Diversity and Inclusion, Match

Developing a Diverse and Inclusive Pipeline in Emergency Medicine: Part 3

Part 3 of a 3-part series on how to build diversity, equity, and inclusion into the specialty.

Is the end of residency the epitome and culmination of education? Even though it may be for some, it is the responsibility of attending physicians to educate newer generations of emergency physicians.

Leaders in academic medicine agree on two separate yet related issues: 1) The need for the physician workforce to become as ethnically and racially diverse as the population it serves, and 2) The need for improved training of all physicians in meeting the needs of an increasingly diverse patient population.1-3 

The United States is becoming culturally more diverse by the minute, and people are forming niches in which they can share similar values and beliefs. Located in Houston, Texas, one of the most diverse cities in the country, our residency program’s county hospital serves a population comprised mostly of under-represented groups (URGs). Over half of our patients recognize English as a second language and do not speak it fluently. It is therefore important to focus on the development of academic pipelines for Underrepresented in Medicine (URiM) residents and faculty in emergency medicine. Some examples include women, people of racial/ethnic minority populations, and persons with disabilities. A physician who comes from the same background as the patient or speaks the same language will be able to build a stronger rapport. It is of utmost importance that we understand the diverse cultural and social backgrounds of our patients. Once becoming faculty, there are many ways to get involved in Diversity, Equity, and Inclusion (DEI) efforts within your institution. Here we identify several ways to promote DEI efforts.

Recruitment
The future of DEI in EM depends on the development of culturally sensitive providers who understand the impact of social determinants of health and the integration of physicians from URGs into current medical education. Admissions committees within medical schools have to do a rigorous and challenging job in not only selecting people that will succeed in medical school but also have a vision of how their selection will impact patient care in the future. Research has shown that search committees succeed in recruiting URMs when they transform the search process, are committed to diversity and are proactive about building a diverse applicant pool.  Involving URG faculty in admission committees or the interview process is one way to increase URM recruitment. Some institutions, such as ours, also incorporates residents and students into this process. Applicants that identify as URGs will feel more comfortable asking questions to individuals that they can relate to. Their perspective will enable them to provide insightful information regarding resources available for URGs as well as insight into the culture of the institution.

Leadership Opportunities
Another way to increase DEI is to support the promotion of physicians of URGs into departmental and institutional leadership opportunities. Examples include serving on committees and becoming a mentor to URG physicians. This is a great way to have a seat at the table. Inclusion and Equity ambassadors can be used within the department and serve as representatives to the institution in efforts to support DEI. Ambassadors can assist with the interview process for faculty, senior leadership, residents, and medical students. Beware that this may put a “big ask” on a small cohort of faculty depending on the makeup of your department or institution. Some may have heard of the "minority tax," which refers to the unintended burdening of URM with demands and services at the expense of working on other scholarly activities required for promotion and tenure.4 One way to account for this, while still allowing opportunities, is to allocate "buy-down hours" for involvement in these activities. 

Scholarly Activities
Lastly, institutions can focus on electing senior leader champions that coordinate programmatic efforts and resources in the form of research and scholarly activity in order to address retention and promotion. One study looked at challenges in Recruiting, Retaining and Promoting Racially and Ethnically Diverse Faculty.5 A few themes that came from this study included the need for senior leader champion and the need for coordinated programmatic efforts and resources necessary to address retention and promotion. In academic medicine, research and scholarly activity is a traditional means of promotion. "Through a national grant, Baylor College of Medicine was able to add a Center of Excellence in Health Equity, Training and Research in order to build on a long history of educational initiatives. Through this grant, we are able to support programs aimed at increasing the number of diverse and highly qualified medical professionals committed to reducing or eliminating health disparities innovatively. One of the programs allow junior faculty scholars to participate in activities with the goal of completing the following: submitting a peer-reviewed publication as first author, preparing a R21/K01/K23 grant application for potential submission, leading a health equity research project with a mixed cohort of scholars, and presenting their research at a professional conference. This will help with career development and promotions requirements. It will also prepare them to mentor the next generation in these efforts.

Medicine is about lifelong learning. Promoting DEI is a lifelong effort. By utilizing examples highlighted in our three-part paper, there are items that can be implemented in every chapter of a physician’s career with the goal of developing a diverse and inclusive pipeline.

Also in this series:
Part 1: Addressing DEI in emergency medicine
Part 2: Integrating DEI into training and curriculum


References

  1. Fernandez, Alicia MD Further Incorporating Diversity, Equity, and Inclusion Into Medical Education Research, Academic Medicine: November 2019 - Volume 94 - Issue 11S - p S5-S6 doi: 10.1097/ACM.0000000000002916
  2. Smedley BD, Stith Butler A, Bristow LR. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. 2004.Washington, DC: National Academies Press;
  3. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2003.Washington, DC: National Academies Press;
  4. Carson TL, Aguilera A, Brown SD, Peña J, Butler A, Dulin A, Jonassaint CR, Riley I, Vanderbom K, Molina KM, Cené CW. A Seat at the Table: Strategic Engagement in Service Activities for Early-Career Faculty From Underrepresented Groups in the Academy. Acad Med. 2019 Aug;94(8):1089-1093. doi: 10.1097/ACM.0000000000002603. PMID: 30649021; PMCID: PMC6626695.
  5. Kaplan SE, Gunn CM, Kulukulualani AK, Raj A, Freund KM, Carr PL. Challenges in Recruiting, Retaining and Promoting Racially and Ethnically Diverse Faculty. J Natl Med Assoc. 2018 Feb;110(1):58-64. doi: 10.1016/j.jnma.2017.02.001. Epub 2017 Apr 21. PMID: 29510845; PMCID: PMC5844367.

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