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Hamilton RH. Building an ethnically and racially diverse neurology workforce. Nat Rev Neurol 2024; 20:222-231. [PMID: 38388568 DOI: 10.1038/s41582-024-00941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
As diversity among patient populations continues to grow, racial and ethnic diversity in the neurology workforce is increasingly essential to the delivery of culturally competent care and for enabling inclusive, generalizable clinical research. Unfortunately, diversity in the workforce is an area in which the field of neurology has historically lagged and faces formidable challenges, including an inadequate number of trainees entering the field, bias experienced by trainees and faculty from minoritized racial and ethnic backgrounds, and 'diversity tax', the disproportionate burden of service work placed on minoritized people in many professions. Although neurology departments, professional organizations and relevant industry partners have come to realize the importance of diversity to the field and have taken steps to promote careers in neurology for people from minoritized backgrounds, additional steps are needed. Such steps include the continued creation of diversity leadership roles in neurology departments and organizations, the creation of robust pipeline programmes, aggressive recruitment and retention efforts, the elevation of health equity research and engagement with minoritized communities. Overall, what is needed is a shift in culture in which diversity is adopted as a core value in the field.
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Affiliation(s)
- Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Alele PE, Kiptoo J, Hill-Besinque K. Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study. BMC MEDICAL EDUCATION 2023; 23:965. [PMID: 38102623 PMCID: PMC10724882 DOI: 10.1186/s12909-023-04933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The clinical learning environment is an essential component in health professions' education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere. METHODS This study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions. RESULTS Ninety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach's alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training). CONCLUSIONS Overall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees' insights provided data that propose improvements on a number of domains in the learning environment.
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Affiliation(s)
- Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Joshua Kiptoo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kathleen Hill-Besinque
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, California, USA
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Deville C, Charles-Obi K, Santos PMG, Mattes MD, Hussaini SMQ. Oncology Physician Workforce Diversity: Rationale, Trends, Barriers, and Solutions. Cancer J 2023; 29:301-309. [PMID: 37963363 DOI: 10.1097/ppo.0000000000000687] [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: 11/16/2023]
Abstract
ABSTRACT This chapter will discuss (1) the rationale for physician workforce diversity and inclusion in oncology; (2) current and historical physician workforce demographic trends in oncology, including workforce data at various training and career levels, such as graduate medical education and as academic faculty or practicing physicians; (3) reported barriers and challenges to diversity and inclusion in oncology, such as exposure, access, preparation, mentorship, socioeconomic burdens, and interpersonal, structural, systemic bias; and (4) potential interventions and evidence-based solutions to increase diversity, equity, and inclusion and mitigate bias in the oncology physician workforce.
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Affiliation(s)
- Curtiland Deville
- From the Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Syed M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Paradis KC, Franco I, Beltrán Ponce S, Chaurasia A, Laucis AM, Venkat P, Siker M, Suneja G, Deville C, Munbodh R, Mattes MD. The Current State of Departmental Diversity, Equity, and Inclusion Efforts Within US Academic Radiation Oncology Departments. Int J Radiat Oncol Biol Phys 2023; 116:219-228. [PMID: 36306980 DOI: 10.1016/j.ijrobp.2022.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Promoting a diverse workforce of health care professionals that delivers equitable patient care is an important goal in oncology, as in all of medicine. Although most medical schools have a diversity office and associated initiatives, little is known about radiation oncology (RO) department-level efforts to promote diversity, equity, and inclusion (DEI). We describe the current state of DEI leadership and initiatives in RO departments in the US to guide future policies and programs. METHODS AND MATERIALS A total of 124 US RO departments affiliated with a medical school were contacted to identify departmental DEI leadership. Identified DEI leaders were asked to complete an anonymous survey assessing characteristics of their departmental DEI leadership, committee/organizational structure, activities, and perceived barriers to, and effect of, their work. Descriptive statistics are reported. RESULTS Among 85 RO departments that responded (68.5% response rate), 48 (56.5%) reported having a departmental DEI leader. Thirty-four DEI leaders completed the survey (70.8%). Of those who answered each survey question, most DEI leaders were assistant or associate professors (n = 24, 82.8%), women (n = 19, 73.1%), and identified with at least one non-White race or Hispanic ethnicity (n = 15, 53.6%). Nineteen (57.6%) had an associated departmental DEI committee; with 10 of these starting in 2020 or later. Few DEI leaders had administrative support (38.2%), funding (29.4%), protected time (23.5%), or increased compensation for added duties Fifteen (50.0%) believed their DEI-focused efforts were considered for promotion. The most reported initiatives included offering programming/education, supporting students from backgrounds underrepresented in medicine, improving recruitment practices/hiring, and implementing pipeline/pathway projects. The perceived impact of DEI initiatives included an increased culture of respect (89.7%), improved health care disparity awareness (75.9%), and improved systemic/structural racism awareness (79.3%). CONCLUSIONS Departmental DEI efforts are increasingly common within RO, however, the structure, resources, and recognition associated with DEI work are variable. Additional dedicated resources and recognition for these efforts will help ensure a culture of inclusive excellence for the RO workforce and patients.
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Affiliation(s)
- Kelly C Paradis
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, Michigan.
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Avinash Chaurasia
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Malika Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Reshma Munbodh
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Cevallos P, Amakiri UO, Johnstone T, Kim TSE, Maheta B, Nazerali R, Sheckter C. Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4900. [PMID: 37035124 PMCID: PMC10079348 DOI: 10.1097/gox.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.
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Affiliation(s)
- Priscila Cevallos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
- Geisel School of Medicine, Dartmouth University, Hanover, N.H
| | | | - Thomas Johnstone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Trudy Sea-Eun Kim
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Bhagvat Maheta
- College of Medicine, California Northstate University, Elk Grove, Calif
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Clifford Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
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Dadrass F, Bowers S, Shinkai K, Williams K. Diversity, Equity, and Inclusion in Dermatology Residency. Dermatol Clin 2023; 41:257-263. [PMID: 36933914 DOI: 10.1016/j.det.2022.10.006] [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] [Indexed: 02/04/2023]
Abstract
Improving diversity, equity, and inclusion (DEI) in dermatology is a critical aim for the specialty to improve the workforce, clinical care, education, and research. This article outlines a framework for DEI initiatives at the residency training level: improving mentorship and residency selection process to improve representation of dermatology trainees; curricular development to train residents to provide expert care to all patients and to better understand principles of health equity and social determinants of health as they pertain to dermatology; establishing inclusive learning environments and mentoring structures that support residents to become successful future clinicians and leaders of the specialty.
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Affiliation(s)
- Farinoosh Dadrass
- Loyola University Chicago Stritch School of Medicine, 2160 South 1st Avenue, Maywood, IL 60153, USA
| | - Sacharitha Bowers
- Division of Dermatology, Department of Internal Medicine, Southern Illinois University, 751 North Rutledge Street, Suite 2300, Springfield, IL 62702, USA
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, Third Floor, San Francisco, CA 94115, USA
| | - Kiyanna Williams
- Department of Dermatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Moeller J, Salas RME. Neurology Education in 2035: The Neurology Future Forecasting Series. Neurology 2023; 100:579-586. [PMID: 36564205 PMCID: PMC10033166 DOI: 10.1212/wnl.0000000000201669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
In the past decade, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Health systems science, health humanities, diversity, equity, and inclusion and health disparities are becoming core components of neurology curricula, and, in the future, will be integrated into every aspect of our educational mission. The ways in which material is taught and learned have been influenced by technologic innovations and a growing understanding of the science of learning. We forecast that this trend will continue, with learners choosing from an array of electronic resources to engage with fundamental topics, allowing front-line clinical teachers to spend more time supporting critical reasoning and teaching students how to learn. There has been a growing differentiation of educational roles (i.e., teachers, educators, and scholars). We forecast that these roles will become more distinct, each with an individualized pattern of support and expectations. Assessment has become more aligned with the work of the learners, and there are growing calls to focus more on the impact of educational programs on patient care. We forecast that there will be an increased emphasis on educational outcomes and public accountability for training programs. In this article, we reflect on the history of medical education in neurology and explore the current state to forecast the future of neurology education and discuss ways in which we can prepare.
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Affiliation(s)
- Jeremy Moeller
- From the Department of Neurology (J.M.), Yale University, New Haven, CT; Department of Neurology and Neurosurgery (R.M.E.S.), Johns Hopkins School of Medicine, Baltimore, MD.
| | - Rachel Marie E Salas
- From the Department of Neurology (J.M.), Yale University, New Haven, CT; Department of Neurology and Neurosurgery (R.M.E.S.), Johns Hopkins School of Medicine, Baltimore, MD
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Dens Higano J, Tilburt JC, Hafferty FW. Words matter: Tracing the implicit meaning of diversity language (and its absence) in medical school mission statements. J Natl Med Assoc 2023; 115:18-25. [PMID: 36585294 DOI: 10.1016/j.jnma.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/15/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
Despite recent attention to social justice, diversity, equity, and inclusion within medical education, little is currently known about whether and to what extent that attention has translated into the language of formal documents articulating organization purpose: medical school mission statements. Mission statements are the marquee declaration of a medical school's identity and purpose, and a recommended tool for applicants to determine "fit" when applying. This study examines whether and to what extent social justice, diversity, equity, and inclusion have made it into the formal public statements of organizational purpose and identity over the last several years. Mission statements were extracted manually from the 2007, 2017, and 2021 AAMCs Medical School Admission Requirements (MSAR) database for both U.S. and Canadian M.D. granting medical schools. Then each mission statement version was coded for the presence and degree of diversity language including words like social justice, diversity, equity, and inclusion using an agreed-upon lexicon. Frequencies and within school changes over time were analyzed. Among 139 medical schools with discoverable mission statements from 2007, 91% (n=127) changed their MSs between 2007 and 2021. In 2007, 24% (n=33) of MSs contained diversity language. By 2017 nearly half of MSs; 47% (n=65) contained any reference to such language. But by 2021, despite 46 school having changed their MSs again, only a few more included diversity language in their MSs (56%; n=77). The most common terms used were "diversity," followed by the increasing presence of words like "inclusion," "equity," and "justice" by 2021. Curiously, a few schools redacted diversity language from 2007 to 2021. A Diversity Thesaurus of 22 terms was iteratively identified, with all terms searched in all MSs. Overall, mission statement change was quite common with most medical schools making changes across the 14 years covered in this study. And despite a doubling of the number of medical schools MSs mentioning diversity over a 10-year period, that increase seemed to slow in recent years even among schools who had a chance to change their MS. As of mid-2021, two in five US medical schools still have no mention of diversity related language in their most formal, said articulation of organizational purpose.
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Affiliation(s)
- Jennifer Dens Higano
- Physical Medicine and Rehabilitation resident at Mayo Clinic in Rochester, Minnesota, United States.
| | - Jon C Tilburt
- Department of Medicine and Biomedical Ethics, Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona, United States; Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Frederic W Hafferty
- Center for Ethics, Professionalism, and the Future of Medicine, Accreditation Council for Graduate Medical Education, Chicago, Illinois, United States
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Esparza CJ, Simon M, Bath E, Ko M. Doing the Work—or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers. Front Public Health 2022; 10:900283. [PMID: 35812485 PMCID: PMC9256912 DOI: 10.3389/fpubh.2022.900283] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/26/2022] [Indexed: 12/26/2022] Open
Abstract
While the number of positions, committees, and projects described as “Diversity, Equity, and Inclusion (DEI)” work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.
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Affiliation(s)
- Caitlin Jade Esparza
- School of Medicine, University of California, Davis, Sacramento, CA, United States
- *Correspondence: Caitlin Jade Esparza
| | - Mark Simon
- Storywalkers Consulting, Davis, CA, United States
| | - Eraka Bath
- The Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Ko
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
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