Mount Sinai Researcher Launches Three Studies of Alzheimer’s Disease in Asian Americans

Updated on Oct 5, 2023 | Diversity and Inclusion, Featured, Psychiatry, Research

Clara Li, PhD, a clinical neuropsychologist and Associate Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, has received new grants that will total more than $12 million from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). The funding will support three new projects that seek to improve the diagnosis and treatment of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in Asian Americans.

Asian Americans are historically under-represented in clinical research on AD/ADRD. As a result, many older adults with Asian ancestry do not receive adequate diagnosis and treatment for mild cognitive impairment (MCI) or AD/ADRD.

Clara Li, PhD

“Chinese is the third-most-spoken language in the United States after English and Spanish, yet we don’t have many of these tools available,” Dr. Li explains. She’s hoping to change that, with three new studies launched in 2023.

Adapting Assessments for Alzheimer’s: Chinese Translation and Cultural Adaptation

In one of the studies, a five-year effort, Dr. Li will develop assessment tools that are linguistically and culturally adapted for older adults who speak Cantonese or Mandarin, with the hope to extend it to other Asian languages in the future.

Researchers rely on assessment tools from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) to identify research participants with cognitive impairment or AD/ADRD. But those tests were developed for English speakers and Western cultures.

“I’ve seen many Asian American patients who try to take the English tests because a Chinese version isn’t available, and the language is a barrier,” Dr. Li says. “Sometimes a test would suggest cognitive impairment, but when I would translate the test myself into Chinese, the patient would score in the normal range.”

Language isn’t the only barrier. Cultural differences also make the test confusing for many Asian American patients. When asked to identify an image of a witch on the standard test, for instance, some of Dr. Li’s patients said “janitor” or “cleaner”—a common error because witches aren’t typically depicted with brooms in Chinese culture.

The lack of adequate tests hampers diagnosis and treatment, and also affects research seeking to better understand AD/ADRD in Asian Americans.

“Because we can’t enroll patients unless they can take the tests in English, many are excluded from studies. As a result, Asian Americans make up less than 2 percent of the participants in U.S. clinical trials,” Dr. Li explains. “If we want to increase diversity in research, we need to adapt these materials for Chinese speakers and eventually other Asian languages.”

A Research Infrastructure for Alzheimer’s Disease in Asian Americans

In the second study, Dr. Li will develop a research infrastructure and tools for studying AD/ADRD in older Asian Americans. She and her colleagues will develop questionnaires to fully characterize Asian American participants, including social determinants of health and any environmental or lifestyle factors that could increase or decrease their risk of developing AD/ADRD.

This five-year study will also investigate blood samples from Asian American participants to determine whether there may be novel biomarkers in this population, and whether known biomarkers are relevant to people from Asian backgrounds.

“Amyloid and tau are well known as biomarkers associated with Alzheimer’s disease, but those biomarkers were developed primarily from Caucasian samples. Therefore, the generalization of these findings in Asian Americans is not always clear, including criteria for amyloid and tau burden to establish AD/ADRD risk,” she says. “There may be different thresholds for those biomarkers in different populations.”

Support for Mild Cognitive Impairment

Dr. Li’s third newly funded project is a two-year pilot clinical trial. She and her colleagues will adapt the Memory Support System (MSS) for use in Chinese Americans who speak Cantonese or Mandarin. The MSS is a memory calendar training program to help older adults with MCI organize and remember their daily activities. The system is a component of the Healthy Action to Benefit Independence & ThinkingÒ (HABIT) Program, an evidence-based intervention that provides lifestyle and behavioral treatments for older adults with MCI.

“I see patients with MCI who want to do something to prevent the development of dementia, but if they can’t speak fluent English, they aren’t able to participate in clinical trials,” Dr. Li says. “We hope that by adapting this program, we can offer Chinese American older adults with MCI an opportunity to participate in a trial that seeks to improve memory and function, as well as their mood and quality of life.”

Alzheimer’s Disease Research at Mount Sinai

In addition to the three new studies Dr. Li has launched this year, she is leading two clinical trials at the Alzheimer’s Disease Research Center at Icahn Mount Sinai and is the site Principal Investigator for the Asian Cohort for Alzheimer’s Disease (ACAD) study, a multisite project to analyze genetic data to identify risk variants for Alzheimer’s disease in Asian Americans and Asian Canadians.

Through these projects, she hopes to improve research participation, diagnosis, and treatment related to patients of Asian ancestry—an effort that is long overdue, she says.

“There’s a lot of work that needs to be done. In addition to research inequities, there aren’t enough bilingual physicians outside the community, which often makes it difficult for Asian American older adults to receive integrated specialty care, leading to delayed diagnosis and treatment for AD/ADRD,” she adds.

Mount Sinai serves a diverse patient population and is committed to improving care by addressing bias and racism. Icahn Mount Sinai and Mount Sinai Health System created the Center for Asian Equity and Professional Development to address the equity and professional development challenges faced by Asian Americans and Pacific Islanders.

Learn more about the Alzheimer’s Disease Research Center

Public Health and Racial Justice Program Encourages Girls of Color to See Themselves As Agents of Change

Updated on Oct 4, 2023 | Community, Diversity and Inclusion, Featured

The Mount Sinai Department of Health Education, with support from The Blavatnik Family Women’s Health Research Institute, hosted its first in-person cohort of the Public Health and Racial Justice Program. Over the course of six weeks in July and August, 15 youth participants, all identifying as girls of color, met daily at The Mount Sinai Hospital to explore a variety of public health issues through a racial justice lens.

The Public Health and Racial Justice Program emphasizes the power and importance of civic engagement, community organizing, and youth activism in addressing the inequities that drive health disparities. The program aims to build skills, foster pride, and nurture community connection so that participants understand themselves as lifelong stakeholders invested in shaping the policies, institutions, and structures that affect the health and well-being of their families and their communities.

“Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

The Public Health and Racial Justice Program was designed and launched in the spring of 2020 as a direct response to the COVID-19 pandemic and the Black Lives Matter movement. Due to pandemic restrictions, the previous four cohorts participated in a part-time version of this program over video conferencing.

With generous support from the Helen Gurley Brown Foundation, and in partnership with The Blavatnik Family Women’s Health Institute, the Department of Health Education was able to significantly expand this summer programming, offering a full-time opportunity with a stipend for participating youth.

More than 80 guest speakers—primarily women of color—from across the Mount Sinai Health System, and from local and national organizations, spoke on a variety of issues, broadening participants’ understanding of the many different pathways one can follow into health equity and social justice work. The program featured union labor organizers, doulas, scientists, clinicians, sexuality educators, grassroots activists, researchers, and leaders from city agencies, including the Bureau of Health Equity Capacity Building at the New York City Department of Health and Mental Hygiene, and the New York City Public Advocate Office.

“My favorite part was hearing from the different activists and non-profit workers,” said one participant. “Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

Another participant added, “I loved meeting all the guest speakers and organizations. The most meaningful part was the new relationships I made and learning more about how to help my community.”

Participants completed a culminating project reflective of their summer experience. Each participant selected a public health issue affecting their community, which they documented using a unique photography application. They were then led through a series of semi-structured, dialogue-based activities with staff and peers to support their development of a complementary narrative. This narrative included suggested action steps for those inspired to get involved.

Participants presented their projects at a celebratory symposium on the final day of programming, attended by Mount Sinai staff, community partners, and their family and friends. Their work was featured in a gallery at The Mount Sinai Hospital, and guests were invited to explore.

For many of the participants, spending the summer in a safe space with other girls of color was a profound experience.

When asked about the most meaningful part of the program, responses included:

“Having that space to be myself and being able to express what I am thinking at the moment. Being vulnerable and having that respect that most of the time adults don’t give to teenagers. I loved the relationships that were built in such a short amount of time.”

“Feeling comfortable and welcomed into this space and meeting all these wonderful and intelligent people who inspire me to embrace who I am.”

“Getting to know other people of color that are around my age and listening to everyone’s different opinions and perspectives.”

 

For some participants, learning about the relationship between racism and health was new and eye-opening.

“All the things we talked about and learned about in the program were all new information to me so everything surprised me,” said one. “It surprised me that we aren’t taught these things in school but if we want to gain more knowledge on these topics, we have to learn it on our own or from a program like this. I learned a lot about Black maternal health, homelessness, workers’ rights.”

Many of the participants also appreciated learning more about the various career paths that can contribute to health equity.

“At first I thought I knew what career I wanted to be, to become a nurse practitioner. But I met really nice people in the program who talked about their careers and that gave me more options to be open to my opportunities,” said one. “I also thought that many professionals had one path and that they knew they were going to be where they are now but I learned that there is nothing wrong with switching to a different field and it’s all about being happy that you’re doing that job.”

When asked to share their final thoughts on the program, one participant said, “I truly appreciated having the opportunity to be a part of such a wonderful program. I learned so much from the positive and caring program leaders/educators, the speakers, and the other girls in the program.”

To learn more about the summer 2023 session, read the full report

GOALS Employee Resource Group Event Offers Support and Dialogue for Black Men’s Mental Health

Updated on Jul 28, 2023 | Community, Diversity and Inclusion

Sidney Hankerson, MD, MBA, was the keynote speaker, and led the discussion.

The Growth in Operations, Administration, and Leadership Society (GOALS) Employee Resource Group (ERG) hosted its quarterly outing at Mount Sinai’s Corporate Services Center in June to recognize National Mental Health Awareness Month.

This event, coordinated by Shawn Lee, Associate Director of Operations for the Central Billing Office at the Mount Sinai Health System, brought together about 20 Black men from across the Mount Sinai community to have a candid conversation about the importance of mental health and surmounting the stigmas on mental health care.

The event’s keynote speaker was Sidney Hankerson, MD, MBA, Vice Chair of Community Engagement and Associate Professor of Psychiatry, and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. Dr. Hankerson, who is a nationally recognized expert at engaging faith- and community-based organizations to increase access to culturally relevant mental health care, facilitated the conversation and provided information on how to manage the challenges that Black men may encounter not only in health care but in their personal lives, as well.

Men, regardless of their race or ethnicity, have lower rates of seeking mental health services compared with women, Dr. Hankerson said. But Black men also face a complex array of socio-cultural factors, including racism and discrimination, misdiagnosis and clinician bias, and the common misconception that seeking help is a sign of weakness.

Among the tools available to support Black men’s mental health include culturally competent care, connections to religious communities that support mental health, exercise and behavioral activation, and social support. “I was pleased to see so many of our Mount Sinai brothers come together to create a sense of community for Black men,” said Reginald Miller, DVM, DACLAM, Dean for Research Operations and Infrastructure and Professor of Comparative Medicine and Surgery, and Environmental Health and Public Health at Icahn Mount Sinai. “Building a supportive network of Black males has been a main focus for GOALS.”

“We wanted to create a safe space where Black men can feel heard while also being able to connect with like-minded individuals, with whom they probably would have never met without a forum like this,” said Mr. Lee. “We look forward to expanding our GOALS network, collaborating with other groups, and aligning with system initiatives to foster equitable pathways for our members.”

To learn more about the GOALS ERG, email GOALS@mssm.edu or visit the website GOALS (Growth in Operations, Administrations and Leadership Society).

Read more about diversity, equity, and inclusion at Mount Sinai.

Mammograms Have Been in the News. Here’s What You Need to Know

Updated on May 23, 2023 | Diversity and Inclusion, Featured, Your Health

Mammograms have been in the news lately, and it can sometimes be a bit confusing. But the guidance from Mount Sinai doctors remains unchanged and simple: You should start getting mammograms at age 40 and continue yearly.

In this Q&A, Elisa Port, MD, FACS, Chief of Breast Surgery and Co-Director of the Dubin Breast Center, explains why changing guidelines from groups such as the U.S. Preventive Services Task Force have not altered the recommendations of doctors like herself to urge women to start mammograms at age 40 and have them every year. She also explains why this longstanding recommendation for annual mammograms starting at age 40, based on extensive data, is critical for Black women, who are more susceptible to an aggressive form of breast cancer, and why new regulations from the Food and Drug Administration on breast density are also important.

Elisa Port, MD, FACS

What is the latest advice on the age that people should start getting regular mammograms?

The age that women should start getting mammograms has never changed from the perspective of health care professionals. There is tons of data and research that has shown that starting at age 40 and yearly thereafter is the best way to detect breast cancer early and gives women of all those age groups the best chance of survival if they do develop breast cancer that is found through early detection. What has not been consistent is that, starting in 2009, and then again in 2016, a number of groups, such as the American Cancer Society and the U.S. Preventive Services Task Force, started putting out guidelines that differed from that. These were basically prioritizing different factors, and taking into account such things as the anxiety of patients, false positives, and cost. But doctors have known all along that the optimal way to screen women for breast cancer, with the highest chance of survival, is starting at age 40 and continuing yearly thereafter.

What is the U.S. Preventive Services Task Force?

The task force is an independent, volunteer panel of experts on prevention and evidence-based medicine that provides guidance to primary care physicians about preventive services such as screenings and counseling services. It is one of several leading sources of guidance to physicians.

What are the reasons for the new guidance from the task force to start mammograms at age 40?

One of the reasons for the change in its guidance on mammograms was newer data, very disturbing, showing that Black women—who we know can develop cancers younger—are more at risk for developing a particularly aggressive kind of cancer called triple negative breast cancer that can grow more rapidly. The death rate in Black women who get breast cancer is substantively and unacceptably higher. So this change in recommendation is a limited response to that data, saying one thing we can do to address that is revert back to starting screening at a younger age. But they did not go far enough.

How is the risk for Black women different?

One of the biggest issues specific to Black women is that breast cancer is not just one disease. Breast cancer involves multiple different subtypes. Each of these different subtypes is treated differently, has a different pathway, and behaves differently. One of these subtypes, called triple negative breast cancer, is the most aggressive kind of breast cancer and also one of the most difficult to treat. We know that of all breast cancers, triple negative makes up only about 15 percent. However, there are certain groups that have a higher chance of developing triple negative breast cancer and are at high risk for developing that subtype. Black women are one of those groups. When they develop breast cancer, there is a 30 percent chance it will be triple negative, not 15 percent. So it is much higher. As a result, they may need to be screened earlier, and with greater frequency.

Should people be concerned if they cannot afford a mammogram?

At Mount Sinai, we feel very strongly that women should keep to our guidelines, and we accept all insurance. We will do everything within our power to make sure that all women, even those without insurance, regardless of their ability to pay, get the care they need.

Are there any exceptions for the guidance that mammograms should start at age 40?

One of the things that we have made so much progress on, and that I’m so proud of, is there is not a one-size-fits-all approach. There are groups where we might even start screening earlier. Women with a family history of breast cancer, particularly at a young age, may start screening earlier and add other adjunctive tests like ultrasound or MRI—these are all considered in our high-risk populations. For example, if your mother was diagnosed with breast cancer at age 45, we typically advise starting screening about 10 years younger than the youngest family member diagnosed with breast cancer. Doctors might recommend starting at age 35, and recommend that you seek personalized advice and guidance regarding screening.

The FDA recently updated its regulations to require mammography facilities to notify patients about the density of their breasts. What does this mean for patients?

The density notification is a very important step because it tells women and their providers if they might be at higher risk for having a cancer missed, and potentially should be adding screening tests, like ultrasound and MRI, to close the gap in case mammograms are missing something. What is most important is that knowledge is power—women should be empowered to know more about their bodies. It does not automatically mean everyone needs an ultrasound or an MRI. It is a very nuanced discussion with one’s doctor, but it is a data point that can factor heavily into making these decisions. Breast density can only be determined one way, and that is based on a mammogram. We cannot tell breast density from the physical exam, or age, or family history. Based on that mammogram, one can then have an educated conversation regarding whether any additional imaging is appropriate

Will this new regulation produce any changes for Mount Sinai patients?

Many states, including New York, already had laws regarding breast density notification before the FDA’s action. So here at Mount Sinai, patients are already learning about their breast density, without the new FDA notification. Now all states, including New York, will need to do this in a uniform way. So there may be some small change for us in the notification language we send to patients.

What should I do if I have any questions or concerns about mammograms?

Primary care providers and gynecologist are the ones who order most of these tests. Their role is to customize and personalize any kind of cancer screening based on the individual, her family history, age, and other medical issues. That is what a good doctor does: takes all these considerations and puts it all together in a thoughtful approach for the individual.

Learn more about the Center of Excellence for Breast Cancer at Mount Sinai

Shaping the Future of LGBTQ+ Medicine

Updated on Jun 1, 2023 | Diversity and Inclusion, Featured

Fellows of the LGBTQ+ Medicine Fellowship from left to right, Jean Carlo Rodriguez-Agramonte, MD; Alexander Boulos, MD; Roy Zucker, MD.

Throughout the day, the flow of patients at Mount Sinai Health System’s Institute for Advanced Medicine clinics is nonstop, says Jean Carlo Rodriguez-Agramonte, MD. “But I couldn’t be happier, seeing these patients and knowing I’m helping them,” he adds.

Caring for LGBTQ+ people forms the bulk of Dr. Rodriguez-Agramonte’s training as part of the LGBTQ+ Medicine Fellowship at the Icahn School of Medicine at Mount Sinai. The third fellow since the program’s inception, he rotates through various specialties—internal medicine, adolescent medicine, and endocrinology, to name a few—through a year of training to learn skills needed to provide competent care for LGBTQ+ populations.

“The kind of care we’re trying to impart is one that is focused on addressing the patient’s identity,” says Erick Eiting, MD, Medical Director for Quality of the Center for Transgender Medicine and Surgery, and program director of the LGBTQ+ Medicine Fellowship. The fellowship is now gearing up to recruit its fourth fellow in the upcoming academic year.

Learn more about applying for the LGBTQ+ Medicine Fellowship

When Mount Sinai created the fellowship in 2020, it was one of the first two such programs in the country—the other was at the University of California, Los Angeles. “There’s a dire need for fellowships such as ours,” Dr. Eiting says. “That there were none prior was shocking given the legacy of health crises with the LGBTQ+ population in this country.”

Erick Eiting, MD

Only about a third of medical students have had any sort of LGBTQ+ training, and even that might be in the form of lectures that span one day, notes Dr. Eiting. “We need to step up and shape the future of LGBTQ+ medicine,” he says.

At the core of that effort is addressing disparity. Studies have shown that rates of depression, suicidal ideation, substance use, and HIV are significantly higher in LGTBQ+ populations, and yet access to health services to address those issues continue to be difficult for these communities, says Alexander Boulos, MD, MPH, who was the second program fellow. “Having a physician who’s well-trained to be sensitive to the patient’s gender identity and sexual orientation can help ensure proper testing, or asking the right questions,” he says.

The LGTBQ+ Medicine Fellowship has evolved over each iteration, and continues to challenge itself to grow. “Just as we train each fellow, we try to have each fellow help us expand the offerings we have,” Dr. Eiting says.

With a goal of diversity, the program is aiming for greater representation in gender, racial, and socioeconomic background from future fellows.

“Having people with rich and diverse backgrounds will bring about the ‘rising tide phenomenon,’ where a rising tide lifts all boats,” says Dr. Eiting. Just as a fellow receives instruction from the institution, so too does the fellow teach and be able to share experiences with staff who work alongside them, he adds.

Additionally, the fellowship seeks to ensure relevance amid rapidly changing technology in the health field. For example, Mount Sinai recently launched a telehealth program for pre-exposure prophylaxis (PrEP) for HIV, and Dr. Eiting hopes future fellows might be able to think creatively about technological innovations. “Telemedicine has great potential for LGBTQ+ medicine. How can we take it further?” Dr. Eiting asks. “That’s a goal: to always be thinking about how we can increase access more.”

Read more about the experiences of current and past LGBTQ+ Medicine Fellows

Jean Carlo Rodriguez-Agramonte

Alexander Boulos

Roy Zucker

Jean Carlo Rodriguez-Agramonte, MD; 2022-2023 LGBTQ+ Medicine Fellow

What drew you to the fellowship?
When I was applying, there were only two such programs of its kind: one at Mount Sinai and one at UCLA. But what was a particular draw for Mount Sinai was that there was a large Latino population, especially Puerto Rican, in New York. There’s a saying that Puerto Rico almost feels like a borough of New York City. But coming from there, I was interested in continuing to treat and understand that population.

What were some of your takeaways from the fellowship?
The amount of patients I’ve seen here and the availability of resources is incredible and humbling. As a physician, you don’t get sidetracked from your goal of treating patients simply because of the lack of resources.

For example, when a patient comes in here, they get to have their labs done immediately, instead of having to wait weeks. Then, I get the results first, and I’m able to explain the results to them. It feels more personal and leads to better communication. Sometimes, when patients get their results first without any guidance, it leaves them with a lot of questions and causes unnecessary stress.

Being surrounded by so many experts here at Mount Sinai, it doesn’t feel like you’re constantly running into walls. Patients sometimes expect you to know everything, but we don’t know everything. At least here, I know where to tell my patients to go to, even if I don’t have all the answers.

What were some challenges or highlights faced during the program?
I got dropped into a population I wasn’t used to seeing a lot of, such as the transgender population. I had a lot of learning to do on how to properly care for them. Not just medically, but also on things such as using the proper pronouns, and centering their identity as part of the care.

A highlight for me was being able to treat Latino patients at a deeper level. In general, it’s very difficult to provide preventive care without understanding the person’s underlying culture, since so many nuances are unsaid. But I’ve had so many Spanish speakers say to me, “I’m so glad I can speak to you on my own terms. Because you get it.” That connection feels special to me each time I hear it.

What do you hope to achieve after the fellowship?
I hope to implement the things I’ve learned here in Puerto Rico, particularly regarding providing better transgender care. I also hope to be part of the conversation there for improving medical education on LGBTQ+ populations. Just as it is here, medical school systems there lack inclusive care instruction.

Part of why I wanted to go into family/internal medicine and pediatrics is that I like the “figuring out the puzzle” part of medicine. Unlike in surgery, where all the complicated part of diagnosis is done and you’re fixing the problem, in family medicine, you’re talking and listening to patients and figuring out what is wrong. Similarly, I want to figure out where the missing parts are in research and education, and find the answers.

Alexander Boulos, MD, MPH; 2021-2022 LGBTQ+ Medicine Fellow

What drew you to this fellowship?
Ever since medical school, I’ve been involved in increasing awareness of LGBTQ+ health issues, giving training and competency lectures to faculty, staff and residents about the LGBTQ+ patient, and even starting a PrEP clinic at the Veterans Affairs in the Bronx to help increase access to medication that can be used to prevent HIV for at-risk patients living in underserved communities.

I realized that I’ve been working in LGBTQ+ medicine all this time and not even knowing it. When I discovered the existence of this program while completing my preventive medicine residency program here at Mount Sinai, I knew it was the perfect opportunity to help set the tone for the rest of my career.

What were some of your takeaways from the fellowship?
I remember vividly, after my first day of this fellowship, calling my family and friends and saying, “I’ve never seen so many gay patients in my life!” And I was absolutely loving it. How was it that I was already a resident and hadn’t had much exposure to LGBTQ+ patients?

In the program, I was able to rotate and learn from experts in almost every field, including infectious disease, endocrinology, plastic surgery, urology, OB/GYN, psychiatry, adolescent medicine, and addiction medicine. The scope of experiences I had was nothing short of amazing. I got to scrub in for gender-affirming surgeries, including vaginoplasty, chest masculinization, and facial feminization. I’ve worked with experts in HIV/AIDS treatment, provided gender-affirming hormone therapy to transgender and gender-diverse patients, and even cared for intersex pediatric patients.

Why do you think LGBTQ+ fellowships are important?
Especially today, there are many places in the United States where health care access for LGBTQ+ communities continues to be a challenge. We’ve seen a recent wave of anti-transgender bills passed throughout the country that serve to block and/or limit access to gender-affirming care.

Programs such as this one are important for changing the future of medicine, as it serves as a bold statement about the need for more training and resources to serve a community that has all too often been left out on their own. We need more doctors to be advocates for LGBTQ+ patients and to be aware of their specific health needs, just as we are trained to do so for every other patient.

Unfortunately, that training isn’t quite the norm yet, and I’m here to help change that. I’ve found my purpose in this field and I want to help make a difference for my community.

How do you intend to make that difference, after your residency?
As I gear up for graduation and make my way out in the real world, I plan to continue serving the LGBTQ+ community clinically as a primary care physician, focusing on HIV/AIDS treatment, PrEP management, anal cancer screening, and gender-affirming care.

In addition, I hope to play a part in medical education reform where we can incorporate important LGBTQ+ competency trainings in medical school curriculums. Doctors and medical students need to be more comfortable treating LGBTQ+ patients, and they’ve shown that they are open to learning.

I also hope to increase my community outreach engagement to the LGBTQ+ population directly and find new and innovative ways to teach and inform the community about important health issues, such as ones they might find too uncomfortable bringing up to their provider. I’m excited to see what the world has in store for me, but one thing I do know is that it all started here.

Roy Zucker, MD; 2020-2021 LGBTQ+ Medicine Fellow

How did you get involved with the first fellowship?
I had been working in LGBTQ+ medicine in Tel Aviv for about seven years, and was in the infectious disease program at the Tel Aviv Sourasky Medical Center (Ichilov). Mount Sinai has a collaboration with my hospital, and Mount Sinai’s dean of education came to Ichilov to discuss setting up a one-month observership program at its Institute for Advanced Medicine.

I participated in that program and realized physicians seemed to only be looking at their own disciplines, and no one was looking at LGBT care holistically. For example, a transgender patient will get the best care with a transgender medicine practitioner, but if HIV is involved, another provider would need to be involved.

I thought, “Why not a training program where providers are taught to look at the broader picture of LGBTQ+ care—including the spectrum from transgender medicine to psychiatry to HIV care?” I wrote an email to David Reich, MD, President of The Mount Sinai Hospital, not expecting a response. In five minutes, I got an email back, and soon we started discussing starting up the program. A year and a half later, I became the first fellow.

What were some of your takeaways from the fellowship?
Unlike in Israel, the patients at Mount Sinai are much more diverse. The exposure to the patient diversity really challenged me as a physician in how I get to treat and address patients. There were initial cultural and language differences, but patients were patient with me. On the professional side, because I had already been treating patients and involved in LGBTQ+ medicine for many years, I felt I had a lot to offer to people working alongside me. While Mount Sinai was giving me expanded knowledge, I also felt people could learn from my experience in Israel too.

While the term “leadership” might be overused in America, I felt it was really on display at the Health System level, and also at the Icahn School of Medicine. Their commitment to health care delivery and excellence has led to great name recognition in Israel, where being affiliated with Mount Sinai is an impressive achievement.

What are you working on today?
Since August of 2021, I have been the Director for LGBTQ Health Services with Clalit, the biggest health service organization in Israel overseeing 5 million patients. We created LGBTQ+ clinics in Tel Aviv, Jerusalem, and Haifa.

I am also Director for LGBTQ Health Services with Ichilov in Tel Aviv, and in partnership with city hall, we’re about to open an LGBTQ community health center that integrates medicine and community initiatives. A focus of this center involved “clinical champions”—people within Ichilov who are specialized in a specific branch of LGBTQ medicine such as geriatrics or adolescent medicine, who will focus on research and education.

These are some current steps, but I am hoping to guide what the future of medicine might look like for LGBTQ+ people.

What might that future look like?
Even in 2023, LGBTQ+ patients are still hesitant to access health care services because they’re afraid of exposing themselves and are not comfortable discussing their sexuality with providers. Patients are going to hospitals when their conditions become an emergency, not before, when things can still be prevented. We need to provide accessibility on the patients’ terms—if they’re only comfortable in an LGBT-defined space, it should be there.

But in the long term, I hope that LGBTQ+ care goes beyond just about providing accessibility and addressing discrepancies, but more into “community-oriented” care. This means thinking about LGBTQ+ populations across all ages—how they’re exposed to LGBTQ+ topics, how they age and their mental health, etc. For example, if you’re talking about sexual health and gender identities at a younger age, having that acceptance early on affects mental health outcomes later in life. When you put it there from the beginning for young people, they don’t feel as on the fringe.

As someone who has an entrepreneurial soul, I found Mount Sinai embraced that spirit. I came to New York and people here at the program helped take an idea from my head and made it real. The biggest motivational word of mine is “no”—when someone says “no,” all the more I want to make it happen. Mount Sinai certainly helped with the obstacles to make my dream happen.

Committed to Education and Equity: A Q&A With Reena Karani, MD, MHPE, the New Chair of the National Board of Medical Examiners

Updated on May 17, 2023 | Community, Diversity and Inclusion, Featured

 

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.

Read more about the Institute for Medical Education at Mount Sinai

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