When it comes to diversity, academic medicine in the United States is severely lacking.
A 2019 report by the Association of American Medical Colleges noted that medical school faculty in the U.S. are predominantly white, making up 63.9% of the field. Asians make up the next largest group at 19.2%, followed by Latinos at 5.5% and Black people at 3.6%.
There are a myriad of barriers that underrepresented groups face when trying to enter the medical profession, said Carmin Powell, MD, a Stanford Medicine clinical assistant professor of pediatrics. These include microaggressions, racial discrimination and the minority tax, or the burden of extra responsibilities placed on minority faculty in the name of diversity, she said.
Powell said that seeing these same problems at Stanford Medicine inspired her in 2017 to co-found the Leadership Education in Advancing Diversity Program, or LEAD, 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. Run through the Graduate Medical Education department, the diversity leadership program also supports those who wish to publish scientific papers on program topics.
A paper Powell and Yemane published in the Journal of Graduate Medical Education in December reported that 99% of 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 their ability to implement changes during their medical training. Rebecca Blankenburg, MD, associate chair of education in pediatrics, was the study's senior author, and Powell was lead author.
Training program leaders plan to publish another study on how participants in the program felt the training affected their sense of belonging in 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 trainees, and her goals for the future of the program.
What spurred you to create a medical education diversity leadership program?
The goal was always to see if we could change the culture in medicine.
A lot of it came out of my own experiences as a medical student and a resident. It became clear that a lot of the things that deter underrepresented minorities from staying in academic medicine were the same challenges that I had in terms of facing bias and microaggressions in the clinical setting, whether it was from colleagues or patients. Also, I felt like a lot of people weren't aware of the impact that implicit bias can have.
My colleagues and I were all in conversations about developing a program around bias and how to mitigate it. How do you talk about inclusion between trainees and faculty? Also, how do you support people who are interested in diversity, equity and inclusion work and developing scholarship around these issues?
How has the program helped trainees so far?
The spirit of community that's been built within the LEAD program has been really great to see. The first year, we started in pediatrics. But we quickly expanded to include other graduate medical education departments because we knew that everyone has different experiences when it comes to diversity, and what they perceive inclusion and equity work to be.
People feel, at least in this program, supported enough to talk about this and even feel emboldened to teach it to their respective departments. It was fantastic to see some residents give workshops from what they learned through the program.
Also seeing them advance in their own leadership -- some trainees went onto publish their workshops and some went on to write pieces in academic medicine journals. LEAD alum Dr. Devika Bhushan is now the new California Surgeon General. This shows the far-reaching effects of the program.
What has the program illuminated about biases and microaggressions at Stanford Medicine?
When LEAD branched out from pediatrics, we were hearing that some of this stuff is even more pervasive in certain departments.
It was really hard for trainees to speak up when they heard a racist or derogatory comment, for fear that it would come back to them in performance evaluations.
That prompted the need for more investigation throughout all of graduate medical education.
What can members of Stanford Medicine do to further help program trainees?
We want to see more departments support the LEAD scholars. I think the anesthesia department is a wonderful example. One of the former program scholars who is now on the steering committee, Felipe Perez, has been able to get their department's leadership on board with the program in terms of supporting trainees that participate, giving them leadership roles within the department's diversity committee and even supporting their scholarships.
They've been a great model of saying, "Not only do we want you to participate in LEAD, but once you complete it, come back to our department and teach us more."
That's what we hope to see across all departments.
What are your goals for the future of LEAD?
The main thing is that we really want to cultivate a place where people can self-actualize who they are, which is really, really hard to do -- especially in medicine, and especially in academic medicine.
The only way to do that is if you foster environments that are totally inclusive. I think LEAD has done that in a very real, tangible way. The hope is for all institutions to have a model like this.
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