Naudia N. Jonassaint, MD, MHS, is an associate professor of medicine at the University of Pittsburgh School of Medicine and a hepatologist at the UPMC Center for Liver Diseases. In January 2019, she was appointed the Department of Medicine’s first vice chair for diversity, equity, and inclusion. Dr. Jonassaint’s research focuses on preoperative risk assessment in transplantation and explores disparities in liver transplant outcomes.
How did being one of three daughters of Jamaican immigrants shape your worldview?
In Jamaica, my father worked for a bauxite mining company owned by Alcoa. He left for additional training in what was then West Germany. At the same time, my mother left Jamaica for the United States to be a nanny. Despite his training, my father couldn’t find work as a geologist in the U.S. He held a series of jobs — from working as a security guard to driving an 18-wheeler — while going to school full time. After earning his degree, he spent two decades teaching middle school in Cleveland’s Shaker Heights community, one of the nation’s first integrated school systems.
In Jamaica, children are tracked early in their schooling. By age 8 or 9, it’s predetermined if you’ll attend college. For that reason, my parents always stressed the importance of education. They stressed that education and knowledge are tools that no one could take away and had the potential to open many doors.
You were tracked into math and science as a child. How did that affect you?
I started school at age 4 and was lucky enough to be tested. I was offered the opportunity to enter a program that was then called “Major Work.” From second to eighth grade, I was part of this integration initiative and bused 45 minutes each day from our home to the west side of Cleveland.
I had the honor of attending a blue ribbon junior high school near my home. I went to school with hundreds of Black kids who excelled in math and science. When my family moved to the suburbs, my new school tried to set me back in my math and science classes, believing that I wouldn’t be able to keep up academically as a product of the city school system. But my father, now a teacher, insisted that I be enrolled in geometry and advanced biology as a ninth grader. I remember my father advocating for me and refusing to back down. His intervention then would be critical to my future success. I would go on to graduate second in my high school class.
Health Disparities Q&A
Johns Hopkins is known for its rigorous premed track. What was it like?
When I first went to Johns Hopkins University, I struggled. It wasn’t because of the academics, but because no one there was like me. Even most of the Black students in my class were children of doctors or executives. It was difficult because the academics were rigorous and I felt like I did not belong socially.
I thought about leaving. But a former boyfriend said, “Naudia, in high school you played three sports and were in a lot of social activities. Try to find your passions outside of the classroom and maybe you’ll do better.” He was right. After my freshman year, I found my social group and a place for myself in the environment. Eventually, I had the honor of being selected to serve on the board of trustees as the alumni member following graduation.
You’ve said your path to Yale for medical school wasn’t easy. Could you share why?
Since I was 4 years old, I knew I wanted to be a medical doctor. But I had a panic attack the first time I took the Medical College Admission Test® (MCAT) and walked out of the exam. At the time, you could only take the MCAT once a year, so it meant I had to delay med school by a year. But I came back and ended up at Yale for some of the best years of my life.
Many times, I’ve come up against this idea that I had to evolve to get to the next step in my life. Whether it’s taking the MCAT, going to medical school, entering a patient’s room to figure out what’s going on, or being a mother — life can be scary. But you come to realize that millions of people have done these things before you.
At Yale, you wrote a thesis on the Black-White achievement gap. How did that help frame your outlook on health care disparities?
Like most students of color, I constantly wondered: Why am I here and why are only 10% of my med school classmates Black or Latinx? I became very interested in the work of Claude Steele, author of Whistling Vivaldi, and his concept of “stereotype threat.” His research basically says you can create action by imposing a stereotype on a person.
For example, put a woman who tests in the 98th percentile on national tests in math at a table with all men. The stereotype is that she should underperform in that particular setting — and Steele’s research shows she does. We create climates in which people underperform based on the stereotypes to which they’re subjected. These laboratory experiments seemed representative of what happens in our schools and neighborhoods. How many Black minds are lost because the world does not see our children as future scientists, doctors, and engineers?
The pipeline of minorities entering the STEM fields is extremely important to me. My dream is to be a leader in health care delivery. But I realize the health care workforce will never be representative of our country if we stick to our standard measures of merit. When we look simply at scores on a single examination, we are not measuring someone’s ability to be a great physician or surgeon: We are measuring their ability to take that test on that day. There is a bias in “meritocracy” and as a society we have to grapple with that.
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In 2019, you were named the first vice chair of diversity, equity, and inclusion in the University of Pittsburgh School of Medicine’s Department of Medicine. Can you talk about that appointment and your goals in that role?
I’m very grateful to have been chosen because diversity and inclusion are passions of mine. Within the next 20 years, there will be no racial majority in this country. We are entering a time of profound cultural shift. We need to evolve in our understanding of how diverse populations are cared for.
How are we going to evolve in health care? Can our medical school get in front of what our workforce looks like so we can provide the kind of inclusive care that people want and desire? My goal is to ensure that we, as an institution, are constantly thinking about how we evolve our workforce and our environment.
Pitt’s new senior vice chancellor for the health sciences and dean of the School of Medicine, Anantha Shekhar, MD, PhD, recently gave the University a “D” in diversity and equity. What was your reaction?
I thought he was right on the mark. He wants to make this place an “A” in terms of diversity and equity and he has shown real commitment. One of the first things the dean did was promise funding over the next 3 years to recruit faculty who want to advance work in the area of the social determinants of health and well-being.
When we compared our minority faculty numbers to those at medical schools nationally, we were far from the national average. In 2019 when I became vice chair, I was shocked to realize just over 150 physicians self-identified as underrepresented in medicine. We were at less than 3%, while the national average for medical school faculty at that time was near 7%. In just one year, we have recruited 16 new faculty members across the School of Health Sciences. That has increased its diversity by nearly 10% in one year.
With that in mind, everything that I do — not only as vice chair of diversity, equity, and inclusion, but also as the dean of clinical affairs in the School of Medicine — is to think and plan for the continuum. From the time our students start their medical studies to the time they become attending physicians, how can we do a better job holding on to them and having them contribute to our mission? We need to understand how to create an environment and culture in the clinical space that leads them to say: “This is where I want to be.” I want to help breathe life into the dreams of the people who come into this institution.
The difference between a good and great institution is that a great institution sees the failures of its students, trainees, or faculty as institutional failures and not personal failures. We want to create an institution where great minds enter and share their dreams and where each one has the tools, place, and platform to make those dreams a reality. That is a great institution.
What’s been the impact of COVID on students in the School of Medicine?
I think COVID was really devastating to our medical students. You come to a place to experience one of the most academically rigorous times of your life and forge strong friendships. Many physicians thrive on the human connection, and you don’t get that over Zoom.
In addition to an international pandemic, we experienced profound social unrest in the face of George Floyd’s murder. Many sensitive and painful discussions needed to take place and those happened in a less than optimal way given the social isolation. Nonetheless, our students have persevered and are now back in the classroom.
What I have come to realize over time is that we certainly need a strong foundational knowledge in the basic sciences. We need to know how to ask great questions at the bench and bedside to come up with solutions. But I truly believe that what we need most are great listeners, because so much is missed when we don’t listen. My sister used to say, “Do you want to be right, or do you want to be effective?” A doctor who’s right knows the diagnosis and writes you the needed prescriptions for your medical condition. A doctor who’s effective writes you prescriptions and addresses the reasons you might be resistant to taking them.
The future of medicine is not bricks and mortar. While we’re suffering from this virtual world, we also are benefiting from the fact that people who are not in close geographic proximity can be connected to one another. Despite all that we have been through over the last 18 months, I am looking forward to the future of health sciences education and training. The future is bright.