This interview is one in a series of interviews with recipients of the 2023 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They will be honored at the ACGME Annual Educational Conference, taking place in Nashville, Tennessee February 23-25, 2023.
The Family Medicine residency program at the Cleveland Clinic’s Family Health Center in Lakewood, Ohio is recognized with the 2023 Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award. Dr. Sandra Snyder is the program director of the family medicine residency program at the Cleveland Clinic and answered the ACGME’s questions about the outstanding measures this program has taken to foster diversity, equity, and inclusion.
ACGME: Tell us a little bit about your program.
Dr. Snyder: The Cleveland Clinic's three-year family medicine residency has eight residents yearly. We are a dual program training our osteopathic and allopathic residents in osteopathic manual manipulation skills. We have a clinic-first training model and an innovative population health curriculum focused on creating a workforce that mirrors the community our physicians serve.
We have a pre-GME family medicine pathway called the Transformative Care Continuum (TCC) at Cleveland Clinic, in affiliation with the Ohio University Heritage College of Osteopathic Medicine. The TCC is an accelerated pathway based on medical competencies that prepare students for careers in family medicine through a continuous experience from medical school through residency. The program's first cohort started in August 2018 and will complete residency in 2024.
ACGME: Why is your program so dedicated to the concepts of diversity, equity, and inclusion?
Snyder: Our goals as a program are to transform the health of the communities within northeastern Ohio by building a pipeline of primary care physicians to train leaders in value-based health care. We are committed to reducing health disparities in northeastern Ohio by recruiting a primary care physician workforce representing the racial, ethnic, and minority communities we serve. Our residency has created a solid foundation to fulfill our commitment to teaching, modeling, and training students, residents, faculty members, and staff members about health disparities, population health, implicit bias, and allyship. Dr. Martin Luther King, Jr. said it best: "The function of education is to teach one to think intensively and to think critically … Intelligence plus character – that is the goal of education." (credit: The Purpose of Education, February 1947)
ACGME: What work/initiative are you specifically being recognized for?
Snyder: As the residency program director, [along with] the faculty members and the residents—we are dedicated to increasing diversity and inclusion. We have created intentional strategies for reducing barriers for a diverse pipeline of future physician leaders. We are committed to providing solid strategic leadership for a pipeline of a diverse group of family medicine physicians who embrace equity and inclusivity. As we become leaders who can help encourage and guide other programs as our graduates filter out across the country.
ACGME: Please explain what that work/initiative looks like?
Snyder: Our residency has introduced an innovative population health curriculum as a framework for developing empathy and teaching our residents through experiences and education to understand underserved populations better. Our goal is to help address social determinants of health and cultural responses that directly affect diversity, equity, and inclusion. We hope that by providing education and experiences with our four key populations: adults with intellectual and developmental disabilities (IDD), school-based mental health care, the unhoused or homeless, and LGBTQIA+. We will train physicians expanding perspectives and understanding of how to care for these vulnerable populations.
We chose the IDD population to better care for our patients, collaborate with community partners, and improve education at the undergraduate medical education (UME) and GME levels. Our program, Building Bridges, focuses on developing educational materials and resources about interacting with adults who have intellectual and other developmental disabilities. We train front-facing and clinical staff members in disabilities etiquette and respectful patient-centered communication.
Our UME/GME accelerated pathway in population health-focused curriculum creates better patient care for all people and improves the healthcare equity of all people. In our program, UME and GME, medical students, and residents spend a half-day per week working to improve the health of key vulnerable populations. We have a unique pathway, but all residencies could adopt the population health curriculum beginning in residency. We created a focused curriculum to improve health equity by defining an underserved population within our community.
And lastly, our holistic review, especially for the UME admissions for the accelerated pathway, by using Situational Judgement Testing and a behaviorally anchored model, which helps to recruit a more diverse workforce. Our residency recruitment uses questions to identify positive traits of humility, hungry/work ethic, emotional intelligence, and diversity/inclusion. The goal is to recruit learners who embrace and seek out diversity and inclusion in our workforce and to improve patient care.
ACGME: How has this work/initiative helped make your program more diverse and/or inclusive?
Snyder: We are seeing research that diversity may improve health disparities through improving diversity in medical education. We are committed to providing training opportunities that offer experiences and interactions with colleagues and patients that expand our world, increase empathy, appreciate differences, and improve health care and advocacy for all. We seek to be champions for those with health disparities and those who are underrepresented in medicine.
ACGME: How could others use your work/initiative as a model to become more diverse and inclusive? What advice would you give to GME leaders who are looking to do just that, but aren't sure how to start?
Snyder: Be open to change. Medical education has a long history of doing things a particular way, and only when we try something different can we open the doors to true inclusion and diversity. Creating a more diverse workforce of physicians with lived experiences that mirror their patients makes for better medicine and better doctors. We are recruiting for medical education, looking more holistically at the gifts and talents that applicants bring to the table. We are not the only program that asks questions differently and evaluates who may be a good candidate in the broadest sense, selecting and training good doctors in new ways. There is an adage that says, if nothing changes, then nothing changes. We must seek change to become a more diverse and inclusive field.
Learn more about the ACGME’s Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award and nominate a deserving Sponsoring Institution, program, or organization for the 2024 Award – nominations are due by March 15, 2023.