To the Editor:
Recent scholarship asserts that diverse, inclusive climates provide medical schools and teaching hospitals with the necessary capacity to excel as organizations and ensure health equity for all.1 Therefore, it is becoming increasingly important to assess climate and culture around diversity and inclusion in the nation’s medical schools and teaching hospitals as a means for benchmarking and improving.2
However, such assessments are not an easy task. Although a variety of definitions exist in the literature for culture and climate, it is generally understood that these constructs include the beliefs and values of an institution as well as the perceptions, attitudes, and behaviors of the students, faculty, leaders, and staff that constitute it. Data collection can therefore become an onerous task.
Researchers from the Association of American Medical Colleges and the University of Arizona, Colleges of Medicine and Education, partnered to pilot a study of campus climates at two medical schools and identified key methodological considerations. First, conceptual frameworks are essential for content development, as many climate and culture frameworks are multifaceted, requiring data from various sources. Therefore, a mixed-methods design is necessary, with both qualitative and quantitative data collection protocols. Second, it is important to review preexisting data such as policies, documents, and statistics (e.g., student enrollment data), as these provide valuable insight into how an institution has conceptualized and supported diversity. Last, understanding how different groups experience the environment is key to uncovering areas for improvement; thus, data should be collected from varying groups and levels within the organization as well as from as many diverse groups as possible.
Above all, data regarding diversity and inclusion are sensitive and must remain confidential and anonymous. It is especially important when collecting qualitative data to establish a safe, comfortable environment where everyone feels he or she can share personal experiences and opinions without fear of punishment or judgment. For example, junior faculty might feel more comfortable speaking when they are asked in a forum where senior faculty are not present, and faculty from racial or ethnic minority backgrounds and those of the majority culture might speak more candidly when spoken to separately.
Despite potential methodological challenges, comprehensively assessing culture and climate allows medical schools and teaching hospitals to identify strengths and areas for improvement. Such data can then be used to implement the necessary strategies and changes to create diverse and inclusive environments that support collaboration, innovation, and academic excellence as institutions strive to serve their communities.
Laura Castillo-Page, PhD
Senior director, Diversity Policy and Programs and the Organizational Capacity Building Portfolio, Association of American Medical Colleges, Washington, DC; firstname.lastname@example.org.
Sarah A. Schoolcraft, MS
Senior research analyst, Diversity Policy and Programs, Association of American Medical Colleges, Washington, DC.
Jeffrey F. Milem, PhD
Ernest W. McFarland Distinguished Professor of Leadership for Education Policy and Reform, professor of education, and professor of medicine, University of Arizona, Tucson, Arizona.
Celia O’Brien, PhD
Postdoctoral fellow, College of Education and College of Medicine, University of Arizona, Tucson, Arizona.
1. Nivet MA. Commentary: Diversity 3.0: A necessary systems upgrade. Acad Med. 2011;86:1487–1489
2. Milem JF, Dey EL, White CBSmedley BD, Butler AS, Bristow LR. In: Diversity considerations in health professions education. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. 2004 Washington, DC National Academies Press:345–389