Honoring Excellence: Q and A with Katherine Julian, MD of the University of California, San Francisco
This interview is one in a series of interviews with recipients of the 2024 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 March 7-9, 2024, in Orlando, Florida.
The University of California, San Francisco (UCSF), an ACGME-accredited Sponsoring Institution in San Francisco, California, is recognized with the 2024 Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award. Associate Dean for Graduate Medical Education Dr. Katherine Julian, who also serves as the Sponsoring Institution’s designated institutional official, answered the ACGME’s questions about the institution and its efforts to foster diversity, equity, and inclusion.
ACGME: Can you tell us a little bit about your Sponsoring Institution?
Dr. Julian: The UCSF School of Medicine strives to advance human health through a fourfold mission of education, research, patient care and public service. Established in 1864 as Toland Medical College, the UCSF School of Medicine (UCSF SOM) is the oldest continuously operating medical school in the western states. The UCSF SOM occupies eight major sites in the San Francisco Bay Area and in the San Joaquin Valley, with 28 academic departments, eight organized research units, and seven interdisciplinary research centers. The UCSF SOM employs approximately 6,500 full- and part-time faculty members, as well as approximately 2,200 volunteer faculty members, 2,000 non-faculty academics, and 5,800 staff employees. The SOM trains more than 800 MD students, nearly 900 PhD/MS students, and more than 1,700 residents and fellows in 103 ACGME-accredited programs and more than 100 non-ACGME-accredited programs. The UCSF SOM’s education focus is on educating the physician workforce that its patients, state, and nation need, ensuring that every UCSF graduate is prepared for a career providing compassionate, patient-centered care grounded in scientific and scholarly inquiry, social justice, anti-racism, and interprofessional teamwork.
ACGME: Why is your institution so dedicated to the concepts of diversity, equity, and inclusion?
Julian: UCSF has made a commitment to Advancing Health Worldwide. Fulfilling this commitment requires solving the most complex problems in science and health care for all communities and populations. We need diverse team members—those with different backgrounds and life experiences—to address the complex problems our patients face. To build the diverse health care community we need means we must create an environment where all our UCSF community members can thrive and do their best work. That means creating an environment that is diverse, inclusive, and equitable.
ACGME: What work/initiative are you specifically being recognized for?
Julian: The UCSF SOM enacted the Differences Matter initiative in 2015. This multi-year initiative was designed to make UCSF home to people with diverse identities, all of whom are committed to advancing equity, belonging, and anti-oppression in medicine. The first five-year phase of the Differences Matter initiative had six major focus areas: 1) Leadership - to develop an informed, committed, and diverse leadership who are dedicated to advancing diversity, equity, and inclusion in all mission areas and at all UCSF sites; 2) Diversity, Recruitment, and Climate - to increase the diversity of our faculty members, residents, and professional staff members, and increase the personal competencies of all our professionals in teaching, leading, and managing a diverse community; 3) Education - to cultivate the highest quality, most inclusive learning environment for our medical students, residents, and fellows; 4) Clinical Care - to identify and address health care disparities in the clinical environment, at UCSF, and at UCSF affiliates, and ensure that health care professionals are skilled in working with diverse communities; 5) Research - to increase the diversity of our scientific workforce and our clinical trials participants, and to work to ensure that our discovery engine provides better insights into the health and health care needs of our increasingly diverse population; and 6) Pipeline, Outreach, and Pathways - to establish UCSF as a destination for those who seek to eliminate opportunity disparities in our communities.
The UCSF SOM has launched the next phase of this initiative to not only sustain the success of the first phase of Differences Matter, but to implement new areas of focus that have the potential to accelerate the achievement of equity, belonging, and anti-oppression across the medical profession. These new areas of focus include: 1) Diversify Medicine - to expand faculty and leadership from historically excluded groups to transform UCSF and the nation’s medical schools to better solve the complex problems that continue to face our increasingly diverse communities; 2) Generate, Disseminate, and Apply New Knowledge - to critically analyze and explore the role of race, ethnicity, gender, gender identity, sexual orientation, and oppression related to membership in diverse groups in medicine, science, and health, in particular in emerging fields of population health and precision medicine; 3) Build Anti-Racism/Anti-Oppression Expertise within UCSF - to establish competencies by role and devise educational strategies for individuals to develop these competencies, using both internal and curated external resources; and 4) Optimize the Culture of Equity and Inclusion at UCSF - to embed anti-racist and anti-oppressive principles in all systems and structures of the School and provide central resources to support the work of control points so that all have the opportunity to thrive and contribute.
ACGME: Could you explain what that work/initiative looks like?
Julian: As I explained, the UCSF SOM Differences Matter initiative had six initial focus areas (or “pillars”). The first was a “leadership” pillar, which focused on leadership infrastructure needed to advance diversity. A critical reason for the success of the UCSF SOM Differences Matter initiative was that the initiative had support and buy-in from UCSF leadership. To implement the work stemming from the various Differences Matter focus areas, an Executive Advisory Board composed of various SOM leaders (including the DIO and Vice Dean for Education) and Dean’s Diversity Leaders, was created that reported to the Dean. Each focus area had both a faculty and a staff lead (with supported time to lead this work). Each focus area then had additional SOM faculty and staff member participants who volunteered time to advance this important work.
You can learn more about infrastructure and interventions instituted through the first phase of Differences Matter and our individual departments that have helped change the culture at UCSF.
ACGME: How has this work/initiative helped make your institution more diverse and/or inclusive?
Julian: Our recruitment efforts of diverse individuals begin prior to medical school and continue through faculty and staff member recruitment.
Our pre-medical school pipeline programs through the UCSF Center for Science Education and Outreach assist first generation, socio-economically disadvantaged learners by helping them to pursue post-secondary education.
As part of recruiting diverse medical students and advancing patient equity, UCSF developed the Program in Medical Education for the Urban Underserved (PRIME-US), a five-year track for students committed to working with urban underserved communities. This program expanded to the San Joaquin Valley (SJV Prime) for medical students committed to ensuring equitable care for patients in California’s underserved San Joaquin Valley.
UCSF School of Medicine utilizes holistic review for all medical school applicants.
Recruitment of diverse individuals to residency involves multiple initiatives. The UCSF Office of GME hosts the Visiting Elective Scholarship Program (VESP) to encourage fourth-year medical students to complete a clinical elective at UCSF. VESP encourages applications from learners who are from disadvantaged backgrounds, have demonstrated a commitment to working with traditionally disenfranchised populations, or have demonstrated a commitment to working on issues related to diversity, equity, inclusion, and social justice. Additionally, we regularly recruit for our UCSF GME programs at the national Student National Medical Association and the Latino Medical Student Association. We host first- and second-look programs for applicants. All our GME programs utilize holistic review for all GME applicants.
For faculty recruitment, we have implemented a variety of processes to advance diversity. All candidates are required to submit a diversity statement as part of their application. As part of faculty recruitment and retention, UCSF SOM established the Dean’s Diversity Fund to support the recruitment and retention of faculty members committed to diversity and/or who focus on health equity, anti-oppression, and health and health care disparities.
Additionally, our Sponsoring Institution continues to work to build an inclusive community for all individuals. In GME specifically, we continue to work to build community through numerous social events and activities. We also regularly collaborate with our Office for Diversity and Outreach on gathering events.
Finally, we have implemented a GME Pathway program. One of these pathways, the Health Equity and Racial Justice Pathway, engages learners to work to actively dismantle systems of oppression that perpetuate health inequities.
ACGME: How could others use your work/initiative as a model to become more diverse and inclusive? What advice do you give to GME leaders who are looking to do just that, but aren’t sure how to start?
Julian: While there are many contributors to the success of the UCSF SOM Differences Matter initiative, I would highlight four things:
- First, there was a real commitment to the Differences Matter initiative from the leadership team. Not only did this allow for a leadership structure (Executive Advisory Board) for ultimate program oversight, but it also helped create accountability for the various program initiatives.
- The leadership of each of the Differences Matter focus areas was shared by a faculty lead and a staff lead. This allowed for even greater buy-in and more expansive work.
- The design of the Differences Matter initiative with six main focus areas allowed each to have a clear (and narrower) concentration. It also allowed the SOM to ask for faculty and staff member volunteers to help with each. This structure then created smaller “communities” to do this important work so that volunteers came to the work with the necessary interest and commitment.
- Finally, another key element is the ability to obtain regular outcomes data for any of the work being done, so one knows whether the changes being made are successful.
I would also encourage GME leaders that an institution doesn’t have to start with such an ambitious initiative! GME leaders will want to consider their most pressing issues and address these first. These may include broadening the review of applicants to a more holistic approach to advancing initiatives that make the learning environment more inclusive.
ACGME: Is there anything you would like to say that I haven’t already asked?
Julian: I want to emphasize how many people at UCSF visioned, led, and contributed to this work. This includes our SOM leadership, our Dean’s Diversity Leaders, our Executive Advisory Board, each of our Differences Matter focus area leaders, and the many UCSF community members who volunteered their time to work on each initiative. This has truly been a collective effort and I cannot take credit for all this work. The success of the Differences Matter initiative belongs to the UCSF SOM.
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 2025 Award – nominations are due by March 27, 2024. Online registration for the 2024 ACGME Annual Educational Conference closes February 16 – learn more and register today on the conference website.