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

by Karen Appold •

Origins of DEI Initiatives

The impetus for DEI efforts can be traced back to systemic inequalities, lack of representation, and the need to address injustices and discrimination, said Michael J. Brenner, MD, an associate professor in the department of otolaryngology–head and neck surgery at the University of Michigan in Ann Arbor. The civil rights movement in the United States, from the mid-1950s to late 1960s, prompted conversations about the need to address health disparities and inequities. Health disparities are closely linked to social determinants of health, which include economic stability, education access and quality, healthcare access and quality, social and community context, and neighborhood and built environment.

Recent national movements have also energized DEI efforts, including the Black Lives Matter movement that began in 2013, the gender equity and inclusion movement that gained momentum with #metoo in 2017, George Floyd’s murder in May 2020, and increased awareness of anti-LGBTQ+ bias (e.g., homophobia, transphobia), along with national discussions on marriage equality and gender-affirming education and medical care, Dr. Balakrishnan said.

Over the last 15 years, otolaryngology has made increasing investments in diversity. AAO-HNS created a diversity task force in 2007, which became a permanent committee in 2008. The committee was charged with educating and promoting diversity and inclusion, as well as promoting cultural sensitivity. Many other otolaryngology organizations have also increased their efforts to promote diversity, establishing committees and mentorship programs and providing financial support for away rotations or to attend meetings, said Valerie Flanary, MD, a professor of otolaryngology and human communication sciences and director of racial equity and inclusion in the Office of Diversity and Inclusion at the Medical College of Wisconsin in Milwaukee. 

In 2018, The Accreditation Council for Graduate Medical Education (ACGME) formed a planning committee to assess the state of diversity and inclusion in graduate medical education (J Manag Stud. 2009. doi:10.1111/j.1467-6486.2009.00839.x). In 2019, the ACGME Office of Diversity and Inclusion was established, mandating that programs ‘‘engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce” (J Grad Med Educ. 2019. doi:10.4300/JGME-D-19-00760.1). 

Some medical institutions have started their own initiatives. For example, from 2004 to 2014, The Johns Hopkins University School of Medicine in Baltimore implemented a 10-year diversity initiative to increase the number of women and underrepresented minorities (URMs) in the otolaryngology department, Dr. Watkins said. This resulted in a nearly five-fold increase in women clinical faculty, and an increase in URM faculty from two to four and URM full professors from zero to one (Laryngoscope. 2016. doi:10.1002/lary.25455).