Thursday, February 11, 2016

Harvard Medical School students decry lack of diversity

These students are seeking a reputational decline for their school.  Brainless

Students in white coats marched through Harvard Yard last week to call attention to a lack of diversity at Harvard Medical School, as the Black Lives Matter movement rolls into the next storied Harvard institution.

Three dozen Harvard medical and dental students in a newly formed Racial Justice Coalition delivered a petition to the office of President Drew Gilpin Faust, who is leading a search to replace the outgoing medical school dean, Dr. Jeffrey Flier. The petition, signed by over 300 students, calls on Faust to choose a dean who will address the lack of diversity among staff and students, and who has shown commitment to racial equality in health care.

The action took place as nationwide protests about racial inequality ripple through university campuses and medical schools. Late last year, as race-related protests rocked Yale and the University of Missouri, students at Harvard Law School confronted their dean about the treatment of minorities. And Harvard has agreed to retitle the “masters” of its undergraduate residential houses, as well as its medical school societies, because of the connotation of slavery.

Harvard Med’s Racial Justice Coalition was inspired by a national student group called White Coats for Black Lives, part of the Black Lives Matter movement that erupted from national outrage over police brutality. The White Coats group coalesced in December 2014, coordinating a 2,000-person “die-in” at over 70 medical schools that was aimed at framing “police violence as a public health issue, and institutionalized racism as a problem in medicine,” said organizer Dorothy Charles, a medical student at the University of Pennsylvania.

So far, students from White Coats for Black Lives have claimed some small victories: They have spurred the University of California, San Francisco, to expand bias training for incoming students, for instance, and helped shape an anti-racism initiative at Mount Sinai’s medical school. Last December, students at over 20 medical schools, including Harvard Med, pressed their schools to commit to admitting more minorities and ensuring people of color who live near teaching hospitals aren’t turned away because they can’t afford the care.

Harvard Med has come a long way since it admitted its first three black students in 1850. While many students at the time supported the move, a vocal minority threatened to quit if they had to share lecture halls with blacks. The dean, Dr. Oliver Wendell Holmes, kicked the black students out, saying the “experiment” had proved to the faculty “that the intermixing of the white and black races in their lecture rooms, is distasteful to a large portion of the class and injurious to the interests of the school.” Harvard Med did not graduate a black doctor until 1869.

Since then, Harvard has improved its track record: It graduated 574 black physicians from 1980 to 2012, the eighth highest number in the nation, according to the Association of American Medical Colleges. But blacks remain far outnumbered in medicine — they comprise 13 percent of the US population but just 4 percent of the physician workforce — and Harvard is no exception.

In their petition, students noted that just 5.9 percent of Harvard Med’s 9,453 full-time faculty are black, Hispanic, or American Indian, while those groups make up 32 percent of the US population. Little progress has been made since 1980. Meanwhile, the share of Asians and Pacific Islanders, who are not considered “underrepresented” by the AAMC, has shot up from 4.4 percent to 18.9 percent in that time period, according to Harvard Med.

Harvard’s case mirrors the nation: 5.3 percent of US medical school faculty are underrepresented minorities, a figure that has changed very little over the past decade, said Marc Nivet, chief diversity officer at the AAMC.

Nivet said historically, “the rationale to diversify medicine has been to get [minority] medical students to go back to their community and work in primary care.” That’s important, Nivet said, but it has had an unintended consequence: Few minority doctors become faculty members at medical schools.

Another problem, Nivet said, is that the pool of medical students is diversifying too slowly. The number of black medical school graduates in the United States rose by just 3.9 percent from 2002 to 2011.

Harvard Med’s student body is much more diverse than its faculty: 21.7 percent of students are black, Hispanic, or American Indian. But just 11 of the 165 first-year students are African American, and students say the school has a long way to go.

Edirin Sido, a first-year Harvard dental student of Nigerian and Cuban descent, is training at Harvard Medical School as part of her dental education. She said she has noticed a lack of diversity in the doctors who train students in clinical settings as preceptors. When there aren’t many minority faculty, she said, they experience what’s known as a “minority tax” — they get pulled into lots of extra committees and other duties in which an institution is seeking diversity.

“The only way to address that is to have more minorities in the profession,” she said.

Danial Ceasar, an African-American Harvard Med student from Compton, Calif., said he has had just one black teacher in his five months at the school. He has noticed something missing in the curriculum, too.

Sitting in infectious disease class, he saw slide after slide of rashes, and noticed that “there were some days where we would just see white skin.” He said the lessons left him poorly equipped to work with dark-skinned patients.

“I look forward to going back to [treat] communities that are full of black people. I will need those pieces of my education,” he said. Ceasar said Harvard Med has been very responsive to student feedback, however.

The petition that Ceasar and others signed urges Faust to make sure at least 25 percent of interviewed candidates for the dean job come from backgrounds underrepresented in medicine.

Faust, who wasn’t available to receive the petition in person and declined comment to STAT, told the Harvard Crimson she’s skeptical of the quota the students proposed.

“I think that the point that the person who leads the med school ought to be a person with a deep commitment to diversity is absolutely right,” Faust said. “How we accomplish that I don’t think comes through quotas on interviews.”

Harvard provost Alan Garber, who is leading the dean search with Faust, said in a statement that he had met with student organizers and shared their petition with faculty on the dean search committee.

Meanwhile, students received support from one Harvard Med professor, Dr. Augustus A. White III, a longtime champion of diversity who in 1978 became the first black department chief at a Harvard teaching hospital.

“I would sign it in a heartbeat,” he said of the students’ petition.

White wrote a book, “Seeing Patients: Unconscious Bias in Health Care,” outlining how a prejudiced health care system fails minorities. For example, if you’re a Latino man in Southern California with a long bone broken into two parts — a problem that’s easy to diagnose, very painful, and hard to fake — you have 50 percent less chance of getting narcotics to control your pain than a white patient, White said.

“If we had more diversity, we’d have less disparate care,” he said.

White said he would like to see “a greater sense of urgency and outrage” over what Martin Luther King Jr. called “the shocking and inhumane” injustices in health care.

“Diversity is not a panacea,” White said, “but certainly an important element in helping to address that unconscionable reality.”


Reflections on National School Choice Week

Last week was National School Choice Week, with more than 16,000 events from coast to coast shining a spotlight on effective education options for students.

Today, parental choice in education encompasses a variety of education options:

Eight states and the District of Columbia allow parents to enroll their children in any public school they wish, regardless of where they live.

Another 43 states and DC allow public charter schools. Altogether more than 6,700 charter schools enroll over 3 million students.

Public magnet schools, 3,200 nationwide, enroll over 2.6 million students in all 50 states and DC.

Parental choice in education also includes a growing number of private and online learning options as well:

Fully 27 states and DC offer private school parental choice programs, including publicly-funded voucher scholarships, privately-funded tax-credit scholarships, tax credits, and tax deductions. These programs are helping more than 1.2 million students and their families nationwide.

Students in 41 states and DC are also benefiting from fully or blended online learning options, some 2.6 million students.

Finally, more than 2 million students are currently homeschooled (3 percent of American students).

California is also home to a unique parental choice option. It became the first state in 2010 to enact Parent Trigger legislation through the Parent Empowerment Act. Under the law, if a majority of parents whose children attend failing schools sign a petition, school leaders can be replaced, students can transfer to better performing schools, or the school can be converted to a charter school under different leadership.

As Gloria Romero, former state Senator and author of California’s Parent Trigger law, told the Orange County Register:

    "School choice means that we are more than a default ZIP code, automatically assigned to remain trapped in failing schools when bureaucrats refuse to transform...School choice means that parents truly have the power to become the architects of their own children’s educational futures and opportunities".

Romero is right —but there is more work to be done when it comes to empowering parents.

It makes no sense that California students are still largely assigned to schools based on where their parents can afford to live. It’s time California expanded parental choice over how —not just where— their children are educated by enacting education savings accounts, or ESAs.

Two of California neighbors, Arizona and Nevada, have already enacted ESAs, as well as Florida, Tennessee, and Mississippi. Missouri and Oklahoma are also among the first states this year to consider enacting ESAs.

The ESA concept is simple. Parents who do not prefer a public school education for their child simply inform the state and 90 percent of what the state would have spent is deposited into that child’s ESA instead. In most programs, parents are issued a dedicated-use debit card for approved education expenses, including private school tuition, tutoring, online courses, testing fees, and special education therapies. Funds are disbursed quarterly, but only after parents have submitted expense receipts for verification. Any leftover funds remain in students’ ESAs for future education expenses, including college.

California is home to important reforms, including Parent Trigger and the local control funding formula (LCFF) enacted in 2013–14 (see here, too). However, simply spending more money—not to mention the stark absence of accountability measures—is no guarantee of improved student outcomes.

ESAs would empower parents, localize funding, personalize student learning, and put immediate academic and fiscal accountability measures in place.

National School Choice Week underscores that parents, the ones who know and love children best, should be in charge of their education every week of the year.


Learning to read requires direct instruction and parental involvement

Jennifer Buckingham, writing from Australia

Reading seems so straightforward. Skilled reading is unconscious and automatic ­-- most people are not aware of the complex cognitive processes taking place. Few adults remember how they learned to read, so when it comes to working out how to help their children they will often look to the experts. Unfortunately, advice to parents is often confusing and contradictory.

It is not simply a case of 'read to children and they will learn to read'. This is the trap of whole language teaching methods. For children to make the connection between the strange black shapes on the page and the words they hear and say, they have to be explicitly taught.

But even before this happens, children need to develop a large store of words that they can understand and use -- a large 'receptive' or oral vocabulary. Recent studies found that around 20% of Australian children starting school have poor language skills. They do not speak clearly, and they know and use a limited number of words.

The best way to develop these skills in children is through adult-child spoken interaction and through shared reading. Both of these are important. Spoken interaction provides children with models and guidance of how to pronounce words properly and gives them immediate information about the world around them. Clear speech also develops phonological awareness -- the ability to identify the distinct sounds in spoken words -- which is strongly related to the ability to decode words using phonics.

Shared reading -- defined as reading with rather than reading to children -- is essential; firstly because it introduces the concepts of the written alphabet and printed text, and secondly because books expose children to a wider range of words and language structures generally used in speech. Vocabulary can be conceived broadly as general knowledge. To know what the word 'planet' means, is to know what a planet is. Vocabulary and general knowledge are fundamental to reading comprehension, which is the end-game for learning to read.

Parents should not be expected to teach their children to read. But it will help to break the cycle of low literacy if children arrive at school well prepared to learn to read. If, ideally, they then have evidence-based reading instruction in the first few years of school, Australia will be well on the way to fixing its persistent literacy problems.


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