A Commitment to Inclusion
Corinne Haase was used to being the only African-American person in a classroom.
The second-year Doctor of Physical Therapy student had grown up in Boston but attended public school in the overwhelmingly white town of Concord through her participation in METCO, a school desegregation program. Arriving at the IHP, Haase found only a handful of black students studying physical therapy—an underwhelming reflection of the patient population they hoped to serve. And she didn’t hear faculty talking much about the challenges of being a clinician of color.
Haase faced bias during a clinical placement in an affluent Boston suburb. Her clinical instructor was very supportive and always introduced Haase as a physical therapist student. Still, it wasn’t uncommon for her to walk into a patient’s room and have some people, upon seeing a black woman, assume that she was a certified nursing assistant and ask her to clean up a patient or make a bed.
“That’s inevitable,” Haase says of the stereotyping. “I know I’m going to encounter that in my life. I know what to expect because I’ve heard stories from my mom who works in health care. But what do you do when you have a student go into a placement and be mistaken for an aide? How are you going to teach that student to say the right things and not lash out because of built-up microaggressions? And how do you prepare a student from an affluent community so they don’t go into a minority community and stereotype residents? These are some of the things that all faculty need to know so they can teach us.”
Evangeline Begay was living in New Mexico when she was accepted into the Master of Science in Speech-Language Pathology program in 2017. Excited about joining a new academic community, she moved to Boston with her husband and children.
Once she arrived on campus, though, she saw that she’d left behind the diversity that she’d taken for granted in New Mexico, a “majority minority” state with substantial Latinx and Native American communities. “I had the privilege of not having to explain who I was,” says Begay, who graduated in 2019. “No one questioned my name.” People in the Southwest know that Begay is a common Navajo surname.
In Boston, she noticed that Native American culture seemed to be missing. And at the IHP, the faculty were mostly white, as were the large majority of students. Begay struggled with feelings of isolation on campus and off.
Hasse and Begay weren’t alone. Other students of color were talking about their experiences on campus. “There were a lot of concerns about everyday experiences that people were having, whether they were micro- or macrolevel aggressions in regard to racism,” recalls Olivia Meegoda, who graduated in 2018 with a Master of Science in Speech-Language Pathology.
During a clinical placement, one student heard a clinician refer to an injury as an “Indian burn.” A different clinician touched an African American student’s hair without asking for permission. Another black student was described as “articulate,” a word that has been used to imply that most black people cannot speak well, perpetuating a racist trope. “Higher-education institutions have a long way to go to learn how to value students of color, rather than just flaunt the token black or brown student on their admission page,” Meegoda says.
A group of IHP students submitted a list of their concerns and requests to President Paula Milone-Nuzzo. Dr. Milone-Nuzzo, who had been on campus for less than a year, sat down with students, and she listened. “Paula is a good leader,” Meegoda says. “She acknowledges that she is a learner and continues to be open to having conversations with students about racism, ableism, and any other concerns students may bring up.”
Building on the Past
“Our students are vocal in a very collaborative way, and they are focused on solutions and improvements,” says Jack Gormley, the dean of student and alumni services. “Every time we get a new class of students, we have new energy and new perspectives that we incorporate into what we do.”
That ongoing work continues the efforts begun by former president Jan Bellack, who created the school’s original Diversity Council in 2009. In addition to forming the council, Dr. Bellack and the Board of Trustees increased the amount of scholarship funding for students from $3 million in fiscal year 2010 to $6.5 million in fiscal year 2018. It’s contributed to the rise in enrollment of underrepresented students, from 23 percent in 2014 to 28 percent in 2018.
In 2013, Peter Cahn, the associate provost for academic affairs, helped set up a training program on bias in faculty hiring. “We began working with search committees of faculty and administrators and talking them through the psychology of bias and how it can impact every phase of the hiring process, from crafting the job description to placing ads, screening candidates, crafting interview questions, and onboarding faculty,” he says.
The school also was keenly aware of the needs of students with disabilities and of ensuring the campus was safe and respectful for members of the LGBTQ+ community. Outside speakers regularly began coming to campus to discuss diversity. And as a member of the Leading for Change Higher Education Diversity Consortium, the IHP shared with and learned from its institutional peers, adopting practices such as pre-orientation boot camps to help students from disadvantaged backgrounds build the study skills they would need to succeed. This initiative in part helped increase the graduation rate of minority students by seven percentage points in one year, to 93 percent.
Other steps have included purchasing manikins of color and employing standardized patients who are reflective of the area’s population. The work has paid off. For the past two years, the IHP has received a Health Professions Higher Education Excellence in Diversity Award from Insight Into Diversity magazine; in 2018, it was one of just 35 colleges in the country to receive such recognition.
Still, students saw plenty of room for growth. And so did Milone-Nuzzo. She began by taking a new look at the Diversity Council. “The council felt it was operating at 30,000 feet,” she recalls. “It was taking a broad look at the Institute. But at that height, a lot of people weren’t sure what the council did or if its work was important. We wanted to be more visible, and we wanted to be more impactful.”
Milone-Nuzzo assumed Dr. Bellack’s role as chair of the Diversity Council and quickly responded to student requests to add their voice to the group. The council decided to change its name to the Diversity, Equity, and Inclusion Council to reflect a broader scope. One of the first things it did was develop a strategic plan with four goals assigned to separate task forces: increase the number of faculty from underrepresented minority groups; create more outlets for student voices; share the IHP’s core diversity, equity, and inclusion values with new students; and enhance diversity and cultural content in the curriculum.
None of these goals are simple. But Milone-Nuzzo believes recruiting faculty from underrepresented minorities may be the biggest challenge. To address that, the council decided to pursue a new talent acquisition model and the human resources office hired a staff member to work on this exclusively. “You don’t begin the process of recruiting someone when you have an open position. You begin the process of recruiting people just as friend making,” she explains of the approach. “That could mean asking a faculty member at a different university to collaborate on a project or join a workshop as a way of introducing them to the Institute. Then, when there’s an open faculty position, that person is invited to apply.”
Testing a Test Case
Keshrie Naidoo is an assistant professor of physical therapy who earned her doctorate from the IHP in 2005. Dr. Naidoo, who grew up in South Africa during apartheid and studied at the University of Cape Town, was surprised by how few faculty of color she saw in the United States as a whole and PT in particular. She’s researching the issue as part of her doctoral work at Johns Hopkins University.
What Naidoo has found is a basic supply-and-demand problem: There simply aren’t enough students of color in doctoral-level physical therapy programs, and those who pursue the profession can face more academic difficulties and take longer to earn their degrees. “We’re making some progress,” she says, “but the progress is slow.”
Naidoo is testing a networked mentoring model in the Department of Physical Therapy she believes could help boost students’ academic success by decreasing their social isolation. In Naidoo’s study, students work with a faculty advisor, which all students have, but participants will also have a peer advisor who is a second-year student of color who works with both the student and the faculty advisor. In this approach, the first-year student gets additional support. The second-year peer advisor gets the experience of helping another student succeed, just as a faculty member would. The faculty advisor learns more about students from diverse backgrounds, so that they can become an effective mentor to all students. And the IHP will get to see if the model is worth adopting and expanding.
“It’s just one way to retain the current minority faculty and ensure that they aren’t overwhelmed by students’ requests for mentoring. We need to teach our majority faculty that they can mentor students of color, too,” notes MiloneNuzzo.
The Power of Student Voices
“It’s very encouraging that the students are ahead of the faculty and administration on these topics,” notes Cahn. “They asked, ‘Why don’t we have a chief diversity officer?’ And the answer was that if there were an officer, no one else would work on diversity. We’ve come to realize that we all want to do this work, we just need someone to hold us accountable.”
Last March, this student request for leadership led the school to hire Leah Gordon, a radiation-oncology nurse practitioner at Massachusetts General Hospital, as the assistant director of multicultural programming and inclusion.
Dr. Gordon, who is African American and Latina, knows firsthand about overcoming hurdles to success. She became pregnant during her freshman year in college, ended up leaving school, and for a time went on welfare after having her daughter. She’d been drawn to health care by seeing the inspiring work of her midwife during her pregnancy. Six months after her daughter’s birth, she got a job at the Dana Farber Cancer Institute, where she met Kim Noonan, a nurse practitioner who would become a mentor. One day, Noonan stopped her to ask, “What are you doing with your life? I think you should be a nurse, and here’s how you do it.”
Today, Gordon and Noonan, who is white, remain colleagues and friends who continue to talk about nursing and life, and about diversity, equity, and inclusion issues. “I am a walking, living, breathing health care disparity,” says Gordon. “I am a nurse practitioner with a doctoral degree who has worked in health care for over 15 years, and I understand that all these areas of health care disparities that I represent are still not being addressed the way they should be.”
Since arriving at the Institute, Gordon has organized events in collaboration with the Student Government Association (SGA); with KinsIHP, the LGBTQ+ student organization; MEDS, Minorities Engaged in Dialogue and Service; and SRJH, Students for Racial Justice in Health Care. Several of those student clubs have been formed or expanded their activities over the past year. And students have organized several events as well, including a culturally diverse science day at Harvard-Kent Elementary School this past winter when a dozen women and students of color assumed the identity of scientists to demonstrate to the public-school pupils that they can aspire to pursue a career in the STEM fields.
In July, the IHP hired Kimberly Truong, who is Southeast Asian American, as the executive director for diversity, equity, and inclusion to run a newly created Office of Diversity, Equity, and Inclusion. (See page 8 for profile on Dr. Truong.) While Gordon will continue to focus on co-curricular activities, Dr. Truong will work on strategy and policy, with particular emphasis on the faculty. Milone-Nuzzo points to the value of having students participate in the interview process for faculty and some staff positions, another recent development: “We need them as part of our team. This is their training ground for leadership in the future. If they don’t practice those skills here, they’ll be less likely to implement those skills when they graduate.”
Weaving Diversity into the Curriculum
To immerse incoming students in the school’s inclusion values, each new class participates in a session called “What Is the IHP’s Role in Health Care? Exploring the Impact of Power, Privilege, and Positionality.” The event includes a panel of health care professionals as well as small-group discussions among students on a topic that can be awkward or difficult, facilitated by trained faculty and staff. For Shannon Pohle, who had arrived on campus just days after graduating from the University of Massachusetts Amherst, it was a meaningful event. “I learned that we all have our part to do to be more inclusive,” she says. “We all need to address this problem.”
“Students in our programs are focused on the sciences. They’re entrenched in thinking about anatomy and physiology and lab values,” says Naidoo, who was one of the table facilitators at the session. “So, it was a real wake-up call for them to come to this and talk about the patient as a whole and what the patient is experiencing in the health care system and what students’ roles will be. They have to envision this endpoint and how they are going to be health care providers.”
Charles Haynes, a professor of speech-language pathology, says it’s not just students who must pay attention to inclusion issues. “Students go into their classes expecting teachers to be really dialed in to this, when in fact many faculty don’t feel completely comfortable with these discussions, particularly when there are emotional or conflicting points of view,” he says.
Dr. Haynes led the DEI Council’s curriculum task force, which conducted a survey of faculty. The result: faculty members said they wanted—and needed—help with diversity discussions.
Meegoda and fellow SLP student Neha Paranjpe originally devised the idea that helping faculty could take the form of weaving more diversity and cultural competence into course case studies, Haynes says. The task force currently is developing guidelines and tips for diversifying case studies that will include links to additional resources. “We’re also looking at the cases to see if we are inadvertently perpetuating stereotypical thinking through building them,” Haynes says. “That’s a classic diversity, equity, and inclusion problem: How do we avoid creating the very thing we’re trying to dispel?”
He also suggests faculty could lead workshops where they can have honest discussions among themselves: “Two to three people who are willing to get up and say, ‘Here are mistakes that I’ve made. Here are some lessons that I’ve learned. And I’m not there yet.’ That would be very powerful.”
Haynes and others say it’s crucial to ensure that the curriculum in all of the IHP’s academic programs address intersectionality, noting that patients who have multiple identities—someone, for example, who is gay, black, and uses a wheelchair—could be especially vulnerable in health care settings. “Talking about these issues can be like continuously lancing a boil,” he says. “Everyone wants to get it over quickly. Everyone is worried about getting things wrong. No one wants to make mistakes. But part of trying to be healthy is trying to embrace constructive risk-taking.”
Building the Future
The next step, says President Milone-Nuzzo, is continuing to make progress and sharing insights. In July, she shared the IHP’s work with other Partners HealthCare leaders as a member of its inaugural, system-wide Diversity, Equity & Inclusion Council. Sponsored by Partners’ new CEO, Dr. Anne Klibanski, and Massachusetts General Hospital president Dr. Peter Slavin, its goal is to implement a diversity, equity, and inclusion strategy that is representative of all employees and institutions while providing equitable care to patients, according to Dani Monroe, Partners’ chief diversity and inclusion officer. “Being part of the Partners’ council allows us to learn from experts from throughout the system, and they can learn from us,” Milone-Nuzzo says.
The Institute held “The Empowered Bystander Training” in August for students. Led by Lee Forest and Luis Paredes of Bridgewater State University, the session—a modification of the training faculty and staff received to facilitate the power and positionality discussions—explored the ways in which people most often learn misinformation about their own and other groups. Such misinformation is a bias that can be dismantled, Forest and Paredes believe, especially if community members hold each other accountable for doing so.
“Being a minority student, you can feel a little marginalized in certain situations and you want to have open lines of conversation,” says Anthony Fitzgerald Paredes, a Latino nurse practitioner student and SGA president. “There just isn’t enough representation of minorities at the school and we want to feel more comfortable expressing our ideas and thoughts from our perspective.”
He believes a stand-alone student center would be beneficial. “It would be a space for students to meet and learn from and with each other,” he says, noting that it could be used for guest speakers and programming that celebrates different cultures. “It would add an entirely new element to the school and promote greater conversation and interaction among all students.”
Dr. Cahn, the associate provost, says the diversity, equity, and inclusion conversation needs to be expanded throughout the entire campus. “Students are hungry for more understanding of how their role fits into a larger history and allows them to build a more promising future,” says Cahn, who was on the steering committee and was among the speakers at Partners’ Diversity, Equity & Inclusion summit in May.
Dr. Gormley, the dean of student and alumni affairs, looks at how success can be measured. “If five years from now, students are saying that they feel safe and welcome and supported regardless of their unique identities, and if alumni came back and said that they can feel a tangible difference, then we really will have accomplished something,” he says.
Ultimately, for Milone-Nuzzo, it comes down to following the school’s core values of advancing care for a diverse society through leadership in education, clinical practice, research, and community engagement. “We can’t have an environment where we don’t have a commitment to these issues and think that we can prepare our students to treat patients of every background,” she says. “Inclusivity translates into academic excellence, and it’s through these efforts that we can educate our students to be true leaders.”
— By Alyssa Haywoode