Program Director Corner – May 2018

Dr. Ricardo Correa and Dr. Karyne Vinales
University of Arizona College of Medicine Phoenix

The definition of “diversity” in medical education has not changed over the past few decades. It is characterized by, but not limited to, race, ethnicity, gender, age, sexual orientation, education, culture, origin of training, heritage, religion, geography, physical abilities and socio-economic status. Multiple medical organizations have developed programs and projects with the objective to increase the diversity of the workforce in Medicine. For example, at the Association of American Medical Colleges (AAMC) Diversity and Inclusion strives to cultivate Human Capital by enhancing the skills of individuals; build Organizational Capacity by improving institutions’ ability to use diversity as a driver of excellence; and grow a diverse and culturally-prepared health workforce by improving the integration of Public Health concepts into medical education (1).

Another term that is important to mention when we talk about diversity is “minority.” The latter as per the AAMC is defined as those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population (2). Although diversity and minority share some overlap, they are not equal.

Data from the American Association of Clinical Endocrinologists (AACE) support the statement that endocrinology is one of the most diverse areas of Medicine. Fifty-five percent of the early career endocrinologists are females, and 33% of the faculty and fellows are international medical graduates. Because we work with a significantly diverse subgroup, we need to be aware of the challenges that follow each individual.

It is very important to recognize that minorities in Medicine can experience implicit (or “unconscious”) bias, isolation and exclusion, lack of collegiality, stress of living in 2 worlds, and microaggression that can affect their productivity, satisfaction and wellbeing (3,4). At a faculty level, the minorities sometimes are treated as a “token” and as a concession to “diversity” or affirmative action (5). They are expected to work harder and to handle “minorities issues” (3). We would like to briefly define two concepts mentioned above that are relevant to understand in order to improve our collegiality when we work in a diverse environment. Implicit bias: attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. Microaggressions: brief and everyday slights, insults, indignities, and denigrating messages related to a person’s marginalized social identity (or identities) (6). While education may increase awareness of these problems, we can only combat them by exercising consciousness in each act, i.e., the self-reflection of our actions. As an example, although the inequality in salary favoring male sex in Medicine has been vastly publicized, which has increased awareness and education on this topic; nevertheless, the gender gap in salaries has grown in the last couple of years over 25% – including academic medicine – because no action was taken to decrease this implicit bias (7).

In our personal experience, being involved in programs and organizations that stimulate fellows and faculty members of underrepresented minorities to share their experience and network with others of similar backgrounds, such as National Hispanic Medical Association (NHMA), American Association of Physician of Indian Origin (AAPI), Local or Institutional Diversity and Inclusion committees, National Institute of Minority Health and Health Disparities from NIH, has helped in building our careers and developing a deep understanding of collegial workplace. We recommend talking to your faculty members and fellows about diversity and inclusion and resources that are available for them. If you want more information, please email us.

Conclusion

The endocrine community is very diverse. It is our responsibility as the program leaders to understand the concept of minority and diversity in our environment, so we can foster a workforce that is inclusive. At the end, we are producing a new generation of endocrinologists that appreciate the importance of diversity and inclusion in Medicine.

Good Resources

1. https://www.nhmamd.org
2. https://www.aapiusa.org
3. https://www.nimhd.nih.gov
4. https://www.ama-assn.org/about/international-medical-graduates-section-imgs
5. https://www.ama-assn.org/about/women-physicians-section-wps
6. http://www.im.org/page/aaim-diversity-and-inclusion-committee

• Diversity and Inclusion. AAMC webpage. Cited on May 5, 2018 from https://www.aamc.org/initiatives/diversity/
• Underrepresented in medicine definition. AAMC webpage, Cited on May 5, 2018 from https://www.aamc.org/initiatives/urm/
• Rodriguez JE, Campbell KM, Fogarty JP, Williams RL. Underrepresented minority faculty in academic medicine: a systematic review of URM faculty development. FamMed.2014 Feb;46(2):100-4.
• Rodríguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation ofminority faculty in academic medicine. South Med J. 2014 Dec;107(12):739-44.
• Turner, Caroline Sotello Viernes and Myers, Samuel L., Jr. Faculty of color in academe: Bittersweet success. Boston, MA: Allyn and Bacon, 2000
• Sue, Derald Wing,Capodilupo, Christina M.,Torino, Gina C.,Bucceri, Jennifer M.,Holder, Aisha M. B.,Nadal, Kevin L.,Esquilin, Marta. Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, Vol 62(4), May-Jun 2007, 271-286
• Jena, Anupam B.; Olenski, Andrew R.; and Blumenthal, Daniel M. Sex differences in physician salary in U.S. public medical schools. JAMA Intern Med. 2016. 176(9):1294-1304.