A First at Duke

BY ANN GEHAN

Leon W. Herndon, MD, professor of ophthalmology and glaucoma division chief, has worked as a glaucoma specialist at Duke Eye Center for over 25 years. Despite his decades of experience, he recently experienced a first in his career––his first OR day with an all-Black trainee team. Only around 6% of practicing ophthalmologists are minorities, and only 3% of ophthalmologists are Black. Duke’s department of ophthalmology had only had three Black residents in its entire history until last year, when there was one Black member in each residency class. Herndon’s team decided to take a picture to commemorate the historic moment, which later received an overwhelmingly positive reaction on social media. “I’m not a social media kind of person, but it’s been really amazing to see how the picture has generated so much buzz” Herndon said.  

As part of Duke Health’s broader Moments to Movement anti-racism initiative, leaders at Duke Eye Center like Herndon are working to continually improve these statistics through initiatives to recruit and mentor medical students and residents from traditionally underrepresented backgrounds and fight against racism and discrimination in their everyday work. 

After Goldis Malek, PhD, associate professor in ophthalmology, was asked to serve on the School of Medicine’s diversity and inclusion council, she realized that Duke Eye Center did not have its own diversity and inclusion initiative and was inspired to create a council to address specific issues there. After protests across the country this summer called for an end to police violence against Black Americans, Malek and her team recognized an opportunity to continue the council’s work at a crucial moment.  

One of the most tangible results of the council’s work are the banners posted throughout Duke Eye Center, emphasizing their commitment to anti-racism and zero-tolerance policy regarding racism or discrimination of any kind. The council has also started book clubs and educational efforts including training sessions to understand implicit bias and recognize sexual harassment and bullying, in order to create community as well as understanding. “[The book club] was really helpful in starting the conversation, because there are many people who have no idea what communities that are perceived to be different had to go through and still are going through, so this was a great opportunity,” Malek said. 

Eye On Med Students 

Jullia Rosdahl, MD, PhD, associate professor of ophthalmology, and her colleagues recognize that the competitive nature of the field can deter minority students from specializing in ophthalmology. Rosdahl, who serves as the Duke Department of Ophthalmology’s director of medical student education, makes an effort to reach students as early as possible in their careers to encourage them to consider ophthalmology. “We really want the students to know about ophthalmology when they're first starting medical school and to help them realize, ‘This is something I want to learn more about and potentially consider,’ and then be ready to be a great applicant [for residency programs],” Rosdahl says. Since ophthalmology is a competitive specialty and one that requires an early match for residency programs, Rosdahl focuses on encouraging students to consider ophthalmology as a specialty, as well as promoting access to clinical and research opportunities. 

Rosdahl has helped develop Duke’s relationship with various national programs, while also expanding access to programs unique to Duke. The Minority Ophthalmology Mentoring program is sponsored by the American Academy of Ophthalmology (AAO) and Association of University Professors of Ophthalmology (AUPO), and aims to help first- and second-year medical students become competitive applicants for ophthalmology residency by pairing them with mentors, providing access to educational and study materials, and sharing research opportunities. 

Mentor relationships are key for students’ success as they develop their medical careers. Nicholas Johnson, MS, a current medical student at Duke, credits Duke Ophthalmology’s strong tradition of mentorship as a key resource that helped him successfully pursue his interests. As he was learning the basics of ophthalmology, Johnson was able to shadow Herndon, which inspired him to continue to pursue the specialty. “It's just something powerful to see––to put yourself in someone's shoes and be able to see yourself there in the future,” Johnson said. “I think that was one of the key factors that helped me stick with it. It just felt like such a small community or a family within the department that made it difficult to say no.” 

Johnson also participated in the Rabb-Venable Program, a research award sponsored by the National Medical Association that promotes mentoring and career guidance for third- and fourth-year medical students from underrepresented backgrounds. Johnson, who was an incoming third-year student at the time, was one of four Duke trainees selected as finalists for the 2020 program and received the first-place award for medical student presentations. He was able to continue his research project from the program with Felipe Medeiros, MD, PhD, professor of ophthalmology, ultimately culminating in Johnson’s first research publication.  

"No voice is too small. I hope that one day all staff would feel safe to share their feelings or concerns about social injustice in the correct forum."

Denelle Richmond, COT

Even with the limitations presented by the coronavirus pandemic, Rosdahl and her team have worked to continue to facilitate mentor relationships between students and faculty. Typically, Duke Ophthalmology participates in the Visiting Clinical Scholars program, an initiative sponsored by Duke’s medical school that allows fourth-year medical students from diverse backgrounds to participate in a clinical elective at Duke. Rosdahl says that the department’s support for the program has been key to recruiting students from a wide range of backgrounds. “It's been a way that we've been able to recruit some students who have subsequently come back to be residents here, and they've been outstanding residents,” she said. Pandemic-related restrictions have temporarily paused the program, but Rosdahl and her team were able to create a virtual alternative that has replicated the traditional program’s success.  

During the summer and fall months, Duke Ophthalmology developed a four-week virtual elective which allowed students to participate in mentorship opportunities, case presentations, and faculty meetings. The elective specifically targeted students from underrepresented backgrounds and students without ophthalmology programs at their home institutions, allowing more students to gain clinical exposure and develop mentoring relationships with Duke faculty. Rosdahl says that the structure provided unexpected benefits for both students and faculty. “Clearly they’d prefer to be in-person when that is available, but they did feel like there were some things that they got from that virtual elective that they wouldn't have gotten otherwise––the level of exposure to those faculty mentors was much higher than they would get in an in-person activity,” she said. 

Rosdahl credits leaders like Dr. Brenda Armstrong, who served for more than two decades as an admissions dean at Duke’s medical school, for laying the foundation for efforts to recruit and support minority medical students. “She did a lot of personal outreach for students to let them know Black students are welcome here and we want to have Black students at Duke,” Rosdahl said. “She really pulled [students] in, letting these students know, ‘We want you. We want this to be a place for you to come and be a part of things.’” 

Looking To the Future 

The legacy of leaders like Armstrong continues today at Duke Eye Center, especially as recent protests for social and racial justice have spread across the country. This renewed push for equality has helped Duke Eye Center’s existing programs take on a new sense of purpose. “Over the past few years, we have had discussions about these types of social justice issues, and those discussions have taken on a new meaning in the past seven or eight months,” Herndon said. Looking to the future, he remains encouraged and optimistic. “I hope that people get a little uncomfortable having these conversations, because if you're not uncomfortable, then you can’t move on to make a difference, so we're certainly doing the right things. I surely hope that we go from just having discussions to having some really lasting changes that will make a level playing field for all of us,” he said. 

Malek and the council are looking forward to the long-term changes their efforts will produce, “improving diversity and cultivating a culture of inclusivity”. “[Our work] is something that we're not doing for just the next couple months––this is something we would like to do for the long haul,” she said. “This is a learning experience for all of us, because if this was a simple thing to solve, it would have been solved years ago, so we must strive and set the stage for change to occur. Change will take time, but we're hopeful. We have a great group of dedicated people, all of whom are passionate and excited about making a change.”