Member Insights: eNews 2019 Highlights

Diversity and inclusion (D&I) are guiding principles to build an organization that reflects its membership and celebrates multiple approaches and points of view. Strictly defined, diversity is the state of being diverse, or a range of different people who are actively engaged in an organization. In practical terms, it encompasses the understanding that individuals are unique and recognizes differences such as gender, sexual orientation, race, ethnicity, socio-economic status, and other ideologies (Ferrini-Mundy, 2013). The concept of D&I embraces acceptance and respect, building a culture where difference is valued, and taking a holistic approach. By establishing a consistent and logical foundation regarding differences, people are much more likely to have valuable and actionable conversations about specific kinds of differences such as race or gender. It is critical for organizations and institutions to make the endorsement of D&I an essential part of policies and procedures. Strengthening a D&I program will bring the best talent to an organization; supporting various voices will increase levels of creativity and productivity. There are numerous cultural barriers to the progression of marginalized groups to leadership in organizations and academic institutions, especially in Science, Technology, Engineering, Mathematics, and Medicine (STEMM). Recent approaches that incorporate “sponsorship programs” provide opportunity for effective interventions by creating roles for protégés, advocating for people within the organization, enabling new roles and opportunities, and making connections to senior leaders (Huston, Cranfield, Forbes, & Leigh, 2019). In today’s climate, members of organizations and academic institutions want to hear policies and plans to make diversity a reality.

The way organizations foster and nurture diversity is an important aspect of its culture. Diversity initiatives should not only be part of recruitment programs, but also be integrated into on-going workforce management and operations. This requires training staff to increase the support of diversity initiatives. Having a diverse workforce signals that the organization does not discriminate; that is, if an individual is qualified for the position, then he or she has a fair chance of getting it, no matter his or her background. We should strive to create organizations that reflect the communities we serve and where everyone feels empowered to bring their full, authentic selves to the table.

Having people from different lifestyles and backgrounds challenges the way others within the organization think, operate, and can catalyze innovation, insight, and adaptation. Additionally, it helps the organization to reach a wider membership and volunteer base because leadership can relate to more types of people. The major obstacle to implementing a diversity program is the challenges to evaluating its effectiveness. The tendency is to treat this as a subjective area, without clear metrics, analytics, or dashboards pointing towards areas of success and identifying those in need of improvement. There are many D&I tools commercially available—such as The Association Inclusion Index developed by the American Society of Association Executives (2019)—recently adopted by ASPHO to evaluate D&I initiatives within the organization. Embracing D&I is an ongoing process that requires constant commitment, evaluation, and process improvement. The ultimate goal is to build an inclusive culture that encourages, supports, and celebrates the diverse voices of our membership at-large.

ASPHO Diversity Statement:
ASPHO values and encourages diverse and inclusive participation within the profession of pediatric hematology/oncology. ASPHO is focused on attracting, developing, and retaining volunteers who reflect the diversity of its membership to play key roles in leading the Society. The Society seeks to create an atmosphere that encourages varied perspectives and participation in its committees, task forces, and board. ASPHO believes that an open exchange of ideas from diverse perspectives will result in improved decision making and will best serve our members' collective needs and interests and, by extension, those of their patients.

References

1. Ferrini-Mundy, J. Science education (2013). Driven by diversity. Science, 340(6130), 278.
2. Huston, W. M., Cranfield, C. G., Forbes, S. L., Leigh. A., (2019). A sponsorship action plan for increasing diversity in STEMM. Ecology and Evolution, 9(5), :2340–-2345.
3. American Society of Association Executives. (2019). The Association Inclusion Index. Retrieved from https://www.asaecenter.org/about-us/diversity-and-inclusion/association-inclusion-index

Diversity SIG Mission
The ASPHO Diversity SIG (DSIG) aims to support the advancement of all ASPHO members and the field of pediatric hematology/oncology (PHO) through increasing diversity and inclusiveness in a broad sense in the membership and leadership of ASPHO as well as the home institutions of members. The DSIG has made it a top priority for our group’s activities to begin with early outreach where we connect medical students with faculty in the field of PHO at all of ASPHO’s national meetings.

The physician workforce continues to struggle with adequate representation of racial and ethnic minorities, with hematology and oncology lagging in medicine in general. According to the most recent census, 13% of the U.S. population is black or African American and 18% is Hispanic (United States Census Bureau, n.d.). In contrast, only 2.3% of practicing oncologists self-identified as black or African American and only 5.8% of practicing oncologists self-identified as Hispanic (Kirkwood et al, 2018; American Academy of Pediatrics, n.d.; Association of American Medical Colleges, n.d.). Individuals from populations that are underrepresented in medicine are even more underrepresented in oncology than in fellowship or residency programs in general. Thus, early outreach is essential for mentoring medical students and residents who are interested in PHO as a career choice.

LSUHSC Partnership
To further our commitment to mentoring, the DSIG collaborated with Louisiana State University Health Sciences Center (LSUHSC) to engage medical students and residents in the 2019 ASPHO Conference. We began with a meet and greet event the night before the conference. The School of Medicine at LSUHSC hosted the meet and greet under the faculty leadership of Dr. Cathy Lazarus, who is the associate dean of student affairs. The event included a presentation by Dr. Pinkney, 2018-2019 DSIG chair, on career pathways in PHO. This was followed by a question and answer session with Dr. Pinkney; Dr. Pinki Prasad, 2019-2020 DSIG chair; and Dr. Jennifer Krajewski. We also had a presentation from Jessica Briley, a representative of Be the Match, National Marrow Donor Program. Jessica discussed the ongoing efforts to increase the donor pool from diverse racial/ethnic communities and the importance of new partnerships with colleges and universities.

As part of our ongoing push to engage medical students and residents, the DSIG was able to partner with LSUHSC to provide sponsorship of five students and pediatric residents to attend the 2019 ASPHO Conference. At the conference, these selected medical students and residents were paired with faculty guides to help them navigate and answer questions regarding pursuing a career in academic PHO.

Challenges and Barriers to Women in Academic Medicine
Our keynote speaker for the 2019 DSIG workshop was Dr. Bonnie Desselle, vice chair of medical education at LSUSHC and Children’s Hospital of New Orleans, and the title of her talk was “Challenges and Barriers to Women in Academic Medicine.” Dr. Desselle highlighted an American Medical Association video,“Women in Medicine by Numbers”, showing that in 1860, there were roughly only 200 women physicians in the United States, and today, that number exceeds 376,000 (American Medical Association (AMA), n.d.). Despite the increase in women enrolling in medical school, leadership roles for women remain elusive. Less than 10% of women self-report as being a department head or a division chief (AMA, n.d.). In academic medicine, the proportion of women in higher academic ranks is lower than males across the country. The gender pay gap was discussed as studies have shown that women are offered lower pay and less institutional research funding when they join a faculty, and they continue to earn considerably less than men—even among those at the same level and with comparable productivity. The group was able to break out into small sessions to discuss why gender disparities exist and what institutions and physicians can do to help balance gender disparity. There was discussion at the end of the hour about formal mentoring and the importance of training and career development at all levels. The workshop was met with enthusiasm and received great feedback. We plan to incorporate this into a webinar in the upcoming months.

New Members
We welcome new members to join our DSIG. We communicate year-round using ASPHO’s online member community specifically for the DSIG.

References:

1. American Academy of Pediatrics. Demographics of women physicians and pediatricians.
2. American Medical Association. Women in medicine month. Retrieved from https://www.ama-assn.org/member-groups-sections/women-physicians/women-medicine
3. Association of American Medical Colleges. Table 3. Distribution of U.S. medical school faculty by rank and race/ethnicity.
4. Kirkwood, M. K., Hanley, A., Bruinooge, S. S., et al. (2018). The state of oncology practice in America, 2018: Results of the ASCO Practice Census survey. Journal of Oncology Practice, 14(7), e412-e420.
5. United States Census Bureau. QuickFacts: United States. Retrieved from https://www.census.gov/quickfacts/table/PST045215/00.

When people hear that I am a pediatric hematologist/oncologist, I am frequently asked, “How do you do what you do? How do you handle those conversations with children who are so sick and their parents? I couldn’t do it.” I imagine that many of the people reading this article have had similar conversations with family, friends and colleagues. So how does each of us “do what we do?”

I know each of us has several answers to this question. One unique venture I wanted to share that helps me “do what we do” started almost 3 years ago, when I was asked if I wanted to be trained in relationship-centered patient communication. The day I said “yes” to this question changed my life. Our institution enlisted the Academy of Communication in Healthcare to train a handful of physicians and advanced practice providers in relationship-centered patient communication, specifically for a pediatric and women’s healthcare (obstetrics/gynecology) patient population. We now have our Texas Children’s Hospital (TCH) Breakthrough Communications Team which includes 13 faculty-trainers in various subspecialties who are charged with training the more than 1,200 pediatric and obstetric faculty at our hospital.

We teach three key skillsets in the form of brief didactics with interactive roleplay: skillset 1 focuses on initial rapport building with the patient/family and creating an agenda for the time spent together; skillset 2 focuses on reflective listening to patient/family perspectives, including ideas about diagnoses, fears, and expectations; and skillset 3 focuses on the provider sharing the assessment and collaborating with the patient/family to create the plan. Lessons about the importance of the provider expressing empathy are interwoven throughout each of these skillsets. We term the cumulative product “our communication toolbox.” We also use specific feedback in each workshop to reinforce the individual’s most effective approaches and fine-tune approaches that have room for improvement. I have been privileged to watch countless faculty successfully work through very challenging communication scenarios over the years.

Participating in our TCH Breakthrough Communications Team has given me the invaluable opportunity to teach a unique communication toolbox to providers across subspecialties and stages in their careers. The personal use of these skills also continues to improve my own communication and relationships with my patients and colleagues. These experiences actually have taught me just as much as any book or mentor in my medical career, and they have been a huge part of how I “do what I do” every day with eager hands and a heart fulfilled. I urge each of you to seize any similar opportunity that may come your way; the result of taking that opportunity may render more reward than you can imagine!

Every now and then you need a friendly reminder about the things that excite, motivate, and encourage you to carry on. At the start of pediatric hematology/oncology fellowship all the reasons why you chose to dedicate 3 more years of your life to training are fresh in your mind. You remember bonding over pumpkin pie with your 11-year-old male patient diagnosed with acute lymphoblastic leukemia who had to spend Thanksgiving in the hospital, the mother you reassured when her newborn was diagnosed with sickle cell disease (which back home in Nigeria would have given her no hope for a fruitful life), and the new and exciting research taking place and the idea that you could be a part of it.

Then fellowship begins, and along with this new start comes a steep learning curve, new responsibilities, and a neverending checklist. Within the everyday hustle of juggling the consulting and inpatient services, you slowly forget those things that once inspired and excited you. Instead, your mind is occupied with tumor lysis lab results, Children’s Oncology Group protocols, chemotherapy orders, and sleepless nights interrupted by the disharmonious sounds of a pager.

At some point in that first year, though, you are presented with a patient diagnosed with a new and rare condition. That bond you cherished begins to form with your new patient. Intellectually, you are reinvigorated and feel the need to share this energy with the pediatric hematology/oncology community, as I did in New Orleans at the 2019 ASPHO Conference. This provided me the invaluable opportunity to gain experience from constructing a poster, presenting it in a professional forum, and attending stimulating, intellectually driven seminars.

The ASPHO Conference is a place where you can step away from that checklist and press the refresh button. Two wonderful aspects of the conference were the educational session on models for international pediatric oncology outreach and the distinguished career award presentation, which honored Dr. Elliott Vichinsky.

The educational session regarding international outreach reminded me of my past volunteer work and provided exposure to the work my colleagues are doing. It was uplifting to see the joint efforts between American and foreign oncology groups to better the quality of life and outcomes of patients on a global scale. It was even more encouraging to know that I too can be a part of this.

The Distinguished Career Award presented to Dr. Elliott Vichinsky was moving. As the slideshow showcased the start of Dr. Vichinsky’s career, his work within the sickle cell community, and his personal accomplishments, the wave of inspiration rippling through the audience was palpable. To see the impact that one person can have on his patients, colleagues, and community was powerful. It reminded me that the checklists and the countless pages all contribute to a greater effort and cause. They contribute to me becoming the best version of myself for those lives that matter the most—the lives of my patients.

Among fellows, especially within the first year, there can be a fear that a part of who we are will be lost in the everyday workload and that what we love about the field becomes buried and may never resurface. Attending a conference like ASPHO’s allows you, layer by layer, to come back to the surface and breathe. It reminds you of your passions, who you are, and why you carry on.

“All of your patients will die.” Those were the words that were said to me on my first day on the job. Young and fresh out of graduate school, I was scared and nervous, but eager to learn and develop my skills as a practitioner. I didn’t seek out a position in developmental therapeutics, but it was the opportunity that presented itself, and over the next 10 years I would learn that it was the position that was truly meant for me.

Although the expectation of success of Phase 1 clinical trials was set low for me from the beginning, the next 10 years would be a whirlwind of change in the world of pediatric oncology. In the short timeframe of my career, I have seen early phase clinical trials evolve from utilization of cytotoxic chemotherapy in all types of cancers to development of targeted agents for broad indications to the current landscape of “precision” or “personalized” medicine. Once only a thing of science-fiction movies, personalized medicine is as close to reality today as it has ever been.

I am awed and inspired at the state of current pediatric research. In this new era of pediatric oncology, the knowledge of tumor heterogeneity, advancements in cancer biology, and improvements in disease modeling have led to compelling new opportunities for therapeutic approaches tailored to individual patients. Ever-increasing numbers of clinical trials are developed with agents targeting a particular tumor marker or mutation and given to individual patients known to harbor that molecular aberration. Although efficacy of many of these new agents is still under study, the promise of early phase clinical trial success is vastly enhanced as we increasingly utilize the biological basis of a tumor or individual’s genome to guide therapeutic choice.

In addition to molecularly targeted novel agents, the emergence of immunotherapy has also transformed developmental therapeutics. The concept of harnessing the body’s own immune system to fight cancer is not a new one, but not until recently was it translated into clinical practice at such an expeditious rate. Through the use of treatment modalities such as tumor vaccines, cellular therapies, and immune-stimulatory agents, immunotherapy has catapulted into the forefront of childhood cancer drug development.

As a result of an enriched understanding of tumor biology and innovative treatment strategies, cancer drug development has seen unprecedented progress and opportunity over the past decade. As I think back to those words said to me on my first day on the job, I am reminded of how much things have evolved since then. It is not uncommon for patients who enter Phase 1 clinical trials to have prolonged stability, objective tumor response, or even long-term survival with these innovative new therapies. It is an exciting time to be a practitioner in the field of developmental therapeutics, and I eagerly await the future progress of pediatric oncology treatment.