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The importance of diversity and inclusion in medicine
Diversity
There is growing appreciation for diversity and inclusion (DI) as drivers of excellence in medicine. CHEST also promotes excellence in medicine. Therefore, it is intuitive that CHEST promote DI. Diversity encompasses differences in gender, race/ethnicity, vocational training, age, sexual orientation, thought processes, etc.
Academic medicine is rich with examples of how diversity is critical to the health of our nation:
– Diverse student populations have been shown to improve our learners’ satisfaction with their educational experience.
– Diverse teams have been shown to be more capable of solving complex problems than homogenous teams.
– Health care is moving toward a team-based, interprofessional model that values the contributions of a range of providers’ perspectives in improving patient outcomes.
– In biomedical research, investigators ask different research questions based on their own background and experiences. This implies that finding solutions to diseases that affect specific populations will require a diverse pool of biomedical researchers.
– Faculty diversity as a key component of excellence for medical education and research has been documented.
Diversity alone doesn’t drive inclusion. Noted diversity advocate, Verna Myers, stated, “Diversity is being invited to the party. Inclusion is being asked to dance.” In my opinion, diversity is the commencement of work, but inclusion helps complete the task.
Inclusion
An inclusive environment values the unique contributions all members bring. Teams with diversity of thought are more innovative as individual members with different backgrounds and points of view bring an extensive range of ideas and creativity to scientific discovery and decision-making processes. Inclusion leverages the power of our unique differences to accomplish our mutual goals. By valuing everyone’s perspective, we demonstrate excellence.
I recommend an article from the Harvard Business Review (HBR Feb 2017). The authors suggest several ways to promote inclusiveness: (1) ensuring team members speak up and are heard; (2) making it safe to propose novel ideas; (3) empowering team members to make decisions; (4) taking advice and implementing feedback; (5) giving actionable feedback; and ( 6) sharing credit for team success. If the team leader possesses at least three of these traits, 87% of team members say they feel welcome and included in their team; 87% say they feel free to express their views and opinions; and 74% say they feel that their ideas are heard and recognized. If the team leader possessed none of these traits, those percentages dropped to 51%, 46%, and 37%, respectively. I believe this concept is applicable in medicine also.
Sponsors
What can we do to advance diversity and inclusion individually and in our individual institutions? A sponsor is a senior level leader who advocates for key assignments, promotes for and puts his or her reputation on the line for the protégé’s advancement. This invigorates and drives engagement. One key to rising above the playing field for women and people of color is sponsorship. Being a sponsor does not mean one would recommend someone who is not qualified. It means one recommends or supports those who are capable of doing the job but would not otherwise be given the opportunity.
Ask yourself: Have I served as a sponsor? What would prevent me from being a sponsor? Do I believe in this concept?
Cause for Alarm
Numerous publications have recently discussed the crisis of the decline of black men entering medicine. In 1978, there were 1,410 black male applicants to medical school, and in 2014, there were 1,337. Additionally, the number of black male matriculants to medical school over more than 35 years has not surpassed the 1978 numbers. In 1978, there were 542 black male matriculants, and in 2014, there were 515 (J of Racial and Ethnic Health Disparities. 2017, 4:317-321). This report is thorough and insightful and illustrates the work that we must do to help improve this situation.
Dr. Marc Nivet, Association of American Medical Colleges (AAMC) Chief Diversity Officer, stated “No other minority group has experienced such declines. The inability to find, engage, and develop candidates for careers in medicine from all members of our society limits our ability to improve health care for all.” I recommend you read the 2015 AAMC publication entitled: Altering the Course: Black Males in Medicine.
Health-care Disparities
Research suggests that the overall health of Americans has improved; however, disparities continue to persist among many populations within the United States. Racial and ethnic minority populations have poorer access to care and worse outcomes than their white counterparts. Approximately 20% of the nation living in rural areas is less likely than those living in urban areas to receive preventive care and more likely to experience language barriers.
Individuals identifying as lesbian, gay, bisexual, or transgender are likely to experience discrimination in health-care settings. These individuals often face insurance-based barriers and are less likely to have a usual source of care than patients who identify as straight.
A 2002 report by the Institute of Medicine entitled: Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare is revealing. Salient information reported is: It is generally accepted that a diverse workforce is a key component in the delivery of quality, competent care throughout the nation. Physicians from racial and ethnic backgrounds typically underrepresented in medicine are significantly more likely to practice primary care than white physicians and are more likely to practice in impoverished and medically underserved areas. Diversity in the physician workforce impacts the quality of care received by patients. Race concordance between patient and physician results in longer visits and increased patient satisfaction, and language concordance is positively associated with adherence to treatment among certain racial or ethnic groups.
Improving the patient experience or quality of care received also requires attention to education and training on cultural competence. By weaving together a diverse and culturally responsive pool of physicians working collaboratively with other health-care professionals, access and quality of care can improve throughout the nation.
CHEST cannot attain more racial diversity in our organization if we don’t have this diversity in medical education and training. This is why CHEST must be actively involved in addressing these issues.
Unconscious Bias
Despite many examples of how diversity enriches the quality of health care and health research, there is still much work to be done to address the human biases that impede our ability to benefit from diversity in medicine. While academic medicine has made progress toward addressing overt discrimination, unconscious bias (implicit bias) represents another threat. Unconscious bias describes the prejudices we don’t know we have. While unconscious biases vary from person to person, we all possess them. The existence of unconscious bias in academic medicine, while uncomfortable and unsettling, is a reality. The AAMC developed an unconscious bias learning lab for the health professions and produced an oft-cited video about addressing unconscious bias in the faculty advancement, promotion, and tenure process. We must consider this and other ways in which we can help promote the acknowledgment of unconscious bias. The CHEST staff have undergone unconscious bias training, and I recommend it for all faculty in academic medicine.
Summary
Diversity and inclusion in medicine is of paramount importance. It leads to better patient care and better trainee education and will decrease health-care disparities. Progress has been made, but there is more work to be done.
CHEST is supportive of these efforts and has worked on this previously and with a renewed push in the past 2 years with the DI Task Force initially and, now, the DI Roundtable, which has representatives from each of the standing committees, including the Board of Regents. This roundtable group will help advance the DI initiatives of the organization. I ask that each person reading this article consider what we as individuals can do in helping make DI in medicine a priority.
Dr. Haynes is Professor of Medicine at The University of Mississippi Medical Center in Jackson, MS. He is also the Executive Vice Chair of the Department of Medicine. At CHEST, he is a member of the training and transitions committee, executive scientific program committee, former chair of the diversity and inclusion task force, and is the current chair of the diversity and inclusion roundtable.
Diversity
There is growing appreciation for diversity and inclusion (DI) as drivers of excellence in medicine. CHEST also promotes excellence in medicine. Therefore, it is intuitive that CHEST promote DI. Diversity encompasses differences in gender, race/ethnicity, vocational training, age, sexual orientation, thought processes, etc.
Academic medicine is rich with examples of how diversity is critical to the health of our nation:
– Diverse student populations have been shown to improve our learners’ satisfaction with their educational experience.
– Diverse teams have been shown to be more capable of solving complex problems than homogenous teams.
– Health care is moving toward a team-based, interprofessional model that values the contributions of a range of providers’ perspectives in improving patient outcomes.
– In biomedical research, investigators ask different research questions based on their own background and experiences. This implies that finding solutions to diseases that affect specific populations will require a diverse pool of biomedical researchers.
– Faculty diversity as a key component of excellence for medical education and research has been documented.
Diversity alone doesn’t drive inclusion. Noted diversity advocate, Verna Myers, stated, “Diversity is being invited to the party. Inclusion is being asked to dance.” In my opinion, diversity is the commencement of work, but inclusion helps complete the task.
Inclusion
An inclusive environment values the unique contributions all members bring. Teams with diversity of thought are more innovative as individual members with different backgrounds and points of view bring an extensive range of ideas and creativity to scientific discovery and decision-making processes. Inclusion leverages the power of our unique differences to accomplish our mutual goals. By valuing everyone’s perspective, we demonstrate excellence.
I recommend an article from the Harvard Business Review (HBR Feb 2017). The authors suggest several ways to promote inclusiveness: (1) ensuring team members speak up and are heard; (2) making it safe to propose novel ideas; (3) empowering team members to make decisions; (4) taking advice and implementing feedback; (5) giving actionable feedback; and ( 6) sharing credit for team success. If the team leader possesses at least three of these traits, 87% of team members say they feel welcome and included in their team; 87% say they feel free to express their views and opinions; and 74% say they feel that their ideas are heard and recognized. If the team leader possessed none of these traits, those percentages dropped to 51%, 46%, and 37%, respectively. I believe this concept is applicable in medicine also.
Sponsors
What can we do to advance diversity and inclusion individually and in our individual institutions? A sponsor is a senior level leader who advocates for key assignments, promotes for and puts his or her reputation on the line for the protégé’s advancement. This invigorates and drives engagement. One key to rising above the playing field for women and people of color is sponsorship. Being a sponsor does not mean one would recommend someone who is not qualified. It means one recommends or supports those who are capable of doing the job but would not otherwise be given the opportunity.
Ask yourself: Have I served as a sponsor? What would prevent me from being a sponsor? Do I believe in this concept?
Cause for Alarm
Numerous publications have recently discussed the crisis of the decline of black men entering medicine. In 1978, there were 1,410 black male applicants to medical school, and in 2014, there were 1,337. Additionally, the number of black male matriculants to medical school over more than 35 years has not surpassed the 1978 numbers. In 1978, there were 542 black male matriculants, and in 2014, there were 515 (J of Racial and Ethnic Health Disparities. 2017, 4:317-321). This report is thorough and insightful and illustrates the work that we must do to help improve this situation.
Dr. Marc Nivet, Association of American Medical Colleges (AAMC) Chief Diversity Officer, stated “No other minority group has experienced such declines. The inability to find, engage, and develop candidates for careers in medicine from all members of our society limits our ability to improve health care for all.” I recommend you read the 2015 AAMC publication entitled: Altering the Course: Black Males in Medicine.
Health-care Disparities
Research suggests that the overall health of Americans has improved; however, disparities continue to persist among many populations within the United States. Racial and ethnic minority populations have poorer access to care and worse outcomes than their white counterparts. Approximately 20% of the nation living in rural areas is less likely than those living in urban areas to receive preventive care and more likely to experience language barriers.
Individuals identifying as lesbian, gay, bisexual, or transgender are likely to experience discrimination in health-care settings. These individuals often face insurance-based barriers and are less likely to have a usual source of care than patients who identify as straight.
A 2002 report by the Institute of Medicine entitled: Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare is revealing. Salient information reported is: It is generally accepted that a diverse workforce is a key component in the delivery of quality, competent care throughout the nation. Physicians from racial and ethnic backgrounds typically underrepresented in medicine are significantly more likely to practice primary care than white physicians and are more likely to practice in impoverished and medically underserved areas. Diversity in the physician workforce impacts the quality of care received by patients. Race concordance between patient and physician results in longer visits and increased patient satisfaction, and language concordance is positively associated with adherence to treatment among certain racial or ethnic groups.
Improving the patient experience or quality of care received also requires attention to education and training on cultural competence. By weaving together a diverse and culturally responsive pool of physicians working collaboratively with other health-care professionals, access and quality of care can improve throughout the nation.
CHEST cannot attain more racial diversity in our organization if we don’t have this diversity in medical education and training. This is why CHEST must be actively involved in addressing these issues.
Unconscious Bias
Despite many examples of how diversity enriches the quality of health care and health research, there is still much work to be done to address the human biases that impede our ability to benefit from diversity in medicine. While academic medicine has made progress toward addressing overt discrimination, unconscious bias (implicit bias) represents another threat. Unconscious bias describes the prejudices we don’t know we have. While unconscious biases vary from person to person, we all possess them. The existence of unconscious bias in academic medicine, while uncomfortable and unsettling, is a reality. The AAMC developed an unconscious bias learning lab for the health professions and produced an oft-cited video about addressing unconscious bias in the faculty advancement, promotion, and tenure process. We must consider this and other ways in which we can help promote the acknowledgment of unconscious bias. The CHEST staff have undergone unconscious bias training, and I recommend it for all faculty in academic medicine.
Summary
Diversity and inclusion in medicine is of paramount importance. It leads to better patient care and better trainee education and will decrease health-care disparities. Progress has been made, but there is more work to be done.
CHEST is supportive of these efforts and has worked on this previously and with a renewed push in the past 2 years with the DI Task Force initially and, now, the DI Roundtable, which has representatives from each of the standing committees, including the Board of Regents. This roundtable group will help advance the DI initiatives of the organization. I ask that each person reading this article consider what we as individuals can do in helping make DI in medicine a priority.
Dr. Haynes is Professor of Medicine at The University of Mississippi Medical Center in Jackson, MS. He is also the Executive Vice Chair of the Department of Medicine. At CHEST, he is a member of the training and transitions committee, executive scientific program committee, former chair of the diversity and inclusion task force, and is the current chair of the diversity and inclusion roundtable.
Diversity
There is growing appreciation for diversity and inclusion (DI) as drivers of excellence in medicine. CHEST also promotes excellence in medicine. Therefore, it is intuitive that CHEST promote DI. Diversity encompasses differences in gender, race/ethnicity, vocational training, age, sexual orientation, thought processes, etc.
Academic medicine is rich with examples of how diversity is critical to the health of our nation:
– Diverse student populations have been shown to improve our learners’ satisfaction with their educational experience.
– Diverse teams have been shown to be more capable of solving complex problems than homogenous teams.
– Health care is moving toward a team-based, interprofessional model that values the contributions of a range of providers’ perspectives in improving patient outcomes.
– In biomedical research, investigators ask different research questions based on their own background and experiences. This implies that finding solutions to diseases that affect specific populations will require a diverse pool of biomedical researchers.
– Faculty diversity as a key component of excellence for medical education and research has been documented.
Diversity alone doesn’t drive inclusion. Noted diversity advocate, Verna Myers, stated, “Diversity is being invited to the party. Inclusion is being asked to dance.” In my opinion, diversity is the commencement of work, but inclusion helps complete the task.
Inclusion
An inclusive environment values the unique contributions all members bring. Teams with diversity of thought are more innovative as individual members with different backgrounds and points of view bring an extensive range of ideas and creativity to scientific discovery and decision-making processes. Inclusion leverages the power of our unique differences to accomplish our mutual goals. By valuing everyone’s perspective, we demonstrate excellence.
I recommend an article from the Harvard Business Review (HBR Feb 2017). The authors suggest several ways to promote inclusiveness: (1) ensuring team members speak up and are heard; (2) making it safe to propose novel ideas; (3) empowering team members to make decisions; (4) taking advice and implementing feedback; (5) giving actionable feedback; and ( 6) sharing credit for team success. If the team leader possesses at least three of these traits, 87% of team members say they feel welcome and included in their team; 87% say they feel free to express their views and opinions; and 74% say they feel that their ideas are heard and recognized. If the team leader possessed none of these traits, those percentages dropped to 51%, 46%, and 37%, respectively. I believe this concept is applicable in medicine also.
Sponsors
What can we do to advance diversity and inclusion individually and in our individual institutions? A sponsor is a senior level leader who advocates for key assignments, promotes for and puts his or her reputation on the line for the protégé’s advancement. This invigorates and drives engagement. One key to rising above the playing field for women and people of color is sponsorship. Being a sponsor does not mean one would recommend someone who is not qualified. It means one recommends or supports those who are capable of doing the job but would not otherwise be given the opportunity.
Ask yourself: Have I served as a sponsor? What would prevent me from being a sponsor? Do I believe in this concept?
Cause for Alarm
Numerous publications have recently discussed the crisis of the decline of black men entering medicine. In 1978, there were 1,410 black male applicants to medical school, and in 2014, there were 1,337. Additionally, the number of black male matriculants to medical school over more than 35 years has not surpassed the 1978 numbers. In 1978, there were 542 black male matriculants, and in 2014, there were 515 (J of Racial and Ethnic Health Disparities. 2017, 4:317-321). This report is thorough and insightful and illustrates the work that we must do to help improve this situation.
Dr. Marc Nivet, Association of American Medical Colleges (AAMC) Chief Diversity Officer, stated “No other minority group has experienced such declines. The inability to find, engage, and develop candidates for careers in medicine from all members of our society limits our ability to improve health care for all.” I recommend you read the 2015 AAMC publication entitled: Altering the Course: Black Males in Medicine.
Health-care Disparities
Research suggests that the overall health of Americans has improved; however, disparities continue to persist among many populations within the United States. Racial and ethnic minority populations have poorer access to care and worse outcomes than their white counterparts. Approximately 20% of the nation living in rural areas is less likely than those living in urban areas to receive preventive care and more likely to experience language barriers.
Individuals identifying as lesbian, gay, bisexual, or transgender are likely to experience discrimination in health-care settings. These individuals often face insurance-based barriers and are less likely to have a usual source of care than patients who identify as straight.
A 2002 report by the Institute of Medicine entitled: Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare is revealing. Salient information reported is: It is generally accepted that a diverse workforce is a key component in the delivery of quality, competent care throughout the nation. Physicians from racial and ethnic backgrounds typically underrepresented in medicine are significantly more likely to practice primary care than white physicians and are more likely to practice in impoverished and medically underserved areas. Diversity in the physician workforce impacts the quality of care received by patients. Race concordance between patient and physician results in longer visits and increased patient satisfaction, and language concordance is positively associated with adherence to treatment among certain racial or ethnic groups.
Improving the patient experience or quality of care received also requires attention to education and training on cultural competence. By weaving together a diverse and culturally responsive pool of physicians working collaboratively with other health-care professionals, access and quality of care can improve throughout the nation.
CHEST cannot attain more racial diversity in our organization if we don’t have this diversity in medical education and training. This is why CHEST must be actively involved in addressing these issues.
Unconscious Bias
Despite many examples of how diversity enriches the quality of health care and health research, there is still much work to be done to address the human biases that impede our ability to benefit from diversity in medicine. While academic medicine has made progress toward addressing overt discrimination, unconscious bias (implicit bias) represents another threat. Unconscious bias describes the prejudices we don’t know we have. While unconscious biases vary from person to person, we all possess them. The existence of unconscious bias in academic medicine, while uncomfortable and unsettling, is a reality. The AAMC developed an unconscious bias learning lab for the health professions and produced an oft-cited video about addressing unconscious bias in the faculty advancement, promotion, and tenure process. We must consider this and other ways in which we can help promote the acknowledgment of unconscious bias. The CHEST staff have undergone unconscious bias training, and I recommend it for all faculty in academic medicine.
Summary
Diversity and inclusion in medicine is of paramount importance. It leads to better patient care and better trainee education and will decrease health-care disparities. Progress has been made, but there is more work to be done.
CHEST is supportive of these efforts and has worked on this previously and with a renewed push in the past 2 years with the DI Task Force initially and, now, the DI Roundtable, which has representatives from each of the standing committees, including the Board of Regents. This roundtable group will help advance the DI initiatives of the organization. I ask that each person reading this article consider what we as individuals can do in helping make DI in medicine a priority.
Dr. Haynes is Professor of Medicine at The University of Mississippi Medical Center in Jackson, MS. He is also the Executive Vice Chair of the Department of Medicine. At CHEST, he is a member of the training and transitions committee, executive scientific program committee, former chair of the diversity and inclusion task force, and is the current chair of the diversity and inclusion roundtable.