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Competence
Health Benefits
Care
Quality
Diversity
Diversity in Academic Medicine: Supporting Faculty
Advancing Diversity and Excellence in Science and Engineering
University of Michigan – Ann Arbor, MI
January 18 - 19, 2007
Jeannette E. South-Paul, M.D.
University of Pittsburgh
Diversity Kaleidoscope
Nationality
Culture
Sexual
Orientation
Class/
Status
Physical
Abilities
Family
Responsibilities
Physical
Abilities
Race
Gender
Professional
Experience
Education
NEOUCOM
Age
Religious
Beliefs
Marital
Status
Geographic
Location
A Sagging Bridge to Diversity in Academic Medicine
14
25
2022 URM
Matriculants
20
%
12
15
10
1786 URM
Matriculants
10
5
% URM Matriculants
8
0
50
62
74
Year
Jordan Cohen, AAMC
86
95
90
92
94
96
98
'00
Competence
Health Benefits
Care
Quality
Enriching the Pipeline
Diversity
Generational Issues
 Silent Generation (1925 – 1944)
 Boomers (1945 – 1962)
 Generation X (1963 – 1981)
 Millennials (1982 – )
Generational Issues
 Silent Generation (1925 – 1944)
 Boomers (1945 – 1962)
 Work hard out of loyalty
 Expect long-term job
 Pay dues
 Self-sacrifice is a virtue
 Respect authority
 Generation X (1963 – 1981)
 Millennials (1982 – )
Generational Issues
 Generation X (1963 – 1981)
 Work hard if balance is allowed
 Expect many job searches
 Paying dues is not relevant
 Self-sacrifice may have to be endured, occasionally
 Question authority
 Generation X (1963 – 1981)
 Millennials (1982 – )
Handling Generational Issues
 Improving mentoring
 Redefine the ideal worker
 Enhance faculty career and leadership
development
Bickel J, Brown AJ., “Generation X: Implications for Faculty Recruitment and Development in AHCs,
Acad Med., 1005, 80:205-210
Shifting Paradigms in Medical Education
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The individual
Cure of disease
Episodic care
Physician provider
Paternalism
Provider-centered
Anecdotal care
Inpatient-focused
Individual accountability
The community
Preservation of health
Continuous care
Teams of providers
Partnership with patients
Patient/family-centered
Evidence-based medicine
Ambulatory/home-centered
System accountability
Competence
Health Benefits
Care
Quality
Diversity
Enriching the Pipeline
Mentoring – to include diverse mentors
Dynamic curricula
Financial support
Competence
Health Benefits
Care
Quality
Diversity
Creating a Welcoming Organization
Organizational Cultural Competency
 Set of behaviors, attitudes, and policies that come
together in a system, agency, or among
professionals to enable work in cross-cultural
situations
Continuum Of Cultural Competence
Proficiency
Competence
Pre-competence
Blindness
Incapacity
Destructive
Hayes M. Cultural Competency Continuum, 1991
Creating Inclusive Communities
 Know Your Institution
 Leadership priorities
 Influence of NIH
 Promotion record
 Strengths/weaknesses
Explanatory Model: Clinical Setting
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What do you call your problem?
What name does it have?
What do you think has caused the problem?
Why do you think it started when it did?
What does you the sickness do to you? How does it work?
How severe is the sickness? Will it have a short or long
course?
 What are the chief problems that your sickness has caused for
you?
 What kind of treatment do you think you should receive?
 What are the most important results you hope to receive from
the treatment?
Kleinman, Arthur, Patients and Healers in the Context of Culture. Berkley University Press, 1980
Explanatory Model: Managerial Setting
 What is the problem? Who owns the problem? Is it
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defined differently by others? What are the varying
perspectives?
What precipitated the problem?
What is the impact of the problem?
How severe is the problem?
Will it resolve itself or evolve into a bigger problem?
What are the consequences of intervening or not
intervening?
What is the desired outcome?
What is the best solution?
Maximizing the Benefits of Diversity
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Diversity should permeate policy in all areas of campus life
Institutions should recruit, support, and retain diverse student bodies
Institutions should commit to hiring diverse faculty
Diversity efforts should have as their goal development of a positive
campus climate
Diversity efforts should provide safe cultural spaces
Diversity efforts should encourage and foster interracial contact
Institutions should assess the effectiveness of their diversity efforts
and compile evidence that indicates their approaches are working
Institutions should implement, reward, and support pedagogical
practices to achieve diversity
 Milem JF, Chang MJ, Antonio AL (2005). Making Diversity Work on Campus: A ResearchBased Perspective. Wash, DC. Association of American Colleges and Universities.
The Consequences of Premature
Abandonment of Affirmative
Action Admissions
Cohen JJ. JAMA 2003;289:1143-1149
Preserving diversity in
medical schools is important  Student and faculty diversity is indispensable for
quality medical education
 Diversity of the physician workforce improves
access to care for underserved populations
 Diversity of the research workforce can accelerate
advances in medical and public health research
 Diversity among managers of health care is good
business sense
Cohen JJ. JAMA 2003;289:1143-1149
 Has affirmative action been effective
in medical school admission?
Minorities in Medicine
Percentage of URM Participants in Allopathic
Medical Schools
12
10
8
6
4
2
0
URM Students
URM Faculty
Minority Medical School Faculty
 URM faculty increase from 2.6% to 3.7%
between 1980 and 1995
 A/PI faculty rose from 6.6% to 8.6% during
the same period
URM faculty typically promoted to
Associate Professor
3 – 7 years later than Whites
 Petersdorf RG, Turner KS, Nickens HW, Ready T. Minorities in
medicine: past, present, and future. Acad Med 1990;65:663-670
Creating Inclusive Communities
 Know Your Institution
 Leadership priorities
 Influence of NIH
 Promotion record
 Strengths/weaknesses
Core of NIH Roadmap Vision
 At core of this vision is the need to
develop new research partnerships with
organized patient communities,
community-based health care providers,
and academic researchers.
Creating Inclusive Communities
 Know Your Institution
 Leadership priorities
 NIH Roadmap
 Promotion requirements
 Strengths/weaknesses
Minority Faculty and Academic Rank
 National survey of medical school faculty, n=344
 Self-report data
 MDs and other degrees
 Adjusted for age and productivity
 URM faculty less likely to be promoted to senior
rank than white faculty
 Palepu A, Carr PL et al. Minority faculty and academic rank in medicine. JAMA
1998;280:767-771.
Minority Faculty Promotions
 Minority faculty more likely to
 Be IMGs or affiliated with other clinical science
departments
 Less likely to be tenured or tenure track
 Less likely to be recipients of RO1 or other NIH
awards
 More likely to have appointments in private
medical schools
 More likely to be women (API/URM)
 Fang D, Moy E, Colburn L. Racial and ethnic disparities in faculty promotion
in academic medicine. JAMA 2000;284(9):1085-92.
Predictors of Physicians Who Care for Underserved
Populations
 Being a member of an underserved ethnic or
minority group
 Having participated in the National Health Service
Corps
 Having a strong interest in practicing in an
underserved area prior to attending medical school
 Growing up in an underserved area
 Rabinowitz HK, Diamond JJ, et al. The impact of multiple predictors on generalist
physicians’ care of underserved populations. Am J Public Health 2000;90:1225-8
Challenges to Achieving Diversity in Academic
Medicine
 Minority physicians are more likely to choose underserved
areas in which to practice
 Komaromy M, Grumbach K, Drake M. The role of black and Hispanic physicians in
providing health care for underserved populations. N Engl J Med 1996;334:1305-1310
 Gray B, Stoddard JJ. Patient-physician pairing: does and ethnic congruity influence
selection of a regular physician? J Community Health 1997;22:247-59
 Low numbers of minority faculty limit the number of
minority mentors available and disadvantage at time of
recruitment for faculty positions
 Giardino AP, Cooper MC. Perceptions of pediatric chief residents on minority
housestaff recruitment and retention in large pediatric residency programs. J Natl Med
Assoc 1999;91:459-65
Challenges to Achieving Diversity in Academic
Medicine
 Assault on affirmative action reduces the percentage of minority
matriculants from current 12% to 3% (less than before the Civil
Rights movement in the 60’s
 Cohen JJ. The consequences of premature abandonment of affirmative action in
medical school admissions. JAMA 2003;289:1143-9
 Disparities in promotion rates for minority faculty
 Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion
in academic medicine. JAMA 2000;284:1085-92.
 Minority faculty are less satisfied with their academic careers even
when they receive comparable financial compensation
 Palepu A, Carr PL, Friedman RH, et al. Specialty choices, compensation, and career
satisfaction of underrepresented minority faculty in academic medicine. Acad Med
2000;75:157-60.
Retaining Diverse Faculty
 Give your post-doc’s and fellows a reason to stay
 Begin mentoring them during the recruitment
process
 Provide specific skills for success as academic
faculty
 Have visible leaders and administrative bodies that
respond to the needs of trainees
University of Pittsburgh – Office of Academic Career
Development – Joan Lakoski, PhD
 Maximizing Your Postdoctoral Success: An Orientation to a Full
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Academic and Social Life in Pittsburgh
NIH Career Development Award Workshop: Pathway to
Independence: K-99/ROO
Health Sciences Professional Development Workshop for Faculty &
Postdocs: Publishing with Integrity in Academic Journals
Health Sciences Faculty Professional Development Series:
Managing Your Personnel
NIH Career Development Award Workshop: Awards for Basic
Scientists
NIH Career Development Award Workshop: Life After Your K Award:
Making Career Transitions
Competence
Health Benefits
Care
Quality
Diversity
Creating a Welcoming Organization
Supporting young faculty
Assuring a supportive environment
Engaging the promotion mechanism
Competence
Health Benefits
Care
Quality
Diversity
Embracing Your Community
Creating Inclusive Communities
 Know Your Customers
 Know health status indicators
 Partner with your community
 Address community needs
Kaiser Family Foundation
 People of color more likely than whites to live in
neighborhoods that lack adequate health care
resources
 28% of Latinos and 22% of African Americans
report having little or no choice in where they seek
care as compared to 15% of whites experiencing
this difficulty
 Kaiser Family Foundation, March 2005 Policy Brief
Academic Health Centers
 Must prioritize communication with the community
 To remain in touch with community concerns
 To keep community abreast of new discoveries
 To inform the community regarding results of
research
Strategies to Create Inclusive Communities
 Medical Education
 Clinical Care
 Research
 Advocacy
Strategies for Inclusivity – Medical Education
 Curricular reform
 Cultural competence training
 Mentoring
 Electives
Strategies for Inclusivity – Clinical Care
 Community health center network
 Alliance with federally-qualified health
centers
 Community advisory groups
Strategies for Achieving a Culturally
Competent Organization
 Environmental assessment
 Institutional team to monitor the environment
 Case-by-case counseling
 Public health assessment of the community
 Team building activities
Institutionalize Cultural Knowledge
 Educate staff on the cultural groups that the
organization serves
 History, traditions, language, values, family systems
 Incorporate cultural knowledge into service delivery
 Training in and development of systems to manage
medical and social issues
 Female interpreters for Muslim women
 Provide language appropriate resources, referrals
Competence
Health Benefits
Care
Quality
Research and Diversity
Diversity
Clinical Research at the University of Pittsburgh
 Dean/Sr Vice Chancellor for the Health Sciences Arthur
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Levine proscribes internal competition and encourages
collaboration
UPSOM Office of Clinical Research
Community Research Advisory Board – Center for Minority
Health, Graduate School of Public Health
Center for Health Equity Research – Pittsburgh VA and
Division of GIM
Center for Primary Care Community Based Research –
Dept of Family Medicine
CRAB
Community Research Advisory Board
 Vision of Stephen B. Thomas, PhD, Philip Hallen Chair
in Community Health and Social Justice.
 Director for the Center for Minority Health in the
Graduate School of Public Health
 Chaired by Jeannette E. South-Paul, MD and Stephen
Thomas, PhD
CRAB Membership –
Faculty, staff and individuals from academic, health related
and community settings – stakeholders from various ‘walks of
life’ – coming together on a monthly basis for the purpose of:
Increasing the members’ awareness of various aspects of research and
its implications in underserved communities.
Providing feedback, based on diverse perspectives, to investigators
about their proposed or on-going research.
CRAB
Building both the academic and community capacity to:
conduct culturally competent research in partnership
to share knowledge and transfer information to improve
health outcomes
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Creating opportunities for further collaboration and
partnership between research investigators and the
communities/individuals most impacted by racial and ethnic
disparities in health.
Center for Primary Care Community Based Research
 Committed to issues of medically underserved
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communities
Based within FM-Pittnet – a PBRN in community
health centers
Epidemiologic focus
Research registry
Vision of Janine E. Janosky, PhD – Research
Director
Competence
Health Benefits
Care
Quality
Important National Efforts
ELAM Program
AAMC Programs
Diversity
ELAM Program – 10th Year
 Executive Leadership in Academic Medicine for Women
 MCP-Hahnemann – then Drexel University College of
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Medicine sponsored and administered
40 fellows annually from medical, dental and public health
schools
5 weeks annually to include attendance at the Association
of American Medical Colleges meeting
Administrative, financial, diversity, mentoring, political,
media, governmental relations training
Page Morahan, PhD, Rosalyn Richman leaders
Association of American Medical Colleges
Programs
 Women’s Professional Development Seminars for
Junior Faculty and Senior Faculty
 Minority Faculty Professional Development
Seminar
 Inclusion of women and minorities at the senior
leadership professional development seminars
The Tribal Wisdom of the Dakota Indians, passed on from
one generation to the next, says that when you discover
that you are riding a dead horse, the best strategy is to
dismount.
 But in modern business including educational
institutions,
and government, because heavy
:
investment factors are taken into consideration,
other strategies are often tried with dead
horses, such as the following
1. Buying a stronger whip.
2. Changing riders.
3. Threatening the horse with termination
4. Appointing a committee to study the horse.
5. Arranging to visit other sites to see how they ride dead horses.
6. Lowering the standards so that dead horses can be included.
7. Reclassifying the dead horse as "living-impaired."
8. Hiring outside contractors to ride the dead horse.
9. Harnessing several dead horses together to increase speed.
10. Providing additional funding and/or training to increase the
dead horse's performance.
11. Doing a productivity study to see if lighter riders would
improve the dead horse's performance.
12. Declaring that the dead horse carries lower overhead and
therefore contributes more to the bottom line then some other
horses.
13. Rewriting the expected performance requirements for all
horses.
And, as a final strategy:
14. Promoting the dead horse to a supervisory position.
Competence
Health Benefits
Care
Quality
Questions
Diversity