April 23, 2024 • 38 mins
Date: 4/23/24
Name of podcast: Dr. Patient
Episode title and number: 16 Race and Healthcare: Teaching Med Students
Episode summary: Episode 3 of 3 of a miniseries on racial disparities in healthcare. We've heard from Linda Villarosa on how we got to where we are today and what some of the harsh realities of health disparities are, from Michael Tyler on a real life story of how his race actually impacted his care. Today we're pivoting towards solutions as I speak with Dr. Patricia Poitevien, Associate Dean at Brown University's medical school on how to teach this stuff to the next generation of physicians.
Guest(s): Dr. Patricia Poitevien, Senior Associate Dean of Diversity, Inclusion & Equity at Brown University's medical school. https://diversity.biomed.brown.edu/people/patricia-poitevien-md-msc-faap
Key Terms:
[22:57] MCAT - Medical College Admission Test; the test that college students take to be able to apply for medical school
[22:58] STEP - the examination that medical students take close to the end of school to be able to apply for residency training
[32:48] FTE - full time equivalent - 1.0 means a full time job
References: none
Podcast website: www.drpatientpodcast.com
Podcast email, become a guest: drpatientpodcast@gmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Pat Poitevien (00:00):
I am the Senior Associate Dean for Diversity,
(00:02):
Equity and Inclusion at theWarren Alpert Medical School of
Brown University. This is a newrole. It's inaugural. It started
almost a year ago, April 1 of2022, is when I took on this
position. And although we had anOffice for Diversity for many,
many years that was led by anAssociate Dean, the original
(00:27):
thought process or the originalgoal of the Office for Diversity
was really to help supportstudents who self identified as
underrepresented, racially andethnically, so very specific
sort of cohort ofunderrepresented students, the
job of the office was to supportthem. And oftentimes, what that
meant was creating community,connecting students with mentors
(00:51):
who are also from historicallyunderrepresented groups. But it
was a very insular office,right? It was an office created
to help a very specific studentpopulation. And there are always
going to be limitations withsomething like that. Because
supporting students through atoxic environment can only get
you so far. At some point, youhave to look at the environment
(01:13):
and you have to look at thesystems and say, Okay, we've
been supporting the studentsthrough the toxic system for,
you know, a decade. How about,we just changed the system?
[Heather (01:22):
Brilliant, take two steps back]. And so the creation
of this position really had thatsense in mind. It was, yes, we
can continue to support studentsthrough an environment like
academic medicine, which is notjust toxic here at Brown, I
would argue it's toxiceverywhere around the country.
(01:44):
Yes, we should continue to dothat. And understand that we
can't only support students,because students become trainees
and trainees become faculty. Andso really, we need to support
all individuals, includingnurses and other individuals who
self identify asunderrepresented. We need to
(02:04):
support this entire community ofpeople. And while we're doing
that, we also need to looksystemically at how we can
change the system, so that weeventually make our job
supporting individuals who arehistorically underrepresented,
obsolete, right? Like the goalshould be that the system is
inclusive enough that everybodyfeels supported. And no one
(02:26):
needs an Office for Diversitybecause the system is here for
everyone. And so in my role, I'mnow doing both - like really
expanding the support that weprovide for individuals who are
underrepresented beyond juststudents, and looking at the
system to figure out how we cancontinue to make it more
(02:46):
inclusive, really, for everyone.
Heather Johnston (02:49):
What are some of the steps you're taking on
that latter point?
Pat Poitevien (02:53):
So as you can imagine, it's a pretty colossal
endeavor. Luckily, I'm I don'tusually shy away from big
challenges. And so part of thata big part of that certainly is
education. I think that's whereBrown has had strengths for a
really long time. We actuallybegan to partner with our own
(03:16):
Africana American StudiesDepartment on the undergraduate
campus several years back to runcourses on racism in medicine.
And actually, one of theindividuals who works in that
department Lundy Braun is the islike the sort of expert on
pulmonary, the history ofpulmonary function tests and why
(03:38):
there were different standardsfor pulmonary function tests for
African Americans. And forindividuals who are white, she
actually sort of spearheadedthat research, she spent her her
a good deal of her life,lecturing about it, and really
tying together how specificevents during our time of
slavery have trickled down intohow we continue to practice
(03:59):
medicine. So she teaches twocourses here for our students,
and also runs an electivecourse. And we have been doing
that for a really, really longtime. And so we're trying to
expand on some of that initialwork where we, you know, it's
important for us to talk aboutthe historical nature of much of
racism in medicine. Butsometimes when we focus a ton on
(04:23):
history, people presume thatmeans that it's no longer
relevant. It's something thathappened in the past, it's not a
part of who we are anymore. Andso what we're trying to do now
is really transition, thathistorical context, which is
critically important, buttransition it to practical
applications of what you weredoing every single day. So how
(04:45):
do you as a provider ofhealthcare question your
positionality, your power, thedifferential outcomes that you
see in your patients? How how doyou constantly keep that
questioning attitude movingforward so that you can utilize
the historical context that youlearned. But also understand
there's so much more to learn,right? Because this is a
(05:06):
constantly evolving field. Weare we are just now beginning to
catch up with the content thatwe really need to understand in
order to practice medicine in away that's equitable.
Heather Johnston (05:18):
What age medical students, what level of
medical students take thatcourse?
Pat Poitevien (05:29):
We have a course that we run. So Lundy's course,
I'm pretty sure it's for thefirst year students. But then
she runs an an elective course,for the second year students. We
have a separate course thatactually I teach, called Racism
in Medicine, and it just sort ofgoes through, it's a very broad
overview of how racism hasimpacted much of the much of the
(05:54):
medical information that we sortof take for granted that we
don't think about, that we don'tquestion. And so I teach that as
well, also to the first years.
And so a ton of the content doescome in the first and second
years. And that is veryconvenient. Because the first
and second year students as youknow, are sitting in classrooms.
And so a lot of it is didacticup in in the first and second
(06:15):
year. So another project thatI'm working on right now is the
creation of a third yearclerkship on racism in medicine.
Because really, you know, if youthink about the model of medical
education, we do all thispreclinical stuff, right, the
first 18 to 24 months of medicalschool, and then we send our
students out into clinicalspaces, and we say, now it's
(06:40):
time for you to learn thepractical application of
everything that we taught you.
But we don't do that withracism, right, like, so, again,
it kind of goes back to this, Ican teach you a ton of content
on racism in medicine, but whatI really need you to do is take
that content, and make it make adifference. So you know, some of
(07:03):
the some of the skill buildingthat we want to teach our
students is how to engage in aconversation about race with a
family, particularly if you'rein a non race-concordant
relationship with that family?
How do you we know that inpediatrics, for example, we know
that racism is a significantace? So how do you engage in a
conversation with a family abouthow racism is impacting them?
(07:28):
How it might be impacting theirchildren or their other family
members? And how do you do thatin a way that is helpful and
supportive to the patient andhelps to see them for who they
are. So I think that skillbuilding around the context of
the history of racism is our wayof saying, Okay, this is how you
(07:49):
show up and bring this knowledgeinto your exam room every single
day.
Heather Johnston (07:57):
Is there any kind of self reflection
component early on in the firstsecond year or later on third,
fourth year, or even intoresidency where they look back
and I don't know how many yearsyou've been doing the program,
but you know, have you gottenfeedback about it?
Pat Poitevien (08:11):
So for the third year clerkship, we're still
building it. So we haven'tgotten any feedback, but one of
the pieces of the clerkship islike self reflection, and it's
consistent self reflection thatthey have to review with with
the leader of the clerkship,because you know, I don't need
(08:31):
to tell you or this audiencethat racism is, there's so much
about it, that is personal. Andindividuals come into this work
with entirely heterogeneouslevels of engagement with
racism, right? Like you havesomeone like myself, I was, I
was actually reflecting on thisin a group of faculty members,
faculty leaders, and I was theonly black person in the group.
(08:54):
And I said, you have people likemyself, who for personal and for
professional reasons, I thinkabout racism every single day.
Like, I can't remember 24 hoursthat have passed, I don't know,
in the last two decades of mylife, where I have not actively
thought about racism, right. Sothat's one end of the spectrum.
And then you have individualswho, for personal reasons, and
(09:15):
for professional reasons, mightnot ever consider the impact of
racism, or they might only thinkabout it when they're in a
conversation, like the one thatwe're having now or in a
training session. So when youhave individuals at those two
ends of the spectrum, and wedefinitely have students who are
at those two opposite ends ofthe spectrum, making sure that
there's some self reflection tounderstand how our personal
(09:37):
identities and how our ownpersonal histories and
experiences influence how weshow up in exam rooms for
patients is critical, because ifwe're not examining that, then
we're completely missing theboat. Like we're not we're not
all coming into thisconversation at the same level.
I actually don'tI've been looking for, to find
Heather Johnston (09:53):
Are you aware of anyone else doing programs
out if there are other peoplewho are doing it. Because it's
like that, and creatingclerkships around the idea of
like, why reinvent the wheel ifpeople are doing this well, or
racism and how oftenmaybe find ways to collaborate,
so that one person, you know,one schools approach might be
different than the approach thatwe're taking. And we can learn
(10:14):
from one another, from thosedifferent approaches. You know,
one of the one of thechallenges, we have several
challenges in rolling this out.
But one of them is, you know,how do you assess a student
who's gone through thisclerkship? Like, what does it
(10:35):
mean, you know, in every This isschool, right. So in everything
that we do, our goal is that ourstudents are learning something
and growing. And so how do youassess whether someone has, you
know, really understood theinformation that's been shared
with them, and that theinformation has been
(10:56):
transformational? Right, like,you know, we have we have simple
goals and objectives for theclerkship, which we always have
for clerkships, but they don'tfeel meaningful, right? Like, of
course, we want you tounderstand the impact of racism,
yes. But really, I want totransform how you think about
(11:18):
your interactions with people.
That's really hard to measure.
Yeah, so trying to understandhow successful the clerkship is
going to be, because we want tomeasure the outcomes of the
clerkship is some place where Iget tripped up quite a bit. It's
like, how do we think aboutassessment outside of our
(11:40):
traditional measures ofassessment, in order to capture
what it is that we think isreally important about an
educational exercise like this?
That part is a little bittricky. Yeah, you know, when
I was at UFC, I taught a lot ofthe courses on professionalism.
And, you know, how do you teachsomeone to be more professional
(12:02):
in their relationships? It's,this is this conversation is
making me like, think back tothat also, my anxiety is going
up a little bit. But I rememberwe would have the same
conversations. And this was backin 2003 2005, we were having
these conversations like, well,what does it mean that the
(12:22):
student has learned it or notlearned it, and we ended up just
basing a lot of it on selfreflection, if we felt like if
they were able to be very selfreflective on some of their
experiences that they werehaving that was a very good sign
that they're just at leastlearning that at least they were
demonstrating that they learneda skill that over time, then
should help them achieve thegoals we were trying to teach.
(12:45):
Yeah, that is
Pat Poitevien (12:47):
You know, so I've done a ton as you can imagine,
in this role, and just becauseof my own interest, I've taken a
lot of time to learn more aboutwhat it means to be anti racist
and anti oppressive in anacademic environment. And what I
have come to understand is justhow academia itself is an
(13:09):
oppressive environment. And sothe tools that we utilize to
measure success within academiaare oppressive by nature. You
know, there's an entire conceptof epistemic injustice, which I
was not familiar with before Istarted this work. And the idea
is that our entire understandingof higher education is really
(13:34):
baked in oppression, right,because the individuals who
created structures of highereducation were, you know, mainly
European, white men. And so thestructure that they built was a
structure that reflected theirvalues. And so we continue to
function within that structure,of course, but it also behooves
(13:58):
us to question all of the partsof that system if our goal is to
dismantle oppression. And so,you know, you think about
assessment, for example, right,like how we assess competency
and a big part of assessment incompetency in medicine is, you
know, standardized tests aroundmedical knowledge. And, you
(14:22):
know, I see you nodding yourheads, you know exactly where
I'm going with this, right. Buthave we ever demonstrated that
individuals who demonstrate abetter, sort of, I don't want to
say a better grasp, but an abetter ability to recreate or
reproduce their understanding ofmedical knowledge on a
(14:45):
standardized test. Have we everdemonstrate that those people
are better doctors? Providebetter care?
Heather Johnston (14:55):
I'm sure not.
But also that's tricky, becausewhat does better care mean?
Right So how would you even
Pat Poitevien (15:01):
to measure whether we are on the same path?
beginRight? So it's literally it's
like you just startdeconstructing all of these
things that you've always takenfor granted. Like, someone might
say better care is betteroutcomes, right? And I think a
lot of individuals think thatway. So like, if a patient does
well, you have given good care.
(15:25):
Right, like when you talk topatients, and we, you said this
right, before we started thisinterview, they might say,
actually, the relationship thatthey have with their doctor is
the is the sign of the bestcare, and it's not their
outcome, it's their ability totalk to their doctor, confide in
their doctor trust what theirdoctor has to say, and are we
(15:46):
measuring any of those thingswhen we're measuring competency
in medical school? And do weeven know how to measure for
another phenotype of individual?
Because if I don't have a way ofmeasuring how well you
communicate, or how well youdevelop a relationship of trust
with another human being, howcan I make sure I'm selecting
for those people? There's no wayfor me to do it, I'm looking at
(16:08):
your grades, I'm looking at yourMCAT score. And then I'm looking
at an interview with who? With alot of other people who are
entrenched in our older systemwho are not asking themselves
those questions. And so thatsystem is going to recreate and
reproduce the exact type ofphysician that it's always
(16:29):
recreated and reproduced.
Heather Johnston (16:31):
It makes me wonder if the current changes in
the college admissionslandscape, this is on my mind,
because I have one in collegeand one heading to college soon.
Makes me wonder if the makeupyou know, of, of the more
competitive colleges as it'schanging so much now, partly
(16:52):
because of the pandemic, butalso because I think a lot of
the schools just glommed on tothe pandemic as an excuse to
make changes that I think areright, you know, less, less
legacy admissions, more diverseadmissions, blind test, optional
non testing, I love all of that.
It did not help my whiteMidwestern children, but I'm
cool with that, because I thinkit's better for the world. But
(17:14):
it makes me wonder if then, youknow, those students are then
going to feed into the medicalschool system. And it makes me
wonder how that's going tochange down the line.
Pat Poitevien (17:25):
I mean, I'm hopeful that it does change. The
problem is, and you know, my, Itry not to always think about
problems,
Heather Johnston (17:35):
or your job, part of my
Pat Poitevien (17:37):
job, the problem is that you can feed all of
these diverse individuals withdifferent perspectives and
different skill sets into oursystem. But if we don't
fundamentally change our system,we they will either
fundamentally change because youadapt to the system that you're
in for survival, or you beterrible, right, or you just
(17:58):
you're out. And what we havefound is that, certainly
individuals who are at least ofdiverse identities, right, when
they come into our system, wefail them. And I mean, not like
we give them an F, but we do notcreate environments that are
inclusive, we do not createenvironments that encourage
(18:19):
belonging, and we do not createenvironments that encourage
their success. So either theyleave, they're dismissed, or
they fundamentally try to changewho they are in order to survive
in the system. And the wholereason why we brought them in,
which was for their diverseperspective, their diverse
(18:39):
background, and their differentway of thinking about things
gets lost, because the systemitself works to dilute it out.
Right, like, if you think aboutmedical education, our our
medical education system is allabout uniformity. We don't have
a system. And you could arguethat's that's sort of like all
(19:01):
of education in the UnitedStates, right. But I'm just
going to focus on medicaleducation, because that's what
that's my area of expertise. Wereally focus on uniformity.
We're not trying to celebratediverse perspectives, like there
is a way that you do things,right. We talk about clinical
practice guidelines, and we talkabout uniformity and outcomes.
(19:23):
And there's a very specificdefinition of a doctor that we
have in mind. And we try to fiteverybody within that
definition. Now, I'm not sayingthat that's fundamentally wrong,
because we do have to havestandards, right. Like we have
to have standards for what wethink make a successful
physician. And we have to becareful that in the support of
(19:46):
those standards, or even in thereplication of those standards,
what we're not doing iseliminating opportunities for
different perspectives anddifferent thoughts and
innovation frankly. And I thinkthat's always the danger with
any of these large institutions,right? Like you, you say there's
a standard for a physician thatwe want and you create that
standard. And that feels like itmakes sense. You want someone
(20:09):
who has a minimum amount ofunderstanding about, you know, X
and a minimum number of yearsand training around why and a
minimum number of patientexperiences. Totally makes
sense. But what else are weselecting for when we create
those systems? There are otheraspects that we're selecting for
that aim is we dismiss thethings that we claim to
(20:32):
celebrate. Because if a studentcomes on a clinical rotation,
and is rounding with us, andthey say something that is
different than what theattending thinks, depending on
the psychological safety of thatgroup, the attending might just
shut them down. And you know,like medicine is still based in
(20:54):
a hierarchy. So how do youencourage innovation and diverse
thought, when there's a personin charge, who gets to make all
of the decisions, and then theirresident and their students, and
sadly, then there are nurses,and other members of our
interprofessional care team. Andwe create, we have this
hierarchy that we actuallyworked really hard to maintain.
(21:16):
But then we say that we reallywant diversity and innovation
and, you know, like, differentways of thought, but those two
things don't work together. Soone has to be dismantled in
order to welcome the other one.
Heather Johnston (21:29):
It's almost a little dizzying, because you
have to work forwards andbackwards at the same time, like
the students are coming in, youhave to think about who you're
selecting what your makeup is,what your goals are for them
right from the start, but at thesame time, you need to be at the
endpoint and say, well, what, asan institution, are we going to
say defines a good doctor whocan graduate from here? Do we
(21:53):
just want someone with the goodtest scores? Or do we want
somebody who shows empathy inthe face of difficulty and
pressure and is inclusive of allof their patients? And then you
have to say, well, okay, now wehave the definition of the
doctor that we want, we have towork backwards to create the
curriculum. That's verydizzying.
Pat Poitevien (22:12):
And it's particularly hard to do, because
there's a lot invested in thecurrent definition of doctor.
Right, so all of the people whowere in charge, worked through
the current definition ofdoctor, including myself. And so
to question our currentdefinition is to question the
(22:32):
identity of all of the peoplewho are in charge. And some
people are okay with that. Andsome people absolutely are not.
And it really threatens who theyare and their core identity. And
they're not comfortable withthat. Because if I did it one
way, if I became a doctorbecause of this very specific
(22:54):
skill set, if I scored awesomeon my MCAT, and fantastic on my
STEP and blew my board exams outof the water, and published the
way I was supposed to, which iswhat everybody told me to do,
then why do we get to change therules now? Because that's what I
did and why and if you'retelling me that, what I did is
(23:17):
not what makes a good doctor,then you are de facto telling me
I'm not a good doctor. People donot like that. And in the end,
of course, we're not tellingpeople that they're not good
doctors now, because they wentthrough another system. What
we're saying is that we haveopportunities to bring in other
people who can also be gooddoctors, right? Like it's not a
(23:37):
zero sum game. A lot of equitytalk is around, we don't all
work with one pie, right? Likeit's not if I get a slice, you
don't get a slice. You are agood doctor, you've accomplished
a lot. That doesn't mean thathow we define doctor needs to
stay the same in order tomaintain your value as a human
(23:58):
being and as a physician, right?
Like it's not a pie. This isboth and we can bring other
people with other skill setsinto the space, who can also be
exceptional physicians. And thatdoesn't have to threaten who you
are.
Heather Johnston (24:10):
Let me, let's play fantasy for a minute.
Pretend we live in a worldwhere? Well, this might not be
fantasy. I'm not digging you inany way. Let's pretend let's say
future instead of fantasy. Whenyou personally develop an
incredible curriculum that justworks right for everyone around
(24:35):
this topic, could you seesomething like that being able
to be plucked out and used atother medical schools? I think
just restate my question moreclearly. Could you ever see
there being a nationalcurriculum for medical students
on these ideas that all theschools could use?
Pat Poitevien (24:56):
Absolutely.
Absolutely. And I think thatthere are some spaces is where
we're thinking about this on amore sort of national or even
global level. So I'm going to doa little bit, it's not really
self promotion, it's like selfpromotion. But um, the American
Board of Pediatrics actually puttogether a small working group,
(25:17):
I want to say about two yearsago, and I had a chance to serve
on the working group to look atuntrustable professional
activities. And, you know, youmay or may not know, you know,
untrustable professionalactivities are another way that
we are trying to get a bettersense of the competency of our
pediatric trainees, right. It'slike and, and we're doing this
(25:38):
in pediatrics, but the boardsfor all of the other specialties
are also doing something verysimilar, right. There's
recognition that how we'veassessed competency of our
physicians is not perfect. Anduntrustable professional
activities are really based incompetency based medical
education. It's like how do wemake sure that the education
that we're providing is linkedback to the competencies that we
(26:02):
want physicians to have, whichas we shared in the beginning of
this conversation has not alwaysbeen the case, right? Like how
we assess our doctors has notalways been linked to the
competencies that we actuallywant them to have as doctors,
which is like a crazy concept.
Sometimes I say that out loud.
And people look at me like I'mcrazy. I'm like, No, seriously,
like, we're not, I'm not evenkidding, you're not crazy. And
(26:23):
so we have 17 untrustableprofessional activities in
pediatrics. And one of them wasan untrustable professional
activity on like, qualityimprovement and advocacy. And
the working group was actuallycharged with incorporating anti
racism into the into trustableprofessional activity. So that
not only were we calling outwhat we wanted pediatricians to
(26:46):
understand about how raceimpacts pediatric health
outcomes, we also had to callout how those things were going
to be assessed. And the EPA ismeant not only for residents,
the EPA is ultimately meantmeant to help to measure the
competency of all physicians.
(27:06):
And so that, to me, is a verysort of global perspective. Like
no matter where you trained as apediatric resident, we the the
Board expects you to have somelevel of competency in how
racism impacts your patients,how to measure how racism is
impacting your patients, and howto implement systems to help
mitigate the impact that racismhas on your patients. Which is
(27:30):
like kinda revolutionary.
Heather Johnston (27:32):
It is i My mind is working. That's why I'm
looking at you blankly I'm likethinking about 100 things at the
same time. So is the idea herethat if the American Board of
Pediatrics comes out and saysfor example, we expect our
physicians to demonstratecompetency in terms of racially
(27:54):
sensitive relationships withtheir patients, then that will
drive medical schools to berequired to teach?
Pat Poitevien (28:02):
Well, certainly, because that the board is really
looking at the competency ofresidents, it will at least
drive residency education. Andwe actually do a ton. In
addition to just creating theEPA. You know, we also talk
about like, here's curriculumthat you can utilize to help
support what we're saying wewant your residents to be able
(28:25):
to do, right like we don't wantto just put the the requirement
out there, we also want to givepeople the content that they can
deliver to their trainees. Butis as you can imagine,
antiracism in pediatrics is notthat different than antiracism
in adult medicine or ingynecological care or in
surgical medicine, right? Butthe concepts are the same. How
(28:46):
you might execute or assess itmight be slightly different
based on your specialty. Butoverall, we're asking you to do
the same thing. We're asking youto have an understanding of how
racism impacts medicine, we'reasking you to have a questioning
attitude so that you caninterrogate your systems for how
racism is impacting yoursystems. And then we're asking
(29:09):
for you to then help to recreatesystems or mitigate systems
where you're seeing how racismis impacting your patient
outcomes. And even though thatmight change a little bit based
on specialty, it's kind of thesame thing. And you can pull it
back to medical studenteducation as well. Absolutely.
Heather Johnston (29:26):
But you were talking about just the wide
variety of preceptors andteachers that you have, who then
become responsible to teach thismaterial. I wondered if you have
a program in place to teach theteachers?
Pat Poitevien (29:39):
Absolutely. We actually do a ton of Faculty
Development. Some of it isproactive, some of it is
reactive. So I'll explain that alittle bit. You know, right now,
for example, we we actually thispast year, hired outside
consultants because we don'thave enough people with fluency
(30:00):
in how to teach in an antiracist way. We just don't have
enough of those people withinour institution. So we asked a
group to come and help ourfaculty members, again,
understand the complexity ofracism, you know, like racism
and oppression in general isreally complex. People spend
(30:20):
their entire lives, studyingthis writing about it, lecturing
on it. And our faculty membersare busy people, they're seeing
patients, they're teaching. Sothe ex, we can't have an
expectation that they have towould have this level of
expertise, just magically. Andso we hired some individuals who
are doing antiracism workshopswith our faculty right now to
(30:45):
give them some of that skillset. So that's some of the
proactive work that we're doing.
And then the reactive work thatwe do, and I think it's
important that you have both, isthat we also have a system to
report what we call curricularopportunities. So when our
faculty members are sharingclinical content, particularly
in the preclinical years, butalso in the clinical years, when
(31:06):
they are sharing curricularcontent that might be based in
oppression or might not beinclusive and sensitive to
different identities, ourstudents have the ability to
report those, and we call themcurricular opportunities. Those
actually are all reviewed bysomeone who is incredibly
talented here, our AssistantDean for Diverse Curriculum,
(31:27):
Teaching and Learning. She's aPhD and anti racism education,
she's not a physician. And shereviews all of the curricular
opportunities, and then createssort of like individual plans
for those faculty members basedon the report. So sometimes,
it's just that the dermatologylecturer did not have enough
(31:50):
representation of rashes ondifferent skin tones. And so she
goes back to the faculty member,and she says, Here are some
resources, can you please, youknow, create some more slides so
that individuals can see thesedifferent pathologies on
different skin tone, right? Likethat's sort of, that's not hard.
Sometimes it's in something thata faculty member has said, so
(32:12):
the slide is fine, and thecontent is fine, but how they
deliver the content was notinclusive. So one of the other
examples that we hear a lot is afaculty member that might speak
about prevalence related torace, as opposed to relate it to
racism, right, without, so yousay that black individuals have
a higher into or I'll useanother example, you say Native
(32:37):
American individuals have ahigher incidence of alcoholism,
and then you end theconversation, then you move on,
without ever really explainingthat it's not something inherent
to individuals who are AmericanIndian or Native American. It's
actually related to racism andsystemic racism and systemic
oppression that this hashappened. So it's like, okay,
faculty member, we're going toneed you to elaborate a little
(32:58):
bit more about why you see thestatistical difference and have
some more content expertise inhow racism has played a role
here. So that the takeawaymessage is not that this is an
inherent part of this person'sracial biology or whatever, not
whatever that is. But that thisis really a uh, it takes a lot
of work.
Heather Johnston (33:24):
Yeah, I'm so excited. You have that person. I
wonder how many schools havesomeone like that? That role
specifically? I mean, I've neverheard of it.
Pat Poitevien (33:32):
I don't think very many to be honest with you,
like I am. I mean, our team, Ithink I was sharing at the
beginning, you know, our officestarted as this really small
office like just to supportstudents of color. So there were
a total of 3.5 FTE, right, likefor the entire office, in the
year that I've been here, wehave exploded the office because
(33:53):
a lot of work needs to get done.
And we went from 3.5 FTE toabout, we have 12 individuals
now in our group, andaltogether, they're about nine
FTE with like everybody's work.
And it's, like I said, I feelvery, like I feel very, very
privileged to be able to do thiswork in this environment with
(34:14):
this level of support. I knownot everybody has that. So our
goal, of course, is to export asmuch of this as possible so that
even in lower resource settings,we're still getting the students
and the trainees and the facultythe education that they need.
Heather Johnston (34:29):
I love it. I'm so glad you're there. I'm so
glad you have that job and thatyou're there. Oh, man makes me
feel like it's gonna be okay.
Pat, it's been so great talkingto you. I've learned so much
about what you're doing thereand wonderful.
Pat Poitevien (34:49):
This was a lot of fun. I've been in different
interviews before and thisreally did not feel like an
interview. It felt like I wastalking to a friend of Barrett
so thanks for saying stuff, youknow, but um, but I Really
appreciate you elevating it onyour own platform and bringing
such different perspectives tothe table and just your general
treatment of the of the topichas been amazing so I'm really
(35:12):
appreciative of you, thank you.
Heather Johnston (35:13):
You're very welcome!
I am the Senior Associate Dean for Diversity,
(00:02):
Equity and Inclusion at theWarren Alpert Medical School of
Brown University. This is a newrole. It's inaugural. It started
almost a year ago, April 1 of2022, is when I took on this
position. And although we had anOffice for Diversity for many,
many years that was led by anAssociate Dean, the original
(00:27):
thought process or the originalgoal of the Office for Diversity
was really to help supportstudents who self identified as
underrepresented, racially andethnically, so very specific
sort of cohort ofunderrepresented students, the
job of the office was to supportthem. And oftentimes, what that
meant was creating community,connecting students with mentors
(00:51):
who are also from historicallyunderrepresented groups. But it
was a very insular office,right? It was an office created
to help a very specific studentpopulation. And there are always
going to be limitations withsomething like that. Because
supporting students through atoxic environment can only get
you so far. At some point, youhave to look at the environment
(01:13):
and you have to look at thesystems and say, Okay, we've
been supporting the studentsthrough the toxic system for,
you know, a decade. How about,we just changed the system?
[Heather (01:22):
Brilliant, take two steps back]. And so the creation
of this position really had thatsense in mind. It was, yes, we
can continue to support studentsthrough an environment like
academic medicine, which is notjust toxic here at Brown, I
would argue it's toxiceverywhere around the country.
(01:44):
Yes, we should continue to dothat. And understand that we
can't only support students,because students become trainees
and trainees become faculty. Andso really, we need to support
all individuals, includingnurses and other individuals who
self identify asunderrepresented. We need to
(02:04):
support this entire community ofpeople. And while we're doing
that, we also need to looksystemically at how we can
change the system, so that weeventually make our job
supporting individuals who arehistorically underrepresented,
obsolete, right? Like the goalshould be that the system is
inclusive enough that everybodyfeels supported. And no one
(02:26):
needs an Office for Diversitybecause the system is here for
everyone. And so in my role, I'mnow doing both - like really
expanding the support that weprovide for individuals who are
underrepresented beyond juststudents, and looking at the
system to figure out how we cancontinue to make it more
(02:46):
inclusive, really, for everyone.
Heather Johnston (02:49):
What are some of the steps you're taking on
that latter point?
Pat Poitevien (02:53):
So as you can imagine, it's a pretty colossal
endeavor. Luckily, I'm I don'tusually shy away from big
challenges. And so part of thata big part of that certainly is
education. I think that's whereBrown has had strengths for a
really long time. We actuallybegan to partner with our own
(03:16):
Africana American StudiesDepartment on the undergraduate
campus several years back to runcourses on racism in medicine.
And actually, one of theindividuals who works in that
department Lundy Braun is the islike the sort of expert on
pulmonary, the history ofpulmonary function tests and why
(03:38):
there were different standardsfor pulmonary function tests for
African Americans. And forindividuals who are white, she
actually sort of spearheadedthat research, she spent her her
a good deal of her life,lecturing about it, and really
tying together how specificevents during our time of
slavery have trickled down intohow we continue to practice
(03:59):
medicine. So she teaches twocourses here for our students,
and also runs an electivecourse. And we have been doing
that for a really, really longtime. And so we're trying to
expand on some of that initialwork where we, you know, it's
important for us to talk aboutthe historical nature of much of
racism in medicine. Butsometimes when we focus a ton on
(04:23):
history, people presume thatmeans that it's no longer
relevant. It's something thathappened in the past, it's not a
part of who we are anymore. Andso what we're trying to do now
is really transition, thathistorical context, which is
critically important, buttransition it to practical
applications of what you weredoing every single day. So how
(04:45):
do you as a provider ofhealthcare question your
positionality, your power, thedifferential outcomes that you
see in your patients? How how doyou constantly keep that
questioning attitude movingforward so that you can utilize
the historical context that youlearned. But also understand
there's so much more to learn,right? Because this is a
(05:06):
constantly evolving field. Weare we are just now beginning to
catch up with the content thatwe really need to understand in
order to practice medicine in away that's equitable.
Heather Johnston (05:18):
What age medical students, what level of
medical students take thatcourse?
Pat Poitevien (05:29):
We have a course that we run. So Lundy's course,
I'm pretty sure it's for thefirst year students. But then
she runs an an elective course,for the second year students. We
have a separate course thatactually I teach, called Racism
in Medicine, and it just sort ofgoes through, it's a very broad
overview of how racism hasimpacted much of the much of the
(05:54):
medical information that we sortof take for granted that we
don't think about, that we don'tquestion. And so I teach that as
well, also to the first years.
And so a ton of the content doescome in the first and second
years. And that is veryconvenient. Because the first
and second year students as youknow, are sitting in classrooms.
And so a lot of it is didacticup in in the first and second
(06:15):
year. So another project thatI'm working on right now is the
creation of a third yearclerkship on racism in medicine.
Because really, you know, if youthink about the model of medical
education, we do all thispreclinical stuff, right, the
first 18 to 24 months of medicalschool, and then we send our
students out into clinicalspaces, and we say, now it's
(06:40):
time for you to learn thepractical application of
everything that we taught you.
But we don't do that withracism, right, like, so, again,
it kind of goes back to this, Ican teach you a ton of content
on racism in medicine, but whatI really need you to do is take
that content, and make it make adifference. So you know, some of
(07:03):
the some of the skill buildingthat we want to teach our
students is how to engage in aconversation about race with a
family, particularly if you'rein a non race-concordant
relationship with that family?
How do you we know that inpediatrics, for example, we know
that racism is a significantace? So how do you engage in a
conversation with a family abouthow racism is impacting them?
(07:28):
How it might be impacting theirchildren or their other family
members? And how do you do thatin a way that is helpful and
supportive to the patient andhelps to see them for who they
are. So I think that skillbuilding around the context of
the history of racism is our wayof saying, Okay, this is how you
(07:49):
show up and bring this knowledgeinto your exam room every single
day.
Heather Johnston (07:57):
Is there any kind of self reflection
component early on in the firstsecond year or later on third,
fourth year, or even intoresidency where they look back
and I don't know how many yearsyou've been doing the program,
but you know, have you gottenfeedback about it?
Pat Poitevien (08:11):
So for the third year clerkship, we're still
building it. So we haven'tgotten any feedback, but one of
the pieces of the clerkship islike self reflection, and it's
consistent self reflection thatthey have to review with with
the leader of the clerkship,because you know, I don't need
(08:31):
to tell you or this audiencethat racism is, there's so much
about it, that is personal. Andindividuals come into this work
with entirely heterogeneouslevels of engagement with
racism, right? Like you havesomeone like myself, I was, I
was actually reflecting on thisin a group of faculty members,
faculty leaders, and I was theonly black person in the group.
(08:54):
And I said, you have people likemyself, who for personal and for
professional reasons, I thinkabout racism every single day.
Like, I can't remember 24 hoursthat have passed, I don't know,
in the last two decades of mylife, where I have not actively
thought about racism, right. Sothat's one end of the spectrum.
And then you have individualswho, for personal reasons, and
(09:15):
for professional reasons, mightnot ever consider the impact of
racism, or they might only thinkabout it when they're in a
conversation, like the one thatwe're having now or in a
training session. So when youhave individuals at those two
ends of the spectrum, and wedefinitely have students who are
at those two opposite ends ofthe spectrum, making sure that
there's some self reflection tounderstand how our personal
(09:37):
identities and how our ownpersonal histories and
experiences influence how weshow up in exam rooms for
patients is critical, because ifwe're not examining that, then
we're completely missing theboat. Like we're not we're not
all coming into thisconversation at the same level.
I actually don'tI've been looking for, to find
Heather Johnston (09:53):
Are you aware of anyone else doing programs
out if there are other peoplewho are doing it. Because it's
like that, and creatingclerkships around the idea of
like, why reinvent the wheel ifpeople are doing this well, or
racism and how oftenmaybe find ways to collaborate,
so that one person, you know,one schools approach might be
different than the approach thatwe're taking. And we can learn
(10:14):
from one another, from thosedifferent approaches. You know,
one of the one of thechallenges, we have several
challenges in rolling this out.
But one of them is, you know,how do you assess a student
who's gone through thisclerkship? Like, what does it
(10:35):
mean, you know, in every This isschool, right. So in everything
that we do, our goal is that ourstudents are learning something
and growing. And so how do youassess whether someone has, you
know, really understood theinformation that's been shared
with them, and that theinformation has been
(10:56):
transformational? Right, like,you know, we have we have simple
goals and objectives for theclerkship, which we always have
for clerkships, but they don'tfeel meaningful, right? Like, of
course, we want you tounderstand the impact of racism,
yes. But really, I want totransform how you think about
(11:18):
your interactions with people.
That's really hard to measure.
Yeah, so trying to understandhow successful the clerkship is
going to be, because we want tomeasure the outcomes of the
clerkship is some place where Iget tripped up quite a bit. It's
like, how do we think aboutassessment outside of our
(11:40):
traditional measures ofassessment, in order to capture
what it is that we think isreally important about an
educational exercise like this?
That part is a little bittricky. Yeah, you know, when
I was at UFC, I taught a lot ofthe courses on professionalism.
And, you know, how do you teachsomeone to be more professional
(12:02):
in their relationships? It's,this is this conversation is
making me like, think back tothat also, my anxiety is going
up a little bit. But I rememberwe would have the same
conversations. And this was backin 2003 2005, we were having
these conversations like, well,what does it mean that the
(12:22):
student has learned it or notlearned it, and we ended up just
basing a lot of it on selfreflection, if we felt like if
they were able to be very selfreflective on some of their
experiences that they werehaving that was a very good sign
that they're just at leastlearning that at least they were
demonstrating that they learneda skill that over time, then
should help them achieve thegoals we were trying to teach.
(12:45):
Yeah, that is
Pat Poitevien (12:47):
You know, so I've done a ton as you can imagine,
in this role, and just becauseof my own interest, I've taken a
lot of time to learn more aboutwhat it means to be anti racist
and anti oppressive in anacademic environment. And what I
have come to understand is justhow academia itself is an
(13:09):
oppressive environment. And sothe tools that we utilize to
measure success within academiaare oppressive by nature. You
know, there's an entire conceptof epistemic injustice, which I
was not familiar with before Istarted this work. And the idea
is that our entire understandingof higher education is really
(13:34):
baked in oppression, right,because the individuals who
created structures of highereducation were, you know, mainly
European, white men. And so thestructure that they built was a
structure that reflected theirvalues. And so we continue to
function within that structure,of course, but it also behooves
(13:58):
us to question all of the partsof that system if our goal is to
dismantle oppression. And so,you know, you think about
assessment, for example, right,like how we assess competency
and a big part of assessment incompetency in medicine is, you
know, standardized tests aroundmedical knowledge. And, you
(14:22):
know, I see you nodding yourheads, you know exactly where
I'm going with this, right. Buthave we ever demonstrated that
individuals who demonstrate abetter, sort of, I don't want to
say a better grasp, but an abetter ability to recreate or
reproduce their understanding ofmedical knowledge on a
(14:45):
standardized test. Have we everdemonstrate that those people
are better doctors? Providebetter care?
Heather Johnston (14:55):
I'm sure not.
But also that's tricky, becausewhat does better care mean?
Right So how would you even
Pat Poitevien (15:01):
to measure whether we are on the same path?
beginRight? So it's literally it's
like you just startdeconstructing all of these
things that you've always takenfor granted. Like, someone might
say better care is betteroutcomes, right? And I think a
lot of individuals think thatway. So like, if a patient does
well, you have given good care.
(15:25):
Right, like when you talk topatients, and we, you said this
right, before we started thisinterview, they might say,
actually, the relationship thatthey have with their doctor is
the is the sign of the bestcare, and it's not their
outcome, it's their ability totalk to their doctor, confide in
their doctor trust what theirdoctor has to say, and are we
(15:46):
measuring any of those thingswhen we're measuring competency
in medical school? And do weeven know how to measure for
another phenotype of individual?
Because if I don't have a way ofmeasuring how well you
communicate, or how well youdevelop a relationship of trust
with another human being, howcan I make sure I'm selecting
for those people? There's no wayfor me to do it, I'm looking at
(16:08):
your grades, I'm looking at yourMCAT score. And then I'm looking
at an interview with who? With alot of other people who are
entrenched in our older systemwho are not asking themselves
those questions. And so thatsystem is going to recreate and
reproduce the exact type ofphysician that it's always
(16:29):
recreated and reproduced.
Heather Johnston (16:31):
It makes me wonder if the current changes in
the college admissionslandscape, this is on my mind,
because I have one in collegeand one heading to college soon.
Makes me wonder if the makeupyou know, of, of the more
competitive colleges as it'schanging so much now, partly
(16:52):
because of the pandemic, butalso because I think a lot of
the schools just glommed on tothe pandemic as an excuse to
make changes that I think areright, you know, less, less
legacy admissions, more diverseadmissions, blind test, optional
non testing, I love all of that.
It did not help my whiteMidwestern children, but I'm
cool with that, because I thinkit's better for the world. But
(17:14):
it makes me wonder if then, youknow, those students are then
going to feed into the medicalschool system. And it makes me
wonder how that's going tochange down the line.
Pat Poitevien (17:25):
I mean, I'm hopeful that it does change. The
problem is, and you know, my, Itry not to always think about
problems,
Heather Johnston (17:35):
or your job, part of my
Pat Poitevien (17:37):
job, the problem is that you can feed all of
these diverse individuals withdifferent perspectives and
different skill sets into oursystem. But if we don't
fundamentally change our system,we they will either
fundamentally change because youadapt to the system that you're
in for survival, or you beterrible, right, or you just
(17:58):
you're out. And what we havefound is that, certainly
individuals who are at least ofdiverse identities, right, when
they come into our system, wefail them. And I mean, not like
we give them an F, but we do notcreate environments that are
inclusive, we do not createenvironments that encourage
(18:19):
belonging, and we do not createenvironments that encourage
their success. So either theyleave, they're dismissed, or
they fundamentally try to changewho they are in order to survive
in the system. And the wholereason why we brought them in,
which was for their diverseperspective, their diverse
(18:39):
background, and their differentway of thinking about things
gets lost, because the systemitself works to dilute it out.
Right, like, if you think aboutmedical education, our our
medical education system is allabout uniformity. We don't have
a system. And you could arguethat's that's sort of like all
(19:01):
of education in the UnitedStates, right. But I'm just
going to focus on medicaleducation, because that's what
that's my area of expertise. Wereally focus on uniformity.
We're not trying to celebratediverse perspectives, like there
is a way that you do things,right. We talk about clinical
practice guidelines, and we talkabout uniformity and outcomes.
(19:23):
And there's a very specificdefinition of a doctor that we
have in mind. And we try to fiteverybody within that
definition. Now, I'm not sayingthat that's fundamentally wrong,
because we do have to havestandards, right. Like we have
to have standards for what wethink make a successful
physician. And we have to becareful that in the support of
(19:46):
those standards, or even in thereplication of those standards,
what we're not doing iseliminating opportunities for
different perspectives anddifferent thoughts and
innovation frankly. And I thinkthat's always the danger with
any of these large institutions,right? Like you, you say there's
a standard for a physician thatwe want and you create that
standard. And that feels like itmakes sense. You want someone
(20:09):
who has a minimum amount ofunderstanding about, you know, X
and a minimum number of yearsand training around why and a
minimum number of patientexperiences. Totally makes
sense. But what else are weselecting for when we create
those systems? There are otheraspects that we're selecting for
that aim is we dismiss thethings that we claim to
(20:32):
celebrate. Because if a studentcomes on a clinical rotation,
and is rounding with us, andthey say something that is
different than what theattending thinks, depending on
the psychological safety of thatgroup, the attending might just
shut them down. And you know,like medicine is still based in
(20:54):
a hierarchy. So how do youencourage innovation and diverse
thought, when there's a personin charge, who gets to make all
of the decisions, and then theirresident and their students, and
sadly, then there are nurses,and other members of our
interprofessional care team. Andwe create, we have this
hierarchy that we actuallyworked really hard to maintain.
(21:16):
But then we say that we reallywant diversity and innovation
and, you know, like, differentways of thought, but those two
things don't work together. Soone has to be dismantled in
order to welcome the other one.
Heather Johnston (21:29):
It's almost a little dizzying, because you
have to work forwards andbackwards at the same time, like
the students are coming in, youhave to think about who you're
selecting what your makeup is,what your goals are for them
right from the start, but at thesame time, you need to be at the
endpoint and say, well, what, asan institution, are we going to
say defines a good doctor whocan graduate from here? Do we
(21:53):
just want someone with the goodtest scores? Or do we want
somebody who shows empathy inthe face of difficulty and
pressure and is inclusive of allof their patients? And then you
have to say, well, okay, now wehave the definition of the
doctor that we want, we have towork backwards to create the
curriculum. That's verydizzying.
Pat Poitevien (22:12):
And it's particularly hard to do, because
there's a lot invested in thecurrent definition of doctor.
Right, so all of the people whowere in charge, worked through
the current definition ofdoctor, including myself. And so
to question our currentdefinition is to question the
(22:32):
identity of all of the peoplewho are in charge. And some
people are okay with that. Andsome people absolutely are not.
And it really threatens who theyare and their core identity. And
they're not comfortable withthat. Because if I did it one
way, if I became a doctorbecause of this very specific
(22:54):
skill set, if I scored awesomeon my MCAT, and fantastic on my
STEP and blew my board exams outof the water, and published the
way I was supposed to, which iswhat everybody told me to do,
then why do we get to change therules now? Because that's what I
did and why and if you'retelling me that, what I did is
(23:17):
not what makes a good doctor,then you are de facto telling me
I'm not a good doctor. People donot like that. And in the end,
of course, we're not tellingpeople that they're not good
doctors now, because they wentthrough another system. What
we're saying is that we haveopportunities to bring in other
people who can also be gooddoctors, right? Like it's not a
(23:37):
zero sum game. A lot of equitytalk is around, we don't all
work with one pie, right? Likeit's not if I get a slice, you
don't get a slice. You are agood doctor, you've accomplished
a lot. That doesn't mean thathow we define doctor needs to
stay the same in order tomaintain your value as a human
(23:58):
being and as a physician, right?
Like it's not a pie. This isboth and we can bring other
people with other skill setsinto the space, who can also be
exceptional physicians. And thatdoesn't have to threaten who you
are.
Heather Johnston (24:10):
Let me, let's play fantasy for a minute.
Pretend we live in a worldwhere? Well, this might not be
fantasy. I'm not digging you inany way. Let's pretend let's say
future instead of fantasy. Whenyou personally develop an
incredible curriculum that justworks right for everyone around
(24:35):
this topic, could you seesomething like that being able
to be plucked out and used atother medical schools? I think
just restate my question moreclearly. Could you ever see
there being a nationalcurriculum for medical students
on these ideas that all theschools could use?
Pat Poitevien (24:56):
Absolutely.
Absolutely. And I think thatthere are some spaces is where
we're thinking about this on amore sort of national or even
global level. So I'm going to doa little bit, it's not really
self promotion, it's like selfpromotion. But um, the American
Board of Pediatrics actually puttogether a small working group,
(25:17):
I want to say about two yearsago, and I had a chance to serve
on the working group to look atuntrustable professional
activities. And, you know, youmay or may not know, you know,
untrustable professionalactivities are another way that
we are trying to get a bettersense of the competency of our
pediatric trainees, right. It'slike and, and we're doing this
(25:38):
in pediatrics, but the boardsfor all of the other specialties
are also doing something verysimilar, right. There's
recognition that how we'veassessed competency of our
physicians is not perfect. Anduntrustable professional
activities are really based incompetency based medical
education. It's like how do wemake sure that the education
that we're providing is linkedback to the competencies that we
(26:02):
want physicians to have, whichas we shared in the beginning of
this conversation has not alwaysbeen the case, right? Like how
we assess our doctors has notalways been linked to the
competencies that we actuallywant them to have as doctors,
which is like a crazy concept.
Sometimes I say that out loud.
And people look at me like I'mcrazy. I'm like, No, seriously,
like, we're not, I'm not evenkidding, you're not crazy. And
(26:23):
so we have 17 untrustableprofessional activities in
pediatrics. And one of them wasan untrustable professional
activity on like, qualityimprovement and advocacy. And
the working group was actuallycharged with incorporating anti
racism into the into trustableprofessional activity. So that
not only were we calling outwhat we wanted pediatricians to
(26:46):
understand about how raceimpacts pediatric health
outcomes, we also had to callout how those things were going
to be assessed. And the EPA ismeant not only for residents,
the EPA is ultimately meantmeant to help to measure the
competency of all physicians.
(27:06):
And so that, to me, is a verysort of global perspective. Like
no matter where you trained as apediatric resident, we the the
Board expects you to have somelevel of competency in how
racism impacts your patients,how to measure how racism is
impacting your patients, and howto implement systems to help
mitigate the impact that racismhas on your patients. Which is
(27:30):
like kinda revolutionary.
Heather Johnston (27:32):
It is i My mind is working. That's why I'm
looking at you blankly I'm likethinking about 100 things at the
same time. So is the idea herethat if the American Board of
Pediatrics comes out and saysfor example, we expect our
physicians to demonstratecompetency in terms of racially
(27:54):
sensitive relationships withtheir patients, then that will
drive medical schools to berequired to teach?
Pat Poitevien (28:02):
Well, certainly, because that the board is really
looking at the competency ofresidents, it will at least
drive residency education. Andwe actually do a ton. In
addition to just creating theEPA. You know, we also talk
about like, here's curriculumthat you can utilize to help
support what we're saying wewant your residents to be able
(28:25):
to do, right like we don't wantto just put the the requirement
out there, we also want to givepeople the content that they can
deliver to their trainees. Butis as you can imagine,
antiracism in pediatrics is notthat different than antiracism
in adult medicine or ingynecological care or in
surgical medicine, right? Butthe concepts are the same. How
(28:46):
you might execute or assess itmight be slightly different
based on your specialty. Butoverall, we're asking you to do
the same thing. We're asking youto have an understanding of how
racism impacts medicine, we'reasking you to have a questioning
attitude so that you caninterrogate your systems for how
racism is impacting yoursystems. And then we're asking
(29:09):
for you to then help to recreatesystems or mitigate systems
where you're seeing how racismis impacting your patient
outcomes. And even though thatmight change a little bit based
on specialty, it's kind of thesame thing. And you can pull it
back to medical studenteducation as well. Absolutely.
Heather Johnston (29:26):
But you were talking about just the wide
variety of preceptors andteachers that you have, who then
become responsible to teach thismaterial. I wondered if you have
a program in place to teach theteachers?
Pat Poitevien (29:39):
Absolutely. We actually do a ton of Faculty
Development. Some of it isproactive, some of it is
reactive. So I'll explain that alittle bit. You know, right now,
for example, we we actually thispast year, hired outside
consultants because we don'thave enough people with fluency
(30:00):
in how to teach in an antiracist way. We just don't have
enough of those people withinour institution. So we asked a
group to come and help ourfaculty members, again,
understand the complexity ofracism, you know, like racism
and oppression in general isreally complex. People spend
(30:20):
their entire lives, studyingthis writing about it, lecturing
on it. And our faculty membersare busy people, they're seeing
patients, they're teaching. Sothe ex, we can't have an
expectation that they have towould have this level of
expertise, just magically. Andso we hired some individuals who
are doing antiracism workshopswith our faculty right now to
(30:45):
give them some of that skillset. So that's some of the
proactive work that we're doing.
And then the reactive work thatwe do, and I think it's
important that you have both, isthat we also have a system to
report what we call curricularopportunities. So when our
faculty members are sharingclinical content, particularly
in the preclinical years, butalso in the clinical years, when
(31:06):
they are sharing curricularcontent that might be based in
oppression or might not beinclusive and sensitive to
different identities, ourstudents have the ability to
report those, and we call themcurricular opportunities. Those
actually are all reviewed bysomeone who is incredibly
talented here, our AssistantDean for Diverse Curriculum,
(31:27):
Teaching and Learning. She's aPhD and anti racism education,
she's not a physician. And shereviews all of the curricular
opportunities, and then createssort of like individual plans
for those faculty members basedon the report. So sometimes,
it's just that the dermatologylecturer did not have enough
(31:50):
representation of rashes ondifferent skin tones. And so she
goes back to the faculty member,and she says, Here are some
resources, can you please, youknow, create some more slides so
that individuals can see thesedifferent pathologies on
different skin tone, right? Likethat's sort of, that's not hard.
Sometimes it's in something thata faculty member has said, so
(32:12):
the slide is fine, and thecontent is fine, but how they
deliver the content was notinclusive. So one of the other
examples that we hear a lot is afaculty member that might speak
about prevalence related torace, as opposed to relate it to
racism, right, without, so yousay that black individuals have
a higher into or I'll useanother example, you say Native
(32:37):
American individuals have ahigher incidence of alcoholism,
and then you end theconversation, then you move on,
without ever really explainingthat it's not something inherent
to individuals who are AmericanIndian or Native American. It's
actually related to racism andsystemic racism and systemic
oppression that this hashappened. So it's like, okay,
faculty member, we're going toneed you to elaborate a little
(32:58):
bit more about why you see thestatistical difference and have
some more content expertise inhow racism has played a role
here. So that the takeawaymessage is not that this is an
inherent part of this person'sracial biology or whatever, not
whatever that is. But that thisis really a uh, it takes a lot
of work.
Heather Johnston (33:24):
Yeah, I'm so excited. You have that person. I
wonder how many schools havesomeone like that? That role
specifically? I mean, I've neverheard of it.
Pat Poitevien (33:32):
I don't think very many to be honest with you,
like I am. I mean, our team, Ithink I was sharing at the
beginning, you know, our officestarted as this really small
office like just to supportstudents of color. So there were
a total of 3.5 FTE, right, likefor the entire office, in the
year that I've been here, wehave exploded the office because
(33:53):
a lot of work needs to get done.
And we went from 3.5 FTE toabout, we have 12 individuals
now in our group, andaltogether, they're about nine
FTE with like everybody's work.
And it's, like I said, I feelvery, like I feel very, very
privileged to be able to do thiswork in this environment with
(34:14):
this level of support. I knownot everybody has that. So our
goal, of course, is to export asmuch of this as possible so that
even in lower resource settings,we're still getting the students
and the trainees and the facultythe education that they need.
Heather Johnston (34:29):
I love it. I'm so glad you're there. I'm so
glad you have that job and thatyou're there. Oh, man makes me
feel like it's gonna be okay.
Pat, it's been so great talkingto you. I've learned so much
about what you're doing thereand wonderful.
Pat Poitevien (34:49):
This was a lot of fun. I've been in different
interviews before and thisreally did not feel like an
interview. It felt like I wastalking to a friend of Barrett
so thanks for saying stuff, youknow, but um, but I Really
appreciate you elevating it onyour own platform and bringing
such different perspectives tothe table and just your general
treatment of the of the topichas been amazing so I'm really
(35:12):
appreciative of you, thank you.
Heather Johnston (35:13):
You're very welcome!
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