APPD 2017 WORKSHOP PROMOTING DIVERSITY IN …...Mendoza, Pediatrics 2015 US Census future estimates...
Transcript of APPD 2017 WORKSHOP PROMOTING DIVERSITY IN …...Mendoza, Pediatrics 2015 US Census future estimates...
PROMOTINGDIVERSITYINTHEPIPELINEOFPHYSICIANSStephanieDewar,MDPatriciaPoitevien,MDAldaMariaGonzaga,MD
Objectives• Stimulateadiscussionandanassessmentofdiversityeffortsinyourtrainingprogram• Considerthecomponentsthataremissingandpracticehavingconversationsaboutthechallengesfaceenhancingand/ormaintainingthediversityinyourprogram.• Discussapproachestorecruitingandsupportingamorediverseresidencyapplicantpool• Holisticreviewofresidencyapplicants• Enhancementorshipactivitiesinyourprogram
Outline
• Whyisthisimportant?• Disparities inthePhysicianWorkforce
• Whatarethebarrierstooursuccess?• ProgramDirectorRoleinChange• Bootsonthegroundstrategies
• Recruitment• Mentorship
• Howdowetalktoadministration/leadershipaboutthis?• MonitoringProgress
Diversity
• “ thestateofhavingpeoplewhoaredifferentracesorwhohavedifferentculturesinagroupororganization”
Source:Merriam-Webster'sLearner'sDictionary
Diversityinpediatricpatients
• In2010,50.4%ofinfantsintheUSwereminorities• 1in4USchildrenliveinanimmigrantfamily• AsianAmericanandLatinogroupsaccountfor75%ofthegrowthoftheUSchildpopulationoverthepast2decades
Mendoza,Pediatrics2015
USCensusfutureestimates
• By2020,44.5%ofallchildrenwillbeminorities• By2050,1in3childrenwillliveinanimmigrantfamily• TheproportionofLatinochildrenintheUSwillequaltheproportionofnonHispanicwhitechildren,each36%
Mendoza,Pediatrics2015
RacialandEthnicDisparityinHealthCare
• Anydifferencesbypatients’raceorethnicitynotrelatedtopatientpreferencesorclinicalappropriateness
RacialandEthnicDisparitiesexistinthecareofourpatients
§ Cancer§ Prematurebirth§ HIV§ Obesity§ Sicklecelldisease§ Autismspectrum§ Downsyndrome§ Painmanagement§ Cerebralpalsy
§ Asthma§ Cysticfibrosis§ ADHD§ Diabetes§ Endoflifediscussions§ MentalIllness§ Traumaticbraininjury
PowerShuffle• Honorconfidentiality.• Unconditionallyrespectyourselfandothers.• Speakforyourselfonly.• Activelylisten:considerotherpeople'swordsasgifts.• Noput-downsorhostileanalysis.Avoidinterpretingotherpeople'sexperience.• Givecaringfeedback.
• Thisexercisewillincludeadialogue,notadebate.Therearenolosersorwinners.• Agreetodisagree.• Everyonehastherighttopass.• Itisokaytoexpressyouremotions.• No"rescuing."• Takeresponsibilityforyouownlearning- askforwhatyouneed.
Questionstoconsiderduringthedebrief
1. Howdiditfeeltobeinthegroupwhichhadtowalkacross?2. Howdiditfeeltobeinthemaingroupandwatchotherscross?3. Whatsurprisedyouduringthisexercise?4. Whatisthesignificanceofwhatyouexperiencedduringthis
exercise…foryourschool(department/division/program)?Foryourownpracticeofmedicine?Forhealthcareingeneral?
5. Howwouldyoufeelifyourdoctorbelongedtooneofthegroupsmentionedinthisexercise(notyourown)?
6. Howdoesthisactivitybuildcommunityandindividualcourage?
ProgramSelf-Assessment
Makingtheargumentfordiversity
• Alignwiththestrategicgoalsofyourinstitution• Makethemoralargument• Linkdiversitygoalswithqualitymeasures,safetymeasures,patientsatisfaction,employeesatisfaction• Createobjective,measurablegoals – defineyourROI• Bepreparedtodiscardineffectivediversitytoolsforbetterones
RecruitmentEfforts
MissionDriven
ThemissionofthePediatricResidencyatChildren'sHospitalofPittsburghofUPMCistoeducateandsupportadiversegroupofresidentsinaninnovativeandcollaborativeenvironment.Ourgraduatesareexceptionalpediatriciansequippedtosucceedintheiruniquecareerpathspromotingthehealthandwellnessofchildrenandcommunities.
Preparation
AssessYourProgram
• Trackthenumbersof• URMapplicants• URMinterviewees• URMcandidatesranked“tomatch”• URMphysiciansjoiningyourprogram
• Knowyourfacultydata• DepartmentstatisticsofURMfaculty
• Knowyourcultureofdiversity
AskforanExternalLook
• Currentresidentsofunder-representedbackgrounds(ifyouhaveany)• Medicalstudents• Faculty• Anotherprogramdirector• Staffmembers
Ourexternallook
• Website• Diversitycorner• Mission• Faces• Faculty
• Openconversation• ItokaythePDisn’tanURM• Askquestionsaboutwhatit’slike• Bepreparedfortheanswer
Whatwedid(everythingtheytoldus)• Diversityandinclusioncommittee• Websiteupdates• Recruitmentefforts• Residentconversations• MeetingswithUPSOMstudents• Outreachtootherschools• GMEoffice,FacultyGrandRounds,Societymeetings
Prepareyourpartners
• Showyourfacultythatthisisimportant• SelectionCommittee• Facultydevelopmentonunconsciousbias• HaveeveryonedotheIAT
• Interviewers• Bestpracticesonhowtotalkaboutdiversity(evenifyou’renotfromanURMbackground)• Howtoopenthedoortotalkingwiththecandidateabouttheirbackground
RecruitmentSeason
StepOne
• Examinetheapplicantpool• LookatschoolswhotraditionallytrainURMphysicians• Askyourselfwhycertainstudentsmightnotbeapplying• TrackURMapplicantsseparately• Invite“risky”applicants
HolisticReview
• Flexible,highly-individualizedprocess• Balancedconsideration• Multiplewaysapplicantsprepareforanddemonstratesuitability
• Underthisframework,candidatesareevaluatedbycriteriathatare• Institution-specific• Broad-based• Mission-driven• Thatareappliedequitablyacrossentireapplicantpool
AAMCRoadmaptoDiversity:IntegratingHolisticReviewPracticesintoMedicalSchoolAdmissionProcesses,2010
ApplicationReview
• EAM• Experiences• Attributes• Metrics
• Weareprettycomfortablewithmetrics
AAMCRoadmaptoDiversity:IntegratingHolisticReviewPracticesintoMedicalSchoolAdmissionProcesses,2010
Experiences
• Howdidthisapplicantgethere?• Highlightsoflife’sstory
• Examples• Careforafamilymember• Employmenthistory• Geographydistance• Research• Volunteerism
Attributes
• Skillsandabilities• Personalandprofessionalcharacteristics• Demographics• Examples:• Listeningskills• Multilingualabilities• Intellectualcuriosity• Socioeconomicstatus• Parentaleducationlevels
Wheredowefindthese?
• MSPE• Openingparagraphs• Comments
• CV• Volunteerism• Leadership
• Personalstatement• Letters• Perseverance,leadership,resilience,communication
ReviewthesampleERASapplication
Assignsroles:PD,APD,selectioncommitteemember
InterviewDay
• ConsiderofferingaURMfocusedday• Gatherfacultyandresidentstogetherfora“pre-”event
• Plantyourresidentswithaninterestindiversityatkeymoments• Lunch,tour,morningreport
• Matchfacultyandapplicants• Addressdiversityinyourremarks
AddressDiversityinYourRemarks
• DiversityandInclusionCommittee• Activities/successes
• Mentoringprogram• Mentortraining?
• FacultyDevelopment• Integrationintonoonconferenceseries
TheInterview
• Facultymatchisimportant• Consideraddingamemberofyourdiversitycommitteetotheitinerary• Askaboutattributesthatarestrengths• Allowapplicantstoaddressstrugglestheymayhavehad• Lowerboardscores,repeatcoursework,timeoff
• Beexplicitaboutprogramcommitmenttodiversity
FollowThrough
• Makesurecandidatereceiveanemailfromyouaftertheinterviewday• Followuponquestionstheymayhaveraised• AskaURMfacultymemberorresidenttoreachouttothembyphone
• Addressconcernsaboutneighborhoods,housesofworship,family,institutionaldiversity• Considera“secondlook”
RankMeeting
• AssignanadvocatefortheURMapplicants• Diversitycommitteemember
• Includeseparatespreadsheet• Spendtimeaddressingexperiencesandattributesatmorelength
• Knowthesecandidatesbetterthantherest• Doyourhomework• CalltheDeanofStudentsorletterwriters
SealingtheDeal
• Emailagainandoffertoanswerquestions• Askyourresidentstocallandfollowup• Ifyoudoasecondlookday• Addabreakfast/lunchwithURMfaculty
• Inquireaboutopportunitiesforsignificantothers
OnboardingandResidencyTraining
PostMatch
• ReachouttomatchedURMresidentstopersonallyaddressconcernsaboutthemove• Includequestionsabouttheinterviewenvironmentinyourpostmatchsurvey• Debriefwithyourteamaboutthebarriersthatmighthaveoccurredwitheachoftheseapplicantsyoudidnotcatch
CheckinEarly
• ConsiderpairingthemwithaURMseniorresidentearlyintheyear• Haveresourcesavailableforpersonalneeds• Housing,restaurants,housesofworship
• Advisorassignment• Layeredmentorship
• Personalemailsandanearlymeeting
AdvisingandMentorshipPrograms
• Mentorshipisthemostpowerfulinterventiontoimprovesuccessofresidentsfromdiversebackgrounds• ConsideraURMmentor(ifavailable• Supportthelivedexperienceofbeingaminorityinmedicine
• Earlyandspecialattentiontosupporttheirweaknesses• Efficiency• EMR/notewriting• Preparationforintrainingexam
“IamhonoredtostandundertheshadeofatreeIdidnotplant.”
Dr.ValerieMontgomery-Rice
SetTheStage
• Beclearaboutyourcommitmenttotheirsuccess• Beclearthatyouaretheretosupportthemthroughanydifficultiestheymayface• Maywanttoexplicitlyacknowledgethattheymaybetreateddifferentlythantheirmajoritycolleaguesandthatyouareavailabletotalkwiththematanytime
• YouarementoringthefutureURMleadersinacademicmedicine
ResidentRetentionandSupport
• Addressfellowshipplansearly• Askabout(encourage)planstostayinarea• Inquirefrequencyinsmallgroupsaboutthecultureofdiversity• Bespecific:whatdoweneedtodotokeepyouhere?
SocialNetworking
• Encouragethemtogetinvolvedwithprofessionalgroups:• StudentNationalMedicalAssociation(SNMA)/NationalMedicalAssociation
• GatewaySociety• LatinoMedicalStudentAssociation(LMSA)• MinorityHousestaff Association• PrideHealth
BreaktheSilence:TimetoTalkaboutRaceandRacism• Facultyneednotonlytheabilitytorecognizeprejudiceanddiscriminationbutalsothetoolstospeakupagainstitwhentheywitnessit
• Don’tavoiddiscussions– befearless• Don’tpretenddiscriminatoryincidentsdon’thappen• Silenceinthefaceofinjusticenotonlykillsanyspaceforproductiveconversations,butalsoallowscancerousideastogrow
Acosta&Ackerman-Barger.Acad Med2016Sep20ePub aheadofprint
CelebrateDiversity
• Advocatefordiversity• Students,residents,faculty
• Advocatefordiscussionsaboutdiversity• Roundtablediscussion• Meettheprofessorsessions
• Theseexpressionsofastrongcommitmenttodiversitygoalongwayandcanhaveahugeimpactonyourinstitution’sculture
CrucialConversations
CrucialConversations
• Whatmakesaconversation“crucial”vs.typical?• First,opinionsvary• Second,thestakesarehigh• Third,emotionsrunstrong
CrucialConversations
• Whydon’tcrucialconversationstendtogowell?• Emotionstendtorule• Yourbodyphysicallyreacts• Weareunderpressure• Wearestumped• Weactinselfdefeatingways
TypicalResponsesinaHeatedDiscussion
• Masking,Avoiding,Disengaging=SILENCE• Controlling/coercing,Labeling,Attacking/Belittling=VIOLENCE
8CorePrinciplesofCrucialConversations
1. Begintorecognizetheconversationsthathaveyoustuck2. StartwiththeHeart:Focusingonwhatyoureallywant3. LearntoLook:HowtoNoticeWhenSafetyIsAtRisk4. MakeitSafe5. Master[yourown]stories6. Learnhowtoeffectivelyshareyourownviews:[STATEyourPath]7. Howtoencourageotherswhentheygetemotionaltosharetheir
ownviewsandgetbacktothefacts[AMPP]8. MovetoAction
#1Recognizeacrucialconversation
• Stuckconversation• Stuckissues• Feelingsof• Anxiety• Fear• Judgement• Anger
#2StartwiththeHeart
• WhatdoIreallywantformyself?Andothers?Therelationship?• HowwouldIbehaveifIreallywantedtheseresults?• Refusethe“sucker’schoice”
#3LearntoLook
• Inthemidstoftheconversation,learntorecognizewhenthingsarenotgoingwell• Stepoutofthecontentoftheconversationandobservehowtheconversationisgoing
#4MakeitSafe
• ConditionsofSafetyMutualPurposeandMutualRespect• Apologize• ContrasttoRepairMisunderstandings• UseCRIB
• Committoseekmutualpurpose• Recognizethepurposebehindstrategy• Inventamutualpurpose• Brainstormnewstrategies
#5MasterYourOwnStories
Seeandhear
TellaStory Feel Act
IncitingEvent
Facts Interpretation Emotion Behavior
#6LearnhowtoEffectivelyShareYourViews
• Shareyourfacts• Tellyourstory• Askforotherspath• Talktentatively• Encouragetesting
#7EncourageOthersWhenTheyGetEmotional• Asktogetthingsrolling• Mirrortoconfirmfeelings• Paraphrasetoacknowledgethestory• Primewhenyouaregettingnowhere
#8MovetoAction
• Decidehowyou’lldecide• Documentdecisionsandfollowup
RolePlay
• Breakintogroupsof3• IdentifyRoles(A,B,C)• A=yourself• B=Chair/Administrator/FacultyMember• C=Observer
• Reviewhandoutdescribingroles• Conversation5mins• Debrief5mins• Changeroles