Releasing the Net to Promote Minority Faculty Success in Academic Medicine

Workforce Diversity and Equity Among Critical Care Physicians

Health disparities persist among minoritized populations. A diverse clinician workforce may help address these disparities and improve patient outcomes; however, diversity in the critical are workforce (particularly among women and those historically underrepresented in medicine (URiM)) is lacking. This review describes factors contributing to low respresentation of women and URiM in critical care medicine, and proposes strategies to overcome those barriers.

From othering to belonging: a framework for DEI history-telling and strategising

The medical profession in the USA is-and has long been-a segregated workforce. Currently, just 5.0% of all US physicians are black. Understanding the origins and mechanisms of this disparity is essential to creating a future where black healing and healers are supported by our medical system. In pursuit of this future, this article offers 'othering' and 'belonging' as frames of analysis and intervention for diversity and equity initiatives.Building on previous historical studies of racism in medicine, this project reveals how the figure of the 'American physician' was created through exclusionary/othering tactics. In part 1, we analyse antebellum historical sources to demonstrate the role of medicine in creating and promulgating racial categories and hierarchies. Next, in part 2, we explore the historical conditions that produced the American physician as a significant professional identity by analysing texts by the American Medical Association and affiliated state medical societies. Then, we turn towards solutions in part 3. To redress inequities produced by othering, particularly the continued exclusion of black people from the medical profession, we argue that medical leaders should cultivate a professional culture of belonging. As we will explain, belonging goes beyond tolerating and respecting difference; it entails shared culture, equal rights and inclusive structures.

An Interactive Allyship and Privilege Workshop for Trainees in Medicine

Introduction

Despite growing efforts to increase diversity in recruitment and to teach principles of diversity, equity, and inclusion (DEI), representation of individuals underrepresented in medicine continues to fall short. This demonstrates a need for efforts that target the work environment and culture to increase retention alongside existing recruitment initiatives. We designed this interactive allyship workshop with a focus on building skills necessary for being an ally that has been missing in existing allyship curricula.

Methods

This workshop was led by multidepartmental faculty with experience in DEI training. Participants engaged in a number of interactive activities to reflect on their own identities and privilege and practiced ways to engage in difficult conversations. Prior to the workshop, participants completed a survey that was repeated at the workshop's completion to evaluate their perspective change and understanding of allyship. We also collected responses to a self-reflective exercise during the workshop.

Results

Participants included 68 anesthesia and surgery attendees, 53 of whom (78%) completed the postsurvey. Participants strongly agreed that this workshop was important to the workplace and medical training. Themes from the self-reflective exercises included endorsement of sponsorship and mentorship activities, community support, and advocacy.

Discussion

Interactive skill-building activities are important and effective at helping trainees develop as allies. Long-term follow-up is needed to assess longitudinal knowledge retention and translation into behavioral change to create a more inclusive and supportive work environment.

Are We Really Retaining URiM Faculty in Academic Medicine?

INTRODUCTION

Previous studies have identified the need to improve recruitment and retention of faculty who are underrepresented in medicine (URiM); however, it is unclear to what extent medical schools have been able to sustain growth and retain URiM faculty representation.

METHODS

Numbers of URiM faculty at each AAMC medical school from 2012 to 2021 were obtained from the Association of American Medical Colleges Faculty Administrative Management Online User System database. Year-over-year percent change was calculated for each school and year of the study period for all URiM faculty, junior URiM faculty, and senior URiM faculty. Pearson's correlation was used to compare percent change in 1 year to the previous and subsequent years for all three groups. Pearson's correlation coefficients were also used to compare percent change between junior and senior URiM faculty for the same, previous, and subsequent years.

RESULTS

The percentage change for URiM faculty at all ranks between adjacent years occurring from 2012 to 2021 was weakly and negatively associated (r = - 0.06, p value = 0.03). There was significant positive correlation between the percent change in junior URiM faculty and senior URiM faculty in the same year (r = 0.11) and previous year (r = 0.09).

DISCUSSION

URiM faculty growth in 1 year is not sustained in the next year. More research is needed to better understand efforts at retention of URiM faculty in academic medicine.

The Relationship Between the Social Mission Content of Medical School Mission Statements and Minority Faculty Representation Among Faculty and Senior Leadership

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.

Using an Adaptive Listening Tour and Survey to Promote Faculty Reflection on Diversity, Equity, and Inclusion (DEI) in the Pre-clinical Undergraduate Medical Curriculum

Descriptive studies regarding how to integrate diversity, equity, and inclusion (DEI) into medical education are lacking. We utilized the AAMC's Key Steps for Assessing Institutional Culture and Climate framework to evaluate our current curriculum via listening tours (n = 34 participants) and a survey of the 10 pre-clinical block directors, to better understand the opportunities and challenges of improving DEI in the pre-clinical curriculum. Opportunities included diversifying cases and standardized patients, enhancing information on systemic racism and social determinants of health, and increasing racial humility and population genetics/epigenetics training. Faculty had issues with "correct ways" to incorporate DEI and time constraints.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01924-7.

Diversity in the pathway from medical student to specialist in the Netherlands: a retrospective cohort study

Background

Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce.

Methods

We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory.

Findings

Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist.

Interpretation

In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce.

Funding

ODISSEI.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study

BACKGROUND AND OBJECTIVES

Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax.

METHODS

Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods.

RESULTS

Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement).

CONCLUSIONS

Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Implementation of a Chief Resident Selection Process Designed to Mitigate Bias: Lessons Learned

BACKGROUND

Chief residency selection processes are often opaque and beset by bias, which can result in disparities in who is selected for this important role. As a chief residency can lead to future academic and/or leadership positions, efforts to increase diversity in academic medicine and physician leadership may be aided by an inclusive chief resident (CR) selection process designed to mitigate bias.  Objective: To implement and evaluate the acceptability of a CR selection process that is inclusive and designed to mitigate bias.  Methods: In the 2021-2022 academic year, we designed and implemented a CR selection process aligned with published strategies known to mitigate bias in academic recruitment. The four-step opt-out CR selection process included a nomination survey, structured interviews, a clinical review, and a holistic review of each candidate. Each step was clearly delineated, assigned a specific number of points, and scored on a designated rubric. The candidates with the highest and second-highest number of points were awarded the two CR positions. Our selection process excluded examination scores and precluded consideration of "fit" between the selected CRs, as these are known sources of potential bias. In January 2023, we surveyed our department to obtain post-implementation feedback and to assess satisfaction with the process, before repeating the process for 2022-2023.

RESULTS

Survey response rates were 47% (14/30) for residents and 29% (18/63) for departmental faculty. The majority of responding residents (64%) and faculty (100%) were satisfied with the CR selection process, finding it fair and inclusive. Nearly 80% of residents and 100% of faculty wished to repeat the process in 2022-2023.  Conclusions: An inclusive CR selection process utilizing strategies to mitigate bias was feasible, and acceptable to residents and faculty. We recommend that residency training programs make efforts to implement CR selection practices that are inclusive and aim to mitigate bias.

"A Look Under the Hood": Reflections on the Inaugural RIME Mentorship Program

In 2021, Research in Medical Education (RIME) celebrated 60 years of advancing scholarship in health professions education (HPE). At that time, the nation's educational institutions faced a public reckoning on the long-standing pandemic of racism that sweltered in their practices and policies, laid bare by COVID-19 and the Black Lives Matters movement. RIME responded with a mentorship program for minoritized early career HPE faculty, which aims to amplify their voices in settings where their experiences and contributions are frequently dampened. The program fosters professional development through structured activities, participation as RIME committee interns, and formal mentorship channels to support career growth and offer experiences with scholarly publishing. This commentary was written by the first cohort of RIME mentees who are HPE scholars from various professions and diverse backgrounds with struggles traversing professional landscapes as immigrants and as individuals with minoritized identities and hopes for belonging in medical and educational institutions. In this commentary, the mentees describe the merits of the RIME mentorship program and what it meant to them and their unique marginalities. They also examine opportunities for improvements within the program to further reduce barriers faced by minoritized early career HPE faculty who often face limited support with scholarly activities.

Pro-Con Debate: Consideration of Race, Ethnicity, and Gender Is Detrimental to Successful Mentorship

Anesthesiology remains a specialty with low representation of women or members of racial and ethnic groups considered underrepresented in medicine (UiM). In the United States, women account for 33% of anesthesiology residents, while physicians identifying as Black, African American, Latinx, American Indian, or Alaska Native account for approximately 10%. Underrepresentation of these groups is even more pronounced in academic anesthesiology, especially at the senior ranks and roles, such as department chairs. Leaders in the field have recently shared recommendations for how individual departments, medical schools, hospitals, and professional organizations can create and support a more diverse anesthesiology workforce. These commentaries have often stressed the importance of mentorship for supporting women and physicians from UiM groups, including mentorship of trainees and practicing anesthesiologists seeking to advance their careers. While the value of mentorship is undisputed, it remains a matter of controversy whether race, ethnicity, or gender should be explicitly considered by mentoring programs and individual mentors. In this article, we discuss whether and how race, ethnicity, and gender should be considered in the setting of mentorship programs and the formation of individual mentoring relationships, as well as some of the potential consequences that lie therein.

Scoping Review of Restorative Justice in Academics and Medicine: A Powerful Tool for Justice Equity Diversity and Inclusion

Purpose

Restorative Justice (RJ) as a practice and mindset is growing within academic medicine and health care. The authors aim to categorize the extent to which RJ training and practices have been researched, explored, and applied within health care, medicine, and academic contexts.

Methods

In July 2021, the authors conducted a scoping literature review, searching four databases for peer-reviewed articles and book chapters discussing RJ. Authors also used bibliography searches and personal knowledge to add relevant work. Reviewers independently screened article titles and abstracts, assessing the full texts of potentially eligible articles with inclusion and exclusion criteria. From each included article, authors extracted the publication year, first author's country of origin, specific screening criteria met, and the depth with which it discussed RJ.

Results

From 599 articles screened, 39 articles, and books were included (published 2001-2021). Twenty-five (64%) articles discussed RJ theory with few describing application practices with substantial depth. Ten (26%) articles only referenced the term "restorative justice" and seven (18%) discussed legal applications in health care. Fifty-four percent were from outside the United States. Articles tended to describe RJ uses to address harm and often missed the opportunity to explore RJ's capacity to proactively build community and culture that helps prevent harm.

Conclusions

RJ in health care is a rapidly expanding field that offers a framework capable of building stronger communities, authentically preventing and responding to harm, inviting radical inclusion of diverse participants to build shared understanding and culture, and ameliorate some of the most toxic and unproductive hierarchical practices in academics and medicine. Most literature calls to RJ for help to respond to harm, although there are very few well-designed and evaluated implementations. Investment in RJ practices holds significant promise to steer our historically hierarchical, "othering" and imperfect systems to align with values of justice (vs. punishment), equity, diversity, and inclusion.

Diversity in the pediatric research workforce: a scoping review of the literature

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.

Mitigating the Isolation of Minoritized Faculty in Academic Medicine

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.

Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021

Background

According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.

Objective

To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.

Methods

We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.

Results

Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.

Conclusions

Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.

Career Progression and Research Productivity of Women in Academic Cardiothoracic Surgery

BACKGROUND

The objective of this work was to delineate career progression and research productivity of women practicing cardiothoracic surgery in the academic setting.

METHODS

Cardiothoracic surgeons at the 79 accredited US cardiothoracic surgery training programs in 2020 were included in this cross-sectional analysis. Data regarding subspecialization, training, practice history, and publications were gathered from public sources including department websites, CTSNet, and Scopus.

RESULTS

A total of 1065 surgeons (51.3% cardiac, 32.1% thoracic, 16.6% congenital) were identified. Women accounted for 10.6% (113) of the population (7.9% of cardiac, 15.5% of thoracic, 9.6% of congenital surgeons). The median number of cardiothoracic surgeons per institution was 12 (interquartile range [IQR], 10-17), with a median of 1 woman (IQR, 0-2). Fifteen of 79 programs (19%) had no women. Among women faculty 5.3% were clinical instructors, 51.3% were assistant professors, 23.0% were associate professors, 16.8% were full professors, and 3.5% had unspecified titles (vs 2.0%, 32.9%, 23.0%, 37.5%, and 4.6% among men, respectively; P < .001). Women and men authored a comparable number of first-author (0.4 [IQR, 0.0-1.3] vs 0.5 [IQR, 0.0-1.1], P = .56) publications per year but fewer last-author (0.1 [IQR, 0.0-0.7] vs 0.4 [IQR, 0.0-1.3], P < .0001) and total publications per year (2.7 [IQR, 1.0-6.2] vs 3.7 [IQR, 1.3-7.8], P = .05) than men. The H-index was lower for women than for men overall (8.0 [IQR, 3.0-15.0] vs 15.0 [IQR, 7.0-28.0], P < .001) but was similar between men and women who had been practicing for 10 to 20 years.

CONCLUSIONS

Gender disparities persist in academic cardiothoracic surgery. Efforts should be made to support women in achieving senior roles and academic productivity.

Experiences of agency in historically underrepresented racial and ethnic dental faculty at predominantly white institutions

PURPOSE/OBJECTIVES

Historically underrepresented racial and ethnic (HURE) dentists remain underrepresented in dental education and dental practice, and surprisingly, little is known about the factors that enable them to thrive. The lack of information about their experiences is a critical gap in the literature. The purpose of this critical qualitative study is to describe how HURE dental faculty in predominantly white institutions (PWIs) exercise agency to thrive and advance in academic promotion when faced with challenges and adversity in the workplace.

METHODS

Thirteen semi-structured interviews were conducted in 2021 and 2022 with HURE dental faculty from 10 different institutions. Interviews were audio recorded, transcribed, and analyzed using the construct of agency and tenets of critical race theory to understand how they thrive in their institutions.

RESULTS

HURE dental faculty experienced racism as normal from both faculty and students. Racism centered around white faculty guarding access to white spaces, including things that should be open to everyone like meetings and information about promotion. To counter this, HURE faculty engaged in individual agency by fighting for their perspectives to be heard, proxy agency by seeking and building relationships with mentors and colleagues who could use their whiteness to create change, and improvisational agency by going outside their institutions for support.

CONCLUSION(S)

To thrive in PWIs requires HURE faculty to exercise various forms of agency to directly or indirectly advocate for themselves as professionals. These findings have implications for dental leaders to change their existing structures and improve the work environments for HURE dental faculty.

Undue burden: Black faculty, COVID-19, and the racial justice movement

A crucial reckoning was initiated when the COVID-19 pandemic began to expose and intensify long-standing racial/ethnic health inequities, all while various sectors of society pursued racial justice reform. As a result, there has been a contextual shift towards broader recognition of systemic racism, and not race, as the shared foundational driver of both societal maladies. This confluence of issues is of particular relevance to Black populations disproportionately affected by the pandemic and racial injustice. In response, institutions have initiated diversity, equity, and inclusion (DEI) efforts as a way forward. This article considers how the dual pandemic climate of COVID-19-related health inequities and the racial justice movement could exacerbate the "time and effort tax" on Black faculty to engage in DEI efforts in academia and biomedicine. We discuss the impact of this "tax" on career advancement and well-being, and introduce an operational framework for considering the interconnected influence of systemic racism, the dual pandemics, and DEI work on the experience of Black faculty. If not meaningfully addressed, the "time and effort tax" could contribute to Black and other underrepresented minority faculty leaving academia and biomedicine - consequently, the very diversity, equity, and inclusion work meant to increase representation could decrease it.

Pseudoleadership as a contributor to the URM faculty experience

Pseudoleadership for faculty underrepresented in medicine (URM) has been defined as when URM faculty are placed in leadership positions only because of the racial and ethnic diversity they bring, when they are not ready or trained for such roles because of being early in their faculty careers. It occurs when senior leaders push early career URM faculty into spaces where it is difficult for them to be successful.  Pseudoleadership can open up URM faculty to manipulation by superiors and impact URM advancement, as work of leadership positions take time away from scholarship and other activities which institutions value for promotion. Pseudoleadership is typically a problem for early career URM faculty and can be seen when ranks such as lecturer or assistant professor are placed in leadership or other administrative positions without careful thought on how to support the advancement and promotion of this group. In this manuscript the authors discuss pseudoleadership, its impact on the advancement and development of faculty who are underrepresented in medicine and a path forward.

Towards a common lexicon for equity, diversity, and inclusion work in academic medicine

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.

Trends in the Diversity of Pediatric Faculty: 2000 to 2020

OBJECTIVE

Academic medicine diversity is important for addressing health disparities and training the next generation. A recent study highlighted the lack of diversity among pediatric trainees over time. However, trends in US pediatric faculty diversity have not been clearly illuminated. The aim of this study is to evaluate pediatric faculty diversity trends and compare racial/ethnic representation between pediatric faculty and the US population.

METHODS

Repeat cross-sectional study of the Association of American Medical Colleges Faculty Roster of pediatric faculty from 2000 to 2020. Trends in sex, race, ethnicity, and rank were compared with the Cochran-Armitage test. Data on faculty race/ethnicity were compared with the general and child population by using US Census Bureau data.

RESULTS

Trends in underrepresented in medicine (URiM) faculty representation significantly increased at all ranks: professor (+3.5%, P < .0001), associate professor (+3.0%, P = .0001), and assistant professor (+2.5%, P = .0001). URiM male representation remained unchanged (P = .14), whereas significantly increased trends occurred in URiM female representation (+3.4%, P < .0001). African American/Black males significantly decreased representation at associate (-0.4%, P = .04) and assistant professor levels (-0.6%, P < .0001), and American Indian/Alaska Native males significantly decreased representation at the assistant professor rank (-0.1%, P < .0001). The percentage of URiM pediatric faculty representation was considerably lower compared with 2020 US overall and longitudinal child population representation.

CONCLUSION

The stagnation of URiM male representation and lack of faculty diversity reflective of the US population may have a critical impact on the ability to recruit/retain a diverse pediatric workforce and promote equitable care.

Can academic dentistry become an anti-racist institution?: Addressing racial battle fatigue and building belonging

Racism, oppression, and marginalization are unfortunate hallmarks that Black individuals face in the United States. While dental schools serve as institutions of both learning and patient care, applying humanistic principles, they are not immune to racism, specifically anti-Black racism. In this paper, the theoretical framework of racial battle fatigue is applied to academic dentistry to consider how it may impact faculty who have experiences with racism and discrimination. The framework of racial battle fatigue allows for a critique of academic dentistry as an institution that may be toxic, neither welcoming Black faculty members nor supporting their professional and career advancement, despite accreditation standards that call on these institutions to be humanistic environments for diversity and inclusion. Black faculty members may face unique challenges in academic dentistry because of racial battle fatigue. The cumulative stress may warrant unique strategies to both recruit and retain them in academic dental institutions. Specifically, pathways may need to be funded to insure that they have support and time allocations for professional development and career promotion. With understanding the effects of racial battle fatigue, dental schools may want to adopt policies and practices that support the professional and personal well-being and success of faculty, especially those faculty members who are Black.

Diversity, Disparities, and the Allergy Immunology Pipeline

Disparities in health outcomes in under-represented racial and ethnic minority groups are evident in allergic/immunologic diseases and have been most completely described in asthma. The last 2 decades have not led to any substantive improvement in these disparities, with under-represented minorities (URMs) receiving worse care in several quality measures. Increasing physician workforce diversity is one strategy to improve access to care and address the health disparity problem because URM physicians more often choose to both work in clinical settings and pursue research that benefits underserved communities.

Diversity of anesthesia workforce - why does it matter?

PURPOSE OF REVIEW

Although recent census demonstrates that women comprise 50.8% and ethnic minority groups collectively consist of 42.1% of the US population, the field of anesthesiology still demonstrates disparity in representation and health outcomes across race, ethnicity, and gender. In addition, the growing percentage of people that identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) compounded with limited representation among providers of their care can augment existing disparate outcomes within this community.

RECENT FINDINGS

Compared to male colleagues, women physicians across all specialties have a decreased likelihood of professorship as well as equitable pay and leadership roles. Additionally, a 2019 study of anesthesia residents across race and ethnicity within the Accreditation Council for Graduate Medical Education established that whites were 58.9%, Asians were 24.7%, Hispanics were 7.8%, Blacks were 5.9%, multiracial groups were 3.8%, and Native Americans were 0.3% of the total 6272 residents. In a survey of members of the American Society of Anesthesiologists, self-identification as part of the sexual and gender minoritycommunity was independently associated with an increased risk of burnout. Furthermore, teams with higher diversity in cognitive styles solve problems more efficiently.

SUMMARY

To achieve an optimized quality of healthcare, anesthesiologists and other providers should be a reflection of the communities they serve, including women, people of color, and LGBTQ. In this way, there is an increased likelihood of empathy, effective communication, and insightful perspectives on how to bridge the gap in health equity. A diverse lens is essential to ensure grassroots efforts lead to lasting transformational change.

Finding my people: Effects of student identity and vulnerability to Stereotype Threat on sense of belonging in surgery

BACKGROUND

Diversity in surgery lags behind the medical student population. We documented first-year medical students' vulnerability to stereotype threat (VST) and its impact on a sense of belonging in surgery.

METHODS

All first-year medical students at a single academic institution were surveyed. Demographics, VST, anticipated clerkship experience, and sense of belonging were assessed.

RESULTS

44% of students were vulnerable to ST in upcoming clerkships, with the majority worried about surgical clerkships. More student from races/ethnicities underrepresented in medicine (URM; 74%) and sexual minorities (62%) were vulnerable than white (30%) and heterosexual (38%) students respectively (p = 0.001 and p = 0.017). Knowing a surgeon with a shared identity would enhance belonging for most students (84%). VST was higher for those who do not anticipate working with (p < 0.001) or do not know a surgeon (p = 0.0001) who shares their identity.

CONCLUSION

VST significantly influences a student's sense of belonging in surgery. More research is needed to promote inclusivity in surgery.

Representation of American Indian and Alaska Native Individuals in Academic Medical Training

IMPORTANCE

Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations.

OBJECTIVE

To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021.

EXPOSURES

Enrolled trainees at specific stages of medical training.

MAIN OUTCOMES AND MEASURES

The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties.

RESULTS

The study data contained a total of 238 974 607 White and American Indian and Alaska Native US citizens, 24 795 US medical school applicants, 11 242 US medical school acceptees, 10 822 US medical school matriculants, 10 917 US medical school graduates, 59 635 residents, 518 874 active physicians, and 113 168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds of working in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties.

CONCLUSIONS AND RELEVANCE

This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.

The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools

INTRODUCTION

Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research.

METHODS

Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows.

RESULTS

We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices).

CONCLUSIONS

Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.

Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine

Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward-thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty. It is intended to complement the recently approved American College of Emergency Physicians (ACEP) policy statement aimed at overcoming barriers to promotion of women and URiM faculty in academic emergency medicine. This policy statement was jointly released and supported by the Society for Academic Emergency Medicine (SAEM), American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM).

From Diversity and Inclusion to Antiracism in Medical Training Institutions

The glaring racial inequities in the impact of the COVID-19 pandemic and the devastating loss of Black lives at the hands of police and racist vigilantes have catalyzed a global reckoning about deeply rooted systemic racism in society. Many medical training institutions in the United States have participated in this discourse by denouncing racism, expressing solidarity with people of color, and reexamining their diversity and inclusion efforts. Yet, the stagnant progress in recruiting, retaining, and supporting racial/ethnic minority trainees and faculty at medical training institutions is well documented and reflects unaddressed systemic racism along the academic pipeline. In this article, the authors draw upon their experiences as early-career physicians of color who have led and supported antiracism efforts within their institutions to highlight key barriers to achieving meaningful progress. They describe common pitfalls of diversity and inclusion initiatives and call for an antiracist approach to systems change. The authors then offer 9 recommendations that medical training institutions can implement to critically examine and address racist structures within their organizations to actualize racial equity and justice.

Addressing the gate blocking of minority faculty

There have been ongoing efforts to increase the presence of underrepresented minorities in medicine (URMM), including faculty development initiatives, mentoring programs and outreach efforts. However, URMM faculty face unique challenges that are crucial for academic institutions and leaders to recognize in order to improve retention of this group and allow for meaningful advancement in the field. This paper introduces the concept of gate blocking, defined as what happens to minority faculty as a result of the consequences of the minority tax and systems designed to advantage some and disadvantage others. In addition to defining gate blocking, the authors make recommendations to address this concern in academic medicine and promote the advancement and retention of URMM faculty.

Diversity in neurology leadership: Nuances and nudges

Underrepresented in medicine (UIM) academic physicians are poorly represented among medical school faculty when compared with their proportion in the US population, receive NIH research awards less frequently, are promoted less often, indicate lower career satisfaction, and report higher social isolation, than faculty who are not under-represented. Supporting a successful and sustainable workforce of UIM academic physicians is essential in neurology, because such neurologists are more likely to engage in research to reduce disparities in neurological outcomes that affect underserved and/or low-income communities, and help improve the paucity of diverse race-ethnic participation in clinical trials. Having more diverse academic neurologists serve in such roles could bolster their careers and model possibilities for others who share similar cultures and backgrounds. Beyond leading/joining diversity affairs committees, more UIM are needed in mainstream leadership roles. In this work, we explore self-application vs. appointment/nomination opportunities and how this play a role in leadership opportunities. In addition to considering appropriate weighing of self-applications vs. appointments based opportunities, we highlight approaches and introduce the concept of nudging. Nudging, which refers to purposely increasing the visibility and appeal of particular items with the goal of boosting the odds of selecting those items, has been shown to successfully influence the process of selection, and may help level the leadership playing field for UIM in neurology.

The Diversity Efforts Disparity in Academic Medicine

The diversity efforts disparity in academic medicine can be defined as part of the minority tax that negatively impacts faculty who are underrepresented in medicine. This disparity can be defined as differences between minority and non-minority faculty in their recruitment or assignment by the institution to address diversity issues, climate concerns and conflict around inclusion in academic medicine. It can manifest as disproportionate committee service, being asked to be the face of diversity for the school on websites or brochures or being asked to serve on diversity task forces or initiatives. In this article, the author further characterizes the diversity efforts disparity and provides recommendations for how to identify and address it in academic medicine.

Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity

BACKGROUND

In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity.

OBJECTIVES

The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here.

DISCUSSION

The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.

Developing the Neurology Diversity Officer: A Roadmap for Academic Neurology Departments

Academic neurology departments must confront the challenges of developing a diverse workforce, reducing inequity and discrimination within academia, and providing neurologic care for an increasingly diverse society. A neurology diversity officer should have a specific role and associated title within a neurology department as well as a mandate to focus their efforts on issues of equity, diversity, and inclusion that affect staff, trainees, and faculty. This role is expansive and works across departmental missions, but it has many challenges related to structural intolerance and cultural gaps. In this review, we describe the many challenges that diversity officers face and how they might confront them. We delineate the role and duties of the neurology diversity officer and provide a guide to departmental leaders on how to assess qualifications and evaluate progress. Finally, we describe the elements necessary for success. A neurology diversity officer should have the financial, administrative, and emotional support of leadership in order for them to carry out their mission and to truly have a positive influence.

Cross-sectional Survey-based Study of Underrepresented Minorities in Urology Academic Leadership Roles

OBJECTIVE

To define the current proportion of underrepresented minority (URM) academic urologists in leadership positions.

METHODS

A cross-sectional observational study of leadership positions in active United States Urology Residency Programs in 2020 was conducted. Academic urologists in leadership positions were electronically mailed a survey asking about personal and professional demographics. Self-reported variables including administrative position, race, and ethnicity were collected and analyzed.

RESULTS

Over the study period, 133 urologists completed the survey out of a possible 320 academic urologists for a response rate of 41.6%. Overall, African-Americans represented 9.0%, Hispanics represented 3.8%, and American Indians/Alaska Natives made up 0.8% of leadership roles in the study sample. African-Americans comprised 8.5% (4 of 47) and Hispanics comprised 2.1% (1 of 47) of department chairs. African-Americans made up 7.4% (4 of 54) and Hispanics made up 1.9% (1 of 54) of program directors. The highest proportion of African-Americans in leadership positions was seen in oncology (18.2%), minimally invasive surgery (18.2%), and general urology (10%). The only subspecialties with Hispanics in leadership positions were in andrology/sexual medicine (16.7%) and female urology (15.4%). There were no reported URMs in leadership positions in endourology, neurourology, pediatrics, and reconstructive urology.

CONCLUSIONS

To our knowledge, this study is the first to quantify the representation of URM urologists in academic leadership. There are multiple subspecialties without URMs in leadership positions. This information is vital to understanding the presence and lack of racial representation of the leadership of our field.

Institutional and Faculty Partnerships to Promote Learner Preparedness for Health Professions Education

By the year 2060, it is projected that 57% of the US population will be members of minority groups, with no one group being the majority. While there is increasing diversity of the population, there remain significant disparities in morbidity and mortality affecting minority groups, and persistent low numbers of underrepresented students in the health professions. Increasing the numbers of underrepresented minority students in health care and decreasing the disparity gap have been a priority for many institutions. Increasing diversity requires an approach that not only involves health professions schools but also involves undergraduate institutions, faculty, and other professionals who provide pre-health training to students. In 2018, a group of academic medicine leaders convened the Innovators, Collaborators, and Leaders conference with faculty at institutions across the state of North Carolina to discuss ways to improve learner preparedness for health professions education and increase numbers of underrepresented students pursuing health careers. In this manuscript, the authors share results from the conference and how institutional and faculty partnerships can promote learner preparedness for health professions education.