“Reach Back, Engage, and Just Do It”: Tips to Enhance Diversity in Medicine
Interventional cardiologist Quinn Capers, MD, is on a mission to change the way we think about diversity in medicine.
"Imagine the effect of a medication shortage or an increase in medication prices," he said, looking around a room of roughly 60 physicians, trainees, residents, staff, and medical students who had gathered to hear him speak on campus this week.
"We get upset when pharmaceutical companies charge exorbitant fees for things our patients need. Take insulin, for example," Capers, who is the associate dean of admissions and a professor at Ohio State University (OSU) College of Medicine, continued. "If the price of insulin was raised there would be outrage -- because we need it, or our patients will die. I'd like to frame diversity in the same way -- we need it. Because diversity saves lives."
Recent data supports Capers' assertion. A 2009 study from Germany suggested that the clinical outcomes of patients with chronic heart failure appeared to be dependent upon both patients' and physicians' gender. And a 2018 study led by Stanford associate professor Marcella Alsan, MD, PhD, and colleagues from the National Bureau of Economic Research found that black patients were far more likely to agree to certain preventative health tests -- blood pressure measurements, cholesterol and diabetes screenings, among others -- if they discussed them with a black male doctor.
"Work like this shows the benefit of increasing underrepresented minorities and women in medicine," Capers said. "A diverse medical workforce can reduce harmful disparities that ultimately translate to better patient care. We need to approach this topic with urgency."
Capers' commitment to diversity and inclusion goes beyond rhetoric. He said he has worked alongside others in the OSU medical school to implement changes that have resulted in an increase of underrepresented minority enrollment from 11.1% to a high of 26%, and an increase in the number of women matriculating (so much so that they now outnumber men).
During the hour-long presentation, Capers explained what has helped him throughout his career, offering strategies for improving, and prioritizing, diversity:
Reach back to engage the pipeline
Capers has identified critical moments, or "leaks" in the medical talent pipeline -- which extends from kindergarten to medical school -- where underrepresented and minority students fall out or lose interest in medicine. He said it is essential to reach out and engage students at these junctures and suggested outreach is an effective way to do this. For example, he said OSU has partnered with local high schools, middle schools, and elementary schools to provide students with hands-on exposure to the health sciences.
"Mentor pre-med, med students, really, mentor anyone," Capers suggested. And create mentorship opportunities for groups in need. "We have a black male mentoring round table, which meets quarterly for socializing and inspiration, and we make sure everyone is on a successful track."
After hearing that women found the catheterization lab to be unfriendly and uninviting, Capers and his cardiologist colleagues spearheaded an initiative to invite women into the catheterization laboratory early and often. "We want to demystify it and make it an inviting atmosphere."
Capers is a firm believer in the power of social media, and encourages others to showcase their diversity efforts. He has created a hashtag, #BlackMeninMedicine in an effort to "change the negative implicit bias about black men, and provide young people with role models."
Confront implicit bias
Implicit bias occurs, Capers explained, when the "unconscious mind hijacks the conscious mind," and it stems from our experiences -- not racism. Capers suggested creating an implicit bias reduction 'cheat sheet,' which admission committee members can review prior to interviewing medical school or residency applicants.
"I spend a lot of time thinking about gatekeepers," Capers told the audience. "There are a lot of gates in academia: A gate in college, a gate to get into medical school, then fellowship, and then residency. And who mans these gates? Admission committees, program directors, and leadership." Capers engages the gatekeepers through training on holistic review -- a process that gives equal weight to a student's personal attributes and experiences as well as their academic record -- and implicit bias.
Make diversity and the ability to enhance cultural competence a top priority
What would happen, Capers posited, if diversity and the ability to enhance cultural competency was considered a mark of excellence? It's something OSU's interventional cardiology group is trying, and they now include it as a metric on their interview sheet for fellows.
"There was pushback," Capers admitted, "but if we're serious about ending health care disparities, we need to take this seriously -- so we do."
Just do it, (and then write about so others can follow)
Capers ended his talk with a call for everyone to engage in diversity work, and to share their observations with others. The improvements at OSU did not happen by accident, he said. "It was intentional. So be sure to share your work so that programs can learn your lessons."