Mitigating the Isolation of Minoritized Faculty in Academic Medicine.

Increasing numbers of faculty who are underrepresented in medicine has been a focus of academic health systems. Understanding the experiences of these faculty helps in creating environments that are inclusive and supportive, promoting faculty success. When compared with non-minoritized faculty, minoritized faculty face racism, isolation, diversity efforts disparities, clinical efforts disparities, lack of faculty development, and promotion disparities. While there have been contributions to the literature to better characterize disparities faced by minoritized faculty, little has been written about isolation. Isolation occurs when faculty underrepresented in medicine do not feel like part of the department or institution. They may feel excluded from mainstream culture as if they are invisible. They may be excluded from conversations, group chats, get togethers, or other work-related or social functions. These feelings can manifest as imposter syndrome and impact work performance and decision-making. In this article, the author shares how to recognize and mitigate isolation to promote an inclusive environment for all faculty.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study.

BACKGROUND AND OBJECTIVES: Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax. METHODS: Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods. RESULTS: Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). CONCLUSIONS: Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Implementing High-Quality Primary Care Through a Health Equity Lens.

The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report's framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion, and health equity that have been long overdue. The time to transition those conversations to actionable items to improve the health of patients, families, and communities is now.Appeared as Annals "Online First" article.

Towards a common lexicon for equity, diversity, and inclusion work in academic medicine.

Differential rewarding of work and experience has been a longtime feature of academic medicine, resulting in a series of academic disparities. These disparities have been collectively called a cultural or minority "tax," and, when considered beyond academic medicine, exist across all departments, colleges, and schools of institutions of higher learning-from health sciences to disciplines located on university campuses outside of medicine and health. A shared language can provide opportunities for those who champion this work to pool resources for larger impacts across the institution. This article aims to catalog the terms used across academic medicine disciplines to establish a common language describing the inequities experienced by Black, Latinx, American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander, Women, and other underrepresented people as well as queer, disabled, and other historically marginalized or excluded groups. These ideas are specific to academic medicine in the United States, although many can be used in academic medicine in other countries. The terms were selected by a team of experts in equity, diversity, and inclusion, (EDI) who are considered national thought leaders in EDI and collectively have over 100 years of scholarship and experience in this area.

An Approach to Faculty Development for Underrepresented Minorities in Medicine.

OBJECTIVES: The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty. METHODS: A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, which included conference calls and an in-person workshop covering topics related to writing and career advancement. RESULTS: The workshop included a mix of prepared programming on how to move from idea to project to manuscript, as well as time for spontaneous mentorship and manuscript collaboration. Key themes that emerged included how to address the high cost of the minority tax, the need for individual passion as a pathway to success, and how to overcome imposter syndrome as a hindrance to writing. CONCLUSIONS: The "for URM by URM" approach for faculty development to promote writing skills and scholarship for junior URM Family Medicine physicians can address challenges faced by URM faculty. By using a framework that includes the mentors' lived experiences and creates a psychological safe space, we can address concerns often overlooked in traditional skills-based faculty development programs.

Increasing the Rural Workforce of Family Medicine Physicians: A Community-Focused Approach.

There is an increased need for Family Medicine physicians who make up approximately 40% of the primary care work. In this article the authors share perspective on how to engage the community in increasing the rural workforce of Family Physicians. Suggestions include introducing the school to the community in which it lives, matching the applicant to the needs of the community and not just the needs of the school, including community members as part of the admissions process and recruiting applicants primarily from inside the state.

Responding to COVID-19: Perspectives on Curricular Changes in a Rural Medical School.

Coronavirus disease 2019 (COVID-19) rapidly led to global human devastation, including multiple deaths, sicknesses, and financial reverberations across many individuals and communities. As COVID-19 gained its foothold in the United States, medical school administrators, faculty, and students had to undergo rapid change to mitigate the disease spread, putting all parties in dubious situations. Medical school administrators had to make swift and judicious decisions that would best serve the student body and the diverse patient population at clinical sites. Medical schools with students practicing in rural, remote regions with a dearth of healthcare resources have even more complicated decisions to make in these unprecedented times. We provide an overview of rapid decision-making processes that can be used by curriculum leaders and medical school administrators to continue to meet accreditation requirements while attempting to keep medical students safe and prepared for graduation in response to the COVID-19 health crisis.

Scholarly productivity of faculty in primary care roles related to tenure versus non-tenure tracks.

BACKGROUND: Increasing the number of primary care physicians is critical to overcoming the shortage of healthcare providers. Primary care physicians are increasingly called upon to address not only medical concerns but also behavioral health needs and social determinants of health which requires ongoing research and innovation. This paper evaluated scholarly productivity of faculty in tenure versus non-tenure tracks in primary care roles, defined as family medicine, internal medicine, internal medicine/pediatrics and pediatrics. METHODS: The study included physician faculty in the clinical departments of Brody School of Medicine serving between the 2014-2015 and 2018-2019 academic years. Department, track, and rank at the beginning of each academic year (e.g., 2014-2015) were correlated with having any publications in the following calendar year (e.g., 2015), as determined from a search of the Scopus database. RESULTS: A total of 1620 observations and 542 unique faculty were included in the analysis. As of 2018-2019, 19% percent of primary care faculty were either tenured or on tenure track, as compared to 41% of faculty in other departments (p < 0.001). Primary care departments were also disproportionately staffed by junior faculty (60% as compared to 48% in other departments; p = 0.087). The proportion of faculty with any publications was significantly higher for faculty on the tenure track compared to those not on the tenure track (34% vs. 14%, p < 0.001). CONCLUSIONS: Academic productivity was lower among non-tenure-track physician faculty, as measured by publication in peer-reviewed journals. This was exacerbated among faculty in primary care departments, who were also more likely to hold non-tenure-track appointments. The loss of tenure-track positions disproportionately impacts scholarly activity in primary care and may be limiting progress in care-oriented research. Findings suggest that providing non-tenure faculty the time and resources to be involved in research, in addition to their clinical work, as well as access to research collaborators and mentors can promote scholarly activity among this group.

The Medical Library as a Component of a Medical School Outreach Experience.

The United States is facing a shortage of physicians for minorities and patients in disadvantaged areas. Many medical schools have pipeline programs to promote the interest of minority students in medicine. The Brody School of Medicine at East Carolina University established the Brody RISE program. Recruitment efforts targeted schools within Pitt County, NC. Students participate in interactive STEM activities and campus tours. Laupus Health Sciences Librarians developed interactive activities that engage critical thinking and teach anatomy and medical history. The organizers of the Brody RISE program continually evaluate and expand the program. Laupus Library continues to partner in these activities.

Mentoring Underrepresented Minority in Medicine (URMM) Students Across Racial, Ethnic and Institutional Differences.

Cross cultural mentoring for underrepresented minority in medicine (URMM) students has increased significance. It is especially important for non-URMM faculty and others from different backgrounds, ethnicities and cultures to know how to provide mentorship for URMM student success. This article provides approaches to mentorship for URMM students. Recommendations include mentoring around scholarly projects, identifying mentorship role, acknowledging personal attributes for mentoring, addressing racism, stereotypes and bias, collaborating with Historically Black Colleges and Universities and being attentive to the unique needs of URMM students.

Improving Underrepresented Minority in Medicine Representation in Medical School.

OBJECTIVES: Despite the efforts of various leading organizations in medical education, representation of black students in US medical schools has declined since the mid-1990s. The Florida State University College of Medicine (FSUCOM) has undertaken efforts to increase black and other underrepresented minority in medicine (URMM) representation in medical school through the Bridge to Clinical Medicine Program. This program is described and analyzed by the authors. METHODS: Demographic information, Medical College Admission Test scores, undergraduate grade point average, US Medical Licensing Examination (USMLE) scores (Steps 1 and 2), residency match information, and current practice location from 2006 to 2015 were collected from the FSUCOM. Data were analyzed using SAS and linear regression analyses were performed, comparing Bridge students with the College of Medicine and national averages. RESULTS: Sixty percent of Bridge students were black, 21% were other URMM, and the remainder were non-URMM. Black Bridge students scored 7.4 points lower on their Medical College Admission Test, and other-URMM Bridge students scored 6.0 points lower (P < 0.0001) than their non-URMM non-Bridge classmates. Black Bridge students also started with a grade point average that was 0.28 points lower than their non-URMM non-Bridge counterparts, but there was no statistical difference for other-URMM Bridge students. Black students, regardless of Bridge participation, were less likely to pass USMLE Step 1 when compared with non-URMM classmates (P < 0.0001). For USMLE Step 2, however, there were no significant differences in passing rates for Bridge students compared with non-Bridge students. CONCLUSIONS: The FSUCOM Bridge program has not only increased its URMM enrollment but it also has effectively doubled the number of black students in its medical college. Other universities could produce similar results using the program outlined in this article.

A Review of Tenure for Black, Latino, and Native American Faculty in Academic Medicine.

OBJECTIVES: Tenure policies in US medical schools have been under scrutiny for decades while black/African American, Latino, and Native American faculty continue to be underrepresented in medicine. As medical institutions seek to improve diversity, tenure continues to be a major retention tool. We undertook a systematic review of the literature to investigate the role that tenure plays in the recruitment, retention, and advancement of underrepresented minorities in medicine (URMM) faculty in academic medicine. METHODS: We searched PubMed, Google Scholar, Web of Knowledge, the Cumulative Index of Nursing and Allied Health Literature, and the Education Resources Information Center for articles relating to URMM faculty and tenure. Articles published in the last 20 years, in English, that discussed recruitment or retention of women, URMM faculty, and tenure in academic medicine, and were of high quality based on data were included in the study. Narrative reviews, opinion, editorials, and letters to the editor were excluded. RESULTS: Of the 1038 articles we reviewed, 23 met the criteria for inclusion. Tenure was associated with leadership, higher salaries, and comfort in the work environment. URMM faculty comprised the lowest percentage of tenured faculty in academic medicine, with the highest percentage pertaining to white men. CONCLUSIONS: More research needs to be done to determine whether tenure status can improve the number of URMM faculty in academic medicine. Tenure may provide URMM faculty the benefits that they need to progress in their careers and remain in academic medicine.

Cardiovascular Health Practices Among Black Patients in an Urban Underserved Clinic.

BACKGROUND: An understanding of cardiovascular health practices among black patients can provide more comprehensive patient-centered care and reduce health disparities. We studied home blood pressure monitoring in our underserved patient population to determine feasibility of providing automatic blood pressure monitors to our hypertensive patients. We believed that if we provided blood pressure monitors for home use, our patients would increase home blood pressure assessments, frequency of blood pressure assessments, and provide more data on managing their hypertension. METHODS: Forty patients were selected based on their individually scheduled clinic appointments and were randomized to the experimental arm or the control arm. Patients in the experimental arm of the study received an automatic blood pressure monitor for the duration of the study, while the control group received their automatic blood pressure monitor at the end of the study period. All participants received evidence- based patient education upon enrollment in addition to phone calls to collect blood pressure readings every two weeks. After six months, patients completed an exit interview and survey to determine the effects of the study on enrollee health practices. RESULTS: Of the 40 people enrolled, 13 participants completed the study. Of those who completed, 87% of the experimental group checked their blood pressure more often outside of the healthcare setting compared to 60% of the control group. There was no increase in the control group's pre-survey blood pressure monitoring metrics but a 50 percentage point increase in the experimental group's blood pressure monitoring metrics. Telephone data demonstrated that participants who received an automatic blood pressure monitor for home use were more than three times more likely to check their blood pressure outside of the healthcare setting than those who did not have a home monitor. CONCLUSIONS: Home accessible automatic blood pressure monitoring can increase frequency of blood pressure assessment among black patients.

Addressing disparities in academic medicine: what of the minority tax?

BACKGROUND: The proportion of black, Latino, and Native American faculty in U.S. academic medical centers has remained almost unchanged over the last 20 years. Some authors credit the "minority tax"-the burden of extra responsibilities placed on minority faculty in the name of diversity. This tax is in reality very complex, and a major source of inequity in academic medicine. DISCUSSION: The "minority tax" is better described as an Underrepresented Minority in Medicine (URMM) faculty responsibility disparity. This disparity is evident in many areas: diversity efforts, racism, isolation, mentorship, clinical responsibilities, and promotion. The authors examine the components of the URMM responsibility disparity and use information from the medical literature and from human resources to suggest practical steps that can be taken by academic leaders and policymakers to move toward establishing faculty equity and thus increase the numbers of black, Latino, and Native American faculty in academic medicine.