I want to begin by recognizing our 3rd and 4th year students, Kathy Diemer, Angie MacBryde, Tom De Fer and our Clerkship Directors. Our 4th years just completed the match, in stellar fashion if I do say so! And our 3rd years are now 4th years, having completed the last of the large scale Legacy clerkships at the end of March! I could not be prouder of these two classes. While bearing the brunt of COVID-related changes to classroom and clinical learning, they have excelled in every way— academically, professionally, and as leaders, and it is they who helped us solidify our commitment to social justice in education and more broadly. I would also like to recognize Tom De Fer and the Clerkship Directors for spearheading relentless changes to the clinical curriculum in Legacy throughout COVID, paving the way for many of the changes possible in Gateway. Congratulations to all of you for successfully navigating “the bulge” – that difficult time in curriculum transformation when two classes are in the clinical clerkship environment at once!
In the last month, I have had the occasion to speak several times on the topic of addressing racism in medical education, both locally and nationally. It has caused me to reflect deeply on the last two years and I think it is time to revisit Our Commitment to Addressing Racism in Education to assess the progress we have made and what is still left incomplete. Here is what we said we would do and our progress to date:
- We will educate ourselves as we attempt to educate others: We have made significant progress in this domain. We have required bias and antiracism training of all admissions and curriculum faculty and staff. Our Gateway coaches have led the way with the most in-depth training. The School of Medicine Office of Diversity, Equity and Inclusion led by Sherree Wilson has launched the Understanding Systemic Racism Curriculum (modeled on the faculty development provided to our coaches and core curriculum faculty) led by Erin Stampp. They are currently training equity champions to be able to further disseminate this curriculum in a tailored way to each department and program. Our Executive Faculty voted to require this curriculum for all faculty, housestaff, and staff, so as the champion training continues, this will be rolled out broadly to all of us. If you are interested in becoming an equity champion, you can find more information here.
- We will investigate and address biases, discrimination, racism and white supremacy culture in all aspects of our educational work: Here we have also made significant progress. Our admissions team in the MD program has implemented holistic review and implemented other practices to reduce barriers to application to WUSM. As I previously commented, we have seen continued increases in applicants and an almost doubling of students traditionally identifying as under-represented in medicine within our classes over the last 2 years. We will have our largest ever Second Look event on the weekend of April 7 with a larger representation of diversity applicants than we have ever had before.
We have fully implemented a longitudinal health equity and justice curriculum across Phase 1 and Phase 2 of the Gateway Curriculum grounded in structural competence and anti-racism. Recent AAMC Y2Q data (this is a national survey of all second year students across the country) shows that our first cohort of Gateway students rated the curriculum above the 90th percentile (the highest benchmark) in learning effective tools for recognizing their own biases and contributing to their ability to work in disadvantaged communities. Kaytlin Reedy-Rogier and Audrey Coolman have also developed individual curricula in structural competency and anti-racism for each of the Legacy years and our MSTP students, led by Mackenzie Lemieux created a social justice and anti-racism journal club curriculum. In addition, the Gateway clinical skills curriculum trains students a trauma-informed approach to history taking, physical examination and clinical care. Medical students have the opportunity to practice these skills and gain a deeper understanding of the social and structural determinants of health, as well as the importance of an interprofessional team in addressing these factors during the Ambulatory Immersion, through dedicated partnerships with Affinia and Care STL, 2 local Federally Qualified Health Centers and critical partners in our education mission. Our new Phase 2 students are receiving rave reviews in the clinical environment from faculty, residents and patients alike for the skills they have acquired.
We have also implemented a truly thoughtful competency-based assessment system with an eye toward addressing the equity issues identified in grading in the Legacy Clerkships and incorporating the recommendations of the Committee on Equity in Clinical Grading led by Steve Lawrence and Sherree Wilson. Amanda Emke has worked tirelessly to bring this to fruition. It is still too early to determine if we will see an impact on equity in grading and assessment, but this remains a critical outcome that we are committed to measuring and addressing through this new system of assessment. Amanda, Steve and Kathy Diemer are also currently working with a cohort of highly dedicated program directors to help us design the new Medical Student Performance Evaluation (MSPE or Dean’s Letter) and a new standardized department letter to further support the differentiation of our students while attending to issues of bias and equity when applying to residency.
We continue to work on our learning environment and there remains significant work to be done. Our students and residents experience offensive remarks regarding race, ethnicity and gender at unacceptable rates. To this end, the SAFE committee and the Academy of Educators, with dedicated work by Abby Spencer and our Instructional Design Studio, have implemented training for all faculty, housestaff and staff on microaggressions and upstanding. Jenny Duncan and Lisa Moscoso have presented at departments across WUSM on the new reporting and management process for mistreatment including issues of gender, racial and ethnic bias. Finally, it is critically important that we look at our entire educational program through an anti-racism lens- from pre-matriculation to graduation, programming and policies. The Health Equity and Anti-Racism Committee (a subcommittee of COMSE) chaired by Nichole Zehnder does just this and will be continually monitoring our progress.
- We will hold ourselves accountable, admit when we make mistakes, learn from it and continually improve. We also invite our community partners to hold us accountable: Our Program Evaluation and CQI unit is continually gathering data on the curriculum, on student opinion, on the outcomes of our initiatives, and our learner outcomes. We are still too early in the process to see whether we have truly made a difference, but I am hopeful. The curriculum has not gone perfectly, and our students have told us about it. We have relentlessly changed to address concerns and will continue to do so. The early Y2Q data and feedback from our faculty and residents shared above is a good sign that we are making a difference where it matters, but this will be a continual improvement process.
- We will disseminate what we learn so others can benefit from it: We are in the process of completing a mixed methods study of contributions to bias in grading led by Donna Jeffe, Jan Hanson, Eve Colson, Maria Perez and Yaheng Lu. I am participating in a national collaborative of medical education senior leaders to build an institutional self-assessment tool for anti-racism, and many of us are engaged nationally in initiatives at the AAMC, and ACGME to further this work. Our Office of Diversity Equity and Inclusion and our Health Equity and Justice team (Kaytlin and Audrey) have been presenting around the country on the work they have been doing.
This is a long article, but it seemed very important to update you all on the progress we are making and where work still needs to be done. I am pretty darn impressed by what we have accomplished to date (in spite of COVID). This will be a long journey and hard work and it is of such critical importance. It will take ALL OF US to ensure our ultimate success in creating a truly equitable and inclusive environment for all the learners, staff and faculty we serve.