The Toronto Star recently published a front-page article on the University of Toronto medical school’s new Black Students Application Program. One of the key people behind this timely program is Dr. Lisa Robinson, who is a woman with many titles: she is a pediatric nephrologist at SickKids, a scientist and Canada Research Chair, a professor at U of T, and the first-ever Chief Diversity Officer for the Faculty of Medicine. She is also a Black physician. Given her unique intersection of roles, we wanted to feature her on the ArtBeat blog.
Sophia Wen: You are a pediatrician, scientist, and also U of T’s first Chief Diversity Officer. What was your path to these diverse roles?
Lisa Robinson: My path to the other roles is not so unusual. I am a Torontonian originally and did my undergrad at U of T way back a hundred years ago, so I didn’t do a four-year degree, I just did two years. So I went to medical school after that, and then I did my internship in Internal Medicine at Toronto General and quite enjoyed that. If we had “med-peds” programs in Canada the way we did in the US I would’ve done that. Then I did pediatrics – I didn’t get exposure to pediatrics until quite late. I did my residency at Western and then from there I decided to do my fellowship in nephrology. At that point I wanted to combine medicine with intensive research training because a career as a clinician-scientist really appealed to me. For my fellowship I moved down to Duke, in North Carolina. It was a part of a program called PSDP (Pediatric Scientist Development Program), which recognizes that we have few pediatricians who decide to pursue careers as clinician-scientists. I did my research training in the departments of immunology and medicine for four years, and then stayed on as junior faculty for three years. I came back to Toronto in 2002; I’ve been at SickKids ever since. I am a pediatric nephrologist and my clinical interest is in kidney transplantation and acute kidney injury. My research is in mechanisms of lymphocyte trafficking, endothelial injury, and inflammation.
And then there’s my role as Chief Diversity Officer. It’s something that I’ve been thinking about for many many years – not that specific role – but being an underrepresented minority, physician, and scientist, it’s something I’m always aware of. When I go to meetings or conferences, I always do that quick look around the room – not that I should – but I’m always aware of it. I am aware that we are not that diverse in those disciplines, even in Toronto, which is one of the most multicultural cities in the world. In our medical school – not just students but also faculty and graduate trainees in both the clinical and research side – we are not that reflective of our community.
I’ve said in previous interviews that I graduated from U of T 25 years ago. 25 years ago, there were two Black medical students in my class, and it’s not so different now. Toronto is about 8.5% Black. That’s just one example, and there are lots of examples.
In all my roles, I’ve had the opportunity to interact with many different learners for many years. Ever since I’ve had a lab, I’ve always had high school students. I particularly make a point to recruit underrepresented minority students to work in my lab in the summers. I’m really aware of the difference mentors can make, and just how seeing people who look like you can do so much in opening up possibilities.
S: Do you think that being an underrepresented minority has impacted your career and choices?
LR: It’s possible, but I’m very lucky in that I grew up in a household where education was incredibly important and very stressed. Even from when I was young, I was always encouraged to pursue higher education and I always was told, “If you put your mind to it, you can do it.” But I think if I didn’t grow up in a household like that and I didn’t have role models that I could see, visibly, who made me feel like I could do anything if I set my mind to it, I might have turned out very differently.
S: I saw that you founded the Kids Science Program. Could you tell me about that?
LR: I was at Duke for three years, and from the time I started, they had lots of programs at the medical center with close partnerships to the community. I always had middle or high school students who would shadow me or come to the lab and develop those ties. When I came here, I was doing a grant review and there was an outreach component to it. At that point, I became aware we didn’t have a program like that, and that struck me as being really weird. Here we are, in downtown Toronto – one of the most multicultural cities in the world – and it seemed like the perfect opportunity to have that program.
We started the program in 2006 and it’s been going strong ever since. The aim is to work with at risk youth and expose them to careers in STEM fields – sciences, medicine, technology – and to provide experiences they wouldn’t normally have. We work with kids in priority neighbourhoods in the GTA, a lot of the ones that we read about as being challenged by many different issues. We also partnered with the district school board of Ontario Northeast which has many First Nations kids. We also work with kids who receive medical care at SickKids, kids with chronic health conditions because for lots of different reasons, kids with chronic conditions are streamed away from anything academic. People feel like it’s too hard for them, or too much, so they’re not encouraged in the way they should be.
There are different components to the program. We have a Speakers Bureau, where we’ll go to the classroom. We have community partners, such as Visions of Science, which is an after-school and weekend club for underrepresented minorities, in particular Black youth. We go to community clubs and try to expose the kids to science. We partner with schools, so we go to the classrooms and send people to speak to the kids about themselves and their work. We try to make sure it’s really relevant, so the kids see tangibly what you can do with a background in science. The people who speak can be anyone – graduate students, post docs, PIs, technologists, technicians.
If you talk to many young people from marginalized communities and ask them what a scientist looks like, to them it’s some middle-aged white man. But the people who come speak to them are very diverse. There are lots of women, people who belong to many different communities, and their paths are often not so different from kids sometimes.
S: Since it’s been ten years since the start of your program, have you seen any of the long-term effects?
LR: Yes, I think so. It’s hard to quantitatively measure; we survey the kids and the teachers, and we definitely see changes in terms of the kids’ awareness and interest in pursuing science. Obviously, it’s really hard to track the kids for privacy and confidentiality reasons. What we have heard anecdotally from some of the schools is that after the kids participate in the program, especially the middle school kids, they’re more likely to want to pursue more than one science in high school.
We’ve had 16,000 kids involved in the program in some way. It’s all about opportunity; I think about that all the time. I’m so lucky to be able to do all the things I do, but I’ve had lots of opportunities and lots of mentorship in my life. Think of all these incredibly bright young people out there, and if they even had a fraction of the opportunity, think of all the amazing stuff they could do.
S: Could you tell us a bit more about your work as the Chief Diversity Officer and what you do on a daily basis?
LR: It’s a brand new position, I started a year ago exactly. The first year was about taking stock of where we are because there is a lot of excellent work done within the city. The ultimate goal is to make sure our medical school and faculty community more reflective of our actual community, and also making sure that this place is welcoming and inclusive of everybody so that everybody feels as if they belong here and have a chance to succeed.
Part of that is trying to understand who is here. Unlike in the USA where demographic information is always collected and has been for many years, we’re pretty new on this journey. We have some information but not a lot. We have some information on the medical students, but we also need to understand who’s applying to the medical school. Is our applicant pool also not that diverse, or are they diverse and we’re just not accepting them? Because that requires different approaches.
We don’t know much about post-MD training or our faculty either. If you think about the science side as well – there are a number of basic science departments affiliated with us – we have no information as well. We also have no information on the staff here.
Another part of it is trying to understand the experience here. So what’s the culture?
We don’t have to reinvent the wheel; there’s lots of great work being done. At Mount Sinai, there’s a fantastic program called Are You An Ally, bringing attention to what it means to be an ally to people who belong to various communities. This is information and education required of everybody there, including the leaders. We could partner with groups like this and use some of their great resources here.
I’ve also been thinking a lot about unconscious bias. We’re all biased, but being aware of [our biases] and actively thinking about how to keep our biases in check and mitigate them is very important. For all admissions committees and hiring committees, we’re developing educational tools around that.
S: What are some things U of T is doing well in terms of diversity?
LR: One thing we’re doing well is we’re talking about it, which I’m so happy about. It starts at the top. I feel very fortunate because of the leadership. We have a dean who is very supportive of these efforts and it’s part of his mission to make diversity a priority. We are openly talking about a lot of these issues. Another issue we think about a lot is women and academic promotion in the faculty. We have lots of women in the Faculty of Medicine – not in all departments – but there are differences. Even in departments where there are many women in the assistant professor level, most of those departments have proportionally more men at the full professor level than women. So we’re trying to think about why that is, and what can we do to address it.
The communications department is fantastic and they’re adopting out-front journalism. It’d be one thing if we knew about these issues and we were quiet about them, maybe quietly trying to address them but not talk about it, but we’re doing the opposite. As we identify these issues, we put them out there and we say, “Look, this is what the situation is and that is not what it should be in 2017, and this is what we’re trying to do about it.” That way we’re getting everybody thinking about it and not trying to hide behind our shortcomings.
S: So in terms of things we can do better, what are some changes you’d like to see?
LR: Very good question. In terms of numbers, that takes a while to change the demographic. The culture is something we can work on. Bringing attention to the experiences of groups who are not as well represented in our environment or whose issues we don’t really talk about. Bringing attention to everybody’s lived experience, and recognizing the fact that we need to learn from each other and be supportive of each other. Not just within the walls of medical school but also in the hospitals because a lot of the education is within the hospitals; we need to bring more attention to the discussion of the culture.
Bringing attention to the fact that people have different experiences is important. This is an out-there example, but I’ve been around for a while. Not too long ago, I was on the nephrology consult service and I went down to do a consult in the ICU on a very sick child. After, I sat down at the computer to write my consult note, stethoscope around my neck, and meanwhile the team was requesting a consult from a different, surgical service. The trainee came down and did the consult and spoke to the team. The trainee came up to me afterwards and asked me to stamp up some patient requisitions for him because he assumed that I’m the unit clerk. I tried to explain to him that I’m not the unit clerk, and he was really confused about who I was. That’s just a small example but unfortunately that kind of thing happens all the time to many people in our community. He wasn’t rude or anything, but that was just an assumption that he made.
S: How can people who aren’t underrepresented in medicine help the groups who are more underrepresented?
LR: The first thing is enhancing awareness. For example, at OHPSA, Ike Okafor created the Community of Support in 2015. We had some options for high school students but there weren’t that many mentorship options for undergraduate students. So the community of support was created for underrepresented undergraduate students, many of whom were Black. Since Ike started that program in March 2015, he’s got over 500 students now. It’s mentorship and programs, exposure to research programs, help with personal statements, and more. A lot of mentorship in the past was done through the Black Physicians Association of Ontario and the Black Medical Students Association, but there’s only a tiny handful of people there. You don’t need to be Black to mentor a Black undergraduate student. That’s a perfect example of where there are more than thirty medical students now working with the community of support to provide opportunities.
You have no idea how experiences like that can impact students on the receiving end. Because otherwise, where would they get that info and who would they talk to? It can make all the difference in what they decide to do career wise.
S: Have you faced any challenges while setting up these programs?
LR: Sometimes. Overall, the time is right because people in general recognize we need to do things a bit differently. But that’s not always the case. People in medicine and science tend to be a pretty data-driven, skeptical bunch, and they want the data sometimes. Some people also like the status quo, especially when it’s so competitive to get into medical school. The system obviously favours the way it is, and it may favour people’s children, siblings, friends’ children. So if you’ve got those advantages and the system is like this, then those who are close to you may have the same advantages.
So not everybody wants things to change, I think. It would be nice if everybody thought, “Maybe we need to think about things a bit differently because that’s the right thing to do,” but not everybody thinks that way. One of the challenges is needing to bring science and data to this. I don’t view that as a negative, and being a scientist, I’m very happy to do that. One of the approaches we’ve been trying to take is get the data. For example, there was a study done not too long ago looking at the opportunity costs associated with the MCAT. Not just the cost of the test, but the costs of the courses, the study materials, or not working in the months up to the test. It is thousands of dollars and it’s a huge barrier. Many students can’t afford those thousands to prepare adequately for the MCAT and do well on it. I won’t view it as a challenge in the negative sense; I view it as an opportunity.
It’s well-established that if you have a diverse medical school class, the curriculum is better, and there are more opportunities to challenge the hidden curriculum. There are also lots of data to suggest that patients report better care when there’s a diverse physician workforce. There is some data to suggest that diverse teams – from both a gender and ethnic perspective – leads to better science being done, and you publish papers in better journals. Using this kind of data is justification for lots of people.
S: You mentioned that you’d like to see the numbers for our medical school class be more reflective of our community. What do you think anything needs to be changed in the admissions process?
LR: Several things need to change at the same time. One thing is information and education for prospective applicants around medicine as a possible career path. And that doesn’t start when you’re in undergrad, it starts probably even in middle school and high school because that’s where you’re laying the ground that gets people to the path to applying. There’s no point in thinking about medical school for the first time when you’re in the third year of undergrad because the die is cast a bit by then. I think that’s probably the most important piece: much of the focus should be on pathways to medicine.
For admissions, we need to think about people’s applications in a more holistic way. I commend the admissions office here because they’re very well aware of that and they’re trying to think about that. We need to think about people’s experience in a different way. In the past, we put a lot of emphasis on volunteering and doing research. Even for volunteering, for example, what if you don’t have time for that because you’re looking after your family? It’s not necessarily valuing certain experiences over others, it’s a more holistic understanding of what those experiences meant to you and what you got out of them. We need to think more about those lines. Opportunities for experiences differ very much depending on the person’s circumstances.
We need to be able to explain better to applicants that it’s really about how you talk about your experiences, and how you convey to the admissions committee why your experience matters, and what you got out of it. For example, somebody who’s managed to hold down a part-time job all throughout high school and undergrad while doing well is really impressive. It says a lot about that person’s ability to focus, time-manage, work under pressure…those kinds of things. We should make sure that we’re educated to think along those lines.
S: What is the most rewarding part of what you do?
LR: This is going to sound so cheesy, but I honestly think I have the best job in the world because I get to do so many different things, all of which I find incredibly rewarding. One of the things I find the most rewarding is the variety. I love clinical medicine, I love working with kids and families, but I also love the science. I love the opportunity to be able to go to the clinic, see what I see, go back to the lab and think about different approaches to solve problems. Even if I’m thinking on the molecular and cellular level for that problem, with the hope that one day I’ll bring it back to the clinic; I love that continuum. In terms of the diversity and inclusion work, I really love getting to interact with lots of different people, especially young people. I love being able to work with students – high school, undergrad, medical students – who are so keen to make the world a better place and think about things a different way. Their minds are like sponges in a way. And it’s fun!
The students help me. I think I get more out of interactions with them than they do with me because I learn things all the time and it makes me see things from perspectives I never considered before.