Diversity: What does society and the public expect?

1. 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

2. 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

3. California’s Population1995–2020

4. California’s Population 1995–2020 Persons Aged 0-19

5. Documented Immigrationby Area of Origin

6. Poverty Level, Parental Education, and Primary Language at Home for Families with Children in NHANES III*

7. Equal Treatment The Golden Rule (1961)Norman Rockwell

8. 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

9. 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

10. 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

11. Medical Schools and Mechanisms to Benefit the Public’s 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

14. 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.

15. 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..”

16. 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

17. 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)

18. 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) Decanal Plan For Diversity Center of Excellence Diversity And Empowerment 2010 2000 Office of Diversity and Leadership and Senior Associate Dean

19. 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”

20. Faculty Pipeline

21. 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)

22. 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

23. 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