A Look at the Past, Present, and Future of DEI Medical Education Initiatives

by Karen Appold •

Historically, the field of otolaryngology has been one of the least diverse subspecialties in medicine. Regarding ethnicity, for example, a 2022 workforce study from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) showed that only 6% of residents were Black, 4% were Hispanic, and 1% were Native American and Pacific Islander. Of practicing physicians, 2.5% were Black, 3% to 4% were Hispanic, and fewer than 1% were Native American and Pacific Islander (Ear Nose Throat J. 2021. doi:10.1177/0145561320922633).

Despite the status quo, overwhelming evidence supports the benefits of a diverse workforce. Diversification increases high-quality outcomes, strengthens teams, and promotes health equity, said Mariel Watkins, MD, MHS, house officer in the department of otolaryngology–head and neck surgery at the University of Michigan Health System in Ann Arbor. It isn’t just opinion: Data have shown that a provider population that represents its patient population leads to improved patient outcomes and access to quality care (Ann Intern Med. 2023. doi:10.7326/0003-4819-139-11-200312020-00009).

Furthermore, the visibility of diverse and inclusive academic settings increases psychological safety and camaraderie among faculty and learners. Increased race and gender representation has a summative effect on the success and innovation of ideas, given that they are derived from myriad lived experiences (The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy. 2018. Princeton University Press; J Manag Stud. 2009. doi:10.1111/j.1467-6486.2009.00839.x). 

Given all of these benefits, many schools of medicine have been focusing efforts on diversity, equity, and inclusion (DEI) initiatives. Their goal is to increase recruitment, retention, and career advancement for colleagues from underrepresented groups in the otolaryngology field; to work toward a specialty that reflects patients in as many aspects of identity as possible; and to create a specialty that provides a sense of belonging in any colleague or interested trainee, regardless of their unique combination of identities, said Karthik Balakrishnan, MD, MPH, associate professor in the department of otolaryngology–head and neck surgery and surgeon-in-chief at Stanford Children’s Health in Palo Alto, Calif.

It’s important to note, added Candace A. Flagg, MD, a resident in the department of otolaryngology–head and neck surgery at Brooke Army Medical Center in San Antonio, Texas, that the purpose of DEI efforts is to give merit where merit is due. “DEI isn’t meant to encourage schools and programs to accept sub-qualified applicants in favor of race, gender, ethnicity, and so forth,” she said. “Rather, the point is to open the door and give opportunities to deserving individuals who otherwise would have been passed over.”