Reena Karani, MD, MHPE

Reena Karani, MD, MHPE, Director of the Institute for Medical Education at the Icahn School of Medicine at Mount Sinai, was recently elected Chair of the Board of Directors of the National Board of Medical Examiners (NBME), becoming the first woman of color to serve in this role in the organization’s 108-year history.

The nonprofit organization develops and administers state-of-the-art assessment tools for health professionals across the continuum of education, training, and practice. Dr. Karani and other NBME board members direct the organization’s policy and strategy and ensure the advancement of the organization’s commitments to diversity, equity, and inclusion, among other duties.

Dr. Karani, Professor of Medical Education, Geriatrics and Palliative Medicine, and Medicine, has been integrally involved in educating learners at all levels and has served in a variety of educational leadership roles. She was Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs for more than 10 years before being appointed in 2020 as Director of the Institute, whose mission is to advance teaching, learning, and scholarship in health professions education. Over the years, she has mentored hundreds of trainees and faculty members who are now themselves renowned medical education scholars and change leaders around the country.

“We have integrated into our curriculum core skills related to community-based health, global health, physician advocacy, and human rights,” says Dr. Karani, who received Mount Sinai’s Jacobi Medallion for excellence in 2022. “These are key competencies that we believe our physicians of the future need, and it is our obligation to ensure they are prepared for that future.”

In this Q&A, Dr. Karani discusses her new role, her lifelong commitment to advancing innovative medical education and scholarship both nationally and at Mount Sinai, and her thoughts on addressing bias and inequity in the learning environment.

Reena Karani, MD, MHPE, attends a research presentation with faculty and students at the Icahn School of Medicine at Mount Sinai.

What priorities and directions will you pursue as NBME chair?

The National Board of Medical Examiners is fully invested in offering evidence-based, patient-centered, and bias-free assessment tools for health professionals. I’ve been an active part of those efforts for the past decade through my work as a member of several test material development committees and the Board of Directors. My new role as chair represents an opportunity to strengthen our commitment in two areas I see of particular importance. One is mitigating bias, and the second is continuing to advance the assessment of critical competencies necessary for health care practice in the 21st century. Historically, medical education has taught race as a biologic category based on innate differences that produce health outcomes. Yet this is fundamentally flawed, because race is a social category that reflects the impact of unequal social experiences on health. Centuries of structural racism and bias have contributed to racial and ethnic disparities in health, outcomes, and opportunity. Medicine has a long history of racism and bias, beginning with who is allowed to join the profession and ranging from what is taught and assessed and how clinical care is delivered to the policies, practices, and procedures of our systems. It is everywhere, and there is no more pressing a challenge facing us in health professions education today. We must commit to working tirelessly to face and address these issues. This is not easy, and there are no quick fixes, but we must, for the sake of future generations, commit to this work each and every day. This is a personal journey for me, and an organizational journey that the NBME is fully committed to taking on.

What does being the first woman of color to serve as chair mean to you and to the field?

The enormous privilege and honor of being chair is not lost on me, especially in light of all those who struggled before me and worked tirelessly to have a voice at the table. Being chair of the NBME Board of Directors, indeed, feels amazing, even intimidating, but I have the strength of this highly respected organizations’ staff, my colleagues on the Board, and our faculty from the “house of medicine” to propel me forward. It will also allow me, as a faculty member from Mount Sinai, to advance important conversations about assessment and equity, make meaningful contributions to medical schools and learners, and strive to meet the mission of the organization, which is to protect the health of the public.

U.S. Supreme Court Justice Sonia Sotomayor, center, joined Dr. Karani and colleagues during a 2015 visit to the Icahn School of Medicine at Mount Sinai.

How have your varied positions and activities at Mount Sinai prepared you for your new role?

My 23-year career at Mount Sinai has afforded me an incredible foundation as a professor of medicine, medical education, and geriatrics and palliative medicine. With the support of countless mentors and sponsors, I’ve been privileged to have many educational leadership roles here, and each of these roles, from co-directing the Integrated Medicine-Geriatrics Clerkship to serving as Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs, has helped prepare me for this new role.

At the end of 2020, I became Director of the Institute for Medical Education, which is the organizational core that fosters the development and dissemination of best practices and scholarly innovations in teaching and learning, and serves as the trusted professional development source for health professions’ educators and scholars. We are proud to serve as an inclusive home for all medical educators and, as such, all our programming is designed to help educator faculty achieve their full potential.

One focus of your career has been geriatric medicine and palliative care. Why is it important to integrate geriatrics and palliative medicine training into the medical curriculum?

No matter what field of medicine an individual practices, they are going to care for and connect with older people. Even in pediatrics, there are many children in this country who are being raised by their grandparents. In addition, the key competencies in palliative medicine of providing quality care to those with serious illness are also critical no matter what field of medicine a person chooses to practice. So we have a responsibility to teach and assess the key skills and behaviors necessary to care for older people and those with serious illnesses across the continuum of medical education.

I’ve had great opportunities through my work at Mount Sinai to bring these geriatrics and palliative medicine perspectives forward. We have integrated and created opportunities: We’ve woven relevant learning into courses and clerkships, such as how human physiology changes as one ages, what the impact of aging is on pharmacology and pharmacodynamics, and how aging affects mobility and function as part of the study of the musculoskeletal system. And, we also proudly offer a required clerkship in geriatrics and palliative medicine that occurs during the third year of a medical student’s training at Mount Sinai. This allows our trainees to learn from and be mentored by our world-class faculty in geriatrics and palliative medicine.

Is there anything else you’d like to share about your new opportunities and challenges as National Board chair?

I believe my new role sends a strong message to the medical community about the Board’s commitment to ensuring diversity, equity, and justice in all aspects of health professional assessment. Just as importantly, I hope that young faculty see it as an invitation for them to get involved with our organization—to help us build assessments that are relevant and patient-focused and designed to correct the biases of the past for health professionals of the future. I also believe it’s important that young learners, particularly those of color and from historically excluded groups, see the many opportunities that are available to them and reach out to me if there are ways I can support them.

Many of the approximately eight million undocumented immigrants in the United States workforce hold critical and essential jobs. Some of these jobs are in construction, cleaning services, transportation—jobs that ensure we have everything from electric power to groceries to child care.

Undocumented workers are more likely to suffer work-related injury or illness than native-born workers, and more likely to experience dangerous working conditions than documented immigrants.

Yet undocumented immigrant workers are less likely to seek care and benefits for their work-related injury or illness.

There are many reasons for this: fear of employer retaliation, including wage theft, firing, and deportation; lack of awareness of rights and resources; intimidation by complex systems and processes; and mistrust in government and health care institutions. Anti-immigrant rhetoric in the United States intensifies many of these fears.

The Selikoff Centers for Occupational Health at Mount Sinai are dedicated to providing all workers, including undocumented immigrant workers, with the care they need.

Michael Crane, MD, MPH

“All workers have the right to health and safety on the job. It is essential that undocumented workers be made aware of and connected to the services they need and deserve,” says Michael Crane, MD, MPH, Medical Director of the Selikoff Centers. “We are dedicated to providing the highest quality care to all workers across our community, including those who are undocumented.”

Undocumented workers have rights and protections under health, safety, and anti-discrimination laws. The Selikoff Centers for Occupational Health at Mount Sinai, as part of its mission through the New York State Occupational Health Clinic Network, provides no-cost, confidential health care and other support services to all workers who have suffered a work-related injury or illness, regardless of documentation or insurance status. This includes evaluation, diagnosis, and treatment of work-related conditions. Services also include screenings for hazardous exposures (such as asbestos, lead, and other toxins), injury prevention, benefits counseling, and social work services.

“As members of the New York State Occupational Health Clinic Network, we provide health and safety-related services designed to reduce workplace injuries and illnesses,” says Dr. Crane, who is also a Professor of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai. “We diagnose and treat ill and injured workers with the goal of safely returning them to work. Our doctors are experts in occupational medicine who understand work-related injury and help their patients obtain appropriate Workers’ Compensation benefits. Our patients may also avail themselves of the guidance and support of our experts in ergonomics, industrial hygiene, social work, and vocational counseling.”

Agata Bednarska

Undocumented workers are eligible for New York State Workers’ Compensation. This law provides benefits for lost wages and medical treatment when a worker becomes sick or injured because of their job. At the Selikoff Centers, Workers’ Compensation coordinators guide patients through the process, which can be overwhelming and confusing. This is especially important for those facing language barriers or who are mistrustful of government systems.

“Navigating the New York State Workers’ Compensation system can be challenging for many injured and sick workers” says Agata Bednarska, Outreach and Education Manager. “Our Workers’ Compensation coordinators are here to educate, support, and assist patients with filing for New York State Workers’ Compensation benefits. We place significant emphasis on educating our patients about their legal rights. Advocacy, education, and treatment by our specialists can reduce the very significant economic burden of injury or illness on the worker and their family.”