1. Working toward a more diverse healthcare workforce: Evidence and Strategies Pia Castillo, MD Grace Shih, MD MAS Frederica Overstreet, MD MPH Valerie Ross, MS Frederick Chen, MD MPH

2. Disclosures No disclosures

3. Objectives 1.Summarize disparities for Underrepresented in Medicine (URMs) in medical training 2.Present the evidence supporting the role of diversity in promoting excellence. 3.Discuss recent institutional efforts of the UWFM Department to promote diversity 4.Brainstorm at least one strategy that participants can adopt to promote diversity at home institution.

4. Who are URMs? From the AAMC: https://www.aamc.org/initiatives/urm/https://www.aamc.org/initiatives/urm/ "Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”

5. Population of the United States by Race & Hispanic Origin: 2012 & Projected 2060

6. Women/Minorities in Highest Levels of Academic Medicine (National) 12-year average, reduction in each group last 2 years of study Prepared for CEDI by Janice Sabin Yu, Parsa, Hassanein, Rogers, Chang, 2013

7. U.S. Medical School Matriculants by Race & Ethnicity, 1978–2014.

8. Diversity=Excellence: What’s the evidence? Improved outcomes in teaching and learning with improved diversity Physicians from URMS disproportionately serve minority and low income patient populations Communities with improved access and patient outcomes Social Justice

9. Evidence based strategies What we know works: Positive experiences in medical school, with academic support if needed Mentorship, which may or may not be from a mentor of same racial or ethnic background Pipeline programs with no gaps in mentorship Policies and practices that acknowledge and respect the resilience of the individual who had to overcome significant societal barriers Discuss and teach health disparities and the history of racial persecution in society and in medicine -- acknowledge obstacles overcome by members of these groups Changing hiring and recruiting practices

10. UW Dept of Family Medicine Diversity 2013 Diversity task force 2015 Diversity committee formed 8/76 ( 10%) of DFM are URMs

11. What have we done? Development of mission statement Educating ourselves on best practices regarding diversity & hiring Diversity training Committee member on all hiring committees

12. UWFM Diversity Statement We are committed to promoting health equity and creating an inclusive culture by attracting and maintaining a diverse faculty, staff, and student body; ensuring opportunities and equal access to employment, education, faculty/staff development and promotion.

13. Resident Diversity Representative Tasks Developed funded diversity sub-I advertised at Student National Medical Association (SNMA) National Conference and AAFP National Conference Diversity brochure Quarterly meeting with UW Network of Underrepresented Residents and Fellows (NURF) and GME office to help with diversity support and recruitment Structured outreach to medical, undergraduate, and high school students

14. URM Sub-Intern Comments “It was a great opportunity to be accepted as a team member and to participate in all areas of management of patient care. It was an ideal experience right before starting my intern year.” “It was a privilege rotating at UW Family Medicine. I felt welcomed and I learned a lot from the residents and the faculty. It seems that there are some efforts in place to increase racial diversity at UW Family Medicine.”

15. URM Sub-Internship Survey Results Students strongly agreed that this was a worthwhile experience and they felt included They did not see diversity in our residency They did not perceive that diversity was a priority nor the specific efforts being made to increase diversity

16. Diversity measures Demographic data Number of job postings including a statement regarding commitment to diversity Number of search committees with at least one member of the diversity committee Number of consultations with the diversity committee during hiring process Number of faculty that have completed diversity training

17. Challenges Current hiring practices don’t allow time for broad recruitment I-200 in WA: anti-affirmative action law that does not allow for consideration of race in hiring in state institutions Focus in hiring practices not on diversity

18. Discussion

19. References 1.Whitla, D. K., Orfield, G., Silen, W., Teperow, C., Howard, C., & Reede, J. (2003). Educational Benefits of Diversity in Medical School. Academic Medicine, 78(5), 460-466. Retrieved April 4, 2016. 2.Betancourt, J., MD. (2003). UNEQUAL TREATMENT: THE INSTITUTE OF MEDICINE REPORT AND ITS PUBLIC HEALTH IMPLICATIONS. Public Health Reports, 118, 287-292. Retrieved April 4, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497551/pdf/12815075.pdf 3.Section II: Current Status of the U.S. Physician Workforce. (n.d.). Retrieved April 04, 2016, from http://aamcdiversityfactsandfigures.org/section-ii-current- status-of-us-physician-workforce/#fig12 4.Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A. B. (1996). The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations. New England Journal of Medicine N Engl J Med, 334(20), 1305-1310. Retrieved April 4, 2016. 5.Cervantes, L., Chu, E., Nogar, C., Burden, M., Fischer, S., Valtierra, C., & Albert, R. K. (2014). A Hospitalist mentoring program to sustain interest in healthcare careers in under-represented minority undergraduates. J. Hosp. Med. Journal of Hospital Medicine, 9(9), 586-589. doi:10.1002/jhm.2218 6.Orom, H., Semalulu, T., & Underwood, W. (2013). The Social and Learning Environments Experienced by Underrepresented Minority Medical Students. Academic Medicine, 88(11), 1765-1777. doi:10.1097/acm.0b013e3182a7a3af 7.Freeman, B. K., Landry, A., Trevino, R., Grande, D., & Shea, J. A. (2015). Understanding the Leaky Pipeline. Academic Medicine, 1. doi:10.1097/acm.0000000000001020

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