95. Introducing Narratives in Cardiology Series: Dr. Pamela Douglas on Diversity & Inclusion

CardioNerds (Amit Goyal and Daniel Ambinder) introduce the CardioNerds Narratives in Cardiology Series which will feature the stories of amazing cardiovascular faculty and trainees representing diverse backgrounds, subspecialties, career stages, and career paths. To kick this series off, Dr. Pamela Douglas, who heads the Diversity and Inclusion task force for the American College of Cardiology, provides valuable insights in the field and shares her personal story. We are joined by the CardioNerds Narratives #FIT Advisors, Dr. Zarina Sharalaya, Dr. Norrisa Haynes and Dr. Pablo Sanchez for this very important discussion.

Special messages by: Dr. Vanessa Blumer, Dr. Robert Harrington, Dr. Richard Chazal, Dr. Nosheen Reza, Dr. Neha Pagidipati, Dr. Mary Norine (Minnow) Walsh, Dr. Melissa Daubert, Dr. Gerald Bloomfield, Dr. Angela Lowenstern, Dr. Ralph Brindis, Dr. Michael Valentine, Dr. Anna Lisa Crowley, Dr. Malissa Wood and Dr. Geoffrey Ginsberg.

95. Introducing Narratives in Cardiology Series: Dr. Pamela Douglas on Diversity & Inclusion

Show notes

  1. What is “Diversity” & “Inclusion”?
    • Facets of diversity are all aspects of human differences. 
    • These include gender, race, ethnicity, age, physical ability, gender identity, national origin, language, religion, sexual orientation, socioeconomic status, and more.
    • Inclusion is making everyone feel welcomed and included.
    • Inclusion requires having a culture & environment where everyone can thrive regardless of background differences. 
    • This inclusive culture fosters respect & belonging in which we hear, appreciate, & value everyone and their perspectives.
    • Inclusive organizations work with individuals to recognize and eliminate both explicit and implicit biases. They may do this with intentional efforts like professional & skills development as well as addressing awareness, education, and policy. 
    • Diversity measures representation by counting the presence of varying identities and characteristics. But Diversity itself is not the final goal.
    • Diversity is the metric while Inclusion is the goal. For now, while representation is so disparate among certain groups, diversity is an important metric. It’s hard to be truly inclusive with such professional inequities. 
    • “Ultimately what we want is for people to belong. So not just be asked to the dance and sitting around and staring at everybody else but really feeling like you can go out on that dance floor and dance, like nobody’s watching and it’s fine because this is your  community.” – Pamela Douglas
  1. Why is achieving diversity important?
    • Diversity is a virtue in and of itself. 
    • But more than that, diverse groups make better decisions, are more innovative, are better at problem solving, and have an expanded talent pool.
    • Cardiovascular medicine benefits from having a diverse workforce. Science performed by diverse groups has greater scientific novelty and produces higher impact papers in higher impact journals.
  1. Is there a link between professional diversity and healthcare inequities?
    • YES!
    • Physician diversity reduces healthcare disparities and improves healthcare quality.
    • Physicians who train in diverse environments are more culturally competent when treating underrepresented groups.
    • Underrepresented physicians are more likely to serve underrepresented populations.
    • Underrepresented patients are more likely to follow the recommendations of physicians who look like them. This enhanced trust is critical to an effective patient-physician relationship. 
    • In the context of clinical trials and guidelines, underrepresented physician scientists help diversify our clinical trial participants, resulting in a more robust and representative evidence base. 
  1. How are we doing in cardiology with respect to diversity?
    • There have been improvements but we have a long way to go.
    • Women comprise 43% of internal medicine resident physicians by only 22% of general cardiology fellows and even lower proportions within procedural fields.
    • Underrepresented minorities–specifically Blacks, Hispanics, and Native Americans–make up about 32% of the US population but only 13% of general cardiology fellows.
    • Benchmarks for other racial and ethnic groups and for other facets of diversity like socioeconomic status, sexual orientation, gender identity, IMG status, and others are even less clear.
    • Inequities amplify in advanced career and leadership positions. 
      • Only 11%, 9%, 11%, and 24% of Asian, black, Hispanic, and white women, respectively, are full professors compared with 21%, 18%, 19%, and 36% of Asian, black, Hispanic, and white men, respectively (Albert 2018).
      • In the top 40 ranked cardiology programs, there are no female cardiology chiefs (Albert 2018).
      • There were no women editors-in-chief for US general cardiology journals between 1998 and 2018 and only 1 woman editor-in-chief for a general European cardiology journal (Balasubramanian et al., 2020).
    • Such benchmarks are helpful for measuring representation, but remember the ultimate goal is Inclusion. We want to be more holistic in our approach to Inclusion.
    • Let’s focus on competency and quality. Given the benefits of a diverse workforce discussed above, Diversity itself is a competency. If someone brings a different background & perspective, they are valuable to the group, just as someone else with specific leadership and interpersonal skills. 
  1. How do we create a more diverse Cardiology?
    • This requires a multi-pronged approach that spans deep pipeline projects through to career ascension.
    • We must deliberately address implicit bias and both systemic racism & sexism.
    • Among other efforts (detailed below), we have to create a welcoming environment, showcase a culture conducive to work-life integration, and ensure equity in compensation, opportunities, and promotion. 
    • According to a survey of internal medicine trainees, the top perceptions of cardiology careers were adverse job conditions, interference with family life, and lack of diversity. Women and those residents who had already chosen noncardiology careers more strongly valued work-life balance and had more negative perceptions of cardiology than men or future cardiologists. Compared with men, women trainees placed greater value on stable hours, family friendliness, female friendliness, and positive role models (Douglas et al., 2018).
    • Understanding these perceptions was a key motivator for the CardioNerds Narratives in Cardiology series! The CardioNerds “Narratives in Cardiology” series will feature cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. The faculty will be interviewed by fellows-in-training (FITs) to discuss both their clinical expertise and their individual career narratives with the goals of showcasing diversity within the profession, inspiring interest in the field, and demonstrating the more positive culture of modern cardiology.

Show notes updated as of 12.30.2020


CardioNerds Narratives in Cardiology
CardioNerds Narratives in Cardiology

The CardioNerds Narratives in Cardiology series features cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. Discussing why these faculty chose careers in cardiology and their passion for their work are essential components to inspiring interest in the field.

Each talk will feature a cardiology faculty from an underrepresented group, within at least one of several domains: gender, race, ethnicity, religion, national origin, international graduate status, disadvantaged backgrounds, etc.

Featured faculty will also represent a variety of practice settings, academic ranks, subspecialties (e.g. clinical cardiology, interventional cardiology, electrophysiology, etc), and career paths (e.g. division chief, journal editor, society leadership, industry consultant, etc).

Faculty will be interviewed by fellows-in-training for a two-part discussion that will focus on:

1) Faculty’s content area of expertise
2) Faculty’s personal and professional narrative

As part of their narrative, faculty  will discuss their unique path to cardiology and their current professional role with particular attention to challenges, successes, and advice for junior trainees. Specific topics will be guided by values relevant to trainees, including issues related to mentorship, work-life integration, and family planning.

To help guide this important initiative, the CardioNerds Narratives Council was founded to provide mentorship and guidance in producing the Narratives series with regards to guests and content. The CardioNerds Narratives Council members include: Dr. Pamela DouglasDr. Nosheen RezaDr. Martha GulatiDr. Quinn Capers, IVDr. Ann Marie NavarDr. Ki ParkDr. Bob HarringtonDr. Sharonne Hayes, and Dr. Michelle Albert.

The Narratives Council includes three FIT advisors who will lead the CardioNerds’ diversity and inclusion efforts, including the current project: Dr. Zarina SharalayaDr. Norrisa Haynes, and Dr. Pablo Sanchez.


Guest Profiles

Pamela S Douglas MD is the Ursula Geller Professor of Research in Cardiovascular Diseases in the Department of Medicine at Duke University. She has led several landmark and pivotal multicenter randomized clinical trials and outcomes research studies funded by government, professional societies, and industry. She is renowned for her scientific and policy work in improving the quality and appropriateness of imaging in clinical care, clinical trials, and registries and through development and dissemination of national standards for imaging quality, utilization, informatics, and analysis. Dr Douglas helped to establish several important specialty areas including heart disease in women, sports cardiology, and cardio-oncology. Dr. Douglas’ wealth of experience includes authorship of over 500 peer reviewed manuscripts and 30 practice guidelines, service as the President of the American College of Cardiology, President of the American Society of Echocardiography, and Chief of Cardiology at both the University of Wisconsin-Madison and Duke University. She has also previously served on the faculties of the University of Pennsylvania and Harvard University. She has served on the External Advisory Council of the National Heart, Lung and Blood Institute and the Scientific Advisory Boards of the National Space Biomedical Institute and the Patient Advocate Foundation.

Dr. Zarina Sharalaya is an interventional cardiology fellow at the Cleveland Clinic. She completed medical school at The Ohio State University and then completed her residency at The University of North Carolina Chapel Hill. She moved back to her home state of Ohio to do general cardiology fellowship at The Cleveland Clinic. Zarina has been very involved with the Ohio ACC and this year has served as co-chair of the FIT Council. She is passionate about the Women in Cardiology initiative has been able to help formulate the first WIC chapter for Ohio ACC. She enjoys traveling, music, and spending time with her husband and new puppy Zuma.

Dr. Norrisa Haynes is a senior cardiology fellow at the University of Pennsylvania (UPenn). She attended Yale University for her undergraduate studies where she received a Bachelor of Science (BS) in Molecular and Cellular Biology. She went on to complete her medical school and internal medicine training at Columbia University College of Physicians and Surgeons. During medical school, she received a Master of Public Health (MPH) from Harvard University. After residency, she worked for Partners in Health (PIH) in Haiti for 2 years at Hôpital Universitaire de Mirebalais (HUM) as a junior attending. During those two years, she also worked as a Harvard Medical School instructor and Brigham hospitalist. After spending 2 years in Haiti, she started cardiology fellowship at UPenn. She is interested in imaging and is currently obtaining a Master of Science in Health Policy (MSHP). Dr. Haynes is a member of the ACC/AHA joint guidelines committee and is a member of UPenn’s Women in Cardiology group (WIC). Dr. Haynes also serves the fellow representative to the board of the Association of Black Cardiologists (ABC).

Dr. Pablo Sanchez is a cardiology fellow at Stanford University Medical Center. He completed medical school The University of Arizona, in Tucson. He completed Internal Medicine training at Brigham & Women’s Hospital, and served as Chief Resident from 2018-2019. He is devoted to furthering diversity and inclusion, and passionate about using compelling and effective methods to aid medical education. His clinical and research interests encompass critical care cardiology, end-stage heart failure, respiratory failure and ARDS. He plans to pursue further training in critical care medicine. Outside of medicine, his time revolves around his wife/family, friends, Latin American music and mambo/salsa dancing.


References

1. Albert MA. #Me-Who anatomy of scholastic, leadership, and social isolation of underrepresented minority women in academic medicine. Circulation. 2018;138(5):451-454. doi:10.1161/CIRCULATIONAHA.118.035057

2. Douglas PS, Rzeszut AK, Noel Bairey Merz C, et al. Career preferences and perceptions of cardiology among us internal medicine trainees factors influencing cardiology career choice. JAMA Cardiol. 2018;3(8):682-691. doi:10.1001/jamacardio.2018.1279

3. Douglas PS, Williams KA, Walsh MN. Diversity Matters. J Am Coll Cardiol. 2017;70(12):1525-1529. doi:10.1016/j.jacc.2017.08.003

4. Damp JB, Cullen MW, Soukoulis V, et al. Program Directors Survey on Diversity in Cardiovascular Training Programs. J Am Coll Cardiol. 2020;76(10):1215-1222. doi:10.1016/j.jacc.2020.07.020

5. Poppas A, Albert MA, Douglas PS, Capers Q. Diversity and Inclusion: Central to ACC’s Mission, Vision, and Values. J Am Coll Cardiol. 2020;76(12):1494-1497. doi:10.1016/j.jacc.2020.08.019

6. Mehta LS, Fisher K, Rzeszut AK, et al. Current Demographic Status of Cardiologists in the United States. JAMA Cardiol. 2019;4(10):1029-1033. doi:10.1001/jamacardio.2019.3247

7. Balasubramanian S, Saberi S, Yu S, Duvernoy CS, Day SM, Agarwal PP. Women representation among cardiology journal editorial boards. Circulation. 2020. doi:10.1161/CIRCULATIONAHA.119.042909

95. Introducing Narratives in Cardiology Series: Dr. Pamela Douglas on Diversity & Inclusion