Sylk Sotto-Santiago
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"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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Item 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, SylkBackground/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.Item Socialization of Graduate and Medical Students into Academic Careers(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2022) Stamper, Gavin; Sotto-Santiago, SylkPurpose: Socialization is the process through which individuals acquire and incorporate understanding of the organizational culture with shared attitudes, beliefs, values, and skills. This process differs from student to student but is impacted by culture. Our study examines the socialization of medical and graduate students into academic careers and considers their cultural background. Methods: This research uses the CECE model for cultural engagement along with the graduate student socialization scale by Weidman & Steins (2003). Study population included graduate, medical, and professional students. Participants were recruited via social media advertising as well as targeted communication through various national organizations and school diversity offices. The survey was available from June 15, 2020 and preliminary data was taken on July 8, 2020 which yielded 110 survey responses. Demographics: Race/Ethnicity: Asian/Asian American (18.39%); Black/African American (10.34%); Latina/o/x/e (6.90%; Middle Eastern or Northern African (2.30%); White (59.77%); Multiracial (1.15%); Caribbean (1.15%). Gender: Woman (69.41%); Man (21.28%); Genderqueer/fluid, Questioning/Unsure, Trans Man, Trans Woman, Non-binary (1-3% each). Sexual orientation Heterosexual/straight (68.24%); Bisexual (7.06%); Gay (8.24%); Queer (5.88%); Lesbian, Asexual, Pansexual, Questioning/Unsure, prefer not to respond (1-4% each). Results: Between 58-62% of respondents report never being given an opportunity to: engage in research that helps advance their knowledge of inequities, engage in research relevant to their identity, engage in research contributing to the improvement of the communities with whom they identify. Most students (56-71%) have never discussed becoming a faculty member, what it entails, or other careers in academia. Conclusions: Students report lacking cultural engagement in research; this includes both learning about the cultural communities they belong to but also working on research aimed to improve those communities. Institutions have an opportunity to fill a gap in education by working towards a more culturally engaging campus environment while also recruiting students to academia.Item 192. Health Equity Starts with Us: Recommendations from the Indiana Clinical and Translational Sciences Institute Racial Justice and Health Equity Task Force(Cambridge University Press, 2022) Sotto-Santiago, Sylk; Tucker Edmonds, Brownsyne; Wiehe, Sarah; Moe, SharonOBJECTIVES/GOALS: The Indiana CTSI Strategy Committee charged the Racial Justice and Health Equity Taskforce to identify priorities with short-term and long-term goals consistent with the I-CTSI mission. In addition, I-CTSI leadership asked for a general description of current state and the resources necessary to achieve the proposed goals. METHODS/STUDY POPULATION: The Taskforce applied an inclusive excellence model to the way we look at the I-CTSI structure, policies, and programs while performing an environmental scan within and across I-CTSI partner institutions. In order to reach equitable solutions and consensus, listening tours were held with partner stakeholders guided by the SOAR framework for strategic planning. This approach allowed us to assess current resources, needs, and gaps across the system, along with a baseline of measures currently monitored. Taskforce members openly discussed strengths and opportunities for enhancement of current programs and services. In addition, these conversations offered an opportunity to disrupt existing practices and through collective agency we identified priority areas that promote equity, diversity and inclusion. RESULTS/ANTICIPATED RESULTS: The Taskforce identified recurring themes in conversations with all partners, which led to the formation of three working groups that examined recruitment broadly: workforce, staffing, and research participation; professional development across all stakeholders from community members to I-CTSI staff; and data-centered metrics informing current state, decision-making, and accountability. Recommendations included these priorities, content, and implementation strategies. The Taskforce delivered a report to the I-CTSI leadership fostering the promotion of diversity, equity and inclusion along with a systematic collection of gender, race, and ethnicity data for individuals utilizing I-CTSI services and resources requiring additional metrics and tracking. DISCUSSION/SIGNIFICANCE: The pandemic shed light on the manner in which marginalized groups are rendered particularly vulnerable to death and disease by systemic and structural racism. The I-CTSI recognized that we cannot advance population health without attending to root causes of inequity and that includes our internal structure. We offer a potential model for other CTSAs.Item Relationship of Trust and Research Engagement(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2023) Bruns, Rebecca; Vinaixa, Conor; Haywood, Antwione; Ridley-Merriweather, Katherine Ellen; Sotto-Santiago, SylkBackground/Objective: Lack of trust is a major barrier to research participation and can lead to disparities in health outcomes. Scales that measure trust in healthcare organizations and biomedical research have never been synthesized into a single tool, nor has such a scale been used to assess attitudes regarding trust in a more focused community. This project aims to measure trust in medical researchers and healthcare institutions in Indiana. Methods: A survey was created by combining previously validated trust scales (Shea et al., Mainous et al., and Hall et al.) along with questions about demographic backgrounds. Cognitive interviewing was conducted in three focus groups to finalize survey questions. The questionnaire was sent to participants recruited via email from the All IN for Health registry, a statewide database of volunteers interested in research participation. Results: At the time of analysis, 481 participants had completed the survey. About half of respondents were age 60+, and almost three times more women participated than men. The majority had bachelor's degrees or higher (72.5%). About half of participants agree that healthcare organizations cover up their mistakes. Half disagreed that patients get the same medical treatment regardless of race/ethnicity. Almost one in five respondents (17.4%) believe that medical researchers conduct experiments on people without their knowledge. Conclusion: Preliminary results suggest additional efforts may be needed to foster trust in healthcare research and organizations. Results may not be generalizable to the entire population due to differences in gender, race/ethnicity, and level of education across initial respondents. One limitation is that recruitment using the All IN for Health registry may have produced biased results. Further studies are needed to understand factors that may influence trust. Scientific/Clinical/Policy Implications: Results may influence public outreach and research recruitment to gain trust from Indiana residents and enhance participation in medical research.Item “Am I Really Good Enough?”: Black and Latinx Experiences with Faculty Development(Michigan Publishing, 2020) Sotto-Santiago, SylkThis 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.Item Community Engagement, Motivation and Participation in Health Advisory Boards(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2022) Stamper, Gavin; Sotto-Santiago, SylkPurpose: All IN for Health is dedicated to helping improve the lives of Indiana residents through community engagement by increasing health research literacy and promoting health resources. It also provides opportunities to participate in research and clinical studies, hosting a state-wide participant registry. All IN for Health is made possible by the Indiana Clinical and Translational Sciences Institute, combining the research expertise of Indiana University, Purdue University and University of Notre Dame. Its health advisory board is composed of community members and provides advise, feedback and recommendations. Objective: This study aims to provide health advisory boards (HABs) in Indiana information to understand the motivations and interests of potential board members to be used for recruitment and community outreach. Methods: In looking for new members of the All IN for Health HAB, 488 applicants answered questions about their motivations for and interests in becoming a part of the HAB. In order to identify what motivates people to get involved, answers were analyzed for common themes via a thematic analysis. All answers remained anonymous, and no personal data was used in the analysis. Results: Analysis revealed six recurring themes in the motivation to join the HAB and 9 recurring themes were identified about interest in the position. These themes can be grouped by previous diagnosis (family, friends, and self), being a caregiver, the greater good/change and advocacy, and personal experience. Discussion: These themes are tied together by experience in the healthcare system whether it be as a patient, a caregiver, provider, or researcher. HABs are important as they help connect with communities by listening to community needs, addressing specific topics, helping to build consensus and coordination, among many other benefits. By understanding motivation and interests of potential HAB members we can genuinely put the communities’ interest first in public and population health.Item Perspectives of Internal Medicine Residency Program Directors on the Accreditation Council for Graduate Medical Education (ACGME) Diversity Standards(Springer, 2021) Martinez-Strengel, Angela; Balasuriya, Lilanthi; Black, Aba; Berg, David; Genao, Inginia; Gross, Cary P.; Keene, Danya; Latimore, Darin; Sotto-Santiago, Sylk; Boatright, DowinBackground: To increase diversity and inclusion in graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) issued a revision to their Common Program Requirements during the 2019–2020 academic year mandating that all residency programs must have policies and practices to achieve appropriate diversity among trainees and faculty. Objective: To explore the perspectives of internal medicine program directors (PDs) and associate program directors (APDs) on the ACGME diversity standard. Design: Qualitative study of internal medicine residency program leadership from academic and community programs across the USA. Participants: Current PDs (n = 12) and APDs (n = 8) of accredited US internal medicine residency programs. Approach: We conducted semi-structured, in-depth qualitative interviews. Data was analyzed using the constant comparative method to extract recurrent themes. Key Results: Three main themes, described by participants, were identified: (1) internal medicine PDs and APDs had limited knowledge of the new Common Program Requirement relating to diversity; (2) program leaders expressed concern that the diversity standard reaches beyond the PDs’ scope of influence and lack of institutional commitment to the successful implementation of diversity standards; (3) participants described narrow view of diversity and inclusion efforts focusing on recruitment strategies during the interview season. Conclusions: Our findings of lack of familiarity with the new diversity standards, and limited institutional investment in diversity and inclusion efforts raise a concern about successful implementation across GME programs. Nevertheless, our finding suggests that structured implementation in the form of education, guideposts, and financial allocation can alleviate some of the concerns of program leadership in meeting the new ACGME diversity standard in a meaningful way.Item “Value my culture, value me”: A Case for Culturally Relevant Mentoring in Medical Education and Academic Medicine(BMC, 2023) Sotto-Santiago, Sylk; Mac, Jacqueline; Genao, InginiaIntroduction: Mentoring programs are one mechanism used to increase diversity and participation of historically underrepresented groups in academic medicine. However, more knowledge is needed about the mentoring experiences and how culturally relevant concepts and perspectives may influence diverse students, trainees, and faculty success. This case study utilized the Culturally Engaging Campus Environments (CECE) model which examines the experiences of students in higher education. We used this model to examine the mentoring experiences of Black and Latine faculty and offer practical implications for the medical education continuum. Methods: Our research approach is best understood through qualitative inquiry stemming from a single-case study which allowed for in-depth understanding of the contexts informing the phenomenon. Phenomenology is well positioned to contribute to understanding science and health professions. Selection criteria included individuals who self-identified as Black or Latine; inclusive of all faculty ranks and tracks. This analysis focuses on 8 semi-structured interviews, averaging 3 h in length. Results: Findings centered on the area of cultural relevance, and participant narratives revealed the connection of mentoring with cultural familiarity, culturally relevant knowledge, cultural service and engagement, and cultural validation. Conclusion: The use of cultural relevance indicators can inform the creation and evolution of mentoring programs towards holistic support of historically underrepresented trainees and faculty. Implications also focus on the development of mentors and championing the incorporation of cultural humility in the mentoring process. The implications in praxis offers the possibility for a new framework for culturally relevant mentoring (CRM). Through this framework we aim to enhance and facilitate inclusive learning environments and career development.Item Reclaiming the mission of academic medicine: An examination of institutional responses to (anti)racism(Wiley, 2021-09-29) Sotto-Santiago, Sylk; Sharp, Sacha; Mac, Jacqueline; Messmore, Niki; Haywood, Antwione; Tyson, Michele; Yi, VaraxyPurpose: The utility of institutional statements is said to provide clarity and reinforcement of an institution's goal. Unfortunately, it can also be argued that these statements are in clear misalignment between the words described and the environments that faculty, students, trainees, and staff of color face. The purpose of this study was to analyze academic medicine institutional statements that responded to 2020 racial tensions following the murders of George Floyd, among others, and the subsequent nationwide protests against police brutality. Methods: We conducted a manifest content analysis of institutional statements generated by academic medical centers after George Floyd's murder. We used manifest content analysis to gain insights into how institutional statements connect structural racism to the mission of academic medicine. We collected and examined institutional statements from 26 academic medicine centers. Selection parameters included statements that were publicly available and published by the institutions during a 2‐week period. We conducted a four‐stage analysis: decontextualization, recontextualization, categorization, and compilation. To better understand the collection of statements, we plotted these institutional statements according to the most salient discussed themes. Results: Overall, institutional statements discussed racism through three subthemes: identifying the racial implications of health disparities, issuing a call to action to address racism, and decentering race. Absent language is also noted. Second, institutional statements evoked institutional values by expressing an explicit connection with the academic medicine mission, naming the value of social justice, and emphasizing the concept of community. Finally, institutional statements largely discussed public health in connection with racism or with institutional values. Conclusion: Our study determines a much‐needed reconnection to the mission of academic medicine. Reclaiming the social mission will be a major step toward recentering the foundation of institutional actions. This call is what ultimately will improve the health and well‐being of marginalized populations.Item Defining Student Success in Academic Medicine(Brieflands, 2018) Tori, Alvaro; Sotto-Santiago, Sylk; Sharp, Sacha; Mac, JacquelineBackground: 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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