Designing a Road Map for Action to Address Bias and Racism Within a Large Academic Medical Center.

The convergence of the COVID-19 pandemic, the Black Lives Matter Movement, and the public anguish and outrage resulting from the murder of George Floyd in 2020 intensified the commitment of many health care institutions to pursue racial and social justice and achieve health equity. The authors describe the Road Map for Action to Address Racism, which was developed to unify and systematize antiracism efforts across the Mount Sinai Health System. A 51-member Task Force to Address Racism, comprising faculty, staff, students, alumni, health system leaders, and trustees, developed recommendations to achieve the goal of becoming an antiracist and equitable health care and learning institution by intentionally addressing all forms of racism and promoting greater diversity, inclusion, and equity for its workforce and community. Grounded in the principles of Collective Impact, the Task Force developed a set of 11 key strategies to effect systemwide change. The strategies affected all aspects of the organization: business systems and financial operations, delivery of care, workforce development and training, leadership development, medical education, and community engagement. The authors describe Road Map implementation, currently in process, including the appointment of strategy leaders, evolution of a governance structure integrating stakeholders from across the health system, development of an evaluation framework, communication and engagement efforts, and process measures and progress to date. Lessons learned include the importance of recognizing the work of dismantling racism as integral to, not apart from, the institution's day-today work, and the need for specialized expertise and a significant investment of time to coordinate Road Map implementation. Going forward, rigorous assessment of quantitative and qualitative outcomes and a commitment to sharing successes and challenges will be critical to eradicating systems that have perpetuated inequities in the biomedical sciences and medicine and in the delivery of health care.

Integrated Holistic Student Affairs: A Personalized, Equitable, Student-Centered Approach to Student Affairs.

Medical education has reached a critical juncture-the structural racism that has permeated the fabric of its systems and institutions for centuries can no longer be ignored. The destructive, disproportionate impact of the COVID-19 pandemic and unabated violence targeting individuals who are Black, Indigenous, and People of Color (BIPOC) exact an incalculable toll on BIPOC students and students from other groups that are historically underrepresented in medicine (UIM). Failing to recognize and act on the well-documented differential experience of BIPOC medical students impedes medical educators' ability to cultivate learning environments where all learners have an equitable opportunity to thrive. Holistic review admission processes, now widely accepted, have challenged admissions committees to consider the "whole applicant" to diversify matriculating classes. While gaining admission is critical, it is merely the first step for BIPOC students, who may face marginalization within what the authors have termed a "sink-or-swim" culture in medical education. For the tremendous potential afforded by holistic review to be realized, the medical education community must extend the holistic approach throughout the medical education continuum, beginning with student affairs practices and support. The authors propose the use of Integrated Holistic Student Affairs (IHSA), a systems-based model that fosters the reexamining and reengineering of existing student affairs structures, policies, and processes to promote a personalized, equitable student-centered approach. The IHSA Model consists of 4 strategic actions-establish vertical and horizontal collaboration, conduct systems thinking analysis, target leverage points for change, and operationalize the change process-and 4 areas of priority for collaboration with student diversity affairs staff and faculty. The IHSA Model provides student affairs staff and faculty with a framework for shifting from reactive, deficit-oriented practices to proactive, empowering, equitable practices, with the goal of allowing BIPOC and all other UIM students to thrive during their journey from matriculation to graduation.

Social Determinants, Risk Factors, and Needs: A New Paradigm for Medical Education.

COVID-19 and the escalation of racism and bias that has come in its wake have had a devastating impact on health professions students. In addition to academic challenges and personal health risks, aspects of students' lives that have often gone unnoticed or inadequately addressed have come to light. Financial constraints that impact access to housing and food, neighborhood safety in light of the spike in hate crimes, and the bias inherent in the continuum from premedical education to undergraduate and graduate medical education are some examples. The authors believe that to better understand students' lived experiences and determine how to best support them, the social determinants of health framework should be applied. This framework, the social determinants of education, encompasses concepts such as social risk factors and social needs in an effort to focus more intentionally on what can be done at a policy, institutional, and individual level. In response to the pandemic, the authors expanded their appreciation of students' risk factors and needs by advancing the scope and refining the definitions of 3 key determinants: from well-being to the power of individual and communal resilience, from equity to centering racial justice, and from student health to public health and infection prevention. The authors propose applying this same paradigm to the lived experiences of staff in medical education, whose needs are often neglected in favor of students and faculty, and who, in many cases, were the most negatively impacted by COVID-19 of all the constituents in an academic health center.