Illustration: Davide Bonazzi.

This spring during her maternity leave, Stephanie Lovinsky-Desir, MD, updated progress reports to the NIH on her research into asthma among kids living in urban areas, reviewed grant applications and abstracts for the American Thoracic Society, flew to Chicago to present an abstract at an American Society for Clinical Investigation meeting, and drove to Baltimore to give an oral presentation of her research at a Pediatric Academic Society meeting. When an opportunity presents itself, its really hard to say no, says the pediatric pulmonologist and mother of three. Junior faculty members are expected to have exponential growth in this early part of our careersbut it overlaps with when were raising young families.

And yet, says Dr. Lovinsky-Desir, compared with the shorter leaves she had after her older two children were born, the 13-week parental leave policy instituted across Columbia University Irving Medical Center (CUIMC) in January 2018 was a significant benefit. While it was still hard to come back to work, especially leaving a new baby with a cold, it was really nice to have that extra month of bonding time with her, she says.

In 2017, for the first time, more women than men enrolled in VP&S. This past year, women were the majority of both medical school applicants and enrolled students nationwide. Racial and ethnic diversity likewise continues to increase among medical students, with nearly 50% of medical students in the United States identifying as non-white. And while great strides have been made in diversifying the ranks of academic medical facultyboth at Columbia and across the countrywomen and people of color remain under-represented at the highest levels of academic ranks, administration, and leadership. To address the issue, VP&S administrators have dedicated recruitment, hiring, and programmatic efforts to expanding the pipeline of women and underrepresented minority faculty to serve the educational, clinical, and research missions of VP&S and to take on leadership roles.

Diversity at all levels of medicine, including students, trainees, faculty educators, researchers, and practitioners, is critically important to educate students to understand medical problems that quickly and easily cross global borders; to deliver culturally sensitive health care to a population that is multicultural, multinational, and multilingual; and to bring new and different research perspectives to the research agenda, says Anne Taylor, MD, vice dean for academic affairs. American medical education, practice, and research can only remain the best by using the full intellectual capital derived from recruiting the most committed, accomplished, and talented workforce from every segment of our population.

The effort at VP&S got a substantial boost in April 2018 when Lee Goldman, MD, dean of the faculties of health sciences and medicine and chief executive of CUIMC, convened two faculty committeesone dedicated to the particular career challenges faced by women and the other to those of underrepresented minoritiesto develop recommendations that would strengthen ongoing efforts to promote opportunities for career success at VP&S for all faculty. Dr. Goldman reviewed the recommendations submitted jointly by the two committees and accepted them in full this year. While the recommendations were developed by advisory committees, their implementation will position VP&S to be the best place for academic medical faculty to flourish, says Dr. Taylor, whose office provided administrative support for the committees.

Convening the committees was part of the medical schools ongoing efforts over the past decade to be sure that career development needs of all faculty are met. These efforts also recognize that women and underrepresented minority faculty face additional unique challenges to career development that require more professional development efforts. Earlier efforts have resulted in measurable progress. Among VP&S faculty 47% are women, compared with the national average of 39%. Even at the highest ranks, 29% of VP&S full professors are women compared with 25% nationally, and 35% of the medical schools tenure-track faculty are women, leading Columbias peer group of medical schools. Racially and ethnically diverse people make up 20% of the faculty at VP&S, with 11% (compared with 8% nationally) from groups traditionally underrepresented in the professoriate.

In recent years, the academic tracks were restructured to create a transparent, objective basis for academic advancement and to minimize arbitrary and potentially exclusionary promotion practices. Parameters of equity, such as numbers of women and diverse faculty in leadership positions and on key committees that review candidates for promotion and honors, are closely monitored to assure a balanced representation of the faculty, and salary equity between men and women is regularly measured. To ensure continued efforts, VP&S committed $50 million to programs to recruit and support women and diverse faculty.

Chief among the recommendations Dr. Goldman endorsed to promote the success and retention of new recruits and current faculty is creation of an Office for Women and Diverse Faculty. All of our programs are driven by faculty interest and faculty demand, says Dr. Taylor. Hired in late 2007, about 18 months after Dr. Goldman became dean, Dr. Taylor now holds the John Lindenbaum Professorship of Medicine and also serves as senior vice president for faculty affairs and career development for CUIMC. From that vantage point, she sees implementation of the committees recommendations as the latest advance in the work with which she was charged when she joined Columbia.

When I came to the medical school, there were no professional development programs for faculty, says Dr. Taylor. VP&S hires some of the most gifted faculty members in the country, so it is our responsibility to support their career success and satisfaction. Her office now oversees orientation programs; leadership and management training, including sessions for all women and diverse faculty cohorts; workshops focused on career development and academic advancement for educators, researchers, and clinicians; and workshops focused on teaching skills, negotiation skills, and management of research teams. Working with women faculty, Dr. Taylor helped to develop the Virginia Kneeland Frantz Society for Women Faculty. Implementation of the advisory committees recommendations will allow for expanded professional development programs but importantly will offer the opportunity to create further changes in the overall culture and climate around diversity and equity.

When Hilda Hutcherson, MD, arrived at Columbia in 1981, she was the first African American woman resident in obstetrics & gynecology. On this campus, there were few African American residents at the time in any department, or even faculty members, she recalls. When I started as an assistant professor in 85, there were no programs to encourage minorities or women to pursue academic medicine. Now a professor of obstetrics & gynecology and senior associate dean for diversity and multicultural affairs, Dr. Hutcherson served on the Committee for Faculty Diversity and Inclusionand she is pleased that the committees work has been so enthusiastically endorsed by the dean. When the list of recommendations was put together, I dont think anyone was thinking wed get 100%, she says. Im so happy that Dr. Goldman took all of the recommendations.

In the absence of formal programs to support her own career development, says Dr. Hutcherson, informal relationships were key to her success. During her early years on the faculty, Gerald E. Thomson, MD, now the Samuel Lambert and Robert Sonneborn Professor Emeritus of Medicine, took note of her passion for encouraging students from diverse backgrounds and urged her to consider formal opportunities to mentor others. It wasnt something I was pursuing at first, says Dr. Hutcherson. Dr. Thomson thought I would be really good and a natural fit and encouraged me to applythats how I ended up in this position. She not only transformed what was once a small office dedicated to recruitment of underrepresented minority medical students into an office with a broader set of programs that support all medical center students, she founded and leads the Kenneth A. Forde Diversity Alliance, which is dedicated to recruiting, retaining, and recognizing a diverse community among students, residents, faculty, and alumni.

Informal associations like that with Dr. Hutcherson and Dr. Thomsonwhereby higher-ranking professionals in the field champion the career trajectories of junior facultyplay a critical role in sustaining diversification of leadership of academic medicine, says plastic surgeon Christine Rohde, MD. These relationships, which differ significantly from the peer-to-peer mentorship and networking many professionals already enjoy, are important but should be supplemented by formal mentoring and sponsorship opportunities available to all, says Dr. Rohde. The Office of Faculty Professional Development, Diversity & Inclusion led by Clara Lapiner, MPH, promotes mentorship and sponsorship for faculty within departments but also has made sponsorship of faculty for outside career development part of its mission.

A sponsorship opportunity from the Office of Faculty Professional Development, Diversity & Inclusion provided funding support from the Virginia Kneeland Frantz Society for Dr. Rohde to attend an AAMC mid-career development training program for women faculty. Since the program began in 2016, 29 women and 20 underrepresented faculty have received funding support to attend AAMC career development seminars. Faculty who have received such support share what they have learned with others. At the end of that course I wrote a list of the things I wanted to try to do in my work life and some were very, very specifictalking to a particular individual about things I wanted to achieve in the futureand others were more general about how I could grow, contribute, increase visibility, says Dr. Rohde. Sponsors have really put me forward for things I wouldnt have thought of myself.

As vice chair of faculty development and diversity for the Department of Surgery and chief of microvascular services at CUIMC, Dr. Rohde now has opportunities to mentor and sponsor colleagues earlier in their careers, with a particular eye on cultivating diversity among those being recommended for leadership. There are scholarships geared toward women, underrepresented minorities, and Ill find people in my department who are eligible, encourage them to go for it, talk to people who will nominate them, she says. And as a Chinese American mother of three, she chooses to take on highvisibility rolesas co-chair of the Women Physicians of NewYork-Presbyterian, as a leader in her professional societies, as a member of the deans advisory committee for women faculty, and now as she applies for a full professorship, a pursuit relatively rare among female surgical faculty. Im very conscious of what I do and what that means for other people who may want to follow my career path in academic plastic surgery, she says. The kids are watchingif we say diversity is important, but the field is not, I think they pick up on that.

Pathologist Richard Francis says he has seen significant shifts in the institutional culture at VP&S since he was a student in the MD-PhD program and since he was hired as faculty in 2011. I feel like it is sincere, the idea of making this a better place for people to work, for patients to be seen, for people to receive their education, says Dr. Francis, who directs the Special Hematology and Coagulation Laboratory and served with Dr. Hutcherson on the deans advisory committee for faculty diversity and inclusion. I dont get the impression that its just lip service, but real follow-through where you can see differences.

He sees particular promise in the deans endorsement of the faculty recommendation that all departments offer training in detecting and fighting implicit bias the unconscious attitudes and stereotypes that can affect behavior. It feeds back into interviewing students, residents, faculty, he says. People need to understand how they view people, how that affects who they recommend, and how they approach trainees and job offers.

In his own career, he has found connection through programs like a Harold Amos Medical Faculty Development Program award from the Robert Wood Johnson Foundation, which expanded his access to mentors. As you get further along, having people to mentor you who are more like you, look like you, have gone through things that youve experienced matters more.

To provide that kind of access among the residents he meets in clinical rotations, Dr. Francis keeps lines of communication open, often helping trainees process their own encounters with implicit bias. Much of that work boils down to acknowledging and validating painful experiences. Sometimes he shares insights from his own journey or offers advice. Its not that someones trying to disrespect you, says Dr. Francis. Theyre updating their schemasometimes it works and sometimes it doesnt and theres friction in that process.

Diverse perspectives advance the kind of problem-solving central to academic medicine, Dr. Francis notes. Acknowledging the friction that can sometimes emerge and working through difficult processes are critical steps for achieving the potential a diverse workforce promises. You have to do something to foster that environment, make sure everyone has an equal voice, that they know that what they have is something of value, he says. Everyone needs to know that their perspective will be heard.

As chair of the Department of Emergency Medicine since January 2018, Angela Mills, MD, has hired 34 new faculty. Among them are 21 women and nine people of color. Diverse teams are smarter, and teams that are both gender and culturally diverse are more likely to introduce innovations, says Dr. Mills. Both as problem solvers and as educators, she says, leaders in academic medicine must innovate. Yet implicit bias often interferes with the recruitment and retention of a diverse team. To reduce that risk, Dr. Mills has standardized as much of the process as possible by requiring that nominating committees define hiring criteria in advance and search committees develop a panel of questions each candidate must answer. What we ask candidates and how we evaluate them is really important when were talking about diversity, she says. Without clearly defined criteria, people tend to redefine characteristics of what theyre seeking to promote male candidates, less diverse candidates.

As a member of the deans advisory committee for women faculty, Dr. Mills brought to the table her personal experience as a first-generation college student, woman, and mother of two rising through the ranks of emergency medicine, as well as her scholarship on the gender gap in her field. In February, the Society for Academic Emergency Medicine published her analysisco-authored with colleagues at Harvardon gender differences in faculty rank among academic emergency physicians in the United States. Later that month, she gave a VP&S grand rounds lecture on the gender gap in academic medicine. Nationally, Dr. Mills notes, more than 50% of medical students are women. Among all residents, 46% are women; in emergency medicine, however, only 37% of residents are women. And the number keeps falling off, she says. The question is how do we promote emergency medicine as a specialty that supports women, promotes women, and allows women to successfully transition into academic medicine if they choose?

She has found that the new 13-week parental leave policy helps recruitment. I use that as a selling tool, and Ive had just as many men as women take parental leave, she says. Its a great benefit to all parents. She also is optimistic about the potential of #SHEmergency, a professional development group that fosters community and develops methods for awareness of gender bias among female-identified residents and emergency medicine faculty. The groups article, #Shemergency Presents: Recruitment & Retention of Female Residents, appeared this summer in AAMCs journal, Academic Medicine. We developed specific events where residents and faculty partner on strategies and plans to combat disparitieseverything from mentorship to speaking invitations, awards and recognition, salaries.

Like Dr. Francis and Dr. Rohde, Dr. Lovinsky-Desir credits an early career development award for providing the professional connections and coaching she needed to take a tactical approach to her own career advancement. In my regular circles on the academic campus, often Im the only woman of color, she says. Its important to see people in leadership who look like you, who have gone through similar experiences. If theyve made it, I too can make it.

Among members of the deans advisory committee for faculty diversity and inclusion, the power of solidarity and connection made the idea of an Office for Women and Diverse Faculty particularly attractive, says Dr. Lovinsky-Desir. As the odd person out, sometimes your voice gets lost. Its a little harder to speak up, she notes. If theres a space where we can unite, uplift one another, I think it will empower us as we go back into our teams.

This article originally appeared in the 2019 VP&S Annual Report.

Already, says Dr. Lovinsky-Desir, she sees other changes emerging from the recommendations advanced by the deans advisory committeesa powerful, self-reinforcing effect both on campus culture and the advancement of women and minorities across VP&S. She was recently invited to serve on a search committee. Not only was she able to lend her perspective on the search itself, Dr. Lovinsky-Desir was fascinated by the insights she gleaned about what search committees prioritize when assessing candidates for senior leadership positions. We often dont get that as junior faculty, women, minorities, she says. I learned so much about what features are valued in a person in senior administrative leadership, and that perspective will enhance my growth here as a junior faculty member.

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The Future Is Now: A Diverse and Inclusive Faculty - Columbia University Irving Medical Center