addressing diversity and inclusion in academic medicine...

Addressing Diversity and Inclusion in Academic Medicine:Are We Doing Enough?

Lisa Robinson, MD, FRCP(C)Head, Division of Nephrology, The Hospital for Sick ChildrenSenior Scientist, Program in Cell Biology, HSC Research InstituteProfessor, Department of Paediatrics and Institute of Medical Science, University of TorontoChief Diversity Officer, Faculty of Medicine, University of Toronto

Objectives

2. Review the current landscape.

3. Discuss University of Toronto Faculty of Medicine’s approach to creating diverse and inclusive teams.

1. Discuss the benefits of diversity in academic medicine.

Diversity and Inclusion- Definitions

Diversity embodies inclusiveness, mutual respect,multiple perspectives, and serves as a catalyst for change resulting in health equity. In this context,we are mindful of all aspects of human differencessuch as socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexualorientation, religion, geography, disability, and age.(from www.aamc.org/gdi)

http://www.aamc.org/gdi


Inclusion is a core element for successfully achieving diversity. Inclusion is achieved by nurturing the climate and culture of the institutionthrough professional development, education, policy, and practice. The objective is to create aclimate that fosters belonging, respect, and valuefor all and encourage engagement and connectionthroughout the institution and community. (from www.aamc.org/gdi)



Culture: Deeply instilled values and beliefs of aninstitution.

Climate: Perceptions, attitudes, and behaviorsreflecting the beliefs and values (the culture) of an institution.(from www.aamc.org/gdi)From McKay PF, Avery DR, Tonindandel S, Morris MA, Hernandez M, Hebl MR. Racial differences in employee retention: are diversity climate perceptions the key? Pers Psychol 2007. 60:35-62


Why is diversity important?

An academic medical centre should reflect the community in which it is housed.

City? State/Province? Country?

Positive impact on workforce

Positive impact on education

Diversity positively impacts patient care

Under-represented minority (URM) faculty aremore likely to work in underserved areas, and tocare for URM patients.

Minority patients tend to seek care from, and toreport greater satisfaction when they receivecare from a minority physician.

Positive effects on curriculum (formal, informal,hidden).

Positive effects on learning outcomes in diverse medical classes.

Creates an environment in which culturalstereotypes and assumptions can be challenged.

Diversity positively impacts medical education

Diversity positively impacts science

“While women continue to be underrepresented as workinggroup participants, peer-reviewed publications with gender-heterogeneous authorship teams received 34% more citations than publications produced by gender-uniformauthorship teams.”


RB Freeman and W Huang. Collaborating withPeople Like Me: Ethnic Coauthorship Withinthe United States. Journal of LabourEconomics (2015). 33 (S1 Part 2): S289-S318.

5-10% increase in citations for papers authoredby multi-ethnic teams.

How are we doing?

Hispanic/Latino, Black/African-American, Native American,Alaskan Native, Native Hawaiian, Pacific Islander- 31.4%

US Medical School Graduates by Race/Ethnicity 2015

AAMC Facts and Figures

Hispanic/Latino, Black/African-American, Native American,Alaskan Native, Native Hawaiian, Pacific Islander- 10.4%

Distribution of US Medical School Faculty by Sex and Race/Ethnicity

AAMC Faculty Roster, December 31, 2016

5.8%

Canada’s racial diversity (2011)Total population 34.88 million6.78 million (20.6%) foreign-bornIn the past 5 years, most immigrants came from:Asia (including the Middle East)AfricaCaribbeanCentral and South America

6.26 million (19.1%) of total population belongto visible minority groups:South Asian, Chinese, Black- 61.3%

Indigenous- 5.4% (1.89 million)National Household Survey, 2011

Toronto’s racial diversity (2013)Population 2.79 million (5.5 million in GTA)

Very multi-cultural (>140 languages and dialects;>30% of residents speak a language other thanEnglish or French.

1.24 million (50%) born outside of Canada1.16 million (47%) reported themselves as beingpart of a visible minority.Statistics Canada: Persons, other than Aboriginalpeoples, who are non-Caucasian in race, or non-white in colour.

Toronto’s Top 5 Visible Minority Groups

South Asian 12.0%Chinese 11.4%Black 8.4%Filipino 4.1%Latin American 2.6%

Indigenous 0.5% (13,605)(First Nations, Metis, Inuit) (70,000?)

How are we doing?

39.6% of faculty are female; 12.5% of female faculty are full professorsAAMC Faculty Roster, December 2016

How are we doing?

60.4% of faculty are male; 27.8% of male faculty are full professorsAAMC Faculty Roster, December 2016

2000 Promotion Rates AssistantAssociate Professors Recruited

1983-2000

Whites 30.0% (CI 28.0-32.1)

Blacks 21.7% (CI 23.3-29.1)

Hispanics 26.2% (CI 18.4-25.0 )

Nunez-Smith M et al, Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Publ Health (2012),102(5): 852-858 .

2000 Promotion Rates AssociateFull Professors Recruited 1983-2000

Whites 31.6% (CI 30.0-33.4)

Blacks 19.8% (CI 16.2-23.4)

Hispanics 27.3% (CI 24.0-30.6 )

Nunez-Smith M et al, Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Publ Health (2012),102(5): 852-858 .

Promotion of URM faculty to Associate Professor lags behind promotion of White faculty by 3-7 years.Petersdorf RG et al. Minorities in medicine: past, present, and future. Acad Med (1990), 65: 663-670.

Slower advancement (scholarly and professional) for minority facultyCora-Bramble D. Minority faculty recruitment, retentionand advancement: applications of a resilience-basedtheoretical framework. J Health Care Poor Underserved (2006), 2: 251-255.

The “Cultural Tax”

Diverse faculty are saddled with disproportionatelyheavy load of committee and advising work

Knowles MF and Harleston BW. Achieving Diversity inthe Professoriate: Challenges and Opportunities (1997).

Rodriguez JE et al. Addressing Disparities in AcademicMedicine: What of the Minority Tax? BMC Medical Education (2015). 15: 6.

URM faculty at academic institutions aremore likely to report feelings of isolation,exclusion, invisibility, poor fit.

Price EG et al. The role of cultural diversity climate inrecruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med (2005); 20: 565-571

Polioli L et al. The experience of minority faculty who areunderrepresented in medicine, at 26 representativeU.S. medical schools. Acad Med (2013); 85: 1492-1498

How are we doing?

Price EG et al. Improving the Diversity Climate in AcademicMedicine: Faculty Perceptions as a Catalyst for InstitutionalChange . Academic Medicine (2009)

URM faculty are almost 4 times more likelyto report dissatisfaction with diversity.

URM faculty are 3 times less likely to believethat networking includes minorities.

URM faculty are significantly less likely to believe that they will remain in their currentinstitution in 5 years.

How are we doing?

How are we doing?

Compared NIH-funded awardees to the relevant population of individuals eligible for such an award.

Fig 1. Representation ratios of NIH-funded workforce vs therelevant labor market, by race and ethnicity, and by sex2008-2012.

How are we doing?

-Study initiated with medical faculty from 24 medical schools in 1995-Designed to examine gender, racial, and ethnic disparities in productivity, advancement, and promotion.-Schools with ≥200 faculty, ≥50 women, ≥10minority faculty.Survey of the same faculty in 2012-2013

National Faculty Survey

Publications: Women vs Men

Differences disappeared for women with no children.

2010-11: interviews with 100 former recipients of NIH Career Development Awards and 28 mentors

Compared survey responses of 1,267 award recipients (clinician-investigators), 2006-9

How are we doing?

Career aspirations of women vs men

1853 recipients of NIH K08 and K23 awards in 2000-2003800 physicians who continued to practice in US academicinstitutions and who reported their current salary

How are we doing?

University of Toronto’s Faculty of Medicine: Strategic Priorities

1. Understand our environmentComprehensive surveys- diversity, equity,inclusion. Medical students, post-MD trainees, faculty, staff. Graduate students, post-doctoral fellows,scientific staff.

Policy and Analysis team (Glenys Babcock, Caroline Abrahams, Mariela Ruetalo,)

Appointments: Chief Diversity Officer (Jan 2016)Diversity Strategist (Jan 2017)- Anita Balakrishna


1. Understand our environmentShare findings with stakeholdersProfessional Association of Residents of OntarioVice-Chairs EducationToronto Academic Health Sciences Network (TAHSN)

CEO’s, Education, Research


1. Understand our environmentFollow-up:Resources re: reportingResponse toolkit (with Office of Resident Wellness)Diversity Dialogue-

‘Let’s Talk Islamophobia’‘How to Become an Ally’ workshop

Expansion to other domains (eg research environment)

Strategic Priorities.

2. Recruitment, retention, promotion, and leadership opportunities for peoplewith diverse backgrounds and experience

Summer Mentorship Program (high school)Community of Support (undergraduate)-

partner with MD/PhD students and Clinician Investigator trainees

BRITE (Black Researchers’ Initiative to Empower)Diversity Mentorship Program (medical students)Indigenous/ Black Student Application Programs

(MD admissions)

Academic Medicine 2017

Weill Cornell/Rockefeller/Sloan Kettering Tri-InstitutionalMD-PhD pipeline program (1993)

Summer research programClinical shadowingCareer development workshopsExtensive multi-tiered mentoring

245 alumni: 74% pursuing or completed MD, PhD, or MD-PhD

88% advanced degrees17% MD-PhD


2. Recruitment, retention, promotion, and leadership opportunities for peoplewith diverse backgrounds and experience

Indigenous Faculty WorkshopAcademic Promotion Session for WomenBlack Faculty academic appointment/promotion workshopMentorship/networking for women in scienceAthena-Swan?Invited speakers who reflect our population

Women:EducationMentoringInstitutional public image

Men:Corporate strategyPolicyFinanceGovernment relations


3. Enhance our curriculum

MD ProgramTheme leads: LGBTQ2S, Indigenous Health,Black Health (new)

Social Justice in Medical Education

Weave concepts of equity, power and privilege,inclusivity, and anti-oppression throughout

Post-MD curriculum?


4. Address unconscious bias- admissions,search, and hiring committees

Education- videos, workshops, written materialSearch CommitteesMD Admissions Committee

5. Focus on AllyshipOpen forum, FoM communications, workshops,Sharing stories, on-line modules, education for leaders

Lessons from the Business WorldDiversity is a key driver of innovation and is critical for success on a global scale.

A diverse and inclusive workforce is crucial forattracting and retaining top talent.

Nearly all respondents reported that their companies have diversity strategies in place (butnot all plans are the same- cultural/regional differences).

321 executives with companies with annual revenue > US $500 million

Lessons from the Business World

Responsibility for success of the companies’diversity/inclusion efforts lies with senior management.

7/10- buck stops with C-level and Board of Directors

Characteristics of Successful Diversification Programs in Academic Medicine

Multi-pronged approach

Takes a relatively long time to see demographic changes.

Can see cultural shift much earlier.

EQUALITY ≠ EQUITY

“Promotion of social justice, equity, diversity, and professionalism”Source: Values, Faculty of Medicine Strategic Academic Plan, 2011-2016

Thank you!

addressing diversity and inclusion in academic medicine...

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