Title IX Plays a Role in Medical Education

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello, and welcome to today's episode of MedEd Thread. I'm your host, Dr. Tony Tizzano, director of student and learner health, a- and assistant clinical professor of surgery here at Cleveland Clinic in Cleveland, Ohio. Today, I am very pleased to have Rachel King, Cleveland Clinic's director of educational equity and Title IX coordinator, join us. Rachel, welcome to the podcast.

Rachel King:

Thank you very much.

Dr. Tony Tizzano:

Well, Rachel, you know, this is a great time to have this conversation, as it's the 50th anniversary of Title IX. But give us a, a little sense of yourself, and where you're from, and how you came to come to the Cleveland Clinic.

Rachel King:

So, I'm a lawyer, and I have practiced higher ed law for almost 20 years at this point. So, I came to the Cleveland Clinic out of a higher education background. And so, Title IX is very well-understood and ingrained in higher education, and that's the background that I come from.

Dr. Tony Tizzano:

Fabulous. So, I think some people might be surprised that there's a Title IX coordinator at the Cleveland Clinic. What's the impetus for this position?

Rachel King:

So, Title IX is a federal law that prohibits sex discrimination in educational programs, where the organization offering the program receives any federal funds. So, you think most typically about schools, and colleges, and universities as obviously being educational programs, but Title IX applies anywhere there are educational programs, including academic medical centers, including prisons, really any kind of federally funded education. So, at the Cleveland Clinic, we have, you know, all kinds of different educational programs. We have our residency programs, our medical, bioethics, pharmacy residencies. We have research fellows and other fellows who are in educational programs. We have all the health professions' educational programs. As well as our affiliate degree programs, the medical school, various master's degree programs. We have a PhD program. And then, we even have programming for middle school, high school, and college students. So, we have a lot of education. And Title IX prohibits sex discrimination, or discrimination on the basis of sex, in all of those programs. And it applies not just to the students in those programs and the trainees, but also anyone who's employed in an educational program.

Dr. Tony Tizzano:

So, that's a, a really broad purview for your position. What are some of the key elements of the Title IX program that you oversee?

Rachel King:

So, the, the one thing we're really required to have under the regulations is a process for people to make reports about sex discrimination and sexual harassment, and then to have a process to address those reports. So, we have a policy and some procedures that allow for different ways to resolve Title IX reports. We allow an informal resolution, if that's something that both of the parties want to have happened. We obviously can do a formal investigation and make a specific finding as to whether or not the policy has been violated. And, complainants, which is the term that we use for people who've been subjected to harassment or discrimination, can decide what they want to do, and they can decide, in most cases, if they just don't want to do anything. So, one of the hallmarks of a Title IX process is to allow the person who's been subjected to discrimination or harassment to really decide what's gonna happen with their report.

And then, beyond kind of that process, which we refer to as a grievance process, there's a lot of training and education, both about Title IX and how to make reports, and certain employees are required to report if they learn about a potential Title IX violation. And then, just general education around, you know, harassment in general and both people's rights, and also more educationally how to not harass people.

Dr. Tony Tizzano:

So, Rachel, I've taken a number of my learning courses at Cleveland Clinic, our online training portal for employees. What part do you play in producing those sorts of segments?

Rachel King:

There is a Title IX segment in my learning, and we're working on a new one that covers not just Title IX but all of the laws that prohibit discrimination and harassment in education. But a lot of those also are based on other civil rights laws. Title VII prohibits discrimination in employment. Title VI prohibits other forms of discrimination in education. So, some of those are related to Title IX, and some of them are just related to other laws that address discrimination and harassment.

Dr. Tony Tizzano:

So, over the course of time, since you began in this role and you've seen these various initiatives rolled out, have you seen a change in the number of these things that come to you based on awareness or having been educated?

Rachel King:

Yeah. It's a little difficult to tell because there was a period of time of several months at the beginning of the pandemic when I received no reports at all. I think because people weren't with each other quite as much, and no one was really in a position of wanting to complain about anything. There was a steep increase in the first six months or so, and then it's been a pretty steady number of reports.

I think what I've seen more than the specific report about particular conduct is a lot more questions, a lot of people wanting training, a lot of program leadership wanting to understand how to address discrimination or harassment in their programs in a general sense to reduce it, I always think that we obviously have a good process for addressing reports if they come to me, but it'd be much better to prevent the harassment in the first place. So, a lot of the work that I do is directed towards kind of making the world a better place.

Dr. Tony Tizzano:

So, creating awareness.

Rachel King:

Yeah, creating awareness.

Dr. Tony Tizzano:

Okay. You know, I know, certainly in the popular media, the MeToo kind of programming and so forth, how does that impact what you do? Do you think that helps?

Rachel King:

Yeah, I think it is important to raise awareness that if you harass someone, it's gonna be addressed. And that, there aren't people who are above having their harassment of others be addressed. So, especially, you know, medicine is a hierarchical system. It's easier to harass people in a hierarchical system if you are in a position of power. And so, I think stories about people in positions of power who face the consequences of their harassment are helpful. I think it's important to know that there's no one who's going to be, you know, no matter how much money they bring to the clinic, or something like that, you know, if they are harassing individuals here, we're gonna address it.

Dr. Tony Tizzano:

Great. So, it sounds like hopefully we have a fairly transparent sort of approach to this within the enterprise. So, you know, the initial footprint was more or less in the educational space. How does bringing that to the medical institution enterprise, how does that differ? Or doesn't it differ?

Rachel King:

Well, there are different aspects to our program from what we would have if we were a traditional higher education program. So, there are certain additional processes that higher ed institutions have to do. For example, if you do a Title IX investigation, in higher education you have to have a live hearing as part of that, where one party's representative gets to cross-examine the other party's representative. We're not considered an institute of higher education, so we don't have to have those kinds of aspects to it.

And then, I think, if you are a college or university, Title IX applies to every person at your college and university. You know, the custodians are considered employees of an educational program. Here, you have whole swathes of people who aren't impacted by Title IX. They are subject to other civil rights laws, to Title VII in particular, which prohibit discrimination in employment. But there's a whole large amount of the clinic that doesn't kind of fall under Title IX, which means that we kind of sit in parts of the clinic. Because we address residencies, fellowships, and internships, we cover kind of every institute. But we don't cover every person.

Dr. Tony Tizzano:

I see. So, there has to be some educational element more or less one way or another.

Rachel King:

Right.

Dr. Tony Tizzano:

So, if you were to look at the, the, the depth and breadth of questions you get, what are the... what are the most common things that surface?

Rachel King:

So, by far, most of the reports I receive are comments that people have made that are sexually harassing comments. I have received since I've been here about one report a year of a sexual assault that's taken place. So far, I think they've all been between residents. But otherwise, they are primarily sexist comments that people receive from either their peers or someone in a position of authority. To actually violate Title IX, it has to be a very serious form of harassment. Usually, one comment or a few comments isn't going to violate Title IX. But we can address it, and then whether or not it violates Title IX. So, I always encourage people to report because if someone reports even one comment, you know, we can stop that conduct without worrying about whether or not it violates the policy.

Dr. Tony Tizzano:

So, over the course of time, you know, I think the scope of Title IX has changed to encompass, for example, transgender individuals and so forth. Can you comment on that?

Rachel King:

Yeah. So, the law says it, prohibits discrimination on the basis of sex. And really, what's changed over time is what we consider on the basis of sex. So, sort of early on, we identified that we mean not just sex at birth, but also gender. And so, as people have increased their awareness of different gender identities, that's why it's kind of fallen under Title IX. Similarly, when you discriminate against someone on the basis of their sexual orientation, you're really doing it based on what you think a person of their sex should be, and that's a form of sex discrimination. And so, those are the ways in which the interpretation of the language, which has not changed in 50 years, has kind of broadened.

Dr. Tony Tizzano:

So, when I look at this in kind of the broader sense and I look at all of the efforts that we have in the areas of diversity, equity, and inclusion, and our vision being that Cleveland Clinic's a place for a person like me, it seems that this sort of legislation in your office really supports that endeavor.

Rachel King:

Yeah. I mean, I think you have to have a role like this. You have to have somewhere to go. If you say, we're going to assure that you will not be harassed in your workplace or in your educational program, there has to be a way for people to report if it does happen, and for us to address it if it does happen. So, this is one element of the broader effort to ensure that everyone feels like they are safe here, essentially.

One thing I've started to work on outside of Title IX is advising people who feel that they've been subjected to sexist, or racist, or other forms of microaggressions. Which is not necessarily harassment because they may not be overt, but they can have a very negative impact on the person who is subjected to microaggression, which is kind of an insult on the basis of a person's identity. So, that's another way to kind of improve the culture here, is to help people be able to address those kinds of things when they occur.

Dr. Tony Tizzano:

Excellent. So, is your position commonplace in academic medical enterprises such as ours, or not?

Rachel King:

So, I'm not aware of another person who is basically full-time addressing discrimination and harassment in education in an academic medical center that isn't attached to a college and university. So, my position is extremely common. I think every college and university is actually obliged to have a Title IX coordinator. I think most academic medical centers have this kind of an additional duty for a preexisting position. But most places don't have someone who is separate.

I was originally hired here to be the Title IX coordinator and the Section 504 coordinator, which is basically the ADA, and since then I've expanded to address other forms of discrimination and harassment as well. But I think Cleveland Clinic's pretty unique in having a full-time person in this position.

Dr. Tony Tizzano: 

Yeah. I'm proud to hear you say that. You know, I wonder if, over the course of time, as, as this program develops, and, you know, within marginalized communities, where there is safe haven and where there is not becomes known, do you think this will help us to attract a more diverse population of applicants to our educational programs?

Rachel King:

I think it's part of as we were talking about before, it's a piece demonstrating that we're an inclusive and welcoming community. I do think that. And I do a lot of orientation sessions and other kinds of things to make people aware that I'm here if people need me.

Dr. Tony Tizzano:

You know, I've always felt, as an obstetrician-gynecologist, that I was advocate for women, and, and parallel to all that is all the diversity, equity, and inclusion sorts of things. And I've always been impressed with every time I approach a new learning objective, such as microaggression or discuss Title IX, that there are things I'd never considered. And even though you may, and I've been doing this for 30 years. Even though you consider yourself, I think I'm kind of an expert, there is so much to learn. And the sensitives take a long time. Any other thoughts that you have or, or questions that I haven't asked that you think deserve attention that we should chat about?

Rachel King:

I think the only other thing that I would mention, because Title IX obviously applies to our educational programs. You know, we have protections against discrimination and harassment for everybody at the clinic. We have a non-discrimination policy that applies everywhere, including to education but also outside of education, that prohibits discrimination on the basis of what we refer to as a protected characteristic. So, race, gender, sex, religion, national origin, et cetera. So, we've obviously focused today on Title IX, but people who are not part of educational programs shouldn't worry that they aren't protected from discrimination and harassment. And certainly, it's not my role to address discrimination and harassment outside of education, but I'm certainly a resource for people if they have questions about how the policy applies outside of education.

Dr. Tony Tizzano:

So, if someone has a concern, where do they go? How do they get started?

Rachel King:

So, I have a lot of email addresses and websites. So, there's an educational equity website, which is public facing because not all the students that we have access to our intranet. There's a Title IX website, which is public facing, because that's an expectation in Title IX. So, people could literally go to the Cleveland Clinic website and type in, educational equity, or type in, Title IX, and they will find an incredible amount of information, including how to contact me if I can be helpful.

Dr. Tony Tizzano:

Are you typically that first point of contact? Or does someone go to their supervisor and then they steer you? What happens most often?

Rachel King:

What happens most often is someone will go to their program leadership, and their program leadership will come to me. Or, actually, if you're talking about residents for example, someone will go to their program leadership, their program leadership will go to GME, and GME will bring it to me. I do get direct reports, but they are not as common as ones that come through programs or come through human resources.

Dr. Tony Tizzano:

So, the person that this is occurring to isn't usually the person who contacts you first off?

Rachel King:

It's not usual.

Dr. Tony Tizzano:

Because I would think you'd have questions. You wonder yourself, am I being overly sensitive? Where does this fall?

Rachel King:

Yeah.

Dr. Tony Tizzano:

So, I'm sure there must be some education that occurs along the way.

Rachel King:

Yeah, exactly.

Dr. Tony Tizzano:

Is this being a team of individuals who would approach these reports? Or do you do this singularly?

Rachel King:

Title IX wants you to have one person who is specifically identified as the Title IX coordinator. But I work with a lot of other people. I have three deputy Title IX coordinators, one who is the HR person for the Education Institute, one who is the HR person in Akron, and then I have someone in Florida who... because there's obviously a great deal of education in Florida. So, we have those folks.

And then, when I've done an investigation, I've always paired up with another investigator because I think that's the most effective way to do it. So, ultimately, the responsibility falls to me, but I rely on lots of other people to help me with these situations when they occur.

Dr. Tony Tizzano:

So, it's a team approach.

Rachel King:

Absolutely.

Dr. Tony Tizzano:

Well, those are all the questions I have. Is there anything else you'd like to add?

Rachel King:

No. I really appreciate the opportunity to talk about this today.

Dr. Tony Tizzano:

Well, Rachel, thank you so much. This has been timely. You've enlightened us. This has been a great podcast. And to our listeners, thank you very much and we hope to see you on our next MedEd Thread podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.