Additionally, the University of Michigan Health System has a longstanding history of training a majority of Black otolaryngology residents in the United States, Dr. Watkins said. In recent years, women have been represented as a majority in its residency program.
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November 2023Challenges to DEI Initiatives
Even with these efforts, several obstacles have hindered DEI initiatives in medical education. Most recently, on June 29, the U.S. Supreme Court (SCOTUS) voted 6–3 to end the use of affirmative action in college admissions. The justices ruled that admissions programs used by the University of North Carolina and Harvard College violated the U.S. Constitution’s equal protection clause, which prohibits racial discrimination by government entities.
That same day, the Association of American Medical Colleges (AAMC) issued a statement expressing its disappointment in SCOTUS’ decision. “Today’s decision demonstrates a lack of understanding of the critical benefits of racial and ethnic diversity in educational settings and a failure to recognize the urgent need to address health inequities in our country,” the association stated in a news release.
The AAMC subsequently filed an amicus brief urging the court to refrain from a broad prohibition on awareness of an applicant’s race. It stated, “Diversity in the education of the nation’s physicians and other healthcare professionals is a medical imperative. As an overwhelming body of scientific research compiled over decades confirms, diversity [J Health Soc Behav. 2008. doi:10.1177/002214650804900401] literally saves lives by ensuring that the nation’s increasingly diverse population will be served by healthcare professionals competent to meet its needs.”
AAMC’s brief went on to state that “research confirms that being treated by a racially diverse care team, or by doctors with exposure to diverse professional or educational environments, greatly increases the likelihood of positive medical outcomes, particularly for minority patients.” AAMC was joined in the brief by 45 other healthcare organizations interested in the issues.
As a result of SCOTUS’ decision, Dr. Flanary said that many educational programs that address race in any form are being examined, reworked, and, in some cases, dismantled as their legality is challenged. “DEI efforts may need to be reframed into efforts that address health disparities, acknowledge the existence of systemic barriers, and use metrics to demonstrate the impact diverse providers have on the health of disparate populations,” she said.
Other challenges to implementing DEI can arise from competing priorities and resistance to change. “Creating a just society isn’t simple; if it were, we would already live in one,” said Romaine F. Johnson, MD, MPH, a professor in the department of otolaryngology–head and neck surgery at UT Southwestern Medical Center in Dallas. “Inequities often subtly emerge or are deliberately instituted,” he said. “Even institutions with good intentions can face significant challenges that divert their focus, making strong commitments to DEI challenging.”