Clinical trials are important for evaluating the efficacy and safety of healthcare interventions and for guiding future research. The underrepresentation of various populations, however, hampers our understanding of disease causes and the generalizability of findings in clinical trials as a result of recruiting and retention issues.
While the benefits of diverse teams are well documented, medicine lacks the racial and ethnic diversity necessary to provide the best care for all patients and create an environment ripe to propel scientific innovation.
The National Institutes of Health’s definition of underrepresented in medicine (URiM) in the biomedical sciences includes Black/African American, Hispanic/Latinx, American Indian, Alaska Native and Native Hawaiian and other Pacific Islanders. Whereas people in these groups comprised 36.2 percent of the U.S. population in 2019, only 10.8 percent of active physicians and 9.1 percent of medical school faculty identify as URiM.
Many academic medical institutions have developed targeted faculty development, mentorship, and peer support groups in an effort to increase racial/ethnic parity and strengthen support for URiM faculty.
Needs analyses are essential tools to find ways to support URiM professors as part of these initiatives. The technique of conducting stay interviews is intended to examine the reasons why people “remain” at a company.
Researchers from Boston University Chobanian & Avedisian School of Medicine identified three themes through the stay interviews: areas of strength, challenges to advancement, and suggestions for improvement.
Programs are needed to provide the tools on how to navigate challenges in academic medicine and create safe spaces where URiM faculty could share their experiences and support each other.
Sabrina Assoumou
“Academic medical centers can improve the quality of care and address health inequities by recruiting and retaining faculty from URiM groups. However, retention of URiM faculty is a barrier to reaching equity-related goals, as URiM faculty are less likely to remain in academia and be promoted compared to their peers,” explains corresponding author Sabrina Assoumou, MD, MPH, the Louis W. Sullivan, MD, Professor of Medicine at the School.
A one-time, semi-structured stay interviews to explore the experiences of URiM faculty were conducted between October 2016 and April 2017. To preserve participant privacy, interviews were not audio recorded; instead, the interviewer wrote notes as they were being conducted.
The semi-structured interview guide asked questions about the opportunities and difficulties of being a URiM faculty member, looked into what kept people at their school, and produced ideas for how to make the process better.
Of the 17 (70 percent) faculty members in the School’s Department of Medicine who agreed to participate, 65 percent identified as Black or African American, 35 percent as Hispanic/Latinx and 47 percent identified as female. Most participants were at the instructor level (53 percent) and only one participant (6 percent) was a full professor.
Participants highlighted leadership, professional development assistance, and a collegial environment as important supports of their work. Lack of openness and trust, hefty workloads and job expectations, a sense of tokenism, and racism were all obstacles in the way of their growth.
Their suggestions for improvement focused on broadening the definition of URiM to create a larger community, expand supports for URiM faculty, increase the prominence of conversations around race and racism across the institution, and increase focus on hiring and promoting URiM faculty.
Participants identified mentorship, patient community, URiM networking opportunities, and leadership assistance in their development as strengths. Implicit prejudices, a sense of tokenism, organizational management challenges, and a lack of transparency and confidence in their job were all retention inhibitors.
It was suggested that initiatives be expanded to include all URiM group members, that URiM faculty development activities be maintained, and that funds for advancement be enhanced.
“Stay interviews can be an important tool to use in identifying organizational strategies to increase retention and improve organizational culture amidst a time of high burnout,” says first author Ellen Childs, Ph.D., a former research scientist at Boston University School of Public Health.
These results, according to the researchers, highlight the significance of encouraging leadership, URiM-specific faculty development programs, networking opportunities, and acknowledgment of accomplishments as factors that affect faculty retention at a sizable academic medical center. Participants also emphasized the importance of sponsorship and strong mentor networks.
“Programs are needed to provide the tools on how to navigate challenges in academic medicine and create safe spaces where URiM faculty could share their experiences and support each other,” adds Assoumou who also is an infectious diseases physician at Boston Medical Center.
It’s important for medical organizations and institutions to prioritize diversity and inclusion in order to create a more equitable and just work environment for all employees, regardless of their background. By taking steps to address the challenges faced by underrepresented groups, the medical field can move towards becoming more diverse, inclusive, and representative of the communities it serves.
