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 ofpractice 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
On Tuesday, March 20, the Department of Medical Education hosted a Town Hall to announce a clear message about racism and bias: The time to change is now. After the event, we distributed a post-event survey eliciting your feedback. Based on the post-town hall survey results, we identified and answered the top nine questions posed.
How did this initiative start? Are we just appeasing students? What happens to resistant faculty?
As a result of ISMMS medical student activism and advocacy aimed at having our medical school recognize the historical underpinnings of racism and bias in medicine and in our medical training, we launched the Racism and Bias Initiative in 2015. Since the initiative’s launch in 2015, we have undertaken several RBI interventions that have primarily addressed events related to racism and bias in curricular and student affairs, admissions, and other functional areas of the School.
During this time, medical education leadership also:
Envisioned a transformational change vision for the initiative.
Developed and approved an integrated change management strategy and structure.
Participated in retreats and training opportunities to build internal capacity to lead transformational change.
The students ignited this process, and it is now a paradigm shift for our school.
How does racism and bias manifest itself in the School and hospital? What are the real issues we’re facing?
In our school, we see persistent patterns and behaviors that privilege white students, faculty, and patients. These patterns and behaviors are deeply embedded in our structures. They are written and unwritten “rules of the game” and include policies, practices, distribution of resources, relationships, lack of faculty of color, unequal access to and quality of care, persistent beliefs in the genetic and biological view of race, and unequal outcomes for academic success for students of color.
What are the specific action plans? How can we track progress?
We have developed a new timeline feature on Change Now that allows you to stay informed about where we are at in the process, where we are headed, and where to find additional information (blog posts, references, etc.). The timeline will be updated on a monthly basis.
How do we measure outcomes? How do we know if we are successful?
Starting in June, the Guiding Coalition will define what the change targets will be, how to get there and how to measure success. Prior to the implementation phase in August, we will share a more formal plan and metrics on Change Now.
How are leaders held accountable? Why should we trust leadership? Why can’t we bring in an anti-racist third party?
One of the mechanisms and structures set in place to hold all of us accountable is the Guiding Coalition, comprised of individuals from across ISMMS (staff, faculty, students, other stakeholders) who contribute unique skills, roles, lived and professional experiences, perspectives and networks in order to enable the most innovative ideas to emerge.
The Guiding Coalition is a powerful, enthusiastic group of change leaders who:
Represent all our constituent groups
Develop new strategies
Oversee the transformational change targets
Identify options for implementation
Make decisions about where the energy and resources should be focused in order to transform ISMMS
In order for transformational change to be profound, lasting, foundational, and irreversible we need a long-term commitment that can only be driven from within.
How can people get involved? What are roles for allies and activists?
You can get involved in many different ways.
On an individual level, we encourage you to start or continue to adopt anti-racist approaches, a racial justice lens and anti-bias mindsets, behaviors, and practices. This includes focused and sustained actions that reduce power differentials and eliminate racism. It’s an active way of seeing and being in the world in order to transform it.
Our individual actions can cumulatively serve to maintain existing forms of inequity or they can serve to dismantle systems of oppression. Because racism is at all levels and spheres of our school and society, anti-racism must permeate everything. It doesn’t just happen in the work force, the classroom or in select aspects of our lives. Throughout the year we will provide tools, training, and other opportunities for all of us to learn more about how to be anti-racist.
If you want to play more of an active role in identifying what needs to change in order for us to provide health care and education that is free of racism and bias, and how to get there, you can join the Guiding Coalition in June for a series of interactive sessions. If you would like to sign up, click here [insert link] by 5 pm on May 21.
After the change has been identified, we will provide more information about how you can support the change and be an ally.
Why are we worried about changing processes and people if we haven’t yet acted on seemingly minor issues raised by students?
If our vision is for transformational change, we recognize that organizations or institutions don’t change, people do. Therefore, it is critical for our strategy to not only identify what needs to change (content), but how we as individuals and as a community engage, prepare, support embrace and utilize the change (people side). We have been intentional about the process of how we design, develop, and deliver the change so that it isn’t just a top down strategy, and aims to center marginalized voices. All of this is needed in order to transform or shift the culture of the school from the current state to the future vision.
Where will we be in one year from today? What do we know will be different?
This a great question, and we will know more after we identify the change targets, outcomes and outputs, and tactical plan. Stay tuned. We will know more after June.
What are our guiding principles? How do we know how to undertake this process?
In order to transform the School from the current state to one that actively identifies and explicitly addresses all forms of racism and bias, centers racial justice and health equity, and lifts up underrepresented voices and experiences we must recognize the current state, support individuals and ISMMS through the transition state, and envision and actualize the future state. We are relying on a strong foundation of research and the practice of change management to inform and guide our process map.
While not necessarily comprehensive, the following principles capture many of the qualities of transformational change (Gass, 2014).
Attend to the whole system.
Transformational change is a true systems approach that attends equally to hearts & minds, behavior, structures and the social systems in which they exist.
Be the change.
A fundamental tenet of transformation is that who we are impacts the results we will create. We use practices to “be the change.” We don’t just talk about the change, and we don’t wait for the change to happen.
It’s all about “we.”
Our dominant culture teaches us individualism and competition. Transformational change invites us to recognize that we not only need each other, we are profoundly interconnected. It’s important to appreciate that collaboration is not just about being nice to each other. It’s about learning how to embrace the rich diversity of different interests and perspectives that can help us achieve the critical breakthroughs we need at this time of increasing complexity and political divisiveness.
Practice, practice, practice.
It’s important that we understand the necessity of practice to integrate real change in our lives and in our work, clinical and learning environments.
What we appreciate, appreciates.
Critical analysis is an important tool that helps us attend to the whole system while we transform our approach to racism. But it also has limitations. There is a need to balance critique with an appreciation of what’s good. Throughout this process we will learn how to build as well as how to deconstruct, to honor as well as critique.
Go the distance.
We have approached this work from the onset with an eye toward what is required to sustain the transformation. The structured process of RBI is designed to integrate sustainability throughout the process.
On March 20, 2018 the Department of Medical Education hosted a town hall meeting in an effort to share our approach to the next phase of the Racism and Bias Initiative—the people and process side of the transformational change. The town hall presented a unique opportunity for students, staff, senior administrators, faculty, and others to come together to learn how we are going to address racism and bias in curricular and student affairs, admissions, and the clinical learning environment.
Dean Muller presented a change management strategy that will guide our transformational change process and fielded questions on the next steps. Members of the leadership team responsible for shepherding change in their functional areas spoke of their personal commitment to the initiative.
The town hall included a question and answer portion in which students voiced concerns regarding the current climate of the learning environment, and highlighted the necessity for systemic, transformational change.
Some of those concerns were echoed in the post-town hall survey:
These results demonstrate that while there is uncertainty regarding the strategy that informs the Racism and Bias Initiative, there is strong interest and support for the cause. As we proceed with the Racism and Bias Initiative, we hope to provide transparency and authenticity that speaks to this uncertainty. We will work actively and relentlessly to realize our vision: to become a health system and health professionals school with the most diverse workforce, providing health care and education that is free of racism and bias. In doing so we ask for your help.Track our work and get involved by signing up to participate in interactive sessions that will aim to answer the question: “What needs to change in order for us to provide health care and education that is free of racism and bias, and how do we get there? Sign up here.
