DEI leaders face a multitude of barriers to establish change across medical institutions
Key takeaways:
- Four key themes reflected ongoing challenges for DEI leaders.
- Academic medical centers have not invested in the depth and breadth of resources needed to support DEI leaders to be successful.
Diversity, equity and inclusion leaders reported multiple institution-level challenges to carry out the work needed to promote diverse, inclusive and equitable environments across academic health centers, according to study results.
The findings, published in JAMA Network Open, suggest large-scale, sustained investment, grounded in theories of change, supported by evidence and constantly interrogated for purpose, operationalization, and impact is needed to dismantle and transform systems within academic medicine.
Motivations
“We had two motivations for this study. The first was that all members on the research team have worked and/or are currently working in diversity, equity and inclusion [DEI] in academic medicine and we wanted to explore our peers’ experiences more systematically, particularly in light of the renewed racial justice movement in 2020,” Michelle J. Ko, MD, PhD, associate professor in the division of health policy and management at UC Davis Health School of Medicine, told Healio.
“Second, findings from our prior study had reflected different relationships between admissions and DEI offices across institutions. We wanted to therefore learn more about how and why some partner with other units, and some don’t,” Ko added.
The qualitative study included 32 participants who held formal DEI positions in their school of medicine, health system or department (56% cisgender women; 50% Black or African American; 25% white; 19% Latinx or Hispanic) from 27 institutions with a mean 14 years of experience in medical education.
Between December 2020 and September 2021, researchers interviewed participants and sought to better understand the experiences of DEI leaders, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges. They used a phenomenographic approach with iterative concurrent analysis to code transcripts and identify thematic categories across participants.
Key themes
More than half of participants held a dean position (53%), and 13% held two or more titled DEI roles. The majority (63%) self-identified as underrepresented in medicine and 34% as the first generation to attend college.
Researchers identified four key themes that reflected ongoing challenges for DEI leaders:
- variability within roles, responsibilities and access to resources across participants and institutions, in addition to within the same position throughout time;
- mismatch between institutional investments and directives and reduced efficacy due to lack of integration with other units within the school or health system;
- lack of evidence-based practices, theories of change or standards to guide their work; and
- work experiences that drive and exhaust leaders, with multiple participants that described burnout due to increasing demands not met with equivalent increase in institutional support.
“Academic health centers succeeded in expanding dialogue and naming new positions and initiatives, but they have not invested in the depth and breadth of resources needed to support DEI leaders to be successful,” Ko said. “They risk burnout and turnover of leaders who are predominantly members of minoritized communities — the very people DEI programs are supposed to retain and promote. Without acknowledgement of these challenges, they risk repeating yet another generation’s cycle of concluding that DEI effort does not work.”
Researchers reported limitations of the study, including the timing, recruitment process and stated aims that may have selected for participants motivated to participate due to their personal challenges at work, and researchers focused on individuals with formal titles, but effective DEI initiatives rely on the broader campus community.
‘Enacting real change’
“The DEI landscape in academic medicine is shifting, with institutions facing financial and political challenges, and it will be informative to see how DEI work can be sustained,” Ko told Healio. “We have several ideas on where to go next — the harder part is choosing which one. DEI work needs to be embedded throughout academic health centers, with appropriate funding, staff and authority. Establishing an underfunded position or office, in a separate silo, is insufficient for enacting real change. Instead, it signals that institutions are not genuinely committed to DEI, irrespective of their statements.”
References:
- Esparza CJ, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.15401.
- Ko M, et al. JAMA Netw Open. 2023;doi;10.1001/jamanetowrkopen.2022.54928.
For more information:
Michelle J. Ko, MD, PhD, can be reached at mijko@ucdavis.edu.
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