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

TMED Blog

| 16 September 2020

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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-…;

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

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