Promoting Diversity in Emergency Medicine: Summary Recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup Sheryl L. Heron, MD, MPH, Elise O. Lovell, MD, Ernest Wang, MD, and Steven H. Bowman, MD
Abstract Although the U.S. population continues to become more diverse, ethnic and racial health care disparities persist. The benefits of a diverse medical workforce have been well described, but the percentage of emergency medicine (EM) residents from underrepresented groups (URGs) is small and has not significantly increased over the past 10 years. The Council of Emergency Medicine Resident Directors (CORD) requested that a panel of CORD members review the current state of ethnic and racial diversity in EM training programs. The objective of the discussion was to develop strategies to help EM residency programs examine and improve diversity in their respective institutions. Specific recommendations focus on URG applicant selection and recruitment strategies, cultural competence curriculum development, involvement of URG faculty, and the availability of institutional and national resources to improve and maintain diversity in EM training programs. ACADEMIC EMERGENCY MEDICINE 2009; 16:450–453 ª 2009 by the Society for Academic Emergency Medicine Keywords: diversity, CORD, summary recommendations
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he Council of Emergency Medicine Residency Directors (CORD) requested that a panel of CORD members lead a workgroup on racial and ethnic diversity in emergency medicine (EM) as part of the best practices track during the 2008 CORD Academic Assembly. Following a presentation from the panel outlining national statistics, trends, and issues involving diversity in EM, the workgroup met to discuss and address the current state of diversity in EM, specifically with respect to residency programs. Ten EM program directors (PDs), associate PDs, and faculty members from across the UniFrom the Department of Emergency Medicine, Emory University School of Medicine (SLH), Atlanta, GA; the Department of Emergency Medicine, Advocate Christ Medical Center (EL), Oak Lawn, IL; the Feinberg School of Medicine, NorthShore University HealthSystem, Evanston, IL; and the Department of Emergency Medicine, Cook County Hospital (Stroger) (SHB), Chicago, IL. Received October 28, 2008; revision received December 23, 2008; accepted January 11, 2009. Address for correspondence and reprints: Sheryl L. Heron, MD, MPH; e-mail:
[email protected]. Presented at the Council of Emergency Medicine Resident Directors (CORD) Conference, New Orleans, LA, March 28–30, 2008.
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ted States participated in the workgroup. The discussion highlighted definitions, concerns, and recommendations to help PDs improve diversity in their residency programs through changes in resident and faculty recruitment and retention strategies. The members of the workgroup, the panelists, and CORD membership reconvened at the conclusion of the Academic Assembly to share and further discuss their findings. BACKGROUND By the year 2050, the U.S. Census Bureau projects that minorities will represent 54% of the national population. African Americans will represent 12% of the composition, while Hispanics, the fastest growing minority group, will nearly double to represent 30% of the population.1 The 2002 Institute of Medicine Report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care reported ‘‘Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services.’’2 Minority group members are less likely than whites to receive appropriate cardiac medication, coronary bypass surgery, kidney dialysis or kidney trans-
ª 2009 by the Society for Academic Emergency Medicine doi: 10.1111/j.1553-2712.2009.00384.x
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plants, HIV therapy, diabetes care, pediatric care and maternal and child health, mental health, rehabilitative and nursing home services, and surgical procedures. In addition, disparities in cancer management have been described with respect to diagnostic testing, therapy, and analgesia.2 Clinical settings such as the emergency department (ED), which demand time-sensitive decisionmaking in the face of incomplete information, increase the potential for bias and stereotype to negatively impact the medical care of racial and ethnic minorities.3 The benefits of racial and ethnic diversity among health care professionals have been previously described. Racial and ethnic minority health care providers are more likely to serve minority and medically underserved communities, thereby increasing access to care. Racial and ethnic minority patients report greater levels of satisfaction with the care provided by minority health professionals. Racial and ethnic minority health care providers can help health systems in efforts to reduce cultural and linguistic barriers and improve cultural competence. Diversity in higher education and health professions training settings is associated with better educational outcomes among all students.4 In 2003, the Association of American Medical Colleges (AAMC) Executive Council adopted a definition of ‘‘underrepresented in medicine,’’ as ‘‘those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.’’4 Prior to this, the AAMC utilized the term ‘‘underrepresented minority’’ which specifically included African Americans, Mexican Americans, Native Americans, and mainland Puerto Ricans. The new definition allows a shift in focus from a fixed aggregation of four racial and ethnic groups to a continually evolving underlying reality. The new definition accommodates including and removing underrepresented groups (URGs) on the basis of changing demographics of society and the profession. The new definition also allows a shift in focus from a national perspective to regional or local perspective on underrepresentation and data collection and reporting on a broad range of racial and ethnic self descriptions.5 In 2008, the AAMC published the ‘‘Roadmap to Diversity: Key Legal and Educational Policy Foundations for Medical Schools,’’6 which serves as the organization’s policy statement for creating and sustaining diversity in medical education. They describe five major themes that are necessary for successful implementation of diversity goals, including commitment to diversity by leadership and effective development and implementation of diversity related policies.6 At an Academic Emergency Medicine (AEM) national consensus conference on disparities in emergency health care, EM workforce diversity and training culturally competent emergency physicians (EPs) were stressed as strategies to help eliminate racial and ethnic health disparities.7 A 1993 study revealed that 40% of EM programs had no minorities.8 Although there has been significant growth in the total number of EM residents in the past 10 years, the percentage of EM residents from URGs has remained the same. Table 1 demonstrates the comparison of URG EM physicians in 1997–1998 to 2007–2008.9,10
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Table 1 Comparison of EM Residents from URGs 1997–1998 and 2007– 20089,10 Year African American Hispanic Native American Total EM residents
1997–1998, n (%)
2007–2008, n (%)
191 (6) 137 (4) 7 (
