Résumés
Abstract
Purpose: Equitable appointments of departmental leaders in medical schools have lagged behind other Equity, Diversity, and Inclusion (EDI) advancements. The purpose of this research was to 1) analyze how policy documents communicate changing ideas of EDI, employment equity, and departmental leadership; and 2) investigate department heads’ (DH) perspectives on EDI policies and practices.
Methods: We conducted a critical discourse analysis to examine underlying assumptions shaping EDI and departmental leadership in one Canadian medical school. We created and analyzed a textual archive of EDI documents (n = 17, 107 pages) and in-depth interviews with past (n = 6) and current (n = 12) DH (830 minutes; 177 pages).
Results: Documents framed EDI as: a legal requirement; an aspiration; and historical reparation. In interviews, participants framed EDI as: affirmative action; relationships; numerical representation; and relinquishing privilege. We noted inconsistent definitions of equity-deserving groups.
Conclusions: Change is slowly happening, with emerging awareness of white privilege, allyship, co-conspiracy, and the minority tax. However, there is more urgent work to be done. This work requires an intersectional lens. Centering the voices, and taking cues from, equity-deserving leaders and scholars, will help ensure that EDI pathways, such as those used to cultivate department leaders, are more inclusive, effective, and aligned with intentions.
Résumé
Objectif : La nomination des directeurs de département dans les facultés de médecine accuse un retard en matière d’équité, de diversité et d’inclusion (EDI) en comparaison avec d’autres avancées. L’objectif de ce travail était 1) d’analyser dans quelle mesure les documents de politique reflètent l’évolution des idées liées à l’EDI, à l’équité en matière d’emploi et au leadership départemental; et 2) de sonder le point de vue des directeurs de département (DD) sur les politiques et les pratiques en matière d’EDI.
Méthodes : Empruntant le cadre d’une analyse critique du discours, nous avons examiné les conceptions sous-jacentes qui façonnent l’EDI et le leadership des DD dans une faculté de médecine canadienne. Nous avons créé et analysé un corpus de documents relatifs à l’EDI (n=17, 107 pages) et d’entrevues approfondies avec des directeurs de département anciens (n=6) et actuels (n=12) (830 minutes; 177 pages).
Résultats : Les documents décrivent l’EDI comme une obligation légale, une aspiration et une réparation historique. Lors des entretiens, pour définir l’EDI, les participants ont évoqué l’action positive, les relations, la représentation numérique et l’abandon de privilèges. Nous avons noté des incohérences quant à la définition de « groupe en quête d’équité ».
Conclusions : Le changement s’opère lentement, avec une prise de conscience des notions de privilège blanc, d’alliance, de complicité et de taxe pour les minorités ». Cependant, il y a un travail plus urgent à accomplir. Ce travail nécessite une perspective intersectionnelle. Le fait d’écouter les leaders et les universitaires en quête d’équité et de leur accorder une place centrale fera en sorte que les voies de l’EDI, comme celles empruntées pour cultiver le leadership dans les départements, soient plus inclusives, plus efficaces et plus en adéquation avec les objectifs.
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Bibliography
- Tang V, van Buuren A, Martimianakis MAT. Evolving discourses of COVID-19 and implications for medical education: a critical discourse analysis. Can Med Educ J. 2019; 13(6); 6–18. https://doi.org/10.36834/cmej.71675
- Sonnenberg LK, Do V, LeBlanc C, Busari JO. Six ways to get a grip by calling-out racism and enacting allyship in medical education. Can Med Educ J 2021;12(4):111–5. https://doi.org/10.36834/cmej.71566
- Naidu T. Modern medicine is a colonial artifact: Introducing decoloniality to medical education research. Acad Med. 2021;96(11S):S9–12. https://doi.org/10.1097/ACM.0000000000004339
- Lingras KA, Alexander ME, Vrieze DM. Diversity, equity, and inclusion efforts at a departmental level: building a committee as a vehicle for advancing progress. J Clin Psychol Med Settings. 2021;1–24. https://doi.org/10.1007/s10880-021-09809-w
- Morse M, Loscalzo J. Creating real change at academic medical centers—how social movements can be timely catalysts. N Engl J Med. 2020;383(3):199–201. https://doi.org/10.1056/NEJMp2002502
- Kruse SD, Hackmann DG, Lindle JC. Academic leadership during a pandemic: department heads leading with a focus on equity. Front Educ. 2020;5. https://doi.org/10.3389/feduc.2020.614641
- Page SE. Making the difference: Applying a logic of diversity. Acad Manag Perspect. 2007;21(4):6–20. https://doi.org/10.5465/amp.2007.27895335
- Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383–92. https://doi.org/10.1016/j.jnma.2019.01.006
- Pritlove C, Juando-Prats C, Ala-Leppilampi K, Parsons JA. The good, the bad, and the ugly of implicit bias. The Lancet. 2019;393(10171):502–4. https://doi.org/10.1016/S0140-6736(18)32267-0
- Costello CY. Professional identity crisis: race, class, gender, and success at professional schools. Vanderbilt University Press; 2005.
- Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15(1):1–5. https://doi.org/10.1186/s12909-015-0290-9
- Cyrus KD. Medical education and the minority tax. JAMA. 2017 May 9;317(18):1833–4. https://doi.org/10.1001/jama.2017.0196
- Campbell KM, Rodríguez JE. Addressing the minority tax: perspectives from two diversity leaders on building minority faculty success in academic medicine. Acad Med. 2019 Dec;94(12):1854–7. https://doi.org/10.1097/ACM.0000000000002839
- Balzora S. When the minority tax is doubled: being Black and female in academic medicine. Nat Rev Gastroenterol Hepatol. 2021 Jan;18(1):1–1. https://doi.org/10.1038/s41575-020-00369-2
- Faucett EA, Brenner MJ, Thompson DM, Flanary VA. Tackling the minority tax: a roadmap to redistributing engagement in diversity, equity, and inclusion initiatives. Otolaryngol Neck Surg. 2022 Jun 1;166(6):1174–81. https://doi.org/10.1177/01945998221091696
- Fuentes-Afflick E. Promoting inclusion in academic medicine. JAMA Netw Open. 2018;1(4):e181010–e181010. https://doi.org/10.1001/jamanetworkopen.2018.1010
- Ludmerer KM. Seeking parity for women in academic medicine: a historical perspective. Acad Med. 2020;95(10):1485–7. https://doi.org/10.1097/ACM.0000000000003556
- Alwazzan L, Al-Angari SS. Women’s leadership in academic medicine: a systematic review of extent, condition and interventions. BMJ Open. 2020;10(1):e032232. https://doi.org/10.1136/bmjopen-2019-032232
- Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Acad Med J Assoc Am Med Coll. 2018;93(11):1694. https://doi.org/10.1097/ACM.0000000000002146
- Chyu J, Peters CE, Nicholson TM, Dai JC, Taylor J, Garg T, et al. Women in leadership in urology: the case for increasing diversity and equity. Urology. 2021;150:16–24. https://doi.org/10.1016/j.urology.2020.07.079
- Feng R, Hoffman SE, Wagner K, Ullman JS, Stippler M, Germano IM. Women neurosurgeons in academic and other leadership positions in the United States. World Neurosurg. 2021;147:80–8. https://doi.org/10.1016/j.wneu.2020.12.069
- Keane AM, Larson EL, Santosa KB, et al. Women in leadership and their influence on the gender diversity of academic plastic surgery programs. Plast Reconstr Surg. 2021;147(3):516–26. https://doi.org/10.1097/PRS.0000000000007681
- Lee LK, Platz E, Klig J, et al. Addressing gender inequities: creation of a multi-institutional consortium of women physicians in academic emergency medicine. Acad Emerg Med. 2021;28(12):1358–67. https://doi.org/10.1111/acem.14361
- Levine RB, Ayyala MS, Skarupski KA, et al. “It’s a little different for men”—sponsorship and gender in academic medicine: a qualitative study. J Gen Intern Med. 2021;36(1):1–8. https://doi.org/10.1007/s11606-020-05956-2
- Odei BC, Gawu P, Bae S, et al. Evaluation of progress toward gender equity among departmental chairs in academic medicine. JAMA Intern Med. 2021;181(4):548–50. https://doi.org/0.1001/jamainternmed.2020.6267
- Tricco AC, Bourgeault I, Moore A, Grunfeld E, Peer N, Straus SE. Advancing gender equity in medicine. Cmaj. 2021;193(7):E244–50. https://doi.org/10.1503/cmaj.200951
- Crenshaw KW. On intersectionality: essential writings. The New Press; 2017.
- Jordan A, Shim RS, Rodriguez CI, et al. Psychiatry diversity leadership in academic medicine: guidelines for success. Am J Psychiatry. 2021;178(3):224–8. https://doi.org/10.1176/appi.ajp.2020.20091371
- Kaslow NJ, Schwartz AC, Ayna DK, et al. Integrating diversity, equity, and inclusion into an academic department of psychiatry and behavioral sciences. Focus. 2021;19(1):61–5. https://doi.org/10.1176/appi.focus.20200024
- Simonsen KA, Shim RS. Embracing diversity and inclusion in psychiatry leadership. Psychiatr Clin. 2019;42(3):463–71. https://doi.org/10.1016/j.psc.2019.05.006
- Riner AN, Upchurch GR, Trevino JG. Sponsorship to improve diversity and inclusion in surgical leadership. Am J Surg. 2022;223(4):817–8. https://doi.org/10.1016/j.amjsurg.2021.09.022
- Zhu K, Das P, Karimuddin A, Tiwana S, Siddiqi J, Khosa F. Equity, diversity, and inclusion in academic American surgery faculty: an elusive dream. J Surg Res. 2021;258:179–86. https://doi.org/10.1016/j.jss.2020.08.069
- Coe C, Piggott C, Davis A, et al. Leadership pathways in academic family medicine: focus on underrepresented minorities and women. Fam Med. 2020;52(2):104–11. https://doi.org/10.22454/FamMed.2020.545847
- Rosseau G, Kim EE, Klein AL, Lartigue JW. Diversity in neurosurgery. In: Agarwal N, Reddy V, editors. Surviving Neurosurgery: Vignettes of Resilience. Cham: Springer International Publishing; 2021;p. 421–31. Available from: https://doi.org/10.1007/978-3-030-86917-5_81
- Cusson T, Lebel K, Spalluto L, Hillier T, Darras K, Yong-Hing C. Recommendations for Improving Canadian Radiology Equity, Diversity and Inclusion. Can Assoc Radiol J. 2022 May 26;08465371221099956. https://doi.org/10.1177/08465371221099
- Yong-Hing CJ, Patlas MN, Khosa F. Pioneering EDI in Canadian academic radiology. Can Assoc Radiol J. 2022 Nov;73(4):614-5. https://doi.org/10.1177/08465371221099479
- Khatchikian AD, Spalluto LB, Patlas MN, Yong-Hing CJ. Canadian association of radiologists commitment to equity, diversity and inclusion in canadian radiology. Can Assoc Radiol J. 2022;0(0). https://doi.org/10.1177/0846537122111
- Soklaridis S, Lin E, Black G, Paton M, LeBlanc C, Besa R, et al. Moving beyond ‘think leadership, think white male’: the contents and contexts of equity, diversity and inclusion in physician leadership programmes. BMJ Lead. 2022;leader-2021. https://doi.org/10.1136/leader-2021-000542
- Betancourt JR. Eliminating racial and ethnic disparities in health care: what is the role of academic medicine? Acad Med. 2006;81(9):788–92.
- Dalhousie University. Department chairs. Available from: https://www.dal.ca/about-dal/leadership-and-vision/leadership-team/department-chairs.html [Accessed on Aug 15, 2022].
- Stockard J, Greene J, Lewis P, Richmond G. Promoting gender equity in academic departments: a study of department heads in top-ranked chemistry departments. J Women Minor Sci Eng. 2008;14(1). https://doi.org/10.1615/JWomenMinorScienEng.v14.i1.10
- Berdrow I. King among kings: understanding the role and responsibilities of the department chair in higher education. Educ Manag Adm Leadersh. 2010 Jul 1;38(4):499–514. https://doi.org/10.1177/1741143210368146
- Ahmed S. ‘You end up doing the document rather than doing the doing’: Diversity, race equality and the politics of documentation. Ethn Racial Stud. 2007;30(4):590–609. https://doi.org/10.1080/01419870701356015
- Bhopal K, Pitkin C. ‘Same old story, just a different policy’: race and policy making in higher education in the UK. Race Ethn Educ. 2020 Jul 3;23(4):530–47. https://doi.org/10.1080/13613324.2020.1718082
- Chen AY, Kuper A, Whitehead CR. Competent to provide compassionate care? A critical discourse analysis of accreditation standards. Med Educ. 2021;55(4):530–40. https://doi.org/10.1111/medu.14428
- Foucault M. The archaeology of knowledge: Translated from the french by AM Sheridan Smith. Pantheon Books; 1972.
- Fairclough N. Critical discourse analysis. In: The Routledge handbook of discourse analysis. Routledge; 2013. p. 9–20.
- Whitehead C, Kuper A, Freeman R, Grundland B, Webster F. Compassionate care? A critical discourse analysis of accreditation standards. Med Educ. 2014 Jun;48(6):632–43. https://doi.org/10.1111/medu.12429
- Marshall J, O’Hearn S, McLeod R, et al. Diversity in leadership: report with recommendations [Internet]. Halifax,: Dalhousie University, Faculty of Medicine; 2017. Available from: https://cdn.dal.ca/content/dam/dalhousie/images/faculty/medicine/ForFaculty_Staff/Div_Lead_Report_July_2017.pdf
- Diversity in Leadership [Internet]. Dalhousie University. Available from: https://medicine.dal.ca/about/diversity/diversity-in-leadership.html [Accessed on Aug 15, 2022].
- Canadian Institutes of Health Research. Tri-Council policy statement: ethical conduct for research involving humans. [Internet]. 2018. Available from: http://publications.gc.ca/collections/collection_2019/irsc-cihr/RR4-2-2019-eng.pdf [Accessed on Aug 17, 2022].
- Branch LS. Consolidated federal laws of Canada, employment equity act [Internet]. 2021. Available from: https://laws-lois.justice.gc.ca/eng/acts/e-5.401/ [Accessed on Oct 11, 2022].
- Scotia N. Human Rights Act. RSNS C. 1989;214.
- Dalhousie University. Employment Equity Policy [Internet]. Available from: https://www.dal.ca/dept/university_secretariat/policies/human-rights---equity/employment-equity-policy.html [Accessed on Oct 11, 2022].
- Acosta DA, Lautenberger DM, Castillo-Page L, Skorton DJ. Achieving gender equity is our responsibility: leadership matters. Acad Med. 2020;95(10):1468–71. https://doi.org/10.1097/ACM.0000000000003610
- Henry F, Dua E, James CE, et al. The equity myth: racialization and indigeneity at Canadian universities. UBC Press; 2017.
- Romero R, Miotto K, Casillas A, Sanford J. Understanding the experiences of first-generation medical students: implications for a diverse physician workforce. Acad Psychiatry. 2020 Aug 1;44(4):467–70. https://doi.org/10.1007/s40596-020-01235-8