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Reede, Joan Y. MD, MPH, MS, MBA

doi: 10.1097/ACM.0b013e31826e2f45
Diversity and Inclusion in Academic Medicine

Dr. Reede is guest editor of the Diversity and Inclusion in Academic Medicine collection of articles in this issue; as well as dean, Diversity and Community Partnership, and associate professor of medicine, Harvard Medical School; and associate professor, Society, Human Health and Behavior, Harvard School of Public Health, Boston, Massachusetts.

Addressing diversity in academic medicine is not a simple endeavor. Its complexity requires thinking and acting in new and different ways. Science and medicine are advancing in a rapidly changing society—one that struggles with ideals of equity and justice in the face of disparity, bias, and lack of access to health care. Society’s values, beliefs, laws, and regulations have shaped and continue to shape the lives and actions of individuals both inside and outside of our professions and institutions. Academic medicine operates within this environment. How we recruit, retain, and advance our diverse students, residents, fellows, faculty, and administrators will determine our ability to meet the needs of our society.

Historically, diversity efforts have been tied to numerical outcomes without fully understanding and acknowledging the capacity of diversity to transform an institution. This pattern evolved from practices in which diversity programs and initiatives were positioned outside of standard organizational functions. Whether this placement was intentional or unintentional, the lack of integration limited institutions’ capability to capture the rich array of talents and potential that diversity offers.

Diversity contributes to the capacity of an institution to achieve all of its mission and goals. The paradigm of diversity as an isolated or marginalized initiative must shift to one of diversity inclusion, where consideration of diversity is embedded in all organizational activities. Succeeding in diversity inclusion requires that institutions recognize potential contributions from the full array of each individual’s unique and varied dimensions of diversity (e.g., education and training, culture, experiences, networks, interests, gender, race/ethnicity, etc.). Activating diversity inclusion necessitates systems thinking, leadership commitment, engaging stakeholders from within and outside an institution, identifying resources, and examining existing policies, practices, and programs as well as designing new ones.

It is critical that diversity inclusion-related activities be grounded in data. Diversity research often relies on a limited subset of information with data that focus primarily on the individual, failing to account for the complexity of the environment in which the individual operates. Although there have been advances in interdisciplinary research, which draws from different perspectives, we have not made full use of the richness of knowledge and methodologies available across the disciplines to study diversity inclusion efforts. In addition, diversity-related research seldom offers explicit theories. Frequently, diversity models are transferred from one setting to another without specifying or understanding the unique context in which decisions are made and programs implemented. In times of limited resources and increased calls for accountability, it is important that diversity inclusion efforts be built on an evidence-based foundation.

This issue of Academic Medicine presents 12 articles that are consistent with a diversity inclusion framework that incorporates 7 principles:

  1. Commitment—leadership that is able to create and communicate an unambiguous vision;
  2. Consistency—recognition that both short-term and long-term efforts will be required to address systemic and cultural issues;
  3. Collaboration—building partnerships that cross internal and external boundaries;
  4. Creativity—innovation, willingness to ask new questions and to embrace change;
  5. Communication—conveying and receiving information in multiple ways across multiple constituencies;
  6. Consideration—mindfulness of differences and the multiple dimensions of diversity; and
  7. Continuity—programming that spans pathways that cross the educational and career spectrum.

Increasingly, researchers and institutions are recognizing that diversity extends beyond race and ethnicity, and several articles in this issue reflect this perspective. Johnson and Bozeman1 propose a model that uses the concept of asset bundles to develop socioeconomic diversity as well as racial and ethnic diversity among accepted applicants. Thew and colleagues2 explore cross-cultural communication involving the deaf community in medical education. To broaden traditional views of diversity, Young and colleagues3 examine diversity through a framework of surface (visible) and deep (less visible) dimensions. In addition, Smith4 emphasizes the importance of building institutional capacity for diversity using a framework that is both inclusive and differentiated.

Many of the articles in this issue contribute to the evidence base for diversity inclusion efforts by using new or existing data to examine the impact of policies and programs on workforce diversity. Ginther and colleagues,5 for example, use National Institutes of Health data to investigate characteristics that may affect an individual’s chances of receiving an RO1 award. Using a subset of U.S. Census data, Myers and Fealing6 examine how efforts and policies to increase diversity affect the representation of minorities in medicine and related science fields. Niu and colleagues7 investigate the role of diverse interethnic interactions in medical students’ perceptions of their preparedness to care for diverse patients. Bailey and Willies-Jacobo8 study the inclination of minority and/or disadvantaged students to choose a medical program focused on providing care to underserved communities. To better understand the role of diversity in faculty development, Adanga and colleagues9 use interviews and Web searches to study the presence of diversity programs targeting underrepresented minority faculty in U.S. medical schools.

The remaining articles in the collection examine and analyze existing innovative initiatives to encourage diversity in academic medicine. The article by Deas and colleagues10 summarizes the processes and outcomes of the implementation of a Medical University of South Carolina strategic diversity plan. Toney11 captures the 34-year history of the University of Illinois at Chicago Urban Health Program. Both articles reinforce the importance of obtaining commitments from leadership, consistency in effort, collaboration and communication with internal and external communities and partners, and continuity of programming across the pipeline. Similarly, in describing the PROMISE: Alliance for Graduate Education and the Professoriate program in Maryland and offering suggestions for its replication, Tull and colleagues12 address the value of engaging stakeholders, considering organizational context, and linking efforts to institutional mission and values. All three articles provide examples of the ways in which addressing diversity benefits minority as well as nonminority individuals.

The analyses, concepts, and theories referenced in this collection of articles present a foundation for continued dialogue, exploration, and generation of new research addressing diversity and diversity inclusion.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

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1. Johnson J, Bozeman B. Perspective: Adopting an asset bundles model to support and advance minority students’ careers in academic medicine and the scientific pipeline. Acad Med. 2012;87:1488–1495
2. Thew D, Smith SR, Chang C, Starr M. The Deaf Strong Hospital program: A model of diversity and inclusion training for first-year medical students. Acad Med. 2012;87:1496–1500
3. Young ME, Razack S, Hanson MD, et al. Calling for a broader conceptualization of diversity: Surface and deep diversity in four Canadian medical schools. Acad Med. 2012;87:1501–1510
4. Smith DG. Building institutional capacity for diversity and inclusion in academic medicine. Acad Med. 2012;87:1511–1515
5. Ginther DK, Haak LL, Schaffer WT, Kington R. Are race, ethnicity, and medical school affiliation associated with NIH R01 Type 1 award probability for physician investigators? Acad Med. 2012;87:1516–1524
6. Myers SL, Fealing KH. Changes in the representation of women and minorities in biomedical careers. Acad Med. 2012;87:1525–1529
7. Niu NN, Syed ZA, Krupat E, Crutcher BN, Pelletier SR, Shields HM. The impact of cross-cultural interactions on medical students’ preparedness to care for diverse patients. Acad Med. 2012;87:1530–1534
8. Bailey JA, Willies-Jacobo LJ. Are disadvantaged and underrepresented minority applicants more likely to apply to the Program in Medical Education–Health Equity? Acad Med. 2012;87:1535–1539
9. Adanga E, Avakame E, Carthon MB, Guevara JP. An environmental scan of faculty diversity programs at U.S. medical schools. Acad Med. 2012;87:1540–1547
10. Deas D, Pisano ED, Mainous AG, et al. Improving diversity through strategic planning: A 10-year (2002–2012) experience at the Medical University of South Carolina. Acad Med. 2012;87:1548–1555
11. Toney M. The long, winding road: One university’s quest for minority health care professionals and services. Acad Med. 2012;87:1556–1561
12. Tull RG, Rutledge JC, Carter FD, Warnick JE. PROMISE: Maryland’s Alliance for Graduate Education and the Professoriate enhances recruitment and retention of underrepresented minority graduate students. Acad Med. 2012;87:1562–1569
© 2012 Association of American Medical Colleges