Bridging the Cultural Divide in Academic Medicine Through ......Date Bridging the Cultural Divide in...

Date

Bridging the Cultural Divide in Academic Medicine Through Inclusion Excellence

David A. Acosta, M.D., FAAFP

University of Mississippi Medical Center

September 26, 2017

© 2015 AAMC. May not be reproduced without permission.

Agenda

• Review the benefits of diversity and a diverse research workforce

• Analyze the cultural divide between academic researchers and minority populations

• Describe the tenets and benefits of an inclusive learning and workplace environment

• Bridging the cultural divide through inclusion excellence


"...representation in the scientific workforcematters because scientists, as individuals withtheir own points of view on what is important,make critical decisions for society on what shouldbe studied and supported."

- Clifton Poodry, Ph.D., NIGMS/NIH

https://publications.nigms.nih.gov/multi

media/video/poodry102008-captions.html

https://publications.nigms.nih.gov/multimedia/video/poodry102008-captions.html

Benefits

of

Diversity

McLeod PL, Lobel SA, Cox TH, 1996; Hurtado S, Milem JF, et al 1998, 1999; Clayton-Pedersen et al, 1998; Gurin P,

1999; Chang MJ, 2003; Milem JF, 2003; Hakuta K et al, 2004; Milem JF, Chang MJ, Antonio AL, 2005; Herring C, 2009;

Page S, 2007; Smith D, 2009; Ross H, 2011; Wilson T, 2013

Diversity

Innovation

Creativity

Complex

Problem

Solving

Prediction

Forecast

Identify strategically relevant differences

Learn about relevant differences

Act to create business results from relevant differences

Systematically achieve results by

continuously using differences

Davidson MN. “The End of Diversity As We Know It…”, 2011

Understand

Difference

See Difference

Engage Difference

Leverage

Difference

Benefits of Diverse Research Workforce

• More sensitized to the health needs and priorities of the communities of color due to their lived experiences

• More likely to have a unique cultural intelligence and more likely to be culturally agile to nuances of minority populations

• Concordance with race/ethnicity matters

• Concordance with language matters

• Sensitivity towards and understanding of the important role historical trauma experienced by communities of color plays

• Ask different questions than their non-URM colleagues

Scientific American Special Report, How Diversity Empowers Science & Innovation, 2014


Fewer than 10% of minority populations participate in

clinical trials (NIH NIMHD) – significantly less for

cancer clinical trials (1.3%)


Minority Participation in Clinical Trials

• “The most important reason we need more minorities in clinical trials is to ensure that the discoveries, the treatments, interventions, and prevention strategies are going to be relevant to those populations.”

- Consuelo Hopkins Wilkins, M.D.,

Executive Director,

Meharry-Vanderbilt Alliance

Levine D, Greenberg R. AAMC News, 2016


Recognized Barriers to Minority Participation

• Lack of engagement between academic researchers and the community1

• Lack of trust of the health care institutions or the health care system1,4

• Lack of alignment with the priorities of the minority communities and what the researchers are doing1

1 - Levine D, Greenberg R. 2016; 2 – van Ryn M, Burke J, 2000; 3 - Svensson K et al, 2012;

4 – Corbie-Smith G et al,1999;Corbie-Smith G, 2002;Corbie-Smith et al, 2004;

• Not asked to participate by their personal physician1,2

• Unconscious bias and stereotyping by physicians2

• Fear of research3

• Fear of “being treated like a guinea pig” 3,4

• LEP3,4

• Poor access3,4

Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

FOUNDATIONAL PRINCIPLES OF INCLUSION EXCELLENCE

Diversity

Commitment

INCLUSION

EXCELLENCE

Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Diversity is an

imperative

• Reflects the

community

• Benefits of

diversity

valued

• Differences

embraced,

leveraged


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Multiplicity of

identities

• Intersectionality

is valued

• Authentic

• Safe environs


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Culture of civility

& respect

• Interconnected

• No tolerance for

discrimination

• Equitable

contributions


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE• TO is valued &

practiced

• Infrastructure &

building capacity

in place to

leverage talent

• Contributions

recognized &

rewarded


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE• Policies &

practices

• Investment in

professional

development is

the norm

• Continuous

learning

• Effective

adaptations


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Information flow

• Intergroup

dialogue

• Collaborative

conflict resolution


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Culture of

inclusion to

achieve equity


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• Intentional,

constructive

alliances with

community

• Expands access

• Promotes

understanding to

overcome biases

• Social

accountability


Intersectionality

Authenticity

Community

Engagement

Alignment

with Mission,

Culture &

Values

Sense of

Belonging

Effective

Communication

Talent

Optimization &

Differences

Leveraged

Shared

Responsibility

&

Accountability

Equitable

Access to

Opportunity

Diversity

Commitment

INCLUSION

EXCELLENCE

• All are held

responsible &

accountable for

diversity &

inclusion efforts

• Expectation to

reflect these

values with

customers

• Data collected,

analyzed,

monitored

regularly

informs decision-

making & change



Equality and Human Rights Commission, 2010

Benefits of Inclusion Excellence


Culturally-Tailored Approach


Application Corresponding FPIE

Use cultural humility approach #1 Commitment to diversity

#2 Intersectionality & authenticity

#3 Sense of belonging (civility &

respect)

Culturally-Tailored Approach to Enhance Minority Participation:

Begins with self-awareness (self-reflection, self-critique)

Unconscious bias training

Requires an open & respectful attitude toward differences

Recognizes the legitimacy of alternative ways of thinking and being other than your own

Willingness to learn about the unique perspectives of others & the communities they come from

Allows the possibility that the learners themselves might grow & change as a result of appreciating others in this way

Tervalon M, Murray-Garcia, 1998


5 E’s – Dealing with Resistance

• Engage the other without personalizing resistance “Would you mind talking about your perspective?“

• Explore the root cause for the resistance; “I’m interested in hearing more about this? Do you mind sharing?”

• Empower the person – make it safe, listen with intent and allow them validation

• Empathize; “I can hear how this has been difficult for you.”

• Educate about the rationale and the process involved.






respect)

Study & understand the explanatory model

of illness

#5 Equitable access to opportunity

(professional development)







respect)


of illness



Ask about, listen to and respect past

experiences (historical trauma)

#8 Commitment to community engagement







respect)


of illness






Enhance cultural intelligence & cultural

flexibility



#6 Effective communication (training)







respect)


of illness







flexibility




Community liaisons to bridge & build

relationships, trust








respect)


of illness







flexibility







Cultural narratives (stories) of successes #6 Effective communication








respect)


of illness







flexibility







Cultural narratives (stories) of successes #6 Effective communication


Community-based participatory approach

(partnership, shared decision-making,

reciprocity [data results])

#3 Sense of belonging

#4 Talent optimization (community expertise)


#7 Alignment with mission….



Date

Bridging the Cultural Divide in Academic Medicine Through Inclusion Excellence

David A. Acosta, M.D., FAAFP

[email protected]

Bridging the Cultural Divide in Academic Medicine Through ......Date Bridging the Cultural Divide in...

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