2020 CABDI Report / EVMS DE&I Actions

 Note: We are presenting an overview of the CABDI recommendations below. For complete context, please read the full CABDI report.

1. The report notes that students strongly believe Eastern Virginia Medical School is a great place to attend medical school and that it is distinguished from other medical schools by its community-oriented focus and increasing diversity in the student body. The report recommends that the positive sentiments of students should be highlighted to reinforce and strengthen the culture and the school’s reputation.

2. The report finds that there is a comparatively lower level of trust in leadership and confidence in the future of EVMS among non-white and women employees. The report recommends that more be done to address trust among non-white and women employees.

3. The report concludes that EVMS’s diversity, equity and inclusion, or DE&I, initiatives are seen as improvements by students, faculty and staff and highlights expectations that the school will do even more. The report recommends EVMS do more to recruit, enroll and support students from diverse backgrounds; attract and retain African American and other non-white faculty; and close the gap in positive experiences between whites and non-whites and between men and women.

4. The report notes that implementing the 2020-2024 strategic plan leadership development and education initiative on diversity, equity and inclusion for employees will provide needed skills and training throughout the school and recommends that leadership make DE&I an even greater management priority.

5. The report finds that a more comprehensive focus on DE&I — integrated throughout the EVMS strategic plan and leadership initiatives — is needed to enhance current efforts and further demonstrate leadership’s commitment to a more diverse and inclusive culture. The report recommends that priority of attention by leadership on these issues will lead to an increased understanding and awareness about the importance of DE&I at EVMS.

We continue to make great strides in support of diversity and inclusion efforts. As an institution of higher learning responsible for the training of the next generation of healthcare professionals, for the development of new scientific knowledge aimed in providing solutions to community needs, and for the delivery of excellent clinical care, we choose to be engaged with and respond thoughtfully and intentionally to the social and demographic changes transforming our society and community. To accomplish this, the institution intentionally integrates its efforts through programming and quality improvement initiatives that promote “inclusive excellence.”

Inclusiveness in higher education has become a national priority recognized by accrediting agencies such as the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), one of our accrediting bodies. In its 2011 diversity position statement, SACSCOC stated, “Diversity is not an abstract concept; rather, it is a true picture of an ever-changing national demographic landscape that reflects every sector of society. Institutions of higher education mirror diversity through their missions, their structures and their students, faculty and staff.”

To fully realize its potential and embody excellence in all its forms, the institution must tap into the vast and rich resource of diversity found within itself and the Hampton Roads community.

In 2019, we chose to engage in a Strategic Planning initiative “Advancing Health Equity and Inclusion for Community and Academic Impact” that speaks to the promise of our mission now and for the future, and our continued commitment to excellence in education, research, clinical care and community/public service. It is an outgrowth of the President’s vision and actions, along with the institution’s mission and long-time commitment to create a diverse, equitable and inclusive academic environment and community. The four-year plan, with a budget of $7.3 million, engaged several hundred individuals across the institution as well as community partners. As a result, it is one of the most comprehensive plans of its kind for an institution of our size, covering all segments of the campus — students, faculty and administrators — and strengthening our ties with local and regional communities.

Admissions
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, established in 2015 to complement the well-established one-year program, has been instrumental in expanding the pool of diverse students prepared to enter medical schools. In the past three years, the program has successfully matriculated over 90% of its underrepresented minority students into medical schools, with 16 of them joining a specific 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
Our institution 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 Alliance promotes an inclusive climate for LGBTQ students, faculty and staff engaging the community to participate in volunteering opportunities in the community and facilitating educational opportunities at our institution 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 our 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 Accreditation 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, we 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 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 we invited our 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.

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 2019 health equity and inclusion strategic plan and 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.

Our 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]

Our institution recognizes that cost can be a barrier to enrolling in medical and health professions programs — particularly for underrepresented minority students. To that end, we have been engaged in a targeted effort to significantly increase the scholarship funds available to our accepted students. This continuing endeavor is part of our current comprehensive capital campaign. If you are interested in making a gift to support these scholarship efforts, please contact Development.

Diversity and inclusion scholarship funds

• 15 Diversity and Inclusion Scholarship Funds
• Six started in last five years
• Total Gifts Committed in last five years: $324,633
• Total Gifts Committed since inception: $1,405,657
• Total number of students potentially supported by scholarships each year: 15

Overall scholarship funds

• 86 philanthropic scholarship funds overall
• One pass-through fund
• 29 funds started in the last five years
• Total Gifts Committed in last five years: $4,238,703
• Total Gifts Committed since inception: $16,174,276
• Total number of students supported by scholarship in 2019-2020: 88 scholarships awarded to 81 students (some students were awarded multiple scholarships)

Pass-through scholarship funds
On average, students at our school receive approximately $310,000 in scholarships from outside entities each year.

Scholarships provided by core dollars
Annually, $400,000 is set aside in the Dean’s budget to award scholarships to MD students. Specifically, $100,000 is set aside for incoming medical students and is renewable annually for their four years, assuming suitable academic progress.

Last year, through the Diversity and Inclusion Plan, an additional $100,000 was set aside in the Dean’s budget to award scholarships to students identified as disadvantaged. Half of it is for MD students; the other half is for students in the Health Professions programs.

Our robust faculty development and retention program supports and ensures inclusion of faculty from school-defined diversity categories. The program includes faculty onboarding and grand rounds, online educational material, and guest speakers. The Professional Enrichment and Growth (PEG) Grant is available to faculty members to allow participation in activities geared toward professional growth and advancing departmental and institutional academic missions. Over the past four academic years, 73 PEG grants have been provided, representing a total investment of $283,571.

In addition, faculty are identified each year to participate in national professional development programs, including the AAMC Minority Faculty and Mid-Career Minority Development Seminar and the Early and Mid-Career Women Faculty Professional Development seminars. Leadership development programs also are provided for Women in Medicine and Science to support and advocate for the full participation and advancement of women in medicine and science in all career stages.

Regular professional development and networking events are hosted to build a community of mutual support. While diversity in the leadership of our institution has been an ongoing effort with evidenced progress, fostering and maintaining a diverse workforce and learner population by strengthening recruitment and retention of diverse faculty, staff, and learners was identified as a priority need in the 2020 – 2024 EVMS Strategic Plan: Advancing Health Equity and Inclusion for Community and Academic Impact. The five strategic priorities of that plan include:

1. Provide Enriched Training and Assessment for Access and Success
2. Foster and Maintain a Diverse Workforce and Learner Population
3. Strengthen Community Engagement and Health Equity
4. Enhance Health Equity Research and Clinical Service Delivery
5. Benchmark for Excellence (which will promote the development of metrics and tracking of progress leading to better decision making and communication)

A number of efforts are underway to advance the strategic priority in faculty recruitment and retention.

• Our selection as one of the AAMC institutions to pilot a Holistic Review program for faculty recruitment and retention
• Enhanced mentoring and onboarding of faculty
• Promoting diverse faculty recruitment and recruitment focused on health disparities research

[Recommendation #3]

Our institution has regularly supported research efforts targeted to health disparities in our communities. These have been funded by the National Institutes for Health (NIH), foundations and others. Example topics of this research include: healthcare disparities (NIH-funded on behalf of the American College of Surgeons, Dr. L.D. Britt); high-risk pregnancy for mothers and infants (NIH-funded, Drs. Abuhamad and Pepe); prostate cancer biomarker detection (NIH-funded, Dr. Semmes); diabetes hypertension control (Dr. Siraj); and asthma, booster seat safety, healthy eating, school preparation, and policy implementation (Pediatrics'  Community Health division).

In the 2020–2024 Strategic Plan, we developed a program to build upon these past efforts and investigate social determinants contributing to health disparities in our community. Specific activities include:

1. Focused pilot funding from the EVMS-Sentara Healthcare Analytics and Delivery Science Institute (HADSI) for health disparities research. In the past three years, 22 pilot awards have been funded with a total funding of $333,000. A majority of these awards (16) support health disparity projects focusing on various diverse topics such as thyroid cancer management in patients with diabetes, melanoma cancer disparities in Hampton Roads, health of refugees and Hispanic population in Hampton Roads and rural/urban opioid health disparities.
2. Prioritizing the creation of a Health Disparities Research Cluster. The leadership team of the cluster has been formed with recommendations from several experts in this area.
3. Approval of a new seed grant program ($700K) for health disparities research, with rollout planned in late 2020.
4. Approval of a new faculty researcher in health disparities research, with recruitment beginning in late 2020
5. The implementation of a new software program to track progress in efforts for health disparities research.
6. Creation of the HADSI VA COVID-19 Registry, in collaboration with academic and healthcare partners across Virginia, to facilitate equity in testing and disease management. 

Our institution serves as a safety net for under-served and under-resourced populations, providing access to care particularly for those suffering from higher rates of chronic illnesses, such as diabetes, cardiovascular diseases, cancer and serious mental-health issues. In fiscal year 2018, EVMS Medical Group provided $14.6 million in uncompensated care. Our medical group provides 415,203 patient visits annually overall in 29 clinical sites throughout the Hampton Roads region. Programs and services staffed by our healthcare providers that target under-served and under-resourced populations include the Sentara Ambulatory Care Center (ACC) and the EVMS Sickle Cell Disease Management Program.

Recognizing the disproportionate impact of COVID-19 on minority populations, EVMS Medical Group is proactively reaching out to patients during the pandemic to ensure safety and improve quality of care. This outreach includes assessment of access to telehealth for our diverse patient population. Additionally, the Diversity and Inclusion office partnered with EVMS Medical Group physician Benjamin M. Goodman, MD, to conduct a virtual learning session for the Sickle Cell Community Support Group on the topic “Staying safe during the COVID-19 pandemic.”

Institution-wide diversity and inclusion training on cultural awareness and implicit bias and conversations on social justice have been integrated into the annual training and development program. Cultural awareness and implicit bias education is provided to the Board of Visitors and is part of the required annual training for faculty, staff and residents. Leadership and faculty search committees, as well as the Admissions Committee, are also provided diversity and inclusion, implicit bias and holistic review training regularly.

In addition, a robust program on social justice brings national topic experts each year to provide the EVMS and Hampton Roads communities with learning opportunities on health equity challenges and interventions. Recent speakers have included Harriet Washington, author of “Medical Apartheid”; Thomas LaVeist, PhD, creator of the documentary “The Skin You’re In”; King Davis, PhD, project leader for “The Central Lunatic Asylum for Colored Insane Archives: Evolution of Psychiatric Care in Virginia”; and Sheri Fink, MD, author of “Five Days at Memorial: Medical Ethics and Equity in Emergencies from Hurricane Katrina to Pandemics.”

The 2020-2024 EVMS Strategic Plan, Advancing Health Equity and Inclusion for Community and Academic Impact, has identified DE&I training and continued campus climate improvement as a high priority, and planning and implementation of programs to enhance our DE&I and leadership training efforts are underway. [Recommendations #4 & #5]

As reported in our Community Engagement Report for fiscal year 2019, 107 initiatives produced the following results:

• Community Engagement Service Hours: 101,662.74
• Number of Community Members Directly Assisted: 46,268
• Number of Student Encounters: 3,182
• Number of Faculty & Staff Participating: 367
• Longest Running Initiatives: Every Women’s Life, Community Care Day, HIV/AIDS Resource Center, Medical & Health Specialties Magnet Program at Maury High School and CINCH
• Initiatives with the most hours: HIV/AIDS Resource Center, Community Health & Research projects, Global Health and HOPES Free Clinic

A permanent Community Advisory Board (which also is recommended in the Strategic Plan for Advancing Health Equity and Inclusion for Community and Academic Impact) that reports to the president will improve communications and accountability for diversity, equity and inclusion in the community.

EVMS is developing a Community Inclusion and Health Equity initiative which includes a permanent, Community Advisory Council to provide input on the education, research and patient care activities at EVMS, an internal Stakeholder Steering Committee and a national expert advisory on community engagement. It is Strategic Priority 3 in the Strategic Plan.

In response to the community need for information regarding COVID-19, the institution has provided educational opportunities for healthcare professionals, as well as community members. All community-focused webinars were well received as reflected by the large number of participants and questions to the experts. The series of webinars included the following topics:

• “COVID-19 Update: What the Community Should Know.” This panel of local medical professionals (clinicians, a public health leader, hospital administrators and a psychologist) provided updated COVID-19 information targeted toward the general public to understand facts and to calm fears.
• “Pregnancy and the Pandemic for Parents.” Topics presented included an overview of pregnancy and the pandemic, hospital expectations, anxiety and stress during labor and delivery, nursery care and care of the baby of a COVID-positive mom as well as Breastfeeding and COVID-19.

The institution works diligently to engage Small, Women-Owned and Minority-Owned (SWaM) businesses and provides certification and recertification training and orientation on opportunities.

CHAIR

Gilbert Bland, MBA is the former national President of the Minority Franchise Association of Burger King Corporation and charter member of its Inclusion Advisory Council. Mr. Bland currently serves as President and CEO of the Urban League of Hampton Roads and as a board member for the Virginia Chamber of Commerce, Sentara Healthcare and the Hampton Roads Community Foundation. Mr. Bland’s past leadership roles include service on the State Council of Higher Education for Virginia as Chair, the Old Dominion University Board of Visitors and James Madison University Foundation. For the past five years, Mr. Bland has been recognized by Virginia Business Magazine as one of the 50 Most Influential Virginians.

Mr. Bland engaged the following business and community leaders to join the advisory board:

Edward L. Ayers, PhD, Tucker-Boatwright Professor of the Humanities and President Emeritus of the University of Richmond, is a prominent historian of the American South, author and co-host of a nationally syndicated radio show on American history. He previously was the Buckner W. Clay Dean of the College and Graduate School of Arts and Sciences at the University of Virginia, where he began his teaching career. He has received a presidential appointment to the National Council on the Humanities, served as a Fulbright Professor in the Netherlands, and has been elected to the American Academy of Arts and Sciences.

L.D. Britt, MD, MPH, the Edward J. Brickhouse Chair in Surgery and the Henry Ford Professor of Surgery, is Professor and Chair of Surgery at EVMS. Dr. Britt is a past President of the American College of Surgeons, the Society of Surgical Chairs and the ACGME Residency Review Committee for Surgery; past Chair of the Board of Regents of the American College of Surgeons; the American Association for the Surgery of Trauma and the American Surgical Association. He is the first EVMS faculty member elected to the National Academy of Medicine, one of the highest honors in the fields of health and medicine. Dr. Britt is principal investigator on a $2.5 million National Institutes of Health grant to develop strategies to address healthcare disparities in various health care specialties.

Susan R. Colpitts is a Founder of Signature Family Wealth Advisors and leads the Client Services Team. Ms. Colpitts has received various national recognitions for her accomplishments, including Research Magazine’s Advisor Hall of Fame and the United Way of South Hampton Roads Volunteer of the Year. She is currently a Director of the Hampton Roads Community Foundation and Vice Chair of Virginia Humanities. Previously, she served as Trustee of the Eastern Virginia Medical School Foundation, Director of Building Goodness Foundation, Chair of the United Way of South Hampton Roads and Chair of the Virginia Symphony.

Delceno C. Miles is President/CEO of The Miles Agency, a Virginia Beach-based niche marketing and public relations firm. She currently serves on the boards of the regional Hampton Roads Chamber of Commerce and the Chamber’s Virginia Beach division. Her prior community service includes being appointed to the State Council of Higher Education for Virginia and being elected to the Virginia Beach School Board, serving as its vice chair for two years. In 2009, she was honored by Inside Business with its Women in Business Achievement Award. In 2011, the YWCA of South Hampton Roads named her its Woman of Distinction in Communications, and from 2011 through 2016, Inside Business named her one of the top 75 most powerful leaders in Hampton Roads. In 2013, she was inducted into the Inaugural Hall of Fame by the Hampton Roads Black Media Professionals.

Xavier R. Richardson, MBA, is Senior Vice President & Chief Corporate Development Officer for Mary Washington Healthcare. In this capacity, he also serves as president of Mary Washington Hospital and Stafford Hospital Foundations. Prior to joining Mary Washington Healthcare, Mr. Richardson served as an assistant director of the U.S. General Accounting Office in Washington, D.C. His responsibilities there included identifying issues, events and trends to be evaluated for financial markets and federal human-resource management. He also served on the staff of the U.S. Senate Governmental Affairs Committee to examine campaign finance reform issues and managed the Combined Federal Campaign for three federal agencies, a fundraising project that raised more than $1 million in contributions.

James “Jim” Wood Jr., MDiv, has been Senior Pastor of First Presbyterian Church, the oldest and largest Presbyterian church in Norfolk, for 20 years. Rev. Wood is graduate of the University of South Carolina, Princeton Theological Seminary and Drew University. He is currently a PhD candidate in Global Leadership at Regent University. His passion is lived out through his preaching and teaching, pastoral care and love for outreach. Having led dozens of mission teams — in Russia, Guatemala, Nicaragua, Kenya, and Sudan, among others — his commitment is deeply felt and long-term.

Jonathan C. Zur is President & CEO of the Virginia Center for Inclusive Communities, an organization that works with schools, businesses and communities to achieve success through inclusion. Under Mr. Zur’s leadership, the center increased the number of programs delivered annually by nearly 1,000 percent. In 2017, Mr. Zur was appointed to the Commonwealth Commission on Diversity, Equity and Inclusion, formed in the aftermath of the tragedy in Charlottesville. In 2016, he was a speaker at the inaugural White House Summit on Diversity and Inclusion in Government. He has received a Martin Luther King, Jr. Drum Major for Justice Award, FBI Director's Community Leadership Award, Leadership Metro Richmond Ukrop Community Vision Award, and Stettinius Award for Nonprofit Leadership, among other recognitions.