The Future of Leadership in Diversity and Inclusion
New Approaches to an Old Problem
When a patient’s physician looks like the patient does, same ethnicity or gender, studies have shown that patients are more compliant and less likely to no-show for appointments. Yet the current population of physicians does not look like the general population of the U.S.A. The uncomfortable truth is that physicians as a group tend to be far more white and male than the general population. Thus, academic health centers have failed in a fundamental way in which they could have improved the public’s health.
New approaches are needed to improve the diversity of the U.S. physician work force, says Chiquita Collins, Ph.D., the inaugural vice dean of inclusion and diversity for the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. UT Health San Antonio is acutely aware of this problem, she said, since the university is located in an underserved Hispanic-majority region the size of Pennsylvania.
One of her first new projects was starting a monthly diversity grand rounds. Dr. Collins invites nationally renowned minority physicians and scientists to speak to students and trainees. “We decided to open the grand rounds so anyone on campus can attend. We often served lunch and had several hundred attend regularly. When surveyed, 95 percent of participants say the program has value to them.”
These grand rounds were especially important for the minority students already here, since it provided a role model of leadership they could aspire to. Robert Hromas, M.D., dean of the Joe R. and Teresa Lozano Long School of Medicine, concurred, “If you can’t see it, you can’t be it.” Dr. Collins put together multiple leadership mentoring programs for minority students, from individual monthly mentoring and diversity projects to supporting travel to meetings.
The George Floyd tragedy renewed awareness of the racism systemic in society, and these minority student leaders were ready to seize the opportunity for change. They led multiple “White coats for black lives” rallies. They also assisted in a curriculum review to identify and exclude long held discriminatory paradigms, such as the GFR automatically being calculated higher for African Americans, resulting in fewer kidney transplants.
Dr. Collins, an associate professor in the Department of Population Health Sciences, said her team has developed multiple recruitment strategies for faculty from diverse populations. The Inclusive Excellence Recruitment/Retention Program provides multiple levels of support—including mentoring, group dinners, and attendance at relevant meetings—for new faculty from socially disadvantaged backgrounds.
Dr. Collins also started a Loan Repayment Faculty Recruitment Program for faculty who are engaged in research directly relevant to health disparities. This program not only assisted faculty from underrepresented backgrounds but also promoted research into economically disadvantaged populations who are medically underserved. The program is intended for those who have educational debts that make entering an academic career difficult. “We have three faculty members who have received the loan repayment assistance. They can renew annually for up to three years,” Dr. Collins said.
Another initiative that Dr. Collins has led is a partnership with the San Antonio Independent School District to develop the CAST Med High School, which is located at Brooks City Base (formerly Brooks Air Force Base) on the Southeast Side of San Antonio. The school opened in fall 2019 with its first freshman class of 150 students. This school year another class of 150 incoming freshmen began class.
CAST Med High School has three pathways for students: biomedical research, medical professions and public health. This public high school is open to students across Bexar County through a lottery system. Using a lottery system was a conscious choice to prevent the bias an admission exam gives to students who are socially advantaged. Many minority students lack access to basic study aids such as the internet, and rarely have tutorial help from any quarter.
UT Health San Antonio serves as the high school’s anchor partner with the goal of helping the school prepare medical school aspirants, Dr. Collins said. “This high school caters primarily to low-income Hispanic students. With a strong educational foundation in high school, we hope to see these students attend college and then go on to attend medical school or another health care program at our university.”
Dr. Collins said she is partnering with CAST Med High School and sister undergraduate institution, UTSA, to create a seamless pipeline into medical school. “The Long School of Medicine has the incredible opportunity to shape curriculum at this high school to prepare students academically for future careers in biomedical research, medicine and public health. Students are assigned a counselor at UTSA to assist them toward admission and earning their bachelor’s degree. Our admissions office then offers a defined program to counsel them on applying for medical school. Our students and faculty are able to act as mentors and encourage the next generation of medical students,” she said.
A GLOBAL APPROACH
Dr. Collins said that to make an impact on diversity in medicine, everyone must participate, because everyone is a stakeholder, and everyone can make a difference. Her office is unique because it truly caters to everyone—students, house staff, faculty and staff. “We want to make sure decision-making committees on campus are not allowing bias to taint their work,” she said. Every year she provides mandatory Implicit Bias Training to mission critical committees, such as admissions, resident selection, and leadership search committees.
“This bias training has the goal of ensuring we are educating physicians who reflect the patient population and are culturally sensitive,” said Dr. Collins, who is recognized at the state and national levels for her work in health disparities.
“We have a majority of patients who identify as Hispanic or Latino. We also have a growing Asian population. In addition, we have a large refugee population in this area. In order to reduce health disparities among these populations, we need physicians who patients feel comfortable talking to and who they have something in common with.”
One motivation to enhance diversity for all medical schools is the accreditation process. Accreditation by the Liaison Committee on Medical Education (LCME) requires a defined diversity program. This was a seminal opportunity to get the school working together on diversity, Dr. Collins said. “That was our first success here. We went through the 18-month accreditation process from the LCME and received no citations at all for diversity or inclusion.”
Dr. Collins said her goal at the Long School of Medicine is that her team’s efforts will result in an institutionalization of diversity and inclusion. “I want it to become so organic that it is just who we are here.” In this manner, diversity and and inclusion becomes habitual, and will last long after she has retired, she said.
Since this is a regional, state and national issue, Dr. Collins believes she must remain active across the region and country. In San Antonio, she is a member of the Population Health Advisory Committee, which provides science-based, expert advice regarding steps to minimize risk and offer recommendations on mitigation and prevention strategies for the city of San Antonio, the City Council and the mayor.
She is a founding member of The Texas Medical Schools’ Diversity and Inclusion Consortium, which includes diversity officers from all the medical schools in the state. The consortium’s mission is to create a network for key stakeholders and decision makers involved in student, resident and faculty diversity and inclusion efforts so they can share ideas, best practices and possible solutions to challenges.
Dr. Collins is the chair-elect of the Association of American Medical Colleges (AAMC) Group on Diversity and Inclusion. She will become chair in 2021 of the group created to support the efforts of the AAMC-member institutions and academic medicine to realize the benefits of diversity and inclusion in medicine and biomedical sciences.
She also serves as a member of the AAMC Equity, Diversity, and Inclusion Cross Continuum Competencies Committee, which is tasked with assisting the AAMC in developing competencies tiered across the continuum of medical education.
“The AAMC has a long history of being at the helm of making policy that affects schools across the country. We must work in tandem with the other medical schools. It is important that we create synergy and work together to elevate diversity, equity and inclusion for everyone,” she added.