Addressing diversity and inclusion in medical programs can feel overwhelming. 

To know where to start, it’s essential to understand your end goal. “I think naming the issue and identifying the desired outcome is really integral to being able to make progress in this area,” says Michele Holton, a diversity strategy consultant who is co-leading a joint Washington University (Department of Pediatrics) and St. Louis Children’s Hospital task force focused on teaming and cultural competency.

During a webinar on improving diversity, equity and inclusion in medical programs, Holton walked through what it means to promote DEI within our medical programs and three interventions that can help even the smallest medical program strengthen their DEI efforts.

Understanding Equality Vs. Equity in Medical Education

Equality in medical education refers to a state of being equal, regardless of one’s status, rights and opportunities. However, equity refers to an understanding that people — based on their unique life experiences — may need more or different things to achieve a similar, just or fair outcome.

As a society, we have been socialized with the concept of equality by treating everyone that we encounter in our lives the same — by being fair and just. It’s seen in our society as a golden rule but is a rule that is insufficient for some situations, especially when it comes to medical education. The concept of equality also speaks to giving everyone the same tools to create the same outcomes. However, people want and need different things in society. They may have similar results, but the needs will differ depending on the person.

Equity is more about treating people based on their needs instead of what you need. To do that, you need a degree of empathy. “You have to be able to listen and understand and feel the experience of someone different than yours,” Holton said.  It’s essential to think about what is happening to us as individuals and what systemic changes are needed. So, when justice is involved with equity, equal access should appear.

What Is the Difference Between D&I and DEI in Medical Programs?

• D&I stands for diversity and inclusion. 

• DEI incorporates the concept of equity, as well. 

• DEIB, another term you’ll frequently hear in conversations about expanding access to opportunities in medical programs, adds in the additional element of belonging. 

Supporting Equity in Medical Programs

Understanding and addressing equity will have implications not only for patient engagement but also for the experiences of residents, fellows, and so forth. All parties involved require intentional action to drive change, both at the individual and systemic levels.

It may be helpful to think about these concepts in patient care first. Each patient brings a unique set of circumstances and experiences to their appointments, and physicians need to create a diagnosis, medical plan and/or treatment plan to follow that accounts for those experiences holistically. You must be intentional with how you engage to ensure that each individual patient’s needs are met. Finding places of commonality and practicing empathy throughout this process can have significant impact.

Similarly, residents and their families come from different places and needs. By offering tailored support to each resident, based on an understanding of what they uniquely need, you can improve the quality of all your residents’ educational experiences. 

3 Ways to Strengthen Your Medical Program’s DEI

Improving diversity and inclusion in your medical program can significantly strengthen the overall culture of your program. These three interventions give medical programs a straightforward path to get started with supporting greater DEI in their medical programs. 

Awareness 

Awareness involves a “level-setting” communication of useful information on key issues, Holton noted. It can involve:

• Providing perspective about organizational, local and national experiences of medicine from a racial perspective. Assume there will be some experiences that are encountered within the hospital, from inadvertent micro aggressions all the way to blatant racism. 
• Addressing role diversity throughout the organization. Help residents understand the perspectives of the entire team, appreciating and respecting the roles everyone plays when it comes to patient care. 
• Providing an open space for conversation. This happens by setting the tone and stating the goals and expectations of your program, calling out what’s not OK, and educating the new and veteran physicians so you can achieve the culture change you desire.

Affinity 

This is about building relationships. “It’s creating a space that allows people to connect based on shared interests that they have shared experiences,” Holton said. This can include:

• Providing more opportunities to connect, helping people feel safe speaking up and helping people feel they have the support they need. 
• Supporting and encouraging providers to share experiences in a safe place. This can be accomplished through mentoring relationships or through formal and informal gatherings.

Advocacy

Speaking up is key for anything impeding or “serving as barriers of the experience that’s desired,” Holton said. 

• Being clear on what to do if a provider encounters racism.
• Proactively offering support by having a designated resolution process. 
• Looking at patterns and addressing issues that may be more systemic.

By implementing these three elements, medical programs can begin to take significant steps in improving diversity and inclusion.