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Aysola J, Murdock HM, Lett E, Williams C, Wade R, Higginbotham EJ. Operationalizing inclusion: moving from an elusive goal to strategic action. Epidemiol Rev 2023; 45:140-145. [PMID: 37259471 DOI: 10.1093/epirev/mxad005] [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: 08/30/2022] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
To mitigate the structural and institutional biases that contribute to inequities in health, we need a diverse cadre of individuals to feel included and advance within our field in order to bring a multicultural set of perspectives to the studies we conduct, the science we generate, the health and academic systems we design, and the medical and scientific knowledge we impart. There has been increasing focus on diversity, inclusion, and equity in recent years; however, often these terms are presented without adequate precision and, therefore, the inability to effectively operationalize inclusion and achieve diversity within organizations. This narrative review details several key studies, with the primary objective of presenting a roadmap to guide defining, measuring, and operationalizing inclusion within work and learning environments.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Medicine, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
| | - H Moses Murdock
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elle Lett
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
| | - Corey Williams
- MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19178, United States
| | - Eve J Higginbotham
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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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.
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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
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Wahab RA, Oluyemi E, Jackson T, Feliciano-Rivera YZ, Roubidoux M, Zhang B, Mehta TS. A Needs Assessment for Inclusion, Diversity, and Equity: Survey Results of the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2023; 5:56-66. [PMID: 38416964 DOI: 10.1093/jbi/wbac070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To assess and understand the inclusion, diversity, and equity (IDE) needs of the Society of Breast Imaging (SBI) membership to guide development of a strategic plan and goals for the Inclusion, Diversity, Equity Alliance (IDEA) of SBI. METHODS A 23-question survey developed by IDEA was distributed electronically to all SBI members in November 2020 to assess and understand the society's IDE needs. Descriptive statistics were used to summarize the responses. Open-ended responses were reviewed by the authors and sorted into three categories: supportive, nonsupportive, or neutral suggestions. RESULTS The response rate was 12% (453/3686). Only 55% (238/429) of respondents agreed that the diversity of SBI leadership reflected the diversity of the society, with stronger agreement that actions of SBI aligned with their core values of collaboration and collegiality (327/249,75%), and of respect for diversity and inclusiveness (303/429, 70%). Overall, 65% (172/264) of respondents were satisfied with the quality and diversity of speakers at the annual symposium; however, White respondents agreed more compared to non-White respondents (P = 0.035), and those practicing greater than 20 years agreed more compared to those practicing 6 to 10 years (P = 0.023). Of 88 total suggestions, three common themes were: more resources for recruitment, retention, and education for a diverse staff; further increase in diversity among leadership and membership; and more patient care resources. CONCLUSION In addition to showing areas of agreement by SBI members, this survey also identified opportunities for SBI and IDEA to further incorporate IDE into our initiatives and organization.
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Affiliation(s)
- Rifat A Wahab
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH, USA
| | - Eni Oluyemi
- Johns Hopkins Medicine School of Medicine, Department of Radiology, Baltimore, MD, USA
| | | | | | - Marilyn Roubidoux
- University of Michigan Health Systems, Division of Breast Imaging, Ann Arbor, Michigan, USA
| | - Bin Zhang
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, USA
| | - Tejas S Mehta
- University of Massachusetts Medical Center, Department of Radiology, Worcester, MA, USA
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Vaughn J, Lin Y, Leonard C, Yang H, Mancuso J, Blodgett NP, Brisson R, Molloy MA. Creating Inclusive Learning Environments for Chinese and American Pediatric Nursing Students. Clin Simul Nurs 2022; 71:19-25. [PMID: 36187568 PMCID: PMC9514971 DOI: 10.1016/j.ecns.2022.07.003] [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] [Indexed: 01/26/2023]
Abstract
During the COVID-19 pandemic, students from two schools of nursing, in China and the United States respectively, engaged in a transcultural simulation activity to explore how a global healthcare crisis has been managed within their different cultures. This article describes the development and implementation of the project and evaluates student perspectives on the simulation...s influence on increasing awareness of diversity, equity, and inclusion. Data for this project were collected through student verbal and written reflections and faculty comments. Results Students reported the virtual simulation positively impacted their learning and enjoyed the opportunity to navigate through a virtual scenario collaboratively while discussing cultural similarities and differences. Faculty noted the simulation was valuable and described challenges faced during the development. Conclusions Students and faculty found the simulation was a meaningful learning experience. Findings suggests that the transcultural simulation improved student knowledge of cultural competence and understanding of diversity, equity, and inclusion constructs.
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Affiliation(s)
| | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322 USA
| | | | - Honghong Yang
- School of Nursing, Fudan University, Shanghai 200032 China
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Establishing a benchmark of diversity, equity, inclusion and workforce engagement in radiation oncology in Europe – an ESTRO collaborative project. Radiother Oncol 2022; 171:198-204. [DOI: 10.1016/j.radonc.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022]
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Approaching diversity and inclusion in the radiology department. Abdom Radiol (NY) 2021; 46:5471-5474. [PMID: 34129056 DOI: 10.1007/s00261-021-03148-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
There are numerous benefits to increasing diversity and inclusion within our radiology departments, and both areas need to be a part of our core mission to garner real change. A diverse and inclusive radiology department not only benefits the radiology department, but also our patients and society as a whole. Our paper provides our thoughts on a practical step-by-step guide on how to increase both diversity and inclusion within the radiology workplace, such that every voice can be heard, and every person can be seen.
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Smith TY. The time is now: A model for diversity recruitment and retention in emergency medicine training programs. AEM EDUCATION AND TRAINING 2021; 5:S126-S129. [PMID: 34616986 PMCID: PMC8480503 DOI: 10.1002/aet2.10659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
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Alexis DA, Kearney MD, Williams JC, Xu C, Higginbotham EJ, Aysola J. Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System. JAMA Netw Open 2020; 3:e2021452. [PMID: 33226428 PMCID: PMC7684446 DOI: 10.1001/jamanetworkopen.2020.21452] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/06/2020] [Indexed: 11/14/2022] Open
Abstract
Importance With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care. Objective To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments. Design, Setting, and Participants A qualitative mixed-methods analysis of survey data collected from February to April 2015, was conducted followed by analysis of narrative data collected in June 2017. The setting was 2 health systems and 4 health professional and graduate schools. Participants were faculty, trainees, staff, and students (3506 survey respondents and 52 narratives) affiliated with the University of Pennsylvania and the University of Pennsylvania Health System. Data analysis was conducted in 2018 and 2019. Exposures Independent variables included the following respondent characteristics: gender identity, sexual orientation, race/ethnicity, position, generational age group, length of employment at institution, disability status, belief system or religion, and primary site of work or study. Main Outcomes and Measures Survey questions were used to assess participants' perception and experiences of professionalism in the workplace as measured by a 5-point Likert-type scale. Results For the survey, there were 3506 respondents from a pool of 18 550 potential respondents (18.9% response rate). Of 3506 survey respondents, 2082 of 3231 (64.4%) were women, 331 of 3164 (10.5%) identified as gender or sexual minority groups, and 360 of 3178 (11.3%) were non-Hispanic Black individuals. In adjusted analyses, women compared with men (adjusted odds ratio [aOR], 1.8; 95% CI, 1.4-2.3) and Asian individuals (aOR, 2.0; 95% CI, 1.7-2.3) and Hispanic individuals (aOR, 2.0; 95% CI, 1.4-2.7) compared with non-Hispanic White individuals were more likely to value institutional professionalism. In addition, gender identity and sexual minority groups compared with heterosexual respondents (aOR, 1.5; 95% CI, 1.2-1.8) and non-Hispanic Black individuals compared with non-Hispanic White individuals (aOR, 1.3; 95% CI, 1.2-1.4) were statistically significantly more likely to consider changing jobs because of unprofessional behavior at work. The qualitative analysis of narratives revealed that marginalized populations (including but not limited to women, gender and sexual minority groups, racial/ethnic minority groups, those who identify as having a disability, and religious minority groups) reported (1) greater infringements on their professional boundaries, as well as increased scrutiny over their professional actions, and (2) a tension between inclusion vs assimilation. Conclusions and Relevance The findings of this study highlight the need for health care organizations to revisit how they define and operationalize professionalism to improve inclusivity.
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Affiliation(s)
- Dominique A. Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew D. Kearney
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - J. Corey Williams
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chang Xu
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eve J. Higginbotham
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia
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Piggott DA, Cariaga-Lo L. Promoting Inclusion, Diversity, Access, and Equity Through Enhanced Institutional Culture and Climate. J Infect Dis 2020; 220:S74-S81. [PMID: 31430385 DOI: 10.1093/infdis/jiz186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advancing the health of all members of the global community remains core to the mission of the infectious diseases profession. Training, research, healthcare-delivery, and other infectious diseases-related institutions play a central role in meeting this goal. The promotion of inclusion, diversity, access, and equity (IDA&E) is critical to harnessing the full range of human creativity, innovation, and talent necessary to realizing the education, research, patient care, and service missions that constitute the principal objectives of such institutions. Strong and positive institutional cultures and climates are essential to achieving these IDA&E goals. We discuss opportunity gaps that exist in leveraging institutional culture and climate to optimize IDA&E. We further identify effective strategies to address these gaps and achieve excellence in education, research, patient care, and service in infectious diseases and the broader healthcare and biomedical space. We discuss the importance of both local and global context in conceptualizing IDA&E to best achieve these aims.
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Affiliation(s)
- Damani A Piggott
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liza Cariaga-Lo
- Department of Education, Brown University, Providence, Rhode Island
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Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. J Natl Med Assoc 2020; 112:247-249. [PMID: 32336480 DOI: 10.1016/j.jnma.2020.03.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diversity and inclusion are terms that have been used widely in a variety of contexts, but these concepts have only been intertwined into the discussion in healthcare in the recent past. It is important to have a healthcare workforce which represents the tapestry of our communities as it relates to race/ethnicity, gender, sexual orientation, immigration status, physical disability status, and socioeconomic level to render the best possible care to our diverse patient populations. METHODS We explore efforts by the Liaison Committee on Medical Education (LCME), the Institute of Medicine (IOM), and other medical organizations to improve diversity and inclusion in medicine. CONCLUSION Finally, we report on best practices, frameworks, and strategies which have been utilized to improve diversity and inclusion in healthcare.
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Affiliation(s)
- Fatima Cody Stanford
- Obesity Medicine Physician Scientist, Massachusetts General Hospital and Harvard Medical School, Division of Neuroendocrine and Pediatric Endocrinology, Affiliated Faculty, Mongan Institute of Health Policy Associate, Disparities Solutions Center, United States.
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