ASH Clinical News March 2017 | Page 33

FEATURE recognize that there are other groups that are often left out of the equation ,” said Dr . Churchwell . “ We are talking about members of the lesbian , gay , bisexual , and transgender ( LGBT ) community , women , veterans , people with disabilities , and others . We have to be more open in our mindset , and our tent of inclusion should be broadened .”
As the definition of diversity has evolved , so have the efforts to increase it . Many initiatives now link the idea of diversity with that of inclusion , or “ involvement and empowerment , where the inherent worth and dignity of all people is recognized .” 8
“ There are arguments for diversity related to proportionality ; in other words , the idea that if African- Americans comprise 13 to 15 percent of the general population , the percentage of African-Americans among our nursing and physician staff should reflect that percentage ,” explained Marcella Nunez-Smith , MD , MHS , director of the Equity Research and Innovation Center at Yale School of Medicine in New Haven , Connecticut . “ Inclusion language represents the idea that diversity is more robust – and more difficult – than reaching a ‘ quota ’ of minority staff members .”
Why Diversify ?
Inclusion is what animates diversity , according to Laura Castillo-Page , PhD , acting chief diversity and inclusion officer at the AAMC . “ You may have diversity within your institution , but if you don ’ t leverage that diversity , you don ’ t get the benefits ,” she explained .
Research has shown that the benefits of diversity in health care are innumerable – for patients and physicians . African-American and Latino patients are more likely to seek medical care from physicians of their own race based on personal preference and language , and when patients see a physician of their own race , they are more likely to rate the physician ’ s decision-making style as participatory , compared with patients seeing a physician of a different race . 9 , 10 Patients who have experienced more than one discriminatory experience may delay seeking medical care and may have poor adherence to health recommendations . 11
These attitudes extend to medical students : A survey found that white students at the most diverse medical schools ( ranking in the highest quintile for racial and ethnic diversity in the student body ) were more likely to rate themselves as highly prepared to care for minority populations than students who attended the least diverse medical schools . 12
“ Another rationale for gaining diversity is that diverse teams are simply more successful ,” said Dr . Nunez-Smith . “ Whatever the goal is , teams do it better , faster , more efficiently , and more effectively when they include a diverse perspective .”
All-Out Efforts to Promote Diversity
Medical associations like ASH and AAMC , medical institutions , and the U . S . government have all launched a variety of initiatives to increase diversity in medical education and training .
In 2003 , ASH was one of the first professional societies to launch its own effort to increase the number of underrepresented minorities in hematology-related fields and the number of minority hematologists with academic and research appointments : the ASH Minority Recruitment Initiative . This group of programs includes the Minority Medical Student Award Program , which offers an introductory , mentored , biomedical research experience to medical school students , and the new Minority Resident Hematology Award Program , which supports minority resident physicians as they conduct hematologyfocused research . ( For more about these initiatives , see the SIDEBAR on page 32 .)
“ We are trying to create more opportunities for underrepresented minority trainees to pursue a career in hematology ,” said Dr . Avalos . “ By creating longitudinal pathways , we hope to maintain student and resident interest in hematology and to develop a networking community where they can stay in touch with each other and their mentors along the way .” According to Dr . Castillo-Page , AAMC is actively exploring holistic admission , which “ involves working with admissions committees to think more broadly about admissions criteria , or moving beyond test scores to include the student , the student

Patients who have experienced more than one discriminatory experience may delay seeking medical care and may have poor adherence to health recommendations .

experience , and what they bring to the table ,” said Dr . Castillo-Page .
Once they ’ re in the door , AAMC also is working to provide mentoring and academic support to all medical students , regardless of race , to ensure that they have the support they need to succeed . “ We don ’ t want to just enroll more minority students ; we want to make sure that they get in and graduate successfully ,” she said .
Many medical institutions also are intensifying their efforts to foster more inclusive environments on their campuses . At Vanderbilt University , the newly created Inclusion Initiatives and Cultural Competence Office hosts professional development and training events to help students develop skills to promote social justice and to have constructive conversations , Dr . Churchwell explained .
Vanderbilt University was recently chosen by the NIH to be the Data and Research Support Center for the Precision Medicine Initiative Cohort Program , designed to study genetic , environmental , and lifestyle factors affecting health . “ Part of the grant will go toward putting together processes , concepts , and tools to ensure that research projects include people of underrepresented status ,” said Dr . Churchwell . “ We are going to take our precision medicine work and look at how social determinants of health in underrepresented populations influence genomics and clinical expression of disease .”
Diversity among the health-care workforce has also become a federal concern , with the government implementing a series of programs intended to promote diversity and inclusion in health care , such as the Health Careers Opportunity Program and the Programs to Increase Diversity Among Individuals Engaged in Health-Related Research .

What the Fisher Decision Means for Medicine

In 1997 , the state of Texas adopted a holistic review process ( known as the “ Top 10 Percent Rule ”) for all state-funded universities that offers automatic admission to eligible students in the top 10 percent of their high school class . Admission for remaining Texan and out-of-state students is based on a variety of other factors , including applicants ’ academic achievements , personal achievements , special circumstances , and race and ethnicity . Since its implementation , the program has significantly increased the racial and ethnic diversity of the student body at
Texas ’ public universities .
In 2012 , though , the Top 10 Percent Rule was challenged in court by Abigail Fisher , a white high school senior who graduated outside of the top 10 percent of her class and was rejected from the University of Texas – Austin ( UT ) in 2008 . Ms . Fisher filed suit against the university and other related defendants , claiming that UT ’ s use of race as a consideration in other applicants ’ admissions decisions was in violation of the equal protection clause of the 14th Amendment .
In a 4-to-3 decision , the Supreme
Court upheld the decision of a lower court , which concluded that UT ’ s use of affirmative action met a test known as “ strict scrutiny ” – in other words , the use of race for admissions was used to further a compelling interest . The ruling signaled that schools could continue to use raceconscious policies , as long as they could demonstrate that the policies are necessary , flexibly applied , place minimal burden on non-beneficiaries , and are subject to periodic review and evaluation .
For U . S . medical colleges and universities , this decision confirmed that “ diversity
is a vital component of excellence in education , clinical care , and research ,” according to AAMC President and CEO Darrell G . Kirch , MD . “ It bolsters the use of individualized , holistic review in admissions , based on each school ’ s mission and circumstances … and re-affirms the educational benefits of diversity .”
SOURCE Supreme Court of the United States . Fisher v . University of Texas at Austin et al . No 14-981 . Accessed January 19 , 2017 from https :// www . supremecourt . gov / opinions / 15pdf / 14-981 _ 4g15 . pdf .
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