Effective Strategies to Improve Diversity, Equity and Inclusion in Pathology

Transcript

• 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.