2024 TEACH Education Day

Thank you Dr Whicker now you know I didn't wear my teach green what you demonstrated today but there's a little green in the tie so I app go get away with that well um gosh good afternoon everyone and thanks for joining us for teach education day and for this keynote presentation um the third Richard C very PhD endowed lecture at the Virginia Tech real School of Medicine welcome to those here in person enjoying some lunch and those who are zooming in as well uh the lectur ship was established in on October 29th 2021 at that time when the toll of Al uh had made it too difficult for Dr VAR to continue in his work we celebrated his career in this Auditorium with tributes from his colleagues and students and friends and we were delighted that he and his family were here to hear that and experienced that at the close of that event we announced that in honor of his retirement after joining the Virginia Tech Krillin school of medicine on April 1st 2008 as founding associate in for medical education and in appreciation of his commitment dedication and Service as senior Dean for academic Affairs and architect of our Innovative curriculum that we we were delighted to announce the creation of the Richard C PhD andow lectureship I want to thank many of you are who are here and others for helping us to achieve that endowment goal so that we can continue this lectureship at perpetuity Eric passed away the following June after we announced this uh program leaving a sense of loss for all of us who knew and loved him um today we're just very pleased that has as has been our tradition over the last years that Rick's wife is here their daughter and son-in-law Liz and Brock mches are here granddaughters Sylvia and Ryan mches so hi everyone nice to see you here yes Applause if abolutely I to me being in this space together helps me remember other times here and U brings back warm memories of Rick's Life and Legacy choosing the very lecture is no easy task I want thank the planning committee for their hard work creating and annually updating a list of potential speakers who are illuminaries and rising stars in medical education in the US and internationally and we are delighted that our Top Choice for 2024 Dr quent yans accepted our invitation Dr yans is assistant professor of medicine at Northwestern University fineberg School of Medicine and an advanced heart failure and Transplant cardiologist uh with the bloom or Blum bloom bloom the bloom uh Cardiovascular Institute of Northwestern Medicine he serves also as the Director of pathway programs and student support within the office of diversity and inclusion at fineberg and is the medical director of Community Affairs at Northwestern Medicine it's a lot for a young faculty member to be doing he must really care about these things of course he does Dr humans has a passion for mentorship building inclusive environments in academic medicine engaging the community in all aspects of Health his work highlights racial disparities and bias in medical education and has been published in the New England Journal of Medicine jamama Internal Medicine Archives of internal medicine and other journals his clinical interests are in heart uh sorry are in Health Equity and heart failure and cardiovascular disease his research uh centers on the social determinance of health and heart failure and Community engaged research for heart failure prevention and treatment optimization so fueling Dr y's work in these varied roles is a passion for science for humanism and for fostering a sense of inclusion and belonging in patients communities and the learning environment these are values that Dr VAR championed every day one person at a time with a big smile on his face so please join me in welcoming Dr quent newans to the podium well thank you so much Dr liman thank you to Virginia Tech and thank you so much to the very family for this really warm and welcoming invitation to come speak with you all today it is my pleasure to be here as mentioned I'm an advanced heart failure and Transplant cardiologist but I have a real passion for medical education and specifically how we can move from diversity to inclusion and belonging um I want to share with you that I'm going to provide some real world examples things that I've been through um and for the trainees who might be here things that I was able to implement even as a trainee to hopefully Empower you to consider what are the things in your environment that you might want to change and how can you take small steps to change those things in a learning environment um I first want to honor Dr VAR and his family um and what I learned we had a really wonderful faculty dinner last night and I asked for some tidbits about Dr VAR and what I learned is that every Friday he would take his team um and to basically a social outing to learn more about who they were not just in the clinical setting or in the education setting but really who they were as people and I think that really embodies the leadership that Dr very brought to this institution and for that I am grateful um this quote was really inspired inspired me and I think connected to Dr very the art of teaching is the art of assisting Discovery and that's really what he brought here as the dean and what I hope to at least impart a little bit um in my talk today regarding Discovery and so as was mentioned you know I don't have any relevant Financial disclosures but what I would like to disclose is the passion that I have for several of these different topics and so as was mentioned you know I'm the director of pathway programming and student support and in that role I lead a couple of pathway programs that try to help bring students who might be high school students or college students into the immersion of medicine so that they can recognize and really see themselves in the Medical Specialties whether that's in uh physician um pharmacist nursing physicians assistant really anything we want them to get into science and really develop a love for science I'm also the medical director of Community Affairs because I feel that with this work related to Health Equity you really have to include the community in as much as you can and if you don't do that if you don't start with that step you're really a step behind in terms of making progress with the community and then finally in this last year I've joined as core faculty specifically for Recruitment and as we think about diversifying the workforce it obviously starts with Recruitment and what the efforts that we should take in order to create a diverse class whether that's in the different Allied healthc Care Professionals within our system so I want to start with a story if you can believe it that's me right there all the way to the left um I had a few grayer hairs at that time few fewer fewer gray hairs um but this is my first year of medical school and I had a couple of friends um so those two friends there Mike and um and Manuel we were the actually the only two black men in our class um of 180 in medical school so coming into an environment where you're already kind of othered and very few of you that creates and builds on um a difficult situation when you recognize that we all are here to learn medicine the best we can and I want to tell you a brief story about when I was an internal medicine uh uh student a third-year medical student so we're rounding we're rotating I had a co- student with me who was very lovely very nice she was a a white woman student who was part of the same sorority actually as my senior resident and they had a great relationship so they would come together um they would laugh at the same jokes um they were they were friends they developed a friendship and when I you know obviously during 30 year was trying the best I could to be successful and to be a great student and so I asked my senior resident um some for some feedback about halfway through the rotation I asked how was I doing you know how did she think I what could I improve on how did she think things were going and her response was well Lucy's really smart so so I'm asking about my performance and how I'm doing and her response was to mention my co-student and how smart she was if Lucy was smart what did that mean about me you know if she's doing well by contrast how am I doing and so I want us to kind of frame that in terms of the environment that we create for our Learners and how we can potentially do better moving forward to create a really inclusive and belonging environment so here are learning objectives for today we're going to discuss some of the tools that are available for recruitment of underrepresented minority Learners in 2024 we'll illustrate ways that bias can affect the clinical learning environment and move towards diversity and inclusion and again you know I titled this talk a toolkit so I'm hopeful that each of us will take away some really easy lwh hanging fruit things that we can do to improve the clinical learning environment for our Learners and then finally we'll define the role of mentorship in supporting Learners from underrepresented backgrounds over the span of their training Journeys it's something I'm really passionate about and I'm hopeful to really impart to you as well I think it's always important for us to start with the why so what's the case for diversity why should we have a diverse physician Workforce well I think one of the primary things is when we think about the patients who we care for the disparities un unfortunately persist in a number of different Specialties within medicine I in cardiovascular disease we know that hypertension or high blood pressure has run rampant in certain communities we know that my field of specialty heart failure unfortunately has a lot of disparities in terms of how how many patients have heart failure and the outcomes related to heart failure and we know that if we diversify the work force those clinicians who ultimately end up caring for patients will may end up caring for more patients from diverse backgrounds for example there's a study that found that non-white Physicians cared for 53.5% of minority in 70.4% of non-english-speaking patients we we know that patients from underserved groups were significantly more likely to see non-white Physicians than white Physicians and init additionally there's a moral obligation to write the wrongs of the past related to racial discrimination so these are all reasons why we should at least consider that diversity really is really important but if we move from diversity how do we create an inclusive environment so we'll start also with some definitions so what does the aamc Define as underrepresented in medicine so underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to the numbers in the general population I argue very much so that we should really try to increase the numbers of those who are underrepresented so that we can care for the patients who really need it those patients who unfortunately deal with disparities whether is in Cancer Care in cardiovascular care in rheumatologic care and otherwise so I love this data from the a AMC because it really does show us okay how are we doing in terms of our diversification of the workforce so if we look here um we can see from 2016 this is data from 2016 to 2023 and it shows a breakdown in terms of the applicants to um to medical school and their racial breakdown so as we can see comparing 2022 to 2023 or let's start from 2016 if we look at black and African-American around 5,000 applicants applied and really the numbers have stayed relatively stagnant 2021 was an interesting year you think about maybe potentially thereis an effect related to the um the pandemic um and then 2022 we're around 6,000 and then there's been a kind of minus 4. three decrease from 2022 to 2023 if we think about um Hispanic or Latin X again numbers are around 5,000 and they increased in 2021 but then have kind of come down to to 6,000 and then comparing that to our white applicants um we see that the numbers have been around 30,000 27,000 and then to 26,000 again there's a decrease from 2022 to 2023 so those are applicants when we look specifically at matric mul we see for specifically for black matriculant into medical school um there was about 1,700 here and that also has sort of stayed relatively stagnant although has increased by a couple of hundred to 2300 in 2023 and we compare that to for example Hispanic 2900 and for black and 11 11,000 so these numbers have stayed relatively stagnant over the last several years um the the worrisome thing is what's going to happen after the Supreme Court decision last year and so I went to Brown University for undergrad as as was mentioned and there's a really striking um uh set of circumstances that have just occurred in the last few months there was a 40% drop in the black freshman class at my alma mater at my institution directly related to the Supreme Court decision about how can we choose our our classes in terms of the the uh the proportion of classes and the proportion of students who come to our classes it's very interesting because we don't yet know what impact this will have on matriculation into the Health Sciences but we know that there's likely going to be an impact so what can we do about it how can we change how can we adapt to what now may be a mandate related to the government and how we diversify our Workforce and I think the way that we respond is is that we must and we need to transition to a holistic review process think about you know our institution here think about Virginia Tech think about kilan school of medicine what are the things that make an amazing physician or clinician at Virginia Tech what are the things that what are the aspects and components what are the themes that you want for a good doctor a good pharmacist a good nurse and how do we ultimately choose a class that is in line with those themes holistic review is actually the best way for us to do that so how does AMC Define holistic review it's a flexible mission-driven approach to recruit and assess an individual's competencies by considering their experiences attributes and metrics in order to select applicants who will best contribute to the program's unique goals learning environment and the practice of medicine the core principles of holistic review we'll talk about that are outlined that's the that's the ultimate way for us to decide how are we going to who's going to be the future how are we going to make up a class that is diverse in every way again that is in line with the themes that's important to the school of medicine here there was a big change that we all know about in 2020 that makes holistic review really one of the most important things we can do and that was the shift in our step one scoring in medicine to P fail why was this shift important particularly when we think about diversifying the workforce who does well on standardized test scores right that's the big question it's those students who have had access to the Preparatory coursework that's necessary it's those students who from day one were able to learn how to take the test and learn how to do well on the test and one of the things we know is that there's not a big connection between the scoring on step one and how good of a physician a doctor ends up being there's no connection there but unfortunately for many years we used step one and we use the score on step one to determine what specialty a person could go into that doesn't make any sense right a a test that was not designed to do that was used to understand whether a student might be able to go into Dermatology or Orthopedics versus family medicine or internal medicine and now one of the things that we argue in this perspective piece is now that this is past fail it opens up a world of opportunity and as we know with every opportunity there comes challenges but a world of opport for us to steer clear and get away from just test scores to how can we really assess our students as they're applying and I think holistic review really does that this is some interesting data from the AMC and it looks like the impact of holistic review in terms of the makeup and the diversity of classes and what you can see is schools that use many holistic review elements it actually increased their diversity 81% of those schools increase their diversity 16% were unchanged and 4% decrease and down at the bottom there total schools using holistic review 72% of those schools saw an increase of diversity so this this study shows that holistic review can successfully help with diversifying the workforce and I think that's great for us to consider but I want to you I want to show you what we do specifically at Northwestern so I as I mentioned I'm one of the core faculty in our internal medicine program and um so how do we actually do this in terms of um logistically deciding on how we can choose our our candidates so we have an actually five different domains that we assess one being clinical competencies and that's the thing is the foundation really has to be clinical competence right we're not trying to choose folks who are not going to come and succeed in medicine but we want people to have the underlying foundational clinical competency but what are the other things that we assess exceptional experience in community service so choosing candidates who have been involved with and engaged with the community recognizing that brings a huge amount of value to the practice of medicine leadership potential in research and again that's potential right so these are students who have Adam Grant has this great book called uh hidden potential so you want to identify those students who maybe because of their background haven't yet achieved but they have the potential to have huge impact in leader uh in research uh leadership potential in medical education who are going to be the future future medical Educators who are going to give this talk this this very lectureship um for our our students in the future and for our institution and then lastly and importantly resilience factors what are those factors and those barriers that they've gone through and they've been able to overcome to get to where they are that shows grit that shows that if they are are approached with or have to tackle a really difficult scenario or situation they're going to be able to get over that because of the resilience factors that they have had and so we score these out um we have a huge group of 20 uh faculty members that actually review all of our candidates and so it is a it is a heavy lift because you have to go through and you're not just relying on scores you can't really just decide based on a level of score that you're not going to include but you're really G to really review every applicant and learn who they are and what they will bring to your institution and it helps you decide who will you interview you're going to learn more about them as you interview them and really see how can they contribute to the the environment that is at your institution so I really uh focus on holistic review in terms of how we diversify the workforce but I want to Circle back here because you know the experience that I had with Lucy I don't think it is um unfortunately an experience that many of us may face in uh in the learning environment so we should really name what were some of of the things that I felt and experience as in in that environment there you could consider that a microaggression right something very small that kind of cuts at you and if it happens once it's not too bad but if it happens multiple times it does great at you it contributed to impostor syndrome particularly because I was being compared to my classmate and it's just these feelings of do I really belong or am I an impostor here can I gain confidence here can I succeed here there a stereotype threat recognizing that was probably a stereotype that was aligned with who I am and my identity that might have contributed to how she was treating me there's homop and and that's an aspect of you know do you feel connected to the people do you feel like you're aligned with the people who are in your training environment there's this concept of tokenism as well you know being one of the only black residents in the institution am I only there because of that or am I there because I add something to the institution I add value and then obviously there's this whole concept of implicit bias which thankfully after uh in the last four years we've been exploring increasingly and recognizing but I think all of these play a role in the impact that it has on trainees who are underrepresented in medicine and we should be able to not just recognize it but also name it and recognize the impact that it can have so what is implicit bias it's an unconscious preference for a specific social group that can have adverse consequences and one of the things we have to recognize is that we all have them right it's something that we all have and we shouldn't really place a value judgment on whether it's bad or good because oftentimes we use our implicit biases to protect ourselves as well but the first step is for us to recognize that we have them so that we can see when implicit bias might be playing a role in our assessment of Learners um and so that happens both in recruitment but then also in our assessment of the performance of Learners and so the first EP to recognize that we have our implicit biases and then the next step is once we recognize that we have them we have to understand how we can mitigate implicit bias so this is one of the things I want us to take away in terms of our toolkit so what are the tools that we can use what are the ways that we can do to actually minimize the implicit bias that we might bring to our Learners one is reflection so think about even just in the last week I'll I'll invite you to think what were some moments where maybe in your gut you might have felt where an interaction didn't go well or whether there was a a body language that might have been off and just consider and reflect might there have been an opportunity where potentially implicit bias played a role in that interaction don't stereotype but individualize right oftentimes we might meet a meet a person and this is whether it's a patient or a learner and we immediately come to stereotypes but we have to really individual ual and consider what is this indiv what has this individual gone through and what are the things in their life that we might be able to uh latch on to so that we don't have bias against that person take the perspective so perspective take try to consider what are the life experiences that they've gone through and really empathize with those life experiences and that can minimize implicit bias and then lastly and this is really important because implicit bias happens when we're in our day-to-day and going through very quickly we have 15 minutes to see a patient we have five minutes potentially to uh to assess a learner but slow down because that's where implicit bias really plays a role it's that quick switch and we use that quick switch and that stereotyping to to assess people but we have if we slow down then we can take these other steps including reflection and make a difference now one of the things I wrote with actually a resident traine at our program you know this is now our recruitment season right so I'm sure here and in many places we're actually using the virtual recruitment process to assess people there's a lot of positives to that right trainees don't have to fly everywhere throughout the country um they can really access things very easily but it also is an area that can be ripe for bias so what are the things that we can take away and considering our recruitment processes specifically in the era of virtual recruitment these are some of the things that we recommend for our recruitment um uh teams to consider one we encourage implicit Association tests recognizing that again that recognition of the implicit bias that we might have can at least begin the work of Bringing Down the bias develop structured interviews with a standard rubric that way we are assessing every applicant who comes to the door in the same way with a standardized rubric very very important um utilizing many multiple interviews because we recognize if we have dispersion and the amount of folks that people meet then if there's one person who's bringing a certain level of bias then we have a little bit of experssion and dilution if you will of that impact on the assessment of that applicant blinding interviewers to applicants cognitive application data I think this is can be challenging but it's actually really important because that way that person has the opportunity to show you exactly who they are and to consider the really humanistic aspects of them outside of some of the cognitive data that you're still going to use at the end of the day when you're assessing p uh the folks who are applicants um but it's helpful to do that during the interview VI encouraging virtual meetups for underrepresented faculty staff and applicants again this comes to this point of how do you create an environment where folks feel comfortable and that is required and in order to do that it's required for you to make sure that they have opportunities to meet The Faculty to meet the staff to meet the students who are here so that they can understand exactly what environment they're joining and then and finally evaluate diversity representation at the end of the interview cycle to identify areas for for improvement I think number six is probably one of the most important things you don't want to start an initiative and just have it be that right you have to constantly be iterating and trying to improve and trying to work and that takes an assessment of the processes that you have in place and a really intentional change to make that happen so that's recruitment but I think um you know considering bar graphs and thinking about experiences are one thing but I wanted to share a very personal experience that I had in my learning environment because it had a really huge impact on my training so as a resident um I was taking care of a patient and I think if all of us who had patient care experiences we know that unfortunately there can be a spectrum in terms of um how folks are treated I had a patient who came in who was complaining of chest pain and demanding um ivv narcotics to help with his pain and the team had had issues with Trying to minimize the amount of narcotics but treat the pain and to do the effective workup that was necessary to determine did he really have an underlying cardiac cause to his pain um so I came on as a resident covering in the afternoon and the patient had had his anagram procedure in the morning and did not have was not found to have any cardiac cause so the andram was clean he had non-obstructive coronary artery disease so um he was ready for discharge so I went in with my intern I'm the senior resident have my long white coat on you know and um we said you know uh Mr Jay your your anagram was clean um you know you're ready for discharge and he said um I'm not going anywhere and so we had kind of a back and forth discuss ing why thankfully clinically he didn't have a reason to be in the hospital and things escalated rather quickly he started screaming and braining us and we ultimately I turned to my intern and I said um you know we should we should get out of here we should call security this is not an environment that's safe for us and he immediately turned to me and he said I'm not playing your games and um it's one of those experiences is that um as someone who is from South Carolina and um you know obviously a black person um I had never had that experience or that exposure and when you think about what impact that has on you and how much time you've spent trying to learn to take the best care of every patient and you're belittle to the point of just being a person of and of of a certain skin color it has a huge impact so I left the room and I talked to my attending Doctor Who was the cardiologist who's on service and um he didn't do much to be honest with you he said well you you shouldn't go back in there but we'll continue to take care of and and I'll handle it don't worry on the flip side I called my program director who is uh who is very caring great educator and he took me into his office and we did a huge debrief on that experience and that exposure he said first of all I'm sorry that happened and he said secondly we need to make sure that we have policies in place that where people can speak up and speak out if that happens one of the things I learned over the course of this experience is that this is unfortunately not uncommon and whether it's related to race whether it's related to ethnicity whether it's related to sexual orientation or identity Learners in the learning environment have things that happen to them that tear away at their confidence and at who they are because it's part of their identity it's something you can change and when you think about all of the expectations for our Learners in terms of learning to be a good doctor of pharmacist or nurse or um anything that's hard enough as it is but when you add in these macroaggressions it makes it really hard to be focused on how do you become a good doctor and so this was my experience many go through this experience so I want to empower us to consider how do we respond in these bias scenarios how do we really come to the aid of our Learners and how do we protect them in a way from these types of experiences um so what are some of the challenges you know we're all there to take care of patients right um so one of the things is balancing patient autonomy and ethical principles of justice and Mal feance we want to make sure that we're doing the best we can to care for patients because many patients obviously when they're in the hospital they're at their worst they're having their worst time but how do we balance taking care of the patient and then also caring for our Learners we all live in with this right in medicine first Do no harm um but then we also have to consider how can we first Do no harm to the patient but also protect our clinicians there's this big concern about building lasting patient clinician relationships and whether if we speak up and speak out will that hinder that therapeutic relationship that the team might have or that the individual might have um there's a there's a perceived lack of support from colleagues particularly if there's not a policy in place or at least a foundation of uh expectation for response and then there's risk of poor patient satisfaction scores you know we all are beholden right to the likelihood to recommend right and how does something like this affect a patient's experience within the the hospital system so I have a few recommendations and how to respond to this um the first and this was by uh Justin Bullock actually when he was a trainee um in ultimately in the uh when into their ology publishing academic medicine back in 2021 but I think this is a really helpful framework in terms of how do you approach um caring for your teams in the learning environment and the first is a pre-brief which I hadn't thought about but I think it's a really great idea so when you are initially exposed to your team and starting um starting rounds with the team considering a pre-brief with your learners in terms of how would you like if something happens in in microaggression happens what would you like to happen how would you like for this team to respond I think starting with that is important because one it recognizes and sets the foundation that this is something that you care about and this is something that we do in terms of protecting the team no matter what and then two they actually tell you so folks will tell you I would prefer that you step up or step out or speak out or they might say I would prefer to not do anything in the moment but to to talk about it later you kind of get that opportunity to hear from the Learners and to explore with the Learners and it sets that foundation and then it goes through multiple steps about recognizing the microaggression analyzing it considering their response and then ultimately checking in immediately afterwards I think the easiest model in terms of response though is this safer model step in When You observe behavior that does not align and this was published at Mayo Clinic but it it includes every institution does not align with your institutional values address the inappropriate behavior with the patient or visitor focus on M Clinic values such as respect and and and healing explain the expectations and set boundaries with patients and visitors and then report the incident to the supervisor and document very easy very direct and it's actually something similar as what we put into place in terms of a policy at our hospital after my uh after my incident unfortunately you know it's something that our Learners go through but I think it's so important for us to consider what are the policies that we can put in place after something or potentially even before something happened to make sure that we all feel empowered to stand up and stand out um for our for our Learners and that's again protecting what our Learners should go through um these are some of the other challenges that Learners who are underrepresented in medicine go through and this was published related to medical students and residents and fellows but I would argue that this is probably true for all of the Learners throughout the health system there's a lack of support potentially there's discrimination and harassment there can be lack of cultural representation lower satisfaction in the clinical learning environment we talked about episodes of microaggressions and bias pressures to be embassadors for their race and then trouble with professional and personal identity each of these are very defined but I think if we recognize that these are problems and these are issues that those our learning environment face then we can make targeted initiatives that can respond and address each of these and I'll give you an example um so as a Cardiology fellow you know I'm I'm a cardiologist as fellows again I think empowering our trainees to consider how they can even impact their environment is really important so a couple of colleagues and I wrote this how cardiovasular disease fellows can promote diversity and inclusion in cardiology and we're very specific about the strategies that we can use so the first is you know that UI uim trainees face barriers to success on teams so what can you do as a learner to try to help with that the first thing is lead diverse teams with intention review expectations from the beginning facilitate goal setting and minimize rivalry among trainees these are loow hanging things these are things that we can do from the outset to make sure that team our teams feel supported mistreatment during clinical care is common so so again that part of responding to bias and mistreatment making sure that we step in if we do see it um uim trainees La adequate mentors and sponsors this is a conversation that I've had over the course of the day today we should be mentoring and sponsoring aggressively for our our students and our trainees so connect diverse traines to mentors involve trainees in Mentor in research projects provide feedback to the medical school and The Residency leadership and then serve as a resource resource for our training I'm I'm on the editorial board for a journal of cardiac failure and one of the things that we do is we actually look at the author block for the the projects that are submitted to us to be published and we look for diversity within that author block I think it requires all of us across the health systems and across the even at the journal level to consider diversity and how can we really uh impact change in terms of our our mentorship and then lastly as we know as many uh Workforce uh work forces do there's a lack of of Cardiology Workforce diversity and so how can we Advocate to the leadership about being outspoken about diversity within the workforce these are again are lwh hanging for things that we can do today to really diversify and to create an inclusive environment and I want to finish up with something that I am very passionate about and have done here at has have done at Northwestern and that is support through mentorship because I think mentorship is the key to creating an inclusive environment so why is mentorship important mentorship in academic medicine AIDS in professional development career guidance specialty selection and research advancement you really can't get to be a cardiologist or an advanced heart failure cardiologist without the appropriate mentorship to get there participating in mentoring relationships associated with increased job satisfaction so there is something there obviously for the mentor as well and folks who are at academic centers and in academic medicine they recognize the power of the of mentorship for for themselves as well and then trainees in medicine identify mentors by more senior peers as having a positive impact on their well-being but how do we create really the infrastructure for mentorship and this is a saying actually that I coined as a as a resident that I think is so true you're never too old to need a mentor and for the trainees who might be listening you're also never too young to be one so consider that you can help no matter what stage you're in to be your mentor ship for those who are younger than you and to that end um I want to share with you our our mentorship program called strive which is the student to resident institutional vehicle for excellence so the foundation for strive is really grounded in this which is that there's so many silos that exist in the academic center the medical school is in one place the the residents and fellows are in another um the hospital is in one place the classroom is in another and so when do you really connect and how do you really connect the two and I would argue that peer mentorship specifically and that's near peer mentorship is the way to sort of bridge the gap and that's what we did with our program we connected residents and fellows with medical students in the name of mentorship and I think it's really important because our program it was specifically resident Le and training driven because I think that residents only residents know the trials tribulations that they go through and how best to share with their near peer partners because they've just gone through the medical education process they've just been medical students um so they know they're very much in tune to the challenges that are being faced by those who are underrepresented in medicine so this is our process map for strive um and this is how we sort of provide our mentorship program so we identify those residents and fellows who are underrepresented in medicine and that's by self-report um we invite participation and strive and for folks to actually be mentors in our program and then we identify those students who are also underrepresented in medicine through our office of diversity and inclusion and we connect them through various programming that occurs throughout the year we started this program in 2016 we had some hiccups as as you know as you might be aware of um during the pandemic we had the transition to complete virtual and now we're back to inperson and these are our pillars of programming so we review the curriculum for our students and that includes and it's really great because for example as a as a resident I was interested in cardiology and I wanted to take care of patients with heart disease and so during the cardiovascular module for example I would meet with the students and review the cardiovascular module with the students so that's where the curriculum review sessions come into play so residents who are in Psychiatry or in neurology really they they bring with them their expertise to the curriculum review session so they get a lot out of it because they learn how to teach and how to be mentors and the students get a lot out of it because they're actually able to learn and review what's going to be on their testing so it ends up being great uh panel discussions M M2 is going into M3 there's a lot of we were discussing this earlier there's a there's a hidden curriculum about what's expected when you get to M3 year in terms of medical education and how you should comport yourself how you should behave on on rounds and so we have our residents who were just medical students teach our students what's expected of their performance in terms of whether you're medicine or in the O in surgery and it really is a powerful connection that they can make and then finally and I think importantly social events so getting to know team members outside of the medical environment what's important to them what drives them what's their family life like you really cannot put a price on how important that is in terms of building an environment where you really drive towards inclusion and belonging that part is key um these are some more details in terms of exactly what we did with our panel discussions and with our social events um this is published in jgme so if you're at all interested in learning more about how we were able to effectively create this I think it's important but if you think about this is one example right but if we think about our pipeline programming considering medical students to undergraduate students residents and fellows to medical students even Junior faculty to Residents and fellows this is something that we can do across our system to make sure that folks feel supported and that they know they can be successful and again it comes down to learning what drives people and we learning what impact they would like to have and supporting them to get there um one of the things we thought was very important was to make sure that we have a lot of University in terms of the sub Specialties and so we had great representation in our strive program and um just like anything else as I mentioned you don't want to just start something and let it flourish but you really want to study it to make sure that you're having the impact that you want to have so we did a a small survey study on the resident mentors about attitudes and as you can see many agreed or strongly agreed that St that strive made them a better mentor it helped them deal with the challenges of underrepresentation in medicine um that they benefited professionally um uh from participating and strive and whether they would recommend this for medical trainees who are underrepresented in medicine so we were very pleased to see that the residents um actually got a lot out of as well the mentorship model that we created but I think it's so important also to cons to hear the voice of the trainees um the voices of their residents directly so one said strive as an outlet to discuss the unspoken rules and experiences of being minority in medicine again this whole concept of a hidden curriculum if you've never been exposed to it you just don't know what to expect and so having folks who can share with you what that expectation is like is really hugely important I have enjoyed getting to know the medical students and strive they were excited to learn very engaged ask great questions there were many challenges I had to navigate on my own as a medical student I simply didn't know how some things worked and I didn't know who to act ask isolation right I didn't even know who to ask um so providing that infrastructure to know who to ask um I feel like I'm having a meaningful difference in their lives and helping um them feel confident with their residency and then you know I think this is a really great voice of the medical student so this was a student who participated in the program he said finding strive was one of the defining moments of my medical career coming from a ryal town in Brazil and then a smaller undergraduate institution here in the United States I was equally excited and intimidated to be starting medical school at a highly prestigious large academic center such as Northwestern the mentors that strived helped me feel like I belonged here and have supported me both academically and personally to help me reach my full potential I'm forever grateful to each of the residents who took time for their busy schedules to help me navigate the overwhelming undertaking of going through medical school as an underrepresented minority student I hope they understand the magnitude of the impact they had on my personal and professional life something small something that is a few experiences or exposures where people feel they really feel like they're being supported it can have a huge impact and it can make for something where you might not feel like you can be successful but it can make you feel and understand that you can be successful I think if we create these environments for our trainees then we'll be all the better for it one of the things that we um we argued in this piece was just you know identifying and addressing the source of discrimination and bias are important we have to do that but then creating spaces like the ones in strive through a model of near peer mentorship should be a consideration for academic centers while we'll trying while we TR while we are trying to tackle the episodes of discrimination and bias that exists we can in the meantime support our trainees with programs like this um to end you know what are some of the other ways that we can consider consider building inclusion and belonging in our training environments how can we start today the first which has already been done here is to commit to diversity Equity inclusion and belonging there's a commitment that is already there in me being here to give this talk even you know and so how do we build on that commitment collect and make transparent our climate data regarding this so if we we need to understand what's our current state in terms of surveys and climate data to recognize where are the issues that we might be able to that we might need adjustment um act as personal Navigator so this comes back to really taking ownership in terms of mentorship for our trainees creating safe and open spaces for dialogues we've talked about and then this is really important build into the budget that we value This Money Talks right so until we put our money where our mouths are in terms of is this something that's important to us we will still not make the way that we need to make and then longer term we should Define and Define and Implement diversity Equity inclusion and belonging competency Milestones so just as we have milestones for all the other things we do in academic medicine this should be part of who we are and what we do in terms of what should we what do we want to achieve um Implement practical training for our faculty create longitudinal equity anti-racism and anti- oppression curriculum for our trainees and then most importantly I think hold yourself and your program accountable making sure that we're considering at every step with every year are we doing everything we can to make Headway in this really important environment so these are the things that we covered today I want to thank you so much for your attention and for your engagement um and I'd love to take a few questions I'll I'll highlight that this is um this was just about a month ago and um this was now year eight of strive these are all medical students and resid who are part of our our mentorship program and again you see the smiles it's about creating an environment that is safe and inclusive for all of our trainees so thanks so much for the invitation and happy to take questions thank you so much Dr Gans that was amazing and uh fortunately many of us have not had to endure the same level of feelings of not belonging as you have described here and your personal experien is so powerful and meaningful thank you and the practical ways you've shown us and guided us to be able to help our colleagues and our Learners to not have to face those um those feelings of not belonging so what sorts of questions can we ask our presenter thank you for your your talk that was really enlightening I'm really impressed by your strive program I was kind of curious since you've been um having this program since 2016 have you kept track as as far as like your mentees have they gone on to be have more likelihood to be become mentors themselves within this program or in other institutions or wherever they happen um to be thank you for asking that so the question was about um you know whether the mentors have or mentees have gone on to be mentors that's something that we want to assess actually so that's like the next step in terms of our assessment because that's one of the thoughts I have is that I think um there's this whole concept of paying it forward right and with a program like this they've gotten a lot of benefit out of anecdotally I've had residents um come to me who were medical students at Northwestern and they've actually asked for advice on how to start something like this at their institution so I know that there are a few who are thinking about that um but I think looking at it in terms of a more systematic way would be so important and I think that other thing is that I'm hopeful that residents and fellows who are mentors in this are also more likely and more inclined to continue that mentorship as they go into their faculty roles as well um so that will be another additional thing to look at but I think it's so important and I at least anecdotally I think the answer is yes thank you good great to see you again yeah good to see you um boy so much I've got a couple comments and then a simple question first of all this was a phenomenal disc discussion um I I wonder where were you when I was a medical student Northwestern because I needed this program medical school is scary and that transition to second and third year you discuss likewise so so congratulations on on on taking on a very difficult uh conceptual Challenge and I suspect you're going to have great success with that uh to follow up on one of the comments made earlier telling your story and hearing stories uh we we we have narrative medicine here I think the impact and power of that is really really important and we all have our own stories that I think tell so much more than understanding what implicit bias is and how do we identify manage micro all that stuff critically important and we've got to do a much better job at that so I I really applaud you for sharing that story and um I would challenge others here in the school of medicine at King Clinic to share their stories of uh what has happened to them either personally or professionally and I I strongly believe that both are intertwined and are important because we take our personal life to work and and vice versa um the question I have for you um so I have a daughter who's a medical student and you talked us through the changes in step one and how that may have some impact other positive or negative in terms of differentiating What professions underrepresented students in medicine may be able to um to achieve but step two is still scored and I think we all know that what reny training programs are doing is they're looking at step two now as a surrogate for both what step one used to be in what step two used to be as a matter of fact I distinctly remember as a medical student that step one was the test if you did not succeed at step one you're relegated to a different selection of Ry training programs so I wonder um one do you foresee or do you know of any movements uh towards changing the the step two methodology to what step one looks like and you know I also agree with you on holistic review as a solution but it is very very difficult to implement and not that program directors and departments don't or schools of medicine they they want to do this but I'll tell you as a former department chair to provide the amount of release time for my team to properly perform holistic review was completely unaffordable and unreasonable yeah so so I think there's some real headwinds and challenges there despite the fact that it makes sense and we know it is best practice so you could maybe comment and respond to some of those things thank you that's hugely important um so the first comment about step one and step two I think that you're I mean you're absolutely right even students now they're deciding to take step two earlier so that they can have the score on their application before they're considering you know applying to residency so this is hugely important um I think that the direction is likely going to be that step two this is just my opinion that step two also goes to a past fail um and I think that there are challenges in both ways because at this point we use step two we use some test scores to exclude um some of our applicants and to your second point it's it's almost impossible to have a large enough Workforce in terms of Faculty to review indepth enough what needs to be r vied to make these assessments I think what we're going to end up doing I'm you know it's early now right but I think Ai and tools like that are going to be able to help us make these determinations better in the future um but it comes back to what do we think what's important to us and um what do we think uh or what do we invest in I guess is the big thing right now I'll tell you what we do and it's sort of almost like a high you know we I think we get like 4,000 applicants in Internal Medicine so it's really hard even if you have a group of 20 or 30 faculty members to review holistically 4,000 applicants so we do a hybrid scenario where we still have some of our old um our older system and that helps us determine a large proportion of our applicants in terms of who's going to get an interview but then those folks who would not otherwise have been chosen it's a smaller pool now and we do our holistic review on that smaller pool so we want to make sure that we're not missing you know in terms of like who are we missing from that initial evaluation and we actually have found that we're I mean we're missing some really talented folks right when we're just cutting off of based on school they went to and the scores that they had on you know step one or step two and so I think no system is going to be perfect and I I think as we're going towards trying to be holistic there are like uh smaller steps that we can begin to take um incorporating holistic review even if it's not in everyone um but I think ultimately we're going to have to find a system that is meet somewhere in the middle because just realistically as you're talking about it's going to be really hard to go through every application um in a fashion that that respects everything that they've gone through absolutely uh just just a quick comment on holistic review in step two and then a question for you uh first with holistic review we're in that 16% of Institutions that have implemented most of the elements and have not moved our diversity numbers and as we retrospectively we can't prospectively do this but as we retrospectively look at our underrepresented groups our diversity groups through who applied who completed a secondary who was interviewed as in our MMI format who has made offers of admission we see the um the good percent representation by our diversity groups at every stage through the process so this holistic review process is doing well it's in accepting offers made is where we see the drop off and then we get into the questions around how much of it is financial because we don't have the Deep endowments and we have no instate tuition how much of it is something about environment in the community or elsewhere that might be responsible for that but I want everyone to know which sort of category we fit into in that framework but with respect to step two you know um I think you mentioned this to the unintended uses of a lure exam and the secondary market for those and although step one past fail goes back to when it used to be past fail when I took it long years ago step two has all these secondary marketing benefits toward something that many consider important in Resident selection for all of the failings and all of the narrowness of looking at a multiple choice score it's still predicts another multiple choice score board Pass rates yeah and so that's where folks who really want to get rid of it and make it past bill are stuck in terms of managing what what other test would come up from a specialty board or another organization to replace step two as another McQ to predict board Pass rates and failure but I hope it's it's an ongoing discussion from this incus group and I hopefully they'll figure that out my question for you had to do with this really important point you made that the more we listen the more we create opportunities to hear what's going on with the narratives and stories of what folks are facing the more we realize that you know yes there are patients bills of rights that are posted on the walls of many hospitals what has Northwestern Medicine done to create another set of Rights and expectations for patients that acknowledge that the the staff of the hospital also has a right to be treated with respect so how did that was that in place at Northwestern Medicine when you were training or is it in place now thank you for the question um so that is something that actually came out from my experience because the my program director um was also the vice chair for education in the department of medicine and um again just a very supportive leader and so we actually went to the hospital and there was not a policy in place in terms of the expectations for um the response in that type of scenario that now exists so and we were talking about talking about this earlier with some colleagues it's not enough also to have a policy in place that then gets placed into a folder and like it's there but it's not implemented and so how do we really realistically Implement these types of policies and educate folks that this policy exists and so what we've done is we built it in at least in Internal Medicine that there are some didactics that go for the faculty members prior to starting rounds um and part of that is the expectation set setting around responding to these types of things and so we we created a policy that lives at in at the hospital side and we have tried to build it into the education so that it hopefully at some point just becomes part of the culture but it's it's definitely a work in progress here obviously culture change takes time and in the meantime it's about educating and policy change thank you thank you thank you so much Dr yans thank you congratulations on all the outstanding things that you've done at Northwest you thank you for bringing those experiences to us and uh and for your personal experiences as well as your professional experiences thank you um did you have other things to say de I have a little something over here and we hope you you take things away from your time with us your warm memories of a good meal yes some wonderful conversations absolutely and being here together to celebrate uh the legacy of Rick bar and I just know he'd be smiling down upon us to see you so comprehensively and efficiently cover so many important aspects of in creating a learning environment that is embodies belonging and inclusion and opens up a space for people to talk about their lives outside and inside of medicine and all those wonderful things but we also have one of these this is this is our frame certificate for you to put on your wall if there's any room left on your wall have a lot of things on absolutely to commemorate uh your being here with us today and please accept this with with our hearty thanks and congratulations thank you so much thank you so much for being here appreciate this we have a little photo.