The Impact of the Pandemic on Diversity in Academic Medicine

Welcome to today's session on the impact of the pandemic on diversity and  academic medicine we are so grateful to have Dr Wayne Frederick here uh Dr Wayne  Frederick is the 17th president of Howard University and the distinguished Charles R Drew professor of surgery at  the Howard University College of Medicine he's also a practicing cancer surgeon at Howard University Hospital  where he continues to see patients and performer surgeries he is a true son of  Howard having earned three degrees from the University of BS in 1990 and MD in  94 and an MBA in 2011. as president of Howard Dr Frederick has  worked to strengthen the internal operations in order to enhance the student experience and position the  university to more effectively serve the community he has overseen a period of immense growth and transformation at  Howard including record-breaking enrollment numbers and philanthropic donations  Frederick is an expert on Health Care disparities and devotes his time to speaking about and advocating for social  justice as well as diversity equity and inclusion Dr Frederick also serves on the boards  of numerous institutions and organizations including the Federal Reserve Bank of Richmond and Humana  Incorporated Dr Frederick is also a member of Surgical and Medical associations including the American  surgical Association the American Cancer Society in the American College of Surgeons Dr Frederick has a packed  schedule he's actually flying to Newcastle today so we are so fortunate  to be able to get Dr Frederick here to present for two sessions today as you  have questions throughout today's session if you don't mind just typing them into the chat and if they're super  urgent And Timely and need to be answered right away we'll try to work them in but it otherwise Dr Frederick  prefers for us to hold them to the end and then he can answer them all at once  um without further Ado I'm going to turn this over to Dr Frederick thank you so much for being here all right thanks for  having me and thanks to that generous introduction so I'm going to jump right in because I think uh leaving as much  time for the Q a uh is going to be important uh so one of the things that I I do  often I'm fascinated by is a cycle of History  um and when we come upon times like this with the pandemic and we talk about electricity I often try to harken back  to a time that may have been uh somewhat similar and that time uh takes me back  to the flexner report which was uh performed by Abraham flexner near the tune of the uh prior century and this  was a very um important report Abraham flexner took on a very ambitious  um project and that was to go throughout North America both United States and Canada and assess every medical school  he was looking for admission criteria he's looking for preparedness looking at  facilities resources Etc uh what is not often understood or  spoken about in its true light is what he found and recommended and so I'll go  for just a few things that he recommended one was that entrance requirements then adherence to them  um needed to be um beefed up as it were he was concerned about the size and the training of the  faculty felt that but were inadequate the summit allocation of endowment and Visa support the institution he also  thought it was an adequate as well and questioned the quality of the labs that were there  uh some of the relationships between the school and its Associated hospitals he felt was you know a little bit thin uh  kind of sounds like uh some of the issues that we have today with with academic medical centers and but his  overall intent was to reduce the physician Supply because he thought the quality was poor so he called for  reducing the number of schools that existed at that time down to 31.  um annual output of Physicians he wanted to decrease as well and the number of medical schools actually decreased to  85. the number of students decreased by more than 50 percent and the percentage  of schools requiring two years of college admission College of years of college preparation for admission rules  from 3 to 92. so he certainly changed the landscape of academic medicine  but it was some other important things that he spoke about and we have to remember the context and the time in which he did this one of the things he  said was that it was clear that women show a decreasing inclination towards medicine uh the seven medical schools  for Negros should be reduced to only two blacks being a potential source of infection and contagious and needed  their own Physicians and hygiene rather than surgery should be strongly accentuated at these schools where black  students were attending by 1923 only two medical schools for blacks remained at  that time and then between 1920 and 1964 less than three percent of students entering  American Medical Schools uh were black Unfortunately today that number has  remained um unchanged and you will see um what happened with respect to the  number of women who are applying to medical school now one of the things I talk about a lot is unconscious bias and  so needless to say after reading that I wasn't a big fan of Abraham flexner and then as I became president I went to  this building which is called the founders library at Howard University where we store our modern Springer and  Research Center and we have papers from all of our prior border trustees including Frederick Douglass and lo and  behold I found out that Abraham flex and I was a member of our University's Board of Trustees from 1930 to 1936 and even  sued as the board chair from 1932 to 1935. so clearly  um despite what he wrote in his report he was clearly a big supporter of Howard University and of the pipeline to  medicine I'm in spite of that and so sometimes even when we read about things that we may not agree with we need to  put them in context he actually worked on the appropriation that brought this building to be which was intended to  look like Constitution Hall in Philadelphia as the iconic building on our campus today so one of the things I  hope you would take away from this is um we all have unconscious biases they're informed by various things but we must  always um be mindful of the fact that we do and work towards making sure that they don't  have an oversized influence on our way of thinking Howard University has always been an  ambitious project uh the first faculty members of the medical school included uh two  African-American surgeons actually 80 Augusta who's seated here uh to the left  and uh CB Purvis uh second from uh the right here  um again the fact that the medical school uh wasn't only started right  after the Civil War but um with such ambitious projects to train African-Americans in medicine at that  time uh says a lot about it and our founder for whom we're named after Oliver Otis Howard you can see standing  here he's standing with his left side towards us because he lost his right arm  um during the Civil War the applicant's U.S medical schools by race and ethnicity has been a very  interesting Odyssey as I said about it has stayed almost consented three percent and I've spoken a lot about the  lack of African-American men in particular in medicine and one of the major things that we did see  um is that that number did not change as a matter of fact there were less African-American men applying to medical  school in 2015 than applied in 1978 and that has been a concern but I'll draw  your attention to something very unique here that has occurred if you look at black or African-American only  students you'll see Mana at about 1500 women at 20 30 for a total of 44  um and if we come all the way um across to last year you see a  significant jump um across the board primarily  um with women but you see we went from about 4 300 which was around where it  has been consistently to now 6167 so clearly  um some of the efforts that have been laid out to try to improve this and I actually think this is one of the things  that the pandemic has brought us that may have  um may represent a significant change so only five percent of doctors in the US are black again not a very big  difference from the time of flexner but I have some theories about why we had  such a big jump last year you now have students who can do interviews by Zoom  because of the pandemic they didn't have to travel and therefore students of lower income who may not have had to  fly all over the country the second thing is our process is fairly intimidating right we bring students we  put them all in a room um they get to have conversations with each other or over here conversations  amongst the group and those conversations can range from I have you know nine more interviews when you can  be a student of very little means you have one more interview or you can't fly to uh the West Coast if you're in the  east coast Etc and so what we saw with our students at Harvard in particular was that more of those students were  able to access interviews and participate and also did not have that  intimidation of getting into a new place being the only African-American applicant in the room Etc and so we've  seen it that CNET rise we'll see if that's consistent uh and sustainable as  well when you look at the number of active residents and training as well you see of course a similar number right  5.5 percent uh black what's also interesting is that 16.5 percent of the  active trainees were non-us citizens and so all lower dependence on our Medical  Care system or our dependents on that International component of students  is significant and with the pandemic and more difficulty in terms of those  students getting into the country this could be a really significant impact on diversity of the pandemic as well in  medicine so this is yet another thing that I think with the pandemic we're going to have to look at very carefully  we've all seen slides that look like this that kind of project what the  shortage of Physicians would be and therefore where Physicians come from who they are is going to be important I  think this is important when you look at the practice Specialties and you look at meals in particular we've been seeing  some trends of concern in terms of those numbers and where those numbers are particularly  thin we certainly have been trying to encourage our students to get involved  in some these Specialties well underrepresented so a lot of times we  talk about minority students and we have a conversation about primary care and I  think one of the impacts of the pandemic is that we may have more students going into primary care but that could worsen uh the Gap in representation in some of  the sub-specialties and I think we have to be careful about that conversation or at least how we have that conversation  with students to make sure that we don't waste you know some of the areas that are already particularly  depleted and same thing uh for female students as well I think  we have to look at these and see where we have some of the underrepresentation and show  um that we are making an effort to improve what that um what those numbers look like as I said before blackmail  enrollment has been really really um poor until this past cycle where we  had an increase by about 21 of black first year students and I was consistent  among men and women so I think you know that's certainly a silver lining and  certainly something that we hope is going to continue and be consistent as we move forward now  obviously being uh from Howard I'll talk a bit about what we're doing with that electricity and how we see the pandemic  um and that impact uh how would we started on March 2nd 1867 it was a charter approved by the 3090 United  States Congress and signed actually by um the 17th uh president of the United  States President Johnson I mentioned that because he was a known misogynist and uh known races and one of the things  that I think today is particularly important for us to recognize is that while we have a democracy that's complicated and sometimes cynicism can  set in and we have to recognize that it works whether or not we like how it  works whether or not we think it's pretty or fast enough the fact that of the matter is that it does work to some  extent and with that in mind this was a very ambitious project how it was not  started as a normal school or seminary as most of our great universities in  America started it was actually started as a university what was also unique about it was that  um both uh people of both genders were admitted from the very beginning which  was not a practice in high-end um at that time the first they've been more white  presidents at Howard and black presidents which is a little known fact there have been 10 white presidents and I'm the seventh black president  the first black president was Mordecai wire Johnson and he started  um at Howard in 1926 he was 40 years old at the time and you can see that  enrollment was about 1700 with a budget of 700 000 and by the time he left in  1960 we have we had about 10 schools and colleges all were fully accredited and  the budget had risen to about 8 million with a student peso about six thousand he really changed what diversity looked  like not just at Howard but in higher ed he insisted in his contract that in the  fourth year of his contract he would go out and find a black Dean for every  school so at this time if you look at historically black colors and Universities at that time in our history  they were run by white men and most of the faculty were white he really began  to change that and bring the historically black cards and universities into the Contemporary  experience that you see today okay so today Howard has 14 Schools and colleges 10  within our academic Affairs Division and for in health sciences we have a level  one trauma center hospital we have our own TV station our own radio station as  well um and so this makes it a very very complicated Enterprise we have about 12 000 students  which is the highest um in a just in a decade but our highest enrollment ever and our federal  appropriation with one of non two non-military institutions in the federal  budget as well so I like to refer to how it is the most public private institution there's some unique things I  think about the University's offenses when you look at uh Dermatology and you  look at Black rheumatologists in the country by my last uh check and my chair  of Dermatology keeps me honest on this point because um she didn't train at Howard or attend  Howard but she was the one that bored this to my recognition at  um within the past five years ninety percent of the black dentists in America either attended Howard University  undergrad College of Medicine or trained at Howard University Dermatology Department and that's an outsized  um burden as it would you know I think we Pat ourselves on the back for being able to have that type of production but  I think for us as a country to rely on one institution to do that is something that we've got to be very cautious of  and so we can see that Pipeline with our students but it's just a one example of  why that diversity is important and why others have to you know join in I think  when you look at diversity in medicine you can't isolate it because I think life was in Academia is important and  when you talk about the pipeline we have to think of the pipeline um in terms of stem and how are students  pursuing that so how would we currently um have a four-year graduation rate of  about 60 when I started was about 38 the number one reason students don't finish  at how it is because of uh finances we have a significant majority of  females 74 and so again when we look at where the pipeline is coming from I  think that's something for us to think about carefully the top five Majors include biology political science  psychology at one point um two years ago two two years ago political science became number one I  think reflective of our country but the fact that biology and psychology and the top three  um does uh represent the fact that we have a strong pipeline of students um  coming in so our rankings have gone up significantly and I think that has  resulted in a significant interest in students coming uh to the university  however it does create um a concern that I have again when we talk  about the issue of diversity in medicine we have are now receiving about 8 500 to  9 000 applications for medical school uh we are only enrolling a class of about  120 to 125. so there's a lot of interest but the  fact of the matter is that we are now the fifth most selective medical school in the country and that is of a concern  um of my it is a concern of mine because I am uh worried that as this becomes  more competitive especially if we represent a good opportunity for students that that could be problematic  now the other thing that's important to note is that although we are that selective we do have a selection bias 79  of our students were not accepted anywhere else which means that we provided the only opportunity for them  to do medicine and the vast majority of those students were African-American students and the way we do that is  through a secondary application we ask students to  really itemize um why they want to do medicine are they  from another circumstance are they willing to serve in an underserved circumstance and I think it goes back to  the fact that if you really do want to find diverse students and give them an opportunity uh your process has to  reflect that and so we think it's extremely important and you can see that the percentage of our  class where um the Hollywood student was we were the only school that accepted them is  significant it has stayed over 50 something percent and has been as high as 80 percent as well and these students  you may say on the back end is that really helpful well they are matching on the back end well so this some of the  impacts on diversity the first is that I think the pandemic has Spirit of  recognition of Health disparities experienced by communities of color throughout and when you look at Black  Americans will more than twice as likely to die from coven and that has really impacted the black  community significantly in DC when you look at Ward seven and eight in DC which  is just a few miles away from ward 3 a black man who lives there in the nation's capital is going to live 20  years less than a white woman in Ward 3. that Society is unbelievable in the  nations in the U.S capital is absolutely shocking so sometimes we think of access  and rural areas or we think of of access in different ways but the fact that in  our nation's capital we have that type of Gap in life expectancy as a result of  access it means that we have a problem and improving that diversity in the  medical school because of the cultural competency that accommodates is important and so we certainly have to  recognize that black males in particular uh represent a significantly low number  um of students in medical school and that continued effort to increase that representation is important  and I've written about this a lot that we still need to although we've had this increase we still need to be thinking  about how we eliminate that bias from medical school admissions as I mentioned before there are a few things that we  can do one is um clearly the virtual interviews have helped I think getting  students more exposure to the variety of medical schools and options in the country is another one  finances is another very important one we received a gift from Bloomberg philanthropies of about 31.7 million it  was a total of 100 million to the four historically black medical schools and  what this did was to pay down the debt of each medical student who  um who's certainly uh needed that help because of their  loans by a hundred thousand dollars each and that that qualification was important now what we've seen since that  that those students who otherwise would not have taken a chance to do a specialty like new surgery or something  else where the training was longer because they were concerned about debt that they had to pay off uh have started  to take those chances and I think that that's also important as well and so that support philanthropic support that  has come out of the pandemic has certainly helped to accelerate some of the changes there as well  I think in terms of Workforce Development and some of the things that we've been trying pre-pandemic and have continued doing the pandemic if not  accelerated it's trying to get students more support early on we have a pre-health Scholars  Program where we bring students from all the hbcus to Howard every June for about four weeks and  these students we every week we give them a practice MCAT we talk to them about test taking skills  Etc we've seen a significant increase in the MCAT and DET performance we do it  for the dental school as well is how how it started and this has been has proven to be very helpful in terms of expanding  the number of students that we're seeing applying to medical schools the other thing of interest is that if you look at  the top 20 doctorate granting institutions of black or African-American recipients Howard is  number one by a significant margin and we did that again this past Saturday graduating some 95  PhD students we have the largest in-residence program so trying to expand  that program was another thing that we've tried to focus on and this really got accelerated during the pandemic as  well so we started a program was initially called a bison stem cells program and then the cases the cash have  no underwritten this program we bring students in from high school who are  interested in getting a stem PhD or an MD PhD these students have a rigorous  application an interview process the average high school GPA is about 3.89 the average ICT score is close to  1400 and these students do really really well when they come to us they come to  us the summer before the other freshmen start they take an African-American  studies course on a standard course and then we fly them to an international trip obviously the pandemic disrupted  that but we think we'll be back doing that again this summer we've been taking them to Berlin Germany the vast majority  of these students who are Pell Grant eligible do not have a passport have never been out of the country and we  thought it was important to give them that type of exposure what I'm extremely  happy and then every summer they they go off and do research and they've been doing research all over the world what  I've been very happy about is the kind of labs that they've been going to as you can see here very diverse uh group  of labs uh all over the world uh some of the best labs in the country as well  some of them is going as far as Vienna Austria these students have continued to do well  they've been publishing in major journals and winning Awards  um of a wide uh variety and so we've been very proud of them we have a Goldwater scholar uh from last year I  actually just found out we have another gold watch of scholar again uh this year as well  um students are winning the NSF graduate research Fellowship as well and this is  where the first cohort who graduated last year this is where they are going to graduate  school as you can see again very wide variety including University of Virginia  um Hopkins Harvard they're all over the country now what's amazing is a number  of mdp AG students we have currently um in this group is about 30. so if you  look at the number of black mdps in our country Howard continues to do this program for uh the next 10 years  successfully uh we would probably quadruple the number of Black MD phds in  the country with just this one program so pretty excited about this and the  other thing is starting the pipeline annually is important we have a middle school on our campus I assume the Howard  University School of mathematics and science so we call it Ms squared um it's for a bit of player of the words  the kids who come here uh usually are performing below the average for the  city 96 percent of these students actually go on to college and if you stop one of  them they will tell you that they go to Howard University they won't tell you to go to Howard University middle school  but what's great about this is that being on the campus they're able to go to the dental school to go to the  simulation Labs go to engineering and that early exposure is important again I  think when we look at the pandemic the number of young people who now have an interest in medicine and science is  significant but we have to harness that we have to put them into environments and we've seen an increase in our  applications for students wanting to go to the middle school as well I don't think medicine should be isolated and so  the other thing that we've been looking at is students with non-traditional backgrounds who may want to get involved  um pretty sure Rashad is now the dean of my Chadwick Boseman college of fine arts  we have Howard entertainment project which we're sending students out to Hollywood one of the things that we're  finding with students is that they're not isn't I'm not as interested in their major as I am in their mission and so while I  was out in LA with these students at Amazon Studios one of the things that became obvious to me is there were  students in this group who were interested in healthcare education and  Healthcare Communications how do we get the message to students you know students that I think will still go back  you know probably later on in life and decide to go to medical school as a result there although this is where they  start and I also get our curricula needs to be a little more adaptable to try to  bring these students in so we get them there now patient-centered care as I begin to  wrap up here I think is extremely important I mean one of the things that my mentor Dr LaSalle Ford used to say  all the time is the patient must be the object of our affection and I think the  way medicine has been constructed in the United States for a long while the physician has been that Center  and and I think that's something that we have to we look at so we have a new singing high at health school we have a  pharmacy school and we have a dental school as well and so interprofessional education has become  really important for us recognizing that we have to look at Patients more holistically and this gentleman  um was the chair of the Howard University department of surgery the first African-American service National president of the American Cancer Society  the Society of Surgical Oncology the American college students then I can go on and on but what's most important is  that when he graduated from what was then known as Florida a m  um back in 1948 he could only apply to two medical  schools as a result of the impact of the flexing report  um he did not get into either medical school and that would be Howard and Mahari his college President had to uh  call Howard University's present and petition to get him I'm involved what was interesting about  that uh and still is today is that he had an issue taking a standardized tests  he only got one B uh and graduated from Florida a m College as an 18 year old  so it just goes to show that had he not gotten that opportunity none of the  great things that he went on to do uh would have happened he graduated with one B on his transcript so we when we  think of diversity as well and we think of opportunity I hope sometimes we would also think of what are some of the  things that we do today that we can potentially change in terms of evaluating students and their potential  because we can miss you know gems like him and the other thing that I think is important is community centered care I  think the pandemic is going to change how medicine is  um really provided to others but I think we have an opportunity to also interest  a certain diverse group of practitioners into medicine so for instance technology  we have a lot of students who are getting into technology today and we have to keep on impressing upon them  that they can apply what they learn to really assist as we saw in the pandemic we have to start meeting patients where  they are and I do think we have to start deploying a network of mobile Health units  um to help we have to start using telemedicine more in more communities with disparities and along  the lines of using technology I do feel strongly that one of the underutilizations of Technology at  things that are life-saving I'm a type 1 diabetic I use insulin pod system for  the secret for disclosure I'm on their board but I was a patient before I got on their board and that now used a  closed loop system and a continuous glucose monitor and the fact that you can do that  um today with a device can be so transformative for communities if they  can afford or if they can be impacted by that use of technology so certainly  I do hope that we would look at that also the social determinants of Health we need to look at differently as well  our students in my nutrition Science Program go out into the community  uh and uh to shop with um folks in the community at the major  grocery stores and this was an idea that I brought to their Dean I suggested that  it would be helpful if they can not only shop with those residents but then send that information back to their primary  care physicians um you know everybody thought it was a good idea we deployed them and the  community loved it but students being who they are saw a much better opportunity they actually  um decided to do a few things um different one of which was to take  um take that practice to corner stores and as you could imagine  um obviously that's where most um people in the neighborhoods that we were sending them to  um get their groceries that was transformative as well they were able to help those  um shop stewards with where they should position things on the Shelf um how to make sure that healthy options  were available uh to those residents Etc and again this had a significant um  impact as well our Cancer Center does a lot of mobile  efforts as well in terms of getting out to students and that's something that we push  the pandemic really pushed us as uh as a university to look at  what it meant um for diverse communities in terms of these outcomes we were seeing we started covid-19 testing and  vaccine distribution at Howard we got a generous ground from Bank of America and that helped and most of us don't  remember these things now it's kind of you've been through so much trauma with covid but some of us can recall at the  beginning of the crisis you have to get a prescription from a physician to get a test right now we have home tests Etc  but back then communities of color were well under tested and those were the  folks who were going to work so we decided that we would set up a free testing no prescription walk-in one of  the first time in DC and that proved to be very very valuable for those patients  who were very vulnerable and then in February of 21 we started a vaccine clinic what was amazing about this this  picture shows the dean of my nursing school with a 103 year old patient who was vaccinated by a 19 year old nursing  student and she could not have been more pleased um her second pandemic and as  she said she saw something very different she doesn't remember as much the first Dynamic she certainly lived  through the after the effects of it but she was so um humble and warm to be able to come into I would have a 19 year old  nursing student vaccinator the other thing that was interesting in this process is we actually  participated in a vaccine trial for novax while we were  um Distributing both the meduna and Pfizer vaccines and there was skepticism  even with me as to whether or not we'd be able to fulfill the number of patients and being a trusted messenger  in the community would we were able to hit those enrollment numbers uh fairly  quickly despite the fact that we were already Distributing to approved vaccines so I think that that  was very important we took this out to the churches we went into the community with it and I think again as we look at  um what the pandemic impact is going to be is that I think these are things that  aren't going to go away we started with vaccinations but we recognize that we have to continue being out in the  community in order to provide services so as I conclude a couple things that I do want to point  out because I think you have to be introspective when we especially when we talk about these tough issues like  diversity so the first is um this is a picture of my Deans when I started one of my 13 Deans was a woman  uh we know about 14 Schools and colleges and you can quickly see that 10 of my  Deans are women um I'm about to add one uh next week  don't want to get too ahead of myself but we could end up with 11. and so this process has been a rigorous  process of making sure the switch committees are gender balance everybody who sits on the switch committee has to  go um to unconscious bias training and cultural competency training and you  know at doing that at Howard is not very popular initially but everybody who goes comes back and says that they thankful  they did it because they immediately recognize that it was something that was absolutely necessary and they did not  appreciate their own unconscious biases this gentleman in the middle here is Charles R Drew for whose um name is on  the Prof the endowed um chair that I hold the professorship I told you about  Dr le4 before and this lady to the left here was my mom she became a nurse she  wanted to become a physician she ended up practicing nursing for 51 years my  grandfather who was a lawyer felt that women should become nurses my mother was um against that but did it he was a good  man um didn't he wasn't right in that particular issue but she insisted that  she wanted to have three sons she wanted one to be a pilot one to be a physician I want to be prime minister of Trinidad  and Tobago I'm not crazy about politics or Heights so I decided to get into medicine but this gentleman in the  middle of Charles Drew has a saying that I think is important Excellence of performance will transcend artificial  barriers created by man and I think that that still is putting on today  um he would die tragically on April 1st 1950 in a car accident and there's a  myth of that despite the fact that he was the person who discovered and promoted the way to preserve plasma that  he was denied a blood transfusion because he was taken care of at a white  Hospital in the South and that's not true he suffered very very serious injuries that were not  compatible with life and so is um saying and his Mantra is something  that we at Hollywood still live with today equality equity and Justice I think is  what this is about um and I think this pictorial really says it all you know we can give  everybody the same benefits and not necessarily benefit those who are most compromised among us or we can give the  benefits that are needed to some but ultimately the justice is when we take away the barriers and I think that's  what we all need to work on when we talk about diversity this is not an issue of quotas and it's not an issue of just  numbers but as well rather an issue of providing an opportunity an equal opportunity for everyone in our society  to thrive and I think that that's something that we're fully capable of um I took this uh picture back in 2000  and eight I believe it was this is um my son and my daughter my  wife would point out that my son is dressed in a student's guy but my daughter was in a sweatsheet uh like a  cheerleader so the point I want to make here is that we all have unconscious bias sometimes we don't recognize it and  so now I like to close with the future of academic medicine looking like this my kids will be embarrassed to see these  pictures you know I was 17 and 15 my son will be 18 next month and my daughter will be 16 in July I took both of them  to the operating room for the first time this past fall and while my son is going to go after Duke and play division one  soccer and it's going to do economics and finance when I go back to my office with him after the case he said that I  got a rush when he made the incision so like I said um earlier in my talk hopefully he'll have a secure test route  uh you know to Medicine my daughter on the other hand is an activist she wants  to be a female orthopedic surgeon who operates only on Elite female athletes so she she's gonna practice her own uh  during the diversity and bias in some way she performed so thanks for your attention and I appreciate the  opportunity to speak to you I'm happy to answer any questions you may have wow Dr Frederick this uh has been an  amazing um conversation uh these are excellent examples of for what other schools can  do to encourage diversity within their schools and ultimately the medical Workforce  um nationally so there was so much data and information I am super glad that I  will be attending tomorrow's session um as well a repeat session at noon and  I want to encourage others to do the same or encourage your colleagues to attend at 12 o'clock tomorrow as well we  have had to cancel the five o'clock session due to Dr Frederick's busy schedule but we will also have the video  and the presentation online as well on our website  um I uh would like I have some questions myself but I'd like to open  um the floor to others who have some questions for Dr Frederick you can  either type them in the ch at and we will convey them or you can just unmute yourselves and go ahead and ask them  yourselves anybody [Music]  all right well I'll start so a doctor for duck I noted that you um do  encourage and you in your talk you encourage Telehealth to to um encourage diversity in health care  but but I've also heard arguments against Telehealth from other folks  um because of the cost and the lack of resources in underserved communities can  you comment on reconciling those thoughts a little bit yeah sure and it's  a good point and I I don't want to um leave that as an unrecognized hurdle  but I think it's a hood that we should just tackle uh I I think we say you know we often just kind of tore our arms up  and say well they don't have the technology so we shouldn't do it but the reality is that investment of technology is worth it and I think that's where our  arguments should be we should think of how can we invest in that technology and  then go from there you know one example is if you if you use community centers  um in those communities and you set up of that technology so that when patients do have their appointments they can come  to those areas their Library their public libraries that have quiet rooms as well  um where again members can go and you know potentially use it I think we just have to be more creative about how we  get the technology to the patients and then allow them to use  it I think that that could be absolutely transformative in terms of their outcomes because of that lack of access  and as well folks who work you know for hourly wages  Etc it's a challenge you know I operated on a 40 year old woman with breast cancer when I first came back to Howard  and she did not show up for her chemotherapy appointment and I was really unhappy with her and I remember  calling her up you know kind of really you know disappointed and saying to well  why didn't you you know show up and she calmly said to me Dr Frederick I had to  go to work because you know it's coming close to the end of the month I've got my kids to feed and  I'm not able to do that and I was so embarrassed that it never occurred to me to stop myself long enough uh to  recognize the circumstances she was in and that my asking her to show up for an  appointment and not go to work which you know seem life-saving was  really not who um most important priority and I had  done nothing to not only investigate that but to help her mitigate that circumstance and I think that that's  problematic as well and we have to look at our system more aggressively I think to bring those resources to those who  need them absolutely I love your comments throughout your discussion on not only uh but for health care so this  is a perfect parallel for um getting uh the health care to folks  but providing the ongoing resources for supporting their their development and  their success and you exemplified that uh you know for for medical education so  it's not just about recruitment right it's about supporting folks once they  get here or wherever here may be supporting them with the resources they  need to be successful in those areas I think that's that's uh a point that's  often lacking um when when we focus a lot on recruitment numbers we've got to retain  we've got to retain the diverse population that we're interested in keeping and ultimately expanding our  Workforce so I love that Dr Nussbaum you're on mute  we're always on you yeah yeah Wayne welcome to Roanoke I really appreciate your comments today I I was interested  in your point about the virtual interviews and how that uh was a benefit to particularly you know those students  and residents that don't have the means to travel across the country is it your sense that  um once we're out of the pandemic that is there going to be advocacy for continuing to do virtual interviews at  all levels or do you think we're going to go back to um insisting on having  students travel around the country to interview because I I we've seen the same thing just in our ability to  attract a more diverse group of residents over the last two years as we've really benefited by that yeah yeah  I think we're going to go back where creature is a habit so I I do think we're gonna go back and while I'm a big  Advocate I'm sure even how it is going to go back I am going to advocate for us not necessarily going back back you know  for us really trying to assess the situation or even if we go back to be  mindful of the dynamic that might be at play you know that wants or you know all  students may not have the resources to do all that travel and two that even when we bring students we don't create  circumstances where you know they may inter be intimidated you know I think that that leaving students in a room to  interact with one another uh it you know always worries me uh because you know you you have introverts  amongst that group including myself and as you know it introverts um we don't we  want to be around people because the I would say the essence of The Human Condition is interaction we just don't  want them to talk to us and so when you when you look at situations like that I don't think it's a good setup you know I  think when we bring students in the morning before the interview we have to think of different programming and  different ways to engage them so that they go into the interviews as confident as possible and not lose that and the  last thing I'll say about this is that it happens at every level I interviewed um for Fellowship for to do city called  clutchy and I would leave the institution a name but I I wanted to one  of the um events the night before was going to  um have cocktails at that time I didn't drink um and being an injury I went to the  corner of the room had some sparkly water and waited for people to come and say hi the fellows the current fellows  walked around looking at how many people you interacted with and making kind of a note of that and  the next day one of the questions in one of the rooms was did you meet someone last night you didn't previously know  who you would like to train with well that's a tough setting for me to do that  so I met one guy Dave Kuby and uh unfortunately he also gave my name as well and so we lucked out but the  reality is that that's not the right setup right and then the second thing at that same site when I interviewed one of  the questions was of uh they showed you a picture of a old white an older  photograph so from probably the 1930s even 1800s of a white man in Black  and White and I just guessed one of the surgeons who won the Nobel Prize it  turned out to be William Harrison the president with the shortest tenure because he gave a very long inauguration  speech and a call got pneumonia and died well being from Trinidad my you know  American president history wasn't the best and so using those techniques in an  interview immediately are going to eliminate you know someone like me so I think if we're just thoughtful about how  we set it up what we're looking for and also training people to interview right A lot of times people sign up they're on  the admissions committee and they just go for it but but we really have to start thinking of listen these are not  questions that are appropriate and as a matter of fact these are questions that are really helpful so I think and I  think we will go back that's a long slide to tell you that I think we will go back but I think if we do I hope we  pay a lot more attention to how we set these things up so that we get a better you know outcome  those are great thoughts great thoughts uh Dr Hartman has a question in the chat  Dr Hartman did you want to answer ask the question I noticed you turned your video on did you want to ask a question  yourself sure um I'm uh David Harmon I actually am  blind myself and I was curious of your thoughts about uh diversity in terms of  physically disabled people getting into medical school yeah you know absolutely I think this is  a very good thought again and I think we have to be purposeful about recruiting  um recruiting that population and so I have a couple of thoughts about it that that will be it's a bit related to my  own circumstance as well um I have sickle cell and when I applied to do general surgery  um you know as you know we had a pyramid program and so no everybody discouraged  me from doing it because they were like you're not going to have the stamina to do it you're not going to be able to you know do long operations Etc and I  recognize doing that process to your point that we didn't have a system that was very accommodating to any type of  disability that someone may have as a matter of fact people encourage me not to put it in my personal statements Etc  which I think was a mistake because I do think that uh people with disabilities can relate to Patient populations very  differently and actually make excellent providers so I do think that we have to go out and recruit I do think we have to  look at our startup and systems and make sure that we can accommodate how to train  um well enough so that we can accommodate that patient population but I think on the front end we have to make  an effort to to recruit and to ask of those Physicians like yourself to give  us input on what would help well you know what what would be the things that you would need that would best help you  one of the most transformative experiences I've had in my life is going to Cape Town South Africa with my law  school and witnessing a blind former judge who helped write the Constitution  um give a lecture I was fascinated he and his wife partner he uses a system at  elected it was one of the most riveting lectures I've ever been in and I remember coming back and and talking to  my team about how many people we eliminate from our system only because we don't have the vision the the  wideness or the wide enough aperture to say to ourselves the talent is going to  come in diverse forms and let's accommodate and make sure we're doing the right things and so I am you know I  I'm fully supportive of us looking at it but I think it has to be a system issue  and on the front end we have to be actively recruiting thank you [Music]  Dr Bishop uh made an excellent comment in the chat Dr Bishop did you want to uh  unmute yourself and make this comment or do you want me to go ahead and read it  can do it I'm looking for an L somewhere oh there he is he may be driving he is always in  between meetings please feel free to go here okay great  um so this was an excellent presentation and thank you it is interesting that the hospital here in Roanoke for black  citizens was begun to honor Dr Isaac Burrell who was sent to Friedman  Hospital in 1914 due to a segregation he did not survive surgery and his passing  pointed to a need for hospital to serve the black community the hospital was named Borough Memorial and was known for  its excellent excellence in nursing and other areas and it's more than 50-year  history yes you can comment thank you Dr Bishop  any other questions concerns comments comments before we close this lovely  discussion  as a reminder tomorrow at noon is our repeated session  um I I'm telling you there was so much great information throughout the discussion that I was like oh well at  least I'll catch that tomorrow I'll be able to reflect on that a little bit better in between sessions and talk  about it tomorrow so  all right well thank you all so much for joining us I hope you have a wonderful beautiful day and uh Dr Frederick thank  you again for being here with us and we look forward to your discussion tomorrow sure it was my pleasure look forward to  seeing you tomorrow.