1. < General Internal Medicine

Each year as a country, we pause to remember the legacy of Dr. Martin Luther King Jr., whose words (paraphrased) and spoken nearly 60 years ago, “I have a dream…that one day we will live in a nation where we will not be judged by the color of our skin, but by the content our character...” still speak eloquently to legacies that continue to permeate many facets of our society. As a department, the celebration of a national holiday in Dr. King’s honor reminds us of the importance to renew our commitment to principles of equity, inclusion and belonging. We should continue to be at the forefront of efforts to recognize the consequences of racism on the fabric of society and to champion efforts that will lead to solutions for dismantling institutions, policies, attitudes, and legacies that create inequities based on ethnic or socio-demographic background. In this regard, I write to share some examples of work in the department of medicine (DoM), that illustrates this commitment, while recognizing that there is much work that still needs to be done.

Last week, we hosted a special grand rounds inviting department faculty to a story slam focused on health equity. Founded five years ago, the “On Equity Story Slam” continues to provide a platform to give voice to personal and patient care stories that epitomize ways in which societal inequities, many of which could be rooted in systemic racism, intersect with our duty and commitment to provide the best and most compassionate care for all who come through our doors. These stories articulate our core values of creating a community that is characterized by mutual respect and a willingness to work to ensure that someone’s background should not determine the quality of care or outcomes of our interventions. For 45 minutes, panelists from the divisions of general internal medicine, pulmonary and critical care medicine, and geriatrics delivered riveting stories highlighting topics such as identity, inequity, social, political and cultural factors that shape our personal experiences in the delivery of care. It was a privilege to hear these stories which reminded us of the particular responsibility we have as physicians that transcends the delivery of medical care to our patients and sees beyond their clinical diagnosis, to the forces in their lives that ultimately determine their course. These personal and patient stories should challenge and shape perspectives of our complex health care system as we reflect and strategize on how best to serve our patients and communities in greatest need.

I would like to give special recognition to the DoM EDI leadership team including Keith Norris, MD, PhD and Christina Punzalan, MPH for continuing the annual tradition of hosting the story slam over the past five years. In case you missed it, I invite you to tune in and listen to these stories by clicking HERE.

The DGSOM Gold Humanism Honor Society will be hosting a story telling forum titled, “Unbroken: Storytelling As Resistance.” This year’s theme focuses on how we have seen patients, community members, and hospital staff find ways to foster care for themselves, their patients, and their communities within a system and world that oftentimes takes a heavy toll on those working towards justice. Faculty and staff are invited to submit stories, poems, spoken word, choreographed dances, and visual arts that speak to moments of resistance, steadfastness in the face of adversity, and personal self-care. The deadline for submissions is TODAY. Get more information HERE.

Our faculty is very committed to health equity and social justice, and I have had the privilege of sharing some examples of this over the past year and will continue to do so moving forward. This week, I want to give special mention to the groundbreaking work of our Vice Chair for Equity Diversity and Inclusion, Keith Norris, MD, PhD. In December 2022, Dr. Norris and colleagues published in the Journal of the American Society of Nephrology, a report describing the outcomes of the “Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities” workshop. The workshop convened to explore how structural racism contributes to health and healthcare disparities for people living with kidney disease, and to identify opportunities for interventional research to address the effects of structural racism.

Participants noted that few interventions aimed at addressing the greater social, political, system level factors that contribute to health inequity have been developed in the context of kidney health. The workshop developed recommendations for interventions to address the effects of structural racism in kidney disease. These include:

Applying an anti-racism lens to kidney care by continuing to question if evidence of inequities in access to health resources and opportunities are present, determine if there are racial and ethnic disparities present in CKD and kidney failure, and whether there is an underrepresentation of minoritized racial and ethnic groups in the nephrology workforce.

Promote structural interventions that address various aspects of kidney disease, such as high-need social risks that include food and housing insecurity, access to healthcare, and identify prospective target populations, as well as how to overcome the funding challenges typically faced.

Target multiple levels by looking at interventions beyond the patient level, and developing strategies at the provider level, system level which include interventions for social determinants of health, developing culturally responsive education materials, meaningful community engagement, strengthening social networks, and environment.

Promote effective community and stakeholder engagement through a collaborative approach between the health system and target communities. For example, engagement may include convening stakeholder groups to develop research goals, agenda, educational approaches and materials.

Improve data collection to better inform intervention studies, utilize the electronic health record, registry data and non-health sector data which will help evaluate structural interventions.

Advance health equity through new healthcare models by applying an antiracist lens to payment and delivery system reform, improving the scope of coverage so it meets medical and social needs, and reforming health care payment to incentivize equity care transformation and support for the safety net.

We understand the need to increase diversity in the workforce and the delivery of culturally competent healthcare within the diverse communities that make up Southern California. Although we are committed as a department to strengthening our efforts to increasing diversity, equity and inclusion within the DoM and the larger healthcare system, we attempt to do this in the context of prevailing headwinds that were recently articulated by members of our faculty. Dan P. Ly, MD, PhD and Utibe R. Essien, MD, MPH authored a very influential report, that underscores systemic challenges within academic medicine in America that impact recruiting and training of physicians who are representative of the diverse communities that we serve. The publication, “Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools” was recently recognized as “essential reading for busy physicians” by the Annals of Internal Medicine, which compiles an annual curated list of “groundbreaking, practice-changing, clinical content.”

Drs. Ly, Essien and colleagues explored the impact of state affirmative action bans on the percentage of enrollment from underrepresented racial and ethnic groups in US public medical schools. Their study compared 21 public medical schools in 8 states with affirmative action bans, and 32 public medical schools in 24 states without affirmative action bans, across 35 years. They found that states with affirmative action bans from 1985 – 2019 experienced a notable reduction in the percentage of underrepresented students in US public medical schools in the years following implementation of the ban. In the year before bans were implemented in states, underrepresented racial and ethnic groups made up 14.8% of enrollment. That percentage decreased by 4.8 percentage points five years after the ban was implemented and increased .7 percentage point in control schools. Their study demonstrates the relationship between public policy and medical school diversity. The authors conclude that “national efforts to advance health equity should consider medical school admission policies an important target.”

Diana Lopez, MD is a second year, internal medicine resident and leader within the Minority Housestaff Organization (MHO) who embodies our values and commitment to advancing equity, diversity, and inclusion in the department, the DGSOM, and UCLA Health. Dr. Lopez is an MHO executive board member and the historian dedicated to community investment and recruitment. Under Dr. Lopez’s leadership, the MHO hosted the fourth annual Road to Residency Conference, a one-day conference which engaged nearly 200 underrepresented medical students from across the country in workshops, resident and faculty panels, as well as mock interviews. Dr. Lopez has also hosted quarterly workshops for medical students from the DGSOM and Charles Drew, which addresses topics such as how to succeed in medical school. They work closely with the Graduate Medical Education department on recruitment efforts and partner with the Student National Medical Association and Latino Medical Student Association chapters. Dr. Lopez has worked tirelessly to represents UCLA nationally as we seek to recruit future leaders in medicine, who are accomplished and diverse.

Dr. Lopez shares that organizations like the MHO,

“provide my biggest support system, helping me feel like I have a place in the field of medicine. I’m grateful to be able to pay it forward and work with organizations to help guide students towards success.”

When not working with the MHO, Dr. Lopez, is training at Olive-View UCLA Medical Center as a member of one of our primary-care residency tracks. Diana looks forward to building a career focused on safety-net care after residency. Growing up in South Central Los Angeles, Dr. Lopez witnessed the barriers faced by their parents in trying to access medical care and wants to help underserved patient populations access the quality care that they deserve.

I am proud of the commitment of all our colleagues, faculty, trainee and staff to working tirelessly to fulfill Dr. King’s dream.

Dale

P.S. I spend a lot of time on Zoom. Here is a Zoom meeting over the weekend that I really enjoyed. Four generations on the screen.