Shifting Paradigms: Implementing Sullivan Commission Recommendations to Increase Diversity at the University of Virginia School of Medicine Authors: R.J. Canterbury MD, L. Thomas JD, M. Moxley MD, G. Marzani-Nissen MD, J. Densmore MD PhD Senior Leadership Innovators: Arthur Garson, Jr. MD MPH– Executive Vice President and Provost, University of Virginia Steven DeKosky MD – Vice President and Dean of UVA School of Medicine Sharon Hostler MD – Vice Provost for Faculty Development, University of Virginia and Senior Associate Dean, University of Virginia, School of Medicine R.J. Canterbury MD – Senior Associate Dean for Education, School of Medicine M. Norman Oliver MD MA - Associate Dean for Diversity, School of Medicine W. El-Amin MD – Assistant Dean for Diversity, School of Medicine ( ) Presenters: G. Marzani-Nissen MD – Office of Admissions, UVA School of Medicine M. Moxley MD- Office for Diversity, UVA School of Medicine Marcella Willis- 4 th year medical student, UVA School of Medicine

Sullivan Commission Background In 2004, The Sullivan Commission produced a monograph entitled: Missing Persons: Missing Persons: Minorities in the Health Professions. A Report of the Sullivan Commission on Diversity in the Health Care Workforce. Among other issues, it noted the disparity of individuals who were underrepresented in medicine (URM) Increased diversity in the medical workforce has numerous benefits, including a healthier nation. It has been demonstrated that health care providers need to be sensitive to variety in patient ethnicity, socioeconomic status, sexual orientation, and life experiences in order for patients to have successful outcomes.

Vision and Implementation Process In 2004, The Dean and Senior Leadership for the School of Medicine, committed to diversity, envisioned a process by which students, traditionally underrepresented in medicine, could be more fully represented in the medical school class. R.J. Canterbury, MD embraced this mission and formalized a process of outreach and recruitment through the Office of Admissions in the School of Medicine. A cultural shift took place, which included increased membership of students and faculty under-represented in medicine and implementation of a day-long retreat for all Admissions members. This retreat included a focus on holistic approaches to student applications and included presentations on diversity, including lesbian, gay, bisexual and transgender issues. Contemporaneously, a proactive Admissions Office, Assistant Dean for Medical Education and Office for Diversity created pipelines and mentoring initiatives within the greater university as well as in the community. Active recruitment of students in historically black colleges and at pre-medical conferences also increased. Coordination with student groups such as the Daniel Hale Williams Society Student National Medical Association (SNMA) and the National Network of Latin American Medical Students during recruitment activities was enhanced. Students in other organizations such as qMD (an LGBT group) became active in outreach.

Diversity and Academic Outcomes During , the percentage of students underrepresented in medicine who matriculated into the UVA School of Medicine more than tripled from 5.7% to 21%. During , the percentage of students underrepresented in medicine who matriculated into the UVA School of Medicine more than tripled from 5.7% to 21%. Using data from the University of Virginia, School of Medicine Office of Admissions, URM matriculants (African American, Hispanic, Native American, and Alaskan/Hawaiian American), were determined as a percentage of the entering classes during Using data from the University of Virginia, School of Medicine Office of Admissions, URM matriculants (African American, Hispanic, Native American, and Alaskan/Hawaiian American), were determined as a percentage of the entering classes during Average USMLE Step 1 and Step 2 scores increased or remained stable over this time frame. Pass rates for these exams remained stable. Average USMLE Step 1 and Step 2 scores increased or remained stable over this time frame. Pass rates for these exams remained stable. Increased diversity in the medical school has been accomplished in the face of stagnant national percentages of applicants and matriculants underrepresented in medicine. Increased diversity in the medical school has been accomplished in the face of stagnant national percentages of applicants and matriculants underrepresented in medicine.

Outcomes: Diversity and USMLE Results UVA School of Medicine

National Data adapted from Table 28: Total U.S. Medical School Enrollment by Race and Ethnicity within Sex, (2009) Association of American Medical Colleges

Examples of Specific Strategies Changing Admissions Committee – 27 members representing medical students, multiple medical and surgical disciplines and a broad swath of diversity in all forms. Term limits for members Focus on Role of Diversity – Targeted Recruitment of an Assistant Dean of Medical Education - Wendi El-Amin, M.D. Recruited to develop and implement programs and recruitment activities that increase the number of qualified underrepresented minorities who matriculate at the University of Virginia School of Medicine Recruited to develop and implement programs and recruitment activities that increase the number of qualified underrepresented minorities who matriculate at the University of Virginia School of Medicine Dr. El-Amin – working closely with R.J. Canterbury, MD accomplished the following: Dr. El-Amin – working closely with R.J. Canterbury, MD accomplished the following:

Dr. El-Amin – working closely with R.J. Canterbury as mentor accomplished the following Met with Daniel Hale Williams Pre-Medical Society. Interviewed seniors about premed support. Distributed a survey to members of the Society to do a needs assessment. Met with Daniel Hale Williams Pre-Medical Society. Interviewed seniors about premed support. Distributed a survey to members of the Society to do a needs assessment. Created a template for Toolkit for Success to be utilized by undergraduate students. Created a template for Toolkit for Success to be utilized by undergraduate students. Presented at UVA Summer Medical and Dental Education Program. Presented at UVA Summer Medical and Dental Education Program. Created community service opportunities for minority undergraduate students. Created community service opportunities for minority undergraduate students. Served as a mentor for UVA Summer Medical and Dental Education Program. Served as a mentor for UVA Summer Medical and Dental Education Program. Presented at Hampton University to Premed Society Presented at Hampton University to Premed Society Secured Research summer positions for two Virginia Nebraska Alliance interns from Hampton University. Secured Research summer positions for two Virginia Nebraska Alliance interns from Hampton University. Participated in second look weekend at UVA. Participated in second look weekend at UVA. Presented to minority second look participants mock POM class. Presented to minority second look participants mock POM class. Worked with SNMA students and Office of Diversity to explore pipeline initiatives. Worked with SNMA students and Office of Diversity to explore pipeline initiatives. Identified mentors for Daniel Hale Williams Society Identified mentors for Daniel Hale Williams Society

Office of Admissions/Office for Diversity – some keys to success Warm environment, approachable people Warm environment, approachable people Importance of human connection – nurturing Importance of human connection – nurturing Accessibility to accomplished mentors Accessibility to accomplished mentors Visibility of mentors representing diverse backgrounds Visibility of mentors representing diverse backgrounds Creation of and establishment of pipelines in high schools and colleges (e.g. medical science clubs) Creation of and establishment of pipelines in high schools and colleges (e.g. medical science clubs) Active recruitment at health fairs and student fairs Active recruitment at health fairs and student fairs Close connections with SNMA, Daniel Hale Williams Society, LGBT communities Close connections with SNMA, Daniel Hale Williams Society, LGBT communities Holistic review of applications, diversity (in the broadest sense) on Admissions Committee Holistic review of applications, diversity (in the broadest sense) on Admissions Committee Term limits on Admissions Committee membership Term limits on Admissions Committee membership Strong and unyielding support from administration Strong and unyielding support from administration Yearly training on diversity and cross-cultural sensitivity and training Yearly training on diversity and cross-cultural sensitivity and training

References Missing Persons: Minorities In The Health Professions. A Report of The Sullivan Commission on Diversity in the Work Force. The Sullivan Commission (2004) Missing Persons: Minorities In The Health Professions. A Report of The Sullivan Commission on Diversity in the Work Force. The Sullivan Commission (2004) Association of American Medical Colleges (AAMC) website: Association of American Medical Colleges (AAMC) website: