We Must First Live in Equity
Robert Maupin, M.D. (Associate Dean for Diversity and Community Engagement)
While there has been a tremendously important and overdue focus on advancing frameworks of equity in addressing the health disparity challenges that our patients face, within our own culture we must first learn to “Live in Equity”. Living in equity acknowledges that we look within and must first heal our own professional communities. At the recent AAMC Learn, Serve, and Lead meeting’s leadership plenary, Dr. Darryl Kirsch the retiring President and CEO remarked that “We must be relentless in surmounting the obstacles still in our path from unconscious bias to overt harassment to gender- and race-based gaps in salary equity.” A systematic review and meta-analysis of harassment and discrimination in medical training by Fnais et al. (2014), in Academic Medicine in reviewing 51 studies reveals that close to 60% of medical trainees have experienced harassment or discrimination during their training. Female gender and nonwhite race/ethnicity were significant in high incidence of harassment and discrimination, and the most cited source of harassment was from consultants.
Adding a balance in perspective in the AAMC leadership plenary, co-presenter Dr. M. Roy Wilson, Chair of the AAMC Board of Directors observed that “We must do more to ensure that all segments of the public are included in our profession and that biases, even if unintended, do not systematically exclude persons of certain population groups.” A very recent publication in JAMA Network Open, Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace, Osseo-Assare et al. (2018), conducted a qualitative study of work place experience of black, Hispanic, and Native American resident physicians. Findings focused on 3 major themes in workplace experience: a daily barrage of micro-aggressions and bias, minority residents tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identity while seen as “other”. Another study published in LGBT Health by Chester et al. (2014), characterized the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center thru the use of an anonymous, online institutional climate survey to assess the attitudes and experiences of LGBT employees and students. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain “closeted” and were harassed despite medical center policies of non-discrimination.
Collectively these examples speak to the heightened urgency for our academic medical centers to prioritize the health of our institutional climate in a way that fully embraces a true culture of inclusion. Constructive approaches to find an effective path forward are embodied in examples provided in recent publications in OB/GYN literature – Sexism in obstetrics and gynecology: not just a “woman’s issue”, Hughes & Bernstein (AJOG 2018), and Institutional Responses to Harassment and Discrimination in Obstetrics and Gynecology, Eichelberger et al.(Obstet Gynecol 2018). The authors collectively focus on range of interventions which include (but only represent a few from a larger list): create open forums to listen to others’ perspectives on issues of disparity, examine the problems of unconscious bias and gender disparity and how peers participate in it, intentionally build teams that are diverse and inclusive, train in the identification and response to micro-aggressions, and actively track data on harassment and discrimination events as exists with other quality measures. Most importantly such efforts will reflect first steps in our recognition and commitment that we must transform our internal climate and culture in a way that allows us to Live in Equity first before we can be effective in our accountability in advance equity for our patients.