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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Comprehensive, Strategic Plan for 2021 | Addressing Racism Across all Functional Areas of the School

Each Guiding Coalition Sphere is in the process of developing a comprehensive, strategic plan for 2021 that incorporates all activities that contribute to the vision of becoming a health system and health professions school free of racism and bias. This year our aim is to integrate all efforts into one comprehensive plan so that we can work more collaboratively and begin to examine our collective impact. 

The 2021 plan will include:

Change Targets

Change Targets will be...

A concise (one sentence) goal, desired outcome, or end result. Each of the spheres will reevaluate their existing change target and add additional change targets based on the new scope of work (e.g., SNMA actions). The proposed change targets will focus on 1 to 2 year time periods. 

SMART Objectives

Smart objectives are...
  • Specific: includes the “who,” “what,” and “where.” 
  • Measurable: focuses on “how much” change is expected
  • Achievable: realistic given resources and planned implementation
  • Relevant: relates directly to change target
  • Time-bound: focuses on “when” the objective will be achieved

Accountability

Accountability means...

Each sphere will utilize a tool to establish a clear accountability structure to: (1) quickly clarify accountability for the 2021 plan; (2) clarify specific roles for everyone involved in working towards change targets; (3) create a shared language for assigning and tracking accountability; (4) enhance Med Ed’s efficiency; and (5) deepen trust by improving follow-through.  

  •   DARCI Accountability Grid:
    • DECIDER/DELEGATOR: Holds the ultimate power re. the 2021 Plan. Power can be retained as the right of final approval/veto, or delegated to the A. The D in this case is the Guiding Coalition.
    • ACCOUNTABLE: The single person fully accountable for the change target. The A must be given sufficient decision-making power and room to learn/adjust commensurate with accountability. 
    • RESPONSIBLE: Those responsible for doing the work on the project. There may be a number of R’s on a project. R’s are responsible for dealing with roadblocks, raising questions, etc. – not just being “good soldiers.”
    • CONSULTED: Those from whom input will be solicited. 
    • INFORMED: Those to be kept apprised of relevant developments. This is an FYI role.

Success Measures

Success measures means...

For each of the Change Targets there will be metrics that will measure the success of our efforts towards our vision. To identify these metrics, we are examining the characteristics of “significant” system change that provide powerful signals that the system has changed. Here are a few key features that will inform our success measures:

  • The depth of the change in terms of:
    • Disruption of existing system patterns
    • Networks of connections within the system that shape how we interact 
    • Norms influencing the behavior of those who are in the system 
  • The strength of the change in terms of:
    • The scale at which the change has taken place 
    • The level of “buy-in” to the change 
    • The relevance of the change in how strongly it influences the way the system achieves (or not) the change target outcome

Timeline for the 2021 Comprehensive Plan

February 12

Sphere comprehensive 2021 plans are due.

February 22

Spheres present plan to the guiding coalition and obtain feedback.

February 24

 Incorporate feedback and finalize 2021 plan.

March 1

Share the final plan in the RBI’s monthly action updates newsletter and post on Change Now.

June 14

The first quarterly review will happen in June where the guiding coalition will review its work towards the 2021 plans and assess progress. A participatory decision-making structure will be implemented during this meeting to address differences in positional power,  better integrate our efforts, and promote collective impact.

On the Pulse: February’s Action Updates

Every month, we are providing action updates across the Racism and Bias Initiative’s spheres. This month’s action updates bring us closer to collaborating on our efforts, strategically building on existing actions, and developing new actions to address racism and bias across all areas of the medical school.
Admissions Sphere

The Medical School Admissions team has developed and implemented a “Diversity, Equity, and Inclusion Form” to document important discussions about bias or equity that occur at any point during the admissions process. The Admissions Committee has created a procedure called “time-in” in which committee members can state “time-in to learning and discussing” to address potential occurrences of bias, facilitate discussion, and enhance the educational experience. This process is now embedded in the MD and MSTP Admissions Committee meetings. A Committee Learning Climate Pre-Survey was distributed to all Committee members on the MD and MSTP Admissions Committees. This survey will gather a baseline of committee perception of bias in the admissions space. The post cycle survey is poised to go out to committee members. Importantly the Admissions Sphere is actively partnering with the SNMA Leadership to align priorities and develop strategic initiatives for admissions.

Clinical Sphere

The Clinical Sphere is embracing the SNMA action items across many areas. We’ve reinforced communication around the importance of our zero-tolerance policy related to retaliation towards students who take a stand against racism. The Committee on the Student/Trainee Learning Environment will be including students in the process of adjudicating mistreatment reports. The mission statements for Medical Education and for ISMMS are being revised, denouncing racism and incorporating our commitment to racial justice.  SNMA and ISMMS leadership meet regularly to review and update progress on addressing the SNMA action items. A dedicated Chats for Change is ongoing with co-facilitation between Clinical Sphere members and the Department of Pediatrics; this includes workshops for strategies to interrupt instances of bias in the workplace. Med Ed is working with the Faculty Council on targeted URiM faculty recruitment to key committees.

Curricular Affairs Sphere

The Curricular Affairs Sphere is undertaking 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. In addition, the CA Sphere is also seeking to identify all current faculty development offerings on anti-racism and anti-oppressive facilitation techniques. Building on the success in InFocus Weeks, ASM, and Brain and Behavior, we are working closely with course leadership and faculty to enhance anti-racist content and educational practices within the Year 2 Musculoskeletal Pathophysiology Course and the Year 3 Internal Medicine Clerkship. Recognizing the critical role of both content and pedagogy in anti-racist medical education, we are creating a comprehensive plan for our efforts in 2021. In early February we are scheduled to meet with SNMA leadership to share our current progress and discuss next steps, and aim to share details about our 2021 comprehensive plan next month.

Student Affairs Sphere

The Student Affairs team is continuing to develop the “Appreciative Advising” model to provide a framework for increasing advisor and student success. The Student Affairs sphere is partnering with students on evaluation and feedback to inform future planning. We are brainstorming to determine other means of effectively evaluating the success of our advising techniques.  We are also looking ahead to the month of May when each of our weekly faculty advising meetings will be dedicated to Appreciative Advising training. We look forward to collaborating more closely with the Student Sphere of the Guiding Coalition in the coming months.

Student Resources Sphere

The Student Resources sphere has completed a first draft of an equity lens playbook for use by stakeholders throughout the Department of Medical Education. Student Resources is moving forward with plans to fund student research related to anti-racism with the goal of compensating students for taking action to combat racism and bias.

Student Sphere

The Student Sphere is finalizing the last steps of their engagement surveys to be shared with the study body. 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.

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 February 2021 Action Update.

On the Pulse: A Curricular 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:

The Art and Science of Medicine (ASM)

  • Extensive anti-racist curricula exist, and will be expanded and used as a framework for approach to racism as the driver of racial inequities explored in other courses.
  • Anti-racist and anti-oppressive small group facilitation faculty developments

Brain and Behavior

  • Additional content: history of racism in psychiatry, racism as driver of racial inequities in serious mental illness, cerebrovascular accidents (incidence and outcomes) and dementia
  • Additional didactic and small group discussion on racism in psychiatry
  • Inclusion of content on summative exam
  • Faculty developments on anti-racism content
  • Faculty developments on anti-oppressive facilitation techniques

Muscoskeletal (MSK)

  • Meetings with course director and faculty underway, with additional content and faculty developments being planned

Internal Medicine Clerkship

  • Divisional grand rounds being developed
  • Meetings with clerkship director under way

Pediatric Clerkship

  • Anti-racist trainings initiated with all Pediatric Hospital Medicine faculty and fellows and Adolescent Medicine faculty and fellows including introduction to White Supremacy Culture and antiracist bedside skills.

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 January 2021 Action Update.