The panelists also included Al Merati, MD, professor and chief of laryngology in the department of otolaryngology–head and neck surgery at the University of Washington School of Medicine in Seattle, and past president of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) and the American Broncho-Esophagological Association (ABEA); Dana Thompson, MD, MS, MBA, professor of otolaryngology–head and neck surgery at Northwestern University Feinberg School of Medicine; and Lauren D. Holinger, MD, professorship in pediatric otolaryngology and head of the division of otorhinolaryngology–head and neck surgery at the Ann and Robert H. Lurie Children’s Hospital of Chicago, where she also serves as the vice chair for the department of surgery and the executive physician director for ambulatory practice. Dr. Thompson is also the associate executive vice president of the Triological Society.
Explore This Issue
May 2025Addressing the Biggest Challenges
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s a residency program director, the biggest challenge Dr. Malekzadeh has faced in implementing DEI initiatives is the pipeline disparities. “The lack of diversity among medical school applicants, coupled with systemic biases in selection, creates a persistent gap in representation,” Dr. Malekzadeh said. “Another significant hurdle is the underrepresentation of diverse faculty and staff, which limits mentorship opportunities and reinforces existing disparities.”
The biggest challenge Dr. Harley has faced in implementing DEI initiatives at work is individuals who feel that DEI efforts result in discrimination against other groups. To address resistance to DEI efforts from colleagues, Dr. Harley said, “The first step is to acknowledge their concerns and to suggest that DEI should not be binary where, ‘If I win, you lose.’ As it relates to race and ethnicity, we need to find a way for those without a ‘golden resume’ or not born into privilege to have an equal chance in our field.”
The best strategy for promoting DEI in my team is to be a strong advocate for diversity while at the same acknowledging that merit is the most important. — Earl Harley, MD
DEI implementation challenges are a direct result of state legislature measures, according to Dr. Jefferson. “The challenges many of us face both within our departments and across our individual institutions are a direct result of state legislature measures. Either passed or proposed legislation limits our ability to provide DEI-labeled initiatives in Mississippi. However, this does not mean we have become unmotivated and relinquished our efforts to improve inclusivity, to seek and thoughtfully consider diverse perspectives in our quest for achieving equitable outcomes.
“I am a firm believer in taking advantage of any given opportunity to help dispel misinformation or to provide greater clarity for persons resisting DEI,” Dr. Jefferson continued. “In listening to multiple conversations on this subject, I often hear the misinformed attribution of DEI to affirmative action. It is incredibly important to realize that affirmative action means quotas and mandates to provide opportunities for underrepresented persons. DEI is a more comprehensive approach to provide opportunities for the full spectrum of our population, where mentorship, education, and cultural perspective shift, and understanding and policy changes enhance inclusivity, respect, and value for all qualified individuals in a given environment.”
Discussion and Engagement
When misinformed or underinformed people are not engaged, “We miss an opportunity to reach someone who may serve as an ally or someone who may substantially no longer resist DEI initiatives,” Dr. Jefferson said.
Continued discussion and engagement on tough topics are essential, according to Dr. Merati.
“My leadership vibe is to make sure people are staying in the conversation and to keep our eyes on our mission—to care for our patients and our communities,” said Dr. Merati. “The DEI conversation is truly energized by this care for patients and communities. That is medicine at its essence and indeed shares much with robust conversations about population health or chronic ear disease. But the difficult, even overdue, social conversations around DEI have understandably felt personal.
“When willing and concerned colleagues retreat from discussion and engagement on tough topics, progress halts,” Dr. Merati continued. “I am not in the same place I was regarding these matters five or 10 years ago. I don’t assume folks are all in a parallel or similar process as me. For the sake of our patients, partners, trainees, and communities, keep folks talking.”
DEI Initiative Successes
Despite challenges, several DEI initiatives have yielded significant successes, said Dr. Malekzadeh, referring to her work as a residency program director.
“A dedicated diversity committee has had a significant impact on recruitment and inclusivity,” Dr. Malekzadeh said. “A key factor in our department has been the appointment of a diversity champion to oversee and sustain DEI initiatives. Funded visiting sub-internships have allowed students from underrepresented backgrounds to gain exposure to programs that might otherwise be inaccessible. The incorporation of holistic application reviews—valuing resilience, leadership, and diverse experiences—has led to a more inclusive selection process. We established dedicated grand rounds covering topics on diversity as well as increased outreach efforts to diverse medical student organizations and populations.”
Additionally, “strengthened mentorship and sponsorship programs have improved retention and leadership development among diverse residents,” Dr. Malekzadeh added.
Dr. Harley provided an example of success seen from DEI initiatives in his department. “One of the best examples I have of success in DEI is when I interviewed an inner-city Black student for admission to Georgetown, and with my having grown up in the inner city, I saw myself in him and advocated for him to the fullest. The result is that now, years later, he is an up-and-coming pediatric otolaryngologist at a prominent Midwest program,” Dr. Harley said.
Dr. Jefferson explained that the adoption of a holistic approach when considering resident physician applicants “represents an important success for our department. This approach allows consideration of applicants more broadly to include substantial hardships they have encountered en route to training for a career in otolaryngology.”
Improved Patient Care
Along with the potential for both a more inclusive physician applicant selection process and improved retention of diverse residents, DEI initiatives may have enhanced patient care.
“In my head and neck practice in Mississippi, as the only academic institution in the state where over 50% of the population is rural and nearly 40% are African American, it is imperative for practitioners to truly develop cultural understanding and sensitivity,” Dr. Jefferson said. “We have utilized nurse navigation for our head and neck cancer population to identify social determinants of health that we may address even prior to the initial patient visit. Patients and their families have expressed gratitude for the initial telephone contact to initiate the process of identifying useful resources to aid the cancer journey. This has improved the time from diagnosis to initiation of treatment.”
“Additionally, patient navigation has greatly facilitated the coordination of care for patients with challenges in obtaining adequate post-operative services at home, with difficulty in timely consultation for adjuvant treatment at other locations closer to patient homes, and with necessary education of family members regarding patient home care needs,” Dr. Jefferson continued. “Meeting these needs requires a great degree of diverse skills that begins with the nurse navigator developing an understanding of the cultural and social issues patients bring.”
“Recently, our program instituted a health equity curriculum for our residents to gain further understanding of the unique population that we are privileged to serve and the social determinants of health,” Dr. Jefferson said.
Dr. Jefferson explained that the curriculum “addresses structural strategies” by using offerings from guest speakers and the Accreditation Council for Graduate Medical Education, American Medical Association, and American Academy of Ophthalmology curricula “to help guide discussion through examples we have encountered. The curricula provide an opportunity for the resident to identify a patient encounter that did not result in an equitable outcome, where the resident proposes a systemic change that could have optimized the patient’s care,” Dr. Jefferson added.
Toll of Advocating
Advocating for DEI in a sometimes resistant environment impacts individuals emotionally and mentally.
“The best strategy for promoting DEI in my team is to be a strong advocate for diversity while at the same acknowledging that merit is the most important,” Dr. Harley said. Still, “there is an emotional toll in being the face for DEI for your department and advocating strongly for diversity while at the same time being cognizant of your colleagues. I handle this toll by believing what I am doing is right for the greater good of society.”
Dr. Jefferson handles life’s challenges through prayerful optimism. “I try to learn something from every challenge that I can turn around and identify a strategy to mitigate and forge ahead,” Dr. Jefferson said. “The work is too important for the benefit of our patients and the well-being of all those engaged in healthcare delivery. We know that a broad spectrum of perspectives and experiences best informs solutions and best practices.”
Common Misconceptions
A common misconception about DEI in medicine is that underqualified candidates are put forward for specific roles.
“A common misconception is that if you are Black or Latino, you are a DEI hire. The corollary to this is that you are not qualified for the position,” said Dr. Harley. A way to ensure that DEI is sustainable is to select qualified applicants while remembering that many qualified individuals in minoritized communities need an equal chance, Dr. Harley added.
Dr. Jefferson echoed this point. “Universally, whether in medicine or as it relates to other industries, a significant misconception is that DEI efforts mean we are putting forward underqualified persons for specific opportunities and roles. This could not be further from the truth,” Dr. Jefferson said. “The comprehensive nature of DEI work to maximize diverse representation throughout the medical field entails enacting initiatives to mentor, educate, and support the inclusion of all individuals for the opportunity to enjoy successful careers in otolaryngology–head and neck surgery. These diverse and qualified individuals are the future of our specialty, who will see the vision of otolaryngologic health equity.”
“When we maintain focus on the vision, in this instance, otolaryngologic health equity, we ensure that our endeavors remain sustainable,” Dr. Jefferson concluded. “Together, we evaluate and re-evaluate the current state and continue to advance and develop additional programming to best meet the demands and needs to achieve the vision.”
Katie Robinson is a freelance medical writer based in New York.
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