Faculty Development: Diversity & Inclusivity

"This organization is and will always be a safe place for people of all races, genders, ethnicities, creeds, and sexual orientations. We know that diversity is one of our greatest strengths, and we stand against bigotry in any form...It takes compassion, understanding, empathy and kindness to provide the world-class care that we deliver every day. Let us treat everyone inside and outside of work with the same humanity we extend to our patients. Be good to each other. Listen. Empathize. Seek to understand.  Support your colleagues."                                              Dr. Susan Turney,  CEO  MCHS (2017) 

"Every day in our Health System we choose togetherness. As proud as I am of the care we provide to our communities, I'm equally proud of how we do it. People of difference backgrounds, genders, lifestyles, races, political viewpoints, religions and personal values come together here every day in pursuit of just one common goal - enriching lives."      Dr. Susan Turney, CEO MCHC August 3, 2020

Culturally Competent Medical Care Definition:

Cultural competence is a set of congruent behaviors, knowledge, attitudes and policies that come together in a system, organization, or among professionals that enables effective work in crossing cultural situations. Culture refers to integrated patterns of human behavior that include language, thoughts, action, customs and beliefs, and institutions of racial, social, ethic, or religious groups. Competence implies having the capacity to function effectively as an individual or an organization within the context of cultural beliefs, practices and needs presented by the patients and their communities."                                                                                                                                  Association of American Medical Colleges (2005)

Mitigating Implicit Bias in Healthcare and the Medical Office.  52 minute video  MCHS Grand Rounds presentation August 16, 2019  by Preshuslee Thompson, Facilitation and Research Specialist, Kirwan Institute's Implicit Bias/Race & Cognition Program. The presentation's goals are to: summarize how biases develop in our unconscious minds; assess our understanding of the ways in which bias operates in our lives and institutions; and, develop a space and process to consider the connection between health disparities and Provider's implicit bias. The presentation defines implicit bias, its impact on teaming and patient safety, how we all have them, when they are most likely to emerge,what they look like and management of implicit biases.

What are your implicit biases? Here is a way to find out.

Project Implicit is a non-profit organization and international collaboration between researchers who are interested in implicit social cognition - thoughts and feelings outside of conscious awareness and control. The goal of the organization is to educate the public about hidden biases and to provide a “virtual laboratory” for collecting data on the Internet. Here's the Implicit Bias Tests link

Culturally informed care has a very important role in faculty performance and development as demonstrated in the regulations related to it in residency education. 

Culturally informed care is:

•  A developmental milestone for residents to master in their competencies withing their program 
• An element of ACGME's  Clinical Learning Environment Review (CLER) in its Professionalism Focus Area
• An element in at least 4 of the 6 ACGME Core Competencies (Patient Care, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice)
• A core element of the ACGME Common Program Requirements for residents' training (CPRs July 1, 2019 see IV B.1.)
• A requirement of faculty to model and support culturally informed care, per the ACGME CPRs (see section V).

You have several  essential roles in your residents' development in providing culturally competent health care. The CLER National Report of Findings 2019 noted that in the Focus Area of Health Care Disparities Finding 4: "Generally residents and fellows reported that learning about cultural competency happened informally while providing clinical care."  Therefore one essential role is in what you model, what you reinforce and what you guide in your work with residents, according to the CLER findings, is the primary way residents learn how to provide culturally competent care.

A second essential role is to support residents when they are subjected to disrespect for any reason including disrespect based on racial or cultural differences. This role is part of what Dr.Turney addressed in the MCHS View on Diversity and Inclusivitiy on this topic page. When you witness this disrespect it is important for you to recognize it for what it is, step in to protect the resident, support them and then advocate for corrective steps with whomever needs to be involved to reduce the risk of recurrent. Faculty typically do not have experience doing this, so please seek out consultation with colleagues, the program director, HR. Not addressing it is tacit acceptance of it, harms the relationship between the faculty member and resident. and misses an opportunity to correct it.

The Faculty Development website has some materials on this. See the Faculty Development Emails section for the Emails on Civility, Patient Disrespect to Residents and Microaggression. Also a January 2020 article in the AAMC Newsletter provides information on frequency of this behavior and examples of efforts to address and preclude in. The article is at this link.

The July 2020 MedEdPORTAL article Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students, provides all the information needed to lead students and residents in a practical  workshop on recognizing and managing microaggressions. The post workshop surveys indicated learners acquired critical knowledge and practical tools for managing microaggressions.

Lippincott Advisor is a MCHS Intranet resource which provides information on over 60 different patient populations. As noted on the tool:

"This Cultural Perspectives content set is a point-of-reference tool to help health care professionals provide culturally competent care to diverse patient populations across the care continuum as they interact within the U.S. health care system. Each entry is group-specific, highly referenced, and provides general information."

Each of the over 60 patient populations in the Lippincott Advisor provides direct, clear and brief information on that topic in 11 categories. Each category includes its own  "What You Should Do" section with bullet point guidance on how to engage culturally informed care related to that category. Categories are:

• culture/ethnicity/community orientation
• cultural values/beliefs
• religious and spiritual beliefs and practices
• communication and language considerations
• family/gender roles and relationships
• health/illness beliefs and practices
• special health/illness concerns
• activities of daily living
• food, nutrition, and dietary concerns
• birth and postpartum beliefs and concerns
• end-of-life care and concerns.

MCHS Ethics Committee  Educational Series
The Ethics Committee is comprised of multi-disciplinary representatives whose purpose is to focus on and address clinical ethics issues. The Ethics Committee functions as a resource for education and consultation, as well as formulation and implementation of policies/procedures dealing with clinical ethical issues.