On the Pulse: April Action Updates

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 continues to expand upon conversations associated with our new change targets. We have enlisted the expertise of the Institute for Medical Education team for faculty development as well as the Student Affairs team to create a collaborative approach to review student outcomes and how they inform our Admissions work. We also continue to engage, discuss and collaborate with students on our shared commitments and efforts in Admissions. Moving forward we plan on communicating with our larger Admissions Committee members to re-engage and re-energize as one application season winds down and another is on the horizon.

Clinical Sphere

The clinical sphere has continued to work within the pediatrics department to facilitate the Chats for Change series to normalize open dialogue about racism and bias. To increase awareness and the reporting of racism and bias we have added a two part workshop to the series (first part on 4/30/21) that will provide additional education around identifying racism/bias and the compliance hotline.  Leading up to this workshop, we are sent out a survey to elicit case examples of racism and bias in the clinical environment from members of the department. These cases will be used for the Breakout Group discussions, so real-life examples can be discussed. We have created a communication plan on how to better inform members of the Department of Pediatrics and other involved parties of our updates by identifying point people/stakeholders who can distribute emails with updates.

Curricular Affairs Sphere

The Curricular Affairs Sphere has met with affinity group students and community leaders around the proposed Medical Education Program Objective (MEPO) that focuses on the development of medical student knowledge, skills, and attitudes around mitigating bias and racism.  For April, faculty, staff, and leadership within Med Ed will be asked to provide feedback.  The goal is to launch the new MEPO for the 2021-22 academic year.  The Curricular Affairs Sphere is continuing to develop a comprehensive inventory of all current curricula on race and racism, with the intent of identifying thematic threads and ensuring they all have theoretically sound educational frameworks.   Next steps include identifying gaps and redundancies.

Student Affairs Sphere

We have met with the Student Sphere to build a stronger working relationship between our spheres. They were able to provide us insightful feedback about how we can solicit feedback from students regarding advising practices which will help us to know if our change target is making a positive impact. Tara and Daniel also continue to meet with Leona on a bi-weekly basis to map out our May Appreciative Advising meetings which will allow our advisors to build a stronger community among one another and will help them have a greater understanding of why we are using appreciative advising as our advising model.

Student Resources Sphere

The Student Resources Sphere has identified staff throughout the Department of Medical Education to be “equity champions”. Equity champions will participate in a six-part workshop beginning in May. Members of the ISMMS Advisory Committee on Campus Safety are now invited to join. Additionally, Student Resources is also moving forward with plans to fund student research related to racism and bias. Lastly, Student Resources will be working with the Office of Diversity and Inclusion on developing a staff survey on experiencing racism and bias at work.

Student Sphere

In collaboration with Student Council, the student sphere has released its engagement questionnaire as part of the comprehensive student survey to the study body. We have also worked with the Guiding Coalition to discuss and plan next steps for the Mission Statement revision. 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

The culture and climate survey workgroup has started to review and assess existing surveys that have been implemented at other institutions. We are excited to report that the entire ISMMS will participate in the survey, which will result in data that can be used to inform interventions in the Graduate School of Biomedical Sciences and the Medical School. 

Our mission statement campaign is entering the next phase. We dedicated time during a Guiding Coalition meeting to reflect on the very wide range of responses. The Student Sphere also conducted a meeting to discuss the responses. The data from the Padlet will undergo a qualitative analysis by an external expert and will be shared in a community-wide forum to allow for reflection prior to the creation of a revised statement. 

The next Unity in Action Town Hall is scheduled in August for the start of the new academic year and will focus on the experiences with racism of Native Americans and people who identify as AAPI.

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.

What’s Chats for Change?

Beginning in the fall of 2018, the Department of Medical Education at the Icahn School of Medicine at Mount Sinai launched “Chats for Change”—a series of interactive sessions that spark dialogue centered on racism and bias in medicine.

 

 

Chats for Change is built on the notion that in order to respond to racism and to be anti-racist we must engage in dialogue, learning and action. The idea of Chats for Change was developed in response to medical education staff, students, and faculty who wanted dedicated time to engage in a dialogue as a community and deepen our collective understanding and ability to address racism.

By participating in Chats for Change, we offer an opportunity for attendees to explore key concepts related to racism and bias and uncover who they are in relation to others. Even though the dialogue is structured, the expectation is for attendees to express themselves from their own lived experiences and listen for deeper understanding and insights that will promote learning and unlearning.

We invite all faculty, staff, trainees, leaders, students and others within the health system to join us and engage in dialogue as we work towards a common understanding and contribute our best thinking, knowing that other peoples’ reflections help to improve our thinking. We are committed to helping each other reveal our assumptions and biases for self-revaluation.

Did You Know?

The Department of Medical Education launched two versions of Chats for Change:

One that’s offered to all faculty, staff, and students within the Mount Sinai Health System, and

Another that’s offered nationally—to all within the medical education and healthcare communities.

Towards Transformational Change: 2021 Guiding Coalition Change Targets

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

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.

Inside the Student Healing Circle: A Lesson in Dignity

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. 

On the Pulse: Desegregating Healthcare Systems

What does a desegregated health care system look like and how can we get there? This was the theme for the Chats for Change on March 2, 2021.

We gathered.

Nearly 100 students, faculty, care providers, hospital leadership, and administrators gathered to share their perspectives and knowledge on the issue. We had representation from across Mount Sinai’s campuses as well as folks from other institutions in NYC!

We framed the conversation.

We began our conversation by setting a common framework for the dialogue by defining segregated care: the separation of patients based on insurance status. This exists when patients who have public insurance are seen by different physicians, in a different location, or at different times than patients with private insurance. This segregation by insurance negatively impacts patient experience and how students learn about medicine. This separation occurs both within institutions and between the public and private hospital systems. 

The systemic effects of racism, white supremacy culture, and capitalism are embedded into differences in insurance status. As a result, by segregating by insurance, we are segregating patients by race. One-in-four non-elderly New Yorkers have medicaid, and among those Medicaid enrollees, white people are under-represented and people of color or over-represented. Segregated care perpetuates racism and inequity.

As the theme suggests, our goal was to imagine a desegregated, equitable system, which requires us to move beyond the way the system is currently set up. So we moved on to brainstorming the different avenues of care in New York City to acknowledge what is currently in place. Responses ranged from the community health centers, urgent care, private practice, to the internet, with hospitals making up the overwhelming majority. 

We dialogued

In small groups, we discussed the following questions:

  1. What would a desegregated system look like across NYC, assuming there are truly no boundaries? 
  2. Who might benefit from a desegregated health care system?   
  3. What is an immediate actionable change that can be made to bring us closer to a desegregated system? 

The point wasn’t to be bogged down in the barriers. The point was to envision a better future. As such, we framed the conversation as aspirational. Our dialogue didn’t need to be feasible or realistic. We focused the purpose on envisioning who and how people would benefit from a desegregated system and what that would look like, rather than how we would get there. Then, we spoke about changes that could be made to get us closer to what we envisioned. 

We aspired: 

Individuals brainstormed and logged in their responses. Here are some of the themes that arose:  

Desegregated care would mean:

  • Equity in access to resources and longitudinal care 
  • Educating physicians to treat a diverse patient population
  • A renewed focus on preventative care
  • All people, regardless of insurance or immigration status, would be able to access care

We brainstormed ways to get there together: 

  • Mount Sinai should/will publicly denounce Segregated Care both institutionally and across NY.
  • Full price transparency mandated to all hospitals/clinics/healthcare systems to promote using money in a more equitable manner. 
  • Lower the debt burden for medical students to prevent the physician financial stress that contributes to segregated care and diversify our physician network.
  • Move towards a single payer model for healthcare. 

We will take action: 

  • Acknowledge and actively address biases. 
  • We will continue the conversation and note differences in our training, work, and community that are grounded in structural racism and segregated care
  • Talk to peers working at different institutions to see how we can work together towards a desegregated, more equitable system
  • Instead of focusing on barriers, we will focus on the immediate actionable changes that can be made. 

We will continue the conversation: 

If you are working on desegregation and integration at Mount Sinai or any other institution, the Segregated Care Work Group would love to hear from you – please email Emily Xu (emily.xu@icahn.mssm.edu) and Paige Cloonan (paige.cloonan@icahn.mssm.edu) to set up a time to meet with us! Please also reach out if you’re interested in working on a project with us! We welcome everyone – regardless of role or institution. 

Do you have any experiences with segregated care as a provider, patient, or trainee (student, resident, fellow) that you would like to share? Feel free to contact us directly, or submit your story anonymously here


This post was written by Emily Xu and Paige Cloonan, medical students and co-facilitators of the Chats for Change session, “Desegregating Care: Imagining an Equitable NYC Healthcare System.”

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