McDougle, Leon MD, MPH; Lu, Francis G. MD; Castro, Ida L. JD, MA
Dr. McDougle is associate professor, Department of Family Medicine, and associate dean, Diversity and Inclusion, Ohio State University College of Medicine, Columbus, Ohio.
Dr. Lu is Luke & Grace Kim Endowed Professor in Cultural Psychiatry, Department of Psychiatry and Behavioral Sciences, and assistant dean for faculty diversity, University of California, Davis, Health System, Sacramento, California.
Dr. Castro is vice president of community engagement and equity and professor of family medicine and community health, Commonwealth Medical College, Scranton, Pennsylvania.
Correspondence should be addressed to Dr. McDougle, Meiling Hall, Room 066, 370 West 9th Ave., Columbus, OH 43210; telephone: (614) 688-8489; e-mail: Leon.McDougle@osumc.edu.
Academic health centers (AHCs) that embrace faculty diversity as a central and essential aspect in their patient care, education, and research missions will lead the nation toward achieving health equity. Groups that are underrepresented in medicine, including African Americans (3.0%), American Indians/Alaskan Natives (0.1%), people of Hispanic/Latino descent (4.2%), and Native Hawaiians/other Pacific Islanders (0.2%), constitute just 7.5% of the total medical school faculty in the United States1—even though these populations constitute 30.0% of the overall U.S. population (2010 U.S. census). In addition, women constitute only 34% of faculty,1 and self-reported data concerning sexual orientation, gender identity, and disability status of faculty are not uniformly collected and published.
The Group on Diversity and Inclusion (GDI) of the Association of American Medical Colleges (AAMC) developed and implemented the following terms to engage the academic medicine community and guide national priorities.
Diversity, a core value embodying inclusiveness, mutual respect, and multiple perspectives, serves as a catalyst for change resulting in health equity. In this context, we are mindful of all aspects of human differences such as socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability, and age.
Inclusion is a core element necessary for successfully achieving diversity. Inclusion is achieved by nurturing the climate and culture of the institution through professional development, education, policy, and practice. The objective is creating a climate that fosters belonging, respect, and value for all and that encourages engagement and connection throughout the institution and community.
Health equity is the opportunity for everyone to attain his or her full health potential no matter his or her social position or other socially determined circumstances.
Both Smith and Nivet have articulated the need for and the value of diversity to drive excellence.2,3 A diverse faculty represents to the world a medical school's values concerning equity in both hiring and retention. A diverse faculty also expands a medical school's ability to innovate and develop diverse forms of knowledge, as well as its capacity to make fully informed decisions. A diverse faculty promotes the development of vital relationships with many different communities outside the medical school and adds to an environment that will attract persons of many different backgrounds to the medical school. Finally, diversity among faculty enhances the strength and the diversity of the future leadership pipeline.2
A diverse faculty must include fair recruitment and retention. Several excellent references, including “How to be welcoming,”4 describe best practices for recruiting and retaining a diverse workforce, including lesbian, gay, bisexual, and transgender faculty.2–4 In addition, workshops, such as Strategies and Tactics for Recruiting to Improve Diversity and Excellence (STRIDE), are available to train medical school faculty and staff.
Some key institutional practices to encourage diversity among faculty include explicitly expressing commitment to diversity within the medical school's mission and values statement and updating diversity categories so that they align with the AAMC GDI definition of diversity.2,3 Developing and encouraging ongoing cultural competency training for AHC faculty, staff, students, and trainees will promote a climate of inclusion.2,3 Other means of fostering diversity are implementing “partner policies” that accommodate sexual orientation and gender identity; reviewing, assessing, and expanding accommodations for people with disabilities; and adopting and advertising extended promotion and tenure clock policies when appropriate (e.g., maternity/paternity leave). Evaluating and reviewing mentoring programs for junior faculty, with consideration for including meaningful activities throughout the academic year, is also important.2–4
Part of promoting diversity and inclusion is monitoring progress, including identifying benchmarks. Medical schools should select benchmark institutions cautiously. Diversity among peer institutions may be poor, so comparisons may foster a false sense of accomplishment or serve as an excuse to maintain the status quo. Only outstanding performers should serve as true benchmark institutions. Climate assessments are invaluable tools for assessing institutional culture longitudinally. Subgroup analysis of climate assessment data should be conducted to identify trends that may not be apparent otherwise.
Diversity drives excellence, adds value, advances institutional missions, and ultimately improves the health of all, whether through training, research, or direct patient care.2,3 Adopting the appropriate practices—from hiring faculty to monitoring progress—will enable AHCs to lead the nation and world in solving the most difficult health care challenges of the 21st century.
The authors would like to thank the Association of American Medical Colleges' Group on Diversity and Inclusion (GDI) steering committee and Juan Amador, director and GDI program leader.
1Terrell C, Castillo-Page L. Diversity in Medical Education: Facts & Figures 2008. Washington, DC: Association of American Medical Colleges; 2008.
2Smith DG. Diversity's Promise for Higher Education: Making It Work. Baltimore, Md: Johns Hopkins University Press; 2009.
3Association of American Medical Colleges. Striving Toward Excellence: Faculty Diversity in Medical Education. Washington, DC: AAMC; 2009.