1. School of Medicine Office of Diversity and Multicultural Affairs Rafael Ortega, MD

2. Objectives: Explain the Mission and Vision of the Office of Diversity Explain the Mission and Vision of the Office of Diversity Describe the evolution of Diversity at BU School of Medicine Describe the evolution of Diversity at BU School of Medicine Emphasize the importance of Diversity in education and health care Emphasize the importance of Diversity in education and health care Discuss how you can help us achieve our goals Discuss how you can help us achieve our goals

3. INTERRELATED OBJECTIVES

5. http://www.bumc.bu.edu/oma/

6. Office of Diversity and Multicultural Affairs Monitors and promotes diversity at BUSM and BUMC including statistics on students, faculty and trainees. Reports on diversity issues to the Dean and Executive Committee. Collaborates with Departments in BUSM to identify and achieve diversity goals. Works with OSA to monitor progress of students. Mentors students, faculty and trainees. Provides support for medical student cultural and ethnic groups on campus. Explores new funding and grant support for diversity efforts. Manages EMSSP including recruitment, retention and academic preparation and assessment of students. Maintains collaboration with partner colleges and universities and seeks opportunities to expand affiliations. Monitors and promotes diversity at BUSM and BUMC including statistics on students, faculty and trainees. Reports on diversity issues to the Dean and Executive Committee. Collaborates with Departments in BUSM to identify and achieve diversity goals. Works with OSA to monitor progress of students. Mentors students, faculty and trainees. Provides support for medical student cultural and ethnic groups on campus. Explores new funding and grant support for diversity efforts. Manages EMSSP including recruitment, retention and academic preparation and assessment of students. Maintains collaboration with partner colleges and universities and seeks opportunities to expand affiliations.

7. Healthcare Equality Index 2010

8. Boston University School of Medicine will lead medical schools in diversity of faculty, students, staff and trainees, by development of innovative programs that educate, recruit and retain a multicultural constituency. We will create a culture and climate that demonstrates BUSM belief that diversity adds value to intellectual development, academic discourse, patient care and research. We believe that diversity is essential to the development of future leaders in healthcare and research to serve our community, nation and world. The Boston University School of Medicine Office of Diversity and Multicultural Affairs serves as the Dean’s proponent for diversity and cultural competence among students faculty and staff. The Office of Diversity will accomplish this mission through collaboration with all departments to develop model recruitment and retention strategies and for curriculum and faculty development. Mission Vision Boston University School of Medicine will lead medical schools in diversity of faculty, students, staff and trainees, by development of innovative programs that educate, recruit and retain a multicultural constituency. We will create a culture and climate that demonstrates BUSM belief that diversity adds value to intellectual development, academic discourse, patient care and research. We believe that diversity is essential to the development of future leaders in healthcare and research to serve our community, nation and world.

9. Race Ethnicity Gender Sexual Orientation Gender Identity Socio-economic Status Immigration Status Age Disabilities Religious Beliefs Political Beliefs The Expanding Definition of Diversity Military Service Marital Status Same Sex Marriage Children Nationality Educational Attainment Language Health Care Disparities Interracial Marriage Intercultural Marriage Urban vs. Rural

10. Examples of Diversity Organizations on Campus AMERICAN ASSOCIATION OF PHYSICIANS FOR INDIAN ORIGIN (AAPI) ASIAN PACIFIC AMERICAN MEDICAL STUDENT ASSOCIATION (APAMSA) CHRISTIAN MEDICAL DENTAL ASSOCIATION (CMDA) IRANIAN HEALTH CARE STUDENTS ASSOCIATION MAIMONIDES SOCIETY MEDICAL GAY AND LESBIAN ORGANIZATION (MedGLO) MEDICAL STUDENTS FOR CHOICE (MSFC) PHYSICIAN FOR HUMAN RIGHTS (PHR) SOUTH ASIAN MEDICAL STUDENT ASSOCIATION (SAMSA) STUDENT NATIONAL MEDICAL ASSOCIATION (SNMA) OTHER

12. MD Physicians by Race and Ethnicity Black 12% Latino 15% AAMC Data

13. URM House Officers in BMC Residency Programs 12% 14% 17% 21% 11% 8% TOTAL: 632

14. Anesthesiology1729 Dermatology214 Cardiology418 Emergency Medicine448 Family Medicine619 GI49 Infectious Disease36 Internal Medicine22150 Neurology218 Obstetrics & Gynecology416 Opthalmology512 Orthopedics429 Otolaryngology014 Pathology412 Pediatrics *21124 PM&R012 Psychiatry1329 Radiology435 Surgery (General)839 Urology38 Total134641 *Combined program Number of URM House Officers in BMC Residency Programs

15. 15% 17% 8% 21% 25% 0% 44%38% 50% Percentage of URM House Officers in BMC Residency Programs

16. 2010 BUSM Total Full Time Faculty: 1,191

17. 2010 BUSM Total Medical Students: 728

18. 80% 10% 0.4% 10%

19. 2010 BUSM Full Time Gender Faculty Distribution by Rank

20. 2010 BUSM Full Time URM Faculty Distribution by Rank

21. Searching for Excellence & Diversity: A Guide for Search Committee Chairs, a guide developed by the Women in Science & Engineering Leadership Institute (WISELI) at the University of Wisconsin Madison http://www.bu.edu/apfd/recruitment/fsm/

22. “I am in favor of diversity, but I don’t want to sacrifice quality.” “We have to focus on hiring the ‘best.’” “We are so focused on diversity that white males have no chance” “There are no women or minorities in our field.” “There are few available, they are in high demand – we can’t compete.” “Minority candidates would not want to come to our campus.” Common Arguments and Comments http://www.bu.edu/apfd/recruitment/fsm/

23. November 18, 1993

24. U.S. Foreign Born Population / Top Ten Data from 2000 U.S. Census and 2004 Yearbook of Immigrant Statistics (projected for 2010) Total: 33 million

25. December, 2008

26. Direct Services (Interpreters, Linguistic Competency in Health Education Materials) Cultural Homophilly (Using Staff of Similar Background, Understanding Folk Remedies and Traditional Healers) Institutional Accommodation (Clinic Location, Hours of Operation, Cultural Competency and Training) Institutional Resources PATIENT Ethnicity Gender Age Social Class Literacy Health Status PHYSICIAN Ethnicity Gender Age Social Class PATIENT – PROVIDER COMMUNICATION Expectations Bias Stereotypes Expectations Bias Stereotypes Patient evaluations and judgments / Physician cognitions and decision-making Outcomes, Satisfaction, Adherence, Functional Status, Quality of Life The Effect of Race and Ethnicity on Patient-Physician Communication (adapted from Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. 2004 PATIENT -PROVIDER COMMUNICATION PATIENT – PROVIDER COMMUNICATION PATIENT – PROVIDER COMMUNICATION PATIENT – PROVIDER COMMUNICATION

27. What Caught My Attention? Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia Todd K H et al. JAMA 1993;269(12):1537-1539 “Hispanics with isolated long bone fractures are twice as likely as non-Hispanic whites to receive no pain medication in the UCLA Emergency Medicine Center.” The Effect of Ethnicity on Physician Estimates of Pain Severity in Patients with Isolated Extremity Trauma Todd K H et al. JAMA 1994;271(12):925-928 “Physician ability to assess pain severity does not differ for Hispanic and non-Hispanic white patients.”

28. The Language Barrier and PCA Whites received significantly more analgesics than Hispanics after limb fractures. Blacks also received less analgesia than did whites. Language was not the reason. The self-administered narcotics (PCA), including self- administered and self-administered plus infusion, were not significantly different across the ethnic groups. Bernardo Ng et al: The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain 66 (1996)9-12

29. Am J Anesthesiology 1999;26(9):429-432

30. Obstetrical Analgesia

31. Anesthesiology and Disparity

32. Relevant Today? Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments Pletcher et al. JAMA. 2008;299(1):70-78.

33. Percentage of Emergency Department Pain-Related Visits at Which an Opioid Was Prescribed, White vs. Non-White Adapted from: Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments Pletcher et al. JAMA 2008;299:70-78. %

34. Reason and Countermeasures Physicians & nurses underestimate & undertreat pain Different verbal & physical expression of pain Lack of understanding of different ethnic groups Anecdotal information Stereotypes Portrayal of various ethnic groups by the media Patients react differently based on physician’s ethnicity Subtle prejudice Pain Intensity Scales PCA Cultural Competency Evidence-Based Medicine Avoid oversimplification Beware of Hollywood Situational Awareness Self Awareness COUNTERMEASURES

35. Recommended Reading National Academies Press 2003

36. Disparities in Health & Health Care: Definitions – Disparities in health – differences between two or more population groups in health outcomes and in the prevalence, incidence, or burden of disease, disability, injury, or death. – Disparities in health care – differences between two or more population groups in health care access, coverage, and quality of care, including differences in preventive, diagnostic, and treatment services.

37. Other Examples of Disparities Among Some Minorities Higher rates of death from cancer. Less screening and treatment for cardiac risk factors. Less childhood immunizations. Less immunizations for influenza Higher incidence of AIDS in Black and Latino children Less preventative care individuals with disabilities Poorer health in rural residents Source: US Department of Health and Human Services

38. A Recipe for Medical Schools to Produce Primary Care Physicians N Engl J Med 2011; 364:496-497February 10, 2011 Leveling the Field — Ensuring Equity through National Health Care Reform N Engl J Med 2009; 361:2401-2403December 17, 2009 Payment Reform and the Mission of Academic Medical Centers N Engl J Med 2010; 363:1784-1786November 4, 2010 Eliminating Healthcare Disparities in America: Beyond the IOM Report N Engl J Med 358:1081, March 6, 2008 Assessing Race, Ethnicity, and Gender in Health N Engl J Med 356:1279, March 22, 2007 Dissecting Racial and Ethnic Differences N Engl J Med 354:408, January 26, 2006 Editorial Racial Trends in the Use of Major Procedures among the Elderly N Engl J Med 353:683, August 18, 2005 Health Care in America — Still Too Separate, Not Yet Equal N Engl J Med 351:603, August 5, 2004 Racial Disparities — The Need for Research and Action N Engl J Med 349:1379, October 2, 2003 Racial Disparities in Clinical Trials N Engl J Med 346:1400, May 2, 2002 Relevant Today? Keyword “Disparity”

39. Less education -- more likely to have report poor communication with their physicians. More problems with some aspects of the patient-provider relationships. Lower income patients report more difficult patient-provider relationships. Less access to health care information, including information on prescription drugs. Examples of Reasons for Disparities (in many racial and ethnic groups, the poor, and less educated patients) Source: US Department of Health and Human Services

40. Disparities in Health & Health Care Interrelated Factors

41. Cross Cultural Education: A Requirement

42. Diversity: challenges assumptions broadens perspectives enhances socialization triggers intellectual and cognitive gains improves treatment of individuals from different backgrounds Minority physicians are more likely to treat minority patients, and more likely to practice in underserved communities. Diversity in the health professions workforce is key to eliminating health care disparities. The U.S. is still producing too few racial and ethnic minority physicians to assure quality health care for all. Diversity: challenges assumptions broadens perspectives enhances socialization triggers intellectual and cognitive gains improves treatment of individuals from different backgrounds Minority physicians are more likely to treat minority patients, and more likely to practice in underserved communities. Diversity in the health professions workforce is key to eliminating health care disparities. The U.S. is still producing too few racial and ethnic minority physicians to assure quality health care for all. “Diversity is Essential for Promoting Excellence in Education and Health Care”

43. LCME FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree (Standard IS 16) “An institution that offers a medical education program must have policies and practices to achieve appropriate diversity among its students, faculty, staff, and other members of its academic community, and must engage in ongoing, systematic, and focused efforts to attract and retain students, faculty, staff, and others from demographically diverse backgrounds.”

44. LCME Teach basic principles of culturally competent health care. Recognize health care disparities and develop of solutions to such burdens. Meet the health care needs of medically underserved populations. Development of core professional attributes (e.g., altruism, social accountability) needed to provide effective care in a multi- dimensionally diverse society.

45. How Does Diversity Influence Education? Students’ assumptions are challenged Perspectives are broadened Greater socialization across racial and ethnic groups Demonstrated intellectual and cognitive benefits Improved ability to treat all patients More likely to treat racial and ethnic minorities Health Resources and Services Administration, Bureau of Health Professions. The Rationale for Diversity in the Health Professions: A Review of the Evidence. Rockville, MD: U.S. Dept. of Health and Human Services; 2006.

46. Joint Commission Published in 2008: Meeting the HealthCare Needs of Diverse Populations Published in 2010: Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals Will evaluate compliance with the Patient-Centered Communication standards: beginning January 1, 2011

47. Cultural competence requires organizations and their personnel to do the following: value diversity assess themselves manage the dynamics of difference acquire and institutionalize cultural knowledge adapt to diversity and the cultural contexts of individuals and communities served Joint Commission

48. http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf 2008

49. http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf 2010

50. National Center on Minority Health and Health Disparities NIH Institute created by the passage of the Minority Health and Health Disparities Research and Education Act of 2000 NIH has made health disparities a priority Enhance minority health disparities research Increase underrepresented minority students and students from health disparity groups with an interest in careers in biomedical research.

51. Need to Expand Data The data on diversity in health care and outcomes are limited. Most of the data focuses on race and ethnicity. Data needed on other aspects of diversity.

52. Grants.gov - central storehouse for information on over 1,000 grant programs and provides access to approximately $500 billion in annual awards. Funding Opportunities

53. Toward a Deeper Understanding of the Diversity Rationale Michele S. Moses and Mitchell J. Chang Educational Researcher, Vol. 35, No. 1, pp. 6–11, Jan 2006 How did “diversity” come to occupy a key position in education policy? Is there a philosophical orientation that informs applying diversity to education? What is gained and lost by focusing on the diversity rationale?

54. Diversity? Increases affective conflict - interpersonal issues/clashes Increases anger, fear, distrust, frustration Problems greater with race and gender, than with age Increases turnover Less likely to communicate than less diverse groups Tendency to drive out diversity Lower levels of member satisfaction than more homogeneous Organizations that value diversity must develop mechanisms to counteract this

56. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard Statement on Inclusion “At Walmart, we are committed to unlocking the full potential of our global workforce by giving every associate the opportunity to learn, grow and advance.” Top 10 Fortune 500 Corporations (2010)

57. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “Diversity and inclusion are key competitive strengths – critical to maintaining our position as the world’s leading energy and petrochemical company.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

58. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “We value and demonstrate respect for the uniqueness of individuals and the varied perspectives and talents they provide. We have an inclusive work environment and actively embrace a diversity of people, ideas, talents and experiences.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

59. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “When companies recruit and retain individuals with diverse backgrounds, it drives innovation in their processes, products and solutions. Diversity brings innovative approaches to a company, while positively influencing the way the company makes decisions.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

60. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “Above all, we are about people. A philosophy of inclusion drives our organization every day and helps us win in a diverse, global marketplace” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

61. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “We strive to represent and reflect the global communities in which we live and work. To deliver superior performance, we create an environment of inclusion that respects the contributions and differences of every individual. Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

62. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “A diverse workforce and inclusive culture are essential to AT&T. They allow us to attract and retain the best and the brightest to develop the most innovative products and solutions to meet our customers' needs.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

63. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard "What is the business case for diversity?" Successful companies are ones that satisfy their customer's wants, needs and desires. The only way to satisfy diverse customers is to include their perspectives inside the company.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

64. Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard “Diversity is a cornerstone of our global corporate culture. Nothing is more vital to the long-term growth of JPMorgan Chase than our ability to attract and retain talented and dedicated employees.” Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

65. “Putting all our differences to work across the world is a continuous journey fueled by personal leadership from everyone in our company. Our aspiration is that the behaviors and actions that support diversity and inclusion will come from the conviction of every HP employee - making diversity and inclusion a conscious part of how we run our business throughout the world.” Wal-Mart Stores Exxon Mobil Chevron General Electric Bank of America Corp. ConocoPhillips AT&T Ford Motor J.P. Morgan Chase Hewlett-Packard Statement on Inclusion Top 10 Fortune 500 Corporations (2010)

67. A partnership between BUSM and 14 undergraduate colleges emphasizing early admissions and curriculum coordination The Early Medical School Selection Program (EMSSP) Boston University Clark/Atlanta University Morehouse College Spelman College Hampton University The University of the Virgin Islands North Carolina Central University Morgan State University Dillard University Tougaloo College and Virginia Union University Pembroke State University in North Carolina University of the Incarnate Word in Texas University of Texas at El Paso. Historically Black Hispanic American Indian

69. The Academies’ March Toward Mediocrity By BRUCE FLEMING Published: May 20, 2010 “Another program that is placing strain on the academies is an unofficial affirmative-action preference in admissions. While we can debate the merits of universities making diversity a priority in deciding which students to admit, how can one defend the use of race as a factor at taxpayer- financed academies — especially those whose purpose is to defend the Constitution?”

70. Diversity Goals in our Medical Campus Specify timelines. Recruit minority faculty and residents for the various disciplines. Educate students, faculty and staff the benefits of diversity. Seek out outstanding minorities and provide opportunities for success. Recognize outstanding minority graduates of BUSM and invite them back to campus. Refine existing efforts to attract more minorities into the various schools and residencies. Strengthen networking among the existing minority students, residents, and faculty. Enhance and monitor mentoring opportunities in each department. Encourage the participation of existing minority staff in recruiting other diverse individuals. Prioritize leadership development for the next generation of diversity proponents. Dispel the notion that diversity is primarily concerned with recruiting minority physicians.

72. Diversity Faculty Database To include “Diversity” faculty To include faculty with “Diversity-related” interests Voluntary Digital Social Network