Diversity and Inclusion in the Academic Medicine Workforce: Encouraging Medical Students and Residents to Consider Academic Careers

• DOI: 10.15766/mep_2374-8265.10689
• Publication Date: 2018-02-27T18:40:02Z
• Authors: Maria Soto-Greene; Karissa Culbreath; Daniel E. Guzman; John P. Sánchez; Valerie Romero-Le...
• Keywords: Excellence; Attrition; Gender Diversity

OPEN ACCESSFebruary 27, 2018Diversity and Inclusion in the Academic Medicine Workforce: Encouraging Medical Students Residents to Consider Careers Maria Soto-Greene, MD, Karissa Culbreath, PhD, Daniel E. Guzman, John P. Sánchez, Valerie Romero-Leggott, MD Vice Dean, Rutgers New Jersey School; Professor of Medicine, School , PhD Assistant Pathology, University Mexico Medicine; Scientific Director, Infectious Disease, Research Development, TriCore Reference Laboratories, Guzman Fourth-Year Student, Fellow, Building Next Generation Physicians Diversity Inclusion, Associate Professor, Emergency E-mail Address: [email protected] Chancellor for Diversity, Health Sciences Center Office Diversity; Chief Officer, Department Family & Community https://doi.org/10.15766/mep_2374-8265.10689 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: The expansion medical schools increased faculty attrition call heightened efforts encourage students residents consider academic careers. As diversity serves as a driver institutional excellence, special attention ongoing underrepresentation certain groups academia, such racial ethnic minorities, women, lesbian, gay, bisexual, transgender individuals, is warranted. Methods: We developed 90-minute workshop raise student resident awareness medicine careers, benefits challenges having diverse faculty. consists didactic PowerPoint presentation reflection exercise, shared small- large-group format, discussing facilitators barriers pursuing academia. was implemented at nine regional conferences. Results: There were 165 participants. In comparing pre- postworkshop responses learners using sample t test, there statistically significant increase confidence succeed given learners' gender (2.69 vs. 3.34, p < .001), race ethnicity (2.53 3.24, or sexual orientation (3.04 3.42, .001). Approximately 95% felt that each workshop's learning objectives had been achieved. Participants considered be enlightening, motivational, realistic, validating. Discussion: This effective providing an interactive format gain state, benefits, inclusion medicine, can affect their perception being future member. Educational Objectives By end this workshop, will able to: 1.Describe statistics regarding among faculty.2.Explain terms.3.List discuss career.4.Identify least three Introduction Increasing physician workforce has identified embraced core value excellence nearly all institutions professional associations. have well described. Underrepresented minority (URM) (LGBT) physicians are more likely involved practice, research, education, scholarship, service, mentorship activities aligned with identity.1–3 Despite increasing ranks within workforce, URM individuals women present lower proportions compared general population.4,5 less desire career when they do, often feel lack tools success navigating culture.6,7 When do enter remains its highest lower-rank faculty, demonstrating bottleneck initially assistant professor then associate ranks.5 Retention promotion not unique but also by LGBT, Asian members. Contributory factors include insufficient concordant role models mentors, -isms (e.g., racism, sexism), cultural failure recognize service educational decisions.8–10 result, tend report satisfaction engagement institution, which result poor modeling early exit from institution overall. Although mandated Liaison Committee on Education,11 until recently little paid pool candidates considering careers medicine. Much published diversity-related content focused improving patient-physician interaction, through competency, humility, improved communication practices LGBT patients families.12–14 no module dedicated advancing students' residents' (BNGAP)15 Initiative national organization of, interest in, preparedness career. 2015, BNGAP curriculum committee, comprising 25 trainees leaders across country, helped create and/or review series workshops promote awareness.16 Five committee members experience work responsible developing editing particular workshop. six-step Kern model used tool creating structure, implementation, assessment workshop.17 step 1, our problem identification needs consisted performing literature gathering feedback For 2, targeted conducted mixed-methods studies trainees' perceptions including intent preferred development activities.2,3,7,18–20 3, we determined goals based member input. 4, chosen strategies included (PPT) incorporated reflection, understanding, sharing perspectives via discussion. 5, implementation conference residents. speakers hosting school nearby health centers. venue because it afforded opportunities career-specific learning, skill development, positive environments, networking beyond own Step 6, evaluation feedback, questionnaire participant evaluate design context larger stand-alone unit. includes concepts terms, perceived career, culture, climate, policies practices, should prepared how respective address inclusion. Methods drafted revised team experts primary five individuals: vice dean, dean inclusion, chancellor diversity, pathology, student. terms (and even junior faculty). Each session restricted than 50 safe space personal perspectives, ambitions, respect facilitator would DO degree programming. featured two strategies: (1) component, PPT presentation, introduce participants trends, perceptions, (2) discussion reflect share started followed trends gender, ethnicity, orientation. These slides contextualized why important students, gave opportunity journey, highlighting success. broken up into seven Published data academia provided comparison's sake, highlight commonalities between groups. following listing description resources conduct successful Appendix A. Presentation flow 30-slide presentation. outlines participants, key terms; faculty; tips facilitating pursuit overcoming understanding B. Facilitator Guide document gives step-by-step instructions conducting along explanation slide. Slide created ensure consistent sites. Facilitators encouraged experiences authenticity. example, slide 18 features Dr. Sánchez his trajectory college position. replaced facilitator's obstacles overcome enablers addition reported relatable models; hence, her heighten self-efficacy becoming C. Handout handout distributed during small-group segment note D. Train Trainer Video video adjunct guide help visual audio appreciation implement 19-minute Soto-Greene explaining slides, exercises, she anecdotes experiences. Evaluation Form asked complete preworkshop questionnaire. questions served assess participants' towards effectiveness Preworkshop evaluations could completed email prior start upon arrival. after took approximately 5 minutes complete. both questionnaires: •Using 5-point Likert scale (0 = No confidence, 4 Complete confidence), indicate "How much CONFIDENCE you your ability (a) (b) (c) orientation?"•Using (1 Strongly Disagree, 2 3 Neither Agree nor Agree, Agree), "To what extent agree statements: My racial/ethnic culture does align impede my medicine." only postworkshop: met? Describe explain list (d) identify faculty."•Open ended question: What did like about workshop?•Open-ended suggestions improve workshop? Review PPT, guide, form, takes 1–2 hours. cofacilitators lead If one facilitator, additional time spent phone face breakdown run practice session. Materials required pens, AV equipment show chairs tables support per table, flip chart markers comments printed copies form. optimal length 90 minutes; however, tailored resources. A suggested line follows: •Preworkshop evaluation: minutes.•Slides 1–18: 30 19–24 (group exercise discussion): 25–29: 15 minutes.•Slide 30: minutes.•Postworkshop minutes. Results conferences facilitated total 13 presenters (four single presenters, pairs, triple set cofacilitators). All driving institutions. Among chief officers (three) (one) deans (four) rank, 10 full professors, professor, professors. respondents sample—85 (51.5%) women; 74 (44.8%) men; 27 (16.4%) bisexual; 39 (26.9%) Hispanic/Latino; 48 (29.1%) white; 47 (28.5%) African-American/black; 35 (21.2%) Asian; (1.8%) American Indian. 146 19 who training 21 different states Washington, DC. learners, Moreover, believe (2.21 1.87, .001) (2.48 2.04, Data listed Table 1. Learner Responses Pre- Postworkshop QuestionsTable Questions Learners responded question, met?" four Their summarized 2. (N 165) Question, Extent Do You That Workshop Learning Were Met?"Table Met?" Comments overall positive, few improvement. organized objectives. "What workshop?" following: •Objective 1: ○"I liked provided. They realistic view demographics med."○"I utilization (particularly representation it) dearth I small group → made seminar engaging. presenter's story brought concrete narrative statistics."○"I fact see change throughout years amount minorities underrepresented It's evident progress still long way go."•"I found very helpful giving us outline exactly severe under-representation community."•"As South Asian, so interesting 0% Asian. totally caught me off guard actually lights fire under that."•"The presented here confront subconscious sentiments suspicions don't people look high ranking positions. galvanizing, importantly assures we're crazy feeling way."•Objective 2: Explain terms. ○"There great coverage find footing gaining position importance medicine."○"Good job touching aspects just race."○"I loved getting information looks like; always assume know don't. suggestions. It spent!"•Objective 3: List ○"Appreciated time. Chance talk challenges. Thank allowing VALIDATE faced."○"I specific examples mentors' instrumental programs."○"I enjoyed intention obtain positions seek out outside learn opportunities."○"I hearing stories going medicine."•Objective 4: Identify statistical cited proof faculty."○"I breakout challenges/benefits working dislike think I'm opinion wasn't ways buck those under-representation."○"It eye-opening nice. However, focus bit heavy minority."○"Any updated stats studies? example longitudinal study 8 old."○"Solid overview statistics. Improve: There's newer available put discussion."•Objective love wish DACA [Deferred Action Childhood Arrivals] diversity."○"I'd interested hear definition emerged. completely new thought was. It'd real threat LGBTQ legal permissiveness associated employees terminating orientation."•Objective ○"Further supporting insightful."○"Would spoken reference later on, aren't (bias? Not enough applying?)."○"I To speaker's path. challenges?"○"Most clinical educators—I really investigators us."○"More tangible obstacles/disparities students/residents."○"We heard nice similar/changing someone starting, i.e. post-medical graduate."•Objective ran short time, faculty." Discussion educate diversity. general, course received trainees. improvements attendees' attitudes toward metrics evaluation, met. Through evaluations, points disliked. several excellent appreciated numerical, chart, graphical depicting presence Another well-appreciated aspect use quotes describing successes journeys facilitators. Lastly, discussions these validating many students. improvement Some placed emphasis acknowledge number while fewer Our reflects historical emerging Speakers emphasize today, orientation, other forms particular, mentioned deserving attempt characteristics represented may achieved simply asking name affiliation. While existing obstacles. therefore spend encountered journey. response well-received introduction recent data. sources projects become published. suggest download most data, annual date, current referenced 9 census Association Colleges' Faculty Roster update U.S. population chose 2012 year secure subgroups population, physicians, topics, protections groups, addressed topics go scope. demonstrate systematic needed An alternative approach delivering flipped format. classroom reserved advantage individual preclass preparation reading text watching delivers essential background information. Flipped widely education,21 undergraduate22 graduate23 education. Advantages abilities decrease scheduled memory formation spacing rather concentrating sitting. potential disadvantage if work. risk particularly delivered separately model.24 One apply 1–18 watch listen make recording voices over permits class begin discussion, without estimated introductory further enhanced prompted advance. Making assignment would: greater compliance accountability work, better prepare session, alert come limitations findings. brief, onetime intervention, survey immediately before beliefs assumed sustained times 6 months, 12 etc.). numerous personal, institutional, system-level maintaining aimed raising consciousness possibility. Sustained requires modeling, mentorship, nurturing interests, interventions all. Two critical components ensuring choice size. any identity comfortable competent individuals. Latino residents), requirement. engaging environment, recommend limiting size 30–50 Larger sizes difficult some beliefs. addresses unmet need educating pipeline option contribute environment References1. Nivet MA. Minorities medicine: literature. J Vasc Surg. 2010;51(4)(suppl):S53–S58. https://doi.org/10.1016/j.jvs.2009.09.064Google Scholar2. NF, Rankin S, Callahan E, et al. trainee careers—facilitators Health. 2015;2(4):346–356. https://doi.org/10.1089/lgbt.2015.0024Medline, Google Scholar3. JP, Poll-Hunter N, Stern Garcia AN, Brewster Balancing cultures: Indian/Alaska Native 2016;41(4):871–880. https://doi.org/10.1007/s10900-016-0166-xMedline, Scholar4. Yu PT, Parsa PV, Hassanein O, Rogers SO, Chang struggle advance 12-y levels America's teaching Surg Res. 2013;182(2):212–218. https://doi.org/10.1016/j.jss.2012.06.049Medline, Scholar5. Xierali IM, Fair MA, schools: gaps coexist. Analysis Brief. 2016;16(6).Google Scholar6. Jeffe DB, Andriole DA, Hageman HL, Whelan AJ. Reaping sow: workforce. Natl Med Assoc. 2008;100(9):1026–1035. https://doi.org/10.1016/S0027-9684(15)31439–5Medline, Scholar7. Peters L, Lee-Rey Racial Acad Med. 2013;88(9):1299–1307. https://doi.org/10.1097/ACM.0b013e31829f87a7Medline, Scholar8. Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities tax?BMC Educ. 2015;15:6. https://doi.org/10.1186/s12909-015-0290-9Medline, Scholar9. DB. road career: cohort male female graduates. 2012;87(12):1722–1733. https://doi.org/10.1097/ACM.0b013e318271e57bMedline, Scholar10. Price EG, Powe NR, DE, Golden SH, Wand GS, Cooper LA. Improving climate catalyst change. 2009;84(1):95–105. https://doi.org/10.1097/ACM.0b013e3181900f29Medline, Scholar11. Education. Functions structure school: standards accreditation education programs leading degree. https://med.virginia.edu/ume-curriculum/wp-content/uploads/sites/216/2016/07/2017-18_Functions-and-Structure_2016-03-24.pdf. March, 2016.Google Scholar12. Grubb H, Hutcherson Amiel J, Bogart Laird J. Cultural humility populations: novel MedEdPORTAL. 2013;9:9542. https://doi.org/10.15766/mep_2374-8265.9542Google Scholar13. Crandall S. Elective 2005;1:192. https://doi.org/10.15766/mep_2374-8265.192Google Scholar14. Lie Tool Assessing Competence Training (TACCT). 2006;2:325. https://doi.org/10.15766/mep_2374-8265.325Google Scholar15. website. http://www.bngap.org. Updated 2018.Google Scholar16. Williams R, Holaday Lamba M, JP. Introducing scholarship. 2017;13:10554. https://doi.org/10.15766/mep_2374-8265.10554Medline, Scholar17. Thomas PA, Hughes MT, Chen BY, eds. Curriculum Development Education: Six-Step Approach. 3rd ed.Baltimore, MD: Johns Hopkins Press; Scholar18. Yehia BR, Cronholm PF, Wilson Mentorship careers: mixed methods backgrounds. BMC 2014;14:26. https://doi.org/10.1186/1472-6920-14-26Medline, Scholar19. Sanchez Gameda Guilliames CE, Interventions maintain Presented at: GDI/OSA/OSR National Meeting; April 26–29, 2014; San Diego, CA.Google Scholar20. Lu F, Yee LL, C, Zhang L. leadership [webinar]. Colleges https://www.aamc.org/initiatives/diversity/learningseries/452920/increasingasianinclusionwebinar.html. Accessed June 21, 2017.Google Scholar21. Persky AM, McLaughlin JE. classroom—from theory Am Pharm 2017;81(6):118.Medline, Scholar22. Morgan McLean K, Chapman Fitzgerald Yousuf A, Hammoud M. Clin Teach. 2015;12(3):155–160. https://doi.org/10.1111/tct.12328Medline, Scholar23. Martinelli SM, DiLorenzo anesthesiology Grad 2017;9(4):485–490. https://doi.org/10.4300/JGME-D-17-00128.1Medline, Scholar24. AZ, Hsieh G, Kiss Huang GC. Flipping out: GME?J 2017;9(3):392–393. https://doi.org/10.4300/JGME-D-16-00827.1Medline, Scholar Sign latest publications MedEdPORTAL Add below APPENDICESReferencesRelatedDetailsAppendices Presentation.pptx Guide.docx Handout.doc Video.mp4 Form.docx appendices peer reviewed integral parts Original Publication. Download CitationSoto-Greene Culbreath Romero-Leggott V. Careers. 2018;14:10689. Related Trainees Education Activities Opportunities Scholarship Career Roles Responsibilities Helping Develop From Service Providing With Decision-Making Framework Pursuing Residency Position Diverse Early Transparent Appointment Promotion Processes Leadership Medicine: Preparing Be Effective Leaders 21st Century Work, Scholarship, Paving Way Career: Significance Mentoring How Find After Residency: Who, What, When, Where, Why, Copyright PermissionsCopyright © 2018 open-access publication Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsCareers MedicineDiversity InclusionDisclosures None report. Funding/Support Ethical Approval Institutional Board approved study. PDF downloadtabs.loading