1
|
Ng WYK. Editorial: Equity, diversity and inclusion in child and adolescent mental health - a perspective from the American Academy of Child and Adolescent Psychiatry (AACAP). Child Adolesc Ment Health 2024; 29:192-193. [PMID: 38634296 DOI: 10.1111/camh.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
Advancing diversity, equity and inclusion (DEI) are key priorities for the American Academy of Child and Adolescent Psychiatry (AACAP). AACAP was founded in 1953. The mission of the AACAP includes promoting the healthy development of all children, adolescents, and families through advocacy, education, and research. AACAP's Presidential Initiative of CAPture Belonging's goal was to prioritize diversity, equity, inclusion and belonging to create transformational and sustainable changes in the organization and child and adolescent psychiatry. The presidential initiative's strategy had three pillars: advancing diversity, equity, inclusion, and belonging (DEIB) in all program and services, creating a pipeline for diverse child and adolescent psychiatrists, and monitoring DEIB activities and progress. A presidential task force was created and charged with implementing a 2-year action plan and strategy. A 5-point action plan prioritized: awareness, advocacy, workforce and professional development, national partnerships, and sustainability. Focusing on DEIB for any organization enriches the work, community and success that can be achieved. AACAP is proud to have committed to this DEIB path and has already experienced success through continuous membership growth, membership engagement, and record attendance at annual meetings and volunteer involvement. These accomplishments can only enhance AACAP's ability to serve the mission of promoting the healthy development of all children, adolescents, and families through advocacy, education, and research.
Collapse
Affiliation(s)
- Warren Yiu Kee Ng
- Columbia University Medical Center, New York, NY, USA
- New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
2
|
Chrisinger BW. US County-Level Variation in Availability and Prevalence of Black Physicians in 1906. JAMA Netw Open 2024; 7:e2410242. [PMID: 38728031 PMCID: PMC11087833 DOI: 10.1001/jamanetworkopen.2024.10242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/27/2024] [Indexed: 05/13/2024] Open
Abstract
Importance Black physicians are substantially underrepresented in the US health care workforce, with detrimental effects on the health and health care experiences of Black individuals. These contemporary gaps can be traced to the early days of the medical profession using the first edition of the American Medical Directory (AMD). Objective To identify state- and county-level patterns related to the training and availability of Black physicians relative to their White counterparts in the 1906 AMD. Design, Setting, and Participants For this cross-sectional study, data for 41 828 physician entries in 18 US states in or adjacent to the South as well as the District of Columbia were extracted from the 1906 AMD and aggregated to 1570 counties. Data analysis was performed between September 2023 and January 2024. Exposures County-level exposure variables included population density, racial composition, and illiteracy rate among US-born White residents as well as an index of terrain ruggedness and the number of lynchings in the previous decade. Median values of physicians' distance from place of practice to place of medical training (by race of physician) were also used as an exposure variable. Main Outcomes and Measures There were 4 county-level outcomes: (1) presence of any Black physician, (2) proportion of Black physicians per Black population, (3) proportion of White physicians per White population, and (4) community representativeness (reported as the community representativeness ratio). The cross-sectional analysis used generalized additive mixed models with state-level random effects. Results Across 1570 counties, Black physicians comprised 746 (1.8%) of the 41 828 physicians in the dataset. Black physicians tended to train further from their place of practice than their White counterparts. The proportion of Black physicians per 1000 Black residents was 0.08 compared with 1.62 for White physicians; these proportions varied substantially by state. At the county level, the presence of any Black physician was associated with percentage Black population (odds ratio [OR], 28.94 [95% CI, 9.77 to 85.76]; P ≤ .001), population density (OR, 2.63 [95% CI, 2.03 to 3.40]; P ≤ .001), and distance to the nearest Black medical school (OR, 0.62 [95% CI, 0.42 to 0.92]; P = .02). Conclusions and Relevance A variety of structural disadvantages are illustrated in this cross-sectional study of county-level sociodemographic and geographic characteristics associated with the prevalence of Black physicians in the earliest days of the profession. To demonstrate its broader utility for health disparities research, the dataset has been made publicly available with a visualization platform.
Collapse
Affiliation(s)
- Benjamin W. Chrisinger
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Now with Department of Community Health, Tufts University, Medford, Massachusetts
| |
Collapse
|
3
|
Campbell KM, Tumin D, Linares JI, Morley CP. The Relationship Between the Social Mission Content of Medical School Mission Statements and Minority Faculty Representation Among Faculty and Senior Leadership. J Immigr Minor Health 2024; 26:334-340. [PMID: 37902901 DOI: 10.1007/s10903-023-01555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/01/2023]
Abstract
Medical schools with social missions have the potential to increase minority student interest in health disparities research. In previous work, the authors looked at the missions of medical schools to determine if they were associated with minority student representation. In this paper, the authors look at the representation of full-time faculty and senior leaders who are underrepresented in medicine in US medical schools. This study included all MD-granting medical schools in the US with available data on mission statement Social Mission Content (SMC) and faculty demographics. Data were analyzed for representation of faculty underrepresented in medicine (URM) among all faculty, among junior as compared to senior faculty, and among department chairs. In the 2013 data, Pearson correlation coefficients were calculated to characterize the association between SMC and contemporaneous URM faculty representation. In the 2014-2020 data, hierarchical linear models were used to estimate the association between SMC and the annual rate of change in URM faculty representation. In 2013, URM faculty accounted for 7.4% of all faculty at the median medical school, increasing to 8.4% in 2020. As of 2013, URM representation among junior faculty was 9.2% at the median school, 5.6% among senior faculty, and 4.3% among department chairs. The authors found a slow increase in the percentage of URM faculty members (but not department chairs). This trend did not vary between schools with lower vs. higher emphasis on a social mission (based on the mission statement). The increase in chair representation was determined to be associated with the type of the school, whether historically Black or Puerto Rican, and not precisely its mission.
Collapse
Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Dmitry Tumin
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Jhojana Infante Linares
- Department of Academic Affairs, Office of Data Analysis and Strategy, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Christopher P Morley
- Department of Public Health & Preventive Medicine, Department of Family Medicine, and Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
4
|
Chen S, Carter D, Brockenbrough PB, Cox S, Gwathmey K. Racial disparities in ALS diagnostic delay: a single center's experience and review of potential contributing factors. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:112-118. [PMID: 37909302 DOI: 10.1080/21678421.2023.2273361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Outcomes for amyotrophic lateral sclerosis (ALS) patients are improved with prompt diagnosis, earlier initiation of disease-modifying treatments, and participation in a multidisciplinary clinic. We studied diagnostic delay and disease severity at time of clinic presentation between Black and non-Hispanic Caucasian ALS patients. METHODS We performed a retrospective analysis of non-Hispanic Caucasian and Black ALS patients seen in the Virginia Commonwealth University Health System multidisciplinary ALS clinic between 2017 and 2023. Diagnostic delay, ALS Functional Rating Scale-Revised (ALSFRS-R) and upright forced vital capacity (FVC) scores at baseline appointment were collected. Patient's distance from clinic and affluency of residential neighborhood were evaluated. RESULTS We analyzed 172 non-Hispanic Caucasian and 33 Black ALS patients. Black patients had a 64% increase in diagnostic delay compared to non-Hispanic Caucasian patients. Black patients had a lower performance on ALSFRS-R (5.3 points, p < 0.001) and FVC (17.9 percentage points p < 0.001) at time of first clinic visit. Black patients lived closer to clinic, with higher proportion living in the city of Richmond, but in less affluent areas with lower median house income ($55,300 ± 22,600 vs $69,900 ± 23,700). DISCUSSION Our findings demonstrate a large racial difference in ALS diagnostic delay, and greater disease severity and lower respiratory function at time of diagnosis for Black ALS patients. Delay in diagnosis prolongs access to disease-modifying therapies, multidisciplinary care, durable medical equipment, and respiratory and nutritional support. Potential sources of these racial disparities include providers' implicit bias and structural racism.
Collapse
Affiliation(s)
- Shanshan Chen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Demetrius Carter
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Stephen Cox
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Kelly Gwathmey
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
5
|
Campbell KM, Schlag KE, Oni K, Amaechi O, Foster KE, Walcher C, Porterfield L. Overcoming Mission Competition in Departments of Family Medicine. Fam Med 2024; 56:5-8. [PMID: 38055852 PMCID: PMC10836619 DOI: 10.22454/fammed.2023.564792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Departments of family medicine are centered around the tripartite mission of education, research, and clinical care. Historically, these three missions have been balanced and interdependent; however, changes in the funding and structures of health systems have resulted in shrinking education and research missions and an increased emphasis on clinical care. In the wake of waning state and federal contributions to primary care research, many departments of family medicine have adopted a private practice approach. This approach is centered on generating revenue for the institution, incentivizing physicians to remain clinically focused through productivity and intense attention to volume targets. As a department's focus shifts to the clinical care mission, education and research are increasingly neglected and underresourced. Meanwhile, the administrative burden of electronic health records (EHRs) has further encroached on time previously allocated to research, with the EHR burden disproportionately affecting the primary care workforce. To counteract mission competition in departments of family medicine and to recover the vital missions of education and scholarship, devising a clear plan for reclaiming and sustaining a tripartite mission is important. Advocating for increased primary care research funding, enhancing EHRs, balancing clinical and education metrics, and supporting primary care research, especially for groups underrepresented in medicine, are interventions to help fully support education and research missions and to recover and sustain mission balance in departments of family medicine.
Collapse
Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Karen E Schlag
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Keyona Oni
- Department of Family Medicine, Atrium Health-Carolinas Medical Center, Charlotte, NC
| | - Octavia Amaechi
- Spartanburg Regional Family Medicine Residency Program, Medical University of South Carolina Area Health Education Consortium, Spartanburg, SC
| | - Krys E Foster
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Christen Walcher
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
6
|
Brown TR, Benton TD, Ng WYK. AACAP's Strategic Plans to Enhance the Diversity of the Child Psychiatry and Child Mental Health Workforce Across all Mission Areas. Child Adolesc Psychiatr Clin N Am 2024; 33:95-109. [PMID: 37981341 DOI: 10.1016/j.chc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. This requires effectively meeting the mental health needs of historically minoritized communities. A diverse clinician workforce is an essential component of meeting those needs. This article will discuss AACAP's strategic plan for diversifying the workforce, this will be done with 3 main points: promoting diversity, equity, and inclusion (DEI) across all mission area, creating a pipeline of child and adolescent psychiatrists, and monitoring DEI activities and progress on an organizational level.
Collapse
Affiliation(s)
- Tashalee R Brown
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, HUB - Center for Clinical Collaboration, 3501 Civic Center Bolevard, 12th Floor, Philadelphia, PA 19104, USA
| | - Warren Yiu Kee Ng
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, 3959 Broadway, MSCH 6 North, New York, NY 10032, USA; Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, New York, USA
| |
Collapse
|
7
|
Okelo SO, Chesley CF, Riley I, Diaz AA, Collishaw K, Schnapp LM, Thakur N. Accelerating Action: Roadmap for the American Thoracic Society to Address Oppression and Health Inequity in Pulmonary and Critical Care Medicine. Ann Am Thorac Soc 2024; 21:17-26. [PMID: 37934586 DOI: 10.1513/annalsats.202305-412ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Sande O Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Christopher F Chesley
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lynn M Schnapp
- American Thoracic Society, New York, New York
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California; and
- Health Equity and Diversity Committee, American Thoracic Society, New York, New York
| |
Collapse
|
8
|
Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Child Adolesc Psychiatr Clin N Am 2024; 33:17-32. [PMID: 37981333 DOI: 10.1016/j.chc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
Collapse
Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
9
|
Prober CG, Desai SV. Medical School Admissions: Focusing on Producing a Physician Workforce That Addresses the Needs of the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:983-986. [PMID: 37130009 DOI: 10.1097/acm.0000000000005262] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aging population, burnout, and earlier retirement of physicians along with the static number of training positions are likely to worsen the current physician shortage. There is an urgent need to transform the process for selecting medical students. In this Invited Commentary, the authors suggest that to build the physician workforce that the United States needs for the future, academic medicine should focus on building capacity in 3 overarching areas. First, medical schools need to develop a more diverse pool of capable applicants that better matches the demographic characteristics of health care trainees with those of the population, and they need to nurture applicants with diverse career aspirations. Second, medical schools should recalibrate their student selection process, aligning criteria for admission with competencies expected of medical school graduates, whether they choose to become practicing clinicians, physician-scientists, members of the public health workforce, or policy makers. Selection criteria that overweight the results of standardized test scores should be replaced by assessments that value and predict academic capacity, adaptive learning skills, curiosity, compassion, empathy, emotional maturity, and superior communication skills. Finally, to improve the equity and effectiveness of the selection processes, medical schools should leverage innovations in data science and generative artificial intelligence platforms. The ability of ChatGPT to pass the United States Medical Licensing Examination (USMLE) demonstrates the decreasing importance of memorization in medicine in favor of critical thinking and problem-solving skills. The 2022 change in the USMLE Step 1 to pass/fail plus the exodus of several prominent medical schools from the U.S. News and World Report rankings have exposed limitations of the current selection processes. Newer approaches that use precision education systems to leverage data and technology can help address these limitations.
Collapse
Affiliation(s)
- Charles G Prober
- C.G. Prober is professor of pediatrics, microbiology, and immunology, and senior associate vice provost for health education, Stanford University, Stanford, California
| | - Sanjay V Desai
- S.V. Desai is chief academic officer, American Medical Association, Washington, DC, and professor of medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
10
|
Guevara JP, Aysola J, Wade R, Nfonoyim B, Qiu M, Reece M, Carroll KN. Diversity in the pediatric research workforce: a scoping review of the literature. Pediatr Res 2023; 94:904-914. [PMID: 37185966 PMCID: PMC10129297 DOI: 10.1038/s41390-023-02603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.
Collapse
Affiliation(s)
- James P Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jaya Aysola
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bianca Nfonoyim
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maylene Qiu
- Biotech Commons Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Reece
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Mt Sinai School of Medicine, New York, NY, USA
| |
Collapse
|
11
|
Mosley M. Addressing disparities in capital to promote social equity in medical education. MEDICAL EDUCATION 2023; 57:696-698. [PMID: 37056196 DOI: 10.1111/medu.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
Mosley argues that disparities in differential attainment for minoritized groups can be addressed by focusing on the unequal distribution of social, economic and cultural capital.
Collapse
Affiliation(s)
- Marcus Mosley
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| |
Collapse
|
12
|
Campbell KM, Tumin D, Infante Linares JL, Porterfield L, Kisel T. Changing Missions of Medical Schools and Trends in Medical Student Diversity. Fam Med 2023; 55:481-484. [PMID: 37450940 PMCID: PMC10622066 DOI: 10.22454/fammed.2023.928475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Improving diversity in the physician workforce continues to be a challenge and a priority for medical schools. Establishing a school-wide mission statement that addresses diversity, equity, and inclusion can help support efforts to increase the number of underrepresented in medicine (URM) graduates. METHODS In this study, we analyzed changes in medical school mission statements between 2013 and 2021 and correlated changes in mission statements with trends in URM student representation. We performed a web search of 136 medical schools' mission statements and categorized them based on whether they changed their mission statement to add diversity or equity language. We then obtained demographic data of enrolled students at each school and identified the percentage of students identifying as URM in each academic year. We used mixed-effects regression and pair fixed effects linear regression to examine trends in URM student representation and the association between URM student representation and whether a school added diversity and equity content to its mission statement. RESULTS We found that URM student representation increased by 0.4% per year at schools that added diversity and equity content to their mission statements. CONCLUSIONS Changing medical schools' mission statements to reflect values of diversity, equity, and inclusion was associated with an increase of less than a 1% per year in URM representation. More research is needed to explore relationships between URM representation and medical school mission statements.
Collapse
Affiliation(s)
| | | | | | | | - Tibor Kisel
- The University of Texas Medical BranchGalveston, TX
| |
Collapse
|
13
|
Myers AK, Williams MS, Pekmezaris R. Intersectionality and Its Impact on Microaggression in Female Physicians in Academic Medicine: A Cross-Sectional Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:298-304. [PMID: 37404574 PMCID: PMC10316039 DOI: 10.1089/whr.2022.0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 07/06/2023]
Abstract
Introduction The burden of microaggressions in the workplace is an ongoing stressor for female physicians in academic medicine. For female physicians of Color or of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community, this burden is even heavier due to the concept of intersectionality. The goal of this study is to assess frequency of microaggressions experienced by participants. In addition, to explore the associations between microaggression and individual outcomes, patient care practices and attitudes, and perception of pay/promotion equity. Methods This was a cross-sectional analysis of female residents, fellows and attendings conducted from December 2020-January 2021 at Northwell Health across all specialties. One hundred seventeen participants replied to the study in REDCap. They completed questionnaires related to the topics of imposter phenomenon, microaggressions, gender identity salience, patient safety, patient care, counterproductive work behavior and pay and promotion equity. Results A majority of the respondents were white (49.6%) and 15+ years out of medical school (43.6%). Around 84.6% of female physicians endorsed experiencing microaggressions. There were positive associations between microaggressions and imposter phenomenon as well as microaggressions and counterproductive work behavior. There was a negative association between microaggressions and pay equity or promotion. The small sample size did not allow for us to examine differences by race. Discussion Although the number of female physicians continues to rise due to an uptick in female medical school enrollees, female physicians still must deal with the burden of microaggressions in the workplace. Conclusions As a result, academic medical institutions must seek to create more supportive workplace for female physicians.
Collapse
Affiliation(s)
- Alyson K. Myers
- Division of Endocrinology, Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Myia S. Williams
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| |
Collapse
|
14
|
Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
Collapse
Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
| |
Collapse
|
15
|
Rinderknecht FAB, Kouyate A, Teklu S, Hahn M. Antiracism in Action: Development and Outcomes of a Mentorship Program for Premedical Students Who Are Underrepresented or Historically Excluded in Medicine. Prev Chronic Dis 2023; 20:E49. [PMID: 37319343 DOI: 10.5888/pcd20.220362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Black, Latinx, and Native American and Alaska Native people are underrepresented in medicine. The increasingly competitive medical school application process poses challenges for students who are underrepresented in medicine or historically excluded from medicine (UIM/HEM). The University of California, San Francisco-University of California, Berkeley (UCSF-UCB) White Coats for Black Lives Mentorship Program provides a novel and antiracist approach to mentorship for these premedical students. METHODS The program recruited UIM/HEM premedical and medical students through a survey advertised by email, on the program's website, social media, and by word of mouth. The program paired students primarily with race-concordant mentors, all of whom were UCSF medical students. From October 2020 to June 2021, program mentees engaged in skills-building seminars based on an antiracism framework and received support for preparing medical school applications. The program administered preprogram and postprogram surveys to mentees, which were analyzed via quantitative and qualitative methods. RESULTS Sixty-five premedical mentees and 56 medical student mentors participated in the program. The preprogram survey received 60 responses (92.3% response rate), and the postprogram survey received 48 responses (73.8% response rate). In the preprogram survey, 85.0% of mentees indicated that MCAT scores served as a barrier "a great deal" or "a lot," 80.0% indicated lack of faculty mentorship, and 76.7% indicated financial considerations. Factors that improved most from preprogram to postprogram were personal statement writing (33.8 percentage-point improvement, P < .001), peer mentorship (24.2 percentage-point improvement, P = .01), and knowledge of medical school application timeline (23.3% percentage-point improvement, P = .01). CONCLUSION The mentorship program improved student confidence in various factors influencing the preparation of medical school applications and offered access to skills-building resources that mitigated existing structural barriers.
Collapse
Affiliation(s)
- Fatuma-Ayaan B Rinderknecht
- University of California, San Francisco, School of Medicine
- UCSF School of Medicine, 505 Parnassus Ave, San Francisco, CA 94110
| | - Aminta Kouyate
- University of California, San Francisco, School of Medicine
| | | | - Monica Hahn
- University of California, San Francisco, School of Medicine
- University of California, Berkeley
| |
Collapse
|
16
|
Campbell KM. Mitigating the Isolation of Minoritized Faculty in Academic Medicine. J Gen Intern Med 2023; 38:1751-1755. [PMID: 36547754 PMCID: PMC10212885 DOI: 10.1007/s11606-022-07982-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Increasing numbers of faculty who are underrepresented in medicine has been a focus of academic health systems. Understanding the experiences of these faculty helps in creating environments that are inclusive and supportive, promoting faculty success. When compared with non-minoritized faculty, minoritized faculty face racism, isolation, diversity efforts disparities, clinical efforts disparities, lack of faculty development, and promotion disparities. While there have been contributions to the literature to better characterize disparities faced by minoritized faculty, little has been written about isolation. Isolation occurs when faculty underrepresented in medicine do not feel like part of the department or institution. They may feel excluded from mainstream culture as if they are invisible. They may be excluded from conversations, group chats, get togethers, or other work-related or social functions. These feelings can manifest as imposter syndrome and impact work performance and decision-making. In this article, the author shares how to recognize and mitigate isolation to promote an inclusive environment for all faculty.
Collapse
Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
17
|
Legha RK, Martinek NN. White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse. MEDICAL HUMANITIES 2023; 49:142-146. [PMID: 36241381 DOI: 10.1136/medhum-2022-012398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/16/2023]
Abstract
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
Collapse
|
18
|
Poll-Hunter NI, Brown Z, Smith A, Starks SM, Gregory-Bass R, Robinson D, Cullins MD, Capers Q, Landry A, Bush A, Bellamy K, Lubin-Johnson N, Fluker CJ, Acosta DA, Young GH, Butts GC, Bright CM. Increasing the Representation of Black Men in Medicine by Addressing Systems Factors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:304-312. [PMID: 36538673 DOI: 10.1097/acm.0000000000005070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collaborative members identified premedical and academic medicine systems factors that represented opportunities for change. The premedical factors include financing and funding, information access, pre-health advisors, the Medical College Admission Test, support systems, foundational academics, and alternative career paths. The academic medicine factors include early identification, medical school recruitment and admissions, and leadership accountability. The authors offer several points of intervention along the medical education continuum, starting as early as elementary school through medical school matriculation, for institutional leaders to address these factors as part of their diversity strategy. The authors also present the Action Collaborative's process for leveraging collective impact to build an equity-minded action agenda focused on Black men. They describe their initial focus on pre-health advising and leadership accountability and next steps to develop an action agenda. Collective impact and coalition building will facilitate active, broad engagement of partners across sectors to advance long-term systems change.
Collapse
Affiliation(s)
- Norma I Poll-Hunter
- N.I. Poll-Hunter is senior director, Equity, Diversity, and Inclusion, Association of American Medical Colleges, Washington, DC
| | - Zackary Brown
- Z. Brown is a resident, Department of Pediatrics, Mount Sinai Hospital, New York, New York
| | - André Smith
- A. Smith is a graduate of Meharry Medical College, Nashville, Tennessee
| | - Steven M Starks
- S.M. Starks is clinical assistant professor of clinical sciences, Tilman J. Fertitta Family College of Medicine, Houston, Texas
| | - Rosalind Gregory-Bass
- R. Gregory-Bass is president, National Association of Medical Minority Educators, director, Health Careers Program, and immediate past chair and associate professor, Environmental and Health Sciences Program, Spelman College, Atlanta, Georgia
| | - Derek Robinson
- D. Robinson is clinical associate professor, Department of Emergency Medicine, University of Illinois at Chicago, and vice president and chief medical officer, Blue Cross and Blue Shield of Illinois, Chicago, Illinois
| | - Maureen D Cullins
- M.D. Cullins is director, Multicultural Resource Center, and associate director and senior advisor, Master of Biomedical Sciences Program, Duke University School of Medicine, Durham, North Carolina
| | - Quinn Capers
- Q. Capers IV is the Rody P. Cox, MD, Professor in Internal Medicine (Cardiology) and associate dean of faculty diversity, UT Southwestern School of Medicine, and vice chair for diversity, equity, and inclusion, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Alden Landry
- A. Landry is assistant dean for diversity, inclusion, and community partnership, Harvard Medical School, and assistant professor of emergency medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Antonio Bush
- A. Bush is director of research, Equity, Diversity, and Inclusion, Association of American Medical Colleges, Washington, DC
| | - Kimberly Bellamy
- K. Bellamy is lead specialist for workforce diversity, Equity, Diversity, and Inclusion, Association of American Medical Colleges, Washington, DC
| | - Niva Lubin-Johnson
- N. Lubin-Johnson is past president, National Medical Association, and chief health officer, SimPco Solutions, Chicago, Illinois
| | - Clarence J Fluker
- C.J. Fluker is director of community engagement, Equity, Diversity, and Inclusion, Association of American Medical Colleges, Washington, DC
| | - David A Acosta
- D.A. Acosta is chief diversity and inclusion officer, Association of American Medical Colleges, Washington, DC
| | - Geoffrey H Young
- G.H. Young is senior director, Transforming Healthcare Workforce, Association of American Medical Colleges, Washington, DC
| | - Gary C Butts
- G.C. Butts is executive vice president for diversity, equity and inclusion, Mount Sinai Health System, and dean, Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cedric M Bright
- C.M. Bright is interim vice dean for medical education and admissions and professor of clinical internal medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| |
Collapse
|
19
|
Morsy L. Carnegie and Rockefeller's Philanthropic Legacy: Exclusion of African Americans From Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:313-316. [PMID: 36512812 DOI: 10.1097/acm.0000000000005092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller's General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller's philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.
Collapse
Affiliation(s)
- Leila Morsy
- L. Morsy is senior lecturer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; ORCID: https://orcid.org/0000-0002-7131-7473
| |
Collapse
|
20
|
Golden SH. Disruptive Innovations to Achieve Health Equity Through Healthcare and Research Transformation. Clin Pharmacol Ther 2023; 113:500-508. [PMID: 36471657 DOI: 10.1002/cpt.2812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
In order to achieve health equity, we must implement innovative health system, public health, and policy-level interventions to address the historical root causes of structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and residual healthcare provider biases toward minoritized patients has led to patient distrust of medical systems and poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, resulting in present-day social determinants of health (SDOH). To reduce these disparities and achieve health equity, four disruptive healthcare innovations are recommended: (i) infuse health equity principles into clinical workflows by implementing National Culturally and Linguistically Appropriate Services Standards; (ii) address poverty-related SDOH; (iii) deliver care and recruit for research in nonclinical settings to reach marginalized communities; and (iv) leverage health system subject matter experts to advocate for health equity policies. During the COVID-19 pandemic we leveraged the diversity of our workforce to deliver bilingual and culturally tailored COVID-19 testing, education, and vaccines to the Hispanic and Black communities in nonclinical settings, the primary marginalized communities served by our health system that were also disproportionately impacted by COVID-19 infections, hospitalizations, and deaths. Now that we understand the importance of using innovative health equity strategies to reach marginalized communities, we must continue to re-engineer our healthcare systems to deliver care outside of our brick and mortar to overcome barriers in access to care and mistrust in the healthcare establishment stemming from past abuses and remaining experiences of bias.
Collapse
Affiliation(s)
- Sherita Hill Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Lin GL, Guerra S, Patel J, Burk-Rafel J. Reimagining the Transition to Residency: A Trainee Call to Accelerated Action. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:158-161. [PMID: 35263298 DOI: 10.1097/acm.0000000000004646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The transition from medical student to resident is a pivotal step in the medical education continuum. For applicants, successfully obtaining a residency position is the actualization of a dream after years of training and has life-changing professional and financial implications. These high stakes contribute to a residency application and Match process in the United States that is increasingly complex and dysfunctional, and that does not effectively serve applicants, residency programs, or the public good. In July 2020, the Coalition for Physician Accountability (Coalition) formed the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) to critically assess the overall transition to residency and offer recommendations to solve the growing challenges in the system. In this Invited Commentary, the authors reflect on their experience as the trainee representatives on the UGRC. They emphasize the importance of trainee advocacy in medical education change efforts; reflect on opportunities, concerns, and tensions with the final UGRC recommendations (released in August 2021); discuss factors that may constrain implementation; and call for the medical education community-and the Coalition member organizations in particular-to accelerate fully implementing the UGRC recommendations. By seizing the momentum created by the UGRC, the medical education community can create a reimagined transition to residency that reshapes its approach to training a more diverse, competent, and growth-oriented physician workforce.
Collapse
Affiliation(s)
- Grant L Lin
- G.L. Lin is a second-year child neurology resident, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; ORCID: https://orcid.org/0000-0001-6888-2140
| | - Sylvia Guerra
- S. Guerra is a first-year general surgery resident, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Juhee Patel
- J. Patel is a first-year pediatric resident, Lehigh Valley Reilly Children's Hospital, Allentown, Pennsylvania
| | - Jesse Burk-Rafel
- J. Burk-Rafel is assistant professor of medicine and assistant director of UME-GME innovation, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0003-3785-2154
| |
Collapse
|
22
|
Joneja M, Patel S, Lawal S, Healey J. Le racisme anti-Noirs et les études de médecine: un cadre curriculaire pour reconnaître les erreurs du passé et en tirer des leçons. CMAJ 2023; 195:E56-E59. [PMID: 36623862 PMCID: PMC9829066 DOI: 10.1503/cmaj.220422-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Shikha Patel
- Faculté de médecine, Université Queen's, Kingston, Ont
| | - Sabreena Lawal
- Département d'oto-rhino-laryngologie et de chirurgie cervicofaciale, Université d'Ottawa, Ottawa, Ont
| | - Jenna Healey
- Département d'obstétrique et de gynécologie et Département d'histoire, Université Queen's; chaire Hannah en histoire de la médecine, Faculté de médecine de l'Université Queen's, Kingston, Ont
| |
Collapse
|
23
|
Haynes NA, Johnson M, Lewsey SC, Alexander KM, Anstey DE, Dillenburg T, Njoroge JN, Gordon D, Ofili EO, Yancy CW, Albert MA. Nurturing Diverse Generations of the Medical Workforce for Success With Authenticity: An Association of Black Cardiologists' Roundtable. Circ Cardiovasc Qual Outcomes 2023; 16:e009032. [PMID: 36603043 DOI: 10.1161/circoutcomes.122.009032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic exposed the consequences of systemic racism in the United States with Black, Hispanic, and other racial and ethnic diverse populations dying at disproportionately higher rates than White Americans. Addressing the social and health disparities amplified by COVID-19 requires in part restructuring of the healthcare system, particularly the diversity of the healthcare workforce to better reflect that of the US population. In January 2021, the Association of Black Cardiologists hosted a virtual roundtable designed to discuss key issues pertaining to medical workforce diversity and to identify strategies aimed at improving racial and ethnic diversity in medical school, graduate medical education, faculty, and leadership positions. The Nurturing Diverse Generations of the Medical Workforce for Success with Authenticity roundtable brought together diverse stakeholders and champions of diversity and inclusion to discuss innovative ideas, solutions, and opportunities to address workforce diversification.
Collapse
Affiliation(s)
- Norrisa A Haynes
- Division of Cardiology, Yale University, New Haven CT (N.A.H.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Michelle Johnson
- Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York NY (M.J.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Sabra C Lewsey
- Division of Cardiology, John Hopkins University, Baltimore MD (S.C.L.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Kevin M Alexander
- Division of Cardiology, Stanford University, CA (K.M.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - D Edmund Anstey
- Division of Cardiology, Columbia University, New York NY (D.E.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Tierra Dillenburg
- Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Joyce N Njoroge
- Division of Cardiology, University of California, San Francisco (J.N.N., M.A.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Debra Gordon
- Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA (E.O.O.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Clyde W Yancy
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Michelle A Albert
- Division of Cardiology, University of California, San Francisco (J.N.N., M.A.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| |
Collapse
|
24
|
Williams MS, Myers AK, Finuf KD, Patel VH, Marrast LM, Pekmezaris R, Martinez J. Black Physicians' Experiences with Anti-Black Racism in Healthcare Systems Explored Through An Attraction-Selection-Attrition Lens. JOURNAL OF BUSINESS AND PSYCHOLOGY 2023; 38:75-88. [PMID: 35702386 PMCID: PMC9184355 DOI: 10.1007/s10869-022-09825-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 05/05/2023]
Abstract
Anti-Black racism is a specific form of racism directed at Black people. In healthcare, there are poignant examples of anti-Black racism in the recruitment, selection, and retention stages of the job cycle. Research shows that anti-Black racism is associated with inequitable work outcomes and the under-representation of Black physicians. However, empirical findings are scattered with no organizing framework to consolidate these findings. To add to the literature, in this paper we present the attraction-selection-attrition (ASA) model (Schneider, 1987) as an organizing framework to discuss Black physicians' experiences with anti-Black racism and discrimination throughout their careers. We draw from previous literature to highlight specific experiences of Black physicians at each stage of the job cycle (i.e., attraction, selection, retention), and we offer considerations on how practitioners can mitigate anti-Black racism throughout the job cycle. In the wake of COVID-19 and highly publicized social justice movements, healthcare systems are seeking ways to increase the recruitment, selection, and retention of Black physicians to ensure health equity. We believe this guide will be valuable to practitioners, leaders, researchers, and program directions seeking to advance diversity, equity, and inclusion of Black physicians in their healthcare systems. We conclude by providing practical implications and directions for future research.
Collapse
Affiliation(s)
- Myia S. Williams
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Northwell Health, 600 Community Drive 4th Floor, Manhasset, NY 11030 USA
| | - Alyson K. Myers
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY USA
| | - Kayla D. Finuf
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Vidhi H. Patel
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Lyndonna M. Marrast
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Johanna Martinez
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| |
Collapse
|
25
|
Armijo A, Eldeeb K, Fairley S, Groenen M, Montemayor JR, Myrick E, Robinson B, Rogers J, Schokking M, Sheakley M. IAMSE Meeting Report: Student Plenary at the 26th Annual Conference of the International Association of Medical Science Educators. MEDICAL SCIENCE EDUCATOR 2022; 32:15-19. [PMID: 36277268 PMCID: PMC9580428 DOI: 10.1007/s40670-022-01662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Arthur Armijo
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, USA
| | - Khalil Eldeeb
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, Lillington, NC 27506 USA
| | - Stacie Fairley
- Philadelphia College of Osteopathic Medicine-South Georgia, Moultrie, USA
| | - Milou Groenen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Erica Myrick
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Benjamin Robinson
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, Lillington, NC 27506 USA
| | - Jasmine Rogers
- Philadelphia College of Osteopathic Medicine-South Georgia, Moultrie, USA
| | | | - Maria Sheakley
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| |
Collapse
|
26
|
Bernstein J. Not the Last Word: My Flexner Retort. Clin Orthop Relat Res 2022; 480:2091-2094. [PMID: 36149629 PMCID: PMC9555893 DOI: 10.1097/corr.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
27
|
Joneja M, Patel S, Lawal S, Healey J. Anti-Black racism and medical education: a curricular framework for acknowledging and learning from past mistakes. CMAJ 2022; 194:E1425-E1428. [PMID: 36280241 PMCID: PMC9616136 DOI: 10.1503/cmaj.220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mala Joneja
- Department of Medicine, Division of Rheumatology, Queen's University; Education Leader-in-Residence, Queen's University, Kingston, Ont
| | - Shikha Patel
- School of Medicine, Queen's University, Kingston, Ont
| | - Sabreena Lawal
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Ont
| | - Jenna Healey
- Department of Obstetrics and Gynaecology and Department of History, Queen's University; Hannah Chair in History of Medicine, Queen's University School of Medicine, Kingston, Ont
| |
Collapse
|
28
|
Rodríguez JE, Figueroa E, Campbell KM, Washington JC, Amaechi O, Anim T, Allen KC, Foster KE, Hightower M, Parra Y, Wusu MH, Smith WA, Villarreal MA, Pololi LH. Towards a common lexicon for equity, diversity, and inclusion work in academic medicine. BMC MEDICAL EDUCATION 2022; 22:703. [PMID: 36195946 PMCID: PMC9533485 DOI: 10.1186/s12909-022-03736-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Differential rewarding of work and experience has been a longtime feature of academic medicine, resulting in a series of academic disparities. These disparities have been collectively called a cultural or minority "tax," and, when considered beyond academic medicine, exist across all departments, colleges, and schools of institutions of higher learning-from health sciences to disciplines located on university campuses outside of medicine and health. A shared language can provide opportunities for those who champion this work to pool resources for larger impacts across the institution. This article aims to catalog the terms used across academic medicine disciplines to establish a common language describing the inequities experienced by Black, Latinx, American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander, Women, and other underrepresented people as well as queer, disabled, and other historically marginalized or excluded groups. These ideas are specific to academic medicine in the United States, although many can be used in academic medicine in other countries. The terms were selected by a team of experts in equity, diversity, and inclusion, (EDI) who are considered national thought leaders in EDI and collectively have over 100 years of scholarship and experience in this area.
Collapse
Affiliation(s)
- José E Rodríguez
- University of Utah Health, 26 S 2000 E, 5750B EHSEB, Salt Lake City, UT, 84112, USA.
| | | | - Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Tanya Anim
- Lee Memorial Health and Florida State University, Ft. Meyers, FL, USA
| | - Kari-Claudia Allen
- Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Krys E Foster
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Maia Hightower
- University of Utah Health, 26 S 2000 E, 5750B EHSEB, Salt Lake City, UT, 84112, USA
| | - Yury Parra
- New York City Health and Hospitals, New York, NY, USA
| | | | - William A Smith
- Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Mary Ann Villarreal
- University of Utah Health, 26 S 2000 E, 5750B EHSEB, Salt Lake City, UT, 84112, USA
| | - Linda H Pololi
- The National Initiative On Gender, Culture and Leadership in Medicine: C-Change, Brandeis University, Boston, MA, USA
| |
Collapse
|
29
|
Grieco CA, Currence P, Teraguchi DH, Monroe A, Palermo AGS. Integrated Holistic Student Affairs: A Personalized, Equitable, Student-Centered Approach to Student Affairs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1441-1446. [PMID: 35612916 DOI: 10.1097/acm.0000000000004757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medical education has reached a critical juncture-the structural racism that has permeated the fabric of its systems and institutions for centuries can no longer be ignored. The destructive, disproportionate impact of the COVID-19 pandemic and unabated violence targeting individuals who are Black, Indigenous, and People of Color (BIPOC) exact an incalculable toll on BIPOC students and students from other groups that are historically underrepresented in medicine (UIM). Failing to recognize and act on the well-documented differential experience of BIPOC medical students impedes medical educators' ability to cultivate learning environments where all learners have an equitable opportunity to thrive. Holistic review admission processes, now widely accepted, have challenged admissions committees to consider the "whole applicant" to diversify matriculating classes. While gaining admission is critical, it is merely the first step for BIPOC students, who may face marginalization within what the authors have termed a "sink-or-swim" culture in medical education. For the tremendous potential afforded by holistic review to be realized, the medical education community must extend the holistic approach throughout the medical education continuum, beginning with student affairs practices and support. The authors propose the use of Integrated Holistic Student Affairs (IHSA), a systems-based model that fosters the reexamining and reengineering of existing student affairs structures, policies, and processes to promote a personalized, equitable student-centered approach. The IHSA Model consists of 4 strategic actions-establish vertical and horizontal collaboration, conduct systems thinking analysis, target leverage points for change, and operationalize the change process-and 4 areas of priority for collaboration with student diversity affairs staff and faculty. The IHSA Model provides student affairs staff and faculty with a framework for shifting from reactive, deficit-oriented practices to proactive, empowering, equitable practices, with the goal of allowing BIPOC and all other UIM students to thrive during their journey from matriculation to graduation.
Collapse
Affiliation(s)
- C Alexander Grieco
- C.A. Grieco is special assistant to the vice dean for education, The Ohio State University College of Medicine, Columbus, Ohio
| | - Princess Currence
- P. Currence is director of curriculum and education, Rush Medical College, Chicago, Illinois
| | - Daniel H Teraguchi
- D.H. Teraguchi is associate dean for student affairs, University of California Riverside School of Medicine, Riverside, California
| | - Alicia Monroe
- A. Monroe is provost and senior vice president for academic and faculty affairs, Baylor College of Medicine, Houston, Texas
| | - Ann-Gel S Palermo
- A.-G.S. Palermo is senior associate dean for diversity, equity, and inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
30
|
Okelo SO. Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:752-762. [DOI: 10.1055/s-0042-1756491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractStructural inequities in medicine have been present for centuries in the United States, but only recently are these being recognized as contributors to racial inequities in asthma care and asthma outcomes. This chapter provides a systematic review of structural factors such as racial bias in spirometry algorithms, the history of systemic racism in medicine, workforce/pipeline limitations to the presence of underrepresented minority health care providers, bias in research funding awards, and strategies to solve these problems.
Collapse
Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| |
Collapse
|
31
|
Nguemeni Tiako MJ, Ray V, South EC. Medical Schools as Racialized Organizations: How Race-Neutral Structures Sustain Racial Inequality in Medical Education-a Narrative Review. J Gen Intern Med 2022; 37:2259-2266. [PMID: 35710658 PMCID: PMC9202970 DOI: 10.1007/s11606-022-07500-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
In 2021, The American Association of Medical Colleges released a framework addressing structural racism in academic medicine, following the significant, nationwide Movement for Black Lives. The first step of this framework is to "begin self-reflection and educating ourselves." Indeed, ample evidence shows that medical schools have a long history of racially exclusionary practices. Drawing on racialized organizations theory from the field of sociology, we compile and examine scholarship on the role of race and racism in medical training, focusing on disparities in educational and career outcomes, experiences along racial lines in medical training, and long-term implications. From the entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics negatively impact the careers of trainees of color, particularly those underrepresented in medicine (URiM). Indeed, in addition to structural biases associated with otherwise "objective" metrics, there are racial disparities across subjective outcomes such as the language used in medical trainees' performance evaluations, even when adjusting for grades and board exam scores. These disadvantages contribute to URIM trainees' lower odds of matching, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. Additionally, hostile racial climates and less diverse medical schools negatively influence White trainees' interest in practicing in underserved communities, disproportionally racial and ethnic minorities. Trainees' mental health suffers along the way, as do medical schools' recruitment, retention, diversity, and inclusion efforts. Evidence shows that seemingly race-neutral processes and structures within medical education, in conjunction with individuals' biases and interpersonal discrimination, may reproduce and sustain racial inequality among medical trainees. Medical schools whose goals include training a more diverse physician workforce towards addressing racial health disparities require a new playbook.
Collapse
Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Urban Health Lab, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Victor Ray
- Department of Sociology, University of Iowa, Iowa City, IA, USA
| | - Eugenia C South
- Urban Health Lab, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
32
|
Walker VP, Williams DR. Restitution Through Equity-Focused Mentoring: A Solution to Diversify the Physician Workforce. Front Public Health 2022; 10:879181. [PMID: 35719651 PMCID: PMC9199986 DOI: 10.3389/fpubh.2022.879181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Minoritized and marginalized physicians who identify as Black, Latino/a/x and Native American (BLNA) remain unacceptably underrepresented in medicine. Multiple studies provide a compelling argument for prioritizing racial/ethnic diversification of the physician workforce to improve racial/ethnic physician-patient concordance and assist in achieving more equitable health outcomes. Despite a growing awareness for the tangible benefits of a diversified physician workforce, the number of physicians from minoritized and marginalized groups remains relatively stagnant or worsening in certain demographics. The 5:1 ratio of Black students and trainees to Black faculty exemplifies and exacerbates the increased risk for harmful isolation particularly experienced by many BLNA mentees. They too need and deserve the benefits produced by concordant racial/ethnic faculty mentoring and support. However, these demands on time, resources and bandwidth can lead to negative consequences for BLNA faculty engaged in these efforts by contributing to their emotional, mental and physical exhaustion. Given the perpetual paucity of BLNA physicians in academic medicine, immediate interventions to prevent attrition of BLNA faculty, trainees and students journeying along the physician career pathway are urgently needed. Requiring the implementation of mentoring programs explicitly focused on increasing the number of physicians from groups underrepresented in medicine must happen at every point of the education and training process.
Collapse
Affiliation(s)
- Valencia P Walker
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.,Center for the Study of Racism, Social Justice and Health, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Dominique R Williams
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Primary Care, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States
| |
Collapse
|
33
|
Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Psychiatr Clin North Am 2022; 45:243-258. [PMID: 35680240 DOI: 10.1016/j.psc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
Collapse
Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- American College of Cardiology, 2400 N Street NW, Washington, DC 20037, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW This review focuses on physician workforce racial & ethnic diversity as a solution to improve perioperative and peripartum health equity. RECENT FINDINGS Black, Indigenous, and Hispanic physicians remain underrepresented in medicine (URiM) and anesthesiology, and efforts to expand this workforce have had limited impact. Psychological forces, including implicit bias, aversive racism, outgroup bias, racial attention bias, stereotype threat, and imposter syndrome all act to reinforce structural racism and decrease opportunity for advancement. Evidence based solutions are emerging, but require institutional commitment and widespread engagement of the entire medical community. SUMMARY Academic medicine has recognized the need to diversify the physician workforce for more than 50 years, and yet Black, Indigenous, and Hispanic physicians remain URiM. Foundational assumptions and power structures in medicine limit entry, advancement, and retention of URiM physicians. Solutions require leadership and institutional commitment to change the policies, procedures, priorities, and culture of academic medicine.
Collapse
|
35
|
Brown A, Auguste E, Omobhude F, Bakana N, Sukhera J. Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:867-875. [PMID: 35044980 DOI: 10.1097/acm.0000000000004597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Many academic medical organizations issued statements in response to demand for collective action against racial injustices and police brutality following the murder of George Floyd in May 2020. These statements may offer insight into how medical schools and national organizations were reflecting on and responding to these incidents. The authors sought to empirically examine the initial statements published by academic medical organizations in response to societal concerns about systemic, anti-Black racism. METHOD The authors searched for initial public statements released by a sample of academic medical organizations in Canada and the United States between May 25 and August 31, 2020. They assembled an archive with a purposive sample of 45 statements, including those issued by 35 medical schools and 10 national organizations. They analyzed the statements using Fairclough's 3-dimensional framework for critical discourse analysis (descriptive, interpretive, explanatory), which is a qualitative approach to systematically analyzing language and how it reflects and shapes social practice. RESULTS Many statements used formal and analytical language and reflected hierarchical thinking and power differentials between statement producers and consumers. The authors identified several tensions in the statements between explicit messaging and implied ideologies (e.g., self-education vs action to address racism), and they found a lack of critical reflection and commitment to institutional accountability to address anti-Black racism in academic medicine. The authors also found that many statements minimized discussions of racism and de-emphasized anti-Black racism as well as portrayed anti-Black racism as outside the institution and institutional accountability. CONCLUSIONS This research offers insight into how 45 academic medical organizations initially responded following the murder of George Floyd. Many of these statements included self-exculpatory and nonracist discursive strategies. While these statements may have been well intentioned, organizations must move beyond words to transformative action to abolish institutional racism in academic medicine.
Collapse
Affiliation(s)
- Allison Brown
- A. Brown is assistant professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-4552-8146
| | - Emmanuelle Auguste
- E. Auguste is an undergraduate student, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Favour Omobhude
- F. Omobhude is an undergraduate student, Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomie Bakana
- N. Bakana is an undergraduate student, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Javeed Sukhera
- J. Sukhera is chair/chief, Psychiatry Institute of Living and Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
| |
Collapse
|
36
|
Kearns C, Taylor G, Oberoi S, Mertz E. Dominant Power and the Concept of Caste: Implications for Dentistry and Oral Health Inequality. COMMUNITY DENTAL HEALTH 2022; 39:137-142. [PMID: 35543466 PMCID: PMC9156562 DOI: 10.1922/cdh_iadr22kearns06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper explores the issues of caste and casteism in the U.S. as described by Pulitzer Prize winning journalist Isabel Wilkerson in her 2020 book "Caste: The Origin of Our Discontents". Wilkerson argues that a caste system not only exists in the U.S. but operates as a hidden force affecting social inequality. The paper draws on Wilkerson's work to explore caste as an analytical concept. It begins by defining caste and casteism in contrast with racism, the eight pillars of a caste system, the consequences of casteism, and the psychological drivers of casteism. The paper then applies to concept of caste to understanding power, dentistry, and oral health inequality. The paper concludes by emphasizing that the concept of caste and its relationship to oral health inequality must be understood it if we want to create real social change.
Collapse
Affiliation(s)
- C Kearns
- University of California, San Francisco
| | - G Taylor
- University of California, San Francisco
| | - S Oberoi
- University of California, San Francisco
| | - E Mertz
- University of California, San Francisco
| |
Collapse
|
37
|
Titanji BK, Abdul-Mutakabbir JC, Christophers B, Flores L, Marcelin JR, Swartz TH. Social Media: Flattening Hierarchies for Women and Black, Indigenous, People Of Color (BIPOC) to Enter the Room Where It Happens. Clin Infect Dis 2022; 74:S222-S228. [PMID: 35568478 PMCID: PMC9107375 DOI: 10.1093/cid/ciac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Social media platforms are widely used to connect people across multiple settings, including country of origin, profession, race/ethnicity, sexual orientation, gender identity, seniority, and training. Groups that have been marginalized or historically excluded from decision-making encounters may lack formal mentors/sponsors because of a lack of representation of women and Black, Indigenous, People Of Color (BIPOC) in senior leadership positions. This can serve as a barrier to professional advancement at all stages of career development. Identifying and connecting with these potential mentors/sponsors outside of one's institutional space can be challenging. For this reason, leveraging social media to develop these professional relationships through flattened hierarchies can allow for professional networking beyond traditional mechanisms. Here we aim to describe how individuals can connect through social media to advance their careers and scientific and clinical expertise, advocate for communities, and provide high-quality communication to the public.
Collapse
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jacinda C Abdul-Mutakabbir
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
- Department of Basic Science, Loma Linda School of Medicine, Loma Linda, California, USA
| | - Briana Christophers
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Laura Flores
- University of Nebraska Medical Center, College of Allied Health Professions, Omaha, Nebraska, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USAand
| | - Talia H Swartz
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
38
|
Wicklund C, Sanghavi K, Coleman B, Johansen Taber K, Taylor JY, Asalone KC, Beachy S. Improving racial diversity in the genomics workforce: An examination of challenges and opportunities. Genet Med 2022; 24:1640-1643. [PMID: 35467533 DOI: 10.1016/j.gim.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Catherine Wicklund
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Bernice Coleman
- Geri and Richard Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Jacquelyn Y Taylor
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY
| | - Kathryn C Asalone
- Health and Medicine Division, The National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Sarah Beachy
- Health and Medicine Division, The National Academies of Science, Engineering, and Medicine, Washington, DC.
| |
Collapse
|
39
|
Lopez KN, Baker-Smith C, Flores G, Gurvitz M, Karamlou T, Nunez Gallegos F, Pasquali S, Patel A, Peterson JK, Salemi JL, Yancy C, Peyvandi S. Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025358. [PMID: 35389228 PMCID: PMC9238447 DOI: 10.1161/jaha.122.025358] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
Collapse
|
40
|
Ly DP. Historical Trends in the Representativeness and Incomes of Black Physicians, 1900-2018. J Gen Intern Med 2022; 37:1310-1312. [PMID: 33876377 PMCID: PMC8971221 DOI: 10.1007/s11606-021-06745-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dan P Ly
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| |
Collapse
|
41
|
Sumner DR, Hildebrandt S, Nesbitt A, Carroll MA, Smocovitis VB, Laitman JT, Beresheim AC, Ramnanan CJ, Blakey ML. Racism, structural racism, and the American Association for Anatomy: Initial report from a task force. Anat Rec (Hoboken) 2022; 305:772-787. [PMID: 35226417 DOI: 10.1002/ar.24903] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/28/2023]
Abstract
In 2021, the American Association for Anatomy (AAA) Board of Directors appointed a Task Force on Structural Racism to understand how the laws, rules, and practices in which the Association formed, developed and continues to exist affect membership and participation. This commentary is the first public report from the Task Force. We focus on African Americans with some comments on Jews and women, noting that all marginalized groups deserve study. Through much of its 130 year history, some members were an essential part of perpetuating racist ideas, the Association largely ignored racism and had some practices that prevented participation. The Task Force concluded that individual and structural racism within the AAA, combined with the broader social context in which the Association developed, contributed to the current underrepresentation of African Americans who constitute 4.1% of the membership even though 13.4% of the U.S. population is Black. Intentional efforts within the AAA to reckon with racism and other forms of bias have only begun in the last 10-20 years. These actions have led to more diverse leadership within the Association, and it is hoped that these changes will positively affect the recruitment and retention of marginalized people to science in general and anatomy in particular. The Task Force recommends that the AAA Board issue a statement of responsibility to acknowledge its history. Furthermore, the Task Force advocates that the Board commit to (a) sustaining ongoing projects to improve diversity, equity, and inclusion and (b) dedicating additional resources to facilitate novel initiatives.
Collapse
Affiliation(s)
- Dale R Sumner
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sabine Hildebrandt
- Department of Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Massachusetts, USA
| | - Allison Nesbitt
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Melissa A Carroll
- Department of Anatomy & Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | - Jeffrey T Laitman
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy C Beresheim
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher J Ramnanan
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael L Blakey
- Institute for Historical Biology, College of William & Mary, Williamsburg, Virginia, USA
| |
Collapse
|
42
|
Balta JY, Venne G, Noël GPJC. 10 tips on working with human body donors in medical training and research. Anat Sci Int 2022; 97:307-312. [PMID: 35143025 PMCID: PMC9167808 DOI: 10.1007/s12565-022-00651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
Human body donors selflessly decided to make the ultimate gift to donate their bodies to education. Being on the receiving end, the health sciences education community owes it to the donors to ensure that they are being treated with utmost respect by promoting and developing high ethical standards and maximizing the benefits from this gift. Working with human body donors for research purposes has increased over the years, while regulations associated with these processes did not change. This article draws upon current literature and author’s experiences to offer practical tips for health educators and everyone working with body donors to achieve these goals. We offer 10 practical tips that help in starting the conversation about the best ways to work with body donors to maximize their contribution to health sciences education.
Collapse
Affiliation(s)
- Joy Y Balta
- Division of Anatomy, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Gabriel Venne
- Department of Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Geoffroy P J C Noël
- Department of Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Division of Anatomy, School of Medicine, University of California, San Diego, CA, USA
| |
Collapse
|
43
|
Solomon SR, Atalay AJ, Osman NY. Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1513-1517. [PMID: 34292192 DOI: 10.1097/acm.0000000000004251] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.
Collapse
Affiliation(s)
- Sonja R Solomon
- S.R. Solomon is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alev J Atalay
- A.J. Atalay is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora Y Osman
- N.Y. Osman is assistant professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
44
|
Affiliation(s)
- Randl B. Dent
- Department of Health Policy and Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Anushree Vichare
- Department of Health Policy and Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | |
Collapse
|
45
|
Dow A, Pfeifle A, Blue A, Jensen GM, Lamb G. Do we need a signature pedagogy for interprofessional education? J Interprof Care 2021; 35:649-653. [PMID: 34126845 DOI: 10.1080/13561820.2021.1918071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
46
|
Johnson AE, Talabi MB, Bonifacino E, Culyba AJ, Davis EM, Davis PK, De Castro LM, Essien UR, Maria Gonzaga A, Hogan MV, James AJ, Jonassaint CR, Jonassaint NL, Matheo L, Nance MA, Napoé GS, Olafiranye O, Owusu-Ansah S, Pierson-Brown TN, Conrad Smith AJ, Suber TL, Torres O, Tripp R, Ufomata E, Wilson JD, South-Paul JE. Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future. Circulation 2021; 143:2395-2405. [PMID: 34125564 DOI: 10.1161/circulationaha.121.053566] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.
Collapse
Affiliation(s)
- Amber E Johnson
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.).,Veterans Affairs Pittsburgh Health System, PA (A.E.J., U.R.E., M.A.N., O.O.)
| | - Mehret Birru Talabi
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Eliana Bonifacino
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Alison J Culyba
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Esa M Davis
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Paula K Davis
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Laura M De Castro
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Utibe R Essien
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.).,Veterans Affairs Pittsburgh Health System, PA (A.E.J., U.R.E., M.A.N., O.O.)
| | - Alda Maria Gonzaga
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - MaCalus V Hogan
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Alaina J James
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Charles R Jonassaint
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Naudia L Jonassaint
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Loreta Matheo
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Melonie A Nance
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.).,Veterans Affairs Pittsburgh Health System, PA (A.E.J., U.R.E., M.A.N., O.O.)
| | - G Sarah Napoé
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Oladipupo Olafiranye
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.).,Veterans Affairs Pittsburgh Health System, PA (A.E.J., U.R.E., M.A.N., O.O.)
| | - Sylvia Owusu-Ansah
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | | | - A J Conrad Smith
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | | | - Orquidia Torres
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Rickquel Tripp
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Eloho Ufomata
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - J Deanna Wilson
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| | - Jeannette E South-Paul
- School of Medicine (A.E.J., M.B.T., E.B., A.J.C., E.M.D., P.K.D., L.M.D.C., U.R.E., A.M.G., M.V.H., A.J.J., C.R.J., N.L.J., L.M., M.A.N., G.S.N., O.O., S.O.-A., A.J.C.S., T.L.S., O.T., R.T., E.U., J.D.W., J.E.S.-P.)
| |
Collapse
|
47
|
Roberts LW. Advancing Equity in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:771-772. [PMID: 34031293 DOI: 10.1097/acm.0000000000004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
48
|
Lerner BH. Judging Medicine's Past: A Lesson in Professionalism. Ann Intern Med 2021; 174:866-867. [PMID: 34126029 DOI: 10.7326/m21-0648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Barron H Lerner
- New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
49
|
Rivara FP, Bradley SM, Catenacci DV, Desai AN, Ganguli I, Haneuse SJPA, Inouye SK, Jacobs EA, Kan K, Kim HS, Morris AM, Ogedegbe O, Perencevich EN, Perlis RH, Powell E, Rubenfeld GD, Shulman LN, Trueger NS, Fihn SD. Structural Racism and JAMA Network Open. JAMA Netw Open 2021; 4:e2120269. [PMID: 34115135 DOI: 10.1001/jamanetworkopen.2021.20269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Frederick P Rivara
- Editor in Chief, JAMA Network Open , Chicago, Illinois
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Steven M Bradley
- Department of Medicine, Minneapolis Heart Institute, Minneapolis, Minnesota
- Associate Editor, JAMA Network Open , Chicago, Illinois
| | - Daniel V Catenacci
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Angel N Desai
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Internal Medicine, University of California, Davis, Sacramento
| | - Ishani Ganguli
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Brigham and Women's Hospital, Division of General Internal Medicine,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sebastien J P A Haneuse
- Statistical Editor, JAMA Network Open, Chicago, Illinois
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Sharon K Inouye
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Medicine, Harvard Medical School, Hebrew SeniorLife, Boston, Massachusetts
| | - Elizabeth A Jacobs
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Maine Medical Center Research Institute, MaineHealth, Scarborough
| | - Kristin Kan
- Assistant Editor, JAMA Network Open, Chicago, Illinois
| | - Howard S Kim
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arden M Morris
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Olugbenga Ogedegbe
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York
| | - Eli N Perencevich
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Center for Access & Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, Iowa
| | - Roy H Perlis
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Elizabeth Powell
- Assistant Editor, JAMA Network Open, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gordon D Rubenfeld
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Lawrence N Shulman
- Associate Editor, JAMA Network Open , Chicago, Illinois
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - N Seth Trueger
- Digital Editor, JAMA Network Open , Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephan D Fihn
- Deputy Editor, JAMA Network Open, Chicago, Illinois
- Department of Medicine, University of Washington, Seattle
| |
Collapse
|
50
|
Bray SRM, McLemore MR. Demolishing the Myth of the Default Human That Is Killing Black Mothers. Front Public Health 2021; 9:675788. [PMID: 34109150 PMCID: PMC8183820 DOI: 10.3389/fpubh.2021.675788] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
It took a white police officer's knee on George Floyd's neck before white people began to reckon with 400 years of slavery and its aftermath, the effects of which Black people have endured for generations. Monuments are being taken down, flags are being redesigned, and institutions that honored those who denied the humanity of Black people are being renamed. Unfortunately for Sandra Bland, Breonna Taylor, Sha-Asia Washington and countless other Black transgender people including those with capacity for pregnancy, there was no justice even prior to the global pandemic of SARS-Cov-2 or coronavirus; namely racism, violence, and the Black Maternal Health crisis that makes it less likely that Black women will survive pregnancy and childbirth. The purpose of this article is to situate the state of Black people with the capacity for pregnancy in the context of these existing crises to illuminate the myths that racism has perpetuated through science, health services provision and policy. The greatest of these is the myth of a default human that can serve as a standard for the rest of the population. This racist ideal underpins education, provision of care, research, policies, and public health praxis. Demolishing the myth starts with acknowledging that Black people are not the architects of their own destruction: the default standard of whiteness is. The article begins with a historical background on how this myth came to be and elucidates the development and perpetuations of the myth of the default human. Next, we present an evidence based scoping review of the literature to summarize current thinking with specific focus on the Black maternal health crisis, we make policy recommendations and retrofits of upstream public health approaches for existing programs toward health equity. We also situate Black maternal health as part of a reproductive justice frame that centers Black women and birthing people's autonomy and agency. In other words, we use the scoping review to end with reimagining public health policy and provide an actionable roadmap to specifically disrupt the myth of the default human and dismantle racism in education, provision of care, research, policies, and public health praxis.
Collapse
Affiliation(s)
| | - Monica R. McLemore
- School of Nursing, Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|