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  • Viewpoints

    A Leadership Forum on Diversity and Inclusion

    Darrell G. Kirch, MD

    In June, approximately 70 academic medicine leaders representing all AAMC affinity groups gathered in Washington, D.C., for our 2017 Leadership Forum, “Achieving Diversity, Inclusion, and Equity in Academic Medicine.” Six months previously, at Learn Serve Lead: The AAMC Annual Meeting, Joan Reede, MD, professor of medicine and dean for diversity and community partnership at Harvard Medical School and chair of the AAMC Group on Diversity and Inclusion, challenged AAMC group leaders to view the work of all our groups, from those focused on business affairs and institutional advancement to our groups on research and faculty, through the lens of diversity and inclusion. This year’s Leadership Forum took that challenge as our focus, and the result was a robust conversation about the ways in which we as individuals and representatives of our institutions can actively work toward creating diverse and inclusive organizations focused on solving the profound health disparities in our communities.

    The discussion was wide ranging and dynamic, if difficult at times. In her powerful keynote address, Dayna Bowen Matthew, JD, then professor at the University of Colorado Law School and the Colorado School of Public Health, cofounder of the Colorado Health Equity Project, and author of Just Medicine: A Cure for Racial Inequality in American Health Care, described how implicit bias works to produce discrimination that is at least as harmful to health outcomes as explicit racism. Ms. Matthew, now the William L. Matheson and Robert M. Morgenthau Distinguished Professor of Law at the University of Virginia School of Law, presented sobering findings on physicians’ assumptions about their patients, including that many physicians perceive black patients as more likely to abuse drugs, less compliant with medical advice, and generally less intelligent and less well educated than white patients. She also showed how experiencing these implicit biases lowers a patient’s adherence to care and works against our goal to create healthier communities. However, she then offered proven interventions, showing us that it is possible to counteract our implicit biases by foregrounding equity and inclusion in an institution’s culture and systems, meaningfully engaging with the ethnic and racial minority communities we serve, collaborating with groups that have proven track records with minority communities, and using data to track our progress and make ongoing adjustments.

    Bringing together diverse perspectives in teams and organizations has been shown to generate more creative and innovative solutions.

    By focusing on the changes we can make at an institutional and systemic level, we had the opportunity to reflect not only on the impact we can have on our communities by tackling unconscious bias, but also on diversity as a driver of excellence at our institutions. Bringing together diverse perspectives in teams and organizations has been shown to generate more creative and innovative solutions. We need that creativity if we are to solve the challenges we face in academic medicine today—from our national divisions about how to provide and finance care, to reshaping medical education to fit the realities of today’s learners, to redefining health care leadership for the 21st century, to solving the problems of social inequity and health disparity within our communities. And we cannot reap the benefits of a diverse workforce without creating genuinely inclusive environments that welcome, value, and respect our differences. In his presentation at the Leadership Forum, AAMC Chief Diversity and Inclusion Officer David Acosta, MD, defined an inclusive environment as one that creates opportunities for all people to be part of the fundamental fabric of an organization—fully integrated, engaged, and empowered within its structures. He outlined the benefits of an inclusive environment, which include not only more diverse and innovative teams but also increased employee engagement, maximized productivity, and improved community relationships.

    Dr. Acosta then introduced a new tool, the Foundational Principles of Inclusion Excellence (FPIE) survey. This AAMC survey allows individuals to score their institutions in nine measures of inclusion, including demonstrated commitment to diversity, recognition and support of intersectionality and authenticity, equitable access to opportunity, and demonstrated commitment to community engagement. The purpose of this survey, which is in the final stages of development, is to assist medical schools and teaching hospitals in taking a snapshot of staff, faculty, and leadership perceptions of institutional and departmental efforts to achieve inclusion excellence. The survey results will help identify where perceptions are similar and where they may be incongruent, with the goal of sparking a dialogue about current best practices and areas for improvement.

    In addition to the FPIE survey, the AAMC has a number of other ongoing efforts to support our members in creating cultures of inclusion and addressing health inequities in their communities. In May, the AAMC, in partnership with The Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University, published a major unconscious bias report examining the effect of unconscious bias on seven areas of academic medicine and summarizing some effective interventions to remediate these biases. We offer workshops on unconscious bias and how it influences perceptions, decision making, education, and patient care. We also offer professional development opportunities for constituents from underrepresented racial and ethnic minority groups who aspire to leadership positions within academic medicine. We will continue the conversation this fall at Learn Serve Lead, which will feature sessions on confronting implicit and explicit bias in academic medicine; medical education research into diversity and inclusion; burnout and resilience among underrepresented minority faculty, students, and residents; and many more. Ms. Matthew will also join us at Learn Serve Lead for our Voices of Medicine and Society Series, where she will discuss law-based solutions to root out implicit bias and end the legacy of inequality in our health care system.

    Ms. Matthew concluded her presentation with a quote by Martin Luther King Jr., from the second national convention of the Medical Committee for Human Rights in March 1966: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” More than half a century later, we still have much work to do to eliminate health disparities within our communities. But I feel hopeful that, as a community, we are working to develop a deeper shared understanding of the barriers to diversity and inclusion at our institutions and how essential it is to remove those barriers if we are to achieve true health equity and improve the health of all. The work of improving the health of our communities must begin within the walls of each of our institutions, where, by connecting with one another’s individual talents and unique perspectives, we can accomplish more together than any of us could do on our own.