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Insights February 24, 2023

The War of Attrition in Health Professional Education

The Social Mission Alliance Student Assembly held a webinar to address racial and socioeconomic disparities of attrition rates in health professional education. The panelists talk about the current state of attrition, what contributes to these levels, examples they have encountered in the past, and what can be done in the future to reduce disparities. 

Webinar Recording

This webinar was originally hosted on February 23, 2023.

Watch the recording or read the transcript to learn what our panelists had to say about the loss of trainees in the healthcare workforce, and the disproportionate effect it has on students with marginalized identities and those with low income backgrounds.

Discussion Points:

Transcript

(Please note that this has been edited for length and clarity)

About the Panelists

Mytien Nguyen:

Thank you for joining us tonight on a very important topic and conversation. I’m also very excited to introduce our panelists today. Before the introduction, I want to share some thoughts on attrition or, as [previously] said, the loss of human capital, as we navigate through medicine and the health care workforce. So attrition, or losing trainees, people at critical health care workforce individuals exasperate, the current critical, critical shortage of healthcare workers that we have in the United States.

That also exasperates the current barrier to reaching our health equity goals. Therefore, in order to address these health workers shortages and also plan effectively for a bright future where we have health equity, more focus is needed in order to be — needed and dedicated — to the issue of attrition from the health care workforce. And, high level of attrition is a huge loss to the system in terms of the losses to public services spent on training and education of these health workers, trainees, as well as, attrition also contributes to this increase in workload and the worsening condition and for the remaining workforce who stays within the workforce and the training itself, which in turn contribute to lower quality of care and worse health becomes especially for misunderstood communities.

However attrition from the health care workforce is not equitable across identities. Previous studies have shown that students and trainees from marginalized identities, including all Black, African American, LatinX,  Indigenous, trainees, as well as trainees from low income backgrounds, have the highest rate of attrition from medical school.

These disparities in attrition alarming alarmingly parallels and mirrors the public health disparity we see at all patients, where patients from underserved communities are facing the greatest help in equity. We found that trainees who grew up in these same underserved, under-resourced communities are also leaving medical school at higher rates than their peers. Therefore, attrition of marginalized trainees, then perpetuates, and perpetuates this health equity experienced by under-resourced communities.

So the very critical question of attrition is why? Marginalized students are more often to have negative experiences during their training than their white, the male and high income peers. They report higher rates of mistreatment and microaggression as well as discrimination. Prior studies have shown that students who report higher rates of mistreatment and discrimination are subsequently more likely to leave medical school.

So in today’s panel, we really hope to engage in an open and honest conversation about attrition and the cost that it has to the health care system and across the health professions.

I’m really excited and honored to introduce our amazing panelists today. And so to start off, we have the amazing Diana Martinez. Diana is a freedom dreamer, a public health practitioner, educator and thought leader within health equity and social and racial justice with over 17 years of experiences within academia, policy and community based work. Diana is the founding director of the Learning Environment Office at the University of New Mexico School of Medicine, which was launched under her leadership in 2019. Diana has brought public health system transformation and equity framework to the Learning Environment’s mission, which is to foster an inclusive learning environment where teachers, staff and learners drive, where relationships are mutually respectful and beneficial to each other and to institutional climate.

Since its launch, the LEO has grown from a team of 4 to 12, including staff and faculty, making it one of the most robustly resourced offices of its kind. Diana is currently completing her doctorate in public health at John Hopkins University with a concentration in health equity and social justice. 

And then we also have the amazing Dr. Howard Straker. Dr. Straker has more than 30 years of PA educational and clinical experience and is an assistant professor -professor in the Physician Assistant Program at George Washington University School of Medicine and Health Sciences. Dr. Straker serves as a director of the PA MPH program coordinating the joint degree curriculum across the P.A. program and for departments within the Milken Institute School of Public Health.

He teaches in both the Department of Physician Scientist Studies and the Department of Prevention and Community Health. Dr. Stryker’s interests are in the preparation of practitioners to work in underserved communities, diversity and inclusion, health professions workforce, and blended learning pedagogy. Dr. Striker is the past president of the Officials and Assistant Education Association Post of Directors.

Last but not least we have Dr. Patricia Coleman-Burns. Dr. Coleman is an Assistant Professor and emerita at the University of Michigan School of Nursing. As a scholar, Professor Coleman-Burns has focused her career on retention and successful learning behavior of underrepresented nursing students, health disparity and social justice in patient care and provider behavior. She’s also focused on Black ideology, and the Colored Woman’s Club Movement. She is an advocate for the rights of all persons to be free from gender oppression, sexism, racism, and violence.

She served as the co-chair men of the University of Michigan’s Violence Against Women Task Force, as well as serving on several advisory committees on diversity, multicultural, and women’s issues. She serves on the executive board of Safe House Center, which provides services for those impacted by domestic violence and sexual assault. Her research is on racial identity and the reduction of health disparities. 

Discussion Question: What does attrition mean to you, and what do you think is the cause of attrition?

Diana Martinez:

When I think about attrition, I think about a couple of different ways that this happens. And we talked a little bit about this in the introduction, but thinking about forced dismissal and forced withdrawal. I think folks can be dismissed because they’re not meeting academic or professional standards or expectations and I think about this term of “forced withdrawal” as a way to really challenge the assimilation that’s expected to occur during higher and professional education.

So like, if we don’t look like you, if we don’t talk like you were scary, we’re probably a little threatening, perhaps deemed “unprofessional.” Right? And so, I think about how forced withdrawal is really like through the culture and climate of institutions. You know, so it’s it’s students of color, queer women, LGBTQ students who are most likely as already discussed, to be mistreated, harassed and discriminated against, and and not even like in the most obvious or like overt ways.

But, what can look like innocuous, covert slights that are really extremely harmful. And we know that from, you know, like microaggressions it the true effect is really the cumulative impact, right? It’s – the harm is multiplicative. And so I think that the result of that culture can be different for each individual. You know, maybe our studies decline, maybe we’re dismissed because of that, maybe we begin to doubt ourselves and like “do we even belong here?” Or maybe we’re just too tired, right? And like, when we were just done, we quit. 

So, to respond to your second question, I’ll just perhaps take the real macro-view in that, you know, like I think the cause is really white supremacist, heteronormative, patriarchal, capitalist systems, and its effects. 

Dr. Coleman-Burns:

Well, you know, let’s talk about what it looks like. You all are, and thank you so much for inviting me. Thank you. Dan. And all of the people who are in our audience, all under the same name. But I think some of those folk are coming from my community.

So what does attrition look like? You know, this past January the University of Michigan had one of the largest celebrations of the Reverend Dr. Martin Luther King. And, you know, dozens of events and the health sciences come together to do one. And so this year, dentistry led, and I was very impressed by a question that a young dental Ph.D. dental student, I think in his last year, raised as we were talking about recruitment and these issues of retention.

And he raised Dr. King’s quote where Dr. King says, “you know, after all these years, I’m beginning to have doubts about encouraging young people to integrate into a burning house.” So this dental student at the University of Michigan Dental School says, “well, what are you all doing? You keep trying to recruit us. You’re recruiting us into this burning house.”

And whereas I certainly embraced that, I agree, and we talked about it. I’ll talk later about white supremacy ideation, the notion of a culture and a profession that is predominantly centered by white identified people, whatever that may be. But I have to say that this young man, that this is, has been our efforts, and you here represent that. To change the House. To create and build a new foundation, a new house that encourages and meets the needs, not only of you, who are studying in your profession, but to meet the needs of our people who have health care issues.

You know that this toxicity that we experience in, that we can experience in professional education is also perpetrated on the patients that we serve. And so the two are connected to each other. And so I certainly think that’s what we have to do and it’s so good to see young people there. 

And we just want to say that we are recruiting you into something that can, has been historically challenging, un-affirming, dismissive, as as Diana talked about, where most of the students that I’ve worked with for very many years, they’ll say, “yes, it’s a horrible experience. But once we navigate it, once we learn how to negotiate it, we are stronger.”

And so I’ll stop. But we can talk about those who have made it through like you and those who have had and maintain your own integrity, your own value of who you are. And have been able to stand up. Maybe I might slip in one more,  because I wanted to start with the example of a student like one of you.

She wasn’t supposed to be the top student she was. Or maybe he was. And so, at the end of graduation, how you stand up and all of those who have 3.0 and above stand up, those who are 3.5 and above. And so the crowd shrinks. She was the last one standing and people couldn’t believe she was a Black woman.

But when I checked up on talking about attrition, not only in school, but as as your professions. So I checked up on her later. And because of some of the systemic ways in which underrepresented students have to deal with, she was placed in one of the lowest resourced institutions, could not get a job, a job, employment, in one of the top ranking hospitals.

And when I checked on her, she said, Dr. Coleman Burns, they call me PCB, she said “This is the worst experience I ever had. I don’t know why I got into this profession. You all taught us integrity, ethics, being the best discipline, and then we have to go serve in a place in an institution, a hospital that does not value who we are, that has no resources,” because most of us who have federal loans, for example, can only pay those off by spending two years straight out of your profession in the lowest, in what they call ‘health care – health professional shortage areas.’

And you know what that means – no resources, people who don’t want to be there. It’s the worst thing to do to people that we’re trying to prepare for the future, I’ll stop there. 

Dr. Straker:

Right now, there’s a lot of energy on “diversity” and “inclusion”, which usually translates into coming in and recruitment. I look at attrition using the house analogy: we come in the house through the front door. And attrition and you go out the back door. You don’t leave the front door like everyone else when it’s graduation time and this is a reflection of of us being in a society that’s built upon, you know, inequities, you know, and those inequities are, racism is a key one, but it’s classism, and it’s around gender.

It’s part of a capitalist system. And when we think about those structures that make that happen, education has been one. And it started before we even get to health – health professions, education. So when we really think about it, the higher you go in the educational system, the more it’s a weeding out system, the more it’s really designed that if you’re going to end up in the top, then you’re probably going to look like the people who designed the system and those — and they belong to people like them.

It’s an issue of power. It’s an issue of control and privilege. And so we’re, a lot of us aren’t supposed to be here, and it’s designed that way. And what we have to realize is the structures that have been built, have been built upon over years. So they’re little things. Sometimes they are small things within the course of a program that actually causes it, to be, kind of even people’s well-meaning they end up following the system that allows it to say, “hey, you don’t belong here.”

And that ends up being either that people get academically dismissed or they withdraw. I see those as signs of injustice. I see those as, or, it’s kind of hard to study when you’ve got all these other things going on. It’s hard to study when people around you, or you can see discrimination happening or people are abusing either you or people like you.

It’s hard to study when people back home are getting killed, in different ways, in multiple ways, or when you don’t have money. And the system is not designed to care about how you feel. They just, you know, people focus on grades on a test, and even the test and testing in itself is an inequitable system. So it really isn’t designed in a way that necessarily supports other folks other than the ones who have the resources to, to be weeded, to be weeded in, as opposed to those to get weeded out.

So I think there’s been a lot of energy and a lot of attention on diversity. And just like that person who talked about coming into the ‘burning house’ and not enough energy has been put in, how do we keep people, how do we help people navigate through systems, so they can go? And how do we rebuild the system?

And that’s where I think our energy needs to take place. When I think about attrition, that’s what I think. 

Discussion Question: What are these structures that are setting students to fail? Especially, low-income, Black indigenous, LatinX, students from under-resourced neighborhoods, etc.? What are these structures and how do these structures, current structure, manifest and lead to attrition? And how does that impact the community as well, and the costs of attrition?

Dr. Straker:

I think there’s a lot of structures and I know we’ve been looking at our institution at one of the various structures. I can tell you that one of those structures, at least in terms when I think about PA education, a lot of them are really designed from the old traditional way of “learning”, which was you give people a lecture and you give them a test.

And most of our people did not necessarily learn that way in our communities, right? But that’s their lecture. And that test is what is all that really counts. And if you can’t hang for the test, you don’t belong here. And so I think that, it’s as simple, and sometimes as just, is that even the best way to learn?

Education will tell you that that is not the best way to learn. But a lot of us have structures that only have one avenue, one way to teach, one way to learn it, one way for that. And so that begins in the other. Things are simple things like, if you’re in graduate school and you need a GPA of 3.0 to know, to stay off probation or to keep moving forward.

But we’re all in these health professions that are competency based. Why do we have grades to start with? If you pass, you pass, right? If you meet the competency, that’s where it can be. But we’re stuck in these formats of that, if you have grades and they’re built on how many hours you spend in a class. Then I’ll tell you, my program has a seven credit course in the fall and spring.

That is a huge obstacle because if you get a C, which means you’ve passed, you have now jeopardized your GPA and you could be put on probation and ultimately you could get put out for it. Why can’t we split it up? Why can’t we take away the grades? So that’s one of the struggles in terms of just those structures.

There are other structures. I’m going to give other people a chance to talk about some of the other structures that exist. But I think, it’s things like that. We – we don’t think about, good meaning people think that, well, that’s the way it is and you just gotta do it. And I’m willing to help you. Even though they don’t know how. But but. But you just have to meet that and everything will be fine. 

Dr. Coleman-Burns:

I have two examples around the question. The first is the culture and how do you give and equip students with the tools to be successful when they have values that are anti what the systems, what the status quo is?

So, often, that whole idea about “you can’t get a C,” I would have students who would say, “Dr. Coleman-Burns, I didn’t study hard enough.” No, that wasn’t the problem. They kept studying because they didn’t know how to study whatever that system was. And so because they valued class, and if you fail two, you’re out of the program.

In a program that I did in Genesis, from the beginning I gave them a peer facilitated study group. These were not remediation, these were how to be successful in this program from day one around the difficult courses, pharmacology, anatomy and physiology, patho-phys. So there’s a sense of understanding of the cultures that our students come from, and the values they have, not asking them to change their values, but to at least recognize that the House’s values have to be navigated around.

The second thing is that these are clinical professions, and so preceptorship is extremely important. And the second example, I had a student who was a master’s prepared student, and he was going for his nurse practitioner degree. And so, as you well know, these different roles, or if you don’t know, nursing has, you know, the basic generalist role of a basic R.N. or BSN, and then master’s can be more specialties.

But nurse practitioners like my daughter in law, they have their primary care, they have their own clients within, depending on what’s going on in the state. So he was a master’s prepared nurse with a specialty seeking to get his degree as a nurse practitioner. But because of the implicit bias, because he was a Black man and because he he was from an African continent, his preceptor seemingly was afraid of him and would send him in to take care of his patients,

never monitoring him. Never educating the difference between giving special care, and taking on the care, the total care of one’s patient. So she never entered. So what did he do? He gave his patient the care that a master, a master’s prepared nurse would do. I guess what? They wanted to fail him because he did not meet the criteria of the nurse practitioner.

So the biases that are built in are often harmful to our students because they don’t get the mentoring, and the preceptorship that they need, that people are either afraid of them or feel that, “oh, they’re not going to do well anyway,”’ and simply don’t intervene in the progression and development of these students, and then fail them. So that’s a good way (in other words, a bad way) to treat people.

And so, solutions are making sure that students are treated fairly and equitably. And that the faculty and the preceptors have the qualifications to deal with a changing workforce and a changing population and all the needs to reduce health disparities that we can talk more about later.

Diana Martinez:

Thank you for sharing. Those are just such deep examples, and it’s reminding me again of the cumulative impact. And it’s not just like one thing that happens. You know, specific to the work that we’ve been doing around addressing this mistreatment, I am reminded of the concept or saying of “hurt people, hurt people” and that’s part of what we see so much.

When it comes to mistreatment or harassment or discrimination and is chalked up a little bit to me like, “oh, that’s the culture of medicine,” you know, that it’s just like you have to hack that. And if you can’t, then you’re not meant and like you, you know, and it’s just like becomes then this cycle of mistreatment and cycle of harm and where are we, you know, like trying to kind of like stop and be intentional about like how can we heal people so that way, you know, they can do the work to see like I’m not a, you know, a great doctor or nurse or whatever, because I went through this particular system and because I was mistreated, right? I am good at my profession despite that. And how can I change? 

Discussion Question: what is the cost of attrition in your respective profession, to both to the students, to the communities, to the profession itself, to society, any of those broad strata’s? 

Diana Martinez:

I thank you for thinking of cost in this really broad way, because I think the most profound cost is really the cost that we’re talking about in terms of like humans and continued health and racial and other inequities. You know, like we know the inequities cost like, actually like financially, the health care system, I don’t know, to the tune of like several billion dollars a year.

Right. So, yes, there is that financial cost. I think, [inaudible] and and value and richness of and, you know, and strengths of a diverse health workforce. We know that a diverse health workforce is a key strategy for decreasing health equity, only because it’s like, you know, providers of color are more likely to treat communities of color.

But there’s new ways of thinking and new ways of operating and connecting with people that we bring to that environment and that we bring to the educational spaces. You know, when you look at the last, I don’t know, like two plus maybe three plus decades, and despite like hundreds of millions of dollars of investments made going into diversifying the health professions, not only have we not changed health outcomes, we really haven’t changed the face of health professions at all.

Right? I mean, perhaps there’s been like single percentage point changes here and there. But overall, when we’re talking about like BIPOC folks in the profession, we’re like at the same when we as we were, you know, 20, 30 years ago and the cost is like to the community, the cost is to our future, the cost is to our children, the cost is to all of us.

And there’s no, you know, like a dollar amount to wrap around that other than like we you know, we need to continue to like to dive into these spaces to, you know, idea generation and problem solve together. 

Dr. Coleman-Burns:

I’m glad that you asked the broader question. The first thing I ask is why equity and inclusion are better concepts than equality, is that the United States ranks some low, low place across the world in terms of health outcomes.

That’s a huge cost. Yet we are the causes like 6,000 for developing nations where they have better health outcomes and those generally are norm for white males. So I don’t want to be equal to a white male. I want a better health outcome. And so we need to look at the cost of a system that is not functioning well.

It’s the first thing. The second costs are, for most of the students that we work with, they are very upset about the curriculum. Because they often are being taught this very toxic white supremacy education that doesn’t re- they’re having to be tested on something that they know inherently in their spirits is wrong. So, for example, you know, there’s a study out now that was put in Forbes by Catalyst, Colorism in the Workplace that the darker skin you are, the experience that you have in the workplace is – in terms of racism and mistreatment – is highest. Catalyst article on colorism, texturism, around issues around hair not looking like the Victorian image of Florence Nightingale or whoever.

And so that curriculum costs a lot because we’re teaching and we’re miseducating. So, we’re miseducating our young people. My students often say:” why, when I have to sit in a classroom where everything bad about people of color, where we have the highest rates of this, the highest rates of that, and the highest rates… and here is a country that can shut down in two weeks for COVID, but can’t figure this out? Or can put — and I’m glad Biden went to Ukraine – but can get Biden in, and yet nobody knows how to reduce diabetes, hypertension – what is wrong with us?” And so what also happens in this cost is distrust of the health system. The growing number by 2045 the majority people will be all of these different previously under represented groups.

And the health and cost of not being prepared to treat our diverse needs is overwhelming. We see patients because they don’t trust us, don’t trust the system, delay getting prescriptions and medical care, and adhere less to medical recommendations. 

[For example, to my daddy]  they would say “Mr. Coleman, did you take your medicine?” Daddy would say yes, [but] he didn’t take it because he didn’t trust them. And therefore there’s an outcome in our communities, based on the lack of trust because the science is wrong. The science is wrong. 

I use this Apple Watch as a [final] example. And people running around talking about algorithms which are the same things that we use for abnormal lab results and abnormal…

And so about now, a year ago, Apple sent me a note and they said, what is your skin tone? You know why? Because the LED light could not read me. Could not read, I had to do, it was one of the health things on here. It kept giving me an error because it did not know, because it had been normed on a fair skinned person.

This is the science that we’re using to treat people in the sciences and we see it in maternal child death – Why is Serena Williams – why is a wealthy woman, a well – exercise, an athlete. Why does she have complications? Because our science is wrong. And then we had the nerve to teach our young people that faulty science. So that’s a huge cost, let alone, and I said I would stop, but let alone the fact that we recruit, we recruit students who are from low income communities, from first-gen communities, and their families put all the money and resources into them. And then we kick them out and they don’t have a degree. And, you know, if you come out without a degree, you’ll never be able to pay the loans back. You’ll never be able to take your family to the next level. The costs are overwhelming. 

Dr. Straker:

When we look at the costs, and I think we’ve covered the various levels from the big macro picture down to the individual family and person, because I think that that’s one that I don’t think the institutions even pay attention to the way they should is if you put somebody in here and then – and then you kick them out, you’ve actually denied them the opportunity to, you know, for many of us move to a more secure economic level and class and bring our families with us. And so I think that that, you know, we cover we’ve kind of covered all of that. I think one of the things that’s a cost also is it denies our students, our class, their classmates, it denies their faculty, denies the people in the team to learn from that.

It may be a hard lesson for them to learn, but it denies them the opportunity to learn from them. And if you really think about the work around health disparities, it’s the people who struggled through systems 20 years ago or 30 years ago, who then became researchers and said, “There’s something wrong with this picture, I’m going to do something that begins to bring that information forward.”

So we’re actually denying the ability to change and rebuild the system down the road by eliminating people out of our training programs. 

Discussion Question: What work have you personally taken on to mitigate these disparities in attrition and reduce attrition rates in your respective profession for students? 

Dr. Straker:

We (George Washington University School of Medicine) have declared ourselves as an anti-racist school. And to do that, we have built systems within the school of faculty members. I’m a member of one of our steering committees.

And, you know, we’ve since then created diversity officers in each department with specific tasks, including, you know, how people look at recruiting faculty and begin to look at and at systems within their programs and their departments. I think some of those things also are: how do we change the curriculum? And so when people do show up that they actually feel like a) you’re not talking about them, but you’re you’re talking inclusively, you’re talking a way that people can learn from them and that we’re not stereotyping our folks.

And so we actually have come up with platforms of: this is how you design a case, this is how you use case examples in cases and tests and those kinds of things. And to begin to have conversations within our programs that happen around race and gender and privilege and so forth, and so that people can feel part of having that conversation.

So that’s one piece. I think the other parts are things like working with educational learning specialists and not thinking just because you have this health education information, that you are a specialist in learning, and that you know everything about how people learn or and so forth. So I think that’s one thing. We have pushed in our profession,of our professional organizations, that we now have an accreditation standard for PA programs that holds the institution that sponsors the program responsible for support around diversity and retention.

So programs have to now show that they have efforts and they evaluate those efforts around retention. It’s a new standard, so I can’t give you the results, that will take me another ten years to have that. But I think that that is one of those things. And then I know our professional organization has done things like make it part of a strategic plan, get our, you know, try to line up the mission and create resources for our members, including a tool kit that our Diversity Inclusion Mission Commission has has has put together for programs to then have a roadmap of how you can – not telling them everything to do, but how you can then design things, implement them and evaluate them as you move forward. So things like mentoring programs, building faculty, because having somebody look like you is really important when you go to school. And so having not just one, I think that’s the other thing. In any program, it’s not just one. I don’t know if you know about the policy program where they send kids from the same neighborhood to the same college so you have support when you get there. It’s the same idea. So those are a couple of ideas that I know I’ve been a part of. 

Dr. Coleman-Burns:

Well, I can only point out my successes. Some are here in this space. Dr. Dan is an example of the kind of success that we can achieve. That we never lose our support. Dan graduated, I don’t know, 90 million years ago, and we’re still connected and we’re still on the front lines doing the struggle, knowing that this is a protracted struggle, that this is not a four year occurrence. And so looking at and lifting up examples of all of you who have made it through. Lauren Underwood, Congresswoman, Lauren Underwood, comes right about out of our Genesis program.

You know, who right from the beginning said she wanted to do policy, having and being able to support associate deans of nursing schools and chief executive nursing officers in the largest state with the largest number of nurses in our union in California. On this line, I pointed out my own family member, Dr. Jade Burns, who was part – is part of the policy program, so that we stay connected.

That we’re able to look at programs that have been in existence. You know, one of the things that and and we only have like 4 minutes, but the Genesis project is a project that began somewhere around the turn of the century in 1999 and into the thousands. And what we did, and Dr. Jade here, and through the work of people like Dan, we brought in middle school and high school students to introduce them because many of their counselors were telling them that if they were interested in nursing then they would put them in vocational training and take them out of math and science, or say that they weren’t qualified. So we take them to a middle school. 

For students that were looking at coming into the undergraduate program, because of Dr. Jade, we were able to create and fund for years, a six week residential program to do early introduction to the campus so they could learn how to navigate the system.

The little basic things like, you know, what is the course management system, where do I get to? Where do I find my books? You know, all these – where do I get the resources? So provide resources and have people on the ground. And then like I said, we had peer facilitated study groups. We taught them from the beginning, Dr. Howard, how to take those tests.

And you know that it wasn’t them, that there was a formula to doing it, that they could learn how to be successful and also making sure that we dealt with their social issues. I know I’m running out of time, but this one case was of a student who was the first generation of her family, a Hispanic student.

Her mother later said to me, “Dr. Coleman-Burns, I had no idea what this higher education was.” And so we brought her in and the university and a summer program. And because it was the first time she was away from her family, by the time she entered the first semester of nursing, she had already failed two courses.

And so having to work with the university to make sure when they bring our students in to these programs that we are guiding them and making sure that for the health professions, you know, nursing has an undergraduate degree, so for the health professions that we’re able to support for the graduate students, just meeting basic needs around family, religion, and culture, hair, what do I do with my children?

You know, these are all the things that, in Genesis we tried to do, and we supported them and we worked on the curriculum and we worked on to intervene when students were being, Dianna, dismissed, to step in, to have someone to take the risk and then to work with graduate students in their research so that —  one of my doctoral students, you know, back in the day, you weren’t supposed to only look at Black women.

We had to fight her right to hypertension and Black women without comparison. So changing the science and being able to support the work of these geniuses and never give up. 

Diana Martinez:

(Note: there were some audio and technical difficulties in the webinar, which are reflected in the transcript)

Like earlier, we were talking about the house on fire right? We’ve created a reporting system and [inaudible] you know, you had these moments of harm come and it’s … how do you really earn the trust … in the very institution that burned them, so to speak. But we’ve really created, I think, a trauma informed approach that is really around like building trust, building relationships and ensuring that people know that there are options. We don’t do anything without consent, you know, like we’re not going to do anything that would make a learner feel uncomfortable about how we can follow up.

And I’ll just do a quick shout out because I know that one of our team members is here, [inaudible]. So thank you for all the work that you do, you know, But it’s it’s I think like things like this that we’re doing that we can like address the incidents, you know, like at the individual level, but also then like really build this, or paint this picture, in which we can better understand like what is happening in these learning environments? And how can we really create some intentional awareness and skill building education for people to engage in?

And so that’s a little bit about what we’ve been doing. And I just want to also try and throw in the chat. There’s a couple of frameworks that we’ve really been using. I’m not sure if you all are familiar with Dr. Loretta Ross, and the framing of really like calling in vs. calling out, and calling out is really about shaming.

And that’s not going to get us where we want to go. And, you know, like, so how can we be better at calling people in and and learning from moments of harm? And then I’ll just maybe end, and I know we’re a couple minutes over time, but I know like I think, you know, this is a lot. It’s a lot and it’s hard to think like, you know, the house is on fire.

Perhaps it’s even like the foundation, perhaps in the street or the entire city. I don’t know. It feels like that sometimes. And I guess I would just say what helps me sometimes and like, get through that is really just like taking a moment, right? Acknowledge where we are, but also acknowledge where we come from. Right? We are resilient people and while we shouldn’t have to be; it’s not fair, it’s not just. We  think of our ancestors who are monumental, right? Like they are giants. And so I do say you know, like to all of us, like I, you, and we, stand on the shoulders of giants. We would like to get there. Right. And it’s slow sometimes, and it’s difficult, and it’s tough. But this is really building the revolutionary love. That’s what I’m here for. 

Mytien:

Thank you. I love that: “revolutionary love.” And I think we have created a community’ everyone in this Zoom who attended today as well as, you know, our support system, friends, family and loved ones. Thank you so much for, to all panelists, Dr. Stryker, Dr. Coleman-Berns, and Diana for your time, for your thoughts, your insights, sharing.

I think we have a lot of work to do and a lot of things to advocate for as well. And for the students on this Zoom. You yourself are the revolution. And so please take that deep in deeply and strive on. And thank you for joining us today. And I hope everyone has a lovely evening.

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