Barriers and Potential Solutions to Enhancing Diversity in Medicine

A webcast hosted by the Association of Black Cardiologists (ABC) tackled the contemporary barriers and issues affecting diversity in medical training programs and offered potential solutions to enhancing diversity within the medical profession as a whole.

“Towards Legitimacy and Results in Achieving Diversity, Inclusion and Belonging in Cardiology Training Programs” featured keynote speaker Quinn Capers, MD, vice dean of faculty affairs at The Ohio State University College of Medicine and interventional cardiologist. Capers has been instrumental in identifying and addressing implicit bias in medical school admissions processes.

Barriers To Enhancing Diversity

“Diversity is a driver of excellence in health care delivery,” Capers said during his presentation. However, structural and often covert barriers impede diversity in medicine. Capers identified these 4 barriers to enhancing diversity within the medical profession:

1. Doubt or knowledge deficit in regard to the value of diversity
2. Selection processes not mission-based or evidence based
3. Indifference to active, strategic, long-range recruiting
4. Structural and individual bias in selection processes

Discourse on diversity and racism have recently been revitalized following widespread protests against long-standing racial injustices and diversity campaigns in the United States; however, Capers shared results from a 2020 survey published in the Journal of the American Heart Association gauging cardiology fellowship training directors’ perceptions of diversity. Responses demonstrated a lack of cohesive support of improving diversity in their medical programs.^1,2

Fifteen percent of cardiology fellowship program director respondents said that their programs do not need to address diversity and that it should not even be on the radar. Sixty-three percent do not think that diversity needs to be increased in their program, according to survey results.

In addition, 3 out of 10 cardiology fellowship program directors who responded to the survey were not sure if diversity enhances quality.

Respondents were also asked to rank a series of considerations when they are creating their rank list. The top 3 considerations are listed below with their respective responses:

• Clinical skills/acumen (65%)
• Ability to fit in/team player (56%)
• Researcher productivity (36%)

Although the ability to fit in was rated the second most important factor in creating rank lists, program directors rated diversity/ability to enhance the cultural competency of the program as least important. “It is literally the last thing on the minds of cardiology fellowship program directors when they’re making their rank list,” Capers said.

The Pipeline and the Mentoring Cascade

Capers highlighted the importance of improving the pipeline for Blacks and Hispanics aiming to enter into the medical profession through 3 key touchstones:

1. Deep pipeline: Exposure in elementary school and high school
2. Short term pipeline: Mentoring, advising, shadowing, and coaching college premed students and medical students
3. Admissions committees trained in:
   1. Mission-based selection processes
   2. Holistic review
   3. Bias mitigation

Capers’ presentation stressed that all 3 touchstones are equally important. Failing to address the deep and short-term pipeline results in a mere trickle of minority students. “On the other hand, if we’re only working on the pipeline, and the selection process is still biased, that’s no good either, so we have to work on all of these together,” Capers explained.

Minority representation, as well as mentoring, advising, and coaching, are critical in supporting prospective minority medical students, “and they need for us to allow them to shadow, so they can get really excited about our profession,” Capers added.

Mentoring minority students is particularly important in order to create and sustain mentoring cascades. “People who look like you are telling you that you can do it. That’s very powerful.”

Implicit Bias

The ABC presentation also tackled implicit bias and white race preference within medical programs’ admission processes.

The Ohio State University College of Medicine tested their medical school admissions committee through the Black White Implicit Associations Test and found that more than 50% had implicit white race preference, meaning that they unconsciously associated a white individual’s face positively and a Black individual’s face negatively. Fifty-two percent of the women and 64% of the men on the medical school admissions committee demonstrated this white race preference.

Following these results, the admissions committee participated in an implicit bias mitigation workshop, and as a result, the subsequent class was the most diverse in the history of The Ohio State University College of Medicine.

“We’ve now operationalized implicit bias mitigation and made it a part of being on the admission committee,” Capers said.

The Ohio State University College of Medicine was committed to prioritize enhancing diversity through their admissions process. It created a bias reduction cheat sheet for 1-on-1 candidate interviews. It also implemented a process to rate prospective candidates on their ability to enhance cultural competency.

From Barriers to Action Items

Capers also noted the Twitter campaign #BlackMenInMedicine. “We want to flood social media with images of Black male physicians to encourage young people to speak out against injustice and to change the nation’s unconscious bias about Black men,” he said.

And although social media campaigns and exposure to the importance of enhancing diversity in medicine are valuable pursuits, Capers stresses that, ultimately, “the most powerful and most durable anti-racism statement that we can make in the medical profession is to diversity our ranks.”

Furthermore, the larger ambition is to improve health care delivery and patient care; the more diversity represented amongst health care providers, the better the care that is delivered to patients, Capers said.

References:

1. Capers, Q. Towards Legitimacy and Results in Achieving Diversity, Inclusion and Belonging in Cardiology Training Programs: A Program from the Association of Black Cardiologists. Association of Black Cardiologists; October 9, 2020.
2. Crowley AL, Damp J, Sulistio MS, et al. Perceptions on diversity in cardiology: a survey of cardiology fellowship training program directors. Journal of the American Heart Association; August 25, 2020. doi: https://doi.org/10.1161/JAHA.120.017196.