”For the past few decades, medical education’s definition of “diversity” has largely remained the same, as has the social mandate to increase it”.(Mark and Attiah, 2014, p1475) but nowadays the benefits of increased diversity based on gender type, ethnic and racial background of medical students are significant. Greater diversity and inclusion are not only important in equalization, but they also to ensure future physicians can competently care for the dynamic and increasingly diverse patients population which directly impact patient outcomes and improves patient satisfaction through wider access to care for these minor groups of patients in the healthcare workforce to final eradication health disparities within the health care system.
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This essay will discuss how variations in race, ethnicity and gender statuses have been addressed in the term of diversity in medical education at the academic level and evaluate how much it is effective focusing on situations in USA and Canada. Beginning with some facts about increasing diversity followed by the introduced approaches and its effectiveness and ended with a conclusion.
Although the number of racial and ethnic minority medical school applicants is increasing, many steps and approaches need to be taken considerably to ensure their success throughout their medical profession. Specifically, efforts need to be made at all stages of the education process to increase the diversity of physicians. The following paragraphs will demonstrate some facts that indicate increases in medical school applicants of all racial and ethnic minorities by reports conducted in 2008 by AAME followed by the approaches that had been introduced recently.
”The percentage of Black or African American and Hispanic/Latino applicants both increased between 2006 and 2007 by 6.6% and 7.7% respectively” (AAMC,2008, p21). Furthermore, ”Mexican American and Puerto Rican applicants increased by 17.6% and 21.1% respectively” (AAMC,2008, p22). But Asians currently represent the second largest group of applicants accounted for 19.7% after the white applicants who accounted for 57.3 %. However, these increases are still inconsistent with population growth so, AAMC would recommend doing further efforts to promote and increase enrollment of students from racial and ethnic minority backgrounds to provide greater access to and quality of care for those underserved communities (AAME,2008).
There had been recent approaches conducted by students advocating for diversity in medical education at the University of South Carolina School of Medicine Greenville claimed that ”as incoming classes of students are increasingly more diverse, student eﬀorts for diversity and inclusion initiatives must be explored as avenues to eﬀect positive change within the system.”(Moss et al.2019, p1).These medical students at (UofSC SOM Greenville) formed the committee known as Student Advocates for Diversity and Inclusion (SADI) in Fall 2017, with the goals of enhancing the curriculum, increasing the distinguishability of diverse peoples within the medical school and the healthcare system, also supporting the experience of these peoples (Moss et al.,2019) by doing some changes on curricular practices and the development of extracurricular programs. In next paragraphs will demonstrate methods used by this committee.
Firstly, SADI aimed to do some curricular changes by introducing new class sessions on topics of diversity and expansion of the cultural competence curriculum (e.g. in the second year, Loss of Trust: History of Medicine, Race, and Discrimination, and a Patients with Obesity panel). Also, SADI created a checklist to guide case presentations so that they better reﬂect the diversity of our future patient populations. The checklists enumerate various patient characteristics including race/ethnicity, sexual/gender identity, English language ﬂuency, religion, socioeconomic status, disability, and education level. For more instance, faculty members were also asked to ensure each of their case scenarios incorporated at least two characteristics from the list and to consider these characteristics in guiding student discussions about how health disparities inﬂuence the delivery of patient care. The diversity checklists now guide clinical case development and classroom discussion on how diversity and discrimination create health disparities and aﬀect health outcomes (Moss et al.,2019).
Secondly, SADI believed that each student should have opportunities to interact with diverse patients in preclinical years, during the preclinical years, students usually learn history-taking and clinical exam skills through interactions with standardized patients but SADI advocate for the inclusion of diverse patient populations in the homogeneous patient setting for such illustration, Hispanic/Latino populations face particular health disparities for several reasons, including physician preconception, discrimination, lack of training, and language barriers so SADI believed that is important to understand these disparities by providing students practice in caring for these people. Teachers and administrators also introduced new lectures and training focused on Hispanic/Latino, non-English speaking patients; these innovations ensure students are exposed to these populations early, often, and throughout all four years of medical school (Moss et al.,2019).
Lastly, SADI recognized another path for positive change in their medical school by introducing extracurricular programs to facilitate conversations about diversity and inclusion, they provide a platform for students to ask diﬃcult questions on popular celebrity talks, then they collected unnamed student questions on topics of adversity, socioeconomic barriers, immigration, religion, race, and gender in medicine which will be answered by respected physicians, faculty members, and community leaders to facilitate deeper discussions, create protected space for dialogue on diﬀering perspectives, and broaden students’ awareness of issues facing medicine today also obtained feedback from attendees of the event using audience response technology, by which attendees were invited to submit one- to three-word descriptors in response to the program (Moss et al.,2019).
To sum up, SADI believes it imperative to include the perspective of the patient in what strategies they recommend to achieve diversity and inclusion by prepare medical students for the actualities of medical practice necessarily involves the voice of an underrepresented group of patients to better access of all health measures. For these reasons, SADI anticipates recommending a patient serve on the curriculum committee in all medical schools (Moss et al.,2019). Besides, the subsequent paragraph will continue to illustration another effective strategy to include diversity in race and ethnicity.
According to (Marc, 2011) who employs a diversity framework applied by International Business Machines Corporation (IBM) and argues that this framework should be modified to an academic medicine situation to meet challenges to the health care organization, he explored three phases in the progression of diversity within the academic medicine society by using IBM’s diversity framework. In the next three paragraphs will demonstrate each phase in sufficient detail.
The first phase DOS 1.0 is to include isolated efforts which intended to remove social and legal barriers to access and equality with institutional excellence and diversity as challenging targets by forming offices for minority affairs isolated from the existing educational, research, and patient care works. In addition, to provide safe spaces that developed racial and ethnic minority students, these offices were tasked with ensuring compliance with civil rights regulation and agreeing action. As a result, DOS 1.0 reflected the view that racial and ethnic diversity was important but not critical to an institution’s main functions (Marc, 2011).
The second phase DOS 2.0 is to keep diversity on the edge but raised awareness about how increasing diversity aids everyone, allowing excellence and diversity to existing as parallel ends by offering some course work and research opportunities examining public health and health care disparities which have contributed to a sense of inclusiveness on campus and assisted build awareness among members of the majority. As a result, greater diversity in the classroom joined with the intentional integration of diversity as a teaching and learning tool benefit the intellectual development, service orientation, self-awareness, and cultural competence of all students (Marc, 2011).
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In the third phase, DOS 3.0 which is developing today and reflects how much we raise the understanding of diversity will have to widen relevance to institutions and systems, diversity and inclusion are combined into the core of institution works and outlined as essential for reaching excellence. Therefore, diversity work must be seen as more than just solving the issue of inadequate representation of minorities and barriers facing them so, diversity must be strongly coupled with developing a culture of inclusion. As a result, together diversity and inclusion can become a powerful tool to build innovative, high performing organizations (Marc, 2011).
Finally, (Marc, 2011) argued that to fulfill the promise of this concept of diversity, medical schools, and teaching hospitals must acknowledge diversity as a strategic imperative to be included all over the institution and its functions.
In this coming section will discuss how women’s representation has increased over the past few decades in medicine. However, despite increasing representation, women still encounter bias and discrimination comparing to men in this field across a variety of outcomes, including treatment at school and work, hiring, compensation, evaluation, and promotion. Individual and systemic biases produce undesirable environments for women, specifically when the woman have another diminished factor such as a woman of colour.
”The general approach to working toward gender equality, and diversity more broadly, has been largely rooted in attitudes and values” (Kang and Kaplan, 2019, p581) therefore, It is believed that the key to controlling bias is controlling how people think, most of the efforts made to minimise bias in organisations has focused on controlling or eliminating the biases that occur in our minds. for example of such efforts, they did Imply bias training by doing the Implicit Association Test (IAT) which has become routine and increased in popularity. However, despite the millions of dollars spent on ordering the IAT and training people to act without bias, the evidence showed that changes in organisational consequences are rare. More commonly, diversity training programs (especially when done alone and not conjugated with other organisational involvements) has shown to be associated with reduced diversity (Kang and Kaplan, 2019).
The second strategy is to change institutional norms for example women are expected to be kind and nurturing and men are expected to be competent and strong but these norms have strong effects on our behavior, they result in women being socialised into more communal medical specialties such as family medicine and men being socialised into more agentic specialties such as surgery. Fortunately, because we are a social species, changing perceptions of norms also changes behavior so, we are more likely to act like we value diversity ourselves, anyhow if the expression of prejudicial attitudes in discriminatory behaviour is considered normative these practices will become embedded within a social environment. The most important source of such normative change is group’s leaders whereas the behaviour of those has a powerful influence on the people, therefore the communication and behaviour of hospital administration and senior staff, for example, must show a commitment to diversity for others to follow suit (Kang and Kaplan, 2019).
The third strategy is to implement behavioural guidelines and action plans, people usually established abstract of values and goals without action plan for achieving them and no indication of how progress will be measured and success recognized, in some cases abstract or attitudinal diversity goals have been unsuccessful and end up doing more damage than good so we should move from abstract plans to real actions to avoid bad consequences. Organisations must clearly clarify the specific steps that will be taken to endorse their values and goals, and specify the indicators that will be used to measure success, in the attending physician for example, some of these guidelines might include ensuring that at least a third of hiring committee members are women, with success being known as a fixed state of 50:50 men and women on committees within 3 years also ensuring that only standardised questions and structured interviews are used. As a result, there had been a significant increase in the number of women hired over a 3 year period which considered to be an indicator of success. Therefore, without specific behavioural guidelines to notify practice, diversity and inclusion are often unable to advance beyond attitudes and goals (Kang and Kaplan, 2019).
To sum up, ”we should also update our conceptualisation of gender itself to expand beyond the traditional male and female binary, to encompass the range of identities that represent gender diversity.”(Kang and Kaplan, 2019, p582).
The overall conclusion, I believe that Increasing the representation of racial and ethnic minorities and women in the field of medical education is necessary to address worldwide health disparities but many factors need to be addressed to increase the number of individuals from racial and ethnic minorities throughout the medical profession pipeline. However, the process of increasing diversity on gender, race, and ethnicity is ongoing and does not end with applications to medical school. Students should receive support throughout their education and into their careers to ensure their success as physicians.
- American Association of Medical Colleges (2008) Diversity in Medical Education: Facts & Figures 2008. Washington, DC. Available at: https://www.aamc.org/download/386172/data/diversityinmedicaleducation-factsandﬁgures2008.pdf (Accessed: 16 August 2019).
- Kang, S. and Kaplan, S. (2019). ‘Working toward gender diversity and inclusion in medicine: myths and solutions’ , The Lancet, 393(10171), pp. 579-586. Available at https://doi.org/10.1016/S0140-6736(18)33138-6 (Accessed: 14 August 2019).
- Marc, N. (2011). ‘Diversity 3.0: a necessary systems upgrade’ , Journal of The Association of American Medical Colleges, 86(12), pp. 1487-1489. doi: 10.1097/ACM.0b013e3182351f79
- Mark, A. and Attiah, B. (2014). ‘The new diversity in medical education’ , The New England Journal of Medicine, 371(16), pp.1474-1476. doi: 10.1056/NEJMp1408460
- Moss, J., Hardy, E., Cooley, K., Cuﬀe, S., Lang, M. and Kennedy, A. (2019). ‘Students advocating for diversity in medical education’ , AMEE MedEdPublish, pp.01-11. Available at https://doi.org/10.15694/mep.2019.000159.1 (Accessed: 18 August 2019).
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