Toward a Better Yale School of Medicine: Demands for the Administration

Dear Dean Alpern and Members of the Yale School of Medicine (YSM) Administration,

Inspired by the brave examples of NextYale, other students at Yale, and campuses across the country, we, students of color and partners in solidarity, write to demand sustainable reforms to foster a YSM in which all identities are valued. We respect President Salovey’s response to the work of Yale undergraduates and his commitment to better serving all students at Yale University.

Our concerns arise from manifestations of oppression in our intellectual, social, and physical environment. Our formal curriculum treats the medical exploitation of communities of color as historical rather than ongoing, reinforces harmful stereotypes in cases and with standardized patients, underrepresents black and brown bodies in our lectures and medical texts, and remains silent on systemic issues that create health disparities and the way medicine is complicit in propagating them. Our hidden curriculum forces us to bear microaggressions perpetrated by peers and instructors, experience underrepresentation of people of color and women in the faculty and student body, and accept deficient support for students from marginalized backgrounds. Our very physical environment, with buildings baptized after and populated with portraits of white males, is a constant reminder of our historic exclusion as people of color and women.

The mission of YSM aspires “to produce physicians who will be among the leaders in their chosen field,” “to alleviate suffering caused by illness and disease,” and “ to provide outstanding care and service for patients in a compassionate and respectful manner.” Much of the illness and disease that afflicts our community, both domestically and globally, directly links to historic injustice, racism, and gender- and sexuality-based oppression. Many of our sister institutions have already acknowledged this reality and are making strides to counteract its harms. In order to fulfill our mission, YSM must create institutional reform such that students are prepared to address the diverse challenges confronting both the field of medicine and our global community.

We uphold the right of all members of the YSM community to thrive in their living and learning environment. To create this atmosphere of inclusion, we assert the six demands linked below.

We request a response from Dean Alpern by Friday, November 20th, in the form of a school-wide email stating the intention of the administration to fulfill these demands. With this response, we expect the formation of a joint ad hoc faculty-student committee to begin implementation. We expect this committee will provide transparent, quarterly updates to the YSM community.

We hope that you are encouraged by President Salovey’s stated commitments as a starting point to begin this work. Our demands are in direct alignment with his goals, and are specifically intended to initiate actionable reform to end oppression and promote inclusion at YSM. We look forward to building a more supportive and unified YSM community together.

Sincerely,

[the undersigned: https://goo.gl/ePE5KF]

 

Demands for Inclusion and Diversity at Yale School of Medicine

1. We demand increased support for the well-being of minority and underrepresented students.
   1. Increase financial resources to initiatives that accomplish this, including support and funding for Office of Multicultural Affairs (OMCA), broadened Yale Health insurance, emergency funds, and an expanded Peer Advocate program.
      1. Increase funding and staffing for the OMCA and extension of this office to support underrepresented students from the Yale School of Public Health and Yale School of Nursing.
      2. Expand the Basic Yale Health Plan to include dental and optometry services for all students.
      3. Dedicate additional emergency and miscellaneous funds to support the needs and professional development of first-generation, low-income, undocumented, and international students.
      4. Expand the Peer Advocate program to four students per year. There should be two dedicated Minority Peer Advocates that themselves hold underrepresented identities in medicine. All Peer Advocates will be trained to help students access resources at Yale and beyond and be able to relay issues and complaints to the administration.
   2. Hire faculty, mental health professionals, and financial aid staff dedicated to the well-being of minority and underrepresented students.
      1. Hire mental health care professionals located on the medical and nursing campuses who are themselves people of color and who are trained specifically to work with underrepresented individuals in health care professions.
      2. Provide financial aid consultants who are trained to deal specifically with the financial aid application processes of international and undocumented students.
2. We demand creation and implementation of curricular reform that is anti-oppressive.
   1. Institute mandatory US and Global Health Justice longitudinal courses for all health professional schools into the fourth year.
      1. This course should include a curricular development committee of students and faculty of marginalized identities, with consultation from Ethnicity, Race, and Migration faculty, African American Studies faculty, and Women and Gender Studies faculty.
   2. Reform Public Health/Epidemiology and Professional and Ethical Responsibility Threads to include more diverse faculty leaders and highlight issues of structural inequality.
      1. Diversify leaders of Public Health/Epidemiology and Professional and Ethical Responsibility Threads.
      2. Make structural race issues more integral to discussions, especially for highly relevant topics (incarceration, health law, and civil rights in health care).
      3. Have consultation about these topics and sessions with students and faculty with expertise in this area.
   3. Increase the number of people of color presented as standardized patients.
      1. These patients should not play into existing medical and social stereotypes of people of color.
      2. Restructure all workshop cases and standardized patient cases to include social issues (homelessness, previous incarceration, multiple sexual identities and practices, domestic violence).
   4. Have a member of the (expanded, see point 1.a.i.) OMCA office always be a part of curriculum development and reform.
3. We demand the creation and maintenance of a genuinely inclusive learning environment at YSM.
   1. Create a school-wide and hospital-wide bias reporting and accountability system.
      1. Create an online bias reporting system that is regularly monitored and publicly accessible for community members to report on identity-based discrimination.
         1. Incidents reported on this platform will be monitored in real-time and offending parties will be held accountable by a transparent and designated body.
         2. There will be a conflict resolution and remediation protocol for parties identified through this system.
         3. Incidents reported on this platform will be analyzed annually and issued as an annual report, and in aggregate used to inform retraining and other curricula for students, faculty, and Yale affiliates.
   2. Reform course and programming surveys to include the evaluation of identity-based discrimination in the classroom and on the wards.
      1. Course Evaluation Reform
         1. Include questions about the racial and gender climate of the classrooms and conferences in course and semester evaluations.
         2. Publish the anonymous aggregate results of these questions so that they are publicly accessible.
      2. Medical Student Exit Surveys
         1. Publish anonymous aggregate results of these surveys, especially questions on learning environment about harassment and discrimination.
      3. Clerkship Review Surveys
         1. Increase transparency of student feedback about experiencing harassment or discrimination, and the process by which this feedback results in action or retraining for faculty and clinicians.
         2. A student should be included in these discussions.
   3. Implement mandatory anti-oppression training for Yale faculty, staff, those with teaching responsibilities, affiliates, and students.
   4. Make the physical space of Yale School of Medicine more welcoming to and reflective of the contributions of women and people of color.
      1. Name Café Med after a distinguished YSM alumna of color.
      2. Commission paintings of three or more YSM alumni who are underrepresented minorities to be hung in Sterling Hall of Medicine and the medical library.
4. We demand increased diversity among faculty.
   1. Diversify the clinical and research faculty and staff.
      1. Survey the current state of affairs of diversity at YSM and Yale-New Haven Hospital among residents, faculty, and staff, and publish these results.
      2. Create a joint initiative between YSM and Yale-New Haven Hospital to increase recruitment and retention of residents and faculty who identify as LGBTQ+, people of color, and women.
         1. This initiative will have concrete and measurable goals of recruitment and retention.
      3. Create a visiting rotation clerkship program for underrepresented students supported by funding from both YSM and Yale-New Haven Hospital.
      4. All departments at YSM will produce quarterly reports that address diversity and inclusion.
   2. Reward faculty engaged in local health disparities research, community development, and minority student mentorship through tenure track reform.
5. We demand increased funding and programming for recruitment of students of color.
   1. Provide funding for underrepresented students and low-income students for travel and lodging expenses related to Second Look Weekend.
   2. Plan a day-long event before or after Second Look Weekend specifically for underrepresented students.
   3. Increase funding of underrepresented students in the form of scholarships to encourage enrollment in YSM over other schools. We want to be on par with our competitor institutions in this effort.
6. We demand expanded financial support and recognition for students interested in community based participatory research, health disparities research, and anti-oppression scholarship.
   1. The Office of Student Research (OSR) will expose students to the theory and local examples of community-based participatory research happening in New Haven right now.
   2. The OSR should compile a list of research faculty conducting domestic health disparities and community based participatory research for students interested.
   3. The OSR will offer and advertise summer and fifth year funding specifically for research focused on domestic health disparities and the social determinants of health (similar to the Downs Fellowship awarded for global health research).
   4. Create and fund an award for senior thesis projects on issues of domestic health equity.
   5. Dedicate endowed fellowships for students looking to advance health equity during their 5th years (policy, advocacy).