Laura Castillo-Page

Racial and ethnic minority medical students' perceptions of and interest in careers in academic medicine.

Purpose To describe diverse medical students’ perceptions of and interest in careers in academic medicine. Method In 2010, the authors invited students attending three national medical student conferences to respond to a survey and participate in six focus groups. The authors identified trends in data through bivariate analyses of the quantitative dataset and using a grounded theory approach in their analysis of focus group transcripts. Results The 601 survey respondents represented 103 U.S. medical schools. The majority (72%) were in their first or second year; 34% were black and 17% were Hispanic. Many respondents (64%) expressed interest in careers in academic medicine; teaching and research were viewed as positive influences on that interest. However, black and Hispanic respondents felt they would have a harder time succeeding in academia. The 73 focus group participants (25% black, 29% Hispanic) described individual- and institutional-level challenges to academic medicine careers and offered recommendations. They desired deliberate and coordinated exposure to academic career paths, research training, clarification of the promotion process, mentorship, protected time for faculty to provide teaching and research training, and an enhanced infrastructure to support diversity and inclusion. Conclusions Medical students expressed an early interest in academic medicine but lacked clarity about the career path. Black and Hispanic students’ perceptions of having greater difficulty succeeding in academia may be an obstacle to engaging them in the prospective pool of academicians. Strategic and dedicated institutional resources are needed to encourage racial and ethnic minority medical students to explore careers in academic medicine.

Commentary: the building the next generation of academic physicians initiative: engaging medical students and residents.

Data from the 2010 U.S. Census are a reminder of the diverse patient population in the United States and the growing health care needs of Americans. Academic health centers are tasked with reforming the system to expand its capacity for care and with cultivating innovation to generate the teaching, training, and research prowess needed to eliminate health disparities. At the center of this reform is enhancing the system that produces the human capital, including the physicians who care for the patients and the educators who train those physicians. Institutions and foundations have committed to the development of pipeline programs, from kindergarten through college, to create a diverse clinical workforce, but they have limited their direct promotion of diversity in the academic medicine workforce to faculty development programs. Despite faculty efforts, shortcomings in diversity persist, including a paucity of female full professors and deans, an insignificant increase in the proportion of underrepresented racial and ethnic minority faculty, and a lack of knowledge on the cultivation of the lesbian and gay faculty perspective. Furthermore, underrepresented racial and ethnic minority students in particular lose interest in academic medicine careers during medical school, and overall students lose interest in academic medicine careers during residency. The Building the Next Generation of Academic Physicians Initiative is designed to develop interest and promote achievement in pursuing academic medicine careers. This initiative is needed to increase the pool of diverse faculty down the road and elicit their perspectives to more effectively address health care disparities.

Faculty Diversity Programs in U.S. Medical Schools and Characteristics Associated With Higher Faculty Diversity

Purpose To describe diversity programs for racial and ethnic minority faculty in U.S. medical schools and identify characteristics associated with higher faculty diversity. Method The authors conducted a cross-sectional survey study of leaders of diversity programs at 106 U.S. MD-granting medical schools in 2010. Main outcome measures included African American and Latino faculty representation, with correlations to diversity program characteristics, minority medical student representation, and state demographics. Results Responses were obtained from 82 of the 106 institutions (77.4%). The majority of the respondents were deans, associate and assistant deans (68.3%), members of minority ethnic/racial background (65.9% African American, 14.7% Latino), and women (63.4%). The average time in the current position was 6.7 years, with approximately 50% effort devoted to the diversity program. Most programs targeted medical trainees and faculty (63.4%). A majority of programs received monetary support from their institutions (82.9%). In bivariate analysis, none of the program characteristics measured were associated with higher than the mean minority faculty representation in 2008 (3% African American and 4.2% Latino faculty). However, minority state demographics in 2008, and proportion of minority medical students a decade earlier, were significantly associated with minority faculty representation. Conclusions Medical student diversity 10 years earlier was the strongest modifiable factor associated with faculty diversity. Our results support intervening early to strengthen the minority medical student pipeline to improve faculty diversity. Schools located in states with low minority representation may need to commit additional effort to realize institutional diversity.

Assessing the evolving definition of underrepresented minority and its application in academic medicine.

Purpose To assess how U.S. academic health centers (AHCs) define the term underrepresented minority (URM) and apply it to their diversity programs, following the 2003 revision of the Association of American Medical Colleges’ (AAMC’s) definition of URM. Method In 2010, the authors developed and deployed a cross-sectional survey of diversity leaders at 106 AHCs. The survey included questions about the diversity leader and institution’s diversity program; institution’s URM definition; application of that definition; and the diversity leader’s perceptions of the representation and institutional contribution of various ethnic/racial groups. The authors used descriptive statistics to analyze the results. Results Of the 106 diversity leaders invited, 89 (84.0%) responded and 78 (73.6%) provided a working definition of URM. Most programs (40/78; 51%) used the 2003 AAMC definition of URM, which includes racial/ethnic groups that are underrepresented in medicine relative to local and national demographics. Only 14.1% (11/78) used the pre-2003 AAMC definition, which included only African Americans, Mexican Americans, Native Americans, and mainland Puerto Ricans. Approximately one-third (23/78; 29.5%) also considered other diversity factors, such as socioeconomic status, sexual orientation, and disability, in defining URM. Fifty-eight respondents (74.4%) confirmed that their diversity programs targeted specific groups. Conclusions The definition of URM used by diversity programs at U.S. AHCs varied widely. Although some classified URMs by racial/ethnic categories, the majority defined URM more broadly to encompass other demographic and personal characteristics. This shift should prepare academic medicine to eliminate health disparities and meet the health needs of an increasingly diverse population.

AM last page. Understanding qualitative and quantitative research paradigms in academic medicine.

Qualitative research is becoming more prominent in academic medicine and health care fields, and an increasing number of publications using qualitative methods are featured in prominent journals1–3; thus, recognizing the different available approaches can benefit researchers of all types. While a debate may wage between proponents of qualitative versus quantitative research, both sets of methods—and often a blend of the two—offer important insights into the problems the academic medicine community faces.4–6

Racial and Ethnic Differences Between Obstetrician-Gynecologists and Other Adult Medical Specialists.

OBJECTIVE: To compare racial and ethnic differences between obstetrician–gynecologists (ob-gyns) and other large groups of adult medical specialists who provide the predominant care of women. Whether physician diversity influences their practice locations in underserved areas was also sought. METHODS: This cross-sectional study reports an analysis of U.S. national data about racial and ethnic characteristics, gender, and specialty (obstetrics and gynecology, general internal medicine, family medicine, emergency medicine) of 190,379 physicians who came from three resources (Association of American Medical Colleges Student Records System, Association of American Medical Colleges Minority Physicians Database, American Medical Association Physician Masterfile). Underserved locations were identified as being rural, having 20% or more of the population living in poverty or being federally designated as areas of professional shortages or underserved populations. Bivariate measures of associations were performed to study the association between physician race and ethnicity and their practice location. RESULTS: Female physicians in all specialties were more likely than males to be nonwhite, and ob-gyns were most likely to be female (61.9%). Compared with other studied specialists, ob-gyns had the highest proportion of underrepresented minorities (combined, 18.4%), especially black (11.1%) and Hispanic (6.7%) physicians. Underrepresented minority ob-gyns were more likely than white or Asians to practice in federally funded underserved areas or where poverty levels were high. Native Americans, Alaska Natives, and Pacific Islanders were the ob-gyn group with the highest proportion practicing in rural areas. CONCLUSION: Compared with other adult medical specialists, ob-gyns have a relatively high proportion of black and Hispanic physicians. A higher proportion of underrepresented minority ob-gyns practiced at medically underserved areas.

Measuring Diversity and Inclusion in Academic Medicine: The Diversity Engagement Survey.

Purpose To produce a physician and scientific workforce that advances high-quality research and culturally competent care, academic medical centers (AMCs) must assess their capacity for diversity and inclusion and leverage opportunities for improvement. The Diversity Engagement Survey (DES) is presented as a diagnostic and benchmarking tool. Method The 22-item DES consists of eight factors that connect engagement theory to inclusion and diversity constructs. It was piloted at 1 AMC and then administered at 13 additional U.S. AMCs in 2011–2012. Face and content validity were assessed through a review panel. Cronbach alpha was used to assess internal consistency. Confirmatory factor analysis (CFA) was used to establish construct validity. Cluster analysis was conducted to establish ability of the DES to distinguish between institutions’ degrees of engagement and inclusion. Criterion validity was established using observed differences in scores for demographic groups as suggested by the literature. Results The sample included 13,694 respondents across 14 AMCs. Cronbach alphas for the engagement and inclusion factors (range: 0.68–0.85), CFA fit indices, and item correlations with latent constructs indicated an acceptable model fit and that items measured the intended concepts. Cluster analysis of DES scores distinguished institutions with higher, middle, and lower degrees of engagement and inclusion by their respondents. Consistent with the literature, black, Hispanic/Latino, female, and LGBTQ (lesbian, gay, bisexual, transgender, queer) respondents reported lower degrees of engagement than their counterparts. Conclusions The DES is a reliable and valid instrument for assessment, evaluation, and external benchmarking of institutional engagement and inclusion.

A Diversity and Inclusion Framework for Medical Education

director, Advancing Holistic Review Initiative, Association of American Medical Colleges Relevance • Diversity in organizations can lead to increased innovation and less biased decision making; it has a positive effect on key business indicators.1 Thus, diversity is essential for academic medicine. • For the true benefits of diversity to be realized, diversity must be at the core (not the periphery) of academic medicine.2 • Creating a culture and climate that values diversity and inclusion will help support this shift.3,4 • While academic medicine is making significant progress in advancing diversity and inclusion, there remains the need for a comprehensive assessment of climate and culture.5 • The Association of American Medical Colleges (AAMC) developed the Diversity 3.0 framework to provide academic health centers with a guide to assess their culture and climate in order to promote a culture of inclusion. • A comprehensive, inclusive assessment of organizational culture and climate allows for evidence-based interventions that will improve and enhance medical education. A Diversity and Inclusion Framework for Medical Education Marc A. Nivet, EdD, MBA, chief diversity officer, Laura Castillo-Page, PhD, senior director, Diversity Policy and Programs and Organizational Capacity Building Portfolio, and Sarah Schoolcraft Conrad, MS, director, Advancing Holistic Review Initiative, Association of American Medical Colleges

The Inconvenient Truth About Unconscious Bias in the Health Professions

More than 15 years after two pivotal reports from the Institute of Medicine (now the National Academy of Medicine) focused their attention on unequal access to healthcare and established health equity as a pillar of quality care, healthcare disparities persist. Some of this can be traced to overt discrimination against certain groups, but this chapter shines a light on a subtler form of prejudice: unconscious bias. The by-product of a normal—and often useful—human tendency to make associations and split-second judgements, unconscious bias, affects even people who believe strongly in equality and equal care. Left unaddressed, unconscious bias can influence relationships between providers and patients and among providers and their colleagues, affecting clinical interactions, workplace diversity, and even patient outcomes. Providers can mitigate unconscious biases by becoming more aware of them and resolving to overcome them through proven strategies for improving health equity and reversing health disparities.