By Erin Hoover Barnett and Tracey Lam
Oct. 10, 2019 — Dr. Quinn Capers traveled from the Ohio State University College of Medicine in Columbus, Ohio to Portland this week to frame the stark predicament of modern medicine for a standing-room-only Oct. 10 lecture in Hospital 8B60, “The Lack of Diversity in Medicine is a National Emergency: The Way Forward.”
Asian patients who perished following a proven heart valve procedure because the enzyme profile required for success went undetected in a mostly white-subject clinical trial. Studies showing black patients are less-likely to get life, or quality-of-life saving treatments than white. Research documenting female heart surgeons getting better patient outcomes while their numbers and their pay is dwarfed by male surgeons.
“Diversity saves lives,” Dr. Capers said. “You have to believe it. Because then you exert energy and break the inertia.”
More than a lecture
Dr. Capers, professor of medicine, former associate dean of admissions and now vice dean for faculty affairs in the Ohio State University College of Medicine, is an interventional cardiologist who has developed a national following for identifying and successfully addressing implicit bias in admissions processes and for discussing the “why” and the “now what” to help institutions confront bias institutionally and as individuals.
He met with faculty and academic leaders and students and trainees across schools and programs, and celebrated the work and compared notes with facilitators in the OHSU Unconscious Bias Campus-wide Initiative (see featured photo), which is led by the Center for Diversity and Inclusion and has already trained more than half of OHSU’s 17,000 employees. On both days, he offered his two-hour workshop for admissions, human resources and academic program staff and faculty on strategies for addressing implicit bias, staffed by the SoM Division of Continuing Professional Development.
“Dr. Capers’ visit was more than a lecture. It was a dialogue,” said OHSU Chief Diversity Officer Brian Gibbs, Ph.D., who led a cross-school collaboration to host Dr. Capers after Bart Moulton, M.D., associate professor of medicine, OHSU School of Medicine, secured the invitation. “It was a chance to share where we are and where we get stuck and to hear his powerful examples and his strategies that have worked at Ohio State. He buoyed us but, more importantly, he raised the bar for what we as individuals and an institution still must do.”
In every venue, Dr. Capers offered concrete strategies.
To foster diversity:
- Offer a health disparities course in every academic program to frame the human and business case for diversity and attract a critical mass of diverse learners. (Sure, the curriculum is already packed, but you can pick up the specialized knowledge in your fellowship, he said. “Right now is the time to impart in them a sense of justice.”)
- Target and tailor implicit bias training to key faculty and staff groups who need it, such as admissions teams and course instructors.
- Use an holistic admissions process that weights equally students’ experience and personal attributes; distance traveled (barriers they have overcome), and academic record.
- Don’t expect a small group of diverse faculty and students to always carry the message to recruits; create videos and online brochures that depict the institution’s commitment to women and minorities.
To address implicit bias in interviews, patient care and interpersonal interactions:
- Common identity formation: Look for what you have in common (your birth order, your pets, your hometown, your alma mater); empathy reduces bias and shifts the perspective from “them” to “us.”
- Perspective taking: Put yourself in their shoes. Think about what it took them to get to this appointment or moment. Relate on a human level.
- Consider the opposite: If certain data led you to one conclusion, look for data that would support the opposite. Challenge your assumptions.
- Counter stereotypical exemplars: Spend time with or focus on individuals you admire from groups against which you recognize you have a bias.
At Ohio State, Dr. Capers put these strategies on a card for his team to keep with them and use routinely. Their efforts have proved successful.
In spring 2012, Dr. Capers and colleagues gave the implicit association test to 140 members of the M.D. admissions committee and found significant levels of implicit or unconscious white race preference. The team then made intentional efforts to be aware of their biases going into their interviews the following year. The outcome: They admitted the most diverse class in Ohio State history and have only continued to build on those results.
“The admissions committee has the awesome responsibility of determining who gets to be a doctor, a dentist or a nurse and who doesn’t,” said Dr. Capers. “It is human to have implicit bias. The good news is, we can override it consciously.”
The value of action
Faculty and students found his concrete examples empowering.
“Just to be made aware of all these unconscious biases and to learn tools like ‘empathy cures bias,’” said Sandra Iragorri, M.D., associate professor of pediatrics, OHSU School of Medicine, after his Wednesday workshop. “It was wonderful.”
Alexandria (Allie) Dyer, M.D. Class of 2021, left the student dinner that evening feeling optimistic.
“For me, it was powerful and inspiring to be able to be in conversation with an incredible physician who also has built movement around tangible transformation of the disparities and inequities in medical education,” Dyer said. “It was clear that he cares deeply for the success of students that look like me. I felt hopeful that he will be able to contribute to change here at OHSU and grateful to those that brought him here.”
And Dr. Capers created a safe space. One student told of patients making racist remarks out of view of the attending. Dr. Capers advised the student to tell the attending or the program director. “You didn’t work this hard to be treated like that,” Dr. Capers said. “You don’t have to take that.”
To CDI unconscious bias trainers and associate trainers with other roles at OHSU who volunteer facilitators, he offered praise.
“The work that you’re doing is not sequencing the genes that will cure cancer,” he said. “But without your work, the cure won’t get to all who need it.”
Changing the narrative
Dr. Capers left the packed hospital auditorium smiling Thursday afternoon with photos from the K-12 health and science academy launched in Columbus to widen the path to the health professions, including the white coat ceremony for kindergartners.
Having earlier referenced the white female police officer, Amber Guyger, who mistakenly walked into a Dallas apartment a floor above hers, encountered the black male accountant, Botham Jean, who lived there, panicked, shot and killed him, Dr. Capers encouraged changing the imagery around black men by posting and sharing photos of black male doctors, dentists, nurses and pharmacists with the hashtag #BlackMeninMedicine.
“Let’s make it a normal thing,” he said, “to see a black man and think ‘physician.’”