Season 1: Episode 19: Duke University - Dr. Barnett

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand. The PA profession

Unknown Speaker  0:20  
always said that my purpose in life would be to engage in activities that will truly benefit others and communities and to make a difference.

Unknown Speaker  0:33  
Hello there again and thank you for joining us. Welcome to November 2021. We are trucking along with our 19th episode for our first season of the podcast. And today we have the privilege of speaking with Dr. Jacqueline Barnett. Dr. Barnett is an associate professor and the program director for the Duke University School of Medicine PA program. Yes, I said Duke. I know I know. You're saying why did it take so long to get the first program and Pa history on the podcast? Well, better late than never. So if you are new to the PA profession, Duke is where it all started under the leadership of Dr. Eugene Stead. The program began in 1965 and has been a national leader ever since. They were the first and they continue to be ranked at the top of the US News and World Report, most likely due to their impressive list of faculty and their continued demonstration of leadership through teaching service and scholarship for the profession. Today we talked about Duke and about Dr. Barnett's unique path to becoming a PA as well as her unique roles as a PA working with the DC coroner's office. We also talk about her lifelong work on diversity, equity and inclusion. And we focus on the Duke PA program.

Unknown Speaker  1:44  
Jackie, thank you so much for joining us today. It is such a pleasure to have you here. And so excited to get Duke University represented in the podcast. It is the mecca for us as a profession, and how appropriate that we're interviewing today in the middle of PA week, which I think is really apropos. So I appreciate you taking the time. Can we start with talking about your path to becoming a PA first?

Unknown Speaker  2:07  
Sure. And first of all, thank you, Kevin, for the work that you're doing and inviting me to this podcast is it's truly an honor to be here and truly an honor to be here as a Program Director at the phenomenal Duke University of PA program. So yeah, my path into PA education. Several years ago, I was actually working in psychiatry with a psychiatrist. And he said to me, I think you should consider going to medical school or to a PA program. And I said, What's the PA and so he explained to me and he had mentioned that there was a gentleman in the ER who had went to GW PA program, which is the psychiatrists was a GW Medical School grad. And so the person he referred to now I'll just call him John for right now. I thought John was one of the ER Doc's. And so I ended up reaching out to George Washington University, and I was very impressed by how much time they spent with me on the phone because there was no Internet, then no back then.

Unknown Speaker  3:13  
and Lisa Alexander and she sent me a packet of information. And I applied and I guess, shall we say the rest of history from at least how I got to that point. Yeah. That's wonderful. And you as I recall, you are also a National Health Service Corps scholar. So did you apply for that scholarship? Right before you started at GW? Yes, how come from a very rural underserved town with even to this day, still only about 1300 population their good old Tracy's land in Maryland. My parents still live there. And I'm still pretty much there regularly. Think I was actually the first to attend definitely the first to graduate from college and my entire family, no cousins, uncles, I mean, no one. And so GW then was tremendously, extremely expensive. And it's even more so now is one of the most expensive institution in the United States at the time. And so yes, I heard about the National Service Corps and I think actually Lisa Xander told me about that program as I applied. And so I went in as a as a national scholar, and I came out and took commissioned the Public Health Service, and served in the bo P for a little bit, and then ended up at Johns Hopkins at the time, they were having the worst syphilis epidemic, comparable to underdeveloped countries. Back in the night, this is like 9696 97, where I was seeing by six, seven patients a day actually doing DarkField Microscopy looking for the spiral key under it, you know, with the patients and sure, a lot so yes, I ended up filling out my national service for time. You know, they're at that. You got that the health department basically as a Johns Hopkins employee, and the Bureau of Prisons time how much

Unknown Speaker  5:00  
time did you spend working with the prison system?

Unknown Speaker  5:03  
That was about six months with the prison system. And in that role actually ended up going to the Olympics in Atlanta in 1996. And spent the entire guess we were there, I don't know, maybe four or five weeks. I can't remember now how long we were there. But that academic senate goes, I was one of the highlights of my early career, and I didn't realize it was going to be a highlight at that time. But yes, I was six months there and trained down at Glencoe, Georgia with many of the federal law enforcement agency that border patrol DIAC camera roll up, you know, all of us who are out there working and you know, you know, training together. And I was doing stuff that I never, ever thought that I would, you know, would do healthcare providers, they allow us to opt out of firearm training, because our goal is to heal and not to shoot and harm. But I chose to try it out. So I had to get certified on a double barrel shotgun M 16, nine millimeter, and I did it at the top of the class, I just want you to know that Kevin, I came out.

Unknown Speaker  6:12  
That's amazing. I haven't touched a gun again, but I you know, I stepped up and made it known that hey, hey, give me the opportunity. Now. You know, I'll do well. Yeah, you were so you did your time for the NHSC at both the bureau of prisons. And then at Johns Hopkins. When you left there, what did you decide to do for your practice? Yeah, I am. And I loved my time at Johns Hopkins, I actually stayed longer than even what my dollars. So service required me to. And so an opportunity came. Because at the time, Baltimore was about an hour commute for me each day. And so the opportunity came for me to be one of the first TAs in DC to be considered a medical legal investigator to investigate the deaths in DC I'm working with out of the medical examiner's office that had a coup at the time, but it almost felt like that much of the camera crew, the medical examiner's office from New York, basically left and came down to DC. And DC had never had pa but the medical examiner in New York IPAs brought the one pa there with him. And then myself and another pa with the first hired, you know, to do this work, which was probably like nothing I've ever experienced before in my life and never thought that I would be doing that kind of work, you know, as a PA, you know, for me underserved populations to communities, it was about going back treating and providing care, and I never thought that I would be working more so with, you know, people who are not living, you know, in this in this role, but the amount of medicine that I learned and how things work, whether it's, you know, getting drug approvals that, you know, when stuff that we ended up investigating was absolutely amazing. And so, you know, for the audience that may that may or may not know, you know, cases go to the medical examiner's office, anything that's not considered a natural death, and most jurisdictions have to be examined through the medical exams, office, autopsy, so any and all homicide, suicides, accidents, and someone's in the middle of surgery in a hospital, and you know, something goes awry, and they all of those will go to the medical examiner's office. So, again, this is the DC a major city. So you can imagine the number of calls and stuff that we got from accidents and suicides and drug overdose, I mean, just so many, and then to do some of those autopsies that you know, even you know, some of the ones that were like, not sure and ended up being a heart attack, but you know, a 37 year old found dead, you know, that's something that you have to do an autopsy on to find out what's the reason and then to physically see that heart attack to physically see those vessels to physically, you know, to see that cog, same thing with some of the the natural deaths and even some of the accidents and you can kind of like see how things happen. And it really took me back to learning so much of the physiology and the path biology. I mean, when you can really see it, that's one and then to understand, you know, things like, you know what, one of the things that's still really recall was a case that I investigated. Basically, a husband who had started a medication the day before, and in the middle of the night, his wife heard a thump. And he basically was angio edema from you know, from the medication. Sure, sure. We had to do that work to connect it back to the medication. But then from the medical examiner's office to be able to get with the drug companies and all of that to get black label by

Unknown Speaker  9:59  
boxes on, on some of these, say, you know, hey, in this jurisdiction, we are finding a link between angio edema and set death and this particular medication and to be involved in some of that work and understanding that the same thing with toys, you know, back chairs and bathtubs that turnover, and unfortunately, you know, you know, causing deaths, children and doing some of those and being able to link this particular toy or this particular thing to the death, and to investigate that. So that for me was how I could say, Okay, this is where the public health comes in, for me this talk and still continue to contribute as a PA provider, but in a different way to prevent death. So that was, it was a very interesting, but it was one of the busiest times of my life.

Unknown Speaker  10:51  
I mean, that is fascinating, I have to believe that that has really placed an indelible mark on your brain in terms of how you teach as a PA educator all these years to

Unknown Speaker  11:02  
Yeah, I how I teach how I think about things, how I look at students patient care, you know, when I go into, you know, right after that, and I went back into seeing patients again, and when I was writing the prescription of the medication that I just investigated, like six months ago, you notice that I know, it's, you know, a small chance, but the fact that this is what I saw now has a little bit of a label on this a may cause it really had me thinking, but it allowed me to really provide that patient with education and me get that really good history from that patient. Whenever, you know, whenever is related to you know, have you ever had this medication before? You know, will I be giving this to you as a first time medication? Which again, you know, increases my thoughts about you know about it, but it really gave me a more intentional sense of things that cause death that maybe even though I knew it, I didn't think about I thought about it in a different way. So like, anytime I saw, you know, one of my family members or kids with like a toy, I was like, what toy? Is that? Let me see what that is. Yeah, no, they shouldn't have this this cause choking?

Unknown Speaker  12:20  
Yeah, so you have a different set of lenses that you're looking at the world through from that experience? Absolutely.

Unknown Speaker  12:24  
We did so many deaths that in cars in the summer, someone forgetting all about or leaving a pet a child, you know, in a car in the hot summer and, and just that I remember becoming that more cognizant, when I was seeing patients with children said, Please, please, you know, make sure before you leave your car, or don't assume that five minutes in a car that your dog or child is going to be okay. Like, don't make don't even think about that. You know, so just that kind of edgy, you know, just that kind of education. And same thing that, you know, we had lots around, you know, guns and accidental shootings and, but a lot of that kind of stuff, too. So I gave me a different perspective of one the preciousness of life, but to some of the things that increased mortality that we really can have a better control on and some of the preventive care and patient education instruction that we can use to, you know, to support that.

Unknown Speaker  13:23  
A few years ago, there was pushback against the medical community for educating and asking questions about guns in the home and things like that. People felt it was not our role as health care providers to be exploring those things. But from your perspective, it sounds like you've got real world experience, where that really is valuable to help people understand how likely it is that these accidents can happen and you've lived and you've seen it. Oh, yeah, absolutely. So So tell us about your transition to education. Because at one point in time in your career, you you ended up in PA education, you actually are the founding program director for the eastern shores PA program at that historic black college. And so how did that kind of get into that and ultimately lead you down to Duke

Unknown Speaker  14:10  
right. So, um, after the medical examiner's role, I was just burned. I don't want to say burned out. That's not a bad that's not a good way. But it was an exhausting role, because it was two of us to PA and we think of all the deaths that happened in DC it was it was exhausting. I was working 24 hours a day taking three and four pagers and just never got any sleep, you know, just never got any sleep. So I needed a break. I took a break. And I got a call from Brenda Jasper maybe three or four months later and she was starting to she was actually there. I found the program that worked out their academic director, and she was wanting to start the PA program down University of Maryland Eastern Shore and had heard that I might be interested. And so long story short, I Initially, I wasn't interested, I was very content doing what I was doing. But she she pulled at my heartstrings, like draggy, this is you, it's a rural town, you know, it's a poor community, we need PDAs, we need to access health care to increase access health care, they need to know about this profession. And so I said, Okay, I'll come to really help to get the program started and get the first class, you know, going and, and so that's pretty much how I ended there. And I can tell you, that is probably another big area of my career that I am the most proud of the work that we had to do to get that program up and running, as some of the friends that I made are still my best friends, you know, down there at that institution, today, and just the potential impact of, of that program in you know, in that community, I mean, many in that community have never been out of that community. And when you think about the health disparities, that I don't think there's a place greater in Maryland than the health disparities on the Eastern Shore, in Maryland, when we were seeing death rates in children, I mean, just just phenomenal rates, and things like breast cancer and colon cancer, and just some of those things, you know, just just that, you know, again, the infant infant mortality is just, I mean, huge. I can't remember the number now, but it was like 10 times anywhere else in the state, it was really significant.

Unknown Speaker  16:23  
So the social determinants of health are kind of right there in front of you live for you to experience and try to impact.

Unknown Speaker  16:30  
Oh, yeah, it was very much and that that, for me was the draw, it was really about, okay, you know, I've always said that my purpose in life would be to engage in activities that will truly benefit others and communities and to make a difference. And so that was, you know, the reason, you know, they're kind of getting my initial goal, because my house is in another two and a half hours away, but I really wanted to go and help out and be a part and get the program situated, but knew that it would really just be that goal to get them situated. And then I will continue to help out, I will go and you know, to help out with admissions. And then I received a call from Jeff Heinrich, who's the program director at the time at GW. And who basically said, I understand that you're going to be after a year, so you're going to be coming back from the University of Missouri show, we'd love to have you, we'd love you to come back to your alma mater, we can use your skills as relates to clinical stuff. And initially, I was like, Oh, I don't think so. Because my fiance is currently on faculty there. And I don't know if I want to work same place, you know, with them. Yeah. And so it was sort of like a big joke for a while. And so that's basically how I ended up I said, I'll come I'll stay for six months to help you out with the clinical, I'll get some sites for you know, maybe put some processes in place for the for the clinical year, but you know, six months, and I think that should really help you know, that should really help the program, if I guess that would help the program a lot. Because I don't want to be there, you know, full time with my fiance. So needless to say, I was there for 15 years full time.

Unknown Speaker  18:13  
And you two are one of the PA power couples in our profession. So that all worked out pretty well, didn't it? Yeah.

Unknown Speaker  18:20  
So you know, we would laugh out, you know, laugh all the time. We've had tons and tons of jokes, but I look at it that my time at GW I really grew up. I really felt I grew up as an educator, as a student there, which is very different than when I went back as a as a faculty business student there. I was really inspired by Lisa Alexander, her engagement in the profession, all the work she did in the community. Jim Coleen is how committed he was to the profession and scholarly activities and research and public health. Susan dumpee was another one of the faculty there. And and they just pushed for engagement and community and getting involved with APA and Sapele at the time. And so I think that's where my professional advocacy comes from just being in that environment with those I mean, you know, phenomenal leaders. And so then when I got to the program as faculty in 2001, Susan Lola Shore was the Academic Director there and, and she welcomed me with arms, I shoot and I can actually back up a little bit when I went on as faculty to help start the University of Maryland, Eastern Shore. I reached out to my GW colleagues, friends, my faculty and said, I'm going to help them start a program we're starting from nothing. Is there anything can you all help me out? Give me some guys I've never even written objective in my life like I don't know anything about that. And Jim, Jim, call in Susan, lot of shorts it, pick a day, any day, come come back to campus, we will open up our boat to you whatever you want, whatever you need, whatever we can do. To support you, Jackie, got it. And I mean, that was just so heartwarming, you know, to me,

Unknown Speaker  20:09  
as well. So when I got back on, you know, faculty Susan, Allah Shaw was there. That's like Jungheinrich still really good guidance. Susan i, we became very much like sisters, we thought like sisters all the time as well, too. But yeah, so that that was there. So I was there for 15 years and all kinds of wonderful things, community stuff, really getting evidence based medicine going there really increasing access to care for those in those rural communities as they had housing places, putting these students who've never really been in some of these communities, you know, you know, out there and just really continue to spread our wings. As it relates to diversity in health care, access and understanding social determinants of health, then they're like some 15 years, and then recognize the call for Duke as an associate program director at the time GW several years beforehand sort of lost its family medicine or family medicine residents, so we were coming a little bit less. Primary care for me a little bit more specialty, we're seeing more of our students going into specialty practice and way less primary care. And sort of some of the mission that which drove me there was changing a little bit. And so with do Couette, again, for me have the strong mission of primary care underserved communities. I never thought that I would ever leave GW to be quite honest. And I still love that I still love GWS still consider it, the place I grew up. But I said, Okay, it's a chance to think about it. If the opportunity comes, you know, let me see the top of our bodies like Absolutely. So I ended up here, the Associate Program Director really continued to push for that mission, a lot more alignment of our I took over admissions when I came that was one of my two big jobs of admission and student services. And so did all kinds of things to really better align our admissions to our mission, that we're still working on to really increase the accessibility of others to do peer program and education at Duke. And still doing that with all the things that the program has just historically done with community service and rural populations and underserved communities. And that's, and that's still a fight that we're fighting. It's still what we're doing. You know, I've continued to push I think the institution, I like to believe that getting us more of the word and I'm sure you have the same experience being in academic medical centers, a PA program at USC, of getting more visibility across institution, like I would say to our dean, whenever there's something going on in the med school, that involve them in that may involve the PA program in any kind of way, I need to make sure that there's a PA at the table, either me or someone else, like we need to get part of some of these conversations. And I think the program is really looked at I think the program has always been without question and flagship in the medical school. I think it's looked at even more of a leading areas in the medical school, some of the areas around diversity and and that they you know, the dean called me and says, Can I come talk to you and your students figure out what it is that you all are doing right there? Because when we got complaints a year and a half ago, under the judge boards that we have the DPT students wrote a scathing letter to medical students Raiders, wrote a scathing letter to the dean and all about their experiences. He didn't she says, I didn't get any letters from the PA students. What? What is it that you all are doing there that has made their experience so much different and better?

Unknown Speaker  23:52  
I don't think we get enough credit as a profession, from the medical community. And you know, I love my my medical school colleagues are phenomenal at USC. So this isn't a statement about se, it's been my observation over the years that we fly under the radar as a profession, yet, we're often ahead of the curve in many areas. And that's not an unusual story to hear where suddenly somebody from the medical school says, you know, the PA program has been doing this for a couple years. Let's go see what this is about. Yes, we certainly have learned a lot from them, too. But I'm not surprised to hear that, especially at Duke.

Unknown Speaker  24:27  
I think that we are very humble profession. I think that is good. And sometimes it doesn't serve us best. And I think in some of these big spaces and these large academic medical centers that we really do need to toot our horn a lot more. We really need to show our value as an educational program than these institutions that show our value. I think we need to toot our horn to make sure that others recognize our value sometimes and maybe, maybe maybe they do and it's it doesn't appear to be some time but I think some that is that we don't like move it awards, PDA awards or publications. And they they don't know about it, you know, they don't know some of the stuff that we're doing all the work we're doing in terms of innovating our courses and incorporating technology, and all that different learning techniques. They don't know that we're doing all this stuff and we're, you know, we're doing it, we kind of just keep it hidden. And I think that's where we need to be able to dial horn and No, no grand rounds, hey, please put put the PA program down to speak at Grand Rounds as well, you know, so I get all the invitations now we're looking for Grand Rounds speaker you're in about in the program, you know, any other pa that really want to highlight their work. So, so I think it's all you know, coming to fruition, and we continue to do even more of that, as all PA programs, I'm not just speaking about keep it all care programs, I think we really need to continue to highlight and to download a little bit more.

Unknown Speaker  25:51  
Yeah, well, so let's talk about Duke a little bit. Tell us about Duke University's PA program in terms of what are you looking for an applicants what are what is your kind of quintessential applicant to the program that you're hoping is excited about joining you.

Unknown Speaker  26:07  
Central applicant is really someone that is truly aligned with our mission, and core values as it relates to extending care to rural and underserved areas, our values of diversity, equity, inclusion, academic excellence, and, and serving and aspect of research that really helps to continue to promote students, faculty, staff that, you know, the profession, you know, as well. But but but more that academic excellence, and commitment of serving, you know, I think that's the biggest thing, the commitment of serving to know that if you come here, one of the things that we're going to be asking you to do is to serve, you know, to serve the Durham community that has allowed us to occupy this space to serve other communities serve professionally, whether it's as a student, Safa, the North Carolina Academy, or in some of the, you know, local, nonprofits, leadership positions, I think that would be the actually, I don't know, like is the appropriate word, but we have a lot of respect for students that demonstrate grit, you know, that's a word I use a lot that have gone through a few things in the show that they can bounce back from a gut check every now and then who had to struggle, who maybe had to work and go to school at the same time, or who's raising a single a single mom or dad raising two kids, and maybe they don't have a four or three, five, but they and they have a a two, nine, but they've been working and showing grit and supporting a family, because we really think that it takes one a lot of grit to get through this program on anybody's part. And to be able to take that back to communities to help others, you know, get older and gets through, you know, some of the challenges that life throws so we really like looking at and accepting applicants that can demonstrate a little grip.

Unknown Speaker  28:08  
And then in terms of service, tell us if you have an angle, if you will, do you like people that have served in a multitude of different places, getting 20 or 30, checkboxes where they've been part of a variety of communities? Do you prefer somebody that has dedicated their time and energy into one institution and tried to make a difference with one? Or are you kind of agnostic about that?

Unknown Speaker  28:30  
Oh, not too hard and fast on that, but I think we prefer the continuity, like, you know, individually, that's it, you know, this is going to be the community or population or organization that I'm serving for, you know, for whatever the reason, and to put, you know, to have a little skin in the game, you know, Kevin, I like skin in the game I like it's really, that you really take hold and take ownership of something that do to the best of your abilities. I think, for us that that works and something where you, you have to make some sacrifices to serve, you know, that you really have to make some sacrifices, not that, oh, I'm serving as a checkbox, because I want to go to PA program and they want me to serve. But that, you know, if you're gonna serve this place may mean that I don't know, you have to your days are going to be long that you may have a 12 or 13 hour day, three to four days a week or something like that. But that it might even cost you to serve, you know, for you to serve means that I don't know that you have to take a trip out of town every now and then I don't know. But something that really shows that you got a little skin in the game that it means enough to you that you're willing to make sacrifices because for us as a student in the program, we're wanting them to know that this program means enough to them that they are going to have to sacrifice they're going to sacrifice their time away from their family to study whatever they may have to sacrifice time on the weekend to do some service things but they're gonna have to make some sacrifices, you know, as a student in this in this program and to understand sort of what that sacrifice means because we Any of our patients have to make these kinds of sacrifices every, you know, every day. So we we were pretty, I think that's one area where we really feel good about. And thank goodness, many of our students come with that servant leadership mentality. So it's not something that we're having to drill is Oh, no, you will serve here that comes in, hey, you know, I have 12 places that I'm already serving, can I make those a part of the program? Or when can we start serving? Do we have to wait until pa week and then the day of service, we have a day of service that usually kicks off pa we can we start serving for PhD? So luckily, we really attract the students that we think best carry out the mission of the do PA program, you know, as a profession, man, the PA profession.

Unknown Speaker  30:49  
Yeah. So as an applicant, probably one of the best things they could do is take a look at that mission, take a look at the values of your institution, really tried to figure out how they align with that and and illustrate that in their application?

Unknown Speaker  31:02  
Yeah, absolutely. And we really want them to demonstrate it like that, you know, applicants or application that said, you know, I'm really interested in primary care service, but when we look through the application, they've done no service, and all of their work has been in CT surgery, that's not demonstrating that mission to us.

Unknown Speaker  31:21  
I have this I have a smile, because I've been reading a bunch of applications this last week. And absolutely right, we're a primary care program too. And so doing all of your experiences, and CT is is wonderful. But there's some really good schools that focus on surgery, we're just not one of them. So,

Unknown Speaker  31:37  
yeah, thanks. And we'll get into sometimes within our faculty as well, but that they, you know, they are from a rural, underserved community, or they're this asset, but they have to demonstrate it. And other other ways are there say, oh, but you know, it is a Latina applicant, Jackie words, by God. And I said, Yes, but just being a Latino, African, or black applicant doesn't get you into the program. It's what you've done with that, that really helped to, again, extend primary care and some of those other things, and how have you helped others. And so we're pretty passionate about demonstrating who you are and what you have done that really aligns with our mission, because our hope is that you will take that and when you leave us, you will go back to some of these communities and continue to be that extender of the do PA program. And that you know, that mission, those tentacles that we really value.

Unknown Speaker  32:28  
Yeah, and I'll say over the years, I've run into your graduates out in the Southwest in a variety of capacities. And that has been my experience that they continue to, they're all very similar in that way, which I think is a testament to the consistency of your program and what you do. Let's switch gears and talk a little bit about the George Floyd murders, the anti racism movement that is afoot in the United States, and kind of your own experiences. You've been a leader in dei for your entire career. And, and so I would imagine that you have some thoughts on how that has impacted the school, the profession and where we're heading with that, if you don't mind sharing your thoughts.

Unknown Speaker  33:08  
Yeah. You know, I think the past 18 plus months, 20 months now that we're in it, I think, without a doubt been some of the most challenging in my professional career. As a PA, I think it was the George Floyd murders and this racial reckoning that was happening on top of COVID. And on top of a never ending election year, that really just was a tripartite of a perfect storm and my way, I think that and I'm going to call it racial reckoning sometimes people don't like when I say that, but the racial reckoning that happened because of that, I think sent a world went through so many academic institutions across the continental United States and Duke was no different. Duke has a history that they should not be proud of when it comes to race, race relations and discrimination. And that movement in the letters that I spoke of the forehand from the DP students and the med students, I think struck a Core i think it hit this institution at the core of what people were seeing, even in this day and age and the changes that the dean of the medical school all the way up to the President had promised instituted and put in effect, I mean, right away have been short of phenomenal like I would have never guessed it. I was part of a group of us and ended up being six primary writers but you know, more shine and created this black faculty letter calls cost letter that address the experience of many of the black faculty here at this The Medical School we only make up about 4%. I'm the only black program director and the entire university. And I'm, of course the first one at the Duke PA program. I think that the institutional leaders started to viscerally feel the experiences that many have had in this institution and basically said, this is going to start changing today. So for us at the program level, we've already like you said a little bit of a head, we had, you know, students made videos, we did a town hall. I mean, maybe two days after this. I was discouraged from some of these student videos, I was discouraged by some for some things that we put up on our website as related to Black Lives Matter and the student pledge on anti racist program and the institution within the past, oh, I don't know, six to seven months. And I mean, they've gone really strong with every faculty staff has black lives matter, pendants for lab codes, across institution, they sent out letters to every patient that talked about Black Lives Matters, made videos. So when patients or anyone else says things like, well, all lives matter how to respond to that, we created a moment movement, where we had four committees to really look across institution and faculty staffs experiences and make recommendations to the dean. One of the recommendations that came out of that was that we needed the Vice Dean for Diversity, Equity inclusion at that top level, that would work with the programs and institutes and all better, and we are in the process of hiring that I served on that search committee, we've just done so many things that are actionable, things that are really, really actionable and putting money to it, I think, I think don't quote me on this, I think there was a $16 million donation or whatever that they're using to support some of these efforts. So yeah, so from the institution point, I think that they've done everything, I'll bet I could have asked for a better response, we had a campus marched with, with our leaders, our chancellor, our dean, right out in front, as it related to, you know, sort of the white coat of black lives across campus that our students participated in faculty and staff. And we've had several sessions with everyone. I'm very, very proud of the way that Duke has one of the institutions that I think has a really sad and racist history, and how they responded to this call. And I'm very proud of the program faculty, staff and students who are always a little bit ahead over the past couple of years, but who really have continued to, you know, to push me as the program director, especially the students to continue to push me as the program director that I don't need a lot of push to get by and they're good at pushing, that's for sure.

Unknown Speaker  38:00  
Program, you know, it's I'm very, I'm very pleased with the way that we have had, but on the flip side to say that it was it has been very challenging. And when I participated, especially in some of those early Pa town halls with students, faculty, it was just a tiny, it was just disheartening. And I And Howard, we receive, oh, I can tell you no less than 15 to 20 calls each week, from different students or faculty at programs and what they were experiencing at those programs as being faculty of color, or students of color. It was disheartening. And I remember saying I think I even at that townhouse, and this feels more like before Brown versus Board of Education, with some of these folks who are experiencing in these PA programs, often at the hands of other PhDs. Yeah. I just, you know, I'm used to just tear jerking.

Unknown Speaker  38:57  
It's unconscionable. Yeah. So as an educator, then I think we probably should talk about this, this concept of our tool belt that we carry as PDAs. You know, we think about the different things that we need to teach our students to equip them to be able to effectively practice medicine when they leave, as part of a team. And to me, anti racism and how to become a white ally. And some of those things really should be part of that toolkit. I mean, we've always, accreditations often asked us from a public health perspective to talk about social determinants of health and health disparities. But I don't know how you feel. But from my perspective, I don't think we've ever had it to be at this level, where we can make a real significant difference in the health workforce, with what students are encountering while they're in our program. So what is Duke doing to kind of move the needle so to speak, in a positive way?

Unknown Speaker  39:52  
Oh, yes. Thank you for that question that gosh, I'm happy to answer that question. So I can tell you as as one of the things I mentioned to you was around admissions. So that was one of the things we really aligned with our mission and really tried to make our admissions process more of an anti racism process. Because I would hate to sit in some of these admissions meetings and the bias that was coming out around whether the student was a good fit, or if they were too old, or they were single parents, or they, you know, the the pedigree, the institutions they attended, you know, with the be good here at Duke, you know, their vernacular, you know, and all of this. And so we have designed and address these things head on. In committees, you know, we don't want to hear that we sort of revise some of our, our rubrics, and really Dubai as training for those participating in our admissions process. I just recently finished a faculty search process where a lot of the charts that I gave to the committee and potentially put the committee together in terms of who we chose, and a lot of that charge was about how are we going to make this an anti racism search committee that mitigates bias? How will the committee call it in and call it out amongst each other? How can we make our rubrics to be more objective and align them to the mission of the program? You know, basically the whole process, and I met with that search committee chair pretty much weekly reviewed rubrics, and we just did the presentation for the med school at large about this process that we think can be a best process. We have a course a PHS course that we have realigned across the entire curriculum that addresses all of those areas, anti racism, white privilege, supremacy, social determinants health, what it means to be an anti racist, it was the highest rated program, I do believe in the curriculum last year, I mean, just students were just clutching onto this, we look back at all of our curriculum, especially cases, you know, some of the cases that we use for teaching hypertension, diabetes, and looked at, oh, my God, look at the bias in these cases, take us take race out of that 35 year old, black male. So we've removed the race, a lot of the stereotypes as it related to those cases, we're looking at our assessment methodologies, our test items, and looking for where the bias exists in these test items that I have my director of assessment and evaluation and a creative Senior Education strategist position about two years ago, really looking at you know, at those, and we are actively talking about it. During admissions, we have a diversity groups, our students, and that's what they call themselves. And so we have the applicants meet with our students to talk about diversity program, anti racism. So I believe we are touching it in almost every area that I can think of that really has potentially kept some folks out of Duke, either as a student, or as a faculty, or as a staff. And oh, who has made the learning environment, sort of traumatizing for other students that we may not have recognized because of wording and stereotypes and bias in our curriculum for things that people say or do. And we're really looking at finding a better way to address it, call it out in real time, and provide more by standing and support training to those. And lastly, I forgot to say we actually have what they call a dear group, which is one two of the two of the white faculty that meet weekly with the rest of the white faculty to talk about how to be better allies really helping them understand what race and racism and privilege looks like. And you know, Robyn D'Angelo, his work and he Brum work and goats and all that. And they've probably been meeting weekly, I would say at least a year, at least a year now, to really address when something comes up during the course of a week that might have been bias that happened. They're addressing it in that group of you know, look, want to let you know that you did this and and it has come above and how we can support the directedness that no, that really is margin laissent. No, that really is so on and so forth. So

Unknown Speaker  44:21  
yeah, that's fantastic. I was reminded recently in a really amazing conversation with a group of our students, how impactful even just the images on the slides can be and because of systemic racism and bias. So many of the medical images that we use in our lectures are people with white skin. And so to be more inclusive in our presentations in terms of how we demonstrate how this could look in another population in another community versus just always showing people with, you know, skin lesions on white skin. And the other thing that I came out of that meeting with is just truly how how We continue as faculty to traumatize our students who have already had a journey of pain, from racism in their experiences growing up. And then to come to an institution where we're hoping to try to be inspiring them to take great care of patients and be a leader in the community, only then to further traumatize them just really hurts. So we still have a long way to go.

Unknown Speaker  45:22  
Yeah. And with that, Kevin, you want to think that I constantly said, so you traumatize a student at eight o'clock this morning, made them feel really bad about themselves. And then they had to sit down at 830 and take a neurology exam. And they don't do well on the exam. And the first thing people want to say is, oh, well, that student, maybe they just don't have do pedigree, you know, no, that student is carrying the weight of this trauma into an exam that the other students have not had to do. And that and or that same student is sitting in a class where she's seeing he or she's seeing all the patients with syphilis, they see brown skin, but the patient with poison ivy, they see white skin, you know, the message that that sends to the point that I can tell you, when I was working in ID, I had a student, and I had a patient that had syphilis and the students that that can't be simple as NASA, why not just white people don't have syphilis, all the pictures and all that we saw it was a black people or brown skin. So I thought that, you know, it was rare, if ever that that would be so he was questioning. I'm the provider. I'm seeing it now since the base today. He was questioning me on my diagnosis that this was syphilis, because it was a white person. And maybe because I was a brown provider to that he just didn't, didn't I mean, in the being a very uncomfortable situation, because he did not believe that that person said was that was always something that black folks got.

Unknown Speaker  46:48  
Yeah, I mean, it's like I said, we have a long way to go. So so. So let me ask you benna do How long is Director

Unknown Speaker  46:56  
admin, as I've been at Duke since 2006, I've been a DT six years this month, I took honors program that worked in 2018 years ago, it's now

Unknown Speaker  47:06  
Alright, so let's do a future visioning exercise on the day that you're leaving Duke when you finally decide to hang up your stethoscope and move into another journey of yours, whatever that be. What are you hoping that your legacy or your impact will be what what is the kind of the story you would hope to hear the change of do from your transformational leadership that you have been known to

Unknown Speaker  47:29  
provide? I think that one that every person who was in the program, whether student faculty or staff feel that their presence and their voice is valued. I think that that the program as a whole, that we're no longer having conversations about race and inclusion, that that is as far behind us as polio or something. Right? Yeah. That it's it's something that there's never a need to talk about. Because if it really doesn't exist, you don't you don't you know, you don't feel that existence, that across the medical center, that we are seeing more PA and prominent decision making positions within the health system, as clinical department chairs, or vice chairs or leads, and across the educational programs as Dean's, or division chiefs or so on and so forth. I think that that when people think of primary care training, and a service to underserved communities, that they think of Duke, especially on this side of town, they go on your side of town, but thinking on this side of town, I want them to think of Duke, I think that would you know that would be it. And I think that we have a and I think that our program overall, that our curriculum, and I can say this pipe all PA programs working with us because it's the intensity of this curriculum is not so stressful to students, faculty and staff that we find a better way to deliver peer education than the way that it has been delivered over the past 40 to 50 years. And definitely since I've been a PSE nearly 30 years, that we find a better way to do this and hoping that we're able to use some of the things that we were forced to do with COVID over the past year and a half to sort of help us D bulk and D intensify the curriculum without losing some of the excellence that's in our curriculum because I definitely think there's a different and a better way to do it that with several years of doing it that some of the stuff that I'm working on right now at you know within our program.

Unknown Speaker  49:58  
I agree, I think One of the challenges of our diversity in our profession could be the the model of education that we provide. It's very, for the most part, the dynamic of it is very singular across all programs. It's a gut check for 2426 28 months, 33 months in some programs. And it's just nonstop. You know, the classic we thing we hear in the education is drinking from the firehose, and I think that really scares some people away. And the lack of flexibility, if you look at the NP profession, they have a much more flexible curriculum than we have. And if you look at the outcomes, it doesn't seem to make a significant difference. And so maybe we need to be thinking out of the box. Jackie, thank you so much for your time, it's been such an honor to have you and also represent Duke during pa week. This obviously will be out in about a month, but the chance to just talk to you about your profession and your history as a PA was really a privilege. And I do appreciate it.

Unknown Speaker  50:56  
Yeah. And thank you, Kevin, thank you for your work. We look at USC as our partners in this business. We have very, very similar missions. I really appreciate your leadership and work and even doing these podcasts, you know, to highlight some of the other programs and do yes, Pa week this week, we say happy birthday to Dr. Stead. You know, again, as we celebrate and I think just to celebrate all the work of TAs and all the work of PA educators know across this country during this week, and let's continue to elevate this programs and elevate our profession and let all know what TAS can do. So thank you so much for having me. I really appreciate it's truly truly an honor.

Unknown Speaker  51:35  
I want to thank our guest Dr. Jackie Barnett for her time and talents. today. It was truly an honor to speak with her about her path to becoming a PA and about the work she has done to bring diversity, equity and inclusion to the forefront of each program. She has been a part of her clinical work in the coroner's office was a nice surprise and highlights a different role. The PA is can and do play in some parts of the country. While her vision for the founding program of our profession, moving forward provided a glimpse of what Duke is all about.

Unknown Speaker  52:07  
Join us next week as we speak with Dr. Patrick Knott and Mr. Jason Radke from the Rosalind Franklin University PA program, we talked about the commitment from their institution to inclusion, including the name change to honor Dr. Rosalind Franklin and her contributions to science. We also talked about their Chicago area program and about the benefits of postgraduate training programs, which Dr. Knott has been a part of for many years. Finally, we discussed Dr. Knott's current path as an academic leader and as an inventor, and scholar.

Unknown Speaker  52:38  
Until next time, we wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Southern California.