00:00:00 Hey, everybody. Welcome to another episode of the Healthy Project podcast. I'm your host, Corey Dion Lewis. And today we've got a very special guest joining us. I have Dr.

00:00:12 Malika afFair. She is a leader in health equity. She currently serving as the Senior Director of Equity and Social Accountability for the association of American Medical Colleges, or AAMC. Dr. Fair, thank you so much for being here.

00:00:29 I really appreciate it. Thank you for having me. I'm really excited to be here with you today. Yes. So before we get into the conversation, can you tell the people a little bit more about yourself and what gets you up in the morning?

00:00:44 Sure. So I am an emergency physician by training, and I work at the AAMC doing work that helps both medical students think deeply about what it means to be a physician, not just for the patient in front of you, but for the community that they are serving to improve health. Yes. But also to achieve health equity. So what gets me up in the morning?

00:01:10 One, I have a toddler, so she gets me up in the morning really quickly. But what's my why she is part of it? Because I see a future where when she walks into the hospital, she's treated Fairly and she's not treated just based on the color of her skin, but she's given all of the opportunity to live a healthy life and achieve her own health goals. And that's just not the case in our nation. It's not the case in our world.

00:01:42 And I was introduced to this as a young child. Well, as a teenager, I remember my dad brought me an article home and he talked about inequities in HIV AIDS medication and what was happening in South Africa. And he basically said, Malikaa, you say you're interested in all this health care stuff. Here's a problem. And people that look like you on the other side of the world don't have the same medications that we have here.

00:02:12 What are you going to do about it? And I remember thinking to myself, I'm 16.

00:02:20 That's a big question to ask. But it planted a really important seed, not necessarily of solving that problem, but how do we solve these problems in our health care system? So I always went in thinking I wake up every day to solve problems, to fight for those who cannot fight for themselves, to think about people who are marginalized in some way, under resourced in some way in this nation. And they should have the best not only health care, but they should be able to have total health. No.

00:02:55 Absolutely. And I think it's so beautiful how you're kind of the beginning of your journey in healthcare, becoming a doctor, an emergency medicine physician. It's just great. What got you excited about specifically about emergency medicine? And how do you feel like that experience helps with your current role in equity and social accountability?

00:03:27 So this is a brief shout out for my mentor, dr. Marcia Perry, at the University of Michigan. She introduced herself years ago when I was a medical student as an emergency physician and gave me an opportunity to shadow her. And I remember thinking to myself, I can't go into emergency medicine, and that's a scary, busy place. And I also thought about, do I feel comfortable driving at night in Flint to Flint, Michigan?

00:03:58 Do I really want to be in the Er? So that was one side of me, and the other part of me said, this is an established, really impressive black woman physician, and she's offering up her time to let me shadow. Why would I say no? So I listened to the second voice and went to Flint, Michigan, and was blown away by that experience. And I shadow her multiple times.

00:04:23 She has, was, and has been a fantastic mentor for me. But what I saw was something I had been looking for up until that point. I saw patients who looked like me, who came from a similar background. I also saw medical school come to life because up until that point, I had been learning about medicine and learning about diseases in the books and in classes. But I hadn't seen someone come in with a stab wound, a heart attack, a baby being born all in the same night.

00:04:56 And so it was like medicine jumped off of the books. And the last thing I saw was the state of the healthcare system right in front of me. Everything that's right with the healthcare system, everything that's wrong with the health care system manifests itself in the Ed. And so for someone who already knew I wanted to take care of patients with marginalized identities, black patients in particular, someone who was interested in public health and someone who wanted a fabulous mentor, I was sold. I was sold in the Hurley Flint emergency department, and I've kind of been sold ever since.

00:05:36 Yeah, that's so great. And I can relate to a certain extent because for myself, working as a clinical health coach in a federally qualified health center, you hear about before I started in that position, I heard about social determinants, and I've heard about these things, but it was so different. When I'm in that clinic and I'm working with somebody who has an A, one C of 14 and they have no transportation, the closest food they have is a gas station or the food pantry that all the food pantry has are cupcakes and things that are donated from the bakery at the local store. And it's like, oh, this is different. It just feels different.

00:06:27 You know, it's true. But when you have to help somebody in those situations, especially when they look like you and you can kind of have that commonality there, it makes it so much more real.

00:06:45 I've heard about social responsibility, and mostly I've heard about social responsibility from I think corporate social responsibility. These companies say, hey, we love health equity too, and they have it on their website. But your role, which you talk about, social accountability, can you tell me a little bit more about that? And what does that mean for those providers that are in medical school and aren't providing yet, those right now? What does that look like, that accountability piece?

00:07:21 So I'll take you back to the emergency department. Let's say I take care of you or take care of a patient, and I say, eat healthy food, exercise, make sure you get that diabetes under control if that's a disease that you have. And then I don't check any blood work. I don't ever ask you to come back. I don't have you see your primary care physician.

00:07:43 I think that's asking you to be responsible, but that's not being accountable. And as physicians, we set up ways for patients to have accountability both to themselves and to the healthcare system with blood work, with regular check ins. And that's something that I get the opportunity to do on a national level with medical schools, with teaching hospitals, with health systems. We want to make sure that not only can you do a good job as a physician and think about social determinants of health and think about public health, but we're creating ways for you to check in, to say, am I doing this work? Am I teaching this?

00:08:28 Am I being that kind of physician that is thinking about the whole person and not just the disease that you're coming in with today or the issue that you're having? So I can go into more detail, but it's just a different framing that we're trying to help create systems of accountability for everyone who's in the healthcare system. Yes. Not just like your primary care doctor or your emergency physician. This is making sure everybody's on the same page because we're hopefully the goal is to make sure everybody's healthy.

00:09:07 So every aspect of health care should be on the same page. Exactly. So an example of that is, most recently, I worked with my colleagues this is led by our colleagues in a unit called Academic AfFairs at the AAMC. And we produce competencies around diversity, equity, inclusion. And so essentially it's saying when you graduate from medical school, when you're getting ready to go to residency, or when you are finishing residency, or when you're finishing residency, or when you've been practicing three and five years, what do we expect?

00:09:41 What do we want you to do? What do we want you to say? What do we want you to understand about a patient? I can provide you the link to that document, but I really enjoyed helping to develop that because it had me think about, well, what should I have known as a medical student or what did I know as a resident? What kinds of things did I have to struggle with and think about how to advocate for my patients who didn't have resources.

00:10:11 So that had to go in there and then even as a faculty member. So now this template is out there for every physician in the United States, in Canada, they can look and kind of look at those lists and see where they are. Oh, that's great.

00:10:29 What kind? Not really necessarily feedback, but I feel like just from the outside looking in, I can hear somebody saying, well, I feel like I'm being accountable, but I don't have time to go through a checklist. I have this whole patience or provider burnout. I don't have time to do this. What would a response be to that person that feels like one, they're already doing it and they're saying, I don't have time.

00:11:02 Well, I think that one of the things that we did with this document is, one, it's not required and it's not a checklist. It's not a formal assessment tool that you can just print out and do the checkboxes. It's really used for students and faculty to create their own curriculum and to create something that works for them. So let's say you live in a community that has, and I won't even say, a certain ethnicity or a certain race that's heavily represented there. And you have meetings with them and they say, look, I want to be treated this way.

00:11:37 I want you to acknowledge this cultural practice of mine. Well, you can use these competencies to match it up and to say, okay, I want to make sure that my students learn about this cultural practice. They ask these questions. So it's not meant to be a standalone thing, something to do that's extra. It's supposed to be integrated, integrated into every class, into every patient experience, and something that makes our care excellent, not something added on, but it will allow.

00:12:10 Us to get excellent care. Right. It almost sounds like it can be something that's forever evolving. Too it's not like it's just going to stay one. There's not just one way about doing it.

00:12:25 As we grow, as providers grow, this thing can evolve into so much more. Too. Absolutely. It's not a static document. And all the work that we're doing around equity and social accountability diversity equity, inclusion, health equity of the AAMC, there's no checklist.

00:12:45 It's not static. We're supposed to be learning and growing together. And that's what I would want from my physicians. That's what I hope other people would want from us. Yeah, absolutely.

00:12:55 As health equity, dei work has gotten better and more of a kind of more of a light on it, specifically within the past couple of years, one of the things that I have been told just from other providers, that diversity equity was never a part of their training. And now a lot of places are starting to add that a little bit more. What have you noticed or what have you heard from students that are going through this stuff now and kind of adding more health, equity, social determinants, materials and work. What kind of things have you noticed from those providers that didn't have that and the ones that do have it now? Are there any differences besides the obvious ones?

00:13:47 Well, I think the most inspiring part of that question is not just recognizing that a shift is happening, but who's making this shift happen, and it's the students. So they're coming in, they're getting this information from undergrad. They're getting it from just being more socially aware and socially conscious. And so they're coming into med school, they're coming into residency, and they're demanding that it be part of their curriculum. They're demanding that it's part of the way that they take care of patients.

00:14:17 And it's caused faculty members who didn't have it as part of their training to say, whoa, I support you, but you got to help me. Help me. Oh, no. So it's our role at the Double A MC to help develop, give faculty development, and provide those resources so that our students and faculty can actually learn together and can co create what this new generation of physicians should look like. And honestly, that's how medicine is supposed to be, right?

00:14:50 Things that I learned in medical school about how to treat a heart attack has changed, and it should because we've learned more. There's been more research. Same with de and I and antiracism. We've learned more. We know how to talk about it.

00:15:06 We know how to integrate it. We know how it applies to how you take care of patients. So if we are going to be committed as a specialty to continuous education, this is just one great example of how to do that. No, that's great.

00:15:25 I can see how it can be challenging, especially when you've gone through X amount of years of doing something one way, and now you have a whole group of kids being like, no, this is what I want to learn. And you agree with them, but you're like, you don't even have the tools to even have that conversation or have an in depth conversation that you can teach somebody when you're trying to learn yourself. I can see how that can be intimidating. Yeah, I think it is intimidating for a lot of people. And certain institutions have made it less burdensome when they take it on as a group, when they say, we're in this together.

00:16:08 This is not just a responsibility, one faculty member. We're all going to work on it together and redo our whole curriculum. We're going to look at every slide. We're going to look at every case. We're going to make sure we've got diversity in the images so we can see different shades in our pictures and different shades in our anatomy.

00:16:28 It can't be on one faculty to make this change. It's got to be a whole group that work on it together. Right. So with the AAMC.

00:16:40 We got social accountability and we're holding people accountable to improving how they help people. Can you tell me a little bit more about the equity? Can we talk more about the equity side of that too? And what does that look like within your role? And what are some more things that the AAMC are doing to combine that health equity piece with the social accountability piece together?

00:17:09 So when I think about equity, I think about equity broadly. So health equity for me is everyone can reach every person can reach their own health goals regardless, despite any barriers that they might have. They can reach the state of health that they want to have. But there's other forms of equity that people want to see. They want to see equity in career goals, being able to attain their career dreams.

00:17:36 There's equity in education and students want to be able to get into med school, have a great experience, do well, reach that highest level of academic achievement. So we're approaching equity very broadly at the AMC and making sure that we look at there's a whole team of people looking at equity and assessment. So making sure that all students get Fair grades and get access to equitable grading strategies and being able to get those awards regardless of their race, ethnicity and background, equity and hiring and promotion and tenure. And then of course, health equity. So we work on tools and resources that kind of address all that.

00:18:23 I think for me it's important to just have those equity questions in your head that you pause and you just say whatever policy I just introduced or whatever new procedure or new protocol I just developed, is it benefiting one person or one group more than the other? Is someone being harmed by this? Have I thought about all the people that could be impacted? And even just pausing to ask that question I think is going to be a good practice for the entire healthcare community that has not always been there. But that's something that we are trying to encourage people to think about and to practice.

00:19:08 Yes, stop and think of the whole not just one person though, the whole thing. Stop and think. Just stop and think right when I say it Dr. Fair, it just sounds so easy. Just stop and think first.

00:19:27 Why do we make it so complicated? What makes stopping and thinking about how one decision, how that's going to affect other people? Why is that so hard? It's hard because it's not in a vacuum. It's tied to a lot of deep feelings that people have.

00:19:50 Fears about their position in life, fears about our nation becoming more diverse and we've got a lot of political divisiveness in our nation right now. And so I think easier to just not think about it. Just do your work and go home and not try to dabble in anything that seems to be too progressive or too pushing the envelope or too out there. The problem with that is equity impacts all of us. It's not just people who identify with a marginalized identity or progressives or a certain political party or conservatives.

00:20:38 It impacts all of us. But the buzzwords are really concerning to people. I can't touch any diversity issues. I can't touch any equity, can't touch any inclusion, can't do anything with certain groups. But that's why I think that even if we don't mention Buzzwords or even if we can't protest, if that's something that you don't want to do or you decide not to be kind of out there, I think that we all have a responsibility to think about equity in our own lives and in the work that we do.

00:21:16 And that's just not something that we're not there yet. But I think we can get there, right? And I totally agree that we can get there. And I feel like it's going to take a lot more time than people realize, though, because when you're trying to change a whole system or a whole mindset, that doesn't happen overnight. I feel like even when people have good intentions, there's still unconscious biases that we have.

00:21:50 There's just so many pieces that we have to put in check. But with things that you guys are doing at the AAMC and other organizations, I feel like we're definitely doing some great things to get there with piggybacking off of that, with the work you're doing for any student, any college or education institution that wants to say, hey, we want to make a better effort in our dei, or we want to make sure that we're holding ourselves more accountable. What are some of the things they can do with the American Medical Colleges or the association? What are some resources? What's that first step?

00:22:43 What can people do? So one first step that you can do is we have a tool that's available on our website called the Dice Inventory or the Diversity Inclusion Culture Equity Inventory. And this is something that has about almost 90 questions in it. And the institution can go through and ask themselves the question, do I have this or do I not have this? And it's a set of questions that will give you a good snapshot of do I have what it takes to advance diversity, equity, inclusion in my institution or don't I?

00:23:17 And where are my areas for improvement? And it gives you a scorecard we're not collecting. We did have a project where we collected data from over 100 of our medical schools and we have that report available for free online if anyone wants to see that. But if an institution is wanting to know what they can do now, they can take this report themselves. They don't have to share these data with anyone, but it gives them an opportunity to create an internal roadmap.

00:23:45 And that's an example of that accountability piece. Because without asking yourself that question and doing your own checklist and your own inventory, it's kind of difficult to figure. Out where to start. And so that's one place I would start. No, that's awesome.

00:24:01 You don't know where to go if you don't know where you're starting at. It's a great place. Okay, so, Dr. Fair, for those people that want to be advocates and who want to support these health equity causes but fear of losing their job kind of keeps them quiet, what is your advice for those that want to do more but feel like they can't? I think that's a really great question.

00:24:34 And especially in this time, right now in our nation, you may not be able to do all the things that you would like to do depending on what institution you're in or what state you're in or what new policies have just been introduced. But I would say that everyone has a role to play. Whether it's writing a letter to your local representative or supporting a cause, donating money to an organization that is fighting for the rights that you are passionate about. Setting up a meeting with your leaders at your institution, requesting information or contacting your board of directors and saying, this is something that you're really passionate about. I think there are ways to do this that may not have you in the that may not threaten your job or your education, but I would be really creative, because the only way that we're going to change and ensure health equity in this nation is for all of us to persevere and to be creative and committed to this work.

00:25:44 I do think it will take some disruptors who can really get out there and change the entire system, but there are those of us who are going to work inside the system and are going to be relentless in our commitment in a way that really furthers this cause, but doesn't cause people to lose their job. So I would just really encourage anyone to think creatively about this and to write letters and to talk to their leaders in their institution about the things that they're most passionate about. No, that's real. Dr. Fair, thank you so much for being on the podcast with me today.

00:26:26 I really appreciated it. Anybody that wants to connect with you, learn more about you and what you're doing at the AAMC, where can they. Find you at so they can find me on the AAMC's website or on LinkedIn. My full name is Malikaa Fair. Not on Twitter right now because I was hacked, but maybe I'll come back.

00:26:50 One of the things that can happen, but happy to speak with any students or residents or faculty members. This is a passion of mine, and I really think that we can't do this alone. We have to do it together and community. Absolutely. Again, Dr.

00:27:08 Fair, thank you so much for your time today and everyone, thank you for listening to the Healthy Project podcast. How about you? Next time.