Community Support, Partnerships, and Inclusive Environments for Black Students and Professionals in Science, Engineering, and Medicine: Proceedings of a Workshop (2024)

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Making Institutional Walls More Porous

Opening the last panel of the workshop, moderator Camara Jones, M.D., M.P.H., Ph.D. (King’s College London) observed that throughout her career, she has seen and experienced the importance of both “inside” and “outside” strategies. It is important for institutions and communities to work together, and also for community members to recognize that institutions are not monoliths. “All of us find ourselves inside and outside of different institutions simultaneously.” She shared an insight that the important job is to “make the institutional walls more porous.” She also suggested that the onus is on the institutions, which may be trying to paper their walls to prevent this. She asked the presenters to discuss how increased porosity can affect communities and institutions, and what they see as key components of porous institutional walls. The presenters were Sherri Charleston, Ph.D. (Harvard University); Benjamin Linder, Ph.D. (Olin College of Engineering); Nancy Oriol, M.D. (Harvard Medical School); and Joan Reede, M.D., M.S., M.P.H. (Harvard Medical School). They made brief presentations, followed by a discussion guided by Dr. Jones and workshop co-chair Shirley Malcom, Ph.D. (American Association for the Advancement of Science).

INSTITUTIONAL EXAMPLES

Diversity and Inclusion at Harvard University

Dr. Charleston described her work as Harvard University’s first chief diversity and inclusion officer within the Offices of the President and Provost. Harvard has a decentralized structure, she explained, and her office has to pull the community together to target initiatives and catalyze change. She noted that throughout her career she has been involved with student success. She observed the need for institutions to “ready ourselves for student success rather than shift the burden to the students.” This is especially important because underrepresented students are less likely to be full-time students, and degree completion rates, especially in science, technology, engineering, and mathematics (STEM) at Predominantly White Institutions, are grim. Culturally sustaining pedagogy is necessary to create success for students in STEM.

Dr. Charleston spoke about the Presidential Initiative on Harvard & the Legacy of Slavery, launched in 2020.¹ It began with a study commissioned by Harvard president Lawrence Bacow, Ph.D., about the university’s

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¹ For more information, see https://legacyofslavery.harvard.edu.

entanglement with slavery. It was a multi-school approach to harness the power of research to create an environment that lives up to Harvard’s motto of “Veritas,” or truth. The research was also foundational for work about belonging and for the next phase of the initiative on reckoning. Among the recommendations in the resulting report (Harvard University, 2022) are to engage and support descendent communities, honor those who were enslaved, work in partnership with Black colleges and universities, and honor and work with Native communities. An endowed fund of $100 million was created. One key is to work with and learn from Historically Black Colleges and Universities (HBCUs) and other Minority-Serving Institutions so that Harvard becomes a student-centered, student-ready institution.

Engineering for Everyone at Olin College

Dr. Linder explained that Olin’s vision of “Engineering for Everyone,” as articulated by Olin president Gilda Barabino, has two embedded meanings. Engineering education is for everyone, and engineering as a profession must serve everyone.² Olin’s new strategic plan prioritizes impact-centered education. As an example, Dr. Linder described the social innovation program he directs called Affordable Design and Entrepreneurship (ADE). Twelve years old, ADE involves undergraduate students in engineering, business, and the liberal arts at Olin, Babson, and Wellesley Colleges.³ He explained that the term “affordable” signals equitable design and entrepreneurship with respect to communities’ social, political, economic, and environmental contexts.

The mission is to inspire and educate students to work with people and communities to address challenges endemic to injustice through design and entrepreneurship. The shared community values are people, impact, humility, and justice. In practice, there are five tracks with multidisciplinary teams: air quality, community development, food processing, global health, and rights and privacy. Dr. Linder identified three reasons why ADE is important.

First, a key component for more porous institutional walls is practice-driven purposeful work. Bryan Stevenson, founder of the Equal

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² See https://www.olin.edu/about.

³ For more information, see https://www.olin.edu/ADE.

Justice Initiative, has said that an important way to fight injustice is to get closer to the issues, proximate to the suffering.⁴

Second, purpose-driven porosity affects internal learning communities, making them more accessible to students, faculty, and staff. He noted that minoritized students enroll in ADE at levels beyond their representation at all three campuses, adding that evidence shows educational experiences that help make the world a better place are more attractive, welcoming, and inclusive for students from diverse backgrounds. Engaging with communities outside the walls of the academy changes the community beyond the students when they come face to face with the diversity, or lack thereof, among the faculty and staff. Representation is a form of institutional porosity, he suggested.

Third, creating the conditions to practice purposeful work requires intentional design of the learning community beyond what usually happens in the academy. Social learning theory supports the idea of identity development and progressive participation by students. ADE students are learning how to make a difference, he said. The message to students is that they are welcome and trusted. Students take ADE for one, two, or three semesters and thus decide how involved they want to be in this type of participation. These intentional structures challenge conventional academic systems, he added, from staffing courses, to registration, to academic calendars.

Family Van and Harvard Medical School

Picking up on the theme of getting proximate, Dr. Oriol discussed the Family Van, a mobile health unit she helped create in 1992. At that time, the neighborhoods around Harvard Medical School had exceptionally high infant mortality rates, and she realized she wanted to help. She grew up in Philadelphia, Pennsylvania, near Temple University and felt the answers would not come from a hospital. As an anesthesiologist with no public health training, she knew she did not have the answers herself either. So she and a third-year medical student went to the streets to see what they could do. It became clear, she said, that the issue was not just infant mortality, but more broadly, the diseases of poverty that affect everyone. They spent a year working with formal and informal community groups to figure out how to bring services to the people. The Family Van was set up to provide

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⁴ See, for example, https://www.carnegiefoundation.org/blog/empathy-and-social-justice-the-power-of-proximity-in-improvement-science/.

screenings, make referrals, and offer other services to address the social determinants of health. Community health workers run the program, in collaboration with neighborhood health centers, in a model they call “the knowledgeable neighbor: someone who understands your world, listens without judgment, and shares their knowledge to help you take care of yourself.” She noted that the concept has grown and evolved continuously over the years.

The Family Van is funded by philanthropy with Harvard Medical School supporting about 20 percent of the budget. She noted that the school has never tried to control or brand the van. “They recognize and respect that our success is because we were designed and directed by our community.” For the first 5 years, student volunteers were not involved because it was felt that a foundation needed to be built with regular staff who knew Boston well. To expand services and offer services in additional languages, they began to accept student volunteers, which is now valued by both the students and the community members. Community members enjoy the students’ energy, appreciate that they are helping to educate the next generation in how to listen, and are particularly proud when the volunteers are students of color. Students of color say that the van is an oasis and inspires them to share their knowledge, feel less isolated, and battle constant assimilation anxiety.

While the community foundation and social mission have inspired hundreds of scholarly projects over the years, she stressed that the Family Van has been a vibrant two-way street of knowledge and respect. It was designed by mining the brilliance of the community, and every student can see the value from listening to and learning from the community, as well as experience a model of care based on patient autonomy and self-knowledge. Evidence that the approach works includes both stories and data. A paper in Health Affairs documents improvements in blood pressure better than traditional settings, resulting in saved money and lives (Rittenhouse et al, 2020). Increased community efficacy and generosity have also been shown, and students have also been positively influenced in terms of their empathy and cultural humility. She estimated the operation of about 2,000 mobile clinics around the country, about half of which are part of a collaborative network to share best practices.⁵

Sharing a photo of a ribbon cutting of a new van, Dr. Oriol characterized it as a “picture of porousness.” Surrounded by community health

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⁵ See, https://www.mobilehealthmap.org/.

workers, students, medical leaders, and others, funded by Harvard Medical School and Boston Scientific, the Family Van was designed by the community to address their health issues. It provides an oasis of comfort and growth for the community and students, she concluded.

Biomedical Science Careers Program

Dr. Reede observed that institutions with DEI programs target individuals at different stages in their careers, but they are often siloed, and opportunities are missed as people move from one stage to the next. To bridge these gaps, the Biomedical Science Careers Program (BSCP) encompasses medicine and other health careers to come together to support students. It began in her office at Harvard Medical School but is now a separate nonprofit. It supports students of every race, ethnic background, financial status, and gender, from high school to postdoctoral. Students are brought together with advisors and mentors in their fields of interest. It has involved more than 15,000 students, trainees, and early-career professionals and 1,500 volunteers in 38 states. Several programs have spun off from it, including the New England Science Symposium in which students at every level, especially students of color, share their biomedical and health-related research, engage in discussion, create their own community, and expand their professional networks. BSCP provides a way for industry and the academy to come together to support students and help them transition from one level to the another. Dr. Reede shared written testimonials from participants about the role that BSCP has played in their pathways, including finding ways to connect during COVID-19.

Dr. Reede suggested four aspects of BSCP related to porosity. The first is shared ownership in all aspects of the program. Second is inclusion of multiple voices who can be responsive to changing environments and needs. Third is continuity across academic and career transitions, with multiple points for entry, exit, and reentry, rather than just one path. Fourth is the need for sustainability.

DISCUSSION

Dr. Malcom observed that the presentations came from the country’s oldest and one of the newest institutions and show that porosity is different in different places. Olin, which was established in 1997, has an advantage of starting with a blank sheet of paper, she observed. Change looks different

at Harvard, and change may have to be created on the outside to address what is happening on the inside. She questioned how good ideas can change structures and systems, not just tinker around the edges.

“In-Reach” and Outreach

Dr. Jones asked Dr. Charleston about the role of the community in the Legacy of Slavery initiative. Dr. Charleston noted that one aspect of the report (Harvard University, 2022) was recognition of the need to learn from HBCUs and community colleges, but to design slowly and with intentionality to create enduring partnerships. Dr. Malcom agreed that co-creation is the best strategy. As a regent at Morgan State University, she commented that she sees opportunities but also resource constraints that confront HBCUs, as shown in the differences in endowments between Morgan State compared with Harvard.

Dr. Jones noted that the workshop has focused on community support and inclusive excellence to promote Black men and women in science, engineering, and medicine, and asked about the different types of communities in which institutions find themselves. Dr. Reede said these different communities are not mutually exclusive. The people and organizations are often connected and overlapping. Part of what we need to do is de-silo, she said, to see connections and leverage opportunities.

The question is how to use these relationships and build more porous institutions and value the brilliance not yet known, suggested Dr. Jones. In response to a question about why ADE is not required for all students, Dr. Linder explained that it started across several different programs and was created as an experiment. It has grown over the years. It is not required out of recognition that not all students identify with this type of work at this stage in their lives. That said, he noted that many other programs at Olin reflect ADE’s participatory and intentional work.

As another example of porousness, he pointed to Olin’s partner Insper, a business and engineering school in Brazil, which designates a faculty position for a community member. The individual participates in the academy, which is the opposite direction of the normal flow. The appointment is a direct recognition of the excellence, insight, and expertise in the world that is vital to students, Dr. Linder observed. Dr. Reede added that the curriculum can also incorporate meaningful community input such as in grand rounds, faculty training, and other ways to share expertise. “It’s not a question of how am I going to find community, it’s

how am I going to find the expertise I need. Expertise exists in many places,” she said.

Dr. Oriol noted that the Family Van began with trying to solve the specific problem of infant mortality, but it has also shown an entire generation of medical students the value of co-design and the brilliance of the community. While not intended initially as an activity to increase the porosity of the institution, the Family Van has facilitated better engagement with community partners in the institution’s work on infant mortality and supported the training of medical professionals with a better understanding of the need for bidirectional interactions. Many volunteers have gone on to positions of power, with students recognizing the value of listening to and learning from the community. It has also inspired many community members to go on to school or pursue careers. High school and undergraduate students have the opportunity to take initiative; for example, a college student co-developed a course for high school students about reproductive health that has been applied elsewhere. Dr. Malcom suggested that needs like these may not be fulfilled outside of the community. She wondered if this approach could affect medical education, which is often quite rigid. Dr. Linder noted analogies in engineering education. Institutions are inherently conservative and will not change without being proximate to other options, he commented. ADE demonstrates another set of values and can raise questions about other programs. An important part of the Olin approach is constant experimentation, he added. “We have lots of places where we can do better, but Olin was founded to transform engineering education. Having positionality around questioning education itself and serving as a lab school with experiments like ADE and engaging in conversation with peers like Insper in Brazil, leads to change.”

Dr. Reede suggested the importance of developing and designing efforts to bring people in, open their eyes to possibilities, and carry them forward, while also creating spaces for individuals who can become decision makers and challenge assumptions. In these spaces, she said, there should not be just “one person” but an army of individuals trained to be in those spaces and have not just a seat at the table but a voice to lead and determine the agenda. How to prepare people with different perspectives and thinking about what excellence is are needed. Harvard should be striving to get these perspectives because it is essential and fundamental to organizations thriving. She called for both “in-reach and outreach,” as well as humility and de-siloing the work.

Use of Data

Dr. Malcom agreed with a participant’s comment about collecting longitudinal data on these and other programs. She noted that the data are needed to “justify what we do” to convince people about its value. Dr. Charleston described her involvement with a group of community leaders in Milwaukee to use data to move programs forward. Two things emerged. First, sometimes programs are not designed with data-informed practices in mind. Second, when doing this work, it is a long game. Data become essential to benchmarking, to figure out what is being done wrong and right. Diversity is a source of excellence to get to better solutions. In looking at student success, she called for going to the source—the students themselves—which speaks to how institutions can become more porous. “We won’t be the institution of choice for students of color if we are not responsive to their needs,” she added. Creating more opportunities for faculty who are grounded in the community and with each other makes an institution more porous.

Dr. Reede reinforced the need for value. Data are needed not only for funders but also to improve programs and ensure the programs are worthy of the people they are intended for. Dr. Oriol echoed Dr. Reede’s comments mentioning that when you do work that is proximate you often find that the impact is different than expected and that data can assist with evaluating the actual effect of initiatives. The Family Van also collects data for many reasons. It can lead to surprises, she added. She reminded the group that Family Van began with a goal to reduce infant mortality, but only men came for the first 18 months. “This was a surprise because it was assumed that ‘men don’t care about their health.’ What is wonderful about the van is that the data [are] who comes to the van, and it took 10 years of data to develop a clearer view of the impact of the Family Van. If you don’t give people what they want, they won’t come,” she said. Through the data you not only support the evolution of the program that you are administering but also develop best practices for translation and implementation to be used by other groups and researchers.

FINAL THOUGHTS

In closing, Dr. Reede said, “The minute you start to assume things, assume you are wrong. It’s time to stop and rethink.” Dr. Oriol commented that trust has become the big word in health care, but in solving problems

that need proximate exposure, “the operative word is respect.” Dr. Linder suggested framing STEM work as relational and developmental. He stressed the value in engaging with young people so they can innovate to solve problems. Dr. Charleston noted the need for sustainability by creating structures that outlast individuals and to connect bigger structures with what is happening on the ground. She urged looking for places where university strengths align with public problems, create structures, and resource them long term. Dr. Jones concluded, “Each of us has to take our own strengths and passions and dig in where we are, recognizing that we do not have all the answers, but that everyone has something to teach us.”

REFERENCES