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Stuart CM, Mott NM, Mungo AH, Meguid RA, Mitchell JD, Randhawa SK, Rove JY, David EA. Representation of women among cardiothoracic surgery editorial boards: Trends over the past 2 decades. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00537-3. [PMID: 38942139 DOI: 10.1016/j.jtcvs.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement. METHODS The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex. RESULTS Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% ± 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% ± 0.5% per year (P = .584). DISCUSSION Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership.
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Affiliation(s)
- Christina M Stuart
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Nicole M Mott
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Alison H Mungo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - John D Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Simran K Randhawa
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
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Bullock-Palmer RP, Flores Rosario K, Douglas PS, Hahn RT, Lang RM, Chareonthaitawee P, Srichai MB, Ordovas KG, Baldassarre LA, Burroughs MS, Henderson CS, Woodard PK, Pressoir K, Swaminathan M, Blankstein R, Daubert MA. Multimodality Cardiac Imaging and the Imaging Workforce in the United States: Diversity, Disparities, and Future Directions. Circ Cardiovasc Imaging 2024; 17:e016409. [PMID: 38377238 DOI: 10.1161/circimaging.123.016409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Innovations in cardiac imaging have fundamentally advanced the understanding and treatment of cardiovascular disease. These advances in noninvasive cardiac imaging have also expanded the role of the cardiac imager and dramatically increased the demand for imagers who are cross-trained in multiple modalities. However, we hypothesize that there is significant variation in the availability of cardiac imaging expertise and a disparity in the adoption of advanced imaging technologies across the United States. To evaluate this, we have brought together the leaders of cardiovascular imaging societies, imaging trainees, as well as collaborated with national imaging accreditation commissions and imaging certification boards to assess the state of cardiac imaging and the diversity of the imaging workforce in the United States. Aggregate data confirm the presence of critical gaps, such as limited access to imaging and imaging expertise in rural communities, as well as disparities in the imaging workforce, notably among women and underrepresented minorities. Based on these results, we have proposed solutions to promote and maintain a robust and diverse community of cardiac imagers and improve equity and accessibility for cardiac imaging technologies.
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Affiliation(s)
- Renee P Bullock-Palmer
- Clinical Associate Professor, Department of Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (R.P.B.P.)
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.P.B.P., K.P.)
| | - Karen Flores Rosario
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
| | - Pamela S Douglas
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (R.T.H.)
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, IL (R.M.L.)
| | | | - Monvadi B Srichai
- Department of Medicine and Radiology, Medstar Georgetown University Hospital, Medstar Heart and Vascular Institute, Washington, DC (M.B.S.)
| | - Karen G Ordovas
- Department of Radiology, University of Washington, Seattle, WA (K.G.O.)
| | - Lauren A Baldassarre
- Department of Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT (L.A.B.)
| | | | - Cory S Henderson
- Department of Medicine, Division of Cardiology, Department of Radiology, Boston Medical Center, MA (C.S.H.)
| | - Pamela K Woodard
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, St Louis, MO (P.K.W.)
| | - Kathleen Pressoir
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.P.B.P., K.P.)
| | - Madhav Swaminathan
- Department of Anesthesiology, Cardiothoracic Division (M.S.), Duke University Medical Center, Durham, NC
| | - Ron Blankstein
- Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.)
| | - Melissa A Daubert
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
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Ko M, Ngo V, Zhang AY, Mabeza RM, Hahn M. Asian Americans and Racial Justice in Medicine. N Engl J Med 2024; 390:372-378. [PMID: 38265651 DOI: 10.1056/nejmms2307748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Michelle Ko
- From the Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis (M.K.), and the Office of Health Equity, Diversity, and Inclusion, University of California Davis Health (V.N.), Davis, the Department of Health Policy, Freeman Spogli Institute for International Studies and Stanford University School of Medicine, Stanford (V.N.), and the Departments of Surgery (R.M.M.) and Family and Community Medicine (M.H.), School of Medicine, University of California, San Francisco, San Francisco - all in California; and the Department of Pediatrics, University of Washington School of Medicine, Seattle (A.Y.Z.)
| | - Victoria Ngo
- From the Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis (M.K.), and the Office of Health Equity, Diversity, and Inclusion, University of California Davis Health (V.N.), Davis, the Department of Health Policy, Freeman Spogli Institute for International Studies and Stanford University School of Medicine, Stanford (V.N.), and the Departments of Surgery (R.M.M.) and Family and Community Medicine (M.H.), School of Medicine, University of California, San Francisco, San Francisco - all in California; and the Department of Pediatrics, University of Washington School of Medicine, Seattle (A.Y.Z.)
| | - Angela Y Zhang
- From the Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis (M.K.), and the Office of Health Equity, Diversity, and Inclusion, University of California Davis Health (V.N.), Davis, the Department of Health Policy, Freeman Spogli Institute for International Studies and Stanford University School of Medicine, Stanford (V.N.), and the Departments of Surgery (R.M.M.) and Family and Community Medicine (M.H.), School of Medicine, University of California, San Francisco, San Francisco - all in California; and the Department of Pediatrics, University of Washington School of Medicine, Seattle (A.Y.Z.)
| | - Russyan M Mabeza
- From the Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis (M.K.), and the Office of Health Equity, Diversity, and Inclusion, University of California Davis Health (V.N.), Davis, the Department of Health Policy, Freeman Spogli Institute for International Studies and Stanford University School of Medicine, Stanford (V.N.), and the Departments of Surgery (R.M.M.) and Family and Community Medicine (M.H.), School of Medicine, University of California, San Francisco, San Francisco - all in California; and the Department of Pediatrics, University of Washington School of Medicine, Seattle (A.Y.Z.)
| | - Monica Hahn
- From the Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis (M.K.), and the Office of Health Equity, Diversity, and Inclusion, University of California Davis Health (V.N.), Davis, the Department of Health Policy, Freeman Spogli Institute for International Studies and Stanford University School of Medicine, Stanford (V.N.), and the Departments of Surgery (R.M.M.) and Family and Community Medicine (M.H.), School of Medicine, University of California, San Francisco, San Francisco - all in California; and the Department of Pediatrics, University of Washington School of Medicine, Seattle (A.Y.Z.)
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Groene OR, Huelmann T, Hampe W, Emami P. German Physicians and Medical Students Do Not Represent the Population They Serve. Healthcare (Basel) 2023; 11:1662. [PMID: 37372780 DOI: 10.3390/healthcare11121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany.
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Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorben Huelmann
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wolfgang Hampe
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pedram Emami
- Hamburg Chamber of Physicians, 22083 Hamburg, Germany
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Anaba U, Ishola A, Alabre A, Bui A, Prince M, Okafor H, Kola-Kehinde O, Joseph JJ, Mitchell D, Odei BC, Uzendu A, Williams KP, Capers Q, Addison D. Diversity in modern heart failure trials: Where are we, and where are we going. Int J Cardiol 2022; 348:95-101. [PMID: 34920047 PMCID: PMC9023064 DOI: 10.1016/j.ijcard.2021.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
Over the last three decades, increased attention has been given to the representation of historically underrepresented groups within the landscape of pivotal clinical trials. However, recent events (i.e., coronavirus pandemic) have laid bare the potential continuation of historic inequities in available clinical trials and studies aimed at the care of broad patient populations. Anecdotally, cardiovascular disease (CVD) has not been immune to these disparities. Within this review, we examine and discuss recent landmark CVD trials, with a specific focus on the representation of Blacks within several critically foundational heart failure clinical trials tied to contemporary treatment strategies and drug approvals. We also discuss solutions for inequities within the landscape of cardiovascular trials. Building a more diverse clinical trial workforce coupled with intentional efforts to increase clinical trial diversity will advance equity in cardiovascular care.
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Affiliation(s)
- Uzoma Anaba
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Abiodun Ishola
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiology, St. Elizabeth Heart and Vascular Institute, Edgewood, KY, USA
| | - Alisha Alabre
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Albert Bui
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Marloe Prince
- Division of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Henry Okafor
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University College of Medicine, USA
| | - Darrion Mitchell
- Deparment of Radiation Oncology, Ohio State University Medical Center, Columbus, OH, USA
| | - Bismarck C Odei
- Deparment of Radiation Oncology, Ohio State University Medical Center, Columbus, OH, USA
| | - Anezi Uzendu
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Quinn Capers
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
| | - Daniel Addison
- Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA.
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Feasibility of an Assessment Tool as a Data-Driven Approach to Reducing Racial Bias in Biomedical Publications. J Med Syst 2021; 46:10. [PMID: 34921338 PMCID: PMC8682034 DOI: 10.1007/s10916-021-01777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/05/2022]
Abstract
The editorial independence of biomedical journals allows flexibility to meet a wide range of research interests. However, it also is a barrier for coordination between journals to solve challenging issues such as racial bias in the scientific literature. A standardized tool to screen for racial bias could prevent the publication of racially biased papers. Biomedical journals would maintain editorial autonomy while still allowing comparable data to be collected and analyzed across journals. A racially diverse research team carried out a three-phase study to generate and test a racial bias assessment tool for biomedical research. Phase 1, an in-depth, structured literature search to identify recommendations, found near complete agreement in the literature on addressing race in biomedical research. Phase 2, construction of a framework from those recommendations, provides the major innovation of this paper. The framework includes three dimensions of race: 1) context, 2) tone and terminology, and 3) analysis, which are the basis for the Race Equity Vetting Instrument for Editorial Workflow (REVIEW) tool. Phase 3, pilot testing the assessment tool, showed that the REVIEW tool was effective at flagging multiple concerns in widely criticized articles. This study demonstrates the feasibility of the proposed REVIEW tool to reduce racial bias in research. Next steps include testing this tool on a broader sample of biomedical research to determine how the tool performs on more subtle examples of racial bias.
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8
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Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. MEDICAL EDUCATION 2021; 55:1376-1382. [PMID: 34174108 DOI: 10.1111/medu.14589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Increasing the number of physicians who identify as an underrepresented minority (URM) has been a focus for decades. Despite the US Department of Health and Human Services establishing The Council on Graduate Medical Education focussing on the underrepresentation of minorities in medicine in 1990, US medical students in 1998-1999 were15.2% URM and twenty years later, URM students comprise only 14.6% of matriculants. This reflected our experience at University of Maryland School of Medicine despite our diverse community where over 60% of the population identify as Black or African-American. We share our strategies to mitigate bias in the admissions process and our resulting outcomes. METHODS We implemented multiple interventions including interviewer training, recruitment strategies, holistic screening, changes in the interview process and increased racial, ethnic and gender diversity on our admissions committee. These changes were made over a two-year period initially focussing on the committee, followed by focussed interventions for interviewers. RESULTS With these interventions, we demonstrated an improvement in the number of URM applicants that matriculated. In 2019, we had the first class that was in which no one ethnicity or race comprised the majority of the class, with 54% of matriculants identifying as students of colour. In 2020, in addition to sustaining a majority of the class identifying as students of colour, the proportion of URM students increased from 10%-13% for the preceding 3 years, to 24% of the entering class. CONCLUSION The number of physicians who identify as URM must be increased for the benefit of our patients and health care system. Unconscious bias training for interviewers, focused recruitment strategies, holistic screening deemphasising the MCAT, blinding interviewers to MCAT scores and GPA, and increasing admissions committee diversity are five concrete steps that yielded the desired outcome of increasing URM representation among our medical school matriculants.
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Affiliation(s)
- Kathryn Robinett
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Raushanah Kareem
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kristin Reavis
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Sandra Quezada
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Keir M, McFadden C, Ruzycki S, Weeks S, Slawnych M, Scott McClure R, Kuriachan V, Fedak P, Morillo C. Lack of Equity in the Cardiology Physician Workforce: A Narrative Review and Analysis of the Literature. CJC Open 2021; 3:S180-S186. [PMID: 34993447 PMCID: PMC8712672 DOI: 10.1016/j.cjco.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Abstract
The gender and racial diversity in the cardiology workforce in Canada does not reflect that of the population we serve. As social awareness of the principles of equity, diversity, and inclusion rises, our profession must rise to meet the challenges they present. We detail contemporary examples of publication bias in the cardiac sciences literature and describe the factors that led to oversight in the peer-review process. We performed a narrative review to summarize the published literature on equity and diversity among cardiac physicians. We also summarize the challenges faced by women and racial-minority physicians when pursuing and thriving in a career in cardiology, and the systemic barriers to their success. In the past decade, social justice movements have advanced. Professionalism standards are changing, and awareness and understanding of these advances in terminology is imperative for all physicians. In this review, we summarize key language and concepts, with cardiology-specific examples, and propose a new paradigm of professionalism.
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Affiliation(s)
- Michelle Keir
- Section of Cardiology, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Chanda McFadden
- Department of Allied Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Weeks
- Section of Cardiology, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Slawnych
- Section of Palliative Care and Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - R. Scott McClure
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vikas Kuriachan
- Section of Cardiology, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carlos Morillo
- Section of Cardiology, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Gordon Perue GL, Fox-Rosellini SE, Sur NB, Marulanda-Londono E, Margolesky J, Tornes L, Bure A, Kalika PM, Chileuitt AA, Allespach H, Uthman BM, Alkhachroum A, Sacco RL, Monteith TS. Development of an Equity, Diversity, Inclusion, and Anti-racism Pledge as the Foundation for Action in an Academic Department of Neurology. Neurology 2021; 97:729-736. [PMID: 34408073 DOI: 10.1212/wnl.0000000000012674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/27/2021] [Indexed: 11/15/2022] Open
Abstract
Recent racial inequities as illustrated by the health disparities in COVID-19 infections and deaths, the recent killings of Black men and women by law enforcement, and the widening socioeconomic inequality and have brought systemic racism into a national conversation. These unprecedented times may have deleterious consequences, increasing stress, and trauma for many members of the neurology workforce. The Equity, Diversity, Inclusion and Anti-Racism Committee within our Department of Neurology provides infrastructure and guidance to foster a culture of belonging and addresses the well-being of faculty, staff, and trainees. Here, we present the creation and implementation of our Equity, Diversity, Inclusion, and Anti-Racism (EDIA) Pledge, which was central to our committee's response to these unprecedented times. We outline the process of developing this unique EDIA Pledge and provide a roadmap for approaching these important topics through a Continuing Medical Education Neurology Grand Rounds aimed at fostering a diverse, inclusive, equitable, and antiracist work environment. Through the lived experiences of 4 faculty members, we identify the impact of bias and microaggressions and encourage allyship and personal development for cultural intelligence. We hope that these efforts will inspire neurology departments and other academic institutions across the globe to make a similar pledge.
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Affiliation(s)
- Gillian L Gordon Perue
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL.
| | - Susan E Fox-Rosellini
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Nicole B Sur
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Erika Marulanda-Londono
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Jason Margolesky
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Leticia Tornes
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Annelly Bure
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Paige M Kalika
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Abraham Andres Chileuitt
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Heidi Allespach
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Basim M Uthman
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Ayham Alkhachroum
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Ralph L Sacco
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Teshamae S Monteith
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
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11
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Abstract
In the setting of the immense social, political, medical, and cultural challenges of last year, medicine has been made acutely aware of its participation in inequity and in response offers allyship as a framework for clinicians to pursue change, using tools already apart of the practice of medicine. Allyship in the workplace can be summarized as a strategic mechanism used by individuals to become collaborators who fight injustice and promote equity through supportive personal relationships and public acts of sponsorship and advocacy. The idea of allyship may be intimidating, particularly for practitioners and leaders who do not belong to the communities they endeavor to support. But as the article unpacks, practitioners need not look any further for how to be allies than what they practice every day: lifelong learning; humility in complications; an expectation of imperfection; and, bound together with those who suffer, persistence in the pursuit of healing.
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Affiliation(s)
- Danielle Ellis
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Bevilacqua LA, Siena NM, Gardner CA, Tatarian T, Madani A, Altieri MS. Gender disparities among leadership in academic surgical publishing over the past decade. Am J Surg 2021; 223:47-52. [PMID: 34332745 DOI: 10.1016/j.amjsurg.2021.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women account for 19 % of practicing surgeons in the United States, with representation decreasing with higher academic rank. Less is known about the proportion of women in editorial leadership positions at surgical journals. The objective of this study was to examine gender representation among editorial leadership at high-impact surgical journals. METHODS The five journals with the highest impact factors in general, cardiothoracic, plastics, otolaryngology, orthopedics, urology, vascular, and neurosurgery were identified. Data were abstracted on the proportion of women editors-in-chief (EIC) and editorial board members between 2010 and 2020 to determine how these demographics changed over time. RESULTS Multiple fields had no women EIC over the past decade (orthopedics, urology, cardiothoracic, neurosurgery). In all other fields, women were a minority of EIC. In 2020, women made up 7.9 % of EIC and 11.1 % of editorial boards in surgical journals. CONCLUSIONS Women remain under-represented among leadership at high-impact surgical journals, with varying improvement over the past decade among different subspecialties.
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Affiliation(s)
- Lisa A Bevilacqua
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA
| | - Nicholas M Siena
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA; University of California Los Angeles, Dept. of Surgery, Los Angeles, CA, USA
| | | | - Talar Tatarian
- Thomas Jefferson University Hospital, Dept. of Surgery, Philadelphia, PA, USA
| | - Amin Madani
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Maria S Altieri
- East Carolina University, Dept. of Surgery, Greeneville, NC, USA.
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13
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Bhasin A, Musa A, Massoud L, Razikeen A, Noori A, Ghandour A, Gelovani D, Afonso LC, Lieberman R, Vaidya A. Increasing Diversity in Cardiology: A Fellowship Director's Perspective. Cureus 2021; 13:e16344. [PMID: 34306895 PMCID: PMC8279696 DOI: 10.7759/cureus.16344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Underrepresented-minorities (URM) remain few in number amongst practicing cardiologists and across cardiology fellowship training programs in the U.S. Increased diversity is needed across the entire field and is particularly necessary within graduate medical education cardiology fellowship training programs. Objectives This cross-sectional study was performed to identify which strategies were supported and implemented by cardiology fellowship program directors (PDs) to increase URM representation, to determine which entities hold the responsibility to increase diversity according to program directors, and to quantify URM representation in cardiology fellowship programs. Methods A 15-item survey was submitted to all American College of Graduate Medical Education (ACGME) accredited cardiology fellowship programs via electronic mail. Results Of 250 cardiology fellowship programs, 71 responses were received (28.4%). The number of URM faculty varied from 0-1 to more than six, and URM faculty held leadership roles in most programs (62.0%). A total of 16 respondents (22.5%) were URM program directors. Most respondents agreed that diversity was important to their training program (85.9%). The majority endorsed direct recruitment of URM applicants (60.6%), opportunities for applicants to connect with (54.9%) or be recruited by URM fellows (54.9%), holistic application review (67.6%), promoting mentorship by URM faculty (69.0%), URM faculty involvement in applicant interviewing (54.9%), and increased recruitment of URM faculty members (73.2%). Program directors allocated major responsibility to increase diversity to fellowship programs (71.8%), residency programs (63.3%), and medical schools (53.5%). Conclusions This study found that most cardiology programs have URM faculty in leadership roles, and nearly a quarter of the surveyed program directors were URMs. Cardiology program directors endorsed and employed numerous strategies to increase diversity and URM representation in fellowship programs. Additionally, program directors held fellowship training programs most responsible for increasing URM representation in the field of cardiology.
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Affiliation(s)
- Amman Bhasin
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Arif Musa
- Radiology, Wayne State University School of Medicine, Detroit, USA
| | - Louis Massoud
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Azar Razikeen
- Family Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Arshia Noori
- Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, USA
| | - Ali Ghandour
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - David Gelovani
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | | | | | - Ajay Vaidya
- Cardiology, Keck School of Medicine, Los Angeles, USA
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14
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Karim S, Tamirisa K, Chaudhry H. Fundamental Discussions on Race and Ethnicity for the Cardiology Workforce for the United States of America. J Am Heart Assoc 2021; 10:e018884. [PMID: 34074113 PMCID: PMC8477880 DOI: 10.1161/jaha.120.018884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Saima Karim
- Heart and Vascular Institute MetroHealth Medical Center/Case Western Reserve University Cleveland OH
| | | | - Hina Chaudhry
- Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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15
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Abstract
PURPOSE OF REVIEW Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear. RECENT FINDINGS As documented in other settings, racial bias appears to operate in HF providers' consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vulnerable to bias. SUMMARY Reducing gaps in access to advanced therapies will require commitments at multiple levels to reduce barriers to healthcare access, standardize clinical operations, research the determinants of patient success and increase diversity among providers and researchers. Progress is achievable but likely requires as disruptive and investment of immense resources as in the battle against COVID-19.
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Affiliation(s)
- Raymond C Givens
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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16
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17
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Seeking racial and ethnic equity among neonatologists. J Perinatol 2021; 41:422-434. [PMID: 33495537 PMCID: PMC7829324 DOI: 10.1038/s41372-021-00915-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Racial and ethnic inequities in leadership achievement, compensation, scholarly productivity, and grant funding exists among physicians. This study explores whether similar inequities exist among neonatologists within the United States. STUDY DESIGN A voluntary anonymous survey was distributed to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents. Logistic regression and ordinary least squares were used to assess whether racial and ethnic identity is associated with clinical time, leadership, compensation, publication, grant funding, or academic rank. RESULTS As compared to non-Hispanic White neonatologists, statistical differences were found for underrepresented minorities in medicine in: regions of the country where they worked, total cash compensation received, being awarded an NIH grant, and location of graduate medical education. Fewer differences were found for Asian neonatologists and included location of graduate medicine education. CONCLUSION Racial and ethnic identity remains a significant independent factor influencing professional achievement and compensation.
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19
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Simon MA, Ahmad F, Eitzman DT, Gupta AK, Jneid H, Peterson P, Remme CA, Rice K, Schelbert EB, Sullivan LM, Weinberg JM. Equity, Diversity, and Inclusiveness in Cardiovascular Medicine and Health Care. J Am Heart Assoc 2020; 9:e019137. [PMID: 32941102 PMCID: PMC7763380 DOI: 10.1161/jaha.120.019137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marc A Simon
- Division of Cardiology, Department of Medicine University of Pittsburgh and UPMC Heart & Vascular Institute Pittsburgh PA
| | - Ferhaan Ahmad
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA
| | - Daniel T Eitzman
- Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Ajay K Gupta
- William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London London United Kingdom.,Barts BP Centre of Excellence Barts Heart Centre London United Kingdom.,Royal London and St Bartholomew's Hospital Barts Health NHS Trust London United Kingdom
| | - Hani Jneid
- Division of Cardiology Baylor College of Medicine Houston TX
| | - Pamela Peterson
- Department of Medicine Denver Health Medical Center Denver CO.,Department of Medicine University of Colorado Anschutz Medical Center Aurora CO
| | - Carol A Remme
- Department of Clinical and Experimental Cardiology Heart Centre Amsterdam UMC, location AMC Amsterdam the Netherlands
| | - Kenneth Rice
- Department of Biostatistics University of Washington Seattle WA
| | - Erik B Schelbert
- Division of Cardiology, Department of Medicine University of Pittsburgh and UPMC Heart & Vascular Institute Pittsburgh PA
| | - Lisa M Sullivan
- Department of Biostatistics Boston University School of Public Health Boston MA
| | - Janice M Weinberg
- Department of Biostatistics Boston University School of Public Health Boston MA
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20
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Affiliation(s)
| | - Robert A Harrington
- Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL
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21
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Retraction to: Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019. J Am Heart Assoc 2020; 9:e014602. [PMID: 32757972 PMCID: PMC7763378 DOI: 10.1161/jaha.119.014602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Wang NC. Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019. J Am Heart Assoc 2020; 9:e015959. [PMID: 32204667 PMCID: PMC7428635 DOI: 10.1161/jaha.120.015959] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1969, racial and ethnic preferences have existed throughout the American medical academy. The primary purpose has been to increase the number of blacks and Hispanics within the physician workforce as they were deemed to be "underrepresented in medicine." To this day, the goal continues to be population parity or proportional representation. These affirmative action programs were traditionally voluntary, created and implemented at the state or institutional level, limited to the premedical and medical school stages, and intended to be temporary. Despite these efforts, numerical targets for underrepresented minorities set by the Association of American Medical Colleges have consistently fallen short. Failures have largely been attributable to the limited qualified applicant pool and legal challenges to the use of race and ethnicity in admissions to institutions of higher education. In response, programs under the appellation of diversity, inclusion, and equity have recently been created to increase the number of blacks and Hispanics as medical school students, internal medicine trainees, cardiovascular disease trainees, and cardiovascular disease faculty. These new diversity programs are mandatory, created and implemented at the national level, imposed throughout all stages of academic medicine and cardiology, and intended to be permanent. The purpose of this white paper is to provide an overview of policies that have been created to impact the racial and ethnic composition of the cardiology workforce, to consider the evolution of racial and ethnic preferences in legal and medical spheres, to critically assess current paradigms, and to consider potential solutions to anticipated challenges.
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Affiliation(s)
- Norman C. Wang
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPA
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