The School’s First RBI Quarterly Meeting | June 2021

Jun 28, 2021 | Racism and Bias, Uncategorized

The Guiding Coalition recently held its first quarterly meeting for 2021, which was open to all medical school employees, faculty and students. A total of 58 attendees joined the Guiding Coalition on zoom. While the Guiding Coalition’s goal for these open meetings is to remain transparent about the progress being made towards our change targets and the challenges we face along the way, we hope that these meetings can provide an opportunity for the medical school community to feel more connected, learn how to become more involved in the Racism and Bias Initiative (RBI), and find new ways to collaborate.

Admissions Sphere

In the Admissions Sphere, steps have been taken to build upon the first change target: to reflect on and broaden the education and training of the admissions committee to continually engage in admissions work from an equity lens. During the most recent application cycle, the MD admissions committee consisted of 50 faculty members and 30 medical students and the MD/PhD admissions committee consisted of 32 faculty members and 4 medical students. All committee members attended an in-person orientation session which included trainings on topics such as unconscious bias and diversity as a driver for excellence. Additionally, the admissions sphere developed an equity handbook which has been in use for the past application cycle along with the “Time-In” to Learning tool for effectively addressing instances of racism and bias as they occur. They’ve begun gathering data surrounding the atmosphere around racism and bias amongst the committee members through the DEI form and committee climate surveys, finding that POC on the admissions committees have started to feel more comfortable talking openly about racism and bias with other committee members. In October, the admissions sphere is holding a retreat with the aim of finding more opportunities for collaboration with several pathway programs.

Clinical Sphere

In the Clinical Sphere, they have updated their change target to focus on the entire Mount Sinai Health System rather than limiting it to the Pediatrics Department. This decision was made to accommodate for increased interest and momentum across the health system after the death of George Floyd last year. Within Pediatrics, they have completed five department-specific Chats for Change including their most recent one on reporting racist events to compliance which took place in June. Their chat in July focused on alternatives to reporting. Across these departmental programs, they’ve had over 200 attendees with numbers steadily decreasing with each event.

Despite this decrease in attendance, they have committed to continuing hosting these sessions. As of February, the reporting system has received 19 compliance reports regarding racism and bias within the past 6 months. Although the cause of this spike is unclear, the number is an increase from the 31 total reports for all of 2020. Ultimately, they can see the perception of the clinical sphere changing as more sub-clinical departments are beginning to show interest in starting their own initiatives and using the sphere as a resource.

Curricular Affairs

In the Curricular Sphere, a new Medical Education Program Objective (MEPO) has been developed to address racism and bias. Set to roll out next month, the MEPO states, “Upon graduating, students should be able to demonstrate approaches to mitigate the manifestations of racism, bias, and social inequities in healthcare.” In order to fulfill this MEPO, Curriculum Affairs will assess the inventory of racism and bias curricular offerings and communicate with stakeholders about the change.

Additionally, the sphere met with ODI, national leaders, and a medical illustrator to develop a specialized patient session on navigating racist patients and/or colleagues during clinical encounters for both UME and GME. They also aim to diversify patient representation across all courses by creating a HIPAA compliant image database in collaboration with dermatology resident Dr. Krystal Mitchell-Gba and clerkship students.

Student Affairs Sphere

In the Students Affairs Sphere, we are working to adopt and support advising practices by Learning Community advisors that actively address racism and promote equity. We are proud to have developed a community of practice amongst our faculty advisors. Additionally, we have collaborated with the student sphere to collect feedback from students about their advising experiences and hope to analyze this data as our next step. We’ve also conducted faculty development training sessions on appreciative advising and crating our advising blueprint for the upcoming year. We look to continue this work by adding a new change target focused on implementing new anti-racism communication strategies for our faculty advisors to utilize with their students.

Student Sphere

In the Student Sphere, they have been focused on understanding the barriers and mediators to student engagement in anti-racist work and developing potential interventions to increase student participation in addressing racism. Thus far, they have hosted monthly racial healing circles since June of 2020, collected engagement data via the student council comprehensive survey, created the Participatory Decision-Making Guide with the MSHS task force to address racism, and facilitated collaborations between groups like Student Council and SNMA. As they begin to analyze the data from the survey, they hope that it will provide more information about student engagement, identify gaps in knowledge in the student body, quantify representation from different student categories, and serve as a baseline to examine longitudinal effects.

While much progress has been made, the students have come across challenges in promoting anti-racism as a value in medicine, increasing the visibility of our work, and maintaining student involvement. They have succeeded, however, in building a community of practice among students and creating space for conversation. They hope to continue this work by implementing healing circles for the clinical years and partnering with other medical schools on the new Anti-Racism in Medical Education program that was recently funded by the Macy Foundation.

Student Resources Sphere

In the Student Resources Sphere, we’ve developed an equity lens decision-making playbook and will be using outcome mapping to monitor the changes that result from its use. There was also work put into developing three one hour equity workshops that will be attended throughout the year by “equity champions” elected from different departments. These identified “equity champions” will attend the workshops, bring the knowledge back to their respective units, and give status update on the changes being seen during several report out sessions. It’s been challenging to implement some of our equity-based strategies as it can be difficult for individuals to pushback against the workplace status quo. Many have also voiced that they believe their individual influence is limited and they cannot directly link changes they see to our ongoing equity lens work. Fortunately, we have started to develop a community of practice and are seeing increased interest and active engagement from a diverse group people.

 

For more information about the on-going focused work within the spheres, check out the Change Targets tracker and our latest release of the RBI Action Updates.

 

This post was written by:

Kiarra Lavache

Strategy and Equity Education Summer Program Intern

Change Targets
RBI Action Update
On the Pulse: May Action Updates

On the Pulse: May Action Updates

Jun 21, 2021 | Racism and Bias

Admissions Sphere

The Admissions sphere has been engaged in analyzing data to inform our work moving forward. With upcoming committee training sessions, we will continue to build upon conversations with veteran members and onboard new members to our culture of self-reflection, learning and holistic review. We continue to gather information about the many different pathway programs in our institution, both known and newly discovered, so we are able to come together and learn together how we can best serve our scholars, students and prospective applicants. Learn more.

Clinical Sphere

The clinical sphere has continued to work within the pediatrics department to facilitate the Chats for Change series and normalize open dialogue about racism and bias. We have completed the first part of the two part series and have the second scheduled for June with additional sessions pending. The second session is in collaboration with the Compliance Office to discuss reporting and options. Based on feedback, we are considering holding a third part to the peds chats for change dedicated to alternative actions/solutions to reporting racism/bias. We are gathering data through surveys and outreach around case examples. We are also starting to explore additional departments that are interested in working with our sphere (ex. Neurology). Learn more.

Student Affairs Sphere

The Student Affairs Sphere conducted a month-long faculty development on appreciative advising. The group explored their own identities and how they impact the advising relationship. The group engaged in breakout work exploring each of the phases of appreciative advising: disarm, discover, dream, design, delivery, don’t settle. For each phase, the groups discussed features, good better, and best practices, reviewed an illustrative case, and described best practice advising questions, how to facilitate student growth, what ways this could be implemented via email, what tools or supports would be needed to achieve the “best” features of this phase, and what considerations might be different for a URM student. The groups debriefed and created an approach to best practices to inform a new model of equitable advising. A writing group is drafting a manuscript on the best practices of appreciate advising for building an anti-racist model in Student Affairs. Learn more.

Student Resources Sphere

The Student Resources Sphere has held two of three equity lens workshops with participants from the medical and graduate schools. Participants will integrate techniques and strategies derived from these workshops in order to critically analyze their functional areas for equity barriers and opportunities. After the third workshop, we will cultivate a community of practice in which they think through impactful and practical solutions that lead to lasting, equity-centered change. Learn more.

Student Sphere

The Student Sphere is awaiting results from the student comprehensive survey to analyze and disseminate the results. We have met to discuss best strategies and practices to disseminate the results, including disseminating quantitative data, planning to clarify the results through qualitative interviewing, and identifying next steps with key stakeholders. We have also begun discussions around orientation programming for the incoming MS1 class to provide a foundation of ways to engage in anti-racist work in their medical education. Learn more.

Medical School-Wide

Our mission statement campaign has entered the next stage. The data collected from the Padlet has been shared with an external expert. Once analyzed, the data will be shared in a community-wide forum to allow for reflection prior to the creation of a revised statement. 

 

The culture survey planning is underway and on schedule! The planning group has identified the core questions that will be included in the staff, student, faculty and postdoc surveys that will be administered in the medical school and the graduate school. Workgroups are starting to review the proposed core questions to provide feedback and identify additional questions of interest. Learn more.

For more information about the on-going focused work within the spheres, check out the Change Targets tracker and our latest release of the RBI April 2021 Action Update.

Change Targets
RBI Action Update

Towards Transformational Change: 2021 Guiding Coalition Change Targets

Mar 15, 2021 | Racism and Bias

The Guiding Coalition is launching twenty change targets this year. This is the first year we have created a comprehensive strategy that includes all of the actions or projects addressing racism in bias across the medical school. A tremendous amount of work and strategy went into planning to ensure we are working collaboratively.

Let us know what you think of the 2021 change targets. Share your comments and feedback.

To learn more about the Guiding Coalition’s approach to developing the Comprehensive, Strategic Plan for 2021 to address racism across all functional areas of the School.

What's a Change Target?

A change target is an incremental desired outcome or end result of the Guiding Coalition’s actions that strategically leads the school towards the Racism and Bias Initiative’s vision to become a health system and health professions school with the most diverse workforce, providing health care and education that is free of racism and bias. Although our journey of transformation is guided by our vision, each year we revisit and revise our change targets because transformational change is largely determined through trial and error as new information is gathered. This is why we course-correct throughout the year as the change process emerges. Each month we will continue to share action updates on our progress.

The structure of the Guiding Coalition allows us to leverage and work with twelve different stakeholders (see graphic below) to ensure we are addressing racism across all of the functional areas of the medical school. This year we are excited to include even more students in the process.

Many of the change targets build on the success of last year’s change targets that focused on training the admissions committee, engaging the pediatrics department in Chats for Change, facilitating growth in personal awareness and anti-racist knowledge and skills among course directors, and working with student advisors on an appreciative advising model. We are also introducing new change targets this year to broaden the scope of the work by creating a new Medical Education Program Objectives (MEPO), rolling out a new equity playbook, strengthening and building new admissions pathways, understanding barriers and mediators around student participation in addressing racism, compensating students for anti-racism work, learning about staff experience encountering racism and bias at work, and much more. 

Below you will find the Guiding Coalition’s change targets organized by sphere and school-wide projects. Check out the progress tracker to learn more about the objectives or steps each sphere will take towards achieving each change target.

Admissions Sphere

  1. Further educate committee members to engage in admissions work from a lens of equity.
  2. Reflect on and broaden the education and training of the admissions committee to continually engage in admissions work from an equity lens.
  3. Strengthen and explore existing relationships with schools/organizations/programs in order to enhance existing admissions pathways and brainstorm about new pathways specifically for students from backgrounds underrepresented in science and medicine to matriculate to the Icahn School of Medicine at Mount Sinai.
  4. Establish partnerships with the Assessment and Evaluation team and the Student Affairs team to track aggregate student outcome data (academic and professionalism) to better inform Admissions work

 

Clinical Sphere

  1. Using an interprofessional lens, establishing and maintaining an environment across the Mount Sinai Health System (MSHS) that allows reporting of racism and bias to be empowering, safe, accountable to the community, anti-racist, provides remediation where needed, and closes the loop by providing feedback to the community.

Curricular Affairs

  1. Create a new Medical Education Program Objectives (MEPO) that addresses racism and bias.
  2. Increase the diversity of the standardized patient (SP) population to better reflect the race/ethnicity make-up of the patient population.
  3. Develop a standardized patient session on navigating racist patients or colleagues during clinical encounters, both as a URiSM student and an ally.
  4. Diversify patient representation of black and marginalized individuals in settings not limited to lecture images, symptom presentation, and case examples across all four years of the curriculum.
  5. Identify the role of SES, race, & gender on student scholarly outcomes/products (Scholarly Year, conference presentations, Distinction in Research and other awards) to enhance equity in scholarship.
  6. Growth in personal awareness and anti-racist knowledge and skills among course and clerkship directors who are front-line voices to students and faculty.

Student Sphere

  1. To understand barriers and mediators around and to develop potential interventions to increase student participation in addressing racism.

Student Affairs Sphere

  1. Adopt and support advising practices by Faculty Advisors that actively address racism, promote equity and improve trust among students and Student Affairs.

Student Resources Sphere

  1. Develop and implement an equity lens playbook, a tool for equitable decision-making across the Department of Medical Education.
  2. Compensate students for scholarly work related to racism and bias.
  3. Engage the ISMMS Advisory Committee on Campus Safety in identifying and addressing issues related to racism and bias.
  4. Learn about staff experience encountering racism and bias at work.

Medical School-Wide Initiatives

  1. Create a mission statement for medical education reflects our stance on denouncing racism and our commitment to racial justice.
  2. Conduct quarterly town hall meetings across the Medical and Grad Schools that aim to process, update, and coordinate responses to current events and community needs as they relate to racism and bias.
  3. Conduct a climate survey with faculty, staff, and students in the medical school and identify areas for intervention.

 

On the Pulse: A Global Sphere Update

Mar 15, 2021 | Racism and Bias, Uncategorized

The Curricular Affairs Sphere aims to promote personal growth in antiracist knowledge and skills among course and clerkship directors. We developed this change target in partnership with students and faculty. 

The first steps included conducting focus groups and structured surveys of course and clerkship directors. This process helped us identify existing strengths and areas for growth as well as opportunities for and barriers to growth in antiracist knowledge and skills.

We then began to work systematically with course and clerkship directors to help meet immediate needs while also gathering data on barriers to growth. So far, efforts have included:

Admissions Sphere

The Admissions sphere has expanded our team over the last month. We have started to plan out and work on our updated and additional change targets. We are reinvigorated and plan to build on our work, learning from each other on the Admissions Committee. Partnering with the MD/PhD program and ODI we look to grow our efforts on ongoing training and education of the Admissions Committee, enhancing admissions pathways and formalizing review of student outcomes to better inform our Admissions work.

Clinical Sphere

In the last month, we hosted a Pediatric Chats for Change (co-facilitated by a member from our sphere and a pediatric staff) that led to a strong discussion about the dynamics of breakout groups, including allied only spaces vs BIPOC spaces. We have continued to plan for 1 more Chats for Change session (Feb) and a topic specific workshop (March), which would create 6 total sessions for the department. We have been updating our working group spreadsheet weekly to develop and reflect on our SMART goals. We will no longer be working with psychiatry as their department leadership is actively working on their own internal initiatives. Opportunities have come up to work with specific departments within pediatrics (eg meeting 2/26 with child life specialists and social work to discuss ideas for combating bias towards patients with sickle cell disease) and OB.  Regarding the mistreatment reports, a meeting was held with external consultants from Vanderbilt and a proposed plan for a mistreatment committee was created.

Curricular Affairs Sphere

In February, the Curricular Affairs Sphere developed a comprehensive plan for our 2021 efforts, including refining our change targets and defining our organizational structure.  We met with SNMA leadership to share this progress and incorporate their feedback.  We are nearing completion of a comprehensive inventory of all current curricula focused on race and racism.  This will help us identify gaps and redundancies in the current MD program curriculum.  

In partnership with students, faculty, the Office for Diversity and Inclusion and patient and community representatives we are analyzing this inventory and developing a curriculum map.  To guide this process we developed a draft Medical Education Program Objective (MEPO) that addresses racism and bias: “Recognize and develop approaches to mitigate bias, social inequities, and systemic racism that undermine health and create challenges to achieving health equity at individual, organizational, and societal levels.”  Our team is now soliciting feedback on this MEPO, and will present it and the Curriculum Map to the Course Directors and Clinical Curriculum Subcommittees upon completion.  Final approval and inclusion of the MEPO will occur with the Executive Oversight Committee prior to the 2021-22 academic year.

An analysis of current recruitment and retention practices is also ongoing, with current auditions specifically calling for SPs of color. Finally, our sphere is engaging Course Directors to diversify the representation of Black and marginalized individuals in their curricular materials as well as in patient presentations.  We have identified multiple external resources and are working with faculty and students develop additional resources to meet the unique needs of our curriculum.  We are grateful for the collaboration across multiple teams and offices to move our change targets forward.

Student Affairs Sphere

We have appointed Daniel as our administrative leader.  He will attend weekly advising team meetings.  He will collaborate with Tara and Leona to build faculty development workshops for the advisors taking place in May as well as provide case-based instruction for faculty development. An invitation has been sent to the Student Sphere to meet in March and collaborate to build an evaluative process that includes year to year data and possible on-the-spot advising feedback. The team is also searching for literature for scholarly work.

Student Resources Sphere

The Student Resources will be identifying equity champions and holding a kickoff equity champions to determine processes and practices for equitable decision-making. Student Resources is also moving forward with plans to fund student research related to racism and bias. Additionally, the group will be engaging the Safety Committee, a group that includes students, security personnel, and senior leadership, in identifying safety issues related to racism and bias. Lastly, Student Resources will be developing a staff survey on experiencing racism and bias at work.

Student Sphere

The Student Sphere has finalized 9 questions about anti-racism engagement to be included in Student Council’s comprehensive survey. Results are anticipated May/June 2021. We are continuing to hold monthly racial healing circles and work on the Participatory Decision-Making strategies for the implementation of the MSHS Task Force interventions or action to address racism.

Medical School-Wide

Dr. Muller, staff and students collaborated to develop a department-wide campaign, “Mission: Make a Statement” to update the Med Ed mission statement so that it explicitly denounces racism and commits to racial justice. From now through Friday, March 26, the department is collecting responses and feedback. Visit Padlet and upload anything that will help us shape the new mission statement.

Deans Muller and Filizola committed to a series of quarterly town halls where students, faculty and staff can process, update and coordinate responses to current events and community needs as they relate to racism and bias. The purpose of the Unit In Action town halls is to provide an ongoing forum whereby members of the ISMSS community can engage in conversations that are responsive to the myriad and intersecting ways that oppression and disenfranchisement impacts our institution and daily lives.

The Office of Diversity and Inclusion and the Racism and Bias Initiative are partnering to plan for the development of a department-wide culture and climate survey with faculty, staff, and students in medical school and identify potential opportunities for change.

For more information about the on-going focused work within the spheres, check out the Change Targets tracker and our latest release of the RBI March 2021 Action Update.

Change Targets
RBI Action Update

Inside the Student Healing Circle: A Lesson in Dignity

Mar 12, 2021 | Racism and Bias

After many months of online lectures, tele-health physical exams, and learning how to cope with the responsibilities of becoming a health professional during a pandemic, I ventured out back onto the hospital wards for the first time this week. I went to a cardiothoracic unit where most patients had recently undergone an invasive procedure and were being closely monitored during their recovery.

When I first introduced myself to my assigned patient, I explained that I was a second-year medical school student there to practice my history-taking and physical exam skills, and that I hoped to spend the next hour with him getting to know him better. He interrupted me before I could finish, “Excuse me, miss, let me find you a chair to sit in. I don’t know where they all went,” and proceeded to press his “call” button to alert the floor staff that he needed assistance. 

He inquired about the chairs to the nursing staff on the floor with no resolve, and so I took a comfortable stance and began my interview. In common practice, I began by inquiring what had brought the patient in initially. I learned about his medical history, which was largely uncomplicated until the summer of 2020, and we shared about how God grants us the gift of forgetfulness to allow us to endure pain. Time after time in our conversation, he would express his frustration with his missing chairs. In the end, this elderly Black man sat in front of me with an assistance device working to keep him and his heart alive, and an infection that had kept him in and out of the hospital for 3 months now – and still, he was the most upset about the chairs that were missing from his room. He was most concerned about his dignity as a patient. 

Donna Hicks, a renowned expert on the role of dignity in conflict, defines dignity as the internal state of peace that comes with the recognition and acceptance of the value and vulnerability of all living things. As social beings, our survival is linked to the quality of our relationships, and honoring dignity in ourselves and others is the foundation of any functional, healthy relationship – whether it be with our patients, our peers, family, friends, etc. However, our evolutionary legacy of self-preservation and systemic oppression often puts us at risk of violating our own and others’ dignity.

My patient, Mr. L spent most of his days in the hospital bed longing for a genuine conversation, and in many ways, the chairs represented connection for him – one that we all crave and are deserving of. Not surprisingly, no one bothered to get a chair and the moment stuck with me. In the Hippocratic oath, we, as health professionals, vow to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” As a physician-in-training, medical school has often made me question my own dignity and reckon with how I/we see and acknowledge the dignity of those we interact with every day. We assume the responsibility for managing patients’ care while frequently serving as leaders to apply our unique knowledge-base, skills and training, and to do no harm. Yet our biggest challenge seems to be the most simple one— treating one another with dignity. 

The power of dignity gives us the awareness and skills to avoid unknowingly harming others, while allowing us to recognize the fullness within ourselves and our relationships. Racial healing, which is grounded in indigenous circle and community-sustaining practices, recognizes the need to speak truths about past wrongs, including those created by individual and systemic racism, and to address the present consequences. It is an experience and a tool that can facilitate trust and build authentic relationships as we draw on our stories to learn from and with one another about how we can heal, rather than cause harm to ourselves and others.

Every month in our circle, we cultivate and harvest wisdom about what is on our hearts and what dignity feels like. Even if we feel a lack of dignity, in our healing circle we can garner the capacity to imagine what it might feel like together and continue to share that practice in our profession. Join us for our next racial healing circle on Friday, March 19 as we stitch together moments of vulnerability to remind each other of our own value and dignity in a safe space.

A community poem, generated from the collective wisdom in our circle and prompts from our Healing Circle session held on February 19.

Dignity feels like

Groundedness

Anchoring

Sureness of self

Curiosity, 

Respect from others,

Feeling physically full,

Nakedness

Authenticity

The power of imagining what it could feel like.

 

My relationship and sense of belonging is grounded in dignity when

It has a name

We are dignified over the conflict over it and the need for it

When it’s chosen and unchosen;

Like the dignity of a child or newborn.

May You Be Happy.

May You Be Safe.

May You Be Well.

 

I will recognize the fullness in myself and others by

Appreciating that there is no right answer and we are figuring it out;

Holding fullness with mystery,

Feeling expansive

Even in our own family, with strangers and those we can count with our fingers,

Expressing gratitude.

This post was written by Jennifer Dias, a second-year medical student at the Icahn School of Medicine at Mount Sinai.