nothing has happened, that is privilege. Educate yourself. Read any of the bestselling novels about racism and discrimination. Don’t ask the minorities in your department to teach you.

2. Do you see implicit bias everywhere you look? What are you doing to interrupt  and remove these biases from the workplace?

3. Who are you mentoring and sponsoring? Do your mentees look like you? What signals are you sending when broadcasting your mentoring?

4. If you are a leader, are you creating space in your program’s curriculum for discussing implicit bias?

5. Are you able to go beyond the title of bystander and work to become an upstander? As an upstander, you can use your power and platform to change policies and procedures to be equitable.

Speaker 4 – Oluwadamilola “Lola” Fayanju, MD, MA, MPHS

Oluwadamilola “Lola” Fayanju, MD, MA, a surgical oncologist at Duke University, discussed surgeons’ obligation to address healthcare disparities  through research. Dr. Fayanju stated that currently, African-Americans and Latinx are overrepresented in Phase I Trials and underrepresented in Phase III trials, suggesting failure to convey goals of Phase I studies and enrollment bias in Phase III trials. More efforts need to be taken to prioritize recruitment and inclusion of racial/ethnic minority patients who are disproportionately affected by various diseases. In addition, disparities need to be incorporated into  studies at concept inception rather than tacked on during statistical analysis. 

Dr.Fayanju offered three suggestions for researchers going forward: 

1. Be humble: Get more training.

2. Be collaborative.

3. Be intentional: Who are your collaborators, statisticians, and study team members? Who is at the table when decisions are being made?

Speaker 5 – Eugene Kim, MD

Eugene Kim, MD, a pediatric surgeon at Keck School of Medicine of USC and President of AAS, discussed the AAS Commitment to Addressing Racial Discrimination in Academic Surgery. Recent efforts by the AAS include the creation of the DEI Task Force in 2019 as well as implementing open elections and self-nomination for committee chairs. Within the Executive Council,  the AAS has seen increased diversity at the levels of institutional, surgical specialty, and research background, but the AAS still needs to see more diversity  in race and gender within committee appointments and chairs. The AAS is also

increasing their mentorship efforts. They will be hosting sessions for underrepresented minority surgeons-in-training to meet with AAS leadership.

You may email Dr. Kim at eugeneskim@chla.usc.edu with your thoughts and ideas on increasing diversity of AAS.

 

Conclusions

Reach out to Dr. Clarke on Twitter @DrCNClarke with suggestions, ideas, or questions. The full AAS webinar can be accessed at https://www.aasurg.org/racial-discrimination-in-academic-surgery/

Eileen Peterson is a medical student at the Medical College of Wisconsin and serves as an Associate Editor for the Transformational Times.

Becoming Uncomfortable

From the 7/17/2020 newsletter

 

 

Becoming Uncomfortable

 

 

Bruce H Campbell, MD 

 

 

Dr. Campbell sees parallels in how societal dynamics are at play in two different realms of his life …  

 

 

As a surgeon, I have made mistakes that have hurt people. I hope that this fact is not surprising to anyone since, besides being a surgeon, I am also a human being. I have never hurt anyone in the operating room intentionally but, over the years, I am certain that there have been more people harmed than I realized. 

 

What happened? Certainly, I never deliberately waded into cases where I knew I was in over my head, but there have been instances where I was inadequately or improperly prepared. Maybe there was a gap in my training. Perhaps I missed a critical experience along the way that would have led me down a different path. Maybe I overlooked an article. Maybe the science had not yet taught us the proper way to care for a specific problem. Maybe I blundered or slipped or got lost. Maybe I should have operated but recommended against it. Or vice versa. Over the course of a thirty-year career and thousands of surgical procedures and patient encounters, I have done my best. I know, however, that for  some people, my decisions have led to harm. 

 

 

To reassure myself, I have tried to stay at the top of my game. I attend regular Morbidity and Mortality (“M&M”) Conference to discuss complications. I participate in “root cause analyses” to find systemic problems that lead to errors. I listen to patients, families, and staff when there are concerns. I have enlisted others to watch and make certain that my skills remain up to the task even as I age. I believe, along with Hippocrates, that all physicians should live by the dictum: primum non nocere, or “first, do no harm.”  

 

Nevertheless, I live with the knowledge that there are people out there who will always remember me as the person who hurt them. I always considered this to be part of what I do for a living.

 

 

The instances of physical harm I have caused during my surgical career have come to mind recently as I have engaged in conversations about how our implicit racial biases also cause harm. Like many white people, I have never thought of myself as racist. I am an older, white, cis-gendered, straight, abled male recipient of a suburban white-privilege upbringing. I knew (and had spoken to) very few African Americans until I got out of high school even though my youth was spent in a suburban region actively trying to integrate. On the other hand, my parents were in a club that allowed full membership only to men and, until I was older, included no Blacks, Catholics, or Jews. That seemed normal to me.

 

As a teenager back in the early 1970s, I worked as an orderly in a hospital emergency room on the border between my white suburb and a Black city neighborhood. Although I rarely noticed, my role models – the physicians, nurses, and police officers – treated Black patients and employees differently than they did white ones. I watched and learned. That seemed normal to me. 

 

I do have a vivid memory of a conversation I had with a white police officer whom I knew well. I must have been uncomfortable with how he approached a Black patient; I don’t remember the circumstances, but I do remember what he said. “Y’know,” he told me, “you suburban kids love the race but hate the individual. I love the individual and hate the race.” Oh, I thought. That seemed normal to me. 

 

One day, one of the other Emergency Room orderlies, a Black man, walked in on the tail end of my comments about a Black patient. I stopped abruptly. I remember the sinking feeling in my stomach. What had I said? I wondered. Did he hear that? We never talked about it. 

 

As I matured, I had more Black friends, acquaintances, trainees, students, and colleagues. In retrospect, I don’t remember ever speaking of race with any of them. Just as with surgery, I know I made mistakes. 

 

I have committed microaggressions. I have remained silent when hearing others make remarks that should have been called out. I am certain I have made thoughtless – what I considered at the time, innocent – comments. Although there were never any M&M conferences or formal reviews of mistakes I made as I interacted with Black people, I tried to approach the racial divide between us in the same way I approached surgery: I hoped each opportunity would make me better. I saw nothing wrong with what I was doing. It was “about me,” after all.

 

 

Then I read Ijeoma Oluo’s book, So You Want to Talk About Race. She challenged me to look at myself in new ways and set me straight. Here is what she writes: 

 

“To many white people, it appears, there is absolutely nothing worse than being called a racist, or someone insinuating you might be racist, or someone saying something you did was racist, or someone calling someone you identify with a racist. … 

 

“You may be now insisting that you do not have a racist bone in your body, but that is simply not true. You have been racist, and will be in the future, even if less so.  … 

 

“You cannot tell someone to deny the harm you’ve done to them … It sucks to know that to some people you will forever be the person who harmed them.” 

 

 

Ms. Oluo helped me realize in a new, convicted way how my life experiences have shaped me in ways I never before perceived, both as a person who grew up with white privilege and as a physician afforded the upper hand in doctor-patient relationships. I have hurt people and failed to pause and fully recognize the damage I have caused. I have not always taken ownership of the consequences of my actions. Even though I have “felt bad” at times both in medicine and in life, I now realize how easy it has been to forgive myself and move on.

 

 

I suspect I am not alone. It is time to check our privilege. It is time to become more comfortable with being uncomfortable. It is time to apologize. It is time to be an ally. 

Bruce H Campbell, MD FACS is a Professor of Otolaryngology and Communication Sciences and Associate Director of the MCW Medical Humanities Program. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He serves as Editor of the Kern Transformational Times newsletter.