ABSTRACT
Background
Despite compelling reasons to draw on the contributions of under-represented minority (URM) faculty members, US medical schools lack these faculty, particularly in leadership and senior roles.
Objective
The study’s purpose was to document URM faculty perceptions and experience of the culture of academic medicine in the US and to raise awareness of obstacles to achieving the goal of having people of color in positions of leadership in academic medicine.
Design
The authors conducted a qualitative interview study in 2006–2007 of faculty in five US medical schools chosen for their diverse regional and organizational attributes.
Participants
Using purposeful sampling of medical faculty, 96 faculty were interviewed from four different career stages (early, plateaued, leaders and left academic medicine) and diverse specialties with an oversampling of URM faculty.
Approach
We identified patterns and themes emergent in the coded data. Analysis was inductive and data driven.
Results
Predominant themes underscored during analyses regarding the experience of URM faculty were: difficulty of cross-cultural relationships; isolation and feeling invisible; lack of mentoring, role models and social capital; disrespect, overt and covert bias/discrimination; different performance expectations related to race/ethnicity; devaluing of research on community health care and health disparities; the unfair burden of being identified with affirmative action and responsibility for diversity efforts; leadership’s role in diversity goals; and financial hardship.
Conclusions
Achieving an inclusive culture for diverse medical school faculty would help meet the mission of academic medicine to train a physician and research workforce that meets the disparate needs of our multicultural society. Medical school leaders need to value the inclusion of URM faculty. Failure to fully engage the skills and insights of URM faculty impairs our ability to provide the best science, education or medical care.
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REFERENCES
McCurdy LL, Goode D, Inui TS, Daugherty RM Jr, Wilson DE, Wallace AG, Weinstein BM, Copeland EM 3rd. Fulfilling the social contract between medical schools and the public. Acad Med. 1997;72(12):1063–70.
Nickens H, Smedley B. The right thing to do, the smart thing to do: enhancing diversity in the health professions: summary of the symposium on diversity in health professions in honor of Herbert W. Nickens. Washington: National Academy Press: Institute of Medicine; 2001.
Kington R, Tisnado D, Carlisle D. Increasing the racial and ethnic diversity among physicians: an intervention to address health disparities. In: Smedley BD, Colburn L, Evans CH, eds. The right thing to do, the smart thing to do: enhancing diversity in the health professions. Washington: National Academies Press; 2001:64–8.
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(5):460–6.
Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: Assessing health care quality for minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey. New York: The Commonwealth Fund; 2002.
Census 2000: United States Profile. US Census Bureau web site. Available at: http://www.census.gov/prod/2002pubs/c2kprof00-us.pdf. Accessed: July13, 2010.
Castillo-Page L. Diversity in medical education: Facts & figures 2008. Washington: Association of American Medical Colleges; 2008.
Association of American Medical Colleges. Faculty Roster 2008. Available at: http://www.aamc.org/data/facultyroster/. Accessed: July 13, 2010.
Palepu A, Carr PL, Friedman RH, Amos H, Ash AS, Moskowitz MA. Minority faculty and academic rank in medicine. JAMA. 1998;280:767–71.
Palepu A, Carr PL, Friedman RH, Ash AS, Moskowitz MA. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000;75:157–60.
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(3):259–65.
Smedley BD, Stith AY, Colburn L, Evans CH. The right thing to do, the smart thing to do enhancing diversity in health professions. Institute of Medicine. Washington: National Academy Press; 2001.
Corbie-Smith G, Thomas TB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999;14:537–46.
Price EG, Gozu A, Kern DE, Powe NR, Wand GS, Golden S, Cooper LA. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med. 2005;20(7):565–71.
Nunez-Smith M, Curry L, Bigby J, Berg D, Krumholz HM, Bradley EH. Impact of race on the professional lives of physicians of African descent. Ann Intern Med. 2007;146(1):45–51.
Carr PL, Palepu A, Szalacha L, Caswell C, Inui T. Flying below the radar: a qualitative study of minority experience and management of discrimination in academic medicine. Med Edu. 2007;41(6):601–9.
Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284(9):1085–92.
Price EG, Powe NR, Kern DE, Golden SH, Wand GS, Cooper LA. Improving diversity climate in academic medicine: faculty perceptions as a catalyst for institutional change. Acad Med. 2009;84:95–105.
Aagaard EM, Julian K, Dedier J, Soloman I, Tillisch J, Pérez-Stable EJ. Factors affecting medical students’ selection of an internal medicine residency program. J Natl Med Assoc. 2005;97(9):1264–70.
Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc. 2006;81(11):1435–42.
Odom KL, Morgan Roberts L, Johnson RL, Cooper LA. Exploring obstacles to and opportunities for professional success among ethnic minority medical students. Acad Med. 2007;82(2):146–53.
Association of American Medical Colleges. The Diversity Research Forum: Successfully evaluating diversity efforts in medical education. Washington: AAMC; 2007.
National Initiative on Gender, Culture and Leadership in Medicine: C - Change website. Available at: http://cchange.brandeis.edu. Accessed: July 13, 2010.
Biernacki P, Waldorf D. Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res. 1981;10:141–63.
Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Aldine Transaction: Chicago; 1967.
Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks (CA): Sage Publications; 2006.
The Sullivan Commission. Missing persons: Minorities in the health professions diversity. Washington (DC): The Sullivan Commission; 2004.
Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Acad Med. 2009;84:106–14.
McIntosh P. White privilege, color and crime: A personal account. In: Mann CR, Zatz MS, eds. Images of color, images of crime. Los Angeles (CA): Roxbury Publishing Company; 1998.
AHRQ (2004). National Healthcare Disparities Report: Department of Health and Human Services, US Department of Health and Human Services.
Kelley E, Moy E, Stryer D, Burstin H, Clancy C. The national healthcare quality and disparities reports: an overview. Med Care. 2005;43(3):I3–8.
Siegel S, Moy E, Burstin H. Assessing the nation's progress toward elimination of disparities in health care. J Gen Intern Med. 2004;19(2):195–200.
Freeman J, Ferrer R, Greiner A. Viewpoint: Developing a physician workforce for America’s disadvantaged. Acad Med. 2007;82(2):133–8.
Mullen F, Chen C, Pettersons S, Kolsky G, Spagnola M. The social mission of medical education: Ranking the schools. Ann Intern Med. 2010;152:804–11.
Pololi L, Kern DE, Carr P, Conrad P. Authors’ Reply: Faculty Values. J Gen Intern Med. 2010;25(7):647.
ACKNOWLEDGMENTS
The authors gratefully acknowledge the critical funding support of the Josiah Macy, Jr., Foundation and the supplemental funds to support data analysis provided by the US Office of Public Health and Science, Office on Women’s Health and Office on Minority Health; the National Institutes of Health, Office of Research on Women’s Health; the Agency for Healthcare Research and Quality; the Centers of Disease Control and Prevention, and the Health Resources and Services Administration (contract: HHSP233200700556P). The authors thank Peter Conrad and Sharon Knight, who participated in data collection and data coding, and Kerri O’Connor for manuscript preparation. The authors are indebted to the medical faculty who generously shared their experiences in the interviews.
Contributors
Specific Contributions From Each Author
Pololi: conception, design, data collection, analysis and interpretation, drafting the article, final approval.
Cooper: analysis and interpretation, drafting the article, final approval.
Carr: data collection and coding, manuscript review, final approval.
Funders
United States Office of Public Health and Science, Office on Women’s Health, Contract: HHSP233200700556P
Josiah Macy, Jr. Foundation
Prior Presentations
Society of General Internal Medicine, 33rd Annual Meeting, 2010. Research plenary presentation.
Conflict of Interest
None disclosed.
Ethical Approval
Brandeis University Institutional Review Board for the protection of human subjects approved the study.
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Pololi, L., Cooper, L.A. & Carr, P. Race, Disadvantage and Faculty Experiences in Academic Medicine. J GEN INTERN MED 25, 1363–1369 (2010). https://doi.org/10.1007/s11606-010-1478-7
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DOI: https://doi.org/10.1007/s11606-010-1478-7