Diversity used to be a program. Or someone's agenda. Or maybe just a bundle of good intentions. Now it's increasingly seen as a defining element of a healthy institutional culture. And sustainability has become the watchword for whatever programs are put in place. The architects of a community of diversity at the School of Medicine and its partner hospitals are looking beyond isolated programs toward a shared vision of new possibilities for engaging the School's core mission of teaching, patient care and research. The overarching goal has become meeting the challenges of biomedicine in a global society.

The future of medicine starts here The biggest contributor to change — and the hardest thing to achieve — has been transforming the environment, according to Will R. Ross, MD, associate dean for diversity.

"When we wrote our strategic plan years ago, we looked at what would preclude us from being successful in improving diversity after two cycles of medical students," Ross says. "We learned that it would be what students would sense when they arrived here, how well they would be embraced, the level of contentment living in St. Louis, and finding the social network to engage them."

Ross also recognized early on that in order for a diversity effort to truly take hold and become sustainable it must address not only those groups traditionally underrepresented in medicine — such as African Americans, Hispanics or Native Americans — but diversity as a whole. "I felt we needed to extend a broader net to capture gender, religious beliefs, sexual orientation, disabilities and the economically disadvantaged," he says.

A diverse group of people broadens a discussion, says Ross. "When you diversify any group — students, physicians, scientists, educators — you will then stimulate a greater discussion because there are so many new ideas being generated."

Students at the School of Medicine agree.

When Monique R. Farrow, now a third-year medical student, first arrived, "I didn't get the feeling that Washington University was an 'old boys' club.' I felt more openness to change and progress. The faculty made it clear that they value students' opinions and suggestions and put our recommendations into place."

Ross says that sort of appreciation is not uncommon. "The students here know there is something unique, positive and profoundly transformative at Washington University that gives them the opportunity to see through the lens of so many different peoples."

Mentoring others who have the potential: Members of the Student National Medical Association.

Faculty as a community of mentors
The student population looks to the faculty as vital role models for careers in medicine and science. Two subcommittees formed in 2002, Gender Equity and Faculty Diversity, have helped bring greater diversity to the faculty while at the same time broadening attitudes toward diversity issues.

"These committees raised the level of awareness," says Diana L. Gray, MD, associate dean for faculty affairs and professor of obstetrics and gynecology. "Diversity is not just a student issue, but it crosses all levels of the school, and we must focus on the faculty as well."

Among the successes of the Gender Equity Committee is a gender-neutral policy that allows for up to two one-year suspensions of the tenure probationary period for work/life issues, such as caring for a child or elderly parent.

For increasing the number of women faculty and advocating for change, Gray gives much of the credit to the Academic Women's Network, a volunteer group organized in 1990 to promote professional and social interactions among the female academic faculty and to assist and mentor female junior faculty and trainees in the pursuit of their goals.

The Faculty Diversity Committee, chaired by Mario Castro, MD, MPH, seeks to develop a broad diversity in the Washington University medical community and to enhance recruitment and retention of highly qualified underrepresented minority faculty. The committee helped design an incentive plan for departments to recruit such faculty, with support offered up to three years.

"We need our faculty to understand the value of drawing from a diverse talent pool in order to have the brightest and most talented faculty anywhere," says Castro.

Some of the obstacles to attracting faculty from underrepresented groups mirror those of the students: location and the perception that St. Louis is segregated, Gray says. "But," she adds, "once people arrive here and realize how collaborative and supportive our environment is, they understand they won't find a better place to work."

Diverse patients, diverse needs
In 2006, Barnes-Jewish Hospital launched the Center for Diversity and Cultural Competence, directed by Brenda A. Battle, in an effort to recruit and retain underrepresented minority residents and fellows to enhance the diversity of physicians providing care at the hospital.

One of the group's signature programs, the Residents and Fellows Diversity Initiative, offers grants to 26 residents and fellows who help recruit residents, work in the community offering health care services to the underserved, and mentor students at the School of Medicine. In the initiative's first year, 19 residents and fellows participated; there were 55 applicants for the 2007–08 academic year.

"The importance of diversity in the workplace and the understanding of cultural competency transcends all of medicine," says resident Corey G. Foster, MD. "It helps us deliver high quality patient care within the hospital setting and bridge the social gaps that exist in everyday society."

Battle credits the mentoring program for the record number of minority School of Medicine graduates choosing to do their residencies at Barnes-Jewish Hospital. "These students want to come here and want to feel included," she says. "If we make it a good experience for them, they will encourage their friends to come here as well."

Together with the School's Faculty Diversity Committee, the center is working to improve cultural competence among all those who take care of patients — from the medical assistant to the attending physician. One such effort is the development of a lecture series that presents case scenarios of various personality types. This sort of teaching, says Ross, heightens awareness about the ways we tend to categorize people with whom we interact.

"We're hoping the faculty will embrace this collaborative initiative to engage in culturally competent, patient-centered care," says Ross, "However, it must be woven seamlessly into their activities in order to realize the benefits."

Brenda A. Battle, director of the Center for Diversity and Cultural Competence at Barnes-Jewish Hospital

In the pipeline
To open the School of Medicine environment to more diversity among students and faculty, the Office of Diversity is developing a "pipeline," or cultivating an interest in the school starting at the high school level for students, and encourages other initiatives to do the same.

One example, the Saturday Scholars, provides students from St. Louis-area high schools with a four-week anatomy course organized by medical students. The office then follows up with those students to find out whether they plan careers in science, health care or medicine.

Another pipeline program is the Health Care Advocacy Program in association with Barnes-Jewish Hospital. Washington University undergraduates have the opportunity to serve as a patient advocate at Barnes-Jewish for eight weeks, during which time they are exposed to patients from various cultures. Students who have participated in the program have begun to apply to the School of Medicine, says Lisa H. Stevenson, director of diversity programs.

In addition, the Office of Diversity offers a visiting elective program that offers fourth-year medical students from other schools who are interested in enhancing diversity, working with the underserved or addressing health care disparities with an opportunity to receive up to $2,000 in reimbursement for taking several courses. Students in that program are matched with a resident and a medical student mentor to expose them to the broader medical center community.

"We hope that when it's time to think about residency programs, they will consider Washington University," Stevenson says.

The Student National Medical Association (SNMA), a group that focuses on the needs and concerns of medical students of color, also holds numerous outreach opportunities in the area organized solely by students. They have a mentoring program with undergraduate students planning to apply to medical school, in which they talk about how to write essays for medical school applications, go over interviewing skills and what things to consider when applying to medical school, as well as one-on-one mentoring. SNMA students also have visited a local high school to teach anatomy to an advanced science class, taking organs from the anatomy lab as props.

"The high-school kids really enjoyed that," says Farrow. "It was nice for them to gain exposure to medical students who look like they do."

A variety of programs in the community help get young people of all backgrounds more interested in studying science.

A university-wide effort
Cultural diversity is more than just a School of Medicine commitment: Washington University in St. Louis as a whole has a coordinated effort underway to address this important issue.

Empaneled in the fall of 2005, the Coordinating Council for Diversity Initiatives is headed by Leah A. Merrifield, special assistant to the chancellor for diversity initiatives.

"We see the School of Medicine as a key partner in trying to facilitate a more diverse community," says Merrifield. Through sharing best practices and cross-disciplinary learning, university leaders such as Ross and Gray and partners such as Battle now have a critical mass to make progress.

"Efforts under way at the School, the university and our affiliated hospitals are more comprehensive and complementary than ever before," says Larry J. Shapiro, MD, executive vice chancellor for medical affairs and dean of the School of Medicine. "We're in a climate of change, with new potential to enrich and diversify our medical center community."

Beth Miller, Holly Edmiston and Eric Young contributed to this article.