FEATURE
Diversity Evolution
Efforts to Promote Diversity Across Health Care
ASH and other medical associations are actively engaged in initiatives to increase diversity in the U . S . health-care system and medical schools .
The ASH Minority Recruitment Initiative
More than a decade ago , ASH leadership recognized that hematology in the U . S . attracts few underrepresented minorities , especially in contrast to the diversity of patients with hematologic disorders . Based on the strong evidence that increasing the number of minority physician scientists and physicians will increase access to care and the quality of medical experience for minority patients in the U . S ., the Society developed the Minority Recruitment Initiative ( MRI ), a multifaceted effort targeting medical students , residents , fellows , and junior faculty to attract more minority medical students to hematology and increase the number of minority hematologists with academic and research appointments .
The MRI provides four complementary programs designed to offer opportunities at varying stages of a potential hematologist ’ s career :
• The Minority Medical Student Award Program offers an introductory mentored biomedical research experience for medical students .
• The Minority Graduate Student Abstract Achievement Award is designed to attract and / or retain minority PhD students to the field of hematology through participation in the ASH annual meeting .
• The Minority Resident Hematology Award Program provides support for minority resident physicians in an internal medicine , pathology , or pediatric residency program as they conduct hematology-focused research .
• The Harold Amos Medical Faculty Development Program seeks to increase the number of underrepresented minority scholars with academic and research appointments in the field of hematology .
For more information , visit hematology . org / Awards / 3866 . aspx .
Health Careers Opportunity Program
Funded by the U . S . Health Resources and Services Administration , the Health Careers Opportunity Program ( HCOP ) promotes recruitment of qualified individuals from disadvantaged backgrounds into health and allied health professions programs . Other goals of this program include :
• improving retention and admission rates by putting tailored enrichment programs into action that address the academic and social needs of disadvantaged trainees
• providing opportunities for community-based health career training , emphasizing experiences in underserved communities
For more information , visit bhw . hrsa . gov / grants / healthcareers .
Programs to Increase Diversity Among Individuals Engaged in Health-Related Research
The National Heart , Lung , and Blood Institute sponsors Programs to Increase Diversity Among Individuals Engaged in Health-Related Research ( PRIDE ), an all-expenses-paid Summer Institute , research education , and mentoring initiative . PRIDE addresses the difficulties junior investigators and transitioning post-doctoral scientists may experience as they establish independent academic research careers and negotiate the academic ranks . The primary outcome of the program is to increase the number of scientists and research-oriented faculty with disabilities and those from backgrounds currently underrepresented in the biomedical sciences , by preparing them to successfully compete for external funding for scientific research in heart , lung , blood , and sleep disorders .
The Work That Remains
Despite the growing number of programs available to promote diversity and inclusion , more work remains , according to Dr . Nunez-Smith . “ When the idea of cultural competency training first came about , it forced people to have conversations about diversity ,” she said . “ A couple decades later , though , I think it is time to reevaluate .”
Cultural competency training involves educating people to understand or relate to a patient ’ s diverse values , beliefs , and behaviors , and to adjust treatment based on those factors . However , Dr . Nunez- Smith said that cultural competency training often gets boiled down to threehour workshops that do not translate into necessary long-term behavior changes .
People need to take the next steps in creating inclusive medical education , she said . One updated approach incorporates the idea of cultural humility , or the “ ability to maintain an interpersonal stance that is other-oriented ( or open to the other ) in relation to aspects of cultural identity that are most important to the [ person ].” 13
“ When I sit across from a patient , I am not striving toward competency ,” said Dr . Nunez-Smith . “ I am striving toward humility , toward being open . Every patient has an identity . Everybody has a culture and a lived experience that is informing their health .”
Recognizing that people have different experiences – and that patients and providers have unconscious biases – is central to the idea of diversity and inclusion .
“ When we talk about diversity , we are really talking about a diversity of perspective , a diversity of biases ,” Dr . Nunez- Smith explained . “ We have to own up to the fact that we all cognitively shortcut to certain thoughts and developed biases . There should be no presumption that a person of color is going to be any less biased than anyone else .”
Diversity 2.0 , and Beyond …
To conceptualize diversity ’ s broader relevance to health care and medical education , AAMC developed a three-phase paradigm ( a framework borrowed from technology company IBM ) for incorporating diversity in medical schools and teaching hospitals – what AAMC has termed the “ diversity operating system ” or DOS .
The first iteration of these efforts , DOS 1.0 , included “ somewhat isolated efforts aimed at removing social and legal barriers to access and equality , with institutional excellence and diversity as competing ends . … DOS 2.0 kept diversity on the periphery but raised awareness about how increasing diversity benefits everyone ,” Marc A . Nivet , EdD , former chief diversity officer at AAMC , wrote in a commentary introducing the Diversity 3.0 Learning Series . “ In the DOS 3.0 paradigm , diversity and inclusion are integrated into the core workings of the institution and framed as integral to achieving excellence .” 14
The Diversity 3.0 Learning Series lineup features a series of webinars that delve into the new paradigm , including topics such as “ Attracting Black Men to Medicine : Physicians ’ Call to Action ” and “ A Leader ’ s Role in Addressing LGBT Health .” 15
“ With this next step , institution leaders must look critically at their internal structures , policies , and programs , and ask , ‘ Are we doing the best we can to be inclusive ?’” Dr . Castillo-Page explained . “ It also means investigating what is going on outside the institutions ’ doors and asking , ‘ Are we engaged with our community ? How is our institution perceived by the community ?’”
To have diversity and inclusion be a central part of excellence , the efforts must be intentional and persistent , said Dr . Churchwell . “ You have to think about diversity every moment of every day ,” he said . “ If not , you will fall back into the process of doing things out of habit that were formed in your unconscious-bias brain . You have to be intentional about building programs to populate your candidate pool and creating a nurturing environment for those students within your institution and community .”— By Leah Lawrence ●
REFERENCES
1 . Institute of Medicine . In the nation ’ s compelling interest : ensuring diversity in the health-care workforce . Washington , DC : National Academies Press ; 2004 .
2 . Supreme Court of the United States . Fisher v . University of Texas at Austin et al . No 14-981 . Accessed January 19 , 2017 , from https :// www . supremecourt . gov / opinions / 15pdf / 14-981 _ 4g15 . pdf .
3 . American Association of Medical Colleges . AAMC statement on the Supreme Court ruling in Fisher v . University of Texas at Austin . Accessed January 19 , 2017 , from https :// www . aamc . org / newsroom / newsreleases / 462622 / fisher _ texas _ scotus _ 06232016 . html .
4 . American Society of Hematology . Statement from ASH , AACR , AACI , ASTRO , ASPHO , and LUNGevity Foundation on the administration ’ s executive order on immigration . Accessed February 1 , 2017 , from http :// www . hematology . org / Newsroom / Press- Releases / 2017 / 7076 . aspx .
5 . U . S . Census Bureau . QuickFacts . Accessed January 25 , 2017 , from https :// www . census . gov / quickfacts / table / PST045216 / 00 .
6 . American Association of Medical Colleges . FACTS : applicants , matriculants , enrollment , graduates , M . D . -Ph . D ., and residency applicants data . Accessed January 25 , 2017 , from https :// www . aamc . org / data / facts .
7 . Guevara JP , Adanga E , Avakame E , et al . Minority faculty development programs and underrepresented minority faculty representation at US medical schools . JAMA . 2013 ; 310:2297-304 .
8 . National Institutes of Health . Glossary . Accessed January 18 , 2017 , from https :// diversity . nih . gov / find-read-learn / glossary .
9 . Cooper-Patrick L , Gallo JJ , Gonzales JJ , et al . Race , gender , and partnership in the patient-physician relationship . JAMA . 1999 ; 282:583-9 .
10 . Saha S , Taggart SH , Komaromy M , Bindman AB . Do patients choose physicians of their own race ? Health Aff ( Millwood ). 2000 ; 19:76-83 .
11 . Casagrande SS , Gary TL , LaVeist TA , et al . Perceived discrimination and adherence to medical care in a racially integrated community . J Gen Intern Med . 2007 ; 22:389-95 .
12 . Saha S , Guiton G , Winners PF , et al . Student body racial and ethnic composition and diversity-related outcomes in US medical schools . JAMA . 2008 ; 300:1135-45 .
13 . Hook JN , Davis DE , Owen J , et al . Cultural humility : measuring openness to culturally diverse clients . J Couns Psychol . 2013 ; 60:353- 66 .
14 . Nivet M . Commentary : Diversity 3.0 : a necessary systems upgrade . Academ Med . 2011 ; 86:1487-9 .
15 . Association of American Medical Colleges . Diversity 3.0 learning series . Accessed January 25 , 2017 , from https :// www . aamc . org / initiatives / diversity / learningseries /.
32 ASH Clinical News March 2017