Effective Strategies to Improve Diversity, Equity and Inclusion in Pathology

January 30, 2022

Information

January 27, 2022

Yale Pathology Grand Rounds

Marissa J. White, MD

ID7387

To CiteDCA Citation Guide

00:00Yes. At the end of our conversation today,
00:04hopefully you'll be able to recall
00:06the term underrepresented in medicine
00:07as defined by the Association
00:09of American Medical Colleges.
00:10Describe historical and current
00:12distribution of individuals
00:13underrepresented in medicine or UIM,
00:15both in training and practice,
00:16with an emphasis on pathology.
00:18Specific data.
00:19Recognize how barriers retaining
00:21individuals underrepresented in medicine
00:23evolve at each station or career,
00:25and then outline some key elements
00:27for an impactful DI initiative.
00:30Alright, but before we move forward,
00:32we want to recognize the past and better
00:35understand where we are coming from
00:37and understand the context in which the
00:39disparities that we currently see arose in.
00:42And for those of you who are
00:44readers or audiobook listeners,
00:45I have no stake in this book,
00:48but I think how the word is
00:50passed is a really nice book.
00:51For those of you to listen to,
00:53and I think it really
00:54emphasizes what I want to take.
00:56Drill home with this part
00:57of our conversation today,
00:59which is there is.
01:00The history that we know,
01:02the issue that we're taught,
01:03and then what actually happened and you know,
01:06it's important to be cognizant of
01:09what we thought we knew may not
01:12be reflective of the actuality
01:14of what we're seeing today.
01:16So I want to just pause and recognize our
01:18history in medicine and again of course,
01:20history.
01:20Medicine begins with segregation
01:22and medicine with ***** versus
01:24Ferguson upholding segregation.
01:26And I think there are a few of us
01:29that have some ties to Atlanta.
01:30So I'd just like to highlight the
01:32GREYDIS which is Grady Memorial
01:34Hospital is built in the shape of
01:36an age so that the white patients
01:37were on one side of the H and
01:39the colored patients are black.
01:41Patients were on the other side of the
01:43age and they had separate care teams.
01:45Matt Hopkins at Hopkins was segregated
01:48with the last inpatient unit being
01:50desegregated in about the mid 1970s.
01:53The first black pathology residents
01:55didn't resident did not enter our program
01:58until the year my brother was born,
02:00so again,
02:01segregation of medicine is a very real
02:04thing and this is the real history
02:06that we need to be cognizant of.
02:09Speaking of the history that we
02:10were taught and what you know the
02:12the other aspects of the history
02:13that we didn't necessarily know
02:14the Flexner report we all learned
02:16about the landmark Flexner report
02:18published by Abraham Flexner.
02:20Which is a comprehensive survey of
02:22the US and Canadian medical schools
02:24over the span of 18 or so months.
02:26This was commissioned by the American
02:29Medical Colleges Association Council
02:31medical education and it sought
02:33to reform and standardize medical
02:34education and bring it into what
02:36at the time was science and rigor
02:39providing medical students with
02:40an evidence based education and
02:43institutions such as you know,
02:45the Harverst the Hopkins stood
02:46out as the landmark institutions
02:48and that's what we were taught.
02:50That's what I was taught.
02:51I was taught that the Buckner port was.
02:52Instrumental in revolutionising
02:54medical education and really bringing
02:56us forward and bringing science and
02:58rigor again into medical education.
02:59What I didn't learn was that there are
03:02other chapters of the Flexner report.
03:03There was chapter 13,
03:04the medical education of women and
03:06then chapter 14 medical education of
03:08the ***** and learned about this.
03:10Anecdotally, I don't know what
03:12prompted me to just go look at
03:13the look up the facts and report,
03:15but I look I just decided to
03:17read it one day and I know these
03:19these these two chapters.
03:20So if you look at chapter 13.
03:23Medical education of women and it
03:25briefly outlining the status of medical
03:27education of women in early 20th century
03:29and while Flexner noted that female
03:32student enrollment was declining.
03:34Flexner did note that there was a
03:36clear role for women to be educated
03:39and medicine and become physicians.
03:41However,
03:41they flex or noted that they
03:43women had a decreased decreasing
03:46inclination to enter medical school,
03:48which was interesting.
03:51Now,
03:51as I mentioned,
03:52the flexing report was Brett Rose
03:53revolutionary in terms of.
03:55Bringing science and rigor into
03:56medical education,
03:57but the the consequences at the medical
04:01schools that Flexner felt did not have
04:04the adequate resources or the OR the
04:06whether they be physical resources.
04:09Faculty resources,
04:10whichever institutions that did
04:12not have the resources.
04:14Flexner spell all that out and
04:16then recommended whether they be
04:19closed or remain in existence.
04:21And So what?
04:21Flexner outlined in this Chapter
04:2313 is that none of the three women
04:25medical colleges at that time
04:26could be sufficiently strengthened
04:28without enormous select outlay,
04:30and recommended their closure where
04:31those medical school colleges was
04:33actually in Baltimore as well.
04:35Baltimore as well.
04:37So the implications on the flexing
04:39report for female medical education
04:40there is decreasing female
04:42enrollment with closure of medical
04:44schools with trained female,
04:45but also African American and
04:47working class or socio economically
04:49disadvantaged students.
04:50This also occurred in a time when medical
04:53schools still had some gender based
04:55quotas and so even though there was.
04:58Duckster was arguing that there needed
05:00to be females educated in medicine.
05:02The medical schools were not
05:04forced to have or to get rid
05:07of their gender based quotas.
05:09So what about medical education and
05:11the impact on African Americans?
05:13So out of these seven African
05:15American medical schools,
05:16which were in existence at the time,
05:18including Howard University College of
05:19Medicine and Meharry Medical College,
05:21Flexner argued that only two of
05:24those seven medical schools were
05:25able to provide a quality medical
05:27education at the standards that
05:29Flexner had argued were necessary.
05:32With that in mind, he did,
05:34however,
05:34outline a fundamental need for properly
05:37qualified education physicians.
05:38I'll be at what they narrowed.
05:39Scope of focus.
05:40I'm more so on public health and
05:43hygiene rather than subspecialty care.
05:46So what are the long term implications?
05:48Five of those seven medical colleges
05:51were closed with Howard and Meharry
05:53being the only two that were allowed to
05:57remain open. Morehouse School of
05:59Medicine didn't open until about the
06:01mid 70s and then secondarily with the.
06:05And fundamental need for qualified for
06:09qualified African American physicians
06:11outlined the the scope of practice was
06:14narrowed to again primary care and public
06:16health and hygiene with fewer African
06:18American physicians educated in medical
06:21specialties and the consequences that
06:23there is diminished or decreased access
06:25to subspecialty care for quite some time.
06:28And we still see those profound disparities
06:31in representation in subspecialties today,
06:33including orthopedic surgery,
06:35interventional radiology, cardiology, etc.
06:37So these are some of the
06:39long term implications,
06:41but another one that is,
06:42you know that that's the
06:44elephant in the proverbial room.
06:45Decrease exposure for diverse educational
06:47environments for all medical students.
06:49So not only are we talking about diminished
06:51access to education for African Americans or
06:54individuals underrepresented in medicine,
06:56particularly at the time
06:58indigenous Americans,
06:59would it be included in that as well?
07:01But then also,
07:02on the flip side,
07:04you had Caucasian students that were not,
07:06or white students that were not being.
07:08It educated an environment where
07:11there was diversity.
07:13But what about beyond education?
07:15We had patient segregation in the wards
07:17we talked about that with the greedies
07:19and we talked about that at Hopkins.
07:21But what about desegregation beyond awards?
07:23What about in pathology?
07:25So some of you historians may may
07:27remember that our blood supply
07:29was segregated for quite some time
07:31up until about the mid 1950s,
07:33or well into the mid 20th century.
07:36And this is what this is a an image
07:40published by Paul Hoxworth showing
07:42what the blood storage refrigeration
07:44units looked like,
07:45where you had it on one side,
07:46white blood and the other side colored blood.
07:48And these would be taken from white or.
07:51Brown donors and then stored in
07:53separate areas of the blood bank and
07:56only transfused to specific patients.
07:59And this is also in pathology again.
08:02So for those of you that have
08:04ties to Hopkins,
08:04this is our old original morgue and these
08:07little white tags on the doors are for
08:10white patients and colored patients.
08:13And this is from Doctor Ralph Rubin
08:15who shared this photo and I did touch
08:17base with Doctor John Boitnott.
08:20For those of you, again,
08:21have some Hopkins ties.
08:22Who confirmed that this was an
08:25actual this was. This was real.
08:27There were segregated storage,
08:30refrigeration, sorry there was.
08:33There was segregation in the morgue,
08:35although they did not necessarily
08:36always follow it.
08:37And you know that that take
08:39that for what it means.
08:41But it was built with segregated morgues.
08:45Alright, So what is the argument
08:48for diversity in pathology?
08:50Again, we talk about pathologists
08:52and you know we don't typically see
08:54our patients with the exception of
08:57those and of those of us in forensics
08:59or who those of us who do find
09:02utile aspirations as pathologists,
09:03we primarily look at,
09:04you know tissue under the slides or
09:06we look at blood and tubes and so
09:08we're not seeing our patients and
09:10so you could argue that I work we,
09:12as pathologists,
09:13work in a setting where bias doesn't have.
09:15He doesn't have impact on our
09:17clinical workflows.
09:18We are not impacted by bias.
09:21However,
09:21that couldn't be further from the
09:23truth and you don't necessarily need
09:24to be seeing your patients to be 1
09:27affected by bias or two to perpetuate
09:29and exacerbate health disparities.
09:31But beyond that, you know.
09:34Again, thinking classically about
09:35what workforce diversity does,
09:37we classically think of you
09:39know workforce diversity,
09:40providing improved patient care
09:41with patient provider, concordance,
09:43and the provision of cultural.
09:45Appropriate and patient centered care,
09:47which again might not be as relevant
09:49to most of us as pathologists,
09:50with the exception of those of us
09:52that do interact with patients.
09:53However,
09:54diversity has more has other ways
09:56on touching on how we provide
09:58care and how we can how it can
10:00improve the way we provide care.
10:03Not only does it help us
10:04provide higher quality care,
10:05but as well established that diversity in
10:07the workforce helps increase innovation.
10:09When you have diverse teams,
10:11diverse teams bring increased awareness
10:13of and emphasis on health and health care,
10:15disparities,
10:16diversification of clinical trials.
10:18I think that's a really hot button
10:19topic now that we're more aware of.
10:21But this is something that's been
10:23going on long for for quite some time,
10:25including the post NIH Revitalization Act,
10:28which mandates that the clinical
10:30trials and studies that are receiving.
10:32And age funds need to be thinking
10:35mindfully about diversity,
10:36increased workforce diversity
10:38and touches on all these aspects.
10:40Provision of high quality care,
10:42clinical child diversity help
10:43US verities focus innovation.
10:45So even though we as pathologists are
10:47not directly improving patient care
10:49by patient provider, concordance,
10:51or culturally appropriate and
10:52patient centered care,
10:53there are other ways that diversity
10:55adds value to the work that we do.
10:57And if you are,
10:59you know somewhat of a skeptic
11:01and you know disagree with those.
11:04You know things that I advocate for
11:06in terms of why diversity matters.
11:08Diversity does bring in higher
11:10financial performance with the
11:12McKinsey analysis.
11:13Looking at private sector companies
11:15and looking at financial performance.
11:17And they demonstrate that ethnically
11:20diverse companies were outperform
11:22or more likely to outperform their
11:24non diverse businesses.
11:25So even if there is a question of
11:28whether or not diversity increases
11:30innovation or increases emphasis
11:32and awareness on health disparities.
11:35Or improves the quality of care.
11:37Fundamentally it is financially
11:40beneficial to increase diversity.
11:43So now that we understand the
11:45framework for which we
11:47are building,
11:48our discussion on diversity upon,
11:50let's talk about what we currently
11:52observe the pathway into pathology,
11:54and we understand that you know,
11:55we as a as a medical as a
11:58medical institution had were
12:00segregated for quite some time,
12:02and with that segregation
12:04extending into a pathology space,
12:05we recognize that the long term
12:08impact of overt segregation and overt
12:10exclusion in medical education is
12:12still palpable today in terms of the
12:14representation that we do not see.
12:15In our medical specialties,
12:17so where are we now?
12:19So as it just pause and check in,
12:21here underrepresented is a term that I
12:23will be using for the remainder of the talk,
12:26which means those racial and ethnic
12:27populations that are that are
12:29underrepresented in the medical
12:30profession relative to the numbers
12:32in the general population and this
12:33represents a shift from the 2003
12:36term underrepresented minority which
12:39classically consists of blacks,
12:42individual black individuals
12:44on Mexican Americans,
12:46Native Americans mainland Puerto Ricans.
12:49And for those individuals we would use
12:52the term underrepresented minority.
12:53However,
12:54the AMC decided to shift and use
12:56the term underrepresented medicine
12:57because the old term underrepresented
13:00minority represents affixed,
13:01affixed aggregation of individuals where you,
13:03as UIM allows for an evolution of
13:06the individuals that we are looking
13:08at relative to their population
13:09within the United States and so the
13:11expectation or the hope is that at
13:13some point black individuals will
13:15no longer be underrepresented in
13:16medicine relative to the proportion
13:18of the United States population.
13:20And therefore we can shift the focus
13:23more appropriately to other individuals.
13:26OK,
13:26now again I just said I will be using you.
13:28I am for the remainder of the talk,
13:30but a lot of these data are coming
13:31are are are a little bit older
13:33and so they are priest.
13:35They they predate the ships to you.
13:36I am so URM will be synonymous
13:39and for these slides,
13:41but what I'd like to highlight is
13:42that when we look at when we look
13:44at the very beginning of the path,
13:46we're not the very beginning when
13:47we look at the middle of the pathway
13:48into a career in medicine with the
13:50beginning of the pathway starting
13:51and you know my sons pointed in
13:53kindergarten when we look at the
13:54midpoint in terms of applications.
13:56In medical school we do see that
13:58there have been slight increases
13:59in the number of applications the
14:01medical school over the past.
14:02I'd say since the past 2000s we can
14:04see that that there is an uptick.
14:06However,
14:07we need to be very deliberate in
14:09how we look at these data because
14:12applications are not the only.
14:13Point here, right?
14:14We want to look at how many students
14:16are matriculate ING successfully,
14:18and then how many are actually graduating
14:21applications are not sufficient,
14:23and they don't represent the
14:25entirety of the situation.
14:27So we look at individuals that
14:29are identified at self identify
14:31as black or African American.
14:33When we look at the number of
14:35applicants versus acceptes
14:36again, you see that upward trend
14:38in the number of applications.
14:39But when you look at the number of acceptes
14:42that has remained fairly stagnant and
14:44then it's important take home point,
14:46there is something going on here.
14:47Whether there are barriers to their
14:49acceptances or they're just not being
14:51accepted at increasing rates commensurate
14:53with the number of applications.
14:55Same similar trends seen
14:56in our Hispanic or Latino.
14:58Populations or Latin X populations.
15:00You see that there is an uptick
15:01in the number of applicants,
15:02but not the same rate of increase
15:05in the number of acceptance
15:07applicants versus acceptance.
15:10This deposit check in here are
15:11American Indian or Alaskan
15:13native or Indigenous American.
15:14Population has remained abysmally low
15:16in terms of the number of applicants
15:19versus acceptes and this is often
15:21the unspoken aspect of diversity.
15:24When we think about our Native American
15:26indigenous American population,
15:27profound under representation.
15:29Despite significant disparities in
15:31health and health care delivery.
15:34OK,
15:35so we talked about the midpoint in
15:37the pathway into query medicine,
15:39which is the application to medical school.
15:41We talked about that even though
15:42the numbers of applicants that are
15:44under record that self identify
15:46as underrepresented in medicine
15:47or underrepresented minority have
15:49increased the number of acceptes
15:51has remained stagnant.
15:52What we also see is that there
15:55is declining representation,
15:57so we have the US Census population
15:59which serves as our benchmark
16:01that is our representation in the
16:03total US population will meet.
16:05Look at the various milestones we
16:07look at the medical school graduates
16:09and then we look at the total GME
16:11pool and we look at the total
16:13physician pool we see attrition or
16:15loss of these individuals on the
16:18pathway to a career as a physician,
16:20and again highlighting reiterating
16:21the thing that we saw with the
16:23acceptance versus acceptance.
16:24There's attrition there,
16:25so at every node or every milestone
16:27in this pathway, there is attrition.
16:29There's attrition from application to
16:31acceptance, acceptance to matriculation,
16:33which circulation to graduation.
16:35Graduation to residency residency
16:37to practicing physician.
16:41And. This trend continues so under
16:45representation increases at faculty ranks.
16:48So when you look at Mewis Medical
16:50school graduates and compare their
16:52numbers with full time US Medical
16:54school faculty again you see that
16:57attrition with declining representation
16:59down to about 3.5 three point 5% for
17:03black representation at faculty ranks,
17:06and three point 2% for Hispanic or Latino.
17:11But what an interesting trend here.
17:13However, though,
17:14is that these gender disparities that we
17:16all talk about gender disparities and
17:19feet and in female representation and
17:21hire faculty ranks and leadership roles.
17:23Those gender disparities persist independent
17:25of a self identified race Recognice city.
17:29So even though there are more female African
17:32American or black self identified physicians,
17:36there are more male,
17:37self identified black or African American
17:40faculty and leadership positions.
17:42Including department chairs and
17:44which is what we're looking at here.
17:47Same thing resonates true for Hispanic.
17:51And stepping outside of,
17:53you know the the MD pathway.
17:56Do these trends hold true for our
17:58PhD colleagues?
17:59And they do so when we look at
18:01data from the NIH,
18:02we see that there again is
18:04at trend of attrition.
18:05When you look at let's look at women,
18:07you look at women the there's
18:09attrition from associates to bachelors,
18:11bachelors, Masters, Masters,
18:13electoral etc etc.
18:14When you look at underrepresented again,
18:17there's attrition down to full professor.
18:20So these.
18:21These trends resonate and or these
18:24trends are persistent through not only
18:27the MD pathway but also PhD pathway.
18:31And I'd like to highlight something
18:33that was published by Ginther at all,
18:35where they noted that after controlling
18:37for applicant educational background,
18:39country of origin training,
18:40prior research experience,
18:42publication record,
18:43employer characteristics,
18:44they found that black were African
18:47American self identified faculty remain
18:50less likely than white than white
18:53individuals to be awarded NIH funding,
18:55which again represents a significant barrier,
18:57particularly for our PhD colleagues
18:59and their.
19:00Not only a fat successful
19:02faculty appointment,
19:03but then also successful untimely
19:05promotion from assistant to
19:07associate associate full professor.
19:09This is also somewhat true for MD's,
19:12but may not be necessarily as
19:14critical to successful promotion.
19:16To just highlighting that there are
19:19barriers to successful promotion for
19:21not only individuals underrepresented
19:23but also individuals that I self
19:26identify as female and these hold
19:28true not only for MD but also PhD.
19:31Pathways and I'm talking a lot
19:34about race and ethnicity,
19:36since that is the area that
19:37I am the most familiar with.
19:39However,
19:39I do want to pause again and
19:41check in and remind everyone that
19:43diversity is very diverse when we
19:45look at socioeconomic diversity,
19:47for example,
19:48there is significant and profound
19:51underrepresentation of individuals
19:53that have parents that have the that
19:56have income within the lowest quintile.
19:59Less than you know,
20:01less than 5% of our US medical students have.
20:03Parental incomes within the lowest quintile.
20:07But then when you look at the
20:09top 50% of the of the students,
20:11their parents have the top 5th
20:14and 80th to 95th
20:16percentile. Income just highlighting profound
20:19disparities in socioeconomic status using
20:21parental income as a surrogate marker,
20:24and this has remained relatively stagnant,
20:26and these socioeconomic barriers have been
20:29demonstrated to correlate with performance
20:31and success within medical school with
20:34students that come from that have parents
20:37that have again low socioeconomic
20:39income or socio economic status,
20:41those students are more likely to attrite
20:44within the first first, second, first,
20:46or second years of medical school.
20:48Independent of their emcat scores,
20:51so again, socioeconomic status impacts.
20:55Diversity and has an impact on the
20:58barriers that the students will face.
21:01So why don't we look at some pathology
21:04specific data that we looked at some broader
21:06overall trends and medical education,
21:08and we look at pathology and I again I I
21:12want to just remind everyone that these
21:14are all data that are obtained from AMC
21:17and historically AMC data collection
21:19methods have been somewhat reductive
21:21and exclusive of of of individuals.
21:24So for the up until recently I think is 2017.
21:29You could either identify as black
21:31or African American.
21:31However,
21:32there is incredible diversity
21:33within African diaspora.
21:35Same thing is true for Hispanic and
21:37then for for gender identity you
21:39can either self identify as female
21:41or male and that's it.
21:43So again a lot of these data.
21:44I apologize,
21:45I'm not using the correct the
21:47the most inclusive terminology,
21:49but these are the way that data have
21:51been presented and hopefully moving
21:52forward now that there are more,
21:53there's more inclusion in our
21:55data collection methods.
21:56We will we'll be able to present our
21:58data or the data in a more inclusive way.
22:01Well, let's look at.
22:02Look at some pathology specific data and
22:04my interest in this was sparked by a.
22:07Paper published by one of my
22:09colleagues here in radiation Oncology
22:10at Hopkins Cortlandville,
22:12who published that in 2012.
22:15GME trainee or pathology GME
22:18trainees were there are fewer black
22:22pathology trainees 11 compared
22:23to the overall Jamie Pool,
22:26and that's also in comparison to for example.
22:30Physical medicine and rehabilitation.
22:32Emergency medicine.
22:33Radiation oncology.
22:33So at that time we had worked
22:36we had lower representation of
22:38black students or black rice.
22:40I'm sorry black residents at
22:42that time in 2012 when compared
22:44to other medical specialties.
22:46Hispanics were also less represented,
22:49however that was not
22:50statistically significant,
22:51so I became interested in
22:53kind of looking at longer,
22:54longer trend,
22:55longer term themes and trends in
22:58terms of representation,
23:00and to and look more forward and
23:02see how the trends improve or
23:04if there is improvement.
23:06And So what I noted first was
23:08that pathology is a female,
23:10is a leader for female resident
23:12and fellow representation compared
23:13to other medical specialties,
23:14and that certainly is no secret.
23:16We in pathology reached near gender
23:18parity in the in the early 2000s,
23:20and that has been a sustained increase
23:22in female representation since then,
23:25and so it's we've made significant strides.
23:27So what it highlights is that
23:29we as a specialty
23:30or are are capable of doing it.
23:32We increase female representation
23:34and that increased female
23:35representation has been sustained.
23:37And so it's portant for us to keep that
23:39in mind when we think about how high the
23:41hurdle and amusing hurdle as an analogy.
23:43Since I was a hurdler in college,
23:44what we use, you know that that
23:46there is a high hurdle to overcome,
23:48but we can do it because we did
23:50it for female representation.
23:52With that in mind,
23:54there are still significant barriers to
23:56increasing female representation by fat
23:59***** particularly in faculty ranks,
24:01with which we note that about 39.56%
24:05of female faculty or faculty or female.
24:07So there are still some significant
24:10opportunities for improvement.
24:12But again, there is still sustained increase,
24:15and so we are on the right pathway forward.
24:20And when we look at the 2020 seventeen
24:22distribution of female sex by female sex
24:25Ben pathology compared to the US population,
24:28again, we are doing fantastic with
24:30our pathology residents almost at
24:32the same level of their female
24:35representation in the US Census.
24:37However, again are practicing
24:38pathologists is a little bit lower than
24:40female representation in US Census,
24:42so opportunities for improvement. But again,
24:44we're on the right pathway forward.
24:46So again, it highlights that we can do it.
24:49With that in mind,
24:50but there are some significant
24:51opportunities for us to do it.
24:52We have to increase racial and
24:55ethnic diversity in pathology.
24:57When we look at the distribution
24:58of pathology residents by race and
25:00ethnicity between 1995 and 2017,
25:02at that point in time 8% were Hispanic,
25:064.5% were black and point 1% were
25:10Indigenous American, American,
25:11American Indian, Native American,
25:15Pacific Islander.
25:17These have increased only slightly
25:19in pathology.
25:20For Hispanic, we're a little bit above eight,
25:238% were around 5% for black and.
25:27About the same for American
25:30Indian indigenous American.
25:31Why is this matter? Again,
25:33US census populations here in the top bar.
25:36Hispanic and yellow,
25:37black and blue.
25:39And and just Americans in in black.
25:43And we know again there is significant
25:47underrepresentation comparatively speaking,
25:48when we look at the number of faculty.
25:50We're at 5.2%,
25:51two point 2% and .2% respectively.
25:55So significant under representation.
25:58And when we look at longitudinal trends,
26:00there are none.
26:01The rate of increase in representation
26:04for black faculty and Native American
26:06faculty has not been increasing at a
26:09significant rate. Again, abysmally low.
26:12So there are significant opportunities,
26:15and there's no secret that when
26:16we look even at pathology,
26:18chair and leadership positions again,
26:21these disparities persist again with
26:23the gender diverse gender disparities
26:26persisting as well with data from AMC High.
26:29Highlighting that of our pathology
26:33department's 38% of our clinical
26:35pathology departments or pathology
26:36clinical departments have female chairs.
26:3833% of our basic science pathology
26:41apartments have female chairs.
26:42There are two female, one male,
26:45black or African American chill chair.
26:47Three female,
26:482 male Hispanic or Latin X or Latino
26:51no American Indian Alaska native oh
26:54ornate Hawaiian so again highlighting
26:57the overall trend of attrition.
26:59There's loss on this pathway into
27:02medicine and I just want to pause
27:04here again and think about the
27:06terms that we often use.
27:07We often say the pipeline and,
27:09and when we think about being
27:11in the space of the eye,
27:13we want to be more Cognizant that
27:15we always have room for improvement
27:16and this is an area where I was.
27:19Educated historically,
27:19I had been using the term pipeline
27:22and one of my, you know,
27:24in my studies I recognize and learned
27:26that pipeline is an inherently
27:28is inherently triggering term.
27:30For some individuals who identify
27:32as indigenous American with the
27:34with the with the connotation
27:36or correlation with the the oil
27:38pipelines in the in the Midwest,
27:40and then thinking about to
27:41our the black experience in
27:43America, they call it. You know,
27:44the pipeline into jail. So wanna be.
27:47I'm trying to be more inclusive there
27:48and and avoid using that terminology.
27:50I've been trying to involve
27:51myself and use a term pathway,
27:53but we are seeing attrition on
27:55this pathway into medicine and we
27:57want to be mindful of what that
27:58pathway into medicine may look like.
28:00You know, thinking about our
28:02colleagues and you know,
28:03those individuals that you work with.
28:04Some of them may have and assume you know
28:06may may have earned an associates degree.
28:08First took some time off,
28:10went back out of four year degree
28:11and then took some time off
28:12again and then came back to you.
28:14Know medicine now thinking about
28:16what that individual needs compared
28:18to a a student that goes straight
28:20from high school to medical school.
28:22Or high school to college to
28:23medical school residency.
28:24Their needs are distinctly different and
28:27unique and being inclusive of each person,
28:29lived experiences and what
28:31career supports or what personal
28:34support they need for them.
28:36So I'm going to share some of what I've
28:39learned in some of what we've learned
28:40here at Hopkins and our efforts to
28:43improve inclusion and equity in pathology.
28:46And we'll start with our rotation for
28:48students underrepresented in medicine
28:50and from disadvantaged backgrounds,
28:51and pre COVID.
28:52This was a one month rotation
28:54for students who self identify
28:56as underrepresented in medicine
28:57and at the time we were covering,
28:59housing and travel for students
29:01which rounded out to approximately
29:04$1500 excluding travel,
29:05which includes housing and then school of.
29:08Medicine registration fees and I'm
29:10highlighting this because these are,
29:11you know pre COVID.
29:12We thought a lot of we put a lot
29:15of weight into those, you know,
29:16external rotators, right?
29:17Like oh,
29:17this person did a rotation with
29:18us and they were pantastic,
29:20but we often didn't think about how and
29:22how inequitable of an experience that is.
29:24The students have to have the
29:26money to spend to stay in a certain
29:29location for an entire month.
29:31Essentially pay double rent,
29:33and then travel and pay registration fees.
29:35If you are a student,
29:36that is a perhaps, you know,
29:37first generation college graduate.
29:39Or a student that comes from a socio
29:43economically disadvantaged background.
29:44You know those experiences are
29:47exceedingly difficult to navigate
29:49because they are expensive,
29:50and so for us,
29:52that was why providing cover
29:54financial support is important.
29:57And in terms of increasing equity and access,
30:00we also aim to increase equity by tailoring
30:03the experience to the students and and,
30:05you know,
30:06checking in with them and finding out
30:07what are they actually interested in,
30:08not giving them the same
30:10cookie cutter rotation,
30:11because again,
30:12each student has different interests
30:14has different needs.
30:15We also provided one on one advising
30:17and mentoring with pathology,
30:18junior and senior faculty had the
30:20Met meet with our residency training
30:22program director and the director
30:23of Department of Pathology and then
30:25finally we have exit interviews
30:27to discuss
30:28their experiences and.
30:29And help us self reflect and process improve.
30:33And this is our team and I
30:35want to highlight that again,
30:36none of these efforts can be
30:38done in a silo by one person.
30:39It really does require a team effort and
30:42so here we have lisandra voltaggio myself,
30:46Ralph Ruben, Lara Weiquan,
30:47Junko Solonika, Wind and Sherry Reid.
30:50She's our administrator support.
30:51Who is fantastic.
30:52Trisha Murdock and Alicia,
30:53where again a team effort.
30:57So we had this rotation.
30:59It was established in 2013,
31:01but I didn't become actively involved
31:03with it in about until about 2016
31:05and my involvement was somewhat
31:07serendipitous because I graduated
31:09from moral High School of Medicine
31:10and Morehouse School Medicine has a
31:12pathology department that is fantastic,
31:14but they don't have any clinical
31:16services and so when I came
31:18to Hopkins for as a resident,
31:20I was really interested in just
31:21giving back to my alma mater and in
31:24speaking with Ralph, he said, well,
31:25oh, why don't you do an outreach?
31:27Presentation and we found that
31:28those out the outreach presentation
31:30resulted in students being more
31:32interested in rotating and so we
31:34developed an outreach and active
31:36outreach program targeting programs
31:38at either our historically black
31:40colleges or targeting specific
31:42affinity groups at non historically
31:45black universities and using
31:47those as opportunities to have one
31:49highlight pathology as a specialty.
31:51Because we need students to
31:54go in pathology and then two.
31:56Talk to him a little about what our
31:58rotation looks like and hopefully
32:00generate some interest in our experience.
32:02And so we did.
32:04Active outreach and we again went in with it.
32:07Went into these experiences trying
32:09to reach as many students as
32:11possible in the hopes that maybe
32:13we would get one student rotator,
32:15but again,
32:16it just highlighted pathology as a specialty
32:18to them and we even had students that said,
32:21you know,
32:21I quite frankly have no
32:22interest in pathology,
32:23but I want to go into OB GYN and I want
32:25to learn more about pathology and we
32:27have them rotate and that's totally fine.
32:29So what we do is we have the we give
32:31an overview of what pathologists do,
32:33so this is Alicia.
32:35We're giving a presentation on how our
32:37pathologists involved in this case,
32:38so we give the students a presentation.
32:41The presentation or case presentation
32:43in this in this talk was a
32:45real modular carcinoma,
32:46which hopefully most of the medical
32:48students as they prepare for step one
32:50would be familiar with and we show
32:51them some gross photos that that's
32:53myself and more hustle of medicine,
32:55pre renovations and then walk
32:56them through the case and talk
32:57about the different ways that
32:59pathologists were involved.
33:00Talk about not only the
33:02gross the frozen sections,
33:03but gross examination.
33:05Sign out with staging and diagnosis.
33:08Diagnosis of an occult hemoglobin.
33:11SC disease that clinically
33:13had been a cultured,
33:14not the clinicians had known about it.
33:16We talked about the clinical
33:18pathology and how the you
33:19know they had a type and screen before by
33:21the blood bank and how pathologists are
33:24medical direct medical laboratory directors.
33:26So again, talking with the
33:28different ways that pathologists
33:29are involved with patient care.
33:30So they hopefully walk out
33:32of these presentations,
33:33learning that pathologists are not just,
33:35you know in the doing autopsies which you
33:38know is a very important part of pathology,
33:41but you know we don't all
33:42do pathology autopsies.
33:43If that's certainly not
33:45your area of interest,
33:46but we also kind of reached back earlier,
33:49because, again,
33:50if you try if you start your
33:52outreach efforts that medical school,
33:55you're not going to reach as
33:56many students as possible.
33:57You thinking about the pipe
33:59or the pathway into medicine.
34:01There is significant attrition
34:02once you hit medical school,
34:04but there there is even greater
34:06loss before that.
34:08Think about when you started as
34:09an undergraduate and how many
34:11colleagues you had in your first
34:13biology class and how many students
34:14in your class at their pre Med and
34:17then by the time you graduated,
34:18at least in my experience,
34:19you know it dropped.
34:20It dropped down, you know, precipitously.
34:22You know once you hit that,
34:24you know or inorganic chemistry,
34:26organic chemistry class.
34:27How many students you know switch to
34:29a different major or decided that
34:30they no longer want to be pre Med.
34:32So what we did is we started
34:35reaching out earlier.
34:36I mentioned Doctor Trisha Murdock.
34:39She's Tuscarora Native American,
34:40and she has been a very fierce
34:43advocate for increasing representation
34:45for our indigenous Americans.
34:47And So what she did is looked.
34:49Hooked us up with the National
34:51Labor American Youth Initiative,
34:53which provides a summer intensive
34:55experience for students who self
34:58identify as Indigenous American.
35:00And what we did here is we
35:03brought some microscopes.
35:04Ralph Ruben packed him up in this
35:06car and drove them down to DC for us.
35:08And then we brought some plastinated
35:10or some some nherf lungs and then
35:13some formalin fixed specimens.
35:15But you know,
35:15we want to be mindful again of inclusion
35:17and thinking about the indigenous
35:19American experience and culture and values.
35:21Some indigenous Americans have
35:23concerns about touching tissues
35:25from decedent individuals,
35:27and so we were very explicit and told him,
35:30you know,
35:30these are tissues over here at the station.
35:32Do not come to the station.
35:34You know, you know we will
35:36offer you another experience.
35:37So again,
35:37Trisha,
35:38Trisha Murdock was instrumental
35:39in helping us provide an inclusive
35:41experience for those students.
35:43But then also increasing acts,
35:45increasing their access and
35:46their high school students.
35:47A lot of them just had questions
35:49about college, but again,
35:50just having those conversations with
35:51them and having them speak to you know,
35:53Trisha someone who had this similar
35:55experience growing up in a reservation
35:57and learning more about what you know,
35:59her pathway looked like so that
36:01they can see that it's possible.
36:04This summer we are fortunate in
36:06able to reset restart our active
36:08outreach with our local high school
36:11program and this is our summer
36:13program at Dunbar High School
36:15which is down the street from us.
36:17For some of you basketball fans,
36:19there are a couple of basketball
36:21players that are pretty famous
36:22from Dunbar High School,
36:23but we worked with them over the
36:25summer and again did the same
36:26thing where we bought the specimens
36:28in the bags and the nerve lungs
36:30and the microscopes and had them
36:31look at it and it was super cute.
36:33Because if you can see in in here,
36:35this student has herself one out,
36:36not because they're checking their phone,
36:38but because they were actually
36:39taking a picture like our residents
36:41doing like we do using their cell
36:42phones to their oculars and they
36:44figured this out all on their own.
36:45So really bright students.
36:47They're super interested and again,
36:49we just talked a lot about just college,
36:52and that's that's where they are
36:53at that point in their career.
36:54But just highlighting that,
36:56you know this is you can do it.
36:58These are the steps that you
36:59need to take and we also brought
37:01not only pathologist here,
37:02you can see my colleague Laura Wake,
37:03but then we also brought.
37:05Our Histology Histology lab lead.
37:09Yolanda Mitchell.
37:11And we talked to them who talked
37:12to the students about careers in
37:14laboratory medicine and gave them
37:15some more information about different,
37:17you know,
37:17a different way that you can
37:19get a career in pathology,
37:20and you don't necessarily have to
37:21be a physician to be in pathology.
37:23You can have a very fulfilling career
37:25as a lead laboratory technician and the
37:27different ways that you can get there.
37:30Alright, so.
37:30We focus a lot of our efforts on either,
37:34again, historically black medical
37:36schools or affinity groups or high schools,
37:39or undergraduate programs
37:40that have a greater,
37:41have greater representation,
37:43or of students underrepresented in medicine.
37:45And why do we do that?
37:46Because we want to reach as many
37:48students as possible at one moment,
37:49and this just highlights the point.
37:51So these are data again,
37:52from the AMA masterfile from AMC
37:54and I highlights the number of
37:56medical schools that graduated 300
37:58and 5050 or more black or American
38:01physicians between 1980 and 2012.
38:03And you can see Howard,
38:04Meharry and Morehouse are up there,
38:07and again,
38:08I'm noting Morehouse because Morehouse
38:10wasn't open until about the late 1970s,
38:13early 1980s.
38:14But yet it got in my time when I graduated,
38:18my class was around the size of 50,
38:20such as schools,
38:21to show you that, might you know,
38:23at the time,
38:24Tiny Morehouse School of Medicine had
38:26graduated more than some other medical
38:29schools that are notably missing here.
38:32Find included.
38:33Alright,
38:34so US medical student interest you
38:37know we talking a lot about reaching
38:39as many students as possible.
38:40When I reach as many UIM
38:43students as possible too.
38:44Create the most opportunities
38:46for capturing one student,
38:47but again pathology interest is declining.
38:50We all know that and so why not reach as
38:53many UIM students as possible just to
38:55generate greater interest in pathology?
38:57And so again, that's part of the
38:59reason why we try to go for as
39:01broad an audience as possible.
39:02So when we go back to Morehouse or
39:03when we speak with students at Meharry,
39:05we we try and talk to the whole
39:07class and not just, you know,
39:08the students that self identify
39:10as being interested in pathology
39:11because that may be one person we
39:13want to again generate as much
39:15interest and enthusiasm about.
39:16Our careers and pathology.
39:18And these are just prior data
39:21highlighting that on again US pathology.
39:24Allopathic senior interest
39:26is again declining,
39:27precipitously relative to all
39:29US senior interests and matching
39:32into careers in medicine in US.
39:35So what is the impact been out
39:36of all of this?
39:38So with once we initiate the active outreach,
39:40we noted a dramatic increase
39:42in rotation interest,
39:44so again,
39:45I mentioned that this experience
39:48was established in 2013.
39:50I mean at 1 rotator and then when
39:52I became involved,
39:53the number of rotators between
39:552016 and 2019 was 20 and today
39:59we've had a total of 26 rotators,
40:01some of whom have been virtual
40:04out of these rotators,
40:069 have been have matched into pathology.
40:10We have a few more that are matching that
40:12are applying for the match this year or next,
40:15and we're hopeful that they will
40:17match into pathology as well.
40:19To the former,
40:20rotators have either completed.
40:21Path, Jimmy or you me training at Hopkins.
40:25I'm sorry Pat Jamie,
40:26either residency or fellowship
40:28education or training at Hopkins,
40:30and so we're really proud,
40:31but again,
40:32we had some students that just flat
40:34out said I'm going again into LBGYN
40:36or or surgery or internal medicine.
40:38I don't really have an interest
40:40in and you know pathology,
40:41but I want to,
40:42you know,
40:43do this experience around out my
40:44experience and that's totally fine.
40:46We were thrilled to have them with us.
40:48Conversely,
40:48we had one student come in that was
40:50very passionate about a career in forensics.
40:53And then came in and then decided
40:56that pathology wasn't for them
40:57and that was fantastic.
40:58We were happy that we were able to
41:00help that student figure out that
41:03pathology was not the career for
41:04them and they ended up becoming a or
41:07matching into a vascular surgery program.
41:09And now that student,
41:11we're not that resident.
41:12Physician seeks to give back to her
41:15hometown by being a vascular surgeon and
41:19provide care for Indigenous Americans.
41:21Recognizing that there are profound.
41:23Disparities and diabetes and
41:26indigenous American populations,
41:27so again having impacts even in
41:29medical specialties is important,
41:31so we're happy that we've had
41:33an impact on these students.
41:35Our careers and lives.
41:37So that's the objective feedback.
41:39The subjective feedback has been positive.
41:42One of the best things that
41:45we hope to achieve.
41:46One of the things that we hope to
41:47achieve with this whole experience is
41:49not only introducing them to pathology,
41:50but then also introducing them to
41:52careers in academics and that.
41:54Crews and academics can be very diverse and
41:57don't necessarily need to be basic science,
41:59and you need to have a lab and a
42:01wet lab for example. So again that.
42:05That feedback has, you know,
42:07been fairly consistent and we're
42:08happy that we're able to introduce the
42:11students to what academics can look
42:13like and that a career in academics
42:15is not as unattainable as you know,
42:17the the perception maybe.
42:18And, and that certainly was my lived
42:20experience where when I was, you know, I.
42:22I certainly you know,
42:2420 something year old me wouldn't
42:25have imagined that I would have
42:27ended up in academics,
42:28and this is exactly why,
42:30because I didn't think a career
42:31in academics was accessible.
42:32And I thought academics was one
42:35career pathway.
42:36But unfortunately during the pandemic again,
42:39we had to think creatively.
42:42So what we did is create a virtual
42:44rotation for students underrepresented
42:46in medicine and it started as a rotation
42:50for our in-house internal Hopkins
42:52students who at the time only had one
42:54other rotation that was available to them.
42:56Virtually that was clinical,
42:57and that was radiology.
42:59And so we developed a asynchronous and
43:02synchronous work rotation that again
43:04was all virtual using digital scan slides.
43:07And the students were given again
43:09previewing assignments and were expected
43:11to render a complete diagnosis and
43:13then email their diagnosis to me.
43:16And then we would drive the
43:17slides together during sign out,
43:18and then I would have the students
43:20present the cases to either myself
43:22or my colleagues or other senior
43:23residents as they would if they
43:26were doing it in person experience.
43:28And all that content was supplemented
43:31by asynchronous independent content,
43:34including online learning modules
43:36and so with this experience created,
43:39we were able to we recognize that we
43:41were able to reach a broader number of
43:43students and overcome the equity issue of,
43:45you know that the the fees required
43:47to travel for rotations,
43:49and so we advocated to our School
43:52of Medicine leadership to open this
43:54experience up to UM students and
43:57all students outside of Hopkins.
43:59Recognizing that this election has
44:01been an important element for us to
44:04increase diversity and department.
44:06So with that in mind,
44:07we were able to get quite a few
44:09rotators virtually and we were quite
44:11proud that we were able to continue
44:12to have impact in and increasing
44:14our UM students experiences without
44:17having them travel.
44:20But that's the small picture, right?
44:22Initiating department and institution wide
44:25cultural change. That's the big picture.
44:27That's that's that's the other part of this.
44:30You can recruit, recruit,
44:31recruit as much as you want.
44:33But it means nothing if you haven't
44:35created in a culture of inclusion,
44:37a culture of equity within our department,
44:40because the students are going to
44:42come into your department and then
44:44see that diversity inclusion are not
44:45valued and they're going to walk right away.
44:48Or, even worse,
44:49you may.
44:49They may walk away from medicine entirely.
44:52If they feel that your department or your
44:55or their experience was representative
44:57of medicine at all as a whole,
44:59and so that's really a key part
45:01of this is how you initiate that
45:03cultural change to make sure that the
45:06environment that the students are coming
45:08into the residents are coming into.
45:10The faculty are coming into their
45:11underrepresented in medicine.
45:12The environments that they are
45:14coming into our inclusive,
45:15so they don't leave.
45:17And I'd like to highlight what
45:19Vanderbilt has done so Vanderbilt,
45:21their radiology program builds a
45:24diversity program at at a time
45:27when they had no underrepresented
45:29trainees in the residency program,
45:31so they took us a tiered and
45:34systematic approach to DEI to
45:35look at the whole applicant pool,
45:38their residency program proper,
45:39and then they created
45:41additional diversity program,
45:42specific activities,
45:43defined roles and responsibilities
45:45for their office of of DEI.
45:47Including personnel again,
45:48a team based approach not doing this
45:51in a silo and really dedicating the
45:53funds and the time to doing this.
45:56What they noted was that when they
45:58took this tiered approach and were
46:00I'm sorry my son is screaming it
46:01took a tiered approach to deny that
46:04the number of UAM trainees increased
46:06from zero in 2013 to 6 and 2019.
46:08So again being really deliberate
46:10and so modeling after that,
46:13Hopkins is again trying to foster
46:15a true cultural shift and a true
46:18culture of conclusion at at,
46:19at and within the entire hospital,
46:21but then also within our department.
46:23So there are departmental and
46:26institutional leadership structures so.
46:28Within our department again,
46:29I have myself who I advocated for a
46:32deputy director ship for myself and
46:34I we have a diversity committee.
46:36It not only for our faculty and trainees,
46:38but also for the staff and that is
46:41a part of a broader institutional
46:42DI structure which includes a
46:44senior associate Dean for DIA,
46:46Vice Vice President and Diversity
46:49Officer or Chief Diversity Officer,
46:51and then a vice Provost for DNI
46:54at the broader university level.
46:55We have DI specific activities.
46:58And this picture here is our
47:01house Staff Diversity Council.
47:03We pre COVID we're having
47:05what we're calling on.
47:07I forgot what they're calling.
47:08Network networking or activities and
47:11we would have them every couple of
47:13months and they'll be really informal.
47:15We would have food and then
47:17faculty and fellows.
47:18Residents could all join and just
47:21network and and and and and fellowship.
47:25Since then, they've expanded to include.
47:28Other groups,
47:29including our ELG,
47:30LGBTQI community and other
47:34individuals as well,
47:36and then again facilitating
47:38that working in fellowship.
47:39What else have we done?
47:41So at Hopkins we are trying
47:42to extend beyond implicit bias
47:44training and normalizing and
47:46expanding these conversations.
47:47You know,
47:48these conversations can always
47:49feel a little uncomfortable,
47:50but the more you have them
47:52and the more robust they are,
47:54the more comfortable they become and
47:55the more comfortable you become with,
47:57you know, educating each other.
47:59Again, I was educated on using the
48:01term pipeline and so you know I
48:03I was comfortable in having that
48:05conversation with a colleague.
48:07And so, using intergroup dialogues,
48:09open discussion listening session when
48:11briefings, professional development,
48:12programming, training, focus workshop.
48:15So this morning I did a training
48:16focus workshop with your residence
48:17and they were fantastic.
48:18I was really proud of the of the of
48:20the content that they came up with and
48:22then case and evidence based health
48:24HealthEquity grand Rounds is another example.
48:27What we did recently at Hopkins is
48:29did a micro aggressions workshop
48:31specific to pathology.
48:33So we use pathology specific
48:35cases for example.
48:36So one of them was.
48:37You know you're out,
48:38sign out and you overhear someone
48:40saying that the residents quality of
48:42English is poor and you're disappointed.
48:45Or something to that extent.
48:46And what do you do?
48:47As you observe that macro aggression?
48:49That's not even a micro aggression
48:51and the ways that you can
48:53interrupt the microaggressions
48:54triangle by either being by by,
48:56you know, being a bystander end,
48:58interrupting it.
48:59If you're the source,
49:00you know how you can assist.
49:02Or if you're the recipient,
49:03how you act upon it.
49:04How do you self advocate?
49:06And so we had that microaggressions workshop?
49:08And again it was interactive,
49:09so instead of it being one of
49:11those online learning modules
49:12or a video that you watched for
49:1310 minutes and it ends up being
49:15very interactive and a dialogue,
49:16and you learn more from each other.
49:19I'm just as you all are doing.
49:21We have increased the number of DI
49:23lectures and increase our speaker
49:24diversity so we also had doctor
49:26Andrew de Rep and Doctor Joseph
49:28Graves give a grand rounds to us
49:29and Doctor Lecia where I hope that
49:32you will invite her for a future
49:34grand rounds but she gave a really
49:36nice grand rounds on a holistic
49:38review and how we can utilize that.
49:41What the different elements of
49:42holistic review R and the data behind,
49:44why they're important,
49:46and we also instituted a health disparities.
49:50Curriculum and mini curriculum,
49:51which included health disparities and
49:53pathologists overview by myself and
49:55then looking at COVID-19 health disparities.
49:57From a microbiology perspective,
49:59doctor Hebel Mustafa gave a beautiful
50:02overview of how she advocated for text
50:04test access within the local Baltimore
50:06community and then Doctor Mark Mars
50:08Inky give a nice overview of health
50:10disparities in laboratory medicine.
50:12Touching on not only EGFR,
50:13but then also our reference ranges for
50:16for our transgender nonbinary patient
50:19population or community around us.
50:21We are providing more information
50:23to our internal Chinese.
50:25We have a dedicated path to EI website that
50:27was made beautiful by our path web team.
50:30I cannot even take credit for this
50:33beautiful tile that RJ made but just
50:36highlighting different resources
50:37that are available and and then
50:39just again using these different
50:41platforms to highlight the ongoing
50:43activities throughout the institution.
50:45Not only our house at Diversity Council
50:49but again grand rounds. Different events,
50:51including a little our conference
50:53series throughout the university,
50:55but that's the small picture.
50:57The big picture here and my son you know
50:59at the time was two when we took him to
51:01one of the museums at the Air and Space
51:03Museum down here and and Northern Virginia.
51:05And he totally didn't even see the
51:07space shuttle in the room because he's.
51:09He's like that all the space shuttle is
51:10like that big and he just truly missed him.
51:12So it was our what's what's the big
51:14picture that we're missing here?
51:15And our big picture here is national
51:18organizational leadership investment.
51:20And what does that look like?
51:21That means accountability and our
51:25national organizations holding
51:27our institutions accountable.
51:30So AMC is holding our institutions
51:32accountable by implementing holistic
51:34review and all these holistic review
51:36materials are available for free on
51:37their website and for those of you who
51:39are unfamiliar with holistic review,
51:41it's a mission, missions aligned
51:43admissions or selection process.
51:45It takes everything into consideration
51:47about now about an applicant,
51:48not only their academics or not
51:50only their research experience.
51:51But also.
51:53The value that they would add their
51:56lived experiences and diversity in
51:58the way that individuals and and in
52:00in individuals lived experiences.
52:02Again,
52:03lots of materials that are available
52:06for free on AMC.
52:08But going beyond that,
52:09so for the department chair for for
52:11department chairs and division directors,
52:13you may be quite familiar with the
52:15LC media accreditation process,
52:17but the standards include diversity pipeline.
52:20And again we want to be mindful
52:21term pipeline,
52:22but the way it's written right now,
52:23it's pipeline programs and partnerships,
52:26cultural competence and healthcare
52:28disparities.
52:28All of us that are in leadership
52:30positions are being required to
52:31now comment on what we are doing
52:33to contribute to diversity.
52:34So that's us being held accountable
52:36by our national organizations.
52:38Outside of pathology.
52:40But we have to Belgium milestones
52:42that touched on cultural competency
52:44for the record.
52:45And so these are things that we
52:47should be teaching our medical,
52:48our residents and we are.
52:50We should be holding ourselves
52:52accountable because they are milestones.
52:54And if we are going to check off that,
52:56you know,
52:57for interpersonal communication skills,
52:58one our our resident has reached Level 4,
53:01we should at least check in and
53:03make sure that they are able to
53:05provide culturally competent care.
53:06And how are we assessing that?
53:09Moreover, on the annual survey,
53:11there's an opportunity for you to
53:13comment on for for the residents
53:15to comment on whether or not they
53:16are being educated in health
53:18disparities so things are being
53:20held by accountable by the AC GME,
53:23it means holding each other
53:25as colleagues accountable.
53:26Some of you may be familiar with
53:28this publication that looked at
53:30representation in the cardiology workforce,
53:33and there were some misinterpretations
53:34of the data,
53:35and UPMC was fantastic and highlighting that.
53:39That there were opportunities to
53:41reeducate or improve education of
53:43the faculty members involved
53:45with this publication.
53:47So holding each other accountable
53:49and then the journal editor
53:51held themselves accountable.
53:52Doctor Francis Collins is holding us
53:55all accountable with ending the manual.
53:58Hannah Valentine is making lots of
54:00tools available so that we can.
54:01We have access to them so we have no.
54:03We no longer have an excuse to say
54:05I don't know how to do this but
54:07within pathology we're starting
54:09to see greater representation in
54:11our various publications and we
54:13had asked published a really nice
54:15DNI peace and at your conference
54:17is both use CAP and a SCP and CAP.
54:21We're seeing more.
54:23Content focusing on DNI and equity as well,
54:26so it's really important that our
54:28professional society start to hold
54:30us accountable by giving us the
54:32educational content and resources
54:33so we can take them back to
54:35our respective institutions.
54:38And and and our professional organization
54:40should be leading by example here.
54:43So in summary,
54:44diversity in pathology is critical
54:45as we all strive to innovate,
54:47increase awareness self and
54:48reduce health disparities.
54:49Diversify clinical trials and
54:51provide high quality care.
54:53There are extensive opportunities to
54:55retain female faculty at higher ranks,
54:57so we're on our way.
54:58But there's still more to do.
55:00There are significant barriers
55:02to recruiting and retaining
55:03individuals under representing
55:04underrepresented in medicine,
55:06and those barriers evolve at each
55:08stage in their education and careers.
55:10Be really mindful and sensitive to that.
55:12Then finally impactful DE&IDEI
55:15initiatives should include
55:16personalized outreach and mentoring,
55:18but they should also be component of a
55:20larger institution and or specialty.
55:21Wide cultural changes.
55:22And with that I'd like to
55:24acknowledge again Doctor Lecia,
55:26where my colleague she's been
55:28fantastic and instrumental and our
55:30work here realized in Kirtland Ville.
55:33Also colleagues at Hopkins.
55:35That helps put together the
55:37data that we published.
55:38Again our team at Hopkins and and
55:41our pathology photography support
55:42team for helping us put together
55:44the nice little pamphlet that we
55:46give to the residents or to the
55:48medical students so we do outreach
55:50initiatives and with that if only
55:52everything was as easy as looking
55:54at cars under the microscope.
55:56And hopefully we're not missing
55:57the big picture here,
55:59which again is is inclusion.
56:01So thank you for your time.
56:03I think we're right at the hour and I
56:04guess I'll hang on for any questions.
56:10Thank you so much to Doctor White
56:12for this excellent presentation.
56:15The floor is open for
56:16questions you can speak up.
56:17You can write him in the chat.
56:24To my son is screaming now. I'm sorry,
56:26I'll just say congratulatory comment.
56:30It's really impressive Marissa and I
56:32was so pleased that you and I had a
56:35moment to chat earlier in the day,
56:37but your YOUR programs that get both
56:41at diversity and in in younger people
56:45and and and and also the the problem
56:48we're having in recruiting a pathology.
56:49Are really exemplary and gosh really
56:52should be a model for all of us,
56:55including us here at Yale.
56:57So thank you for sharing that
56:59great success story. Thank you.
57:05So I this Dave Rim,
57:07I would echo Maurice comments.
57:09I think it was really terrific,
57:10but I'm in the world we live in today.
57:13Their audiences aren't so
57:15receptive as perhaps the one here.
57:17And do you have pointers for us as
57:19we try to spread this word to how?
57:22How you approach a non receptive audience?
57:25Yes, I'll I'll. I'll give you an,
57:27I'll share my experience soum.
57:32Mike, so I talked about the
57:34microaggressions workshop and
57:35initially there is, you know,
57:36push back and you know your conversation
57:38about well microaggressions don't
57:39really happen with us, right?
57:41Because we're pathologist.
57:43And then we said the microscope
57:45and we're not really. We
57:46look at our own shoes all the
57:48time. Yeah, yeah, exactly.
57:50Honestly, at some point
57:52you just have to do it up,
57:54and that's essentially what I did.
57:57I said you know, Ralph,
57:58you just need to do this and Mike,
58:00we need to do this and. Thanks.
58:04And I told him that we were having,
58:05you know, we had the the the team
58:08coming in and we did it and after the
58:10fact you know really positive feedback.
58:12So at some point.
58:13When you recognize that there is
58:16a significant opportunity for.
58:18You know a conversation,
58:20you just have to do it and they will all.
58:23There will always no matter,
58:24no matter what you do.
58:25I think Marie you mentioned this
58:26to me no matter what you do,
58:28there will always be a dissenting
58:30voice or voices in the crowd,
58:32and that's fine.
58:33But if you reach,
58:34at least if you reach one person,
58:37that's enough, right?
58:38Because in this space you just
58:41trying to build your your group,
58:43your your team,
58:44and as your team becomes larger
58:46you will have more voices that
58:48will all as a collective.
58:49Groups say you know this should
58:51be interrupted or we should
58:53be focusing on this as well.
58:55So again,
58:56I I I think.
58:58Building your team one person
59:00at a time and at some point
59:02you just have to just say it.
59:05It is what it is.
59:06We can't.
59:07There are certain things that
59:08should not be happening anymore,
59:10and when they do happen they
59:12need to stop and there needs to
59:14be an opportunity for education.
59:16It is what it is.
59:21I have a quick question. Related
59:24to what David asked you,
59:26what do you think as you look back and
59:28reflect on the experience so far with
59:31one or two of the most major obstacles?
59:35That you had to struggle with to
59:37get over some of these things.
59:39Was it financial? Was it other things?
59:42I think the human capital is
59:44the most challenging hurdle.
59:46You know, building the team and I'm
59:48happy to say that now there are a lot
59:51more individuals that are involved
59:52and and the lesson I learned is that
59:55I should have reached out and cast a
59:58broader net earlier because I think.
01:00:00There were a lot more individuals
01:00:03that were interested.
01:00:04But they had no reservations or
01:00:07were a little bit nervous about,
01:00:10you know, putting themselves forward.
01:00:12But if you actively seek out their support,
01:00:14they happily support,
01:00:15you know Mark Mars Inc has been
01:00:17a fierce advocate,
01:00:18and I I should have reached
01:00:20out to him a long time ago,
01:00:21so casting a broad net and and
01:00:24building that team or sooner rather
01:00:26than later is instrumental not only
01:00:28to the success of the activities,
01:00:30but then also their durability.
01:00:31You want to make sure that you know these.
01:00:34Initiatives don't fizzle away once they
01:00:38start. They should not end with me.
01:00:42Great thank you Lisa too.
01:00:46I think the other challenge.
01:00:50I'll think about it.
01:00:51I'll think about the second thing.
01:00:52I think building the team has been
01:00:54has been the most important thing.
01:00:55'cause you cannot do everything
01:00:57by yourself. Understood.
01:01:02Doctor Lu oh hi, you know thank
01:01:06you for this very you know,
01:01:08interesting seminar.
01:01:09I think you know, as as a you know,
01:01:13is really congratulate you for building
01:01:15this team together at Hopkins.
01:01:18You know you showed the data as well,
01:01:21so it seems like the US senior, yeah.
01:01:23I mean you are, you know US medical
01:01:26Graduate School graduate graduation,
01:01:28US medical school seniors.
01:01:30They are generally
01:01:31continued to have declining
01:01:33interest in pathology. So as I'm
01:01:36from your personal experience personal
01:01:39study I know have you identified some
01:01:42of the key factors you know,
01:01:44you know, affect that interest,
01:01:46affected that trend?
01:01:48So that's one question.
01:01:49The second question is,
01:01:51do you believe it is
01:01:53addressable from pathologist?
01:01:56Besides perspective,
01:01:56you know we certainly wanted to have
01:01:58more people coming into our field,
01:02:01but we do not know for sure whether
01:02:03or not it is because we haven't done
01:02:07enough to the students or this is just
01:02:11something really beyond our control.
01:02:13I think that's kind of the question
01:02:15people just trying to figure it out.
01:02:17So what do you want to hear?
01:02:18You know your perspective on that?
01:02:20Yeah, that's the $1,000,000 question.
01:02:22Right now my my personal.
01:02:25These are my personal opinion.
01:02:27'cause I think you know the
01:02:29integrated curriculum and the the
01:02:32condensation of the curriculum.
01:02:34Has really diminished the
01:02:36students exposure to pathology.
01:02:38Uhm, you know,
01:02:39for us we have a our first years
01:02:42condensed down into about six
01:02:44months and then second year is
01:02:46the next calendar year and then
01:02:48they begin the clerkships right
01:02:51after that in the in our in the
01:02:53in the abbreviated second year.
01:02:55Or I guess the the 2nd that starts later.
01:02:57Pathology is a component of
01:02:59each organ system block,
01:03:01but the students are more focused
01:03:03on learning the pharmacology.
01:03:04The more focused on learning.
01:03:05What they feel are the higher yield
01:03:08things that they will be tested on.
01:03:11With that said,
01:03:11I think there are opportunities
01:03:13for us as pathologists too.
01:03:17Advocate more strongly for better
01:03:20representation in the curriculum
01:03:22and for those of us that are either
01:03:25pathology block directors or involved
01:03:28with any of the courses for creating
01:03:31novel experiences to highlight
01:03:33how pathologists are a key member
01:03:35of the multidisciplinary team.
01:03:37So for example, I Co direct a short,
01:03:40very short three day course on
01:03:42neoplasia and one of the things
01:03:44that we do as a mock tumor board.
01:03:46And so I have myself I have Realogy.
01:03:48I have radiation oncology.
01:03:50I have surgery and medical oncology all
01:03:52represented in this mock Schumer board.
01:03:55We go through a mock case and we show
01:03:57we talk about the pathology just as if
01:04:00we would as a as a as at a tumor board.
01:04:03And so the students get an opportunity
01:04:04to see what we as the pathologists do,
01:04:06that they might not have normally
01:04:08had an opportunity to see.
01:04:10And at that point in their medical education.
01:04:15I think other institutions are doing
01:04:16similar novel things where they have
01:04:18like a transition to the wards.
01:04:20Courseware pathology is included
01:04:21as in a transition towards course,
01:04:23but I think that happens
01:04:24too late to be honest.
01:04:25So I think if you if for those of
01:04:27us that again are involved with you
01:04:29and me trying to think creatively
01:04:31about how you can incorporate,
01:04:33you know the pathologists you
01:04:35know told the clinical team that
01:04:38XYZ or something to that extent
01:04:40highlighting that pathologists were
01:04:42an instrumental role in the diagnosis
01:04:44and the subsequent care plan.
01:04:46Is really important,
01:04:49but in terms of,
01:04:49you know why we're seeing at the client.
01:04:51I think it is partially because of that
01:04:53where it is unclear to the students that we,
01:04:55as pathologists are critical to
01:04:57multidisciplinary care and there are
01:05:00different ways that you can contribute
01:05:02to patient care without you know doing
01:05:04an autopsy as a pathologist and that
01:05:06most of us don't do. People don't.
01:05:07Most of us don't do autopsies.
01:05:09Or if we do, do autopsies.
01:05:11Autopsies have very different applications
01:05:13now than they did historically,
01:05:15where we have rapid autopsy programs.
01:05:17Where you're.
01:05:17An instrumental member of Cancer Research.
01:05:20By doing rapid autopsies and harvesting
01:05:22tissue for our colleagues in basic sciences.
01:05:25I think again,
01:05:26highlighting the role of pathology
01:05:28at the roles of pathologists or as
01:05:30early as possible are important.
01:05:32And being that smiling face that
01:05:35they want to see so. Thank you.
01:05:42So that's it.
01:05:43Yes, doctor white.
01:05:44Thank you so much for your presentation.
01:05:47I really enjoyed it and I found it
01:05:49extremely educational and and and and
01:05:50one of the reasons for this is that I I
01:05:53trained in Morehouse School of Medicine,
01:05:55I was a postdoctoral fellow there.
01:05:58It's very interesting that till now I did not
01:06:01know that the greydis etch what that meant.
01:06:04Yeah, and it was for shocking that
01:06:06nobody actually ever ever told
01:06:07us what the Bradys ever meant.
01:06:09Yeah, so thank you so much.
01:06:11And for teaching us and telling us I have.
01:06:16I do have a question.
01:06:17I don't know whether you have an answer
01:06:19because you didn't write that paper,
01:06:20but that Ginther ET al paper graph.
01:06:26I think rather confusing.
01:06:27I don't know how they have crunched
01:06:30those numbers off the R 01.
01:06:32Success rates that shows between
01:06:35various racial groups.
01:06:37Yeah, the potential biases that
01:06:39exist in terms of success rates,
01:06:42because I don't know whether that
01:06:44shows whether that data really,
01:06:45truly represents what's actually
01:06:47going on in terms of biases.
01:06:49Because if you look at the graphs,
01:06:51you notice that the Hispanics have
01:06:54the same success rate as whites,
01:06:56and I wonder whether that is
01:06:59because of some sort of.
01:07:02Incorrect analysis,
01:07:03or whether there is truly
01:07:06a difference that exists,
01:07:07that many of the African American applicants,
01:07:10or perhaps from the HBC US like
01:07:14Morehouse and their environment,
01:07:16is judged perhaps in properly by
01:07:18certain reviewers as not appropriate.
01:07:21I wonder if you have any comments
01:07:23to elaborate on that.
01:07:25Maybe in your next presentation
01:07:26you could expound on that mode.
01:07:29Yeah,
01:07:29so I think that I'm linking.
01:07:32Proper number I think there there is
01:07:34a paper that looks at institutional
01:07:36bias in terms of granting the
01:07:39the the granting of grants.
01:07:43Use the same words in a sentence.
01:07:45There are institutional biases against
01:07:48institutions that you mentioned,
01:07:49like Morehouse or smaller institutions,
01:07:51which hopefully that is diminishing now
01:07:53now that especially during the pandemic,
01:07:55a lot of these institutions
01:07:57have gotten greater notoriety,
01:07:58but there were some biases,
01:07:59and so I think that may be a
01:08:01confounder as you mentioned,
01:08:02since that those institutions are
01:08:04enriched for black individuals or
01:08:06individuals help identify as black
01:08:08in terms of why there are not,
01:08:10why there are not significant
01:08:12disparities in Hispanic I.
01:08:13I will have to go back and look at the paper,
01:08:15but I will say that Hispanic
01:08:17representation has been increasing
01:08:19and that is the one subcategory
01:08:21within the URM category that has been
01:08:23increasing at a significant rate,
01:08:25at least in pathology.
01:08:27And then you know,
01:08:29looking at looking at that.
01:08:30So I, I, you wonder,
01:08:32I I'm not sure if again we're
01:08:36looking at aggregated data, right?
01:08:38So I'm not sure if these are.
01:08:40If we're looking at individuals
01:08:41that are also, you know, coming in.
01:08:44Internationally or what type or what exactly?
01:08:47Again,
01:08:48we need to look at disaggregated
01:08:49data you know.
01:08:50Looking at,
01:08:51you know the data for Black or
01:08:52African Americans when we look
01:08:54at the actual number of African
01:08:55American males in isolation,
01:08:57the number of African American
01:08:58males has not changed at all,
01:08:59but the overall number of African of
01:09:01individuals who identify as black
01:09:03or African American have increased
01:09:05the number of black or African
01:09:07American males has increased.
01:09:08When we look at African American males,
01:09:10it has not,
01:09:11and we're looking at African
01:09:12males from the African continent.
01:09:14Those numbers have increased,
01:09:15so again I have to be really careful,
01:09:18and so I agree with you.
01:09:19I I will go back and look more
01:09:20carefully at that,
01:09:21but I think there there have been data
01:09:24suggesting an institutional bias is yes.
01:09:28Thank you.
01:09:30They were really late on time,
01:09:32but I would assume are yeah.
01:09:36Yeah, if we have time, is it OK?
01:09:38Go ahead, go ahead last one so I'm
01:09:41one of the Apqp residents are pgy 3.
01:09:45I just want to say this is so amazing,
01:09:47especially your work in the community and
01:09:50I was wondering if you guys have and I'm
01:09:52sorry if you said this and I missed it.
01:09:54I did have to take a couple
01:09:55calls during your presentation,
01:09:56but do you guys have resident
01:09:58involvement in all of these programs
01:10:01and just how you implement that?
01:10:03Yeah, thanks for asking so when Doctor
01:10:06where was a resident she was involved.
01:10:10I asked residents if they're interested,
01:10:12but of course their work comes
01:10:13first and so I make it explicitly
01:10:16clear that their clinical service
01:10:18and they're studying comes first.
01:10:20We have some residents right now
01:10:22that have expressed interest,
01:10:23particularly first first year in
01:10:25the third year that are interested,
01:10:27but they are waiting until they
01:10:28have a little more time and things
01:10:30have been kind of unpaused.
01:10:31They have met one on one.
01:10:33With some of our students when asked,
01:10:36but those were again small.
01:10:37One on one meetings with one student at Hawk,
01:10:41but not formally in terms of the outreach,
01:10:43but it's mostly been just asking,
01:10:45asking the resident or asking the Chiefs
01:10:47to ask the residents if there's anyone
01:10:49that's interested, and then again,
01:10:51you clinical services come first.
01:10:54But yeah, thank you for your question
01:10:56and thank you for logging in.
01:10:57Yeah, thank you so much.
01:10:59This is also great.
01:11:01Thanks
01:11:02let's altogether thank Doctor. Right
01:11:03again. Thank you, thank you so much and
01:11:06you're going into a meeting
01:11:08with our chair, right?
01:11:11OK, do I leave this one or stay here.
01:11:13I have no idea in from a link
01:11:16I will come to the link again.
01:11:20Thank you. Thanks everybody.
01:11:22Thank you so much Tina,
01:11:23I really appreciate it. It's
01:11:24a pleasure. Thank you.
01:11:26Right, you know, thank you.