Robust diversity and inclusion activities, including training of the admissions committee in implicit bias and implementation of holistic review, have produced a substantial enhancement in the number of traditionally underrepresented students in medicine, doubling in the last four years the matriculation of underrepresented minority students in medicine to 23%. Of students in the health professions program, 31% are underrepresented minority students. [Recommendation #3]
Medical Master's program
The Medical Master's program (designed to help students become more competitive for medical school admissions) has been a particular success. The two-year Medical Master's program, which was established in 2015 to complement the well-established one-year program, has been instrumental in expanding the pool of diverse students prepared to enter EVMS, as well as other medical schools. In the past three years, the program has successfully matriculated into medical school over 90% of its underrepresented minority students — out of which 16 have joined the EVMS program. [Recommendation #3]
Pipeline programs and community mentoring
Pipeline programs are intended to expose high school students (particularly those from underrepresented minorities) to the medical and health professions as a means of expanding their career aspirations and educating them on the types of courses and knowledge needed for success in those fields. These efforts take time and effort to cultivate and develop, and we are pleased to start seeing significant results from our high-school pipeline programs.
In the past few years, we have matriculated a number of students from the Maury Medical and Health Specialties Program into our MD, Medical Master's and Health Professions classes. And we are implementing strategic monitoring of the pipeline programs, creating longitudinal mentoring matches with medical students and establishing enrichment programs targeted at enhancing diversity in the pipeline.
Our Health Sciences Academy provides opportunities to Portsmouth High School students to expose them to medicine and health professions. The program is expanding to include students from the rural Eastern Shore in the coming years. We also have been working in collaboration with the Norfolk Redevelopment and Housing Authority to establish a sustained longitudinal mentoring program for Norfolk high school students in public housing that involves medical and premedical students as mentors and facilitators.
Social and professional belonging
EVMS nurtures the social and professional belonging and leadership development of the diverse students it attracts by providing support and guidance to student-run groups and organizations. Various affinity groups, including the Student National Medical Association (SNMA), the American Medical Women’s Association (AMWA), the LGBT Alliance, and interest groups on rural and military medicine, are supported and mentored to enhance the diversity of future healthcare professionals and their preparation to serve our diverse communities.
LGBTQIA support and inclusion
A Safe-Zone Training initiative was launched in 2015 to ensure inclusion of LGBTQ students, faculty and staff. The initiative has trained over one hundred allies. The EVMS Alliance promotes an inclusive climate for LGBTQ students, faculty and staff engaging the EVMS community to participate in volunteering opportunities in the community and facilitating educational opportunities at EVMS to foster cultivation of LGBTQ-responsive healthcare professionals.
Nurturing leadership and scholarly activities by Alliance members also has been a key effort. Student leaders have been supported to engage in research on LGBTQ health and have presented every year at the national Annual LGBTQ Health Conference held in New York. [Recommendation #5]
Graduate Medical Education
A Graduate Medical Education Diversity and Inclusion Committee has been established to enhance recruitment efforts in EVMS residency programs. The 2020-2024 EVMS Strategic Plan, Advancing Health Equity and Inclusion for Community and Academic Impact, has identified priority areas in graduate medical education, including implementation of holistic review in residency recruitment and enhanced outreach and recruitment efforts. The initiative was launched with a learning opportunity for the Graduate Medical Education Committee on diversity and inclusion and holistic approaches to residency recruitment hosting William McDade, MD, PhD, Chief Diversity Officer of the Accrediation Council for Graduate Medical Education. [Recommendation #3]
As part of the strategic plan GME has also established funding for and process/support for providing audition electives for Underrepresented Minorities in Medicine (URM.)
Funding was also created to support 3+ residents per year to attend University of Virginia Annual Diversity in GME conference training as well as LBGTQ conferences to assist in development of education programming for residents. To support those efforts, OGME staff have also completed Safe Zone training.
Quality Enhancement Plan
In 2016, EVMS implemented a new four-year undergraduate medical education (UME) curriculum. Our nationally recognized CareForward Curriculum (CFC) transitioned from discipline-based to an organ-system-based curriculum which includes two years of pre-clinical studies and two subsequent years of clinical experience. Included in the new curriculum were key longitudinal threads, including: high value care, care of older adults and those with multiple chronic conditions, wellness and community-engaged learning. This transition allowed for intentional focus on training future physicians to provide team-based person-centered, high value care in the context of the EVMS institutional mission to become the most community-oriented medical school in the country.
Over the past four years, increasing awareness of these topics by both students and faculty have contributed to enhancements in the curriculum and opportunities to engage students in becoming change agents in transforming medical education. When EVMS invited its students to come up with a five-year educational project (Quality Enhancement Plan) that would address accreditation requirements and advance the existing curriculum, it was no surprise that they identified the QEP topic of cultural humility. This topic emerged after approximately 30 meetings involving over 200 students, faculty and staff at EVMS.
Cultural humility is a continuous process of self-awareness of and reflection on one’s own values, biases, and behavior while cultivating a sensitivity and openness to cultural identity, with the intention of honoring the beliefs, customs, values, and experiences of all people. This includes:
- Continuous self-assessment and reflection
- Sensitivity and respect to individual beliefs, customs, values, and experiences (person-important identity)
- Identifying potential power differentials
- Using intentional strategies to reduce potential power differentials
- Recognizing and addressing systemic barriers to equity
Our choice of cultural humility as a Quality Enhancement Plan was based on five key reasons:
- Cultural humility is central to the EVMS 2019 health equity and inclusion strategic plan and to the EVMS vision
- There is heightened awareness in the institution around cultural humility
- It was the students’ most often cited QEP preference
- It will prepare future healthcare professionals for an increasingly diverse world of practice.
The EVMS cultural humility curriculum, named Live Humble, recognizes that as contemporary societies become increasingly diverse, it is imperative that physicians have the ability to effectively and positively interact with people very different from themselves. The enhanced curriculum rolls out gradually in August 2020. It aims to enhance student learning and preparation for their role as future physicians by improving students’ knowledge, skills, and values in cultural humility and structural inequity. This, in turn, will improve quality of care, particularly for those who have been stigmatized.
Over the course of the four-year curriculum, students will engage in several types of activities to build knowledge, awareness of self and others, and professionally appropriate skill sets related to cultural humility. The Live Humble QEP also will include professional development of faculty and staff, development of training modules for relevant stakeholders and ongoing assessments and program evaluation.
The QEP organizational structure and staffing is supported by individuals directly involved with curriculum design and integration within the existing MD program. Successful implementation of the Live Humble QEP initiatives over the five-year implementation phase is supported by an investment of $1.2 million and was created in partnership with key administrators and QEP leaders. This budget addresses QEP program design, development, implementation, publicity, analysis, and evaluation tasks.
The EVMS QEP aims to achieve student learning outcomes, initially in the Doctor of Medicine (MD) program and expanding to the health professions programs over time, by building upon and improving current aspects of the EVMS curriculum and integrating additional activities and assessments. [Recommendation #1]