■2020年乔治·弗洛伊德被谋杀激起了美国种族正义的呼声,包括学术医学。作为回应,学术卫生中心宣布了新的反种族主义倡议,并扩大了与多样性有关的行政职位,股本,和/或包含(DEI)。
■为了了解DEI领导人在美国对抗疗法医学院和学术健康中心的经验,ie,他们的角色结构,官方和非官方职责,访问资源,机构支持,和挑战。
■这项定性研究使用了对在医学院担任正式DEI职位的参与者的关键线人访谈,卫生系统,或部门。面试时间为2020年12月至2021年9月。成绩单是用现象学方法编码的,使用迭代并发分析来识别参与者之间的主题类别。数据从2021年1月至12月进行了分析。
■正式的DEI角色。
■问题引发了对角色职责以及单位或办公室的优势和挑战的反思。
■共有32名参与者(30名[56%]顺性女性中的18名;16名[50%]黑人或非洲裔美国人,6[19%]拉丁裔或西班牙裔,和8[25%]White)来自27个机构,平均(范围)为14(3-43)年的医学教育经验进行了采访。超过一半的人担任院长职位(17[53%]),和多个参与者持有2个或更多的标题DEI角色(4[13%])。三分之二的人自我认同在医学中代表性不足(20[63%]),三分之一的人是第一代上大学(11[34%])。关键主题反映了DEI领导人面临的持续挑战,包括(1)角色的可变性,责任,以及对资源的访问,跨参与者和机构以及随着时间的推移在同一头寸内;(2)机构投资和指令之间的不匹配,包括权限不足,支持人员,和/或资金,以及由于缺乏与学校或卫生系统内其他单位的整合而导致的疗效降低;(3)缺乏基于证据的做法,变革的理论,或标准来指导他们的工作;以及(4)推动和耗尽领导者的工作经验。多位参与者描述了由于需求增加而无法满足机构支持的同等增加而导致的倦怠。
■在这项定性研究中,DEI领导人描述了他们工作面临的多重体制挑战。为了有效地实现DEI的既定目标,医学院和学术中心需要为领导者提供伴随的资源和权力,以促进变革。机构需要承认和实施跨部门整合的战略,超越一个领导和办公室。政策制定者,包括专业组织和认证机构,应该提供指导,问责机制,并支持开展研究,以确定和传播最佳做法的证据。创建声明和立场,没有改变的机制,停滞和不公正。
UNASSIGNED: The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI).
UNASSIGNED: To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges.
UNASSIGNED: This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021.
UNASSIGNED: Formal DEI role.
UNASSIGNED: Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office.
UNASSIGNED: A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support.
UNASSIGNED: In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.