Antonia Makosky is a 1997 graduate of the IHP Direct Entry Nurse Practitioner program and the Doctor of Nursing Practice program in 2015. She returned to IHP to teach in 2007 before joining the faculty full time in 2010 and is now an assistant professor in the Adult-Gero Primary Care NP program. Makosky sees primary care patients as an adult nurse practitioner at the MGH Charlestown HealthCare Center where she also precepts students. She played a role in broadening inclusion at IHP, serving on the Diversity Council and more recently on the JEDI Council. As part of Pride Month, she shared background on how she became involved in inclusivity at the IHP and how it has progressed from when she started.
How did your connection to IHP’s inclusion efforts begin?
When I started teaching, I realized that some students weren't feeling seen and that we weren't doing right by everyone, including our LGBTQ students, but also our students of color. As a person who has a lot of privilege, it took me a little while to see that. I was vaguely aware that there was discrimination, but it took time to have my consciousness raised.
When I was started as full-time faculty, the dean came to me and another faculty member and shared that students of color were having negative clinical experiences, as well as interactions with faculty and peers, and asked us to form a task force. Again, coming from a place of privilege, it took time for us to understand the problem and to recognize that there were scholars and experts who could be resources. We realized one big difference we could make was to focus on changing the classroom experience for our students.
In looking at how to make the classroom more inclusive, I realized that our LGBTQ students were having similar experiences to our students of color. Some were advocating for themselves and wanted us to be more inclusive but there were others who weren’t out or who were still feeling marginalized.
How did you approach making changes to the classroom experience?
I had always considered myself an ally, but I didn't necessarily know how to practice that in an educational setting. I got a lot of help from our teaching assistants who acted as a bridge between the students and the faculty and could tell us things that the students would not. It was not enough to want to support people from underrepresented or minoritized or discriminated against groups; we had to actively change our curriculum and way of speaking in the classroom.
We really have a lot to learn from our students. I have added GLBTQ health and health disparities to my posted scholarly interests so now some students come to me for their scholarly projects about health risks for transgender youth and others have looked at how to change our curriculum to be more inclusive of LGBTQ folks. As part of her project, one of my past teaching assistants, Lisa Keegan, went through two semesters’ worth of primary care theory lectures and changed the language to be more gender neutral. That was a huge help to me and helped me understand where I was unknowingly committing microaggressions. After graduating, Lisa to give guest lectures on LGBTQ health.
Since I started in 2010, and over many meetings with faculty and students, the IHP faculty realized the need to thread inclusion throughout the curriculum instead of just bits of content in a class here and there. The Diversity Council pushed for an IHP wide initiative; that is how the Power, Privilege, and Positionality (PPP) orientation evolved. But once we started that, students would say, ‘orientation was great, but my classes don’t seem to have any of this content.’ Our ultimate goal was to integrate all of these JEDI concepts through every class, but we also felt like not every faculty would teach content in the same way. As we discussed this in Diversity Council, we felt like the best place to start integrating these threads throughout the curriculum would be in the interprofessional IMPACT classes, because these classes are required for new students from every discipline. In the years since that first PPP, the JEDI content has been threaded through IMPACT. The most recent iteration of IMPACT embedded microaggressions for students to deal with in simulation, including microaggressions towards persons of color and microaggressions towards LGBTQ people.
How does this inclusive approach relate to clinical information?
I think it is helpful to look at this from the lens of healthcare disparities. There are many healthcare disparities which arise in the contexts of sexual and reproductive health and also around health problems and considerations for particular populations. My teaching colleague Kenya Palmer has done a great job integrating course content centering on the voices of Black and brown patients. My current teaching partner, Ryan Tappin, is a graduate of this program and teaches a summer course in sexual health at another college. In our Primary Care Theory class, he has introduced more robust content about health risks that affect the gay and trans populations, and how to offer up-to-date medications, like PrEP for example.
We have newer term lecturers, who are former alums, who have worked at Fenway Health and college health as nurse practitioners and bring a broad knowledge of treating health problems specific to the trans population, such as different screenings to make sure we don't miss prostate cancer, cervical cancer, breast cancer. Then there is also hormone treatment which we've now made part of our primary care curriculum.
Just as in the classroom, language is important in the clinical setting. We teach our students about being accessible to the patient by using language that is easy to understand and terms that are acceptable to the patient. My colleague and IHP graduate, Dan Kahn, has developed continuing education for IHP faculty about using inclusive language with our LGBTQ patients. We try to teach our students to use gender neutral and accurate clinical language in our notes.
I think ultimately, we are thinking on three levels: creating an inclusive classroom environment, teaching our students about health care disparities, and teaching how to create trust with all of our patients so we can address health care disparities. These disparities particularly affect Black and brown patients and LGBTQ patients. I am very proud of the work the IHP has done, and continues to do, by integrating these concepts into our curriculum and illustrating their importance in the classroom.
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