Diversity: What does society and the public expect

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Diversity What does society and the public
expect?

• Fernando S. Mendoza, M.D., M.P.H.
• Associate Dean for Minority Advising and Programs
• Professor of Pediatric
• Stanford University, School of Medicine

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Definitions

• Society
• A community, nation, or broad grouping of people
  having common traditions, institutions, and
  collective activities and interests
• Public
• Relating to all people in a nation or state

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Californias Population19952020
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Californias Population 19952020 Persons Aged
0-19
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Documented Immigrationby Area of Origin
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Poverty Level, Parental Education, and Primary
Language at Home for Families with Children in
NHANES III
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Equal Treatment
The Golden Rule (1961)Norman Rockwell
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IOM Report Unequal Treatment(2003)

• Racial and ethnic health disparities exist
• Disparities are the result of social and economic
  inequities persistent ethnic and racial
  discrimination
• Many sources contribute to disparities in
  healthcare including the health care system,
  providers, managers, and patients
• Bias, stereotyping, prejudice and clinical
  uncertainty may contribute to disparities
• A few studies suggest that patients from racial
  and ethnic minority groups may be more likely to
  refuse treatment

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IOM Recommendations

• Increase awareness of health disparities
  throughout the health care system
• Increase the number of underrepresented racial
  and ethnic minorities in the health professions
• Support the use of interpreters (language)
• Integrate cross-cultural education into the
  training of all health providers
• Conduct research to identify sources of racial
  and ethnic health disparities and develop
  intervention strategies to address them

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The Association of American Medical Colleges is
deeply committed to increasing diversity in
medical schools. This commitment extends to
increasing the number of minority physicians
available to serve the nation's ever-growing
minority population, expanding areas of research
undertaken by medical academics, and raising the
general cultural competence of all physicians
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Medical Schools and Mechanisms to Benefit the
Publics Health

• Training the Health Workforce
• Insuring the diversity of the medical workforce
• Educating the workforce for the practice of
  medicine in a diverse public
• Medical Research
• Insuring that medical research achieves both the
  greatest good and deals with the greatest need
  (health disparities)
• Diversifying the research workforce to support
  the above goal.
• Policy Voice on Health Care

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Studies of the Mix of Generalists and
Specialists in the Physician Workforce David  
A.   Kindig,  MD, PhDRobert Wood Johnson 1998
Race and ethnicity appear to be important factors
in how patients select a physician. Minority
patients are five times more likely to report
having a minority physician than are other
patients. The phenomenon is most pronounced among
Hispanic patients, who are 19 times more likely
to have a Hispanic physician.
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Cultural Competency

• Flores, G.- In 2000, survey of 118 US medical
  school show that only 8 had specific course on
  cultural competency
• Pena-Dolhum et al.-Of 19 school with curriculum
  varied materials and limited language support.
• Whitcomb, M.- Editor of Academic Medicine,
  cultural competency because of its critical
  importance to doctors and their patients..

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Research, Policy, and Institutional Change

• Medical schools are the faculty
• Teachers and role models
• Clinical leaders
• Researchers
• Administrators and School leadership
• Associate Professors and Full Professors are
  agents of change

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Population vs. Medical School Faculty
AAMC Faculty Roster 2003, US Medical School
Faculty N 99,411 (Excludes Other/Unknown
ethnic description and Non-Basic Non-Clinical
Sciences departments)
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Four Decades of Minority Programs at Stanford
School of Medicine
1979
1969
Minority Student Recruitment
MAAP
Bakke (78)
Faculty Senate action to establish minority
program
1980
Minority Faculty Development
1989
Minority Assist Deans
EMP
COE
HCOP
Council of Diversity
1990
Institutionalizing Diversity
1999
209 Prop (97)
Center of Excellence
Decanal Plan For Diversity
Diversity And Empowerment
2000
2010
Office of Diversity and Leadership and Senior
Associate Dean
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What Works In Recruitment

• AMP Awareness, Motivation, Preparation
• Awareness Making a health professions career a
  possibility ROLE MODELS
• Motivation Helping teachers, counselors, peers,
  and families in supporting the student in their
  choice of a health career
• Preparation strengthen math and science
• Faculty Champions- those that see the risk, but
  also see the diamond in the rough

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Faculty Pipeline
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What Works for Faculty Development

• Start early to set expectations of URM students
  (e.g. Early Matriculation Program 18 faculty)
• Early exposure to faculty role models and mentors
• Translate research and academic careers into
  something meaningful to URM trainees
• Involve in academic network and leadership
  development (socialization to academic medicine
  and leadership)

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Best Practice Models

• Health Careers Opportunity Programs
• Provide AMP to minority children down to the
  levels of elementary and middle schools
• Support minority college students in their
  preparation for a health career
• Centers of Excellence
• Support medical students in career development
  and ways to serve their community
• Faculty development and institutional change
• Cultural competency curriculum and health
  disparities research

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What Can You Do to Help?

• Be a role model to students
• Middle School 6th grade High School
• Community Colleges Colleges/Universities
• Medical Schools
• Participate in teaching cultural competency in
  medical schools
• Develop and highlight best practice models of
  cultural competent practices
• Support interpreter services for non-English
  speaking patients