Recruiting a Diverse Workforce

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How can residency program directors recruit a diverse physician workforce? Similarly, how can they create an institutional culture that promotes diversity, equity, and inclusion? These are the questions that George Dalembert, MD, MSHP; Nicole Washington, MD; and Adelaide Barnes, MD are seeking to answer through their scholarly projects and initiatives at CHOP (Children s Hospital of Philadelphia).

Drs. Dalembert, Washington, and Barnes are Associate Program Directors of CHOP’s Pediatrics Residency Program. Dr. Barnes also serves as the Chair of the Intern Selection Committee. In thinking about how to best serve their patients and to produce a physician pool that mirrors CHOP’s patient pool, their scholarship was born.

“A diverse physician workforce means better overall patient outcomes,” says Dr. Barnes. “At the same time, a diverse physician workforce is beneficial for providers’ growth as well. When a diverse group of physician voices has a seat at the table, we all learn to advocate for things we might not have previously advocated for.”

With these concepts in mind, Drs. Barnes, Dalembert, and Washington are involved in a multitude of projects and initiatives utilizing a mixed-methods approach whose aims are two-fold. First, continually addressing and improving residency recruitment, and second, building an inclusive, supportive culture for all residents, focusing on bias, microaggressions, and health equity through curriculum development and community support

Regarding recruitment, they referred to published papers and studies as well as strategies from other programs to support their work, while for improving the culture of inclusivity, they created surveys to determine how curriculum related to equity and bias was “sitting with them and what they’ve learned,” says Dr. Washington.

One of the common themes they noted in their work was “intentionality.”

“It’s important to be intentional in crafting an educational experience that’s longitudinal,” explains Dr. Dalembert. “In looking at the data, we’ve seen how physicians have been able to change their practice and think about things before they go into a patient’s room. Intentionality honestly has been a recurring theme across multiple fronts.”

And while the trio are integral members in leading these efforts, they collaborate with an extensive group of invested stakeholders to ensure their work is as successful as possible and sustainable.

Included in this group are Beth Rezet, MD (Vice Program Director for the Pediatrics Residency Program), Joe St. Geme, MD (Physician-In-Chief and Chair of the Department of Pediatrics), Dan West, MD (Associate Chair for Education, Department of Pediatrics and Designated Institutional Official),  Jessica Fowler, MD, MPH (Associate DIO of Diversity, Equity, and Inclusion, CHOP GME), Tiffani Johnson, MD, MSc (a former CHOP pediatric emergency medicine attending who  conducts research on bias, equity, and racism within pediatrics), Angie Ellison, MD, MSc (Vice Chair of the Department of Pediatrics and a pediatric emergency medicine attending), and Steve Ludwig, MD (former Designated Institutional Official at CHOP). Hannah Anderson, MBA (a Clinical Research Associate in Medical Education) and, most recently, Kristin McNaughton have been critical in manuscript development to ensure they are able to share the work with the medical community. They also collaborate with CHOP’s Multicultural Physicians' Alliance (MPA), a resident-run organization whose mission is to create a culture of inclusion among faculty, fellows, and residents.

In discussing the collaborative nature of their work and scholarship, Drs. Dalembert, Washington, and Barnes all agree that they would not have been able to carry out any of this work without the support of their colleagues.

One way they were particularly helpful? Discussing how their work could be used to help other residency programs looking to do something similar.

And Drs. Dalembert, Washington, and Barnes want to encourage other residency programs to lean into the challenges of improving the culture at their institutions as well.

“Even if other residency programs don’t have all the data or the resources to complete this kind of work, I’d encourage them to do it,” shares Dr. Washington. “No particular bad event led to our team starting this work, it’s just the right thing to do. It’s also my hope that our work will inspire others.”

Drs. Dalembert, Washington, and Barnes already have a few ways to do just this in mind.

While they have not yet submitted their work to a peer-reviewed journal for publication, they have identified a few potential targets, including Academic Medicine, Pediatrics, and the Journal of Graduate Medical Education. Because they have touched on so many different topics within pediatrics, they will probably wind up writing a “few different papers” highlighting their findings, notes Dr. Washington.

In addition, they’re considering turning their scholarship into a workshop to be presented at the Association for Pediatric Program Directors (APPD) and the Northeastern Group on Educational Affairs (NEGEA)’s annual meetings.

They are also continuing to do what they can to increase diversity, equity, and inclusion efforts throughout the halls of CHOP.

Drs. Dalembert, Washington, and Barnes’ efforts are far-reaching; they support diversity, equity, and inclusion at CHOP by serving on various hospital committees, working on DEI-related projects, and giving lectures on topics such as bias and microaggressions to other divisions. Their efforts have also extended to peer institutions such as the University of Pennsylvania. The University of Pennsylvania Health System (UPHS) has adopted the model for the Visiting Clerkship for students Under-Represented in Medicine (URiM) and now has 17 visiting clerkship programs throughout UPHS for fourth year URiM medical students with CHOP’s Dr. Jessica Fowler serving as a lead in coordinating these programs.

“We’re seeing a more local impact,” says Dr. Dalembert. “The work that we do has ripples very broadly.”

Of course, Drs. Dalembert, Washington, and Barnes’ work does not just have an impact on CHOP or the local community, it has made an impact on their lives as well.

“Being a part of the journey, whether it’s a patient or a trainee, and thinking about ways to rigorously put in place measures to support growth and change in a way that brings about good is what has value for me,” shares Dr. Dalembert.

“Recognizing how much value effective mentorship has and being the beneficiary of such great mentorship, I love being able to be a mentor and watching my mentees mature, grow, and evolve. That is the joy of being in an educator role,” adds Dr. Barnes.

“The value of teamwork and collaboration is extremely important. We wouldn’t have been effective at moving this work  along without the help of so many different people,” says Dr. Washington. “Teamwork is needed to sustain these types of efforts in the long-term. My advice to others who want to carry out similar work is to utilize a variety of different skillsets and emphasize that all are welcome to participate.”