The following is the second installment of the recently launched “Diversity in Medicine” blog by Philomena Asante, MD, MPH, that will highlight a healthcare institution, medical educational program, or professional medical organization striving to promote diversity, equity, inclusion, and justice in medicine. We know racism and bias exist in medicine. Now, it’s time to focus on solutions.

In this post, Dr. Asante interviews Brownsyne Tucker Edmonds, MD, MPH, MS, Assistant Dean for Diversity Affairs at Indiana University School of Medicine. Dr. Tucker Edmonds discusses the Indiana University School of Medicine’s Program to Launch URM Success.

PA: Tell me about the origins of the PLUS program and how you became involved.

BTE: I joined our Faculty Affairs, Professional Development, and Diversity (FAPDD) team in 2017 to work on professional development for faculty from backgrounds that are underrepresented in medicine (URM). When I joined, the FAPDD team was re-evaluating the effectiveness of its faculty Diversity Recruitment Program (DRP). Our challenge was less in the realm of recruitment and more in retention. We decided to create a new program that focused on URM faculty retention, with funds allotted to the DRP. My role was to envision and implement this retention program, which I later named the Program to Launch URM Success or “PLUS.”

PA: What are the mission, objectives, and main components of the program?

BTE: The program supports the success of URM faculty, which we define as Black/African American or Hispanic/Latinx. We aim both to increase the proportion of our URM faculty who rise from the assistant to the associate professor rank and to accelerate the rate at which that happens. A disproportionate number of our URM faculty remain as assistant professors, sometimes for their entire career. We are figuring out how to boost their productivity and their knowledge and understanding of that process so that more can rank up sooner rather than later. The program emphasizes acquiring the leadership skills and scholarly products needed for promotion.

An overview of the program may be found in our application. The program has four main components: leadership, mentorship/coaching, scholarship, connectivity.

In their first year, PLUS scholars participate in LAMP (Leadership in Academic Medicine Program), an already-existing faculty development program at our institution that is open to all faculty.  This was chosen as a foundation based on our philosophy that faculty of color largely need what all the other faculty need upon entering academic medicine careers. They need that and more.

In the second year, scholars participate in the PLUS Seminar Series and attend monthly workshops on research methods instruction, writing seminars, career coaching, and wellness. Some of the content focuses on unique threats to advancement and vitality for URM faculty. They learn from senior staff and faculty how to handle micro- and macroaggressions, navigate hostile or inequitable work environments, and how to advocate for themselves or a colleague who is being mistreated. These conversations are not always happening in the typical faculty development space, but we recognize that these are important skills for our faculty of color.

Next, we create opportunities for mentorship and sponsorship: candidates identify mentors within their departments when they apply. Once enrolled, they are assigned PLUS Advisory Council (PAC) advisors who are senior faculty and/or staff who serve as advocates. The PAC advisors provide an outsider’s perspective and try to safeguard the scholars against challenges that sometimes occur at the local level around support and advancement.

We also try to tailor our programming to the unique needs and challenges of faculty of color. In both years, PLUS scholars participate in ”connections” events, designed to limit some of the isolation, be it professional or social, that we know faculty of color experience at predominately white institutions. We try to cultivate a sense of community across departments and disciplines.

The program focuses on scholarship, because it is often a hurdle for those who are disproportionately placed in clinical tracks and have a heavier clinical workload to be able to get scholarly products that would allow them to be eligible for promotion. By the end of the 2-year program, PLUS scholars complete a project that results in a scholarly product for submission or dissemination in a peer-reviewed forum.

PA: Who do you recruit, and how many scholars have been accepted in the program?

BTE: Typically, we recruit tenure track and clinical track URM faculty who are at the assistant professor rank and have been at our school for at least 2-5 years. We have enrolled 20 scholars in 4 overlapping 2-year cohorts since 2018. Our first cohort had 4 scholars. The second cohort has five scholars, the third cohort has 9 scholars, and the fourth cohort has 6 scholars.

I actually designed the program for the clinical track URM faculty, although we have also accepted faculty who are fellowship trained or have PhDs. In our first year, we had challenges recruiting clinical faculty because it was difficult to compete with the polish of proposals submitted by research trained faculty. We realized that our application itself was a barrier. We asked candidates to write a proposal, but that is a skill set for which you have to be trained—the process just isn’t intuitive, although we operate as if it is.

This is how inequity operates in institutions: we reproduce ourselves. Our application and review processes were familiar and common and looked like all other grant application processes. We actually had to grow to understand that our application process in and of itself will disqualify people if we’re not careful about what we’re setting as the criteria for excellence.

So, in our second year, we restructured the application to give much clearer templates. We included statements like “Tell me this,” and “Tell me that,” which provided the components, as well as the roadmap, for writing a defensible programmatic proposal. We had to do the same with our budgets. We learned in our first year that people who have never had to put together a budget for a grant proposal don’t know how to put together a proposal. We put up examples and gave people templates for writing budgets. We had to be very prescriptive in how we were asking for those products.

PA: In order to apply, applicants must get a letter from a department head committing to 10% “protected time.” Was it challenging to get institutional buy-in for protected time to participate in the program?

BTE: Yes, protected time was the biggest upfront issue we faced in rolling out the program. We had to decide whether we wanted a true departmental buy-in around “protected time” or if we would ask for a “release of time.” When you’re asking for a release, you have to estimate how much time you’re actually asking for. The time is given “in kind,” because they’re not expected to be doing their clinical duties. They’re going to be released from that to be able to participate in the program activities. We decided to ask for a release in large part because we had precedent for that with LAMP and some of the other faculty development programs at our institution.

Strategically and honestly, I also knew a “buy-down” for true protected time was going to be met with much more resistance by department heads. A buy-down could also potentially disadvantage individuals who were in surgical or other higher-paying specialties. We felt like they weren’t going to support this effort if it was going to cost that much to their department.

PA: PLUS scholars can apply for and receive a one-time award of up to $50,000 to complete a project over the 2 years. How do the scholars use the funds?

BTE: The funds are mostly used to underwrite research assistant-type functions. We made an intentional choice not to allow the award to be used for salary support, because it would go a variable distance for faculty based on their individual subspecialties. I tell folks, especially clinical track faculty, to use these internal resources to extend themselves by, for example, using the funds to support a research assistant who can recruit or put out surveys or someone to complete data analysis so the scholars don’t have to.

PA: How will you measure the success of the program?

BTE: We are tracking long-term measures, such as the rates of promotion and the time to promotion, as well as traditional scholarly products like papers, grants, posters, presentations, and invited speakerships. We are also developing metrics around belonging and strategic network mapping, addressing questions like “Is this enhancing your sense of connection with our institution or with each other?”, “How do we think about our networks in terms of what’s lacking and who is needed?”, and “How can you be connected with the resources or people you need?” Measuring the softer end points around belonging, climate, and support is important because when URM faculty members leave an institution, it’s often because they don’t feel a sense of value, support or belonging to the community. We are also evaluating the impact of the PAC advisors.

We graduated our first 2-year cohort in July 2020! We’ve asked these PLUS scholars to think with intention about their trajectories. We also continue thinking about how we remain a point of contact for them, support them, and help them build skills.  Most recently, we are launching a new program to sponsor professional coaching sessions for our alums.