First Institutional Experiences with the New LCME IS-16 and MS-8 ...

2011 Diversity ResearchForumFirst Institutional Experiences with the NewLCME IS-16 and MS-8 Diversity StandardsModerator:Marc Nivet, Ed.D.Presenters:Barbara Barzansky, Ph.D.Andrew Chesson Jr., M.D.Chenits Pettigrew, Ph.D.Jonathan Appelbaum, M.D.Karen Antnam, M.D.November 8, 2011

The History and Application ofthe LCME’s Diversity StandardsBarbara Barzansky, PhD, MHPELCME Co-Secretary

Goals of the Presentation Describe the history of standards IS-16(institutional diversity) and MS-8 (“pipeline”programs to broaden diversity) Summarize the expectations of the standards Describe the main reasons for citations ofnoncompliance

Previous StandardsMS-8: Each medical school should havepolicies and practices ensuring the gender,racial, cultural, and economic diversity of itsstudents.FA-1: The recruitment and development of amedical school’s faculty should take intoaccount its mission, the diversity of its studentbody, and the population that its serves.

Basis for the ChangeStandard IS-16 was informed by severalsources: Supreme Court decisions 2008 AAMC document Roadmap to Diversity Input from a broad-based advisory groupNew standard MS-8 was based on theexpectations of the previous MS-8 (MedicalStudent Diversity)

New StandardsIS-16. An institution that offers a medicaleducation program must have policies andpractices to achieve appropriate diversityamong its students, faculty, staff and othermembers of its academic community, andmust engage in ongoing, systematic, andfocused efforts to attract and retain students,faculty, staff, and others from demographicallydiverse backgrounds.

New Standards (con’t)MS-8. A medical education program mustdevelop programs or partnerships aimed atbroadening diversity among qualifiedapplicants for medical school admission.

Attention to diversity is now anexpectation for an institution Need for focused, significant, and sustainedefforts (from annotation to IS-16) Institutional policies related to diversity are putinto effect in:- student recruitment, selection, retention- financial aid- the educational program (e.g., culturalcompetence)- faculty/ staff recruitment, employment,retention- faculty development- liaison with the community (e.g., servicelearning)

Schools share responsibility to expandthe pool of diverse applicantsA medical school should work within its owninstitution or collaborate with others to makeadmission more accessible:- Pipeline programs- Collaboration with institutions that servestudents from disadvantaged backgrounds- Community service activities that heightenawareness of medicine as a career- Academic enrichment programs(From annotation to MS-8)Need to document the results

Leading Causes of Noncompliance Failure to codify diversity in institutionalpolicies- at the medical school level, preferably; couldbe at the university level Failure to define categories for students,faculty, and staff that “add value” to thelearning environment Failure to document that there are programs toenhance diversity in place and resources tosupport these programs

Diversity ResearchForum2011 AAMCAnnual meetingAndrew L. Chesson, Jr., M.D.Dean, School of Medicine LSU Health SciencesCenterShreveport, Louisiana

A Case Presentation:Gathering evidence to meet thediversity standardsThis 37 year old medical schoolpresents with a CC of needing toobtain clarification concerningdiversity accreditationstandards…

About Us - (PMHx)North Louisiana physicians andcommunity leaders worked with arealegislators to:• develop a second state-supported SOM• provide more opportunity for Louisianacitizens to enter the healthcare field• train more physicians for Louisiana(especially for rural and underservedareas of the state)

AND…• continue the long Louisianatradition for providing healthcare forits citizens (our hospital had beenserving that mission in Shreveportsince 1886 , when it was founded toprovide healthcare for “newly freedpeople of color and the returningconfederate veterans”)

Social History

Medical Students – (Physicalexam)• We only accept Louisiana residents• Class size: 100 to 118 over 7 years• GPA: 3.63 – 3.73 (3.6 – 3.7)• MCAT: 27.5 – 29 (30.3 – 31.1)• Low tuition: $12,000 to $13,500

Curriculum Strengths• Tremendous clinical experiences, relatedteaching pathology, and considerable timeinteracting with patients as their teachersstarting from the first week of theircurriculum• Despite entering students with less thannational average MCAT scores, at the end ofthe curriculum, they are at or above thatnational average in USMLE Parts 1, 2 and 3pass rate.

Some Diversity Challenges• Despite several HBCs in Louisianawith a high quality of many of theirgraduates, one cannot qualify forstate residency while attendingschool• Hopwood vs. State of Texas [5 thCircuit - 5 state region (Texas,Oklahoma, Louisiana, Arkansas andNew Mexico)]

What brought us to ourpart in the DiversityResearch Forumpanel?(Laboratory and x-ray results)

Last Full LCME Visit – Jan. 2006IS-16Areas of “partial or substantialnoncompliance”• IS-14 (more research opportunities)• FA-2 (Derm currently a single memberdepartment)• FA-1 “Disparity between the regionalpopulation composition and the studentand faculty composition”

• The “pipeline” program is injeopardy due to impending nationalTitle VII funding cuts to all schoolsRecommendation: report on theabove issues in 2 years

Our 2007 Report to LCMEFaculty diversity:• Katrina and Rita made this a challengingtime to recruit any faculty to Louisiana or toclarify any population demographics• The LSU System Diversity Initiative by BOS• Active faculty recruitment is ongoing• Student diversity charts and tables supplied

• Loss of HCOP/Title 7 Funding did occur– Majority of the successful program K-20 wasmaintained with medical center clinical fundingwhile exploring other options to keep this 18year old pipeline intact• Developing more rural and underservedcomponents and gathering data on thosesuccesses (AHEC, Pipeline, 70% of thephysicians in the north half of the state areLSUHSC grads)

UNDERGRADUATERESEARCHAPPRENTICESHIPPROGRAMEDUCATIONALFAMILIARIZATIONPROGRAMJUMPSTARTSUMMERENRICHMENTPROGRAMComputer LabToursPoster SessionsResearchPRE-MATRICULATIONENRICHMENTPROGRAMOil City ElementarySCIENCEACADEMYShreve Island ElementaryLOUISIANA STATEPREPARATORYPROGRAMNewton Smith ElementaryLakeshore ElementaryLouisiana State University Health Sciences Center - Shreveport – Making a Differencewww.lsuhscshreveport.edu/MulticulturalAffairs

Reply from LCME• Student diversity is not fullyresolved and a 2 year report is due• Added reporting: Due to theirconcerns related to state financialinstability, post hurricanes, willneed reporting

Our 2009 Report to LCMEStudent Diversity• Partnership in science educationpipeline with fewer total students butmaintained key bridge components, withmost now supported by LSUHSCinternal funding plus additionalpartnerships added with local schoolboards, SciPort Science Center, LSU-Shreveport, etc., were developed

• Financial stability report:verification that no negativeimpact on our medical schooleducation program from thepost hurricane issues

2009 Reply from LCME• Medical school diversity “remainsin transition” and a report is due in2011

Our 2011 Report to LCME*NOTE: LCME’s change to IS-16 for new sitevisits occurred in this interval• Health Sciences Center refilled ourDirector of Diversity Affairs/EEO• OMA worked with SA to have us becomea field test and beta site for the “roadmap to excellence through diversity”(admission workshop – holistic review,initiated restructuring of admissionsmembers, etc.)

•AHEC expansion to college, pre-college,plus even more first year rotations and 3 rdyear family practice AHEC-relatedrotations•LSU System Diversity Task Forceproduced 3 System-wide white papers; 1)improving campus climates, 2)recruitment and retention of diversestudents and 3) education and training ofLSU campus employees

2011 From LCMEThe area in transition regardingstudent diversity has been partiallyresolved but “had not yet yielded theintended results” therefore, duringthe full survey visit, 2013-2014, thesurvey team “will be requested toreview the School of Medicine’sprogress toward meeting its diversitygoals.”

Questions• What is the “intended” result from theLCME perspective and what does itlook like so we can strive to achieve it?• How does that differ from meeting theSchool of Medicine’s identified diversitygoals (including legislature, statebudget, founding mission, legal issues,etc)?

MS8-IS 16 LCME PreparationDiversity Research ForumAAMC Annual MeetingChenits Pettigrew, Jr.Assistant Dean for Student Affairs andDirector of Diversity ProgramsUniversity of Pittsburgh School of MedicineNovember 8, 2011

Discussion Points• University of Pittsburgh Historical Context1967-68• UPSOM Administrative and OperationalEnvironment• UPSOM Approach• LCME Preparation and Process• Successes and Challenges

Historical ContextUniversity of PittsburghSchool of MedicineStudent Affairs/Diversity Programs

The Foundation• 1967 Health Opportunities Program• 1968 14 Demands• 1968 AA Associate Provost(Intentionality/Professoriate)• 1968 UPSOM Reaffirms No Discrimination• 1972 Independent Office of Special Student Programsestablished• 1972 first AA Assistant Dean for Student Affairs andDirector of Special Student Programs appointed(member of the Admissions Committee)University of PittsburghSchool of MedicineStudent Affairs/Diversity Programs

University of PittsburghSchool of MedicineStudent Affairs/Diversity ProgramsPartnerships

Our Environment (Key Players)UniversityPhysician InclusionCouncilUPSOMAssistant Dean forStudent Affairs andDirector of DiversityProgramsUPMCAssistant ViceChancellor HealthSciences DiversitySenior ViceChancellor HealthSciences and DeanSOMChief DiversityOfficer UPMCVice Dean UPSOMUniversity of PittsburghSchool of MedicineStudent Affairs/Diversity Programs

Physician Inclusion Council• Co-Chairs Chairs of Ophthalmology and FamilyMedicine• Senior Associate Vice Chancellor of the HealthSciences and Special Assistant to CEO UPMC• Faculty, GME, Residents, Administrators• Initiatives (funded)University of PittsburghSchool of MedicineStudent Affairs/Diversity Programs

UPSOM Approach• Intentionality (commitment)• Framework• Definition• Audit/Assessment• Develop Initiatives with goals linked to thedefinition and audit• Surveillance• RealignmentUniversity of PittsburghSchool of MedicineStudent Affairs/Diversity Programs

LCME Preparation CycleWelcomed theOpportunityBullitt PointSummaryAudit AnalyzeAssessmentDrafts, Drafts,DraftsReview 2003(perfect score)SimulationsUPSOM LCMEVetsReview theLCME ProcessDeliberate andIntegrateReview andStudy theStandardsUniversity of PittsburghSchool of MedicineStudent Affairs/Diversity ProgramsID SuccessesandChallengesAssignCommittees(reframed)

Successes and Challenges IS 16• Reaccredited• Students (success)• Faculty, House Staff, Staff (challenge)Currently going through our LCME cycle todevelop response and to realign, redefine orredesign our efforts

Diversity Research Forum:LCME IS-16 ExperienceJonathan S. Appelbaum, MD, FACPDirector, Internal Medicine EducationGDI RepresentativeChair, Diversity and Inclusion Council FSU College ofMedicineAAMC 2011 Denver, CO

The Florida State University College of Medicine will educate anddevelop exemplary physicians who practice patient-centered healthcare, discover and advance knowledge, and are responsive tocommunity needs, especially through service to elder, rural,minority, and underserved populations.

RuralElderlyMinorityMedically Underserved

History of FSU-COM• FSU-COM established June 2000 byFlorida legislature• Mission established by law• First graduation class 2005• First full LCME accreditation 2005• Reaccredited by LCME in 2011◦ Strengths included pipeline programs

Who We Are:Students, faculty and staff (percentage)CategoryFirst-YearStudentsAll Students Faculty Staff*(define)Black 9.2 10.2 6.4 13.5Hispanic 9.2 8.8 3.4 4.2AmericanIndian/AlaskaNative 1.7 0.8 0.9 0.0Asian 10.9 13.3 9.2 3.1

How Do We Meet the Mission?• Pipeline programs• Holistic admissions• Strong student support systems• Ambulatory training model---70% outsidethe hospital in the community setting• One-on-one instruction by communityphysicians beginning Year 1

Community-based TrainingAt the regional campuses, third- and fourth-year studentstrain one-on-one with practicing physicians in privatepractices, hospitals, and other medical facilities.

Outreach Programs-overviewProvide a career pathway for studentswho have been traditionallyunderrepresented in medical schoolOffered from middle school through thepost-baccalaureate level

Pre-College Outreach ProgramsSSTRIDE (Science Student TogetherReaching Instructional Diversity inEducation)In-school science electiveAfter-school tutoringHands-on activities

College-Level Outreach ProgramsMCAT preparationProfessional skillsdevelopmentCertified Nurse TechTrainingPhysician shadowing

Bridge to Clinical Medicine• Created in 2001Program• Transition from post-baccalaureateprogram to MS program in 2009• 97% (35) students entering medicalschool from the Program have graduatedmedical school• 71.4% (20) of these have entered primarycare

Outcomes from Outreach & Advising• 13.3% (126) ofFSUCOM students(2001-2011)havecome through theOutreach pipeline.• 12.0% (54) ofFSUCOM graduates(2005-2011) havecome through theOutreach pipeline.

Medical Student Outcomes34.2% of graduates (450) were from minoritybackgrounds6.9% of graduates were from rural communities55.0% of graduates matched in primary care residency66.7% completing GME are practicing in Florida18.0% completing GME are in rural communities

Boston University | Medical CampusBoston University School of MedicineKaren Antman, M.D.Provost, Medical CampusDean, School of MedicineBoston University Medical Campus

Our LCME report: IS-16Diversity is explicitly a goal in:Boston University• statement on diversity• faculty search manualMedical school• mission statement• 2006 and 2010 strategic plans• institutional learning objectives: behaving “in acaring, compassionate and sensitive manner towardpatients and colleagues of all cultures andbackgrounds.”Boston University Medical Campus

Boston University1839: Methodist Seminary1869: Boston UniversityWilliam Warren, 1 stPresident, admitted bothgenders, all races &religions; study abroadprogramBoston University Medical Campus

Boston University1955 PhD in Theology:Dr. Martin Luther KingBoston University Medical Campus

Boston University Medical Campus1848 Boston Female Medical College1855 Boston City Hospital: 1 st US city hospital1873 Became BU School of Medicine: coed1963 Dental School1976 School of Public Health1996 Boston Medical Center + 14 Community Centers1997 BMC HealthNet Plan: 250,000 membersBoston University Medical Campus

BU School of Medicine1864 Rebecca LeeCrumpler, 1st blackwoman MD1890 Charles Eastman1st Native AmericanMD1897 Solomon CarterFull, 1 st blackpsychiatristBoston University Medical Campus

Boston University Medical Campus

Our LCME report: IS-16Definition• Boston University defines diversity broadlyand includes “the constructs of lifeexperience, gender, sexual orientation, race,ethnicity, physical ability, spiritual beliefs,and intellectual approach”.• Problem re LCME: the standard wantsoutcomes on each.Boston University Medical Campus

Boston University Medical Campus

Our LCME report on IS-16RecruitmentFaculty and leadership searches followprocedures in the faculty search manualentitled, “Searching for Excellence andDiversity”•Develop a large pool of diverse candidates•Avoid unconscious biasesBoston University Medical Campus

Our LCME report on IS-16Coordination• An ad hoc campus-wide Committee onDiversity and Health Disparities was formedin 2008, and the scope of the Office ofDiversity and Multicultural Affairs wasexpanded.• We transitioned from an Office of MinorityAffairs to the Office of Diversity andMulticultural Affairs.Boston University Medical Campus

Our LCME report on IS-16:Admissions• Admissions mission statement specifiesdiversity.• Holistic review selects applicants for theircontribution to diversity.• Robust faculty development programs prepareadmissions committee members in holisticreview.• Dean charges committee to maintain theinstitutional commitment to diversity.Boston University Medical Campus

Boston University Medical Campus

Boston University Medical Campus

Our LCME report on IS-16:Pipeline Programs• Several pipeline programsenhance diversity• Early Medical SchoolSelection Program datesfrom 1960s (Lou Sullivan)• Students from historicallyBlack, Hispanic colleges• 3 year enrichmentprogramBoston University Medical Campus

Our LCME report on IS-16:Financial Aid• Financial aid is need based• Disproportional amount of scholarship moneyawarded to students from groups underrepresentedin medicine.Boston University Medical Campus

Our LCME report on IS-16:Curriculum• The curriculum emphasizes issues relating tothe care of diverse populations.• Experiential sessions enhanced by reflectiveexercises are placed throughout thepreclerkship and clerkship curricula.Boston University Medical Campus

Our LCME report on IS-16:Community EngagementBUSM is fully engaged in the community via its:• Relationships with 11 community healthcenters,• Clinical trials that address health disparitiesand enroll community members• Pipeline programs for public school children.Boston University Medical Campus

Boston University Medical CenterBoston University Medical Campus

Q & ADr. Karen Antman, M.D.Provost of the Medical Campus and DeanBoston University School of MedicineJonathan Appelbaum, M.D.Associate Professor; Director, Internal Medicine EducationFlorida State University College of MedicineBarbara Barzansky, Ph.D.LCME Co-Secretary, Undergraduate Medical EducationLiaison Committee on Medicine EducationAndrew Chesson Jr., M.D.DeanSchool of Medicine, Louisiana State University Health Sciences Center-ShreveportChenits Pettigrew, Ph.D.Assistant Dean of Student Affairs and Director of Diversity ProgramsUniversity of Pittsburgh School of Medicine