Brought to you by the Senate Progress Committee, “Progress Notes” are student-driven, topic-specific, newsletters that bring together voices from within our community and integrates them with available data to provide a holistic view of what strides we have made and continue to make in the pursuit of excellence at Alpert Medical School. This issue of Progress Notes will cover: Diversity @ AMS.
How is diversity defined in Medical Education?
The American Association of Medical Colleges (AAMC) has a longstanding commitment to diversity in order to address persistent health disparities in the United States (1). Across the country, medical schools focus recruitment efforts on groups underrepresented in medicine (URM), meaning “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” (2). URM designation has historically included, and continues to include: Blacks, Latinx or Hispanic-Americans and Native Americans (that is, American Indians, Alaska Natives, and Native Hawaiians).
How are we working towards diversity at AMS?
Here at AMS, the commitment to diversity closely mirrors that of the AAMC with some key Brown-specific goals and strategies best outlined in the Diversity and Inclusion Action Plan (3). If you haven’t yet read this 33-page document, it contains a wealth of information organized into six important domains and the creation of The Brown Council for Diversity in Medicine. The domains are: People, Academic Excellence, Curriculum, Community, Knowledge, and Accountability.
This year’s ODMA fellow, Radhika Rajan MD’20, shared some words with us on the creation of the DIAP:
During my years at AMS, I have seen the commitment to diversity and inclusion efforts change drastically – and I attribute much of this change to student-driven efforts. I started at Alpert in the Fall of 2015, after 4 years as a Brown undergrad. This was the same academic year in which President Christina Paxson released the original Diversity and Inclusion Action Plan for the University, a response to years of prior student-led organizing efforts. In this original DIAP (a massive document), the medical school was mentioned maybe 2-4 times total. We as medical students saw this as a glaring oversight… So, in response, a group of us put together our own DIAP for the medical school. This [led to the creation of] an official DIAP committee, that created the final document. The goals put forth in the document has in large part guided the work that the ODMA has done in the past few years.
The medical school committee that put together the DIAP included broad representation from administration, faculty, staff, residents, alumni and students. Initiatives that were either born or strengthened with the creation and implementation of the DIAP have brought us a long way. Some highlights by domain area:
- Brown Council for Diversity in Medicine: This group of faculty, staff, residents, alumni, students, administrators, and hospital system representatives meets quarterly to dissect the data and work towards department-specific, as well as AMS-wide, diversity and inclusion goals.
- People: More active recruitment of minority students, including efforts to visit Historically Black Colleges and Universities (HBCUs), Diversity Visiting Student Scholarships are now available in five specialites, the TEAM tutoring program, ODMA open conversations, URM alumni dinners, mixers with URM faculty and residents, the Brown Advocates for Social Change and Equity (BASCE) Fellowship program, the new ODMA Faculty Association, the Summer Research Early Identification Program for aspiring biomed PhD’s, and changes to faculty development including the diversity and inclusive teaching additions to the core areas for the Program in Educational Faculty Development (PEFD).
- Academic Excellence: The new Dean’s Diversity Award provides funding to residents and junior faculty for research and programming on diversity and inclusion.
- Curriculum: The Race in Medicine task force has transformed into the Committee on Diversity and Inclusive Teaching, which meets regularly to think strategically about how our curriculum can be improved. This effort, among others, has resulted in written and video guides to inclusive teaching, and has been backed by strong commitments from Administration, the Office of Diversity and Multicultural Affairs, the Office of Medical Education, and the Office of Student Affairs.
- Community: Development of community engagement protocols for student groups leading to increases in events and doctoring panels with community members, not just physicians.
- Knowledge: Spearheaded by the ODMA, data is being collected on URM medical student and resident recruitment, lik exit surveys of med students to assess beliefs around staying at Brown for residency, as well as an ODMA-BMHA residency survey to assess candidates to Brown-affiliated residency programs.
What is our progress with efforts to improve diversity at AMS?
The following graphs and charts help provide a better understanding of the effects of our efforts in the areas of diversity and inclusion within the medical student population, the residency programs and our faculty. Where possible, we also compare our data to nationally available data as reported by the AAMC, which tracks all U.S. medical schools.
Medical Students: The following chart shows the medical student population by race and ethnicity for years 2013-2017. Here, URM groups are described as Historically Underrepresented Groups (HUGs).
*From the 2018 DIAP Annual Report; AAMC’s fact sheet on Total Medical School Enrollment by Race/Ethnicity and Sex (2014-2018).
*From AMS Admissions. Some students may have identified in multiple categories.
*From the Alpert Medical School Diversity and Inclusion Action Plan ; AAMC’s Total U.S. Medical Graduates by Race/Ethnicity and Sex, 2013-2018.
Housestaff (interns, residents and fellows in Brown programs): The percentage of URM interns, residents and fellows has increased in the last four years from 6.2% – 9.5%. It is not uncommon for housestaff to choose to practice and/or pursue careers in academic medicine in the same state or city as where they trained. Thus efforts to improve diversity at AMS, also involve strategies to attract and retain housestaff.
Faculty/Staff: Faculty and Staff recruitment continues to be a challenge for AMS given our indirect hiring relationships with the hospitals and residency programs. This is a major area of focus for the Brown Council for Diversity in Medicine. Thanks to a combination of efforts, in the last four years the percentage of URM faculty has increased from 4.4% – 5.3%. Nationally, 9.2% of faculty in U.S. Medical Schools are URM (4).
Where can we go from here?
Alpert Medical School’s Diversity and Inclusion Action Plan has led to a recharged commitment to diversity that spans not just the people in our community, but every aspect of our medical education. As a medical school, we are fortunate to be at the forefront on the national stage with initiatives such as the Brown Advocates for Social Change and Equity (BASCE) fellowship. Additionally, we applaud the efforts of the BMHA and the ODMA Faculty Association to create a stronger URM housestaff and faculty community at Brown, the efforts of the Brown Council for Diversity in Medicine to spread diversity and inclusion goals beyond 222 Richmond Street by requiring all clinical departments to create their own departmental DIAP’s structured around our same six priority areas, as well as efforts by the ODMA and Admissions that have led to increases in the percentage of Black students in incoming classes. Recent events at AMS, however, highlight the fact that diversity does not always equate to inclusion, and more can always be done to improve the quality of our learning environment and its ability to respond to change.
As students, our vision for diversity and inclusion efforts is similar to that of the AAMC and the DIAP- to graduate medical students prepared to address persistent health disparities in the United States. In order to do that we believe that we need URM faculty and staff recruitment; a more robust emphasis on race and class in medicine within the clinical curriculum; continued integration of diversity and inclusion curricula into regular preclinical lectures; explicit attention to disabilities in medicine, indigenous health, immigration and health; URM alumni engagement; and continued discussions on bias in medicine. In short, we have made progress and are ahead of many of our peers nationally, which is something to be proud of. With steady focus and time, we may begin to see more of the fruits of our labor in the data and in the daily experiences of both our patients and members of the AMS community.
We encourage you to continue the conversation with your classmates, your instructors, your clinical teams and with us by leaving a comment in the comment boxes. We appreciate constructive feedback as well as ideas for new topics for future editions of “Progress Notes”.
References:
- AAMC: Diversity and Inclusion
- AAMC: Underrepresented in Medicine Definition.
- Brown Alpert Medical School Diversity and Inclusion Action Plan
- AAMC: U.S. Medical School Faculty, 2017
Progress Notes are brought to you by the Senate Progress Committee. Special Thank You to Dean Tunkel, Dean Diaz, Dean White, Dean George, and Dr. Green for their assistance on this issue.