Advancing Diversity, Equity, and Inclusion in Hospital Medicine

Pediatric hospital medicine fellow expectations for postgraduate employment

BACKGROUND

Pediatric Hospital Medicine (PHM) has a rapidly changing landscape following subspecialty certification in 2016. As the field continues to evolve, so does the role of fellowship training.

OBJECTIVES

The goal of this study was to characterize postgraduate expectations of current PHM fellows to contribute to the understanding of PHM workforce dynamics.

METHODS

Using a constructivist approach, we employed a cross-sectional survey method with both multiple-choice and free-text questions to study PHM fellows' perspectives regarding posttraining employment and motivations for pursuing fellowship. We used multiple listservs to recruit current PHM fellows for participation. We analyzed survey data using descriptive statistics and free-text responses using conventional inductive content analysis.

RESULTS

A total of 119 PHM fellows (response rate 61%) completed the survey. Most participants anticipated higher starting salaries, more protected time and leadership opportunities, and more efficient career advancement because of PHM fellowship training. Additionally, participants noted several modifiable factors influencing their postgraduate employment considerations which included workplace culture and lifestyle considerations. Participants reported various motivations for pursuing PHM fellowship training, including future job security and career flexibility.

CONCLUSIONS

Despite different reasons for pursuing additional training, the majority of PHM fellows in our study believe that fellowship training should result in increased compensation, resources, and career opportunities than if they had not completed fellowship training. These findings have implications for counseling trainees interested in PHM and for the PHM workforce.

The time has come: discussing the clinical neuropsychology provider's role in cultural respect and inclusion

There has been both a national and global emphasis within the past 3 years to promote diversity, equity, inclusion (DEI), and cultural respect in healthcare and academia. One discipline and healthcare arena where this has been evident is the psychology field. Indeed, there has been rampant and widespread adoption and advancement of DEI and cultural respect across most of psychology. Unfortunately, not all psychology specialties have fully embraced DEI or focused on provider factors, one of which is clinical neuropsychology. Regarding DEI efforts and emphasis in clinical neuropsychology, the majority of research and education has primarily focused on patient demographic and neuropsychological test factors. While such patient demographic and test factors are important and merit significant attention, so too does the focus on the clinical neuropsychological provider. Unfortunately, the clinical neuropsychology specialty has provided little to no focus on the provider's role in DEI and cultural respect. The purpose of this critical review is to focus on the role of the clinical neuropsychologist and how it impacts DEI and cultural respect. Specifically, the review will inform the factors that impact the practice of clinical neuropsychology on the part of the provider including unconscious/implicit bias, diagnostic threat, and microaggressions. Also, the review will inform strategies to create a DEI responsive and culturally respectful clinical neuropsychological practice with the overarching goal to uncover the clinical neuropsychological role to advance and evolve the specialty through a DEI and culturally respectful lens. With considerable work completed in other aspects of DEI and cultural respect, the clinical neuropsychology specialty is well poised to now focus on the role of the provider. This focus can provide a constructive path forward to create new knowledge to advance the role of the provider to optimize overall clinical, research, and training practices.

Analyzing diversity trends in dermatology: A comprehensive overview

Background

Dermatology lags behind other medical specialties in workforce diversity, particularly regarding gender, race, and ethnicity. This study aims to analyze the current demographics of dermatology physicians in the United States, comparing them with other medical specialties, the overall population of practicing U.S. physicians, and the U.S. population as a whole.

Design and Method

Data from the Association of American Medical Colleges and the U.S. Census Bureau (2007-2022) were used to evaluate gender, racial, and ethnic diversity within dermatology. Demographic factors analyzed included gender, race, and ethnicity, with racial categories grouped as White, Asian, and underrepresented minorities in medicine (URiM). Chi-square tests assessed the fit of gender and age distributions with population proportions, while linear regression models examined trends over time.

Results

From 2007 to 2021, the number of dermatologists grew by 22.9%, with a corresponding decrease in population per dermatologist, indicating growth relative to the general population. The proportion of female dermatologists rose by 68.1% during this period, while the male proportion declined by 5.1%. From 2019 to 2022, a significant linear increase (p < 0.001) in URiM representation among dermatology residents was observed, with a model-predicted annual increase of 1.6%.

Conclusions

The increasing diversity in dermatology may be attributed to initiatives such as scholarships and mentorship programs implemented by dermatology organizations and residency programs. By fostering a more diverse workforce, dermatology can better address the healthcare needs of a diverse population and promote health equity across all demographics.

Cultivating Diversity, Equity, and Inclusion in Pulmonary and Critical Care Training: A Path Toward Health Care Excellence

Pulmonary and Critical Care Medicine (PCCM) fellowship training faces increasing competition but lacks diversity, hindering health care excellence. Despite a growing interest in the field, programs lack diverse representation. Addressing this issue is crucial to combat health disparities and bias, benefiting trainees, practitioners, and patients. Sustainable solutions are vital for achieving diversity, equity, and inclusion in PCCM. Strategies for achieving equity among training programs include adopting inclusive recruitment practices, recognizing differential attainment, addressing bias, fostering an equitable academic climate, and implementing multifaceted strategic processes to enhance diversity in mentorship including recognition and compensation for diversity and equity work.

Perspectives on Professional Development Among University and Community Pediatric Hospitalists

Multiple professional societies have emphasized the importance of professional development for physicians. This qualitative study aimed to explore pediatric hospitalists' perceptions of professional development needs and to refine a framework for professional development in pediatric hospital medicine (PHM). We conducted four focus groups in April to May 2019 with 19 pediatric hospitalists at six clinical sites within a single institution. Participants identified key components of professional development including skill development, personal growth, career satisfaction, and individualization. Hospitalists agreed upon 8 domains of professional development: clinical excellence, advocacy, global health, health care administration, informatics, medical education, quality improvement, and research. They also identified missing the mentorship necessary to change their passions into career advancement, highlighted barriers and facilitators, and noted that an alignment in personally meaningful projects to what is meaningful to the institution was in everyone's best interests. Faculty programs should build infrastructure to aid pediatric hospitalists in achieving their career goals.

A Learning Assessment to Increase Diversity in Academic Health Sciences

Importance

Strategies and innovations to advance racial and ethnic equity in recruitment, promotion, and retention at academic health science institutions are needed.

Objective

This learning assessment aims to isolate evidence-based strategies to advance racial equity in the academic health sciences, which have implications for policy and institution-level interventions.

Evidence Review

This learning assessment used a mixed-methods approach, including a quantitative survey, qualitative in-depth interviews, and a scoping literature review. Survey respondents were recruited from outreach lists that included researchers working with racial and ethnic minoritized populations. In-depth interviews were conducted among 60 university administrators, faculty/staff, scholars, students, and individuals affiliated with governmental, nongovernmental, and identity-based professional associations. A search of the literature in PsycINFO, MEDLINE, ERIC, Education Source, Academic Search Ultimate, and CINAHL was conducted for the scoping review. The scoping review included 366 primary articles of studies evaluating strategies to advance racial and ethnic equity at academic health science institutions.

Findings

The survey yielded analyzable results from 328 individuals, including faculty, students, administrators, or staff, and individuals not currently employed at or enrolled full time at a university or college. The interviews included 60 participants with a mean (SD) age of 49.3 (16.5) years, and 39 (65%) were female. The scoping review included 366 primary research articles that met inclusion criteria for analysis. Data were analyzed individually across the survey, interviews, and scoping review, and findings were triangulated. While each of the 3 assessments yielded unique findings, 13 common themes emerged across all project components. Results revealed strategies implemented and evaluated successfully, as well as challenges and barriers to advancing equity in the academic health sciences.

Conclusions and Relevance

In this study, 13 meaningful strategies emerged across the survey, in-depth interviews, and scoping review. Through triangulation of findings, recommendations of actionable steps were made.

A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy

BACKGROUND AND PURPOSE

To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice.

POSITION AND RATIONALE

The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described.

DISCUSSION AND CONCLUSION

Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

Exploring the Impact of COVID-19 on Women Hospitalists: A Mixed-Gender Qualitative Analysis

BACKGROUND

Women physicians have faced persistent challenges, including gender bias, salary inequities, a disproportionate share of caregiving and domestic responsibilities, and limited representation in leadership. Data indicate the COVID-19 pandemic further highlighted and exacerbated these inequities.

OBJECTIVE

To understand the pandemic's impact on women physicians and to brainstorm solutions to better support women physicians.

DESIGN

Mixed-gender semi-structured focus groups.

PARTICIPANTS

Hospitalists in the Hospital Medicine Reengineering Network (HOMERuN).

APPROACH

Six semi-structured virtual focus groups were held with 22 individuals from 13 institutions comprised primarily of academic hospitalist physicians. Rapid qualitative methods including templated summaries and matrix analysis were applied to identify major themes and subthemes.

KEY RESULTS

Four key themes emerged: (1) the pandemic exacerbated perceived gender inequities, (2) women's academic productivity and career development were negatively impacted, (3) women held disproportionate roles as caregivers and household managers, and (4) institutional pandemic responses were often misaligned with workforce needs, especially those of women hospitalists. Multiple interventions were proposed including: creating targeted workforce solutions and benefits to address the disproportionate caregiving burden placed on women, addressing hospitalist scheduling and leave practices, ensuring promotion pathways value clinical and COVID-19 contributions, creating transparency around salary and non-clinical time allocation, and ensuring women are better represented in leadership roles.

CONCLUSIONS

Hospitalists perceived and experienced that women physicians faced negative impacts from the pandemic in multiple domains including leadership opportunities and scholarship, while also shouldering larger caregiving duties than men. There are many opportunities to improve workplace conditions for women; however, current institutional efforts were perceived as misaligned to actual needs. Thus, policy and programmatic changes, such as those proposed by this cohort of hospitalists, are needed to advance equity in the workplace.

How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review

PURPOSE

Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine.

METHOD

The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted.

RESULTS

Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes.

CONCLUSIONS

These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.

Meeting the Accreditation Standard for Diversity

ABSTRACT

While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.

Gender differences in COVID-19-related manuscript authorship by hospitalists during the pandemic: A bibliometric analysis

BACKGROUND

Hospital medicine (HM) has a well-described gender disparity related to academic work and promotion. During the COVID-19 pandemic, female authorship across medicine fell further behind historical averages.

OBJECTIVE

Examine how COVID-19 affected the publication gender gap for hospitalists.

DESIGN, SETTINGS, AND PARTICIPANTS

Bibliometric analysis to determine gender and specialty of US-based physician first and last authors of COVID-19 articles published March 1, 2020 to February 28, 2021 in the four highest impact general medical journals and two highest impact HM-specific journals.

MAIN OUTCOME AND MEASURES

We characterized the percentage of all physician authors that were women, the percentage of physician authors that were hospitalists, and the percentage of HM authors that were women. We compared author gender between general medical and HM-specific journals.

RESULTS

During the study period, 853 manuscripts with US-based first or last authors were published in eligible journals. Included manuscripts contained 1124 US-based physician first or last author credits, of which 34.2% (384) were women and 8.8% (99) were hospitalists. Among hospitalist author credits, 43.4% (n = 43/99) were occupied by women. The relative gender equity for hospitalist authors was driven by the two HM journals where, compared to the four general medical journals, hospitalist authors (54.1% [33/61] vs. 26.3% [10/38] women, respectively, p = .002) and hospitalist last authors (51.9% [14/27] vs. 20% [4/20], p = .03) were more likely to be women.

CONCLUSIONS

Across COVID-19-related manuscripts, disparities by gender were driven by the high-impact general medical journals. HM-specific journals had more equitable inclusion of women authors, demonstrating the potential impact of proactive editorial policies on diversity.

Analysis of Diversity, Equity, and Inclusion Initiatives Presented Across US Academic Department of Surgery Websites in 2021

Despite increased attention devoted to diversity, equity, and inclusion (DEI) within academic medicine, representation, lack of workforce and leadership diversity, and bias within medicine remain persistent problems. The purpose of the current study was to understand the current efforts and attention to DEI within academic departments of surgery in the United States. 251 department of surgery websites were reviewed, using a standardized data collection form and scoring procedure, accompanied by a 10 percent fidelity check by an independent reviewer. Only 16% of departments of surgery included DEI-specific information, such as a DEI mission statement or initiatives on their departmental sites, with less than seven percent of departments reporting a DEI committee. Such public information may have implications for recruitment and retention of diverse faculty and trainees, downstream effects for patient care, and could be critical to public accountability to improve diversity and create a culture of equity and inclusion.

A Path Toward Equity and Inclusion: Establishing a DEI Committee in a Department of Pediatrics

The Diversity, Equity, and Inclusion (DEI) committee was established in 2017 within the Department of Pediatrics at Rush University Medical Center (RUMC), an academic medical health center located on the near west side of Chicago, IL. Results from climate surveys highlighted the need for increased DEI initiatives within the department, and a renewed national reckoning on racial tensions sparked an additional sense of urgency for system-level change. This paper outlines the initial creation and ongoing efforts of the DEI committee. Information related to the structure of our committee, aims of our work, progress toward identified goals, as well as ongoing barriers is provided. Academic medical health centers are tasked not only with working and training together, but also to care for a diverse group of patients within a larger community. As such, academic medical health centers represent a unique backdrop and opportunity for individual and system-level change.