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