Working to mitigate racial and gender inequality in hospital medicine may seem like a daunting task, but every doctor can play a role in turning the march toward equity, according to Jorge Ganem, MD, FAAP.
“Talking about bias, racism, sexism, gender inequality, and health disparities is difficult,” said Ganem, an associate professor of pediatrics at the University of Texas at Austin and director of pediatric hospital medicine at Dell Children’s Medical Center. ‘Austin. SHM Converge, the annual conference of the Society of Hospital Medicine. “There is certainly a weight and a responsibility we all feel. But I think we should address gender inequalities and racial disparities through a lens of quality and patient safety and looking through that. goal”.
We won, along with Vanessa Durand, DO, FAAP, of St. John’s Hospital. Christopher’s for Children of Philadelphia, and Yemisi O. Jones, MD, FAAP, FHM, of Cincinnati Children’s Hospital, devised the concept of “functional alliance” as a way to improve representation in hospital medicine. The approach consists of three categories: listeners, amplifiers, and champions. Listeners are “those who take the time to listen and make room for oppressed and disadvantaged voices,” Ganem said. “Action may not always be possible, but space gives a validation to the feelings produced by oppression of the marginalized.”
He described amplifiers as those who use their privileged position to spread the message by educating their colleagues and other peers. “This includes elevating those from marginalized communities to speak on their own behalf and giving them attention, given their experience,” he said.
Champions are those who actively work to dismantle oppression within systems. Ganem cited organizations such as ADVANCE PHM, FEMINEM i HeForShe as examples of national and global efforts, “but this also includes those who work on committees that address diversity and inclusion in their workplace and present policies and procedures to increase equity,” he said.
It is also important to find opportunities for mentoring and sponsorship. “Positive mentoring relationships are key to preventing wear and tear and decreasing wear and tear,” he said. “Developing successful mentoring programs is essential to retaining doctors’ doctors’ underrepresented in medicine ‘in your organization.” He described a “sponsor” as someone who is in a position of influence and power who actively supports the career of a “protégé” who they have identified as having high potential. “The sponsor can advance a protégé’s career by nominating him or her for leadership opportunities and introducing him or her to career networks,” he said.
Durand additional ways to improve gender, race, and ethnic disparities were discussed. “It can all start by measuring the data,” said Durand, also an assistant professor of pediatrics at Drexel University in Philadelphia. “This means examining gender, race, and ethnicity data by unit or section of your institution, as well as leadership positions.” In 2017, authors led by Hilary Sanfey, MBBBCh, MHPE, FACS, published an article on strategies to identify and close the gender pay gap in surgery (J Am Coll Surg. 2017; 225: 333-8). Her recommendations included policy change, transparency, oversight of metrics, promotion of women in leadership positions, and evaluation of organizational culture. “It goes back to culture, because it leads to accountability,” Durand said. “Behavior change leads to accountability.”
Part of the responsibility of people within a cultural change includes the resolution of microaggressions or indirect expressions of prejudice. In 2016, authors led by Floyd Cheung, PhD, established a framework using the acronym ACTION, which identifies a microaggression without being aggressive or evokes defensiveness toward the person communicating the microaggression. ACTION means Asking questions; Come from curiosity, not judgment; Explain what you have observed factually; Impact exploration: discusses what the impact was; Possess your own thoughts and feelings about the situation; and discuss the following steps.
“It’s true that this can take a while, but when we declare microaggressions, most of us don’t realize that these statements can be harmful or uncomfortable for the person receiving them,” Durand said.
Another strategy for addressing disparities is to partially blind the interview process for students. “You can do this if you don’t give any‘ cognitive information ’to your interviewers (such as scores on U.S. medical license exam steps) that can anchor their position before the interview takes place,” he explained. . “You can also normalize one or two questions that all respondents need to answer, to have a more objective way of comparing answers horizontally rather than vertically.”
This complements the notion of the Association of American Medical Colleges. “holistic review, “a describing principle that allows admissions committees” to consider the applicant “whole,” rather than disproportionately focusing on any factor. “
“The general concept is to evaluate what the criteria are for the place you hire,” Durand said. “The different criteria will have different levels of importance. You would take into account the values of the group or the institution and make sure that these criteria are the most important for the selection, in the lead.”
Ganem and Durand have not revealed any financial relationship.
This MDEdge News article originally appeared on the-hospitalist.org. MDedge is part of the Medscape professional network.