R frank jones assessing the african american urology experience during training-aua 2013 san diego

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  • 1. R. Frank Jones Urologic SocietyAUA Meeting May 5, 2013San Diego, CA
  • 2. RFJUS Members
  • 3. Richard Francis Jones, MDThe First African-American Diplomate of theAmerican Board of Urology - 1936
  • 4. Outline• History Lane– Milestones – African Americans in Medicine– Howard Surgical Legacy• A.A. Experience during urologic training– Diversity in Medicine – Outside of Urology– Diversity in the field of Urology• Urologic “Pipeline” steps to insure AfricanAmericans at the forefront of urologicpatient care
  • 5. Milestones – Diversifying Medicine• 1837 – James Smith- 1st African American toreceive the MD Degree– University of Glasgow in Scotland• 1847 – 40 medical schools in the U.S.A.– David Jones Peck – 1st African American tograduate from an American medical school– Rush Medical School in Chicago• 1864 – The 1st African American womanphysician graduated from New England FemaleMedical College (now Boston University Schoolof Medicine)
  • 6. HUCM - Surgical Legacy• Howard University Surgery ResidencyProgram• Early 1900s – achievement of boardcertification, became one of theprogram’s standards of excellence• Five of the first African Americans toreceive board certification in asurgical specialty were HowardFaculty Members
  • 7. African American SurgeonsPioneers - Board Certification• R Frank Jones MD Urology 1936• J Richard Laurey MD– Thoracic Surgery 1949• Robert Gladden MD– Orthopedic Surgery 1949• Clarence S. Greene Sr.– Neurological Surgery 1953• Samuel Rosser MD– Pediatric Surgery, 1975
  • 8. Assessing the AfricanAmerican UrologyExperience During TrainingTracy M. Downs MD FACSAssociate Professor
  • 9. Introduction• RFJUS – is the society of African AmericanUrologists in North America• Members have diverse backgrounds ofurologic training• Other surgical specialties havedocumented the experience ofRace, Ethnicity and Gender– Orthopaedic Surgery– Vascular Surgery– General Surgery• No formal analysis for the field of Urology
  • 10. Diversity – Urologic Surgery• Primary Objective– Evaluate the extent of diversity and perceivedbarriers to multicultural training in Americanurology programs• Methods– 25 question nonvalidated diversityquestionnaire was distributed to 112 AmericanUrology residency program directors• Results– 62 (55%) program directors respondedVemulakonda, Sorensen and Joyner BD et al. J Urol 2008;180:668-672.
  • 11. Diversity – Urologic Surgery• Results– 62 (55%) program directors responded– Respondents: 92% Male, 90% > 40 y.o.– As Faculty members• 40% No female colleagues• 49% No colleagues of color• 75% No formal process to recruit faculty ofcolor– Current resident training• 36% 1 or fewer female residents• 66% at least 1 black resident• 42% at least 1 Hispanic residentVemulakonda, Sorensen and Joyner BD et al. J Urol 2008;180:668-672.
  • 12. Diversity – Urologic Surgery• ResultsVemulakonda, Sorensen and Joyner BD et al. J Urol 2008;180:668-672.
  • 13. Diversity – Orthopaedic Surgery• Primary Objective– Diversity in the field of orthopaedics vs othersurgical and nonsurgical fields• Variables - Race, Ethnicity and Gender• Residents and Faculty Data– 2007 JAMA Education Supplements– 2007 AAMC Faculty Roster• Residency applicants Data– 2007 Electronic Residency Application Service(ERAS)Day CS et al. The Journal of Bone & Joint Surgery 2010;92(13):2328-2335
  • 14. Diversity – Orthopaedic Surgery• Primary Objective– Diversity in the field of orthopaedics vs othersurgical and nonsurgical fields• Variables - Race, Ethnicity and Gender• Residents and Faculty Data– 2007 JAMA Education Supplements– 2007 AAMC Faculty Roster• Residency applicants Data– 2007 Electronic Residency Application Service(ERAS)Day CS et al. The Journal of Bone & Joint Surgery 2010;92(13):2328-2335
  • 15. Orthopaedic SurgeryResidency Applicant Pool vs Resident Workforce
  • 16. Surgical and Medical SpecialtiesRace/Ethnicity - Resident Workforce
  • 17. Surgical and Medical SpecialtiesGender - Resident Workforce
  • 18. Surgical and Medical SpecialtiesRace/Ethnicity - Faculty Workforce
  • 19. Surgical and Medical SpecialtiesGender - Faculty Workforce
  • 20. Diversity – Radiation OncologyPhysican Workforce
  • 21. Diversity – Radiation OncologyPhysician Workforce
  • 22. Radiation Oncology – Residents in TrainingRace/Ethnicity and Gender 2003 - 2011
  • 23. Radiation Oncology – Residents in TrainingRace/Ethnicity and Gender 2003 - 2011GUPEDSRadOncStart MedicalSchoolA R F
  • 24. Radiation Oncology – Residents in TrainingRace/Ethnicity and Gender 2003 - 2011GURadOncPEDSStart MedicalSchool
  • 25. Urology Residency ApplicantsERAS 2011• Total applicants 431By Gender• Male 325• Female 106By Race• White 242• Black 31ERAS 2012• Total applicants 507By Gender• Male 385• Female 122By Race• White 291• Black 39`Number of Black Applicants by Year 2008 – 2012:(Range : 31-39)
  • 26. Assessing the AfricanAmerican UrologyExperience During TrainingTracy M. Downs MD FACSAssociate Professor
  • 27. African American ExperienceUrologic Residency• Electronic survey mailed to RFJUSmembers– November 2012– Emailed to 61 RFJUS Members– Response rate 36%– 10 questions (Survey)• Respondents (N = 22)– 77% Male 23% Female
  • 28. Medical Schools Attended – RFJUS• U. Michigan (2)• U. Pittsburgh• Morehouse• Temple• UCSD (2)• Yale• Stanford• Howard• U Minnesota• U. Kanasas• U. Miami• Cornell• Albany MedicalCollege• Meharry (2)• Northwestern• Johns Hopkins (3)• Columbia
  • 29. Urology Training Programs– RFJUS• U. Michigan (4)• Emory University• Henry Ford• UT Southwestern• VCU (Virginia)• SUNY Buffalo (2)• AlbertEinstein/Montefiore• Columbia (2)• Harvard (BWH)• U. Kanasas• Medical College ofWisconsin• NYU• Johns Hopkins• UCSF• United States Navy• UT Houston• Eastern Virginia
  • 30. African American ExperienceUrologic ResidencyRESPONDENTS: 22 of 22RESPONDENTS: 22 of 22Need to use the classic Analyze tool? Switch backAnalyze ResultsCollect ResponsesDesign SurveyExport AllExport All0% 04.55% 122.73% 531.82% 740.91% 9PAGE 1Q1Q1How many years have you been in practicefollowing residency or fellowship?Answered: 22 Skipped: 02-5 years5-10 years10-20 years> 20 years0-2 years0-2 years2-5 years2-5 years5-10 years5-10 years10-20 years10-20 years> 20 years> 20 yearsTotalTotal 2222Q2Q2What is your gender?ExportChart TypeChart Type Display OptionsDisplay OptionsAnswer Choices ResponsesExportChart TypeChart Type Display OptionsDisplay Options22.73% 577.27% 174.55% 181.82% 189.09% 20% 09.09% 2FemaleFemaleMaleMaleTotalTotal 2222Q3Q3How would you describe your ethnicbackground?Answered: 22 Skipped: 00% 20% 40% 60% 80% 100%AfricanAfrican-AmericanAfrican-CaribbeanAfrican-EuropeanOther (pleasespecify)AfricanAfricanAfrican-AmericanAfrican-AmericanAfrican-CaribbeanAfrican-CaribbeanAfrican-EuropeanAfrican-EuropeanOther (please specify) ExpandTotal Respondents:Total Respondents: 2222Answer Choices ResponsesExportChart TypeChart Type Display OptionsDisplay OptionsAnswer Choices Responses
  • 31. African American ExperienceUrologic Residency• Were you the first African-American tocomplete your residency?45.5% Yes54.5% No
  • 32. African American ExperienceUrologic Residency
  • 33. African American ExperienceUrologic Residency
  • 34. African American ExperienceUrologic Residency
  • 35. How to improve the “UrologicPipeline” for AfricanAmericans
  • 36. Urologic Pipeline forAfrican Americans• Why?• Who?• Where?• How?
  • 37. Urologic Pipeline forAfrican Americans• Why?–US Demographics are changing–Reduce Disparities in HealthCare
  • 38. US Census Bureau ProjectionsChanges in the US Population Race/Ethnicity2008 and 2050
  • 39. Race/Ethnic Composition of MedicalSchool Graduates 2002 - 2012
  • 40. Urologic Pipeline forAfrican Americans• Who?–Medical School Applicants–Urologic Personality
  • 41. Accepted U.S. Medical Student % byGender and Race
  • 42. U.S. Medical Student Graduates by Gender
  • 43. What Traits Make up a GoodUrologist?
  • 44. Canadian Urologic Association Journal 2011;5(3):182-1855 Dimensions of Personality were analyzed using the Validated personality inventory – NEO PI-R
  • 45. Urologic “Pipeline” Considerations• Gender Gap in undergraduate degreestudents is Wider for AfricanAmericans than Caucasian Americans• Post baccaculaureate degrees “ Pool”of eligible medical school applicants– Whites Women > Men (12.8%)– Blacks Women > Men (31.7%)
  • 46. Urologic “Pipeline” Considerations• Estimated by 2020– 60% of Latino medical school applicants(Females)– 70% of African American medical schoolapplicants (Females)• Recruitment strategies into FutureUrology Programs for AfricanAmericans will need to account forthis Gender gap
  • 47. Urologic Pipeline forAfrican Americans• Where?–Undergraduate Strategy–Medical School Strategy
  • 48. Undergraduate InstitutionsSupplying > 200 Applicants toUS Medical Schools, 2011
  • 49. Undergraduate InstitutionsSupplying > 20 Black Applicants toUS Medical Schools, 2011
  • 50. Undergraduate InstitutionsSupplying > 50 Asian Applicants toUS Medical Schools, 2011
  • 51. Undergraduate InstitutionsSupplying > 140 White Applicants toUS Medical Schools, 2011
  • 52. Undergraduate Institutions> 8 Medical School Graduatesin 2011 (Black)• Xavier Univ. 60• Howard Univ. 32• U. Florida 26• Harvard 22• Duke 20• Stanford 20• Spelman 18• Univ Michigan 18• Univ. North Carolina 18• Yale 18> 20 Medical SchoolApplicants in 2011 (Black)• Howard 87• Xavier 68• U. Florida 64• Spelman 57• U. Miami 56• U. Maryland 48• Hamptom Univ 45• U South Florida 42• Florida State Univ. 41• Cornell Univ. 40
  • 53. Journal of Urology 2011;185(2):647-
  • 54. Urologic Pipeline forAfrican Americans• How?–Identify model programs toemmulate or createpartnerships
  • 55. Urologic Pipeline forAfrican Americans
  • 56. Current Programs to ImproveDiversity in GME• UCSF Graduate Medical EducationDiversity Program– Residency Diversity Committee• MGH Multicultural Affairs Office– Started in 1992– Focus on residency recruitment andpipeline development (i.e. Summerresearch training program)• Vanderbilt University SOM– Associate Dean for Diversity
  • 57. Current Programs to ImproveDiversity in Physician Workforce• American Association of OrthopaedicsSurgeons• American College of Surgeons• NIH Diversity in Biomedical Research(http://acd.od.nih.gov/dbr.htm)• Robert Wood Johnson• American Gastroenterological Association– NIH R25 Grant to support minorityundergraduates and medical students
  • 58. Current Programs to ImproveDiversity in Physician Workforce• American Association of OrthopaedicsSurgeons• American College of Surgeons• NIH Diversity in Biomedical Research(http://acd.od.nih.gov/dbr.htm)• Robert Wood Johnson• American Gastroenterological Association– NIH R25 Grant to support minorityundergraduates and medical students
  • 59. Diversity
  • 60. Conclusion• R. Frank Jones, MD and HowardDepartment of Surgery have been pivotalin the training of African AmericanUrologic Surgeons• 46% of our members were the firstAfrican American in their residencytraining program• 55% trained with other African-Americanurology residents during their training• 50% did experience racial challenges as aresident or fellow.
  • 61. R. Frank Jones Urologic Society• Intentional undergraduate and medicalschool strategies will need to be employedto continue to attract African Americansinto the field of urology• A Gender gap exists between no. male vsfemale African American medical students– Needs to be considered in therecruitment of African AmericanUrologists
  • 62. RFJUS Members
  • 63. THE ENDTHANK YOU