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What to Do About Racism in Medicine?
These Diversity Leaders in Neurology Chart a Course with Faculty

Article In Brief

Following the murder of George Floyd in May and the rise of the nationwide movement Black Lives Matter, neurologists in academic medical centers have doubled down on initiatives around anti-racism—from developing more inclusive curricula to building out programs that encourage earlier recruitment of diverse students in medicine and neurology.

Even before the May 25th murder of George Floyd, Andrew R. Spector, MD, FAASM, vice chair of inclusion, diversity, and empowerment at Duke University Medical Center, considered the department of neurology, where he is the associate residency program director, very engaged in anti-racism initiatives. But in the weeks that followed—when protests and uprisings erupted across the world, and the nationwide movement, Black Lives Matter (BLM), was reignited—Dr. Spector was deluged with emails from colleagues asking for resources to better understand racism. And participation in the diversity and inclusion committee he led jumped up by nearly 30 percent.

Dr. Spector's experience was not unique. Suddenly, underrepresented neurologists and those who served in similar diversity officer positions were inundated with requests for help.

Since Neurology Today first published the story “Meet Neurology's Diversity Leaders” (January 10, 2019) about neurologists working on equity, diversity, and inclusion (EDI) committees in their departments, the AAN has identified a total of 47 diversity officers throughout the US. In interviews with Neurology Today, a number of them shared that coverage of the events around George Floyd and BLM had fueled a surge of interest from members of their institutions in engaging in anti-racism efforts.

“The killing of George Floyd and the witnessing of police brutality had a profound effect on our institution at large,” said Roy H. Hamilton, MD, MS, FAAN, assistant dean for cultural affairs and diversity at the Perelman School of Medicine, and the vice chair of diversity and inclusion for the University of Pennsylvania department of neurology. “Many individuals approached me to ask what they could do.”

Carolyn B. Britton, MD, chief diversity officer of the Diversity and Inclusion Committee of the department of neurology at the Vagelos College of Physicians and Surgeons at NewYork-Presbyterian/Columbia University Medical Center, University's department of neurology, has been involved in diversity efforts over many years. But now, she said, “we are at an inflection point.”

“The nation has changed in these recent weeks because the change is broader than a single race or ethnic group,” said Dr. Britton, who was only one of 30 Black neurologists when she finished her residency at Columbia. “Now, many are able to recognize and speak about their blindness to institutional racism and its role in health disparities and health equity throughout our history.”

Dr. Britton said she felt encouraged by the recent proliferation of chief diversity officers, but, she added, “For institutions to indicate that they are serious about EDI efforts, they must allocate appropriate resources to assure the success of these officers. It is critical that they are integrated into the mission, vision, and values of their departments, and not treated as an appendage to it.”

Those values were front and center at the University of Pennsylvania, said Dr. Hamilton. “In early June, the UPenn department of neurology responded with a statement against racism, held a Town Hall discussion and aggregated and disseminated an anti-racism reading list,” he said. “Importantly, we began having critical conversations and found that despite having a relatively large committee for inclusion and diversity, most of the people doing the work were themselves disadvantaged or underrepresented,” he added.

Seeking White Anti-racists

“Often referred to as the ‘diversity tax,’ individuals who are underrepresented are often called upon on a disproportionate basis to serve in EDI efforts, and we came to understand that this was in and of itself a racist policy,” Dr. Hamilton explained.

The solution was to leverage the raised consciousness of allies in the movement and ask others to step forward, Dr. Hamilton said. So, he and others developed a new framework for his department and organized several committees: 1) equity and anti-racism education, 2) recruitment and retention, 3) community and social action, and 4) intra-departmental equity.

“Each committee has 10 to 15 people, two co-chairs and among the 55 or so members, representation is diverse and inclusive,” he explained.

“But as neurologists who want to do something become active in EDI initiatives, they may learn that there a several disadvantages to fighting racism as a White person, and one of them is battling the optics,” wrote Dr. Spector in a personal essay published on the Neurology website.

One reason the optics can be troubling, he explained, is that White people, like himself, performing EDI work, can be viewed as having a “White savior” mentality, helping people of other races for self-serving, self-promoting purposes. White people need to be cognizant of these legitimate concerns, Dr. Spector said, and ensure that their work is done only in the spirit of true cooperation with people of other backgrounds in a manner that benefits them. He believes that White men working to improve inclusion need to know their limitations.

“Racism is a system built by White people to benefit White people,” Dr. Spector told Neurology Today, “so it's not reasonable to put the burden of dismantling it on anyone else. We need White anti-racists to do this work.”

Recruitment of Underrepresented Neurologists

That sentiment is particularly relevant in academic departments, which do not have diverse representation among their medical faculty. “Throughout my training, I had always found mentors and sponsors who have shaped my career,” recalled neuro-oncologist Reena P. Thomas, MD, PhD, clinical associate professor in the department of neurology at Stanford. “But it was not until I became a faculty member that I realized that I was not seeing the diversity that I grew up with reflected in the academic medicine faculty workforce, at national conferences, or in positions of leadership.”

This was a wake-up call for Dr. Thomas, whose nuclear and extended family reflects this multicultural diversity: Her mother is from El Salvador, her father from India, and she has uncles who are from Puerto Rico and China and another uncle who is African American.

The events of the last few months have deepened her commitment to the cause of fighting racism. Dr. Thomas said she had been acutely aware of the BLM movement having heard about the experiences of her African American father-in-law, who grew up in Alabama. Together with her husband, who is Black, she has had to engage in difficult conversations about race with their two sons, aged 6 and 9. She has fielded questions at work from colleagues who want to help with anti-racism efforts, as well as from well-meaning neighbors who wanted to learn more.

In early August, Dr. Thomas had just begun a new position as associate dean for diversity in medical education at the Stanford School of Medicine. For the last four years prior to this appointment, she had served as director of diversity and inclusion in the department of neurology and chair of the department's committee for diversity and inclusion. During that time, her department chair had supported this work by providing her with protected time and a budget to implement initiatives that would help recruitment and retention efforts for underrepresented neurologists at Stanford.

Under her direction, the Stanford neurology department established a new faculty search protocol to mandate job postings through public and national forums, including the expectation that all faculty recruits be vetted by a selections committee, and interviews of top candidates take place from a national pool of applicants.

It also launched a knowledge and education resource highlighting healthcare disparities in neurology, and its residents, fellows, and faculty are further developing it into a portal. The education chiefs modified their formal didactic curriculum for residents and fellows in each subspecialty area to include formal sessions on disparities, beginning in July of 2020. They broadened their Grand Rounds lecture invitations to include national experts in health care disparities and diversity related to neurology, and plan to focus on diversity and inclusion as a key element of their 2021 department retreat.

Investing in the Pipeline

Now, in her new role, which affords her 50 percent protected time, Dr. Thomas hopes to provide residents, fellows, medical and pre-med students, who are underrepresented in medicine, with the infrastructure and resources needed to help promote leadership and career development, recruitment, and grant support. The new Office of Diversity in Medical Education at Stanford aims to bolster the pipeline and facilitate opportunities for individuals who are UIM.

The same efforts are underway at Harvard and its Massachusetts General Hospital (MGH). There, Nicte I. Mejia, MD, MPH, FAAN, serves on several EDI committees and is involved with multiple initiatives that promote diversity. Recognizing the dearth of opportunities for young people of color interested in pursuing careers in medicine and science, she created mechanisms for trainees to engage in learning opportunities including the MGH Neurology Community Health Diversity and Inclusion Internship for undergraduate and graduate students, the Mass General Brigham Neurology Residency Program Certificate in Diversity and Inclusion for neurology residents, and the MGH Neurology Youth Stroke Education Series for high school students.

Dr. Mejia also spearheads the MGH Youth Neurology Education and Research Program, which engages youth from communities underrepresented in neurology, and provides educational and research opportunities to female, Black, Latinx, American Indian, and low-income youth across Massachusetts. This year the program included 31 interns working across 11 MGH neurology labs.

The program offers weekly didactics, including a speaker series open to students anywhere and partnering with organizations that support students underrepresented in STEM/medicine. The program quickly adapted to the COVID-19 pandemic, offering interactive career chats with leading neurologists and neuroscientists, which are free and open to high school and undergraduate students; in addition, it includes paid remote internships that support the academic development of participating youth.

“Our neurology trainees are doing a great deal as well,” said Dr. Mejia. Together with J. Ricardo McFaline-Figueroa, MD, PhD, she co-leads the Mass General Brigham Neurology Residency Program Certificate in Diversity and Inclusion, which provides a framework for the development of knowledge and skills specific to promoting diversity and inclusion as it pertains to neurology.

One recent graduate, Joshua Budhu, MD, MS, who was formerly a chief resident and is a neuro-oncology fellow, has been writing about equity and his experiences as a Black physician. One of his pieces was published as a blog on the Neurology EDI site. As the son of Guyanese immigrants, raised in Queens, NY, he witnessed first-hand how social determinants of health and racism can play into outcomes as his brother died from a pulmonary embolism while intubated and handcuffed to a hospital bed. His commentary included a call to action: “It is now more important than ever that we collectively push for positive changes as entire communities have been devastated by COVID-19 and the disenfranchised reach a new boiling point of frustration and anger towards a society that has failed so many,” he wrote. “Whether it is ensuring our patients have access to professional medical interpreters, calling out unconscious biases in the work setting, or fighting for changes at the policy level, we all have a part to play.”

Together with neuromuscular fellow, Méabh O'Hare, MD, and a faculty member, Altaf Saadi, MD, MSc, Dr. Budhu wrote in an essay in theWashington Post, “Police keep using ‘excited delirium’ to justify brutality. It's junk science,” they explained, noting that the inaccurate diagnosis misappropriates medical terminology to shield officers from accountability.

“Another certificate trainee, neurology resident, Jillian Berkman, MD, launched a didactic residency curriculum that tackles structural racism and advances equity, embedding noon conference talks on a variety of topics throughout the year. I am excited this could expand across other neurology departments,” Dr. Mejia said.

Next Steps

Dr. Hamilton is currently co-chairing the Diversity Officer Workgroup—established by the AAN in 2017—along with Nimish A. Mohile, MD, who is an associate chair of faculty development at the University of Rochester. They and the other members of the workgroup are in the process of completing a manuscript that details salary support, protected time, and other statistics to help define and bolster the role of the chief diversity officer. The group plans to engage in annual meeting activities, make plans to meet virtually as a group, and hold webinars to support departmental diversity officers over the next year.

Link Up for More Information

• Spector AR. Expanding our image of diversity officers: Paging White men for EDI work: http://bit.ly/Neurology-blog
    • Neurology Today articles on Diversity: http://bit.ly/NT-DiversityCollection
      • Neurology Today articles on social determinants of health: http://bit.ly/NT-SocietyBrain