42 ways to advance racial equity in academic medicine

Academic medicine generally encompasses a tripartite mission of research discovery, clinical innovation, and the next generation of physicians and scientists’ education.

It is the ethics and social justice principles, practices, policies, and innovation that advance research and education in the health sciences, ultimately improving the health and well-being of all.

This is its socially responsible mission. Yet, it seems chief diversity officers, equity practitioners, and scholars everywhere have been lifting even heavier weights within our institutions in recent times. The progress in equity, diversity, inclusion, and justice (EDIJ) within our campus environments has been hard to celebrate while we continue witnessing an overt display of systemic racism and structural violence.

Systemic racism that has been seen throughout the experiences of minoritized groups navigating higher education: racism, discrimination, and (micro)aggressions; cultural taxation and tokenism; bias in recruitment, promotion, and tenure; and challenges to their credibility and expertise.

The additional systemic violence that the COVID-19 pandemic has highlighted to be pervasive of health inequities in communities of color. Being part of academic medicine also means witnessing — and at times being complicit of working in — systems that perpetuate these inequities and health disparities.

But we are also hopeful because of the many ways our committed colleagues, students, trainees, and staff championed the combat against racism and discrimination.

Many of us have been asked: What can I do within my academic role? Although not exhaustive, the list below offers a list of 42 actions faculty, and members of the academic community can do to advance racial equity in academic medicine, in no particular order.

We hope you find this list helpful and that in discussions with your own institutional communities.

1. Reflect on your own identity and privilege. What is your positionality? Positionality is the socio-political context that forms your identity in terms of race, class, gender, sexuality, and ability status (to name a few). How does your identity influence and biases your perspectives?

2. Commit to being part of EDIJ efforts in your unit, at your institution, and your professional societies. If there are no efforts or are not sufficient, name your impression, reaction, and desired action.

3. Engage and share the burden with faculty of color. Did you know that physicians of color care for over 50% of diverse populations and over 70% of non–English-speaking patients in the U.S. Patients from underserved populations are significantly more likely to see a physician of color. Did you know that faculty of color tend to take on more service than their counterparts? Did you know that they do most of the mentoring for minoritized students? Scholars refer to this as cultural taxation and “invisible work,” except that it is evident to those that do it.

4. Work to ensure that “invisible work” becomes desirable contributions that are expected, quantified, and valued in the hiring, promotion, and tenure processes at your institution. Especially now, this must call for an overhaul on the way we credit and reward EDIJ work.

5. Engage in equity-based training, such as anti-bias, anti-discrimination, and anti-racist. Seek educational development in areas of cultural competence and culturally relevant and inclusive pedagogies. Approach these with a commitment to a growth mindset. Do not fall on the trap of relabeling your efforts as anti-racism — especially if it does not challenge the status quo, institutional barriers, structures, and power.

6. Ask what is the percentage of the school’s budget allotted to EDIJ initiatives and efforts, excluding external EDIJ-related grants. You can help advocate for more and request that it is not decreased as a result of COVID-19-related financial impact.

7. Know what EDIJ resources are already available at your institution. Some institutions excel at inventorying and listing these resources but need accountability in identifying the gaps. Ensure your EDIJ contribution is visible.

8. Create new and join affinity groups that include people from groups different from yours, especially those that advance equity and inclusion.

9. Ask yourself if the representation in decision-making committees is adequately diverse, and if the decision is equitable across all diverse groups.

10. Engage with students and trainees in ways that are holistic. Consider their backgrounds, social identities, and lived experiences in relation to fostering meaningful engagement and sense of belonging.

11. Assist in the promotion and tenure process by helping faculty of color get promoted. Assure that mentorship and support are adequate to minimize common obstacles for the promotion of faculty of color. Help identify and remove those obstacles.

12. Engage in promotion and tenure committees to guarantee equitable reviews of dossiers.

13. Call for recruitment practices of faculty/staff/leadership and trainees that guarantee a diverse pool of candidates, fair processes for assessment, affirming interviews and campus visit experiences, and commitment to hire successful candidates who offer the added values of diversity. Participate and help lead in those searches.

14. Understand different communication styles and develop skills in communication across cultures. While affirming people from other cultures, help them navigate the culture and climates at your institution.

15. Contribute to the examination of curriculum content and experiences for cultural competence and biases. Work towards a culturally aware and socially responsible medical education and be mindful of values imparted in the “hidden curriculum.” Hidden messages perpetuate health disparities through the irrelevant addition of race, ethnicity, and gender in clinical cases.

16. Hold executive leadership accountable for EDIJ action plans. Ask that senior diversity officials be appointed to the highest structural level at your institution (the C-suite) and participate in a structure that empowers their effectiveness. If you find yourself in this role, it is your responsibility to acquire the knowledge and expertise in equity and inclusion scholarship and strategic approaches.

17. Acknowledge that you have biases even if you identify as an ally, an immigrant, a person of color, and even a senior diversity official. White supremacy, racism, and ethnocentrism present in many internalized ways.

18. Take the time to learn names and how to pronounce them correctly.
Individualize people by being curious about the meaning or the story behind the individual’s names. Learning to pronounce a name is about respect.

19. Examine institutional-academic partners and health system policies and processes that perpetuate barriers to racial equity.

20. Be uncomfortable and vulnerable. Speaking about race and/or ethnicity is not easy, but it is a must. It is OK to intervene as a bystander, be generous and humble.

21. Learn about student activism and movements; you may not quite realize the power of students driving change.

22. Do not opt for a path of least resistance in fear of being labeled as a “troublemaker” when it comes to issues about equity. Leverage your “friends in high places,” keep your integrity and advocate for the mission of equity.

23. Consider the meaning of words and what they may convey depending on context: minority, politically correct, color-blind, allies, melting pot, resilience, and grit, fit, etc. It is not always what we say or means, but what people hear and how it makes them feel that influences our climate, relationships, and behaviors.

24. Invest in much-needed diverse leadership. Build a pipeline from early on — support and sponsor pre-faculty and faculty of color.

25. When you make a mistake while trying to promote racial equity, admit it. Name the mistake, specifically say why the mistake is a problem, and share how you plan to correct the outcome and not to repeat the error.

26. Practice culturally competent and inclusive research. Does your research engage with marginalized communities? Can you address inequities within your research agenda?

27. Ask about the staff of color at your institution. They deserve respect and attention to equity issues, perhaps more than often acknowledged. Staff often represents the institutional memory, the face and culture of an institution before trainees, community, and patients.

28. Ask leaders for transparency — advocate for metrics around promotion rates, turnover, salary, and patient outcomes to assure equity across your institution. “We don’t know” is only acceptable is followed by “we will do something about it.” Evidence of inequities must trigger action-oriented interventions to resolve these issues urgently.

29. Choose your advocacy lane. Physicians vote less often than the general public. We should at least vote. Others may do more to engage the community and legislators for true systemic and structural changes. Bring advocacy to practice, teaching, community presence, professional society, and publications.

30. Commit to concrete ways to be a better upstander (recognizing something is wrong and doing something to correct it) and push yourself to act in real-time.

31. Stay up to date with geopolitical and local events that affect your colleagues and learners.

32. Avoid loose terms such as “difficult times” and “lost their lives” when describing what your Black colleagues are grieving. It is something much greater.

33. Pour into economic improvement by adhering to supplier diversity, like ordering team lunches from Black-owned and minority-owned businesses.

34. Show up at public events such as rallies, lectures, town-halls, etc. Your absence may be noticed more than your presence. Stay beyond the photo op and be fully engaged.

35. Role model patient advocacy. Identify and root out policies such as segregated care and care that propagates health and healthcare disparities.

36. Advocate for an institutional quality strategy that commits to addressing health and healthcare disparities and that provides quality data to faculty and trainees.

37. Suggest diverse patients, families, and communities to be included in institutional committees.

38. Engage with community members and service organizations.

39. Speak up against injustice and discrimination! Your voice matters to peers, trainees, communities.

40. Ensure that the medical education curriculum is culturally relevant and threads cultural humility. Center how students and trainees can learn to be providers who practice patient advocacy.

41. Review representation in regards to the content, speakers, and consultants you invite to campus.

42. Learn the history of the land and communities where your school of medicine is located. Recognize indigenous land with a formal acknowledgment in presentations, gatherings, media presence. Also, acknowledge the displacement of communities of color depending on where your institution is located.

Sylk Sotto is a bioethicist. Jada Bussey-Jones, Inginia Genao, Maria Maldonado, and Kimberly D. Manning are internal medicine physicians. Francisco A. Moreno is a psychiatrist.

Image credit: Shutterstock.com

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