The Neurologist Is In Episode 8, Part 2: Diversity Training in Neuro-Oncology With Dr Nimish Mohile

In Episode 8, Part 2, Rachel Marie E. Salas, MD, MEd, interviews Nimish Mohile, MD, MS, FAAN, about his diversity initiatives at the University of Rochester, building a career that balances clinical practice with academic research, and Dr Mohile's IDEAS program, now part of the American Neurological Association and the American Academy of Neurology.

Listen to Part 1 here!

About the Speakers:

Rachel Marie E. Salas, MD, Med, FAAN, FANA, is a professor in the Department of Neurology at Johns Hopkins Medicine with a joint appointment in the School of Nursing. She is board certified in Sleep Medicine and Neurology. Dr Salas is the Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness. Dr Salas has been the Director of the Neurology Clerkship for over a decade. She is the Chair of the Undergraduate Education Subcommittee for the American Academy of Neurology and is an appointed member of the Alliance for Clinical Education. She is the director of the Interprofessional Education and Collaborative Practice for the School of Medicine and a Co-Director for Interprofessional Teaming for the High Value Practice Academic Alliance. Dr Salas is also the founder and Co-Director of the Johns Hopkins Osler Apprenticeship Program (in Neurology), a medical education research program for senior medical students and the Johns Hopkins PreDoc Program, a pipeline premedical college program. Dr Salas is a certified strengths coach and uses a strength-based approach and coaching to connect to, support, and develop those involved with her educational mission and clinical practice. Dr Salas is a 2019-21 Josiah Macy Scholar, a 2019-20 AMA Health Systems Science Scholar and a 2021 AΩA Leadership Fellow.

Nimish Mohile, MD, MS, FAAN is a Professor of Neurology and Oncology at the University of Rochester, where he holds the Ann Aresty Camhi Professorship. He serves as the Associate Chair for Career Development and Leadership, Neuro-oncology Division Chief and Leader of the Neuro-oncology service line. Dr. Mohile completed his residency training at Northwestern University, followed by a fellowship in neuro-oncology at Memorial Sloan-Kettering Cancer Center. In 2007, he joined the neurology department at the University of Rochester where he built and fostered the neuro-oncology division and multi-disciplinary brain tumor program. His research focuses on developing and testing therapeutic and supportive care interventions to improve and extend the lives of patients with malignant gliomas. He is a UCNS fellowship program director, serves on the UCNS Certification committee, chairs the American Society for Clinical Oncology Glioma Guidelines Panel and is currently the Chair-elect of the AAN section for Neuro-oncology. As an Associate Chair for Career Development and Leadership, he has spearheaded innovative programs that emphasize personal values, identity and reflective work in the professional development of faculty, administrative staff, advanced practice providers and residents. He also directs departmental leadership programs for residents and faculty to develop leadership skills, implement change and develop resilient teams. At the AAN, he serves as the Physician Lead for the Transforming Leaders Program.

Dr. Mohile aspires to help organizations transform into multicultural, antiracist and equitable entities. He is an advocate for incorporating principles of inclusion, diversity, equity, antiracism and social justice into the profession of neurology. At the University of Rochester, he serves as a departmental diversity officer. He is a member of the NINDS Health Disparities workforce development and diversity panel. At the AAN, he chairs the Diversity Officer’s Subcommittee and is chair of the AAN Anti-racism Curriculum Work Group in addition to being a member of the IDEAS subcommittee and a member of the AAN Special Commission for Racism, Inequity and Social Justice.

Read the Transcript:

Dr Rachel Salas: All right. Welcome back, everyone. This is "The Neurologist Is In." I'm Dr Rachel Salas. I'm a sleep neurologist at Johns Hopkins Medicine. I have the absolute pleasure of having an interview with Dr Mohile. I'm going to have him introduce himself, Dr Mohile.

Dr Nimish Mohile: Hi, Rachel. Thanks for having me today. I'm Nimish Mohile. I am a neuro-oncologist at the University of Rochester. I've been here for about 15 years, where I run the Brain Tumor Program. I have a couple of other roles in neurology at the University of Rochester. I'm the associate chair for Career Development and Leadership. In that role, we work on staff and faculty career development and promotions.

Then I also serve as a diversity officer in our department. I work with other departmental diversity officers here to implement some of our DI roles and our anti-racist missions.

Dr Salas: Well, that's awesome. I love that you're like feet on the ground doing this work. Now I'd like to transition over to your leadership role, not only locally, but nationally and globally, for that matter. I know that a few years ago, you were selected for a very prestigious leadership program within the American Academy of Neurology.

That's where I learned about the work that you were doing with diversity, inclusion, and equity. Before we get into, do that deeper dive, give me a little bit of perspective on how you even got into that. Why is it so important to you?

Dr Mohile: Yeah, I'm going to be honest. It was something that wasn't a part of the early part of my career, was not something I was thinking about in residency or fellowship, or even early faculty. Then probably right around the time that I met you in the Transforming Leaders Program, the AAN.

It was something I had started to think about. I started to notice what faculty and trainees looked like at my institution and started questioning, why is it that there was a real lack of diversity?

Particularly I felt like in our trainees, and I didn't feel that reflected where we were as a country right now. I started thinking about that at that time, and it started from a focus of within our academic departments. What does diversity look like?

That was a very narrow focus at the beginning that I think we've expanded quite a bit over the past five years. I'll be honest, it was not an area that I was thinking about at all earlier in my career.

Dr Salas: Wow. I suspect that when you started thinking about this, you probably did not have, in your department, the current role that you have. Were you instrumental in getting that created?

Is that something that you think that, with time, will accomplish the goals and objectives that you've set forth with the support of your other leaders and peers, that could hopefully at one point be sunsetted? Is this something that you think will need to be perpetuated?

Dr Mohile: I think that's evolving. I started by asking my chair if this was something I could work on. Then by asking, is this something we could incorporate into our strategic plan? In that first year, we got a group of people who became focused on this, identifying some of the challenges that we were facing as a department, and developed what our core areas that we wanted to work on were.

At that time, it was focused on training diversity. How do we engage more diverse trainees in neurology and into our residency programs. Faculty development, how do we make sure that we're mentoring everyone in the department, and that we're overcoming some of the under mentoring that happens for women and those from underrepresented groups?

How do we engage more diverse research participants in our clinical trials programs? How do we get more engaged with our community? How do we start having that dialogue within ourselves as a department and with the community? From those working groups, we had a lot of people working on this.

From there, we decided to create a specific role in this. That's the diversity officer role. That's evolved over time, where we then created a staff version of that role. Currently, I co‑lead those efforts with a staff member because we realized we also have those diversity issues, not just in faculty, but with all of our staff as well.

Now, we run a council, that is faculty residents, our advanced practice providers, our clinical research coordinators, our nurses, our administrative staff. Everybody who falls within our department has some representation within that council.

We've gone on to hire a community engagement specialist. A person who was a patient and a clinical trial participant in the community, to give his perspective and help us in thinking about research.

We're actually now in the process of writing up a job description for a dedicated administrative person, who do some of the administrative work, but also have be at an education level where they can do some of the program and project management for this work.

Dr Salas: That's amazing. I remember talking and hearing about the work that you were starting just a few years ago. Now, it's gone beyond your institution. I know you've written things up in journals, talking about the work you're doing. That's fabulous. That's amazing.

Kudos to you and your team for really investing and serving as an exemplar, not just for neurology but even outside neurology.

I identify also as a health professions educator and always trying to promote the role of the neurologist outside of neurology. I think this is another example beyond medical education on how a neurologist can have this interest and maybe even passion in DEI or Diversity, Equity, Inclusion, and make a career.

If you're academic, do scholarship. If you're in private practice, still have more access to your patients. I want to put that out there because a lot of neurologists, they stay in neurology and think, "Oh, it's just about epilepsy, migraine," or whatever the clinical aspect. There are many other opportunities and many other fields and topics that we could actually get into and make a difference. I don't know if you want to comment on that.

Dr Mohile: I agree with that entirely. I remember so many times where I would interview a undergraduate student from medical school, and they would talk about their passions about social justice and global health and inequity. Then you ask them, "What do you think you wanna do?" They would talk about family practice, or primary care, or other fields, and they rarely talked about neurology.

I think that there was this perception, even when I went to medical school, that your path to neurology was through neuroscience, that it was a very academic and cerebral field. When I look at our peers around the country and what they're doing, it is a field that is about access to care, and eliminating disparities, and social justice, and global health.

I think that that's something that's really important for us to promote to undergraduates and to medical students, so that they know that they could work on these issues as a neurologist.

Dr Salas: I'm glad you brought that up, and I'll put a plug in for a couple of other podcasts. I had done an interview with Dr Deanna Saylor, who is a global health and neurologist, doing some amazing things. She's also a medical educator.

There's all this overlap, and I just finished speaking with Dr Eugene up at UConn, who is an epileptologist, but also a medical educator. She's doing a lot of work, even outside neurology, and promoting those that are thinking about neurology, as like you can do anything you want to do in the field.

You're a great example of someone who has a very robust clinical practice. You're doing clinical research, improving access to care, but then you're also involved in development of faculty, trainees. You're serving as a role model for the students, and really doing some work. Now, I'd like to get a little bit more into that deeper dive I was talking about.

I'm not sure if you heard, there's a Dr Deyrup and Dr Graves that recently, not that recently, but a few months ago, gave a fabulous Grand Rounds on Race in Robbins. As everybody knows, all of you out there, in med school you had this big pathology book, and that was Robbins.

I was surprised to learn that Robbins and Duke, where Dr Deyrup is at, is they are taking out race completely from that one liner which we were all trained. 76‑year‑old, African American, Black, whatever, White person shows up. It's just phenomenal that the work. It's really made some tremendous...caused me to do some reflection.

I'm not sure if you're familiar with their work, but I want to get into your thoughts on how race is a social construct, and we need to be bold, and setting these examples because like the pipeline, the new medical students and new clinicians that are coming through, we don't want them to be trained with the bias that we were trained with.

Dr Mohile: It's a fascinating topic. We talk a lot in neurology about how in being a neurologist you have to be this lifelong learner, you're continuing to learn throughout your profession. We think about that in terms of the science of neurology and medicines and clinical trials and those things.

Race is one of those areas where we really need to learn how to learn lifelong, because we have to change up all the assumptions that we have and we have to unlearn a lot of things we learned in medical school. We were taught in medical school to put race in that one liner. I don't think I was explicitly taught that race was biological.

I came out of medical school actually believing that. This idea that race was a social construct was not natural to me, or this idea that it's racism that led to the creation of races was not something that I was familiar with. I had the luxury of going to some great public schools growing up and a great university, and I did not learn these things.

We have to take some responsibility as physicians to learn about some of these areas, and then to unlearn some of what was wrong. We have to question every place where we're putting race in there, in our history of present illness, in our thinking through associations with disease. Is that really there? Does that box us in?

Do we make assumptions about a patient when they come into the hospital that we shouldn't be making? We have to think about that in relation to their social settings, and making assumptions about people based on their race and what their socio‑economic status might be. We have to challenge ourselves on all of those.

Then the goal of this is, how do we move forward where we can practice care that is going back to your concept of this personomics. That we are personalized to an individual, and understand how race might affect their life, and the traumas they've experienced in their life, their opportunities in their life, without boxing them into a certain category.

I think that's one of the challenges. What I'll add to this is beyond patient care, and it's how we think about race in our trainees and colleagues, and in their experiences to get where they are. This is an area that I've also had to unlearn.

If you had asked me 10 years ago, when I was interviewing a medical student for residency, I would care about where they went to college, where they went to med school, what their scores are, whether they were AOA, the quality of their essay, whether they had recommendations from well‑known people.

We are learning day by day that all of these are impacted by race and racism. We need to rethink all of that and rethink this emphasis that we have on pedigree in academic medicine.

Dr Salas: I'm so glad you said that. That really gives me almost chills, because myself, I'm underrepresented in medicine, and it's just so much. There's so much personal stuff behind that. Just to hear that we're talking about this and being bold, like Duke Medical School, they took race completely out of the curriculum, and look at Robbins textbook pathology, out of the textbook.

These bold movements to change medical education...It's going to change medical education. At the end of the day, it's going to improve medical care. Because we have these built in biases that they have long just been deeply seated, and nobody had ever talked about it.

I'm just so grateful that you are one of the leaders, especially from our field in neurology, that's really making some major changes. I'll let you comment on that first. Then I definitely want to hear a little bit more about your IDEAS program. I feel like anywhere I turn, that program is there.

Dr Mohile: One of these things that we are learning in anti‑racism is the importance of being in that growth mindset, because we're talking about this today but in a year or two years, there might be something else that we're doing right now that we're not seeing the bias in or the racism in.

We have to constantly have this open mind and critically look at all of this to understand where we're perpetuating bias. We're going to find so much more as we look into this in the coming years. One of our goals...

In our IDEAS programming at University of Rochester, is IDEAS is for Inclusion, diversity, equity, anti‑racism, and social justice. We changed the name of that a couple years ago because we felt like it was important to go beyond diversity.

Each of those terms, I think it's important to note are different and sometimes people will equate them but they're all really different. You could have a person focused on each of those areas.

One of my goals over time is to expand the number of people doing this work within a department. The kinds of things that you're doing for inclusion are different than what you would do for diversity.

Very different than what you do for health equity, and then different for anti‑racism and social justice. In the anti‑racism work, a big part of that is developing that growth mindset amongst faculty, staff, trainees, and then allowing for a free and open dialogue so you can start having these conversations and exploring where we have biases. One of the most interesting things we've done is do our M&M conferences based on racism.

Your classic mortality and morbidity is maybe a medical error, or a diagnosis that was missed. The most recent one we did was a case where we thought racism was at play in the treatment of a patient.

It forces you to sit down and reflect on that and to really think about, "Well, this physician in this team approached it this way. Would I have done the same thing? Would my biases have also led me down this road? What can I do to check my biases to make sure that I'm not letting racism impact patient care?"

Dr Salas: Wow, that's awesome. That's really great to turn a traditional standard morbidity, mortality case conference, M&M conference that we all know very well. To get people thinking and reflecting on, and learning from, because these things they happen all the time and calling them out and reflecting.

What would I have done? That's awesome, so kudos to your team. I just want to mention, because I definitely want to ask you a couple other questions before we wrap up.

Your IDEAS program, I know has been expanded to the American Neurological Association and the American Academy of Neurology. I know at this point like several institutions may not...either using IDEAS itself or a play off of it and making it to whatever they need to at their institution.

That's amazing work. You are making a huge impact on programs, people and eventually the patients as well. That's awesome.

Dr Mohile: Yeah, I know. It's been exciting to see and each program does things very differently and has very different focuses, but we appreciated that both of these professional societies using these terms because it extends the breadth of what they're doing.

Incorporating the term anti‑racism is important there because to do anti‑racist work, it's active. It is about making change, and making change fast. We're moving out of this paradigm.

When I started working as a diversity officer, many people would say, "Well, change happens slowly, and you just have to accept that."

In this work, this is not something we're willing to accept. There's inequity. We can't tolerate that. That's something that we need to change now, for our faculty, our staff, and for our patients.

Dr Salas: Dr Mohile, that is very powerful. Kudos to you and your team for all the amazing work that you're doing in this space. Again, beyond you and your clinical work with neuro‑oncology, and all the lives of the patients and the families that you touch.

It's fabulous to know you and to know the work that you're doing. I'd like to wrap up with asking you, in the area of burnout and of focus on well‑being, what do you do for fun? What are some of your hobbies when you're outside of work and your DEI work? What are you doing to have some fun?

Dr Mohile: I've always loved to travel. I travel with my family. That was a little harder in the last couple of years. We have substituted that a little bit with...We love to plan to travel. My retirement dream job is somehow get paid to plan other people's trips. Me and my kids will spend a lot of time planning out trips, hopefully, as we're able to travel a little bit more.

We have all these trips lined up that we can go on, that we've planned out itineraries for. I think that's been a big part of it. I also enjoy weightlifting. We ended up building a gym in our house during the pandemic so that it's more convenient.

That's been a nice way to one, de‑stress, and it's also a place where sometimes we have a lot of meetings at this stage of our careers. I can listen to a meeting on Zoom and also get a workout in at the same time. That's been one of the nice benefits of the pandemic.

Dr Salas: The BOGO. The buy one get one. I love it. That's great. I've never heard anybody talk about their hobbies, like planning vacations. I think that's amazing. Maybe I'll be one of your first clients at some point in the future. I love to travel too. That's awesome.

My last question is, is there anything you'd like to share? I'm used to that last‑minute reflections based on what we talked about, or some thoughts that you'd like to share with the audience.

Dr Mohile: The most exciting thing that I feel like I've got going on right now is that in the next couple of months, the AAN is going to launch an anti‑racism curriculum. This is something we've spent about a year working on.

The goal of putting this together was to think about what neurologists wanted and needed. This is a curriculum put together by neurologists, for neurologists. It's to help us understand how racism is at play in our health system. How it affects our colleagues, and how it affects our patients.

One of the most exciting parts of the curriculum is that at the end, it's meant to teach you how to impact change in your own community, and how to be that anti‑racist change agent. I think that's what we're hoping for, in our profession going forward.

Dr Salas: That's great. I look forward to seeing that curriculum. It's a very important project and something that we need to continue moving forward. Hopefully, we can bring that down to the student and the learner, the early career learner realm as well.

Thank you so much for everything you do. You have been amazing to talk to. I hope that the audience has learned a little bit more about not only what's going on in neuro‑oncology, but some of the fabulous opportunities that a neurologist can do.

That is very important work to provide better care for our patients and also to support us as a field, as faculty, as staff, as trainees, as medical students. Thank you so much. We'll see you around in the future.

Dr Mohile: Thanks for having me.