When it comes to diversity, academic medicine in the United States is sorely lacking.
A 2019 report from the Association of American Medical Colleges noted that medical school professors in the United States are overwhelmingly white, accounting for 63.9% of the field. Asians are the second largest group at 19.2%, followed by Latinos at 5.5% and Blacks at 3.6%.
There are myriad barriers that underrepresented groups face when trying to enter the medical profession, said Carmin Powell, MD, clinical assistant professor of pediatrics at Stanford Medicine. These include microaggressions, racial discrimination and the tax on minorities, or the burden of extra responsibilities placed on minority teachers in the name of diversity, she said.
Powell said seeing those same issues at Stanford Medicine inspired her in 2017 to co-found the Leadership Education in Advancing Diversity, or LEAD, program with Lahia Yemane, MD, who is also a clinical associate professor of pediatrics.
The 10-month program for residents and fellows teaches leadership skills to help trainees address issues related to equity, diversity, and inclusion. Administered by the Department of Higher Medical Education, the Diversity Leadership Program also supports those who wish to publish scientific articles on the topics of the program.
An article by Powell and Yemane published in the Journal of Higher Medical Education in December reported that 99% of the 75 trainees in the first three groups enrolled in the program said they were more confident in their knowledge of diversity, equity and inclusion, and in their ability to implement change during of their medical training. Rebecca Blankenburg, MD, associate chair of pediatric education, was the study’s lead author, and Powell was lead author.
The training program plan to publish another study on how program participants felt the training affected their sense of belonging to academic medicine. Through this work, Powell and Yemane hope to improve the culture of medicine.
I spoke with Powell about the importance of the Diversity Leadership program, its impact on interns, and its goals for the future of the program.
What inspired you to create a leadership program for diversity in medical education?
The goal was always to see if we could change the culture in medicine.
Much of it came from my own experiences as a medical student and resident. It became clear that many of the things that deter underrepresented minorities from staying in academic medicine were the same challenges I had in terms of biases and microaggressions in the clinical setting, whether from colleagues or patients. Also, I felt like a lot of people were unaware of the impact that implicit bias can have.
My colleagues and I were all in conversation about building a program around bias and how to mitigate it. How do you talk about inclusion between trainees and teachers? Additionally, how do you support people who are interested in working on diversity, equity and inclusion and developing studies on these issues?
How has the program helped trainees so far?
The community spirit that has been built within the LEAD program is truly amazing to see. The first year, we started in pediatrics. But we quickly expanded to include other departments of higher medical education because we knew everyone had different experiences with diversity and what they perceived to be inclusion and equity work.
People feel, at least in this program, supported enough to talk about it and even feel encouraged to teach it to their respective departments. It was great to see residents giving workshops based on what they learned through the program.
Seeing them progress in their own leadership as well – some trainees have published their workshops and others have written articles in academic medical journals. LEAD alumnus Dr. Devika Bhushan is now California’s new Surgeon General. This shows the considerable effects of the program.
What has the program shed light on bias and microaggression at Stanford Medicine?
When LEAD split from pediatrics, we heard that some of these things are even more prevalent in certain departments.
It was very difficult for trainees to speak up when they heard a racist or derogatory comment, lest it come back to them in performance reviews.
This has prompted the need for further investigation across higher medical education.
What can Stanford Medicine members do to further support trainees in the program?
We want to see more departments supporting LEAD Scholars. I think the anesthesia department is a wonderful example. One of the program’s former fellows who now sits on the Steering Committee, Felipe Perez, has been successful in rallying his department’s leadership to the program in terms of supporting fellows who participate, giving them leadership roles on the steering committee. diversity of the department and even supporting their scholarships.
They’ve been a great role model for saying, “Not only do we want you to participate in LEAD, but once you’ve completed it, come back to our department and teach us more.”
This is what we hope to see in all departments.
What are your goals for the future of LEAD?
The bottom line is that we really wanted to cultivate a place where people can self-actualize, which is really, really hard to do — especially in medicine, and especially in academic medicine.
The only way to achieve this is to foster fully inclusive environments. I think LEAD did that in a very real, tangible way. The hope is that all institutions have a model like this.
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