EDUCATION

New York American College of Emergency Physicians

Devjani Das, MD FACEP

Devjani Das, MD FACEP

Director, Emergency Medicine Clerkship Director, Undergraduate Point-of-Care Ultrasound Medical Education Associate Professor of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons

Guest Author Nick Jobeun, DO MBA

Guest Author Nick Jobeun, DO MBA

Medical Education Fellow Assistant Professor of Clinical Emergency Medicine Maimonides Medical Center

Guest Author Joshua Schiller, MD

Guest Author Joshua Schiller, MD

Director of Global Health/Social Emergency Medicine, Attending Physician Maimonides Medical Center

Improving Diversity with Recruitment

The value of diversity in the medical field cannot be overstated. Studies have shown increasing diversity among physicians and healthcare professionals, in general, is not only important for the sake of representation, but for improving the quality of care for all patients and for patient satisfaction.1 This further reinforces the importance of promoting diversity, equity and inclusion (DEI) within our specialty.

The most recent AAMC data shows a mismatch between the physician workforce and the demographics of the United States (US). The AAMC reports most doctors are white (63.9%) and male (58.6%). In addition, Undergraduate Medical Education (UME) data shows white students (46.8%) make up the largest racial group of medical students compared to their black (8.4%) and Latinx/Hispanic (6.2%) counterparts.2 This is in stark contrast to US census data, which demonstrates black Americans and Latinx/Hispanic Americans make up 13.6% and 18.9% of the nation’s population, respectively.3

This discrepancy leads us to recognize that a multifaceted approach is needed to acknowledge the root causes of the lack of diversity among emergency physicians. To address this disparity, we should focus on the factors that affect the matriculation of diverse applicants into emergency medicine, as well as methods to facilitate improvement. Strategies that may be used institutionally to increase diversity, equity and inclusion include:

Diversity: Pipeline Programs

In order to increase diversity among doctors, we must focus efforts “upstream,” i.e., in the pipeline leading to medical school. Underrepresented Minority (URM) students face a range of barriers, including inadequate academic preparation, financial constraints and limited access to resources and opportunities. In response, many institutions have implemented interventions to increase the number of URM students who are motivated and prepared to pursue a career in medicine. These programs provide mentorship, academic opportunities and exposure to the medical profession, all of which are common barriers for URM students.4,5 Participating students describe the experience as leveling the playing field and giving them an opportunity to live up to their dreams.5

Equity: Holistic Admissions Process

As an adjunct to modifications to the medical student pipeline, we must also use a holistic and equitable review in the admissions process. A holistic review process can be described as taking equal consideration of an applicant’s experiences and attributes, as well as academic metrics and how the applicant could add value to a program.6 This strategy helps mitigate bias that accounts for the disparity minority students face with a lack of educational opportunities and mentorship.4 In this way, institutions can identify and select candidates who are likely to succeed in medical school and beyond, regardless of their background. This can be done by the creation of goals for recruitment, determination of program readiness and the formulation of DEI committees for recruitment.7

 

Inclusion: Culture of Support

Institutions can also create a culture of support to address the broader social and cultural factors contributing to the lack of inclusion in medicine. By addressing these issues at a systemic level, institutions can provide a learning environment that supports and attracts diverse learners to their institution. Strategies include cultural competency and bias training, increasing awareness and support of diverse learners and creating curricula or DEI task forces.8,9

Ultimately, it is important to remember that increasing diversity does not rely on a singular prescription, but rather a comprehensive and sustained approach to institutional changes. Identifying and addressing the root causes can serve as the foundation for implementing a combination of strategies that will be more effective in achieving a more diverse and inclusive medical community. By creating a supportive learning environment for our learners, we can promote higher achievement throughout the student community.

References

  • LaVeist TA, Pierre G. Integrating the 3Ds–social determinants, health disparities, and health-care workforce diversity. Public Health Rep. 2014 Jan-Feb;129 Suppl 2(Suppl 2):9-14. doi: 10.1177/00333549141291S204. PMID: 24385659; PMCID: PMC3863706.
  • Diversity in Medicine: Facts and Figures 2019 (AAMC). https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
  • US Department of Commerce. United States Census Quick Facts. https://www.census.gov/quickfacts/fact/table/US/PST045221
  • Hill K, Raney C, Jackson K, Murdock HM, Dawson E, Hamilton R, DeLisser H, Mamtani M, Aysola J. A New Way of Evaluating Effectiveness of URM Summer Pipeline Programs. Adv Med Educ Pract. 2021 Aug 10;12:863-869. doi: 10.2147/AMEP.S293744. PMID: 34408526; PMCID: PMC8364337.
  • Stephenson-Hunter C, Strelnick AH, Rodriguez N, Stumpf LA, Spano H, Gonzalez CM. Dreams Realized: A Long-Term Program Evaluation of Three Summer Diversity Pipeline Programs. Health Equity. 2021 Aug 4;5(1):512-520. doi: 10.1089/heq.2020.0126. PMID: 34476324; PMCID: PMC8409231.
  • DeWitty VP. What Is Holistic Admissions Review, and Why Does It Matter? J Nurs Educ. 2018 Apr 1;57(4):195-196. doi: 10.3928/01484834-20180322-01. PMID: 29614186.
  • Gallegos M, Landry A, Alvarez A, Davenport D, Caldwell MT, Parsons M, Gottlieb M, Natesan S. Holistic Review, Mitigating Bias, and Other Strategies in Residency Recruitment for Diversity, Equity, and Inclusion: An Evidence-based Guide to Best Practices from the Council of Residency Directors in Emergency Medicine. West J Emerg Med. 2022 May 10;23(3):345-352. doi: 10.5811/westjem.2022.3.54419. PMID: 35679505; PMCID: PMC9183777.
  • Jongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018 Apr 2;18(1):232. doi: 10.1186/s12913-018-3001-5. PMID: 29609614; PMCID: PMC5879833.
  • Heron SL, Lovell EO, Wang E, Bowman SH. Promoting diversity in emergency medicine: summary recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup. Acad Emerg Med. 2009 May;16(5):450- 3. doi: 10.1111/j.1553-2712.2009.00384.x. Epub 2009 Mar 26. PMID: 19344454.