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Dr. Mala Joneja

Inclusion in Academic Medicine: Conversations and Inspirations - Dr. Mala Joneja

Matthew James, PhD Candidate (Translational Medicine), TMED 801 Course TA
 

TMED 801 - The Profession of Medicine is a course within the Translational Medicine Graduate Program that immerses students in the professional learning environment of medicine. As part of this course, students attend weekly Medical Grand Rounds and have the unique opportunity to meet with the Grand Rounds speaker in a facilitated discussion led by one TMED student to engage in further discussion. These discussions focus on three questions: 

1.    How does the research or grand rounds topic impact patient care?
2.    How is the research or grand rounds topic portrayed in the lay press and is this accurate and/or appropriate?
3.    What career path did the speaker take and would they follow the same path today? 

 

The first Medical Grand Rounds of this academic year featured Dr. Mala Joneja who gave a talked entitled “Inclusion in Academic Medicine: Conversations and Inspirations.” This talk was a departure from the traditional Grand Rounds format, but I hope to communicate the crucial insights that Dr. Joneja provided in her talk and our facilitated discussion on the importance of inclusivity in academic medicine. 

 

In the context of work in equity, diversity, and inclusion in academic medicine, Dr. Joneja views inclusion as the foundation for achieving equity and diversity. If an individual does not feel belonging due to a hostile culture or is actively excluded, then and equitable and diverse field of academic medicine cannot be achieved. It is important to understand the importance of these terms, however if the focus is only on definitions and statistics and not the human significance, they risk becoming overused buzzwords. Dr. Joneja recognizes this and therefore focuses on the role of meaningful conversations from her own experience that show us how understanding our common humanity can foster inclusivity in medicine. 

 

It is important to understand the enormous long-term impact exclusion from medicine can have. In 1918, the Queen’s University Senate introduced a ban on Black students attending the School of Medicine. Dr. Joneja discussed her conversation with Edward Thomas whose research uncovered the devastating impact of this ban, which not only resulted in the direct expulsion of Black medical students who were never able to complete their training, but also fostered an enormous amount of anti-Black racism which persists at Queen’s today. This ban is just one example of the tremendous loss that occurs without inclusion. A generation of Black doctors were unmade, perpetuating systemic inequity in medicine for Black physicians and patients. 

 

Many people who identify as part of a marginalized group in medicine have reported significant microaggressions throughout their training from their peers, preceptors, and patients. A recent study on the effect of racial microaggressions direct at healthcare students showed that students who identify as part of a racial minority have greater reported instances of microaggressions that added significant stress and emotional burden – a result not found in their white peers. The additional burden of microaggressions on marginalized people in a field already that is already exceptionally stressful contributes to a deteriorating sense of self and is another example of the major barriers to inclusion in academic medicine. Students collectively agreed that a diverse leadership team that can better understand the experiences of marginalized students is necessary to help enact change to eliminate burdensome microaggressions. Dr. Joneja was also clear that diversity in the leadership team is only one step in fostering inclusion in medicine; it also requires strong allyship from white people in leadership roles. 

 

The TMED students had an interesting discussion with Dr. Joneja regarding the structure of academic medicine, which is rooted in white, Eurocentric ideals, and often creates barriers for marginalized students and faculty to thrive. We discussed several ways in which the structure of academic medicine must change so that those who have been historically underrepresented in medicine can feel included, maintain a strong sense of self, and thrive with the support of the institution, not in spite of the institution.  This includes adapting curricula (disease presentations on all skin tones, introducing more Indigenous and LGBTQ2+ topics, etc.), altering the structure of different education forums, including Grand Rounds itself, to different cultural perspectives on education, and to actively invest in strategies that prioritize those who have been actively excluded from medical school admission. There is concern that once public attention diminishes, institutions will feel less pressure to follow through with these commitments. Dr. Joneja sees these meaningful conversations as a way to hold institutions like Queen’s accountable for their past failures, actions, and commitments. 

 

With international attention on systemic racism and inequality in recent months, there have been many reports in various media formats centering on discrimination in medicine. Unlike many previous stories on this topic which have largely focused on research and statistics regarding health inequities in Canada, the stories in recent month have also focused on the stories of healthcare workers and patients who have been impacted by systemic racisms, sexism, homophobia, transphobia and many other forms of discrimination. Media attention is another manifestation of these impactful conversations Dr. Joneja discussed in her rounds. The press can be a platform to amplify the disparities that exist in medicine and bring this attention to a broader audience outside of academic medicine. 

 

The TMED group also discussed the ability of the lay press to bring additional attention to inequities in medicine across the country. An example of this is an article presented in the CBC (link below) regarding the inequities in medical access among Indigenous communities in British Colombia. This article discussed the barriers faced by Indigenous people who identified as part of the LGBTQ2+ community and highlighted the need to include indigenous two-spirited peoples in conversations around policy making. While media coverage of these topics has certainly not always been sufficient, it is another avenue to advocate for improvements in equitable access to medical care and improving the culture of inclusivity in medicine. 

 

In addition to serving as Chair of the Division of Rheumatology, Dr. Joneja has a specific interest and passion in medical education. She obtained a Master of Education degree from the Ontario Institute of Studies in Education at the University of Toronto after the suggestion of a mentor during her training. While the degree took longer than anticipated to complete, she greatly valued the experience. When discussing the trajectory of her career, Dr. Joneja expressed to the TMED students that having an atypical career path is not a drawback. The skills gained from her training in education have also informed her work as a leader in equity, diversity, and inclusion within the Faculty of Health Sciences. 

 

To conclude this post, I would like to acknowledge that this blog post is not a comprehensive overview of Dr. Joneja’s Grand Rounds, our TMED discussion, or the topic of equity, diversity, and inclusion as a whole. There are many other important facets to this topic, and I welcome discussion in the forum below so we can continue having these important conversations.

 

It was a pleasure to speak with Dr. Joneja on such an important topic at the first TMED 801 class of the year. As a white person, my path in academia did not have the same barriers as many of my peers, and so I really valued the insight into these important conversations Dr. Joneja provided. I would like to thank her for her time and her inspiring commitment to inclusion in medicine at Queen’s. 

https://www.cbc.ca/news/canada/british-columbia/two-spirit-health-care-… 

Comments

Name
Melinda Chelva

Wed, 09/16/2020 - 16:33

An extremely well written post Matthew! I think you did such a great job highlighting the takeaways from Dr. Joneja’s presentation!

The MGR last week was very enjoyable and motivating! I also strongly believe that the press can be used as a platform to reveal the health disparities that minority and underrepresented groups experience across the world. However, even though we live in Canada, a country that is extremely diverse and welcoming to differences, I do believe that the media in Canada has not been very effective in revealing the health inequities that many minority and underrepresented groups continue to experience. To be specific, several recent studies have revealed that Canadians of colour are more likely to get infected with COVID-19 compared to those who are not considered a minority. However, from what I’ve seen, not many news stations reported such a finding. And this makes me wonder- why? I’m left to think whether the media has been manipulated to under report such results with an intention to “hide” the health disparities that still exist for underrepresented populations? Could this be because the government is worried about the potential repercussions and backlash they could face if such results are released to the general public?

With the multiple discriminatory acts that have taken place this year, there has been much more talk about racism, and many changes have been made to address these situations. However, as we discussed during the MGR last week, I still wonder what steps can be taken to ensure that Queen’s continues to take action to promote inclusivity, even when the pressure settles?

I think it is also important to highlight the difference between equality and equity, as many individuals tend to use these two terms irreversibly, when in reality, they don’t have the same meaning. Specifically, while both equality and equity strive for fairness, it is important to note that equity involves considering an individual’s needs and current situation.

As an individual of colour, I appreciate the recent steps that Queen’s Medicine has taken to increase diversity, inclusivity and equity in its program. In my opinion, I believe that all programs that produce health professionals should have mandatory courses and seminars that educate their students about the importance of welcoming differences and promoting equity. In conclusion, I strongly believe that more open discussions regarding inclusivity, diversity and equity should continue to happen in institutions, in order to foster a sense of belonging among its members.

Name
Melinda Chelva

Name
Mala Joneja

Sun, 09/20/2020 - 19:24

In reply to by Melinda Chelva (not verified)

Thank you for your comments Melinda. You have highlighted the important role that scientists, academics and institutions all have to play in promoting justice and equity. I agree with you, much more discussion is required. It is my hope we can all promote these discussions in our local context.

Name
Mala Joneja

Name
Jummy Oladipo

Wed, 09/16/2020 - 20:53

Great post Matthew! You did an excellent job summarizing the presentation and our discussion with Dr. Joneja.

I think it is great that the TMED program started the year with this very important topic surrounding equity, diversity, and inclusion. Having these critical conversations is a great way to create a more welcoming environment that promotes learning about racial inequalities.

One aspect of our discussion that really stuck out to me was how Dr. Joneja focused on the inclusion aspect of equity, diversity, and inclusion (EDI). She explained how equity and diversity are both included in the practice of inclusion. Once a person or organization is able to promote inclusivity, the other aspects of EDI will be present as well. These three words are being used more and more which is a step in the right direction, however, it is important to ensure that these words do not lose their significance.

With the increased awareness surrounding racism due to the media, it is important that productive conversations are held by healthcare professionals to address health inequities. Dr. Joneja discussed how oftentimes, leaders in healthcare do not know how to respond to instances of racism. They may not even be aware of their own biases. Racism in healthcare is being discussed more and more in the media. This highlights how necessary it is for healthcare professionals to reflect and educate themselves. This way, they too can foster an inclusive environment in their workplaces. The attention to social justice issues has been elevated recently. It has encouraged uncomfortable, but much-needed conversations. Some of which have led to productive change. However, there is still more that needs to be done. In our conversation with Dr. Joneja, we discussed how many institutions, including Queen’s have taken actionable steps toward creating a more diverse community. As a student of colour, I do appreciate the efforts that Queen’s has put in to attain this goal. Although, a question that I raise is how institutions with reputations of being homogenous, can move toward having more continuous systems of support rather than pockets. As this is a complicated topic with significant historical roots, there is not a simple answer to that question. I believe that a great place to start, which Dr. Joneja also mentioned, is to consult leaders of marginalized groups and hear what their needs are. Additionally, supporting members of marginalized groups to hold places of leadership is another great area of improvement.

The heightened public awareness of racial inequalities during the past few months has been encouraging. It is important to sustain this movement so that long-term changes can occur. Dr. Joneja did a great job modeling how to keep the conversations going by sharing personal stories and inspiring others to learn. Since the goal of healthcare is to support the communities in which they are situated, it is important that healthcare professionals are open to learning more about the barriers that marginalized groups face so that they can be better advocates for those they are serving.

Name
Jummy Oladipo

Name
Kassandra Coyle

Thu, 09/17/2020 - 13:08

Thank you for sharing this extremely insightful post, Matthew! You did an excellent job summarizing the wonderful talk Dr. Joneja gave last week.

With the increased awareness surrounding racial injustice in the media, these types of conversations are important now more than ever. Dr. Joneja was kind enough to share many conversations that she has had in the past couple of months. From her presentation, it is clear to me, at least within the Queen’s community, that many people are interested in promoting change and are taking the necessary steps to get there.

However, as Jummy and Melinda both mentioned, the question now turns to whether or not these progressive changes will continue to happen once the media attention dies down. In response to this, I believe that it is our responsibility as both students and up-and-coming members of society to ensure that this change is not temporary. It is our job to continue these tough conversations, as well as holding ourselves and our coworkers accountable for their actions.

Recently, I have seen the hashtag “Movement, Not a Moment” circulating around social media. I believe this hashtag, perfectly summarizes the discussion we had with Dr. Joneja. It is important to remember that issues of social and racial injustice cannot be solved with a quick fix solution, but rather need to continuously be monitored and adapted to allow for a truly inclusive environment.

Name
Kassandra Coyle

Name
Jordan Harry

Thu, 09/17/2020 - 15:06

This was an excellent post that perfectly summarized the key points of Dr. Joneja’s presentation. I believe my peers have summarized numerous key discussion points and areas of future investigation.
I believe that Kassandra’s comment regarding “Movement Not a Moment,” is a highly important concept that all individuals need to keep in mind. I feel that Dr. Joneja’s talk provided ample suggestions for how this could be achieved. As Dr. Joneja presented and responded to questions three main themes resonated with me: the value of conversation, listening, and learning. No matter how big or small conversations are Dr. Joneja demonstrated that they can have lasting impacts and make a difference. Additionally, that if everyone took a moment to listen and educate themselves that it could make lasting change. These are a few simple approaches that every individual is capable of that can work towards strengthening and sustaining this movement.

Name
Jordan Harry

Name
Max Moloney

Thu, 09/17/2020 - 17:00

Thank you for your excellent post, Matthew! Your blog did an excellent job communicating and building on the ideas presented by Dr. Joneja in our discussion.

Dr. Joneja’s presentation and discussion that followed highlighted the role of institutions in leading the development towards a more equitable and inclusive society. In addition, Dr. Joneja articulated the importance of engaging in difficult conversations in order to hold individuals and institutions to account. By continuing these conversations into the future we can learn more about the barriers experienced by marginalized groups and in doing so, work towards creating a more inclusive environment.

As Matthew mentioned, although imperfect, the increase in media coverage and public awareness regarding racial inequities is an encouraging first step towards a more equitable society. However, Dr. Joneja stated in her presentation, it is important to be mindful that the issues raised will take time and persistence to change. As a result, we all must remain committed to equity, diversity, and inclusion in order to see meaningful change in the future.

Name
Max Moloney

Name
Charmi Shah

Fri, 09/18/2020 - 18:11

Great job on this post Matthew! It is very insightful and effectively outlines the key points from Dr. Joneja’s lecture and the class discussion.

It was striking to hear the discussion around how visible minorities face microaggressions which increase stress and emotional burdens, and how this is not a source of additional stress for their white peers. It was striking, firstly, because this additional burden is rarely brought to attention, and secondly, because it reminded me of the concept of stereotype threat. Stereotype threat refers to the fear and anxiety a person has of confirming a negative stereotype about the minority group they are associated with. This stems from the fact that when a person of colour (POC) is the only POC within a team, they often automatically become the “representative” for their group, as all their actions and opinions get associated with the whole minority group. This is a problem because it causes additional pressure on POCs to ensure they not acting in ways that might cause others to reflect badly on their group. This additional burden often causes them to underperform, due to the pressure and competence doubts. This, again, is not a problem white students face in white-dominated fields. However uncomfortable these conversations can be, they needed to lead to productive change so I appreciated Dr. Joneja's openness and insight.

Dr. Joneja’s commitment to having meaningful conversations as a way to hold institutions accountable was encouraging. The problems that are being discussed in the media of social and racial inequalities will require complex, multi-step, and multi-disciplinary approaches. This commitment and conversation will be necessary for sustaining the movement that is aiming for impactful change in social equity and inclusivity.

Name
Charmi Shah

Name
Caitlyn Vlasschaert

Sun, 09/20/2020 - 18:15

Thank you everyone– especially Dr. Joneja and Matthew– for bringing this topic to the forefront of our minds. Something that stood out to me during the Q&A period was a comment about how the onus of explaining how to "do better" should not be placed on the individuals who face systemic racism & bias. As explained in a lay press article: "Experiencing racism in your day-to-day life has a heavy and accumulative impact on your social, mental and emotional wellbeing. But what is less frequently discussed is the damaging psychological impact of constantly having to explain what racism is – or why something is racist. Whether it’s through the ignorance of employers or colleagues, well-meaning questions from friends, or belligerent demands for proof when trying to articulate an example of injustice – people of colour are frequently used as some kind of racism reference database." (https://bit.ly/3ciZDex).

Twitter has provided a means for me to listen to the narratives of BIPOC individuals who have chosen to publicly share their experiences, and also to read about work being done at other centres to address racist infrastructures. For example, a medical student recently Tweeted about an instance of overt racism she experienced, asking for "tips on coping with this stuff" (https://bit.ly/2ZPiN71). She received over 500 responses, including messages of solidarity and advice. Through this medium, I have learned from many voices. Accounts I play particular attention to include those of Dr. Kimberly Manning (@gradydoctor), Dr. Uché Blackstock (@uche_blackstock) and Dr. Qaali Hussein (@QaaliHussein1).

Name
Caitlyn Vlasschaert

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