Sylk Sotto-Santiago

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https://hdl.handle.net/1805/32323

"I am interested in helping restore trust": Perspectives on Trust and Trustworthiness in Biomedical Research

Dr. Sylk Sotto is an Assistant Professor of Medicine and serves in several leadership roles across the Department of Medicine, the Indiana Clinical and Translational Science Institute and the IU Simon Comprehensive Cancer Center's Office of Community Outreach and Engagement. Dr. Sylk Sotto's career calling is about making people feel like they belong, that they are here for a reason, and that she is available to cheer them on. In her role, Professor Sotto makes sure people understand that not everyone has the same access, privilege, or has the same journey. Her service and research centers on the study of inequities in academic medicine. More broadly, Professor Sotto likes to examine the intersection of research, research ethics and health equity while making sure researchers practice cultural humility and relevance. She also studies and addresses structural barriers and opportunities for everyone's success within institutions. She works to enhance medical and STEM education while promoting inclusive learning environments. Lastly, Professor Sotto plans to expand and tailor faculty and professional development programs in ways that focus on historically marginalized groups. Her service is her research. She hopes that her work impacts more practice than theory. She wants to positively affect institutional practices and influence reflection and action. Professor Sotto's translation of research into educational and health equity for historically marginalized groups is another excellent example of how IUPUI's faculty members TRANSLATING their RESEARCH INTO PRACTICE.

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    Culturally Appropriate & Socially Responsive Care [CASRC] Thread
    (2018) Price, Mary; Sotto-Santiago, Sylk; Lazarus, Ken; Christy, Lisa
    Medical Education Objectives for the Social Science Thread (Now:Culturally Appropriate & Socially Responsive Care [CASRC] Thread): 1) The primary goal of the CASRC Thread is not to develop specific sessions for presentation of thread material but to work on identifying gaps and working with course and clerkship management teams to integrate thread content to cover those gaps. 2) There is a need to add emotional behavioral health to the medical student curriculum to help students develop communication skills, rapport with patients, develop ways to interact with patients and how to understand, treat, and build a relationship with patients and those with chronic diseases. 3) Incorporate thread objectives into courses and clerkships from first year through fourth year.
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    Defining Student Success in Academic Medicine
    (Brieflands, 2018) Tori, Alvaro; Sotto-Santiago, Sylk; Sharp, Sacha; Mac, Jacqueline
    Background: The U.S. healthcare delivery system must increase the number of physicians who will deliver health care, as well as increase the number of scientists who will analyze and address the ailments that challenge diverse populations. Because medical schools are responsible for the education and preparation of diverse professionals, medical school administrators are working to create and maintain programs that recruit and retain students from underrepresented groups in medicine. Methods: This study follows A Student Success Ad-hoc Committee (SSAC) charged with a) defining student success, b) exploring the success of underrepresented students in medicine based on this definition, and c) drafting recommendations based on data and evidence collected. This self-study evaluates and assesses medical student experiences, their educational attainment, and outcomes at Indiana University School of Medicine. This aim is explored through the application of higher education theories to undergraduate medical education. Results: This paper demonstrates how an interdisciplinary team of academic medicine professionals endeavored to critically study the perceptions of student success in medicine. The study showcases the institution’s progress towards defining student success informed by literature on student retention and persistence, learning environments, and student outcomes. The paper includes recommendations based on a reflexive process about three areas: admissions and pre-matriculation, academic promotion, and the educational environment. Conclusion: The authors challenge professional schools in conducting self-studies that expand the utilization of theoretical and conceptual frameworks external to medicine, and reinforce the application of higher education research into professional school settings.
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    Moving Beyond Cultural Competence Toward Cultural Humility and the Delivery of Equitable Patient-Centered Care
    (2019) Maldonado, Maria; Dupras, Denise; Sotto-Santiago, Sylk
    In the Accreditation Council on Graduate Medical Education’s (ACGME) 2016 national report of the Clinical Learning Environment (CLE) Review, it was reported that across most CLEs, education and training on health care disparities and cultural competency was largely generic. A “generic approach” to cultural competency implies that sponsoring institutions where training programs are seated have not made an assessment of the specific needs of the patient population that they are serving. While a targeted approach is a laudable goal, it runs the risk of stereotyping the needs of individuals in a specific cultural group. We propose that the time has come to move beyond the goal of cultural competency toward cultural humility and the delivery of equitable patient centered care – care that is delivered that takes into consideration the specific needs of the patient and does not vary in quality based on personal characteristics like gender, ethnicity, geographic location, religion, sexuality, and socioeconomic status. Graduate medical education should ensure that learners develop skills critical to delivering patient- centered care that emphasize the core qualities of curiosity, empathy and respect.
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    (Dis)Incentivizing Patient Satisfaction Metrics: The Unintended Consequences of Institutional Bias
    (Mary Ann Liebert, 2019-02-04) Sotto-Santiago, Sylk; Slaven, James E.; Rohr-Kirchgraber, Theresa; Medicine, School of Medicine
    Background: Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric. Methods: Patient satisfaction and communication scores collected during academic year 2015-2016 were obtained for 369 physicians (119 women and 250 men) at Indiana University Health system. Independent variables included physician gender, race, ethnicity, and subspecialty or division; 190 physicians constituted the study cohort for whom data were available for comparison. Statistical analyses were performed to determine if there were differences between gender and race in patient satisfaction scores (mean, median, t-tests, and Chi-square tests). A factorial analysis of variance model was performed to incorporate both main effects and to determine if there was a significant interaction between them. Results: Median and mean of scores were lower for women physicians and underrepresented physicians. Analysis demonstrated nonsignificant effect between gender-segregated cohorts. Racially underrepresented physicians had significantly lower mean scores than their white colleagues [F(4, 185)=2.46, p=0.046]. Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, ultimately leading to pay inequities through differences in financial incentives toward underrepresented physicians.
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    All Faculty Matter: The Continued Search for Culturally Relevant Practices in Faculty Development
    (New Forums Press, Inc., 2019-09) Sotto-Santiago, Sylk; Tuitt, Frank; Saelua, Natasha
    The evidence appears to be strong that faculty development programs increase retention, productivity, interest in leadership positions, and promotion for faculty. However, the spaces developed for historically marginalized faculty (HMF) are still limited and not focused enough. This study examined tailored programs and perspectives amongst faculty developers regarding the advancement or furthering minoritization of historically marginalized faculty via institutional based and national programs. Findings include best practices in HMF tailored programs, curriculum topics for faculty developer preparedness, and address an “all faculty matter” perspective.
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    “Am I Really Good Enough?”: Black and Latinx Experiences with Faculty Development
    (Michigan Publishing, 2020) Sotto-Santiago, Sylk
    This study focuses on the experiences of Black and Latinx faculty in academic medicine in relation to their educational and faculty development. Narratives by participants reflect on their career path and refer to faculty development programs as valuable but also as dominant group-centric, counter to their cultural backgrounds and the underrepresented faculty experience. Findings reveal the need for faculty development to be spaces for affirmation, validation, and accountability and suggest the need for tailored programs. Furthermore, implications on the research and practice of faculty affairs within higher education and academic medicine are outlined.
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    “I Didn't Know What to Say”: Responding to Racism, Discrimination, and Microaggressions With the OWTFD Approach
    (Association of American Medical Colleges, 2020-07-31) Sotto-Santiago, Sylk; Mac, Jacqueline; Duncan, Francesca; Smith, Joseph; Medicine, School of Medicine
    Introduction Academic medicine has long faced the challenge of addressing health inequities, reflecting on how these contribute to structural racism, and perpetuating negative social determinants of health. Most recently, we have constructed opportunities for dialogues about racism, discrimination, and microaggressions (RDM). As such, we created a professional development program that encouraged participants to (1) openly discuss RDM and the impact they have in academia, (2) learn about tools to address and respond to RDM, and (3) move towards the creation of inclusive environments. The target audience included institutional leaders, faculty, trainees, professional staff, and health care teams. Methods We sought to meet workshop goals by integrating anti-racist dramaturgical teaching, introducing concepts knowledge, and practicing communication tools. To assess learning and evaluate our workshops, participants completed a pre- and postsurvey. Results Results showed that 30 participants were more comfortable with discussing issues related to race/ethnicity, gender identity/expression, sexual orientation, and spirituality after participating in the workshops. Prior to the two workshops, the percentage of learners who felt confident initiating conversations ranged from 29% to 54%. After the workshops, the percentage of learners who felt confident ranged from 58% to 92%. The greatest increase, 100%, was observed in the levels of confidence in initiating conversations related to race/ethnicity. Discussion Despite medical education's commitment to cultural competence and institutional mission statements that value diversity, equity, inclusion, and justice, professional development opportunities are limited. Participants strongly agreed their participation in such a workshop was relevant and important to their professional work.
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    The Power of Social Media in the Promotion and Tenure of Clinician Educators
    (Association of American Medical Colleges, 2020-08-10) Sotto-Santiago, Sylk; Sharp, Sacha; Mac, Jacqueline; Medicine, School of Medicine
    Introduction Social networking sites (or social media [SM]) are powerful web-based technologies used to bolster communication. SM have changed not only how information is communicated but also the dissemination and reception of a variety of topics. This workshop highlighted the benefits of SM for clinician educators. The use of SM was explored as a way to maximize opportunities for clinician educators to network, establish themselves as experts, and build a national reputation leading to promotion. The target audience for this submission is faculty developers who would like to implement a similar workshop, and clinician-educator faculty motivated by promotion and advancement. Methods The training workshop involved an interactive session, with approximately 20 minutes of content, 20 minutes of individual and small-group activities, and 15 minutes of large-group discussion. The effectiveness of the workshop was evaluated by asking participants to complete a postsession survey of SM knowledge, attitude, and action. Results Survey responses (n = 14) demonstrated an increase in participants’ knowledge of SM platforms, ability to identify benefits of SM, skills to disseminate their work, and eagerness to build their personal brand. Discussion This workshop provided a foundation for clinician educators to think strategically about SM use in ways that highlight access to a broader network of colleagues and potential collaborators and that influence the impact of publications and work.
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    Addressing Mental Health Needs of Health Care Workers through Peer Support Groups During the COVID-19 Crisis
    (Indiana University, 2020-12) Thornsberry, Tanner; Nault Connors, Jill; Welch, Julie; Hayden, Julie; Hartwell, Jennifer; Ober, Michael; Sotto-Santiago, Sylk; Draucker, Claire; Wasmuth, Sally; Boustani, Malaz; Overley, Ashley; Monahan, Patrick; Kroenke, Kurt
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    A Program Evaluation of the Engagement of Participants in the AstraZeneca COVID-19 Vaccine Clinical Trial at Indiana University School of Medicine
    (Indiana Medical Student Program for Research and Scholarship (IMPRS), 2021) Ziwawo, Cynthia; Sotto-Santiago, Sylk
    Background/Objective: Since the emergence of various COVID-19 vaccines, there have been a significant amount of members of historically marginalized populations that remain unvaccinated. Specifically, Black and Latino/x populations vaccine rates are consistently lower than their white counterparts not just in Indiana, but across the country. The recruitment of the AstraZeneca clinical trial for the COVID-19 vaccine that was hosted by Indiana University School of Medicine underscored this disparity. The drop off rates for Black and Latino/x participants between being screened for the study to ultimately being enrolled into the study became a cause for concern. The concept of vaccine hesitancy in these communities is a concept worth further exploration in order to determine the best strategies to improve health outcomes as we continue to mitigate the current pandemic. Methods: Interviews with the research assistants of the AstraZeneca clinical trial were conducted in order to identify the major causes of hesitancy and acceptance amongst the individuals that were screened and enrolled into the study. The questions explored the interactions with the participants, specifically for anecdotal evidence of the screened participants that ultimately did and did not participate in the study. Results: Despite the outpouring of Indiana residents that enrolled in the study, many chose not to participate due to unknown potential side effects of the vaccine, access to provider advise, trust, among others. Furthermore, the timeframe of the study was heavily impacted by the availability of the FDA approval of Pfizer’s vaccine, in which many participants chose to drop out for a guaranteed vaccine. Conclusion and Potential Impact: Identifying barriers to vaccine acceptance in marginalized communities will provide vital information for advancing public health efforts to increase vaccination rates. Additionally, implementing these strategies into vaccine clinical trials will allow for more equitable representation, and culturally competent scientific evidence.