Diversity, Equity, and Inclusion in Medical Education

Podcast Transcript

Dr. Jamie Stoller:

Hello and welcome to MedEdThread. 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.

Rachel King:

Hi, welcome to today's episode of MedEdThread. I'm your host Rachel King, Director of Educational Equity and Title IX Coordinator here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to be joined by Dr. Monica Yepes-Rios, Assistant Dean of Diversity Equity and Inclusion for Students at Case Western Reserve University School of Medicine in Cleveland Clinic Learner College of Medicine. Dr. Yepes-Rios, welcome to the podcast.

Dr. Monica Yepes-Rios:

Good morning, Rachel. It is a pleasure and an honor really to be here with you today.

Rachel King:

Thank you. Why don't you tell us a little bit about yourself and where you're from and how you ended up at Cleveland Clinic?

Dr. Monica Yepes-Rios:

Absolutely. So, I'm originally from Colombia, South America. I immigrated to the United States as a preteen and grew up in a very international community in the Washington D.C. area and kind of thinking back, I think that set for me a stage to be very observant, respectful and celebrate the so many cultures around the world. I moved to Cleveland five years ago and an internal medicine physician, my clinical practice is centered with our Hispanic community here in Cleveland. Prior to coming here, I worked all over the United States, my husband was in the Navy and I actually worked with the Uniformed Services, University of the Health Sciences and their medical students that are set across the country in military facilities.

So, also have had just a tremendous exposure to diverse communities across the country. And I've dedicated my career to the education and the service of underrepresented communities and their students in building a learning environment for their students.

Rachel King:

That's great. Can you explain what you do in your role as assistant dean of diversity equity and inclusion for students here?

Dr. Monica Yepes-Rios:

Absolutely. So the role of assistant dean of diversity equity and inclusion is one that brings a lens to the eye in all aspects of the medical school. For example, we have a holistic approach to equitable recruitment at admissions of a diverse student body. How we design our curriculum, to empower our students to learn about health disparities, structural racism, race essentialism, the care of diverse communities, cultural humility as we prepare this next generation of physicians and physician scientists for their practice in the future.

Dr. Monica Yepes-Rios:

How we assess and train our students and faculty to build the need for more inclusive learning environment and working environment and learning to recognize and address bias and microaggressions. How we approach our school's surrounding communities, learn from the communities and also lend service in the form of tutoring, mentoring students, health education and outreach.

Rachel King:

That's a big job. Can you talk a little bit more about why a position like yours is necessary because that seems to encompass kind of everything the medical school should be doing.

Dr. Monica Yepes-Rios:

Rachel, you're absolutely right. So, what I just described is beyond the scope of one person or even one office. So, the position however allows the creation of an infrastructure where overtime, everyone's invested in the same goal, seeking to build an inclusive culture and equitable culture, where we are all educated in the historical and current events that pose disparities in education, in medical education, in healthcare and where we're looking to recognize and address our biases.

So, the position just helps bring that lens and centered on, on everything that we do. But it is not something that one person or one office should or could accomplish on their own.

Rachel King:

And how would you describe your vision or your approach to accomplishing all of those things?

Dr. Monica Yepes-Rios:

So, the approach that we have taken at the school of medicine is to set up with a strategic framework, to see where is it that we want to be, what is that culture that we want to be and how do we get there and what are the steps that we need to take. So we actually applied a framework for culture change from Jay Marquis and Williamson's Six-Step Framework and made some modifications that we thought were really important for this work.

So in that six steps, it asks to identify a catalyst for change, DEI work has been ongoing for many years, but in 2020, no question, the catalyst was defined for all of us and it made us all very aware of how we needed to move faster and deeper with this change. We need to plan strategically for a successful change. What are the elements, who are the stakeholders, how are we going to get this work across, who do we need to engage. Third, we need to engage and empower our organizational members. So, the school of medicine that involves our students, our faculty or staff and invite everyone to know that this is part of their work, this is part of their environment, this is where they work and learn and this is what the culture that we want to improve for everyone.

Importantly cultivate leaders at all levels, so for example, the school of medicine is intertwined with the education institute, graduate medical education, the healthcare setting where we work, the Cleveland Clinic for some of our students at Case Western University, they also practice their clinical clerkships at other healthcare systems in the city. So, really engaging everyone at all levels to make sure we're all talking the same language, looking for the same goals.

Importantly fostering innovation, creativity and risk-taking. As I mentions earlier, the issues of diversity equity and inclusion are not new, I think we have awareness of how much work we need to do. But we also need to think creatively, how do we do this differently because even though we have made improvements and changes overtime, we're not yet where we want to be. So, really going back to the organizational members, our students, our faculty and then think outside the box and be creative. Six steps is to monitor the progress and measure the success and celebrate even small steps along the way and I can talk a little bit more about that.

But we also added a couple of steps that we, I felt were really, really important. So, one of them is transparency in communication. Again, the DEI work has been ongoing, there was a lot of work going on before, but perhaps it wasn't communicated clearly and I am not speaking s- uniquely towards school of medicine, but I think just broadly across the nation and more. So, really being very transparent about the work that is ongoing. What steps we are taking towards this culture change, what is still missing. So being transparent with that I think is really, really important. And being flexible and adjusting to emerging situations.

So as an example during the COVID pandemic, which coincided with national unrest because of so many racial tragedies across the nation. The COVID pandemic also emerged and we came to see xenophobia and disparities towards the Asian community. So, being able to pivot and realize a community that perhaps we were not centered on at that time, also needed to be a community we needed to think about.

Rachel King:

So, what barriers have you identified or what barriers are there to the work that you do?

Dr. Monica Yepes-Rios:

So, as we discussed earlier, the scope of the work is immense and I think that's one of the barriers. Like how do you really boil the ocean? It's also a very emotionally engaging work. So, I'm blessed to have tremendous support from our leadership, from our deans at the school of medicine, Dean Gerson, Dean Isaacson, Dean Logio and many more who are invested in this work. But, the barriers, how do you curate programs, training, how do you assess the audience, how do you assess the effectiveness of the work that you're doing? We have design a number of training programs and we can hear from our audience that they liked the courses, they feel they learn something, but are we really moving towards that culture change?

And while there are some surveys that help measure that culture change, it is a difficult thing when you have students who are with us for a short period of time and they move on and they may feel that survey and we don't know if the same thing may apply to the incoming class. So, I think the barrier is really the scope of the work and continuing the work. Making sure that as you're designing it and developing and implementing it that you're not missing the goal.

I think another important barrier to bring up is that in this work, some people embrace it right away, some people are very excited to learn and grow and honestly, some people don't quite see why we need this work. Some people may see what's happening across the nation or even around the world, but may feel that none of these behaviors, hurtful moments, health disparities can possibly be happening in our own backyard. So one of the barriers is finding how do we do this work so that we can really carry everyone. Those who really embrace it, carry it to a point that they can help lead the work and those who are not quite there yet, at least get it to a point where they can recognize that something needs to be done and overtime, join our work.

I like to quote the work of Dr. Ibram Kendi who calls on all of us to become Antiracists. And we may all be in very different journeys towards this goal, but we can all certainly uplift each other to get to a point of embracing a cultural change.

Rachel King:

Other than the surveys, do you have other ways in which you measure the success of the work that you're doing?

Dr. Monica Yepes-Rios:

Yes, so one way to measure success, I mentioned earlier that it's important to celebrate even small successes and small steps along the way. So, the framework we implemented at the school was to engage our students, faculty and staff to work in small groups with very specific goals, to set smart goals, something that was measurable, achievable, time-based, et cetera. But it is something that's measurable. We set to make a change in the curriculum, we've implement a training program, we can measure how much of that we have done. And as aggregate, we anticipate that it will all build towards this culture change.

Rachel King:

Are there one or two programs or initiatives that you would like to highlight to talk about specifically and all of the different things that you do?

Dr. Monica Yepes-Rios:

Absolutely. So, as mentioned our working groups, action groups actually that we call them because our students really call for us to not sit and talk, but really get to action and start working on some small and big initiatives across the way. So, there's so many that I could highlight. One of them for example, we have a faculty who's very invested in LGBTQ health. We have two medical school program tracks and he engage students from both tracks to review the curriculum that's being taught and find ways to integrate within the curriculum addressing LGBTQ health. And this model has been really successful and very impactful because it no longer becomes unassigned, something else to learn, but something that everyone's thinking all the time that it's just part of how we're teaching science and medicine. And they have been really successful at sharing their work across the nation, so really excited about that model and that work.

Dr. Monica Yepes-Rios:

Another program that I'd like to highlight is one of mentoring. So, we have a group of medical students, residents and faculty who built a Mentor-Mentee match program, where the students could seek mentors. Many of them are underrepresented minority students who are looking for mentors who look like them, who they can identify with. The residents, same, they were looking for those mentors, so we created the Mentor-Mentee match where the residents could actually be both mentors for the medical students or mentees from the faculty. That program is now going on its third year, we're re-engineering it a little bit to really open the doors for more students to be able to be part of it, that students have really benefit from that work.

Rachel King:

Well, that's great. It's remarkable to hear about just the breath of everything that you're doing. Is there anything that I haven't asked you about today that you'd like to highlight or mention?

Dr. Monica Yepes-Rios:

Thank you, Rachel. I think a couple of words that really come to mind are engagement and mindfulness. So i really invite everyone to get involved in diversity equity and inclusion. This is not work that is isolated to an office or a person. When you work in teams with people, when you recruit students, faculty, staff to your organization, when you work in any field of medicine, taking the time to be mindful that is relevant to make a difference. We can pause and say, "Why did I not think of this candidate is eligible or can succeed? How did I describe this candidate to my colleagues at a recruitment or a promotion committee? What language did I just use to describe my patients? Am I so exhausted at the end of the day, my fast brain is taking over and allowing my biases to creep in? Can I say ouch if I hear something from my colleague that is hurtful? Can I step in to be an ally?"

Dr. Monica Yepes-Rios:

So these are moments where we all have the capacity to be mindful and on our own, make a difference and collectively build towards a much more inclusive and equitable learning and working environment.

Rachel King:

That's incredible, thank you so much. So you've been everywhere, you've lived in lots of different places. What do you like best about living in Cleveland or in Northeast Ohio?

Dr. Monica Yepes-Rios:

That's a great question. So, we moved to Cleveland, attracted for the professional opportunities with the Cleveland Clinic and Case Western Reserve University School of Medicine and loved the idea of a mid-sized city, with a preteen son who loves ice hockey, so this seemed like a great place for him and he's thoroughly thrived there. I love the outdoors, I have to come to embrace all seasons. My favorite is the summer and stand up paddling in, in the lake or just so many lakes or, or beyond Lake Eerie as well. But my two Australian cattle dogs love the winter time and rolling in the snow, so I would roll with then and my spouse and I just love exploring the different neighborhoods and incredible cultural foods across the city.

Rachel King:

That's great. Well thank you so much, Dr. Yepes-Rios. This has been a great podcast.

Dr. Monica Yepes-Rios:

Thank you, Rachel.

Rachel King:

To our listeners, thank you very much and we'll see you on our next podcast and have a wonderful day.

Dr. Jamie Stoller:

This concludes this episode of MedEdThread. 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 MedEdThread and please join us again soon.