SASGOG Breakout Session: Encouraging a Culture of Diversity in OB/GYN Matt Hopkins, MD Jani Jensen, MD Michael Moxley, MD

Disclosures The faculty have no disclosures

Objectives Describe background of the diversity landscape Recognize the barriers to improving diversity Provide examples of successes in diversity efforts Provide tools for participants to take to their home institutions for implementation as appropriate

THE DIVERSITY LANDSCAPE

Racial and ethnic minorities tend to have less access to health care than non-minorities

Diversity in the Healthcare Workforce Black and Hispanic physicians account for only 4-5% of the physician workforce – They care for 25% of black and 23% of Hispanic patients Regional differences are more pronounced We can correct these disparities by having practicing academics able to effectively train and mentor those physicians who are most likely to treat these populations and perform meaningful research to improve the quality of care to all patients

UVA School of Medicine Prior to 2003 Diversity generally not a part of the Admissions Committee discussions Admissions committee did not consider the literature on predictive validity of the MCAT in various subgroups The percentage of students underrepresented in medicine (URM) was less than 6%

2003 Supreme Court decision (Grutter v. Bollinger) allows race/ethnicity to be used as a factor in admissions decisions Initiated active national recruitment that was broad and included URM groups

Holistic Admission Process Applicant characteristics for an interview: – Strong academic record – Health care experience – Evidence of social conscience – Ability to work as an effective team member – Leadership ability – Life experience that brings a unique or special perspective to the school

Diversity -> Academic Excellence URM students increased from less than 6% (bottom quartile) to 25.5% (top quartile) Academic credentials of matriculating students rose from about the 75 th percentile to above the 90 th percentile Students scoring above the 90 th percentile on the USMLE Step 2 examination rose from 40% to 69% (Significance of USMLE?)

Class of 1960 Class of 2017

Diversity – UVA Trainees Residents Asian % White % Not Spec415.31% Black/African American243.10% Hispanic or Latino202.59% White/Asian70.96% Native Hawaiian or Pacific Islander10.12% American Indian or Alaskan Native0 White/Black or African American0 White/Hispanic or Latino60.77% Male60% Female40% Total772 URM Residents51 7%

Diversity - Faculty Nationally (2013) 69% White 13% Asian 3% Black 4% Hispanic 0.1% Native American 10% Multi-racial and Other UVA (2014) 81% White 14% Asian 1.9% Black 2.4% Hispanic 0.2% Native American

Mayo Clinic

Diversity

Diversity and Inclusion

Diversity vs Inclusion Diversity Being invited to the party The ways in which we are different, the same, unique Some more apparent / measureable When you count the people Dependent on setting Inclusion Being asked to dance Environment – Mutual respect Culture – Seek diversity – Leverage strengths of diversity When the people count

Considerations Starts with leadership Medical Student Rotations Residency Applicant Interviews Know the current state Identify Opportunities – Schedules, Meetings Mayo Employee Resource Groups (MERGS) – Employee organized groups formed around a common dimension of diversity

BARRIERS TO IMPROVING DIVERSITY

Unconscious Bias

A.k.a. Implicit Bias Judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and stereotypes) that often operate at a level below conscious awareness and without intentional control

Unconscious Bias Automatically activated by the mere presence (actual or symbolic) of the attitude object – Source: Dovidio, Gaertner, Kawakami, & Hudson, 2002 Although automatic, implicit biases are not completely inflexible: They are malleable to some degree and manifest in ways that are responsive to the perceiver’s motives and environment – Source: Blair, 2002

“Most unconscious bias is caused by well-intended people with blind spots” Howard J. Ross

Unconscious Bias in Academic Medicine Faculty Recruitment Undergraduate Medical Education Resident Recruitment Patient Care Tenure Faculty Advancement Faculty Mentoring Medical School Admissions

Project Implicit

AAMC Training

AAMC Workshops

WHAT DOES DIVERSITY LOOK LIKE TO YOUR INSTITUTION?

Questions for Discussion What are traditional vs. non-traditional types of diversity? Does your program consider geographical or educational diversity? Do you actively recruit male candidates for OBGYN residency? What about MD vs. DO candidates? How does your program view foreign medical graduates? What about non-traditional candidates? – Example: 40 yo second-career applicant

SUCCESSFUL RECRUITMENT STRATEGIES

UVA - Expanding Success Institutional support: Started with Diversity Task Force to address Mission and Values statement Communicate that understanding differences is essential to providing culturally humble education and health care Creation of groups: Diversity Consortium, NMA, Diversity Steering Committee Developed a strategic plan

Establishing a Culture of Inclusion as a Strategy for Excellence: A Systematic Approach Leadership Engagement and Commitment Organizational Capacity Leadership and Cultural Competency Development Access and Success Community Outreach, Scholarship, and Education Expanding Educational Access Talent and Leadership Accountability

Diversity Efforts – Faculty/Staff/Trainees Retreat with department chairs and administrators Diversity website updates, linked to admissions/GME Apply holistic selection approach – Examples: OB/GYN, Orthopedics Presentations within UVA community and externally (AAMC)

BREAKOUT SESSION: CREATE A RANKING GRID THAT REFLECTS DIVERSITY OF CANDIDATES

Applicant Checklist Courtesy of Michael Moxley, MD

SUMMARY

Office of Admissions/Office for Diversity - Keys to Success Partnering in culture change Warm environment, approachable peers Mentorship Importance of human connection – nurturing Pipelines Recruitment Community involvement Holistic review (grid); broad definition of diversity Diverse Admissions Committee Strong and unyielding support from administration

“We cannot have first-class universities without diverse student bodies and staffs. We have got to convince faculty members that what is at stake is the quality of the university, that you can’t have excellence without diversity. We have to make an educational argument, not a moral one. And if a large segment of the country does not have a first-class education, the health of the country is at stake.” - Donna Shalala

References and Acknowledgements Missing Persons: Minorities In The Health Professions. A Report of The Sullivan Commission on Diversity in the Work Force. The Sullivan Commission (2004) AAMC Unconscious Bias Training: ml ml UVA School of Medicine Academic Strategic Planning website: as-a-strategy-for-excellence/ Smith, Daryl G: Diversity’s Promise for Higher Education – Making it Work (2009) Unconscious Bias in academic medicine: bias.html bias.html NPR story on Unconscious Bias in medicine: shots/2015/08/20/ /can-health-care-be-cured-of-racial-biashttp:// shots/2015/08/20/ /can-health-care-be-cured-of-racial-bias Blair, I. (2002). The malleability of automatic stereotypes and prejudice. Personality and Social Psychology Review, 6, Dovidio, J., Gaertner, S., Kawakami, K., & Hodson, G. (2002). Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology, 8, UVA Office for Diversity and Equity, Diversity Steering Committee, Office of Admissions, Robin Fisher (Human Resources)