Fostering inclusion: Strategies to promote belonging for women and underrepresented physicians

Longstanding inequities continue to exist within academic medicine. Although the number of women and/or individuals who are racially and ethnically underrepresented in medicine, or URM, has grown over time, careful attention must be paid to the daily encounters experienced by these groups, as they often send messages of exclusion.

This notion inspired Adrianne Haggins, M.D., an assistant professor of emergency medicine at Michigan Medicine, to highlight several of the causes for these inequities, as well as potential solutions, which were recently published in Academic Medicine.

“Historically, there was a time in medicine where women were merely involved to assist white, male physicians,” says Haggins. “And Black Americans were viewed as specimens for the literal purpose of ‘practicing’ medicine. These factors have contributed to the environment that exists today.”

Haggins adds that while academic medicine traditionally promotes a culture of “discovery and innovation,” its legacy is riddled with a history of “elitism, racism and sexism.”

“It’s important to acknowledge that academic medical environments must change in their approach to promoting diversity, equity and inclusion,” says Haggins. “Otherwise, lingering unconscious biases and daily cues will continue to persist within these environments, which can be problematic for retaining talented women and persons underrepresented in medicine.”

A physician workforce that is representative of the diverse U.S. population has the potential to improve health care, but achieving this has been slow moving. Haggins points out that from 1980 to 2016, there has only been a 1.1% increase in the number of Black medical graduates throughout the country.

“When analyzing population growth among racial and ethnic groups considered URM, it’s evident that medical schools still fall short of achieving representative levels of racial and ethnic diversity,” says Haggins. “Therefore, it’s obvious that a critical need for interventions that ensure racial and gender equity exists.”  

The National Science Foundation recently highlighted the alarming rate at which women in academic medicine experience sexual harassment when compared to other professions, with URM women significantly impacted at disproportionate rates.

Additionally, microaggressions, or “brief and commonplace daily verbal, behavioral or environmental indignities, whether intentional or unintentional,” adversely affect individuals who are URM and/or women in academic medicine. Haggins adds that discriminatory patient behaviors towards these physicians can also serve as subtle or overt “reminders” that they don’t belong in their profession.  

“URM and/or women physicians may be outright denied from participating on a care team due to a patient’s racist demands,” says Haggins. “And researchers have pointed out that these behaviors can contribute to ‘belonging uncertainty,’ which means that individuals are made to feel marginalized in the academic and professional setting, thus wondering whether they belong.”

Haggins says that this may cause feelings of disconnection among targeted individuals, which can ultimately lead to reduced levels of motivation and achievement. In addition, limited access to mentoring opportunities among URM and/or women physicians, coupled with discriminatory practices within clerkship evaluations and entrance rates for medical honor societies can also reinforce messages of exclusion among these groups.

“Qualitative studies have shown that many medical students described experiences during their training in which their racial and/or ethnic identities made them feel isolated or ignored on rounds, or even in their classrooms,” says Haggins. “Subsequently, URM faculty also reported feeling ‘invisible’ in the workplace, which is extremely telling.”

Institutional messages within academic medical centers can also “further perpetuate a culture of exclusion,” says Haggins, as a vast majority of their imagery depicts “traditions of medicine,” which often omit URM and women physicians altogether. However, when images of minorities are present, they generally aren’t in positions of authority, which only reinforces longstanding stereotypes.

“While URM physicians arrive eager to contribute and introduce their ideas to their respective institutions, they often find that their visions for their medical careers are incongruent with – or undervalued – in the academic space,” says Haggins. “For example, Black medical students’ perceptions of success have been explored, and these students often describe ‘giving back to their families and communities’ as highly valuable, which counters the individualistic mindset encouraged throughout academia.”

Consequently, while women and persons URM may be present in number when it comes to academic medicine, they are often unseen and unheard.  
In order to offset these differential experiences, Haggins says that a shared awareness among faculty, administrators and trainees can help create a sense of belonging for everyone.  

“By shifting the norms in medicine, we can alter the course of historical exclusion. Inclusive teaching practices that hone in on cultivating mentoring relationships with diverse trainees, as well as fostering crucial discussions about the relevance of personal identities and the importance of diverse imagery can all help promote more welcoming environments.”

Lastly, Haggins notes the importance of rethinking traditional productivity metrics. As physician workforce demographics continue to change, so should institutional perspectives, career aspirations and dialogue around meaningful impact.

“By incorporating metrics that capitalize on a person’s drive to improve the health of and maintain a connection to their community, innovation and advances in health care equity can be spurred if properly encouraged,” says Haggins. “Therefore, it would be in an academic institution’s best interest to develop mechanisms, like community outreach fellowships or institutional grants, that both foster and capture excellence in community involvement.”

Paper cited: “To Be Seen, Heard, and Valued: Strategies to Promote a Sense of Belonging for Women and Underrepresented in Medicine Physicians,” Academic Medicine. DOI: 10.1097/ACM.0000000000003553