Moving Together Toward Health Professions Equity in Academic Medicine

A remarkable and compelling editorial ¹ entitled “Learning from the Past and Working in the Present to Create an Antiracist Future for Academic Medicine” was published in our journal in December 2020. This editorial was the result of my invitation to all members of our editor team and editorial board with lived experience of racism to speak their hearts and minds to our field. Paula T. Ross, Monica L. Lypson, Carrie L. Byington, John P. Sánchez, Brian M. Wong, and Arno K. Kumagai stepped forward to do so.

The message from our 6 colleagues is clear. Racism exists in academic medicine, as it does in the broader society. Social structures and policies are perhaps the most important determinants of health and health inequities at a population level. In the United States, we must acknowledge that health inequities that stem from institutional racism persist. And individual, structural, and symbolic violence exists, as reflected in the experiences of Black people and members of other groups who are deprived of dignity and denied opportunities to thrive in our field. Health professions equity is impeded by racism in society and academic medicine, as is our ability to attain educational, research, and clinical excellence.

The authors of the 2020 editorial commented specifically on the impact of racism in academic medicine with respect to 4 mission domains: exclusion from the health professions and professional development, racism in the learning environment, exclusion from the medical research enterprise, and racial disparities in clinical care. Addressing such issues, among many others, they suggested, will require “our commitment, courage, and a willingness to look at the problem of racism clearly, to embrace difficult truths.” An antiracist future entails “deliberate action, organizational commitment, and most importantly a shared vision for the future.”

Two years have passed since this editorial appeared in Academic Medicine. I would ask our readers to re-read the editorial and also to consider the recommendations proffered by our colleagues in illuminating a way forward for our field.

As individuals, for example, have we examined our own behaviors, beliefs, and assumptions that may contribute to racism? Have we sought to learn more; practiced empathy and humility; held each other accountable; and amplified, invited, and promoted the excellence of non-majority-identifying colleagues? In what ways have we changed our work and challenged the status quo? Have we made it difficult for our colleagues to perpetuate racism? Have we become upstanders in the pursuit of correcting injustices experienced by our peers, learners, and staff? In our spheres of influence, have we allocated more resources to address discrimination and advance inclusion?

At our institutions, have we examined policies and processes to eliminate racism and bias and to support equity, and have we ensured that our curricular and learning materials are free of discriminatory images and language? Have we engaged in more inclusive recruitment, retention, and leadership actions? Have we strengthened our research and clinical practices to address access, enhance participatory engagement, and improve health outcomes for the historically marginalized, especially Black and other underrepresented people and communities?

And, across the field of academic medicine, have we developed structures, frameworks, resources, and policies needed to bring about crucial change in the health professions and across health systems? On a deep level, have we undertaken the hard work of deconstructing racist practices and ensuring an equitable, more just culture for all in academic medicine?

There is still much left to do to move the health professions, and the systems in which we work, along the path toward equity. That said, we may have some signs of progress, albeit terribly slow and terribly overdue. In the past 2 years, for example, the National Academies of Sciences, Engineering, and Medicine, the American Medical Association, the Association of American Medical Colleges, and the Accreditation Council for Graduate Medical Education, among others, have adopted new policy statements, strategic plans, and substantive actions to improve diversity, inclusion, and antiracism practices and to advance health equity. ^2–5

In recent decades, the proportion of deans of medical schools who identify as belonging to historically marginalized groups in medicine has grown slightly. ⁶ More individuals identifying as URIM are applying to medical school, building the potential for greater diversity in the physician workforce of the future. For instance, the number of applicants identifying as Black or African American only or in combination with other race/ethnicity categories in the 2021–2022 cycle increased to 6,465 from 4,603 one year earlier. ⁷ Increases in students from historically marginalized groups enrolled in MD–PhD programs, while still not yet reflective of the broader diversity of the general population or the population of medical students, have also been documented in a study ⁸ comparing demographic and program characteristics between 2009 and 2018. The absolute numbers noted here remain far too low, and yet the recent trends may signal an encouraging shift that is worthy of our attention.

In addition to new policy approaches and evolving demographics among our leaders and our early career colleagues, the manuscripts sent to our journal suggest significant engagement by members of our field to address discrimination and bring about greater awareness and more inclusive practices. Academic Medicine receives a tremendous number of submissions related to strengthening equity in the health professions and health systems as well as elevating the professional roles of people who have been historically marginalized. In each of the print issues of our journal in 2021 and 2022, we have addressed these topics and closely related concerns regarding equity, a reflection of the dedicated efforts of our authors working across the interdependent missions of academic medicine. Several articles ^9–20 in this issue further add to publications and past collections curated by our journal on intersectional themes related to justice, topics of existential importance to our field.

The voices of our learners, leaders, colleagues, and stakeholders have thus joined with those of our 6 editorial colleagues, envisioning a better future for academic medicine and all whom we serve. Academic medicine must create and safeguard an environment of true inclusion and belonging for all. The celebration of excellence through equity is a fundamental mission of the health professions and an imperative for health professions educators.

Dear Reader, let’s imagine a future in which all are welcome in the health professions and health professions learning environment, all have access to professional development and to the medical research enterprise, and all have full access to health and to clinical care. Let’s redouble our work as together we build a respectful, inclusive field characterized by nondiscrimination, welcomeness, and authentic belonging. Although it is a steep, arduous journey, we share a vision of the future and have many worthy companions as we undertake the climb.

Acknowledgments:

The editor wishes to acknowledge Paula T. Ross, PhD, Monica L. Lypson, MD, MHPE, Carrie L. Byington, MD, John P. Sánchez, MD, MPH, Brian M. Wong, MD, and Arno K. Kumagai, MD.