Diversity at Washington University School of Medicine: New Faculty Orientation

1. Diversity at Washington University School of Medicine: New Faculty Orientation Will Ross, MD, MPH Associate Dean for Diversity Associate Professor of Medicine Washington University School of Medicine August 14, 2013

2. Mission Statement Recruitment • Programs ODP • Outreach The Office of Diversity Programs promotes diversity within the academic workforce and leadership in the delivery of culturally competent healthcare and the reduction of health inequities.

3. The racial makeup of the city of St. Louis in the 2010 Census was approximately 49.2% African American, 43.9% White (42.2% Non-Hispanic White, 2.9% Asian, 0.3% Native American/Alaska Native, and 2.4% reporting two or more races. Hispanic or Latino of any race were 3.5% of the population. The racial makeup of St. Louis in 2010. (Each dot represents 25 people – red dots are Caucasian, blue dots are African-American, green is Asian, orange is Hispanic, gray is other.)

4. Missouri Population Growth Rates:1995-2025 Percent Population Projections for States by Age, Sex, Race, and Hispanic Origin: 1995-2025, Report PPL-47, U.S. Bureau of the Census, Population Division.

5. Refugees Processed in St. Louis: 2002-2005 Major Countries of Origin Percentage of all refugees City of St. Louis Department of Health, 2007

6. Health Indicators2011 St. Louis City National • High School Graduation 55% 92% • Some College 60% 68% • Unemployment 11.7% 9.1% • Children in Poverty 35% 11% • Inadequate Social Support 27% 14% • Single-Parent Households 62% 20% • Violent Crime Rate (per 100,000) 2,244 100 http://www.countyhealthrankings.org/missouri/st-louis-city

7. Racial Disparity in the St. Louis Region Percent of Population Where We Stand: The Strategic Assessment of the St. Louis Region. East-West Gateway Council 2011

8. How do we parlay medical workforce development into improved quality of care of an increasingly diverse patient population? Objectives: Recruit a diverse group of students, residents and faculty from groups underrepresented in medicine Increase the cultural awareness of all academic faculty and staff Expand our mission to one that encompasses greater community engagement Realign our programmatic activities with public health strategies to assure further reductions in health care disparities

9. The pipeline approach is based on the concept that the highest yield to enhance faculty recruitment and/or retention requires aggressive efforts to attract highly-qualified URM medical students, residents, fellows and postdoctoral trainees, and to provide them with a nurturing environment that will facilitate career development.

10. Office of Diversity Programs Strategies for Workforce Development:

11. Visiting Medical Student Elective Program established Fall 2007

12. Minority residents and fellows association established in April 2006 with an initial grant from the Barnes-Jewish Hospital Foundation. Its mission is to assist in the recruitment of underrepresented minority residents and fellows and to support the professional development of its members.

13. Resident and Fellows Diversity Initiative • Since 2006, a collaboration between the Barnes-Jewish Hospital Center for Diversity and Cultural Competence, Children’s Hospital, and Washington University School of Medicine. • Provides additional financial support to residents who demonstrate a commitment to improving cultural diversity within the medical center and improving the health of the medically underserved in the St. Louis community. • Promotes mentoring of medical students and undergraduate premed students.

14. Barnes-Jewish Hospital Residents and Fellows Diversity Initiative: Outcomes • A year after the inception of the partnership, 19 residents were accepted into the Diversity Initiative and minorities accounted for 24 percent of the 29 Washington University medical students who matched at Barnes-Jewish Hospital.  • A record eight medical students from groups underrepresented in medicine chose to stay and train at the Washington University Medical Center in 2007. • Eight students who participated in the Visiting Student Elective are now training as residents at the Washington University Medical Center. • This initiative, which documents the effectiveness of longitudinal mentoring and networking, illustrates that measurable outcomes can be achieved when there is concordance on the need for workforce diversity. 

15. Washington University School of Medicine URM Residents, 2006-2010

16. Washington University School of Medicine URM Pre-Faculty Trainees 2006-2007

17. WUSM Faculty: Ethnic Diversity 2000- 2010

18. Faculty Diversity • Why doesn’t faculty diversity mirror trends in student diversity? • Academic medicine not as financially rewarding, making it unattractive for those with large debt burdens • Few mentors of same race/ethnicity • Research funding hurdles

19. The pipeline is part of the solution, not the main problem. “Even if the pipeline were awash with women and minorities, a fundamental challenge would remain: the pipeline empties into territory that women and minorities find uninviting, unaccommodating, and unappealing.” Trower and Chait, 2002

20. BARRIERS TO RECRUITMENT AAMC 2002

21. Targeted Interventions to Increase Faculty Diversity • Develop guidelines for faculty searches • Expand Faculty Diversity Scholars Program • Implement Target of Opportunity Hires where possible • Improve minority faculty retention, through periodic high-level meetings with faculty • Expand the network of diverse faculty • Promote programs that increase pipeline of prospective minority faculty (eg. Visiting Scholar, Adjunct Faculty, Lecturer) • Improve relationship with community physicians, providing faculty titles that reflect mutually beneficial ties

22. Making Cultural Competence a Quality Indicator “Exceptional quality and unmatched experience has earned Barnes-Jewish Hospital a place on the U.S. News & World Report honor roll of America’s Best Hospitals for more than 18 consecutive years, with 15 top-ranked medical specialties recognized in 2010.” Our goal is to expand our definition of quality at Washington University Medical Center to include cultural competence, diversity and inclusion, and incorporate it in all aspects of policy making, administration, research, practice, service delivery and involve systematically consumers, key stakeholders and communities.

23. At Least One of Five Resident Physicians Are Not Prepared to Deal with Cross-Cultural Issues J.S. Weisman et al., “Resident Physician’s Preparedness to Provide Cross-Cultural Care,” Journal of the American Medical Association 294 (September 7, 2005):1058-67

24. Cultural Competency Curriculum • Potential Teaching Forums and Tools include: • Conferences • Symposia & workshops • Journal clubs • Orientation sessions for new faculty, trainees and clinical staff • Focus group discussions with culturally diverse patient populations • Educational materials and video teaching tools • Self-assessment of unconscious biases and stereotyping • Experiential learning in inpatient and ambulatory environments • Assess impact of curriculum and training: • Cross-cultural preparedness ratings of providers, staff and trainees • Track and trend stratified clinical quality and patient satisfaction metrics With permission, James Crane, MD FPP 2009

25. Washington University 2011 Healthcare Leaders Inclusion Institute

26. Cultural Competence: Definition and Conceptual Framework Cultural competence requires that organizations: • Have a defined set of values and principles, and demonstrate behaviors, attitudes, policies and structures that enable them to work effectively cross-culturally. • Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve. • Incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.

27. The Process of Cultural Competence in the Delivery of Health Care Services CULTURAL AWARENESS CULTURAL DESIRE CULTURAL KNOWLEDGE The Process Of Cultural Competence CULTURAL SKILL CULTURAL ENCOUNTERS Transcultural C.A.R.E. Associates. Campinha-Bacote, J. J Transcultural Nursing 2002;13:181-184

28. Conclusion: Achieving excellence in medical education occurs through: • Attracting a diverse professional workforce that is representative of and that understands the constituencies to be served • Developing and sustaining an environment that promotes cultural awareness • Providing resources and opportunities for leadership development and innovation outside of “class room,” in essence creating a medical center without walls

29. Conclusion con’t: • We invite you to participate on our medical school admissions committee as well as residency selection committees. • Serve as a mentor to students, residents and fellows. • Continue to advocate for enhanced diversity as a method of improving the quality of health care. • Fully engage in the St. Louis community.

30. “We must draw the future physician leadership for our health care systems. . . from a richly diverse pool of talent, adequately reflecting our country’s gender, racial, and ethnic melange. It’s simply smart business to do so.” Association of American Medical Colleges Lola Fayanju, M.D. General Surgery Resident

31. Faculty Diversity Committee Chair: Douglas Char – Associate Professor, Emergency Medicine Diana Gray – Associate Dean for Faculty Affairs, Professor of Obstetrics/Gyn Ex Officio Will Ross – Associate Dean for Diversity, Associate Professor, Nephrology Ex Officio – BJ Center for Diversity and Cultural Competence Legail Chandler – Director of Human Resources Richard Chole – Professor and Chair, Otolaryngology Archie Harmon – Assistant Professor, Otolaryngology Michael Lin – Assistant Professor of Radiology Helen Piwnica-Worms – Professor and Chair Cell Biology and Physiology Katherine Robinson - Assistant Professor of Radiology Janice Semenkovich - Professor of Radiology Alan Zajarias – Assistant Professor, Cardiology Cherilyn Shadding – Director of Outreach, Genetics Rochelle Smith – Director Research Programs and Community Outreach, DBBS Yumirle Turmelle – Assistant Professor of Pediatrics Corey Foster – RFDI Resident Representative Charlene Blake – WUMMA Representative Rahel Ghenbot, WUMS Student Representative Uzoh Ikpeama, WUMS Student Representative