Graduate medical education second look days foster community

March 20, 2018

Which comes first – a diverse and inclusive community or the will to create it?

GME programs are a prime example of intentional change

Christopher Swide, M.D. R '91, was residency program director in the Department of Anesthesiology and Perioperative Medicine (APOM) from 2005 to 2017, and was vice chair for education from 2009 to 2017. He created a holistic approach to diversity recruitment. In addition to applicants from underrepresented minority groups, he encouraged his department to consider diverse experience as a valuable asset. Applicants who wanted to do rural medicine, who had an interest in research or an interest in critical care – all those became assets in this approach.

"When you define diversity in a comprehensive way, you begin to recognize that everyone has a skillset and brings something to the table," said Dr. Swide, who credits his department chair, Jeffrey Kirsch, M.D., and the Center for Diversity and Inclusion as instrumental in the change.

The efforts are working. From 2015 to 2018, trainees from URM groups have made up between 25 percent and 42 percent of the incoming class in APOM.*

"It's important for our patients to see that our residents and students reflect what they see in the community. I have learned how to be a better doctor by working with people of a different race or socioeconomic background than me," said Emily Baird, M.D., Ph.D., assistant professor of anesthesiology and perioperative medicine, OHSU School of Medicine, and current residency program director.

The Department of Anesthesiology and Perioperative Medicine has also been a leader in training staff and faculty to be more culturally competent. They were one of the early adopters of unconscious bias training, which is currently an institution-wide initiative. This year, APOM faculty members participated in behavioral-based interview training to help level the playing field for all applicants. Faculty members who could not attend completed a one-on-one session before they interviewed applicants.

Donn Spight, M.D., associate professor of surgery, OHSU School of Medicine, and chair of the department's diversity committee, is championing similar efforts in the Department of Surgery. In addition to academic merit, they are looking at what he calls "grit factors" such as military, career or college athletic experience.

"We have done a great job in gender balance over the past 10 to 15 years. About 50 percent of our GME class is women, which is a national model," said Dr. Spight. "Now, we have to be intentional about making this a place that people with a variety of backgrounds want to come to."

Dr. Swide is now associate dean for graduate medical education, OHSU School of Medicine, and the momentum for a more organized GME diversity recruitment effort is building. Alumnus Gustavo Mendez, M.D. '15, is partly to thank. Dr. Mendez was active in mentoring junior colleagues during his time in medical school. He and members of diversity student groups held events with pre-medical students from Portland State University, the University of Portland and Oregon State University.

Dr. Mendez returned to OHSU for a research project during his residency training at Rush University in Chicago. He encouraged GME programs to use data-driven and literature-based strategies to recruit a more diverse cohort of trainees. Based on feedback from OHSU program coordinators, he recommended an inter-departmental second look effort. Dr. Mendez's vision is coming to fruition.

Apply, visit and come back

In early February, the Departments of Anesthesiology and Perioperative Medicine and Surgery hosted nearly 20 GME applicants for a "second look" at OHSU and the city of Portland. Applicants to both programs met current residents, faculty members and students. They shadowed trainees in the operating room and on the wards, learned about resources within the OHSU Center for Diversity and Inclusion and the Resident and Faculty Wellness Program, and explored the outdoors.

The activities also brought to light the experiences of minorities and people of color in a largely Caucasian state. For example, what is it like as a Muslim trainee rotating in Eastern Oregon? How have medical students from underrepresented minority groups come together after joining OHSU?

"If they hear about a negative experience, I would rather they hear that and we have a chance to talk about why this is happening," said Dr. Spight, who also organized a lunch gathering at North by Northeast Community Health Center, the only clinic in Oregon focused on African American health.

Based on results of the 2018 match, second look days are a smart approach:

• Seven of the General Surgery Residency Program applicants who visited in February matched to OHSU
• 35 percent of the 20 incoming general surgery interns are from URM groups
• Two of the three APOM applicants who visited in February matched to OHSU
• 25 percent of the incoming APOM residents are from URM groups

Dr. Spight is downright poetic when describing the potential for diversity to flourish. "OHSU is like a mountain with lichen on it. It's a rock and yet there are things growing on it. We have to appreciate what we are. We have to find the person who can likely make roots in a relatively austere environment."

With intentional, authentic and engaged people building a community of diversity and inclusion, this is altogether possible. 

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* All URM statistics in this article are self-reported data from applicants and trainees.

Pictured (top to bottom):

Dr. Christopher Swide, associate dean for GME, OHSU School of Medicine

Dr. Donn Spight, associate professor of surgery, OHSU School of Medicine

Early welcome: Department of Surgery residents call all of the new interns after Match Day 2018 to welcome them to the general surgery residency program.