Perspectives on Diversity

Pathways to Physician Diversity

Eleonora Lad, MD, PhD

“The work goes on…

       the cause endures…

              the hope still lives, and

                     the dream shall never die”

                                 - Senator Ted Kennedy










Eleonora Lad, MD, PhD

I was very grateful for the opportunity to attend and represent Duke Medical School at the inaugural “Pathways to Physician Diversity: A National Summit” held at the Mayo Clinic in Phoenix, Arizona on February 9 and 10, 2018. This was an extremely educational and inspiring event attended by participants from medical schools and universities across the United States, with the goal of exploring strategies to increase the pipeline and access to medical careers to individuals from diverse backgrounds. Outstanding speakers included Drs. Richard H. Carmona, the 17th Surgeon General of the United States (who received a standing ovation), David A. Acosta, the Chief Diversity of Inclusion Officer of the Association of American Medical Colleges, Cedric Bright, Associate Dean for Inclusive Excellence at UNC and prior president of the NMA, among many others.  The content of the summit was very rich, but I would like to highlight a few important topics discussed.

The current state of affairs in diversity in medical education is surprisingly bleak, as the acceptance of African American and Hispanic applicants did not change since 1980 despite funding programs to increase diversity, and in fact it decreased for males from these ethnic groups. There is also an existing crisis of American Indian or Alaska Native men. The “leaky pipeline” to success of these ethnic groups is due to economic and societal difficulties, standardized test scores as a major barrier to acceptance, “a hidden curriculum”, numerous socioeconomic challenges at every step, and the presence of microaggressions throughout the course of their education and career. In turn, a lack of inclusion is very detrimental to any institution, as it leads to an incomplete organization, one that does not benefit from advantages of diverse individuals that would enrich it.  As former US Surgeon General Regina Benjamin noted, “unless the current trend is reversed, our country will see a growing ethnic and racial disconnect between those who receive care and those who provide the care.” To counteract the current state, there is a need for very early mentorship and sponsors of underrepresented minority (URM) students through National Medical Association and Student National Medical association programs.

A number of strategies to allow closing the gaps were outlined by a number of speakers, via case presentations or description of current focused programs. Medical student admission committees are starting to consider a more holistic application review, one that goes beyond standardized test scores (the “looking beyond numbers” concept), while considering the true value of diversity. Along with this, there is a need for data-driven education of all members of organization on the benefits of diversity and for changes in the institutional metrics of success. Very early mentorship of URM students in STEM careers and sponsorship by their mentors are critical, as is identifying the right fit between student or trainee and a program/institution. Lastly, after acceptance to an institution or program, it is also important to ensure that URM students have a peer group and a community in order to foster a sense of belonging and their future success.

In the words of Mathatma Gandi, “our ability to reach unity in diversity will be the beauty and the test of our civilization.”  More than ever, this applies to the medical field, which needs to see increased access to medical careers of individuals from diverse backgrounds. Together, through broad initiatives such as the national summit “Pathways to Physician Diversity”, we can succeed.

Reframing our Ways of Thinking about Diversity 

Leon Herndon, MD


Leon Herndon, MD

As we prepare to celebrate Martin Luther King Jr. Day, I want to draw your attention to a book by Damon Tweedy, MD, titled “Black Man in a White Coat”. Dr Tweedy is assistant professor of psychiatry at Duke University Medical Center, and a staff physician at the Durham VA Medical Center. In Black Man in a White Coat, Tweedy describes his experience as a black medical student and resident in a predominantly white, Southern university. He weaves the experiences of an African American physician with those of African American patients, carefully documenting how issues of race permeate American medicine. He also recounts episodes of racial prejudice he witnessed throughout his medical training. 

This book resonated with me, as someone who had similar experiences in my training a decade earlier. The scientific literature is flooded with articles on the subject of racial bias in medicine. In 1996, Dr. H. Jack Geiger wrote an editorial in the New England Journal of Medicine where, after reviewing several studies, he questioned whether “racially discriminatory rationing by physicians and health care institutions” was a cause of racial disparity in the health care system. In 2002 the Institute of Medicine added fuel to the discussion with their book Unequal Treatment, in which they concluded: “Although myriad sources contribute to disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care.” Over the years, a plethora of studies describe racially disparate treatments and outcomes.

More recently, Dr. Darrell G. Kirch, president of the Association of Medical Colleges, noted that “reducing health disparities is more than just the right thing to do—it is a critical component of improving health care quality.”

I am a believer that a diverse faculty and staff can act as role models for all. Seeing individuals from diverse backgrounds succeed as faculty and in other leadership roles provides positive examples of what is possible and demonstrates the degree to which talent from diverse communities is valued by institutional leaders.

It is up to all of us who take care of patients, to find the commonalities and respect the differences between us and our patients. In that way, we can understand what they value, how best to communicate with them, and how to arrive at treatment plans that improve their health while respecting their wishes.

Finally, I leave you with a quote from Martin Luther King, Jr. from over 50 years ago: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Reframing our ways of thinking about diversity on an institutional level provides an opportunity to confront the unfinished business of the past even as we address the newer issues of today. 


InSight into Inclusion

Goldis Malek, PhD

“If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities and so weave a less arbitrary social fabric, one in which each diverse gift will find a fitting place.” 

- Margaret Mead.

I wonder how many of us are cognizant of “unconscious bias” in our day to day activities? Though I would like to think that I have been aware and concerned with issues surrounding diversity, it was after joining the School of Medicine Diversity and Inclusion Council several years ago, that I recognized some of the things many of us do, myself included, without intention or malice, that may have a negative impact on others. I participated in a two day, well organized, orientation led by Howard Ross, one of the nation’s leading diversity consultants, where he provided example after example of the subtle power of this form of second generation discrimination. Any preconceived notion that unconscious bias is simple was rejected during these two days and emphasis was placed on understanding the extent of its prevalence and its consequences. Age bias, race bias, education bias, gender bias, sexual orientation bias, socioeconomic status bias, cultural bias, and the list goes on and on.  At the end of the meeting one fact was clear, the counter to implementation of biases is knowledge and an appreciation for understanding that how we differ will make us stronger both individually and collectively. 

Since then the School of Medicine Diversity and Inclusion Council has met monthly brainstorming on means by which to foster and influence an inclusive climate for all members of our faculty, students and staff. This journey requires agents of change at every level and most importantly with in the department. This was the motivation to organizing a Duke Eye Center Diversity and Inclusion Committee. Collectively, we hope to personalize the goals of the committee, specifically, to the needs and concerns of our department.

Change starts with each of us and is only the first step. Knowledge is power and one would like to think that if an individual is ‘consciously’ committed to change, the act of discovering and identifying one’s hidden biases can be the impetus for change. With that in mind, I would also like to encourage anyone interested in an assessment of your ‘unconscious bias’, to take the Implicit Association Test, available online. Also, I would like to invite all members of the department, who are willing, to contribute to this new blog by sharing their personal diversity and inclusion stories. Finally, if you are interested in becoming more involved in issues surrounding diversity and inclusion or have any concerns or questions please contact me, or any of the members of the Council.

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