This interview is one in a series of interviews with recipients of the 2024 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They will be honored at the ACGME Annual Educational Conference, taking place March 7-9, 2024, in Orlando, Florida.
Indiana University School of Medicine, an ACGME-accredited Sponsoring Institution in Indianapolis, Indiana, is recognized with the 2024 Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award. Dr. Zeina M. Nabhan is the Associate Dean for Graduate Medical Education and a professor of Clinical Pediatrics. She nominated her institution for the award, and answered the ACGME’s questions about the initiative and the institution’s efforts to foster diversity, equity, and inclusion.
ACGME: Can you tell us a little bit about your Sponsoring Institution?
Dr. Nabhan: Founded in 1903, the Indiana University School of Medicine (IUSM) is the largest allopathic medical school in the United States, educating students across its nine statewide campuses. A national leader in medical research and education, IUSM has more than 60 academic programs and specialty divisions. The school is comprised of five basic science departments and 20 clinical departments. We educate and train more than 1,400 medical students, more than 1,350 residents and fellows in more than 110 ACGME-accredited programs and 30 active non-ACGME-accredited programs, as well as 181 master’s students, 203 PhD students, and 257 students in our Health Professions Program.
ACGME: Why is your institution so dedicated to the concepts of diversity, equity, and inclusion?
Nabhan: IUSM has a longstanding commitment to inclusive excellence and ensuring that cultural humility permeates across our missions, people, and settings. We realize that as we strive to embody a culture in which all individuals within the medical school community feel included and respected and where our differences are represented and highly valued, we foster innovative ideas and a deeper appreciation for the unique cultural backgrounds and perspectives. Our commitment to this work stems from our believe that: representation saves lives; diversity improves quality; diversity improves education; solving health inequity improves all health; and fostering inclusive environments allow us to recruit, nurture, retain and leverage our talent.
As the largest medical school in the country, we have a responsibility to be leaders in health equity and inclusive excellence as we aim to make Indiana one of the nation’s healthiest states. As such, we have woven diversity, equity, inclusion, and justice (DEIJ) efforts into all aspects of what we do—research, education, patient care, faculty and staff affairs, and community engagement.
ACGME: What work/initiative are you specifically being recognized for?
Nabhan: In our efforts to live according to our DEIJ values and honor code, we have developed several innovative, systematic, and sustained programs organized under four foundational pillars: Representational Diversity; Inclusive Working and Learning Environment; Cultural Humility and Anti-Racism Training; and Health Equity.
This includes but is not limited to our expansive pathway programs from K-12 students, such as our collaborations with local area high schools with high enrollment of students from underserved backgrounds, summer camps, and the Indiana Clinical and Translational Science Summer Experience for the Economically Disadvantaged (CTSI SEED) program. Our Master of Science in Medical Science (MSMS) program has served as a great pathway for underrepresented in medicine (UIM) students into an MD program at IUSM. Our work in the GME space includes the establishment of the GME Diversity Committee and the Multicultural Physician Alliance (MPA) to support and create community for our residents and fellows. Additionally, our GME office has invested significant effort into DEIJ data strategy to create transparency and accountability for our programs. Moreover, our school offers visiting elective opportunities and second looks for students and residents nationwide who demonstrate that their backgrounds and perspectives will contribute to the IUSM’s DEIJ goals. Our faculty recruitment and retention programs include the Programs to Launch Underrepresented in Medicine Success (PLUS) (ref 1), Incentivizing Diverse Recruitment for Equity in Academic Medicine (iDREAM), and more recently the Clinician Cluster Recruitment Initiative. Finally, our school-wide Learner Mistreatment Reporting System has served as an effective tool for addressing mistreatment and promoting a safer, more inclusive environment for our students and residents and fellows.
ACGME: Could you explain what that work/initiative looks like?
Nabhan: While there are several components to our expansive work, I would first like to highlight the work of our GME Diversity Committee (ref 2). Formed in 2020, our GME Diversity Committee has centered our efforts on initiatives and projects that address our key DEIJ needs, enhance our data strategy for tracking and improving diversity efforts and outcomes, prepare and hold our programs and program directors accountable to DEIJ practices, enhance our recruitment and retention efforts at national fairs and through our Annual DEIJ Open House, and foster inclusive work and learning environments.
- PD DEIJ Toolkit: In 2021, the GME Diversity Committee created the Program Directors (PD) DEI toolkit (ref 3) as a centralized, curated, comprehensive, high-yield, and convenient repository to support program directors in achieving DEIJ goals. The toolkit consolidates school-wide diversity initiatives, current literature recommendations on best practices for inclusive recruitment, DEIJ resources within our organization, and upcoming DEIJ training events/conferences – allowing program directors access to resources, education, and information on our school-wide efforts. The toolkit was modeled after the IUSM’s diversity strategy, which centers around four foundational pillars: Representational Diversity; Inclusive Environment; Cultural Humility and Anti-Racism Training; and Health Equity. The committee also developed a survey to assess how the toolkit may impact the awareness, knowledge, access, adoption, and use of DEIJ resources among IUSM program directors as one way to continuously evaluate our recruitment and ranking practices and address potential barriers to adoption of holistic recruitment practices.
- Data Strategy and Advanced Analytics: In the past three years, we have also invested in data strategies to track diversity trends for each program over time. Providing DEI data and metrics to programs and departments helps create transparency and accountability and informs strategic planning around the work that needs be done to diversify the physician workforce. In this effort to increase transparency and accountability, several DEI dashboards have been developed and made available to department and school leaders.
Additionally, I would like to highlight some of our work on creating an inclusive anti-racist learning environment. IUSM strives to provide a positive, inclusive environment that is conducive to teaching and learning, and that embodies our core values of excellence, respect, integrity, diversity, and cooperation. All members of the IUSM community are expected to uphold the tenets of the Honor Code.
Our approach to inclusive excellence is multifaceted and centers around five focus areas:
1. Spaces of Belonging: The IUSM Community has created many initiatives and affinity groups to help support and foster a greater sense of belonging among our learners, and faculty and staff members. For example, the Multicultural Physician’s Alliance (MPA) is a GME-sponsored resident committee that works to improve diversity, equity, and inclusion (DEI) among residents and fellows by fostering an environment for professional development and a culture of inclusivity.
2. Investing in Holistic Success: IUSM has several programs and initiatives to support the success of our UIM students, residents/fellows, and faculty members through various professional development, coaching, and mentoring programs.
3. DEIJ Training: Our DEIJ trainings are aimed at supporting professional and career development, leadership development, and culture change initiatives aimed at creating more inclusive and welcoming environments. Through our DEIJ training, we help facilitate positive intergroup interaction, reduce discrimination and prejudice, instruct individuals from different backgrounds on how to work together effectively, and increase allyship and upstander skills within our community.
4. DEIJ Curriculum Revisions: In recent years, we have incorporated DEI, antiracism education, and health equity teaching into our student and resident/fellow curriculums. Here it is worth highlighting our published work on leveraging the resident as teacher training (ref 4) for all incoming PGY-1s to incorporate inclusive teaching principles and health equity education in the clinical environment. This curriculum consists of six teaching modules:
- Fostering an inclusive clinical learning environment
- Building a working knowledge of evidence-based and inclusive teaching strategies for clinical learning environments
- Role-modeling professionalism and cultural humility in health care setting
- Co-creating an effective feedback culture to support professional growth and achievement of institutional and clerkship learning objectives
- Identifying opportunities for health equity education in the clinical learning environment
- Continuing lifelong development as an anti-racist and equity-minded physician, educator, and role model
Each module focuses on one of the following equity themes:
- Racism
- Ableism
- Xenophobia
- Cisheterosexism
- Health Equity
- Trauma-Informed Care
5. Addressing Mistreatment: In 2017, IUSM established an online Learner Mistreatment Reporting System (ref 5) that allows confidential and anonymous reports for allegations of discrimination or harassment to be submitted by any IUSM community member. Reports are reviewed by a triage team that investigates and follows up on complaints. The online portal writes to a dashboard for real-time monitoring of the learning environment. Annual and semiannual detailed mistreatment reports are generated and distributed widely among various platforms, including to residents and fellows. These reports include aggregated, de-identified data of metrics, such as the timeliness of the investigation process, the complainant’s status, location of the incident, the alleged mistreater’s role, volume and categories of mistreatment behaviors, and the number and type of institutional intervention imposed. Moreover, IUSM leadership has worked closely with the Academic Health Partners to put policies in place that protect learners and faculty members from improper and uncivil treatment from patient and visitors. These policies, like the Patient Civility Policy and Community Agreement Policy, establish a set of behavioral expectations to ensure all in the workplace are treated with civility.
ACGME: How has this work/initiative helped make your institution more diverse and/or inclusive?
Nabhan: It is important to note that DEIJ efforts take time to actualize with some outcomes being much harder to track than others. An important measure we monitor closely is the percentage of GME learners matched into our programs who come from UIM backgrounds. Since 2017, we have had a steady increase in the percentage of matches of UIM residents and fellows from 7.34 percent in 2017 to 14.5 percent in 2022. In 2022-2023, just over 16 percent of matched GME learners were UIM (including multiracial UIM).
ACGME: How could others use your work/initiative as a model to become more diverse and inclusive? And what advice would you give to GME leaders who are looking to do just that, but aren’t sure how to start?
Nabhan: Our work can be easily adapted by other Sponsoring Institutions. In particular, we recommend:
- Investing in DEIJ programming that supports program directors in their diversity goals.
- Establishing a GME diversity committee as part of GMEC and integrating DEIJ principles into all aspects of the work that is being done; this is instrumental for creating sustainable change.
- Building pathway programs, such as the MSMS program, visiting elective, and second-look programs that are tailored to your institutions.
- Developing comprehensive DEIJ training programs to educate and support learners and faculty and staff members.
- Partnering with health systems to ensure that appropriate policies are in place to minimize and address resident/fellow and patient mistreatment.
- Creating a robust mistreatment reporting system and mistreatment triage team to investigate and follow up on complaints.
ACGME: Is there anything you would like to add that we haven’t already asked about?
Nabhan: On behalf of IUSM, I want to thank the ACGME Awards Committee for this recognition. As an institution, we remain steadfast in adopting innovative recruitment and retentions strategies that will allow us to achieve the desired diversity in the resident/fellow and faculty ranks needed to best serve our state.
Noted References:
- Brownsyne BT, Tori AJ, Ribera AK, Allen MR, Dankoski ME, Rucker SY. Diversifying Faculty Leadership in Academic Medicine: The Program to Launch Underrepresented in Medicine Success (PLUS). Academic Medicine 2022 Oct 1, 97(10):p1459-1466.
- Kara A, Wright C, Funches L, Williamson F, Hicks RA., Sutton TA, Nabhan ZM. Serving on a Graduate Medical Education Diversity, Equity, Inclusion, and Justice Committee: Lessons learned from a journey of growth and healing. Frontiers in Public Health, 2022:1043.
- Nabhan ZM, Scott N, Kara A, Mullis L, Dams T, Giblin M, Williamson F, Wright C. Advancing Equity in Graduate Medical Education Recruitment Through a Diversity Equity and Inclusion (DEI) Toolkit for Program Directors. Journal of Medical Education and Curricular Development. 2023 Oct10;23821205231203136.
- Williamson FA, Sharp SN, Hills GD, Dilly CCK, Nabhan ZM. Leveraging Resident-As-Teacher Training for Health Equity Education: A Transformative Approach, Teaching and Learning in Medicine. 2022 Nov 11;pp.1-8.
- Walvoord EC, Howenstine MS, Allen BL, Ribera AK, Nabhan ZM, Tori AJ, Eichholtz RD, Dankoski ME. Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment. Teaching and Learning in Medicine. 2022 Sep 8; pp.1-11.
Learn more about the ACGME’s Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award and nominate a deserving Sponsoring Institution, program, or organization for the 2025 Award – nominations are due by March 27, 2024. Registration is still open for the 2024 ACGME Annual Educational Conference – learn more and register today on the conference website.