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Challenges in Diversity, Equity, and Inclusion

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Understanding and Cultivating Well-being for the Pediatrician

Abstract

Diversity, equity, and inclusion (DEI) is a framework used to promote high performance teams, prioritizing principles of justice and intersectionality. There is abundant evidence that members of marginalized communities, such as racial and ethnic minorities and sexual and gender minorities, experience higher threats to well-being than members of dominant groups. Such threats include systemic racism and discrimination, bias, sexism, and homophobia, all of which are deeply ingrained in medical culture. Recognizing and responding to these threats requires an understanding of how individual identities influence interactions in the workplace, including evaluations and promotions, team dynamics, and career trajectory. Discrimination and bias are known contributors to adverse outcomes in emotional and physical health, career satisfaction, and social connectedness in the workplace. Any effort to promote well-being and decrease burnout must center DEI as a foundational component of that effort, or risk further marginalization of certain groups and likely failure of the intervention.

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References

  1. Stahl GK, Maznevski ML, Voigt A, Jonsen K. Unraveling the effects of cultural diversity in teams: a meta-analysis of research on multicultural work groups. J Int Bus Stud. 2010;41(4):690–709.

    Article  Google Scholar 

  2. Padamsee X, Crowe B. Unrealized impact: the case for diversity, equity, and inclusion. Kennesaw, GA: Youth Today; 2017.

    Google Scholar 

  3. Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;1989:139.

    Google Scholar 

  4. Berkeley Lab. IDEA: inclusion diversity equity accountability. 2020.

    Google Scholar 

  5. Andersen ML, Taylor HF. Sociology: the essentials. 6th ed. Belmont, CA: Wadsworth; 2011.

    Google Scholar 

  6. Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. 2012;102:1267.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Phillips KW. How diversity makes us smarter. Sci Am. 2014;

    Google Scholar 

  8. Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J. Educational benefits of diversity in medical school: a survey of students. Acad Med. 2003;78:460–6.

    Article  PubMed  Google Scholar 

  9. Guterl F. Diversity in science: why it is essential for excellence. Sci Am. 2014;

    Google Scholar 

  10. Gurin P, Dey EL, Hurtado S, Gurin G. Diversity and higher education: theory and impact on educational outcomes. Harv Educ Rev. 2002;72(3):330–66.

    Article  Google Scholar 

  11. Pololi LH, Evans AT, Gibbs BK, Krupat E, Brennan RT, Civian JT. The experience of minority faculty who are underrepresented in medicine, at 26 representative U.S. medical schools. Acad Med. 2013;88:1308.

    Article  PubMed  Google Scholar 

  12. Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in academic medicine. J Gen Intern Med. 2010;25:1363.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Osseo-Asare A, Balasuriya L, Huot SJ, Keene D, Berg D, Nunez-Smith M, et al. Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw Open. 2018;1:e182723.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. Am Econ Rev. 2019;109:4071.

    Article  Google Scholar 

  15. Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A. 2020;117:21194.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lau ES, Hayes SN, Volgman AS, Lindley K, Pepine CJ, Wood MJ. Does patient-physician gender concordance influence patient perceptions or outcomes? J Am Coll Cardiol. 2021;77:1135.

    Article  PubMed  Google Scholar 

  17. Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician work hours and the gender pay gap — evidence from primary care. N Engl J Med. 2020;383:1349.

    Article  PubMed  Google Scholar 

  18. Khalili J, Leung LB, Diamant AL. Finding the perfect doctor: identifying lesbian, gay, bisexual, and transgender-competent physicians. Am J Public Health. 2015;105:1114.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Braun L, Saunders B. Avoiding racial essentialism in medical science curricula. AMA J Ethics. 2017;19(6):518–27.

    Article  PubMed  Google Scholar 

  21. Penner LA, Hagiwara N, Eggly S, Gaertner SL, Albrecht TL, Dovidio JF. Racial healthcare disparities: a social psychological analysis. Eur Rev Soc Psychol. 2013;24(1):70–122.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bailey N, Krieger N, Agénor M, Graves J, Linos N, Bassett M. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–63.

    Article  PubMed  Google Scholar 

  23. Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86:1370.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993;9:82.

    Article  CAS  PubMed  Google Scholar 

  25. David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med. 1997;337:1209–14.

    Article  CAS  PubMed  Google Scholar 

  26. David R, Collins J. Disparities in infant mortality: what’s genetics got to do with it? Am J Public Health. 2007;97(7):1191–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019. AAMC diversity and inclusion. Washington, DC: AAMC; 2019.

    Google Scholar 

  29. University of Alabama at Birmingham. History of women in medicine. Office for diversity and inclusion. Birmingham, AL: University of Alabama at Birmingham; 2021. https://www.uab.edu/medicine/diversity/initiatives/women/history. Accessed 27 Apr 2021.

    Google Scholar 

  30. University of Alabama at Birmingham. History of minorities in medicine. Office for diversity and inclusion. Birmingham, AL: University of Alabama at Birmingham; 2021. https://www.uab.edu/medicine/diversity/initiatives/minorities/history. Accessed 27 Apr 2021.

    Google Scholar 

  31. Steinecke A, Terrell C. Progress for whose future? the impact of the Flexner report on medical education for racial and ethnic minority physicians in the United States. Acad Med. 2010;85(2):236–45.

    Article  PubMed  Google Scholar 

  32. https://www.childstats.gov. Forum on child and family statistics. Race and Hispanic origin composition. America’s children in brief: key national indicators of well-being. Washington, DC: U.S. Government Printing Office; 2020. https://www.childstats.gov/americaschildren/race.asp. Accessed 2 Nov 2021.

    Google Scholar 

  33. The American Board of Pediatrics. Pediatric physicians workforce data book 2018-2019. Chapel Hill, NC: The American Board of Pediatrics; 2019.

    Google Scholar 

  34. Hofler LG, Hacker MR, Dodge LE, Schutzberg R, Ricciotti HA. Comparison of women in department leadership in obstetrics and gynecology with those in other specialties. Obstet Gynecol. 2016;127(3):442–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Trans Student Educational Resources. Definitions. 2020.

    Google Scholar 

  36. The Williams Institute. Nonbinary LGBTQ adults in the United States. Los Angeles, CA: The Williams Institute; 2021.

    Google Scholar 

  37. Association of American Medical Colleges. Matriculating student questionnaire: 2018 all school summary report. Washington, DC: Association of American Medical Colleges; 2018.

    Google Scholar 

  38. Przedworski JM, Dovidio JF, Hardeman RR, Phelan SM, Burke SE, Ruben MA, et al. A comparison of the mental health and well-being of sexual minority and heterosexual first-year medical students: a report from the medical student CHANGE study. Acad Med. 2015;90:652.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mansh M, White W, Gee-Tong L, Lunn MR, Obedin-Maliver J, Stewart L, et al. Sexual and gender minority identity disclosure during undergraduate medical education: “in the closet” in medical school. Acad Med. 2015;90:634.

    Article  PubMed  Google Scholar 

  40. Piette JD, Bibbins-Domingo K, Schillinger D. Health care discrimination, processes of care, and diabetes patients’ health status. Patient Educ Couns. 2006;60:41.

    Article  PubMed  Google Scholar 

  41. Sellers RM, Caldwell CH, Schmeelk-Cone KH, Zimmerman MA. Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav. 2003;44:302.

    Article  PubMed  Google Scholar 

  42. Kaholokula JK, Grandinetti A, Keller S, Nacapoy AH, Kingi TK, Mau MK. Association between perceived racism and physiological stress indices in Native Hawaiians. J Behav Med. 2012;35:27.

    Article  PubMed  Google Scholar 

  43. Lewis TT, Williams DR, Tamene M, Clark CR. Self-reported experiences of discrimination and cardiovascular disease. Curr Cardiovasc Risk Rep. 2014;8:365.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lewis TT, Everson-Rose SA, Powell LH, Matthews KA, Brown C, Karavolos K, et al. Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN heart study. Psychosom Med. 2006;68:362.

    Article  PubMed  Google Scholar 

  45. Griffin AT. Racism, stress, and health in African American females: the impact of stress experienced from perceived racism on cardiovascular reactivity in African American adolescent and adult females. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2006.

    Google Scholar 

  46. Monahan PO, Shacham E, Reece M, Kroenke K, Ong’Or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. J Gen Intern Med. 2009;24(2):189–97.

    Article  PubMed  Google Scholar 

  47. Zeiders KH, Doane LD, Roosa MW. Perceived discrimination and diurnal cortisol: examining relations among Mexican American adolescents. Horm Behav. 2012;61:541.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. DeSantis AS, Adam EK, Doane LD, Mineka S, Zinbarg RE, Craske MG. Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents. J Adolesc Health. 2007;41:3.

    Article  PubMed  Google Scholar 

  49. Martin CG, Bruce J, Fisher PA. Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring. Horm Behav. 2012;61:661.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 2015;18:1.

    Article  PubMed  Google Scholar 

  51. Hunte HER, Williams DR. The association between perceived discrimination and obesity in a population-based multiracial and multiethnic adult sample. Am J Public Health. 2009;99:1285.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Solorzano D, Ceja M, Yosso T. Critical race theory, racial microaggressions, and campus racial climate: the experiences of African American College Students. J Negro Educ. 2000;69:60.

    Google Scholar 

  53. Ong AD, Fuller-Rowell T, Burrow AL. Racial discrimination and the stress process. J Pers Soc Psychol. 2009;96:1259.

    Article  PubMed  Google Scholar 

  54. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93:200.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Peterson NB, Friedman RH, Ash AS, Franco S, Carr PL. Faculty self-reported experience with racial and ethnic discrimination in academic medicine. J Gen Intern Med. 2004;19:259.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Beagan BL. “Is this worth getting into a big fuss over?” Everyday racism in medical school. Med Educ. 2003;37:852.

    Article  PubMed  Google Scholar 

  57. Nunez-Smith M, Pilgrim N, Wynia M, Desai MM, Bright C, Krumholz HM, et al. Health care workplace discrimination and physician turnover. J Natl Med Assoc. 2009;101:1274.

    PubMed  Google Scholar 

  58. Baldwin DWC, Rowley BD, Daugherty SR, Bay RC. Withdrawal and extended leave during residency training: results of a national survey. Acad Med. 1995;70:1117.

    Article  PubMed  Google Scholar 

  59. Siller H, Tauber G, Komlenac N, Hochleitner M. Gender differences and similarities in medical students’ experiences of mistreatment by various groups of perpetrators. BMC Med Educ. 2017;17:134.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hinze SW. “Am I being oversensitive?” Women’s experience of sexual harassment during medical training. Health. 2004;8:101.

    Article  PubMed  Google Scholar 

  61. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians: results from the physician work life study. J Gen Intern Med. 2000;15:372.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Frintner MP, Sisk B, Byrne BJ, Freed GL, Starmer AJ, Olson LM. Gender differences in earnings of early- and midcareer pediatricians. Pediatrics. 2019;144:e20183955.

    Article  PubMed  Google Scholar 

  63. Spector ND, Cull W, Daniels SR, Gilhooly J, Hall J, Horn I, et al. Gender and generational influences on the pediatric workforce and practice. Pediatrics. 2014;133:1112.

    Article  PubMed  Google Scholar 

  64. Shilo G, Mor Z. The impact of minority stressors on the mental and physical health of lesbian, gay, and bisexual youths and young adults. Heal. Soc Work. 2014;39:161.

    Google Scholar 

  65. Liptak A. Civil rights law protects gay and transgender workers, supreme court rules. The New York Times. 2020. https://www.nytimes.com/2020/06/15/us/gay-transgender-workers-supreme-court.html.

  66. Boatright D, Ross D, O’Connor P, Moore E, Nunez-Smith M. Racial disparities in medical student membership in the alpha omega alpha honor society. JAMA Intern Med. 2017;177:659.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Klein R, Julian KA, Snyder ED, Koch J, Ufere NN, Volerman A, et al. Gender bias in resident assessment in graduate medical education: review of the literature. J Gen Intern Med. 2019;34:712.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Rojek AE, Khanna R, Yim JWLL, Gardner R, Lisker S, Hauer KE, et al. Differences in narrative language in evaluations of medical students by gender and under-represented minority status. J Gen Intern Med. 2019;34(5):684–91.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Ginther DK, Schaffer WT, Schnell J, Masimore B, Liu F, Haak LL, et al. Race, ethnicity, and NIH research awards. Science. 2011;333:1015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. J Am Med Assoc. 2000;284:1085.

    Article  CAS  Google Scholar 

  71. Ginther DK, Haak LL, Schaffer WT, Kington R. Are race, ethnicity, and medical school affiliation associated with NIH R01 type 1 award probability for physician investigators? Acad Med. 2012;87:1516.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Nunez-Smith M, Ciarleglio MM, Sandoval-Schaefer T, Elumn J, Castillo-Page L, Peduzzi P, et al. Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Public Health. 2012;102:852.

    Article  PubMed  PubMed Central  Google Scholar 

  73. National Academy of Sciences (US), National Academy of Engineering (US), and Institute of Medicine (US) Committee on Maximizing the Potential of Women in Academic Science and Engineering. Beyond bias and barriers: fulfilling the potential of women in academic science and engineering. Washington, DC: National Academies Press; 2007.

    Google Scholar 

  74. Cyrus KD. Medical education and the minority tax. JAMA. 2017;317:1833.

    Article  PubMed  Google Scholar 

  75. Ly DP, Seabury SA, Jena AB. Differences in incomes of physicians in the United States by race and sex: observational study. BMJ. 2016;353:i2923.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Wood NI. Departing from doctor-speak: a perspective on code-switching in the medical setting. J Gen Intern Med. 2019;34:464.

    Article  PubMed  Google Scholar 

  77. McCluney CL, Robotham K, Lee S, Smith R, Durkee M. The cost of code-switching. Harv Bus Rev. 2019;

    Google Scholar 

  78. Kishawi D. Hijab in the OR. 2018.

    Google Scholar 

  79. Tabassum NJ. Tattoo subculture: creating a personal identity in the context of social stigma. J Chem Inf Model. 2019;

    Google Scholar 

  80. Madera JM, King EB, Hebl MR. Bringing social identity to work: the influence of manifestation and suppression on perceived discrimination, job satisfaction, and turnover intentions. Cult Divers Ethn Minor Psychol. 2012;18:165.

    Article  Google Scholar 

  81. Harvey WA. Are some emotions marked “whites only”? Racialized feeling rules in professional workplaces. Soc Probl. 2010;57(2):251–68.

    Article  Google Scholar 

  82. Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98:1441.

    PubMed  PubMed Central  Google Scholar 

  83. Greenwood BN, Carnahan S, Huang L. Patient–physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A. 2018;115:8569.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Jordan K. Vicarious trauma: proposed factors that impact clinicians. J Fam Psychother. 2010;21:225.

    Article  Google Scholar 

  86. Shoji K, Lesnierowska M, Smoktunowicz E, Bock J, Luszczynska A, Benight CC, et al. What comes first, job burnout or secondary traumatic stress? Findings from two longitudinal studies from the U.S. and Poland. PLoS One. 2015;10:e0136730.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Hernandez-Wolfe P, Killian K, Engstrom D, Gangsei D. Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. J Humanist Psychol. 2015;55:153.

    Article  Google Scholar 

  88. Pack M. Vicarious resilience: a multilayered model of stress and trauma. Affilia. 2014;29:18.

    Article  Google Scholar 

  89. Mustapha T, Eyssallenne T. Paying a penny for our thoughts and then asking for our 2 cents. Acad Med. 2020;95(12):1788. Diversity in Alpha Omega Alpha Honor Medical Society Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.

    Article  PubMed  Google Scholar 

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Miller, K.K., Mustapha, T. (2023). Challenges in Diversity, Equity, and Inclusion. In: Webber, S., Babal, J., Moreno, M.A. (eds) Understanding and Cultivating Well-being for the Pediatrician. Springer, Cham. https://doi.org/10.1007/978-3-031-10843-3_9

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