The Role of Offices of Diversity, Equity & Inclusion to the LHS+ Community

Abstract

Academic health science centers (AHSCs) in the United States (U.S.) are positioned as leaders in health professions education, clinical care and biomedical health science research. AHSCs often comprise a medical school, other health professions programs (e.g. pharmacy, nursing, physician assistant, etc.), teaching hospital(s), and faculty heavily involved in biomedical, clinical, and medical education research (Anderson G, Steinberg E, Heyssel R, Health Affairs 1994;13:146–58) Whether private or public, these institutions represent societal hubs that provide enormous benefits for the health and well-being of the communities that they serve. As LHS+ communities in the U.S. continue to expand in size and geographical distribution, so too does the social obligation to provide meaningful, culturally responsive, and equitable care for and engagement with this population. At many AHSCs, this engagement is often facilitated and led by offices of diversity, equity and inclusion (ODEIs). This chapter highlights several strategies and opportunities for ODEIs to enact positive change for LHS+ communities within and around AHSCs.

Introduction

Academic health science centers (AHSCs) in the United States (U.S.) are positioned as leaders in health professions education, clinical care and biomedical health science research. AHSCs often comprise a medical school, other health professions programs (e.g. pharmacy, nursing, physician assistant, etc.), teaching hospital(s), and faculty heavily involved in biomedical, clinical, and medical education research [1]. Today, there are more than 150 allopathic medical schools and 36 osteopathic medical schools accredited in the U.S. as part of academic medicine [2, 3]. Many, but not all, of these institutions house an ODEI or equivalent (with alternative names including offices of diversity affairs, multicultural affairs, or minority affairs, among others). Historically, the Perelman School of Medicine at the University of Pennsylvania established the first office of minority affairs in 1968 to recruit and retain minority students [4]. The function of minority affairs offices began with—and, in large part, continues to be—the recruitment and retention of students underrepresented in medicine (UIM), including LHS+ students. As described in earlier chapters, the representation of LHS+ medical students, about 11.3% in 2019, among all those enrolled in allopathic medical schools at the time of this chapter’s writing [5], is sorely inadequate relative to the overall U.S. LHS+ population of ~18% [6]. Given this gap, many AHSCs in recent years have expanded the role of the ODEI beyond health professions trainee recruitment and retention to include more robust functions when working with the LHS+ community. These functions include, but are not limited to: sustaining comprehensive community engagement, assisting in cultural brokerage between the AHSC and the local LHS+ community, and creating strong partnerships in education and research with the LHS+ community.

Social Responsibility to Serve the LHS+ Community

AHSCs and ODEIs have a social responsibility to serve the LHS+ population that rises to the level of a social contract—that is, “social accountability [that] involves a commitment to respond as best as possible to the priority health needs of citizens and society.” [7] This social responsibility should be reflected in the values and mission of each AHSC and ODEI and through the principles of health equity to address the unique language, cultures, socio-political history, and health disparities of the communities served by a given institution. To be clear, this expectation is not mutually exclusive to other marginalized populations, but merely the focus of this book.

LHS+ individuals are the largest racial-ethnic minority group in the U.S. and make up nearly half of all non-White people [6]. The distribution of LHS+ individuals is geographically widespread with particularly high densities in the West, Southwest, Northeast, and some parts of the South—most notably, Texas and Florida (see Fig. 14.1).

Fig. 14.1

Hispanic or Latino Population as a Percent of Total Population by County

The projected increase of the LHS+ population in 2050 to nearly 100 million, representing 26% of the U.S. population (see Fig. 14.2), underscores the acute need for and special focus on AHSCs to ensure that the LHS+ population receives appropriate care and engagement. ODEIs at AHSCs are critical players in fulfilling this obligation, as they often serve as conduits between AHSCs and LHS+ communities, providing the latter with tailored services geared at improving health outcomes.

Fig. 14.2

Projected Hispanic Population 2020 to 2060

Since ODEIs reside within AHSCs, the core values of the institution should guide and shape the mission and vision for these offices. For example, at the University of Arizona College of Medicine—Phoenix, the college articulates “diversity” specifically as one of its core values [8]. This fundamental value is carried through to the mission of the ODEI:

Through Inclusive Excellence, the University of Arizona College of Medicine—Phoenix is committed to and champions diversity and inclusion as core values central to its mission. Inclusive Excellence is the intentional driver of diversity and inclusion, which harnesses the differences, talents and unique qualities of all individuals at the College of Medicine—Phoenix. Inclusive Excellence engages the individual and system in practices that advance diversity in all that we do. Inclusive Excellence is inextricably linked to our pursuit of excellence in our research, clinical and educational missions to meet the needs of the students, faculty, residents, fellows, staff and the communities we serve.

Moreover, through Inclusive Excellence and our tripartite missions, the College of Medicine—Phoenix is committed to mitigating health disparities, especially for marginalized groups and vulnerable populations, in order to improve community health outcomes, particularly in rural, inner-city and medically underserved areas [9].

Some AHSCs may not explicitly state enumerated values but rely on guiding principles in their mission statements that connect to notions of excellence in the educational, clinical, research, and community engagement domains. The commitment to serving society and the community via some, or all, of the aforementioned domains creates an expressed social obligation for an AHSCs to care for the health and well-being of the population inclusive of the LHS+ community. Principles of health equity further focus this institutional responsibility to address the unique social determinants of health (SDOH) and associated health inequities faced by the LHS+ community to help the latter achieve its highest health potential.

Given the above, ODEIs have expanded their focus to help address the SDOH that lead to poorer health outcomes and contribute to health disparities for marginalized, disenfranchised and/or vulnerable communities. The LHS+ community—not being immune to the impacts of detrimental SDOH—unfortunately suffers from many health disparities. When compared to non-Hispanic Whites, for example, Hispanics are 23% more likely to be obese, die at a 50% higher rate from diabetes, and are 24% more likely to have uncontrolled high blood pressure [10]. Health disparities that particularly affect LHS+ patients can be attributed to a multitude of factors. As discussed in previous chapters, unique detriments to LHS+ health include insufficient attempts or resources to provide care in Spanish, a scarce LHS+ physician workforce, lack of health insurance coverage (especially for undocumented immigrants or mixed-status families), lack of culturally appropriate or sensitive care, and structural and societal inequities, among other factors [11]. While the faculty, staff, students, and other individuals affiliated with ODEIs strive to ameliorate the factors contributing to diminished health of medically underserved communities in their vicinity, ODEIs cannot tackle this challenge alone. Rather, to best serve a community in need, ODEIs must leverage other entities within and beyond their respective AHSCs—including members of the target community itself—to enact a multicomponent engagement strategy. This is discussed in greater detail below.

The Modern Role of Offices of Diversity, Equity and Inclusion

In the years preceding this chapter’s writing, it has become increasingly common for ODEIs to serve many functions and roles both within and outside their respective institutions. ODEIs not only focus on the four standard mission areas of AHSCs—clinical care, medical education, research and community engagement—as pertaining to diversity, inclusion, and health equity efforts, but ODEIs also conduct work that overlaps with other domains of medical education and AHSC administration (see Fig. 14.3). To represent and amplify the voices of LHS+ students, residents, faculty, staff, patients, and communities, ODEIs must collaborate and synergize with other institutional offices. While the specific structure, charge, and duties of an ODEI may vary from one AHSC to another, the sections that follow will discuss general practices employed by and opportunities available to ODEI staff to promote the success of UIM groups.

Fig. 14.3

Parts & Partners of Offices of Diversity, Equity and Inclusion

Student Affairs

ODEI staff work closely and collaboratively with the staff of Student Affairs offices. While this work has been described earlier in this book, in general, ODEI officers and directors often serve as:

• Partners in addressing the needs of the LHS+ students, helping the latter navigate student life and personal concerns and issues, aspects of the institutional and local community, career choices in medicine, selection of elective rotations, and residency choice;

• Student advocates on committees for student evaluation and progress (CSEP) and commonly work with the student affairs dean on best strategies to support students;

  • ODEI officers often contribute their unique perspectives to the discussions about the student with other CSEP members when discussing external factors (cultural, traditions, beliefs) that have impacted the student’s performance that are unfamiliar to most non-minority CSEP faculty.

• Writers of students’ letters of recommendation for scholarship opportunities, grants, committee/student organization membership, and residency;

• Sponsors, advisors, and/or institutional representatives for UIM medical student organizations, including the Latino Medical Student Association (LMSA);

• Sponsors of student-run free clinics; and

• Liaisons between students, faculty, and communities external to the institution.

  • ODEIs often serve as the ‘connectors’ and trusted faculty and community liaisons to local racial-ethnic communities.

Faculty and Resident Affairs

ODEI staff work closely and collaboratively with the staff of Faculty Affairs offices, as well as staff affiliated with Graduate Medical Education (GME). While the work and impact of Faculty Affairs and GME offices have been discussed in previous chapters, ODEI officers/directors often serve as:

• Partners in addressing the needs of the LHS+ residents, fellows, and faculty members;

  • Such needs include, but are not limited to: helping these individuals navigate life in their current role(s), personal concerns or issues,, the healthcare system, their institution, their local community (especially the LHS+ community), career advice, and efforts to transform their activities into academic credit for appointment, promotion, and potential funding.

• Writers of letters of recommendation for grant opportunities, promotion, and internal and/or external leadership positions;

• Sponsors for advisory committees for UIM faculty and residents;

• Liaisons between faculty and to communities external to the institution;

  • ODEIs often serve as the ‘connectors’ and trusted faculty and community liaisons to local racial-ethnic communities.

• Connectors to mentorship opportunities and sponsorship opportunities;

• Connectors to precepting opportunities, such as student-run free clinics;

• Sources of funding for professional development opportunities, such as the AAMC Minority Faculty Leadership Seminar, and AAMC Women in Medicine Early and Mid-Career Leadership Seminars;

• Connectors to opportunities for teaching on the topics of health disparities, SDOH, and/or health equity;

• Members of and equity advisors for faculty search committees;

• Sponsors of second-look events for the recruitment of residents, especially those from UIM groups; and

• Content experts to assist Assistant, Associate, and Vice Deans of GME in meeting ACGME Core Requirements on diversity and inclusion, as well as ACGME’s CLER Pathways to Excellence — specifically Pathways 5 and 6 regarding health disparities.

Curriculum

ODEIs can play important roles by engaging in, facilitating, and promoting education with the LHS+ community. Education can be in the form of informative presentations and topics specifically targeting the LHS+ community. Colloquially referred to as “ mini-medical school,” sessions that seek to raise awareness of type 2 diabetes, stress the importance of cancer screenings, and educate patients on heart disease—among other examples—have been offered in Spanish at meeting spaces frequented by the local LHS+ community. Moreover, ODEIs can play a role in assisting patient care facilities within the health system by (1) ensuring that patient education handouts and other materials are accessible in Spanish; (2) identifying Spanish-speaking experts at various levels and in various areas of medical practice at the institution; and (3) encouraging educational presentations and workshops to be given in Spanish. Not uncommonly, ODEIs deploy dedicated promotors—LHS+ community health workers—to develop and disseminate curricular content; this strategy may prove more effective in building trust and communicating with local LHS+ communities [12].

Ultimately, the success of educational initiatives and strategies developed by AHSCs for local LHS+ communities depends on collaboration with and guidance from trusted leaders within those communities [13]. Such leaders may be ministers or faith leaders, K-12 grade school teachers or administrators, civic leaders, or other prominent figures. For a given community, such individuals provide key insights into that community’s historical and ongoing traumas or challenges; select examples include displacement of LHS+ community members through urban development projects, medical malfeasance or neglect of LHS+ community members, and troubled or harmful outreach efforts by an AHSC, among others. ODEIs are uniquely positioned within AHSCs to identify, connect with, and work alongside community leaders to understand any barriers to collaboration that may exist between the AHSC and the LHS+ community it serves. This work, often led by ODEI staff but requiring full commitment from the AHSC at large, is critical in cases where the AHSC seeks to establish a new relationship with its surrounding communities or rebuild previously existing but currently strained relationships.

Opportunities also exist for ODEIs to be involved in curriculum development. Examples of educational initiatives to which ODEIs contribute include, but are not limited to, the following:

• Curricular pathways/tracks: These programs usually involve structured course work that focus on LHS+ communities and their health, health inequities, health disparities, and SDOH. The purpose of these pathway/track programs is to better prepare medical students to provide comprehensive, culturally, and linguistically competent patient care and understand the importance of population health and population health management. Hispanic Centers of Excellence are a good resource, as well as the University of Washington’s Latinx Health Pathway [14];

• Courses on LHS+ health disparities: These are common electives found in many medical schools that provide a substantial amount of health care to LHS+ communities. This is an opportunity to promote community-based participatory curriculum development that engages members of the LHS+ community to participate as partners in developing curricula that address LHS+ health and health disparities and serve as course instructors and panelists [15];

• Student-run free clinics: Some AHSCs leverage the expertise and community connections of ODEIs to establish and/or maintain clinics that provide free or heavily subsidized healthcare to indigent patients, often including undocumented immigrants or refugees of LHS+ descent; and

• Medical Spanish courses: Aimed at improving communication between healthcare providers and Spanish-speaking patients with non-English language preference, medical Spanish courses may achieve greater impact and longevity when implemented with input and assistance from ODEIs.

Admissions

ODEI staff work closely and collaboratively with the staff of undergraduate medical education admissions offices. In this capacity, ODEI officers/directors often serve as:

• Members (both voting and non-voting) of admissions committees;

• Application screeners and interviewers;

• Coordinators of outreach and recruitment efforts;

  • Commonly, ODEIs sponsor health career fairs that specifically target LHS+ and other UIM students in middle school, high school, and college.

• Designers, developers, and executioners of pipeline programming that specifically target LHS+ students in middle school, high school, and/or college interested in health careers;

• Coordinators of second look programs;

• Institutional ambassadors for the purpose of providing follow-up to prospective and admitted students; and

  • ODEI staff commonly reach out to LHS+ students on the admission’s waitlist keeping the connection present and instilling patience and hope. That connection is sustained with both the students that have been accepted as well as those that have not been accepted.

• Presenters and contributors to onboarding at orientation.

  • ODEI are often asked to provide cultural competency training to all students, and frequently provide sessions for LHS+ students on how best to navigate the internal and external community.

Community Engagement

Community engagement describes the collaboration of institutions and their broader community for the mutual exchange of knowledge and resources rooted in partnership and reciprocity [16]. In their 2017 article, Ahmed et al. offer a paradigm for community engagement that has applicability for ODEIs. Their model separates community engagement into five distinct domains: (1) Community Outreach and Community Service; (2) Education; (3) Clinical Care; (4) Research; and (5) Policy and Advocacy. Each ODEI partakes in community engagement across these domains and others to varying degrees depending on its office structure, personnel capacity, financial resources, and expertise.

Community Outreach and Community Service

Community outreach and community service activities are often encouraged for medical students, faculty, residents and staff. The Liaison Committee on Medical Education (LCME), which sets accreditation standards for allopathic medical schools in the U.S. and Canada, requires “the faculty of a medical school [to] ensure that the medical education program provides sufficient opportunities for, encourages and supports medical student participation in service-learning and community service activities.” [17] Community outreach refers to volunteer work that is related to an individual’s professional appointment, such as serving on an organizational board. In contrast, community service refers to service that is unrelated to a professional appointment, such as volunteering to tutor students in an after-school program or helping to fundraise for a local charity. ODEIs are positioned to facilitate community service and outreach benefiting the LHS+ community through a number of avenues:

• 1. Keeping a running inventory of community service and community outreach opportunities that positively impact the LHS+ community and making this available via newsletters, the college website, and social media outlets;

• 2. Connecting and recommending faculty, staff, and/or students to volunteer and leadership roles within organizations engaged in community outreach, acknowledging that some such organizations may make leadership opportunities available by invitation only; and

• 3. Bringing LHS+ community members into AHSCs as part of the mutual and bi-directional spirit of community engagement. In doing so, an ODEI can offer numerous benefits to LHS+ individuals, organizations, and communities at large by referring local candidates for employment at the AHSC, involving business executives in new and ongoing hospital advisory committees, and even enabling community members to contribute to the future physician workforce through a voting role on the medical school’s admissions committee.

Assessments and Improvements of Institutional Culture and Climate

ODEIs are often engaged in assessments of the culture and climate of their respective institutions, or of departments and programs within the institution. Involvement of ODEIs in such efforts is critical for achieving a thorough evaluation of the learning or workforce environment and its inclusivity. As part of these efforts, ODEIs commonly collaborate with Human Resources departments to perform the assessment and monitor results and outcomes. Moreover, ODEIs use data derived from such assessments to drive institutional change to achieve inclusive environments. In partnering with their institutions’ organizational development and human resource departments, ODEIs develop and/or deliver trainings and other educational programs designed to mitigate specific issues that threaten the learning and workplace environments. Examples of such programs include workshops on addressing microaggressions, implicit bias, mistreatment, abrasive behaviors (such bullying), sexual/gender harassment, and racial/ethnic discrimination.

Policy & Advocacy

Many AHSCs have offices of government affairs that directly engage with legislators and other policymakers and may discourage or prohibit other institutional offices from participating in certain policy and advocacy activities. However, ODEIs still have opportunities to influence institutional, local, and national policymaking. As discussed above, ODEIs play a vital role in ensuring that their respective institutions pursue policies and practices that advance racial/ethnic justice for all those served by the institution. In line with this charge, ODEI leadership may collaborate with the institution’s office of governmental affairs and relations, as well as the institution’s legal counsel and human resources department as needed, to participate in advocacy efforts geared at improving the health, wellbeing, and advancement of LHS+ communities. Such collaborations are evident in amicus briefs submitted to the U.S. Supreme Court regarding ongoing legal evaluations of race-conscious admissions in higher education. Moreover, through the relationships the office develops with its local LHS+ communities, an ODEI can provide critical information and understanding of pertinent issues that impact those communities. By engaging with internal entities and with external groups, such as the National Hispanic Medical Association, the Hispanic Chamber of Commerce, the Hispanic National Bar Association, local medical societies, and local Hispanic advocacy groups, ODEIs may provide additional expertise or perspectives that may enhance these groups’ policy and advocacy agendas. Lastly, as a complementary strategy, ODEIs can contribute to advocacy efforts by financially supporting medical students to attend advocacy trainings, conferences, or similar initiatives, such as the LMSA National Policy Summit or other local advocacy activities.

Summary

Through community outreach and service, education, clinical care, research and policy and advocacy engagement activities, ODEIs can be seminal incubators of innovation, bridge-builders, and cultural brokers between academic medical institutions and the LHS+ community. These recommendations, however, should not be interpreted to mean that ODEIs are the sole unit of the AHSC responsible for advancing the health of the LHS+ community. On the contrary, the AAMC recommends the practice of diversity, inclusion excellence and equity mindedness, which requires all individuals and offices of the academic institution to advance these principles that lead to true institutional excellence [18].

Contributions of ODEIs to Other Mission-Related Domains of AHSCs

Clinical Care & Education

While direct clinical care will typically not be provided by the ODEI itself, there may be opportunities for the office to be involved with aspects of clinical care directed at the LHS+ community. The authors acknowledge that members of ODEI leadership, such as the director, Assistant Dean, Associate Dean, or equivalent, may be physicians or other healthcare professionals; these individuals’ clinical appointment may require them to provide patient care on a part-time basis. However, as an office, ODEIs may be involved in the development and implementation of tailored communication strategies and cross-promotion of clinical information material to broaden the reach of AHSCs to the LHS+ community. Additionally, ODEIs may serve as activators to create and/or bolster medical Spanish offerings for trainees and faculty at AHSCs. For example, the University of Cincinnati College of Medicine created a Medical Spanish/Latino Health elective that is sponsored and operated by the College’s ODEI. This longitudinal curriculum offers participants language instruction, simulated patient encounters, didactic sessions covering topics related to healthcare in LHS+ communities, and service-learning opportunities, culminating in course credit [19]. Based on a key 2015 survey enacted by scholars affiliated with LMSA, programs like the University of Cincinnati elective remain rare. While 66% of surveyed medical schools actively provided some form of medical Spanish curriculum, most curricula were “not eligible for course credit” and were challenged by “lack of time in students’ schedules… and a lack of financial resources.” Thus, ODEIs have the opportunity to support and advocate for the incorporation of medical Spanish elements into medical school curricula in order for AHSCs to provide more culturally and linguistically appropriate clinical care [20].

Research

Although more and more medical research is focusing on the LHS+ community, there remains a dearth of research in many areas that address LHS+ health and health disparities. To address this gap, many ODEIs conduct their own research projects, collaborate on research projects, and/or consult with other departments and investigators to access diverse groups or to improve research projects targeting diverse groups. Moreover, the ODEI may leverage opportunities to expand ongoing research projects, improve research methodologies and data collection, and inspire new and more refined studies. For example, LHS+ individuals are often grouped together in research studies. LHS+ individuals constitute a heterogeneous group of a multitude of nationalities from various Latin American countries. Researchers may not always differentiate amongst these groups and, in doing so, may miss opportunities to distinguish important differences [21]. Moreover, there are many barriers related to participation of LHS+ individuals in research projects that may deter a focus on LHS+ communities. Some challenges include language barriers, patients’ potential mistrust of healthcare institutions and providers (often related to the belief that experimentation occurs during health care visits), competing demands (such as conflicts with child care and work), stigma (as in cases of HIV positivity, mental health issues, etc.), and concerns related to immigration status (as undocumented individuals may fear deportation), among others [22]. Here lies an opportunity for ODEIs to help mitigate some of these issues, by serving as liaisons and partners on research projects to build trust, cultural awareness, unconscious bias training, cross-cultural communication skills, and cross-cultural confrontation/negotiation skills to better recruit and retain research participants. Moreover, utilizing and enabling others to engage in community-based participatory research can prove highly beneficial. Community-based participatory research elements involve:

• Fostering trusting relationships with community partners;

• Building on strengths and resources within the community;

• Promoting co-learning and capacity building among all partners;

• Utilizing equitable processes and procedures;

• Using cyclic and iterative processes to develop partnerships and build the research process;

• Disseminating results to all partners;

• Involving key stakeholders in all aspects of the research process from the outset; and

• Pursuing ongoing assessment and improvement of the partnership [23].

Engaging the LHS+ community through a community-based participatory framework will allow the AHSC to begin dialogue with and gain input from the LHS+ community about the specific health-related concerns the latter wants investigated. ODEIs can help orchestrate this valuable shift to improve research participation and research outcomes for the LHS+ community.

Collaboration with LMSA and other LHS+ Associations

ODEIs are a primary collaborator with LMSA at the institutional, regional, and national levels. Support of LMSA members and chapters may include recruiting prospective trainees at LMSA conferences, as well as funding students to attend such meetings for their professional development. At many U.S. AHSCs, ODEI leaders and staff members serve as formal advisors for LMSA chapters and/or work closely with LMSA chapters to support and advise students throughout medical training. There are several critical avenues for ODEI involvement in LMSA student chapters, including:

• Financial and logistical support for events, activities, and professional conference attendance;

• Advising on curricular and extra-curricular matters, including navigating the institutional culture;

• Advocacy on behalf of student interests to institutional leaders and the broader community;

• Psychosocial support or informal counseling to address the academic and non-academic challenges of medical school;

• Direct mentorship of students and/or creation/maintenance of a formal mentorship program;.

• Sponsorship of students to make opportunities accessible to students and allow them to further build their professional networks;

• Provision of nominations and letters of recommendation for scholarships and awards; and

• Service as a professional resource for students to use when lodging complaints related to mistreatment, discrimination, or bias.

Moreover, efforts by an ODEI to cultivate a network of external organizational partners serves the interests of the institution and its trainees. ODEIs may support local and national LHS+ professional associations, such as the National Hispanic Medical Association (NHMA), through opportunities for involvement in institutional initiatives, financial contributions, and in-kind support; doing so opens a mutual support system that grants access to potential mentors and advocates for medical trainees while encouraging the next generation of LHS+ physicians to become mentors and advocates for those behind them.

Planning Ahead for 2050

It is difficult to predict what healthcare and healthcare delivery will be like in 2050; however, we know that the needs of those receiving care will strongly influence the ways in which AHSCs and affiliated organizations will transform medical education, as well as the strategies such entities will employ to develop the healthcare workforce needed to address healthcare needs in a continually evolving society. Demographic projections from the U.S. Census Bureau, the Pew Research Center, and other groups clearly and consistently show that the U.S. LHS+ population will continue to grow. By 2050, LHS+ individuals may constitute 100 million individuals, comprising the majority racial/ethnic group in multiple U.S. states. How will the nation respond to the needs of this growing demographic? What will be the role of ODEI officers and directors? How will this role need to change?

Already, we are seeing forecasts of future healthcare trends that we must prepare for today. Artificial intelligence will be a mainstay, given the amount of ‘big data’ that we are accumulating with the rapid changes in medicine and science. Advanced technology will change the way that healthcare will be delivered. We have already seen the impact that telemedicine has had during the COVID-19 pandemic. Expertise in precision medicine continues to grow at a rapid pace and is predicted to change many of our diagnostic and treatment trends. The rising cost of healthcare will be unprecedented if we continue at the same pace that we are at today.

How will these trends impact LHS+ communities? How will these communities respond to such changes in healthcare? How can we be assured that artificial intelligence will assist in reducing or eliminating health disparities and inequities faced by the LHS+ population? Will every LHS+ patient have access to telemedicine? How will telemedicine guarantee culturally and linguistically competent care? In a world in which vulnerable populations and their suffering often remain invisible, and in which such communities harbor mistrust of the U.S. healthcare system, how will precision medicine be received by LHS+ communities? Will these communities have access to affordable and excellent precision medicine? Will the future bring universal health care coverage so that all LHS+ communities can achieve health equity?

There are no easy answers to any of these questions. But we, as ODEI officers, must begin to contemplate the future in order to better define our roles in the decades leading up to and beyond 2050. We cannot afford to wait to address the future. We need to begin thinking about what skillsets future ODEI directors and officers will need to better serve our faculty, staff, trainees, and stakeholders. At the same time, we need to be at the table with other medical educators and participate in the discussion of what additional skills our LHS+ medical students—and all medical students—will need to be successful as future physicians serving all demographics of our society. We need to be at the table with medical administrators and leaders and participate in the discussion of how healthcare and healthcare delivery must change to serve our new society’s healthcare needs. Lastly, we need to engage the next generation of students and invite them to the table as well; as future medical professionals and academic faculty members, students have an extraordinary capacity to help institutional leaders keep the right focus looking forward and to drive us toward solutions. Although the means by which care is delivered to the LHS+ community will change, the paramount social obligation to provide the best care will remain steadfast for AHSCs and their ODEIs.

Personal Narratives:

• Francisco Lucio, JD | Associate Dean, Equity, Diversity and Inclusion

• The University of Arizona College of Medicine - Phoenix | LMSA FPAC Deputy Director

My mother immigrated to the United States from El Rodeo de San Antonio, a small rural town in Michoacan, Mexico. My father was born in Donna, Texas, but my paternal grandparents had roots in Matehuala, San Luis Potosi, Mexico. I was born and raised in Salinas, California, a migrant farm working community known as the “Lettuce Capital of the World.” As social and structural factors would have it, both my parents were farm workers. My father did the dangerous work of spraying pesticides in the fields and my mother the back-breaking harvesting and packaging of lettuce. Growing up in a family and community of farm workers, I was privileged to have early exposure to the power of activism and workers organizing for fair wages and improved work-safety measures. Some of my earliest memories were attending United Farm Workers (UFW) rallies and seeing a sea of red from hundreds of farm workers demonstrating peacefully—but powerfully—for change. This grassroots and collective action left an indelible impression on me.

The pursuit for equity and justice led me to study political science at San Diego State University as a first-generation college student. While in San Diego, I had the opportunity to volunteer at a non-profit organization, Latino Health Matters, that engaged in improving the health of the Latino community as both local and transnational issues. Growing up with a father diagnosed with type 2 diabetes, along with other family members on dialysis due to complications from diabetes, I was keenly interested in health and how these outcomes were preventable. My studies, however, took me down a path to law school. After teaching middle school English as a Second Language for a year, I left the sunny coast of California and headed to New York City where I studied at St. John’s University School of Law. Similar to the dearth of diversity in medical school, I was one of only two Mexican students in the school and without a faculty mentor from a similar background. Fortunately, there was the Latin American Law Students Association (LALSA) that was a supportive resource.

After graduating law school, I was drawn to use my legal training and background in education toward working with students. I cut my teeth in health care at the Manhattan Staten Island Area Health Education Center where I directed pipeline programs for underrepresented youth including many Latino students, advocated for health workforce policy reform to be more inclusive of underrepresented in medicine individuals, and gained a deeper understanding of health disparity issues afflicting the Latino and other communities. Eventually, I made my way to New York University School of Medicine (NYU SOM) where I was the director in the office of diversity affairs. While at NYU SOM, I helped support students to attend and participate in LMSA activities and events.

In 2017, I became the inaugural Associate Dean of Diversity and Inclusion at the University of Arizona College of Medicine—Phoenix. In my years at the college, I helped create a culture of inclusive excellence and led important diversity initiatives for faculty, students, and staff that resulted in the Higher Education Excellence in Diversity (HEED) award in 2019. Many of these activities targeted the Latino community. I continued to support LMSA students through conference sponsorships, as well as scholarship and award nominations. In 2017, we hosted the LMSA Western Region Executive Board Leadership Retreat, where I gave a talk on integrating diversity and inclusion topics into the medical school curriculum. The following year, I had the privilege to begin serving on the LMSA National Faculty/Physician Advisory Board. And, in 2019, I was honored with the LMSA Regional Faculty Advisor Award. LMSA makes important impacts for Latino health issues that is in tune with my early-instilled drive to advance equity for marginalized and disenfranchised groups. I look forward to continued engagement and support of the organization.

• David A. Acosta, MD | Chief Diversity and Inclusion Officer

• Association of American Medical Colleges (AAMC) | LMSA Faculty Advisor, University of Washington School of Medicine LMSA Chapter (2010–2013) LMSA Faculty Advisor, University of California Davis School of Medicine LMSA Chapter (2013–2017)

Immediately following my family practice residency training, I was hired by Northeastern Rural Health Clinics, Inc. as one of the medical directors of a federally qualified health center (FQHC) system made up of three community health clinics (CHC) located in northeastern California (two of which were National Health Service Corp sites). The FQHC served a number of rural medically underserved communities that included a large migrant farmworker population and two American Indian tribes (Northern Paiute and Maidu). My entry into academia was through the clinical educator pathway, where my colleagues and I served as clinical preceptors for the University of California Davis Department of Family and Community Medicine. Our CHC served as a clinical rotation site for family medicine for residents, medical/nursing/physician assistant students that had a major interest in serving rural underserved communities. After 8 years of service and teaching at the FQHC, I made the decision to follow my newly found passion as a medical educator and joined the faculty at the Tacoma Family Medicine (TFM) Residency Program, an affiliate of the University of Washington School of Medicine, Department of Family Medicine. At TFM, I was responsible for the development of curriculum in rural health, obstetrics, health care maintenance, procedural medicine, and health disparities. The residency was located in the heart of an underserved inner-city community that had a large population mix of African American/Black, Latinx, and Vietnamese patients. Our clinic functioned much like a CHC, so I felt right at home. There, I served as medical director of the residents/faculty clinic and was soon promoted to associate residency program director. After 2 years, I had the honor of developing the first rural medicine fellowship program in the U.S. for post-residency graduates that desired further training in rural family practice. This led to the development of a high-risk obstetrical clinic that served a large Hispanic population where the fellows worked. Speaking Spanish was a requirement for our fellows. I ultimately became residency director. After 13 years of service at TFM, I was recruited to the main campus at the University of Washington (UW) in Seattle to serve as the inaugural associate dean of multicultural affairs. It was there that I was first introduced to LMSA by our LHS+ medical students. The UW did not have a LMSA chapter when I arrived and, together with the medical students, we formed the inaugural chapter. I served as faculty advisor during my tenure at the UW and became the inaugural chief diversity officer. After 10 years of service, I was recruited to the University of California Davis School of Medicine, where I served as chief diversity officer and associate vice chancellor of equity, diversity and inclusion. I was honored to be asked to serve as the LMSA faculty advisor when I arrived and served in that capacity until I left for the AAMC. I had the pleasure and honor of attending many national and regional meetings and served as a keynote speaker and session lead. I continue to cherish the many LMSA mentees that I have mentored over the years and continue to mentor. LMSA provides me hope for the future as I witness the incredible leadership that will carry the torch forward with the sole purpose of being the voice for and providing the care for the communities we have all come from.