ARTICLE IN BRIEF:
Academic medical centers have appointed “diversity leaders” to bolster training and recruitment of underrepresented neurologists and promote the importance of diversity in medicine. Here's what they're doing in neurology departments around the country.
Imagine Dr. Johnson. Dr. Johnson works at a large academic institution. Dr. Johnson is a full professor and chair of a neurology department. Dr. Johnson is president of the American Academy of Neurology (AAN). Close your eyes for one moment and consider...who did you picture? Did your ideas of what Dr. Johnson looks like change as more of the description unfolded?
If you're like most of us, by the time you got to the end you may have envisioned Dr. Johnson as a middle-aged man who was advanced in his career, and most likely white. There's no shame in having that mental picture; in fact that picture would be historically accurate. Because this image is so strong, with little that helps us shake our initial perceptions, we can refer to the possibility of any other characteristic as a blind spot. If I told you that Dr. Johnson was a Latina or a black man or LGBTQ, we would have no difficulty envisioning and celebrating these accomplishments.
Thus began a presentation to the AAN Board of Directors this past September by neuro-oncologist Alyx B. Porter, MD, FAAN, director of the Cultural Humility Course for Mayo Clinic School of Medicine in Arizona, representing the recent work of the 2018 AAN Diversity Leadership Program (DLP) graduates. Current AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, asked the group to answer this question, among others: How can the AAN help academic departments establish the position of an equity, diversity, and inclusion (EDI) officer and define his or her department's role?
Their presentations laid out the facts: The academic neurology faculty in the US is 64 percent white, 1.9 percent black or African-American, and 2.2 percent Latino or Hispanic. Yet the general population of the US is 60.7 percent white, 13.4 percent black or African-American, and 18.1 percent Latino or Hispanic.
“Our goal within neurology, and within the field of medicine in general, is to have a physician workforce that reflects the population we serve,” Dr. Porter observed. “In order to ensure that we make progress in addressing this disparity, additional efforts must be pursued,” she said.
To that end neurology chairs in a few institutions have designated a diversity advocate in their departments. An inclusion and diversity survey crafted by the AAN's Diversity Officers' workgroup in February 2018 found that 24 of 79 respondents indicated that they had some form of inclusion and a diversity “champion” in their department. But formal EDI officers are still rare. Neurology Today set out to identify and interview a few of these officers and to describe some of the ways that they are working to improve workplace diversity.
UPenn: Diversity Training
Roy H. Hamilton, MD, MS, FAAN, FANA, a 2017 AAN DLP graduate, has been vice chair for diversity and inclusion in the department of neurology at the University of Pennsylvania since July of 2017 and reports directly to his chair, Frances E. Jensen, MD, FACP, FAAN, FANA.
A cognitive and behavioral neurologist, Dr. Hamilton came to Penn in 2002 for his residency and remained, joining the faculty at the university in 2009. Although his vice-chair position is department-specific, Dr. Hamilton has also been serving as an assistant dean for diversity and inclusion at the Perelman School of Medicine at Penn since 2012. His responsibilities include chairing the department's inclusion and diversity committee, and serving on the department's Executive Committee and its Committee on Appointments and Promotions. He oversees training activities that increase the department's EDI focus. For example, the department offers unconscious-bias training for faculty; a curriculum in disparities in neurology for residents; and invites speakers on topics relating to EDI on grand rounds. He also works to enhance existing pipeline and outreach efforts for recruitment of underrepresented individuals in neurology at the medical student, resident, fellow, and faculty levels.
“As my position in the department has begun to mature, I have come to realize that an important aspect of my work is to address widely held misconceptions about the role and impact of diversity and inclusion in academic medicine, and neurology specifically,” Dr. Hamilton said. “While it is critically important that persons in my position continue to act as advocates for individuals who are historically underserved by or underrepresented within the field of neurology, it is also important to raise awareness more broadly that increasing the diversity and inclusion of professional organizations strengthens their resilience, creativity, and productivity,” he explained. “Thus enhancing diversity and inclusion in neurology strengthens the ability of our field to excel in all its other goals: clinical excellence, research, and education.”
One challenge that many people in Dr. Hamilton's position face is that of finding adequate support for what they do. “Although many academic medical institutions endorse diversity and inclusion as core values, the fact of the matter is that this commitment to diversity and inclusion is often not matched with the allocation of resources that would be necessary to pursue these efforts most effectively,” he pointed out. The diversity officer could be even more successful with the benefit of protected time, administrative support, and dedicated funds toward building and maintaining diversity and inclusion programs, he said, all of which could be supported at the department, medical school, health system, or university level.
UCSF: Looking Beyond Organic Development
At the University of California, San Francisco (UCSF), the neurology department has accomplished such a step forward under the leadership of S. Andrew Josephson, MD, FAAN. “Shortly after I was [named] interim chair, I led a strategic planning initiative where it became clear that diversity is not just something that would happen organically, and that it needed a real commitment,” Dr. Josephson said. “We live in an inherently diverse community in San Francisco, and although we had spent a great deal of time talking about diversity in the past, I felt that it lacked a coordinated effort.”
One of the first things he did when he became chair in 2017 was to set diversity as one of his four major missions, right alongside research, clinical affairs, and education. “I felt we needed to be deliberate in order to ensure diversity of not only those with underrepresented status, but [also in] gender, religion, sexual orientation, socioeconomic status, and disability,” he said.
Creating the position of vice chair for diversity, Dr. Josephson allocated a budget to support a diversity committee run by faculty, staff, and trainees. The committee helps organize and support activities such as diversity grand rounds, training to address cultural competence and inclusion, and the acquisition/creation of new educational materials for residency.
Mayo Clinic: Multiple Diversity Awards
Widely known for its diversity advances since 2011, the Mayo Clinic has won multiple diversity awards over the past several years for its work as an institution under the leadership of its neurologist-chief executive officer John H. Noseworthy, MD, FAAN. Neuromuscular specialist Michelle L. Mauermann, MD, has been the diversity leader for the department of neurology at the Mayo Clinic in Rochester, MN, since 2015.
Up until then, Mayo had about 10 such leaders, a figure that has tripled in number over time. The Office of Diversity and Inclusion, which oversees the program, encourages department diversity leaders to be given protected time; indeed Dr. Mauermann receives protected time from her department chair, Claudia Lucchinetti, MD. Dr. Mauermann meets with other diversity leaders every other month, and attends a yearly two-day retreat with people involved in some way with diversity and inclusion from practice, education, and research areas.
Dr. Mauermann has also made a concerted effort to increase the diversity of Mayo's residents in neurology and to consider different aspects of diversity including gender and ethnicity. Indeed Mayo has created 16 groups that devote resources for employees of shared backgrounds.
These Mayo employee resource groups are employee-organized alliances that form around a common dimension of diversity. Each group has an executive sponsor and coordinator and receives support from several offices: Diversity and Inclusion, Human Resources, and Public Affairs.
“Our pipeline in neurology typically comes from our own medical school, residency, and fellowship programs,” Dr. Mauermann said, “so we invest time in recruitment efforts of neurology candidates. Patients are looking for diverse physicians. Similarly, potential candidates want to see a department that represents them.”
After taking the Implicit Association Test, the Resident Recruitment Committee completes unconscious-bias training offered through the Association of American Medical Colleges (AAMC). They also discuss the AAMC best practices for conducting residency program interviews. The committee seeks to identify the unique strength, experience, or perspective a candidate could bring to the residency program. When residency candidates come to interview, Dr. Mauermann makes time to personally interview those who have expressed interest in diversity. Over the past three years, dedicated efforts to emphasize diversity in residency recruitment have helped the program achieve an 11- to 19-percent representation of active residents from groups underrepresented among neurologists.
What the Pipeline Looks Like
The pipeline issue has been the focus of many department chairs for some time, with neurology residency recruitment static at about 2.6 percent of all medical students yearly. Notably, the department at Penn has been very effective in developing a pipeline from the Perelman School of Medicine to the Penn Neurology residency program, Dr. Hamilton said. In their 2018 match, eight out of 158 students matched in neurology, nearly doubling the average at 5.06 percent. Three of eight students who matched at Penn's program, 37.5 percent, were medical students from underrepresented communities, a tribute to the success of the department's diversity recruitment efforts.
“This has involved strategic placement of underrepresented faculty members in leadership positions in the medical school that put them in close contact with students interested in neuroscience and neurology,” said Dr. Hamilton. “Our students [also] are perennial recipients of the AAN's Medical Student Diversity Program,” a five-day leadership training program that exposes students to career options in neurology and offers them the opportunity to connect with mentors during the AAN Annual Meeting.
Stanford: Diversity and Precision Medicine
The neurology clerkship at Stanford School of Medicine, awarded the highest-rated clinical clerkship at the institution for nine years in a row, has also essentially nearly doubled the national rate for medical students entering neurology. Its chair, Frank M. Longo, MD, PhD, and his leadership team believe diversity in neurology is essential for many reasons.
“As precision health becomes more important, it is critical for our field to better and more deeply engage the overall community to have the greatest impact. We can only do this if neurology in general and our department at Stanford, [specifically], reflect the community with all of its views, nuances, and experiences,” he said. “This is accomplished by having a diverse group of trainees and faculty.”
Neuro-oncologist Reena P. Thomas, MD, PhD, has been serving as director of diversity and inclusion in the neurology department at Stanford since 2017, a position Dr. Longo has supported by allocating Dr. Thomas protected time and financial resources. She had previously served as the diversity liaison for the department of neurology from 2015 until 2017. (Only two other clinical departments at Stanford have similar positions: surgery and radiology.)
Dr. Thomas' leadership role for diversity and inclusion, broadly defined, allows her to focus on recruitment, retention, and advancement of trainees and faculty. “My greatest challenge also provides an incredible growth opportunity,” she said: “attracting the most talented and diverse applicant pool possible, then honing their strengths to develop the next generation of leaders in academic neurology.”
Toward that end she has attended conferences at the AAN, the Latino Medical Student Association, the Student National Medical Association, and her local Student Interest Group in Neurology. She has also participated in Stanford's First Generation Mentorship Program and recently received its Mentor of the Year award.
“Increasing our diversity efforts comes with the bonus that we will recruit an increased number of highly talented young people and we will have a greater number of neurologists to meet the increasing demand for neurological care,” Dr. Longo said.
That was the consensus of the diversity and inclusion advocates as well. “Being an active spokesperson for this notion, that inclusion and diversity efforts benefit everyone, is evolving into an important part of my position,” Dr. Hamilton said.
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