A task force of neonatologists has created a toolkit filled with recommendations for enhancing recruitment and retention efforts within their specialty, particularly for candidates from underrepresented groups.
Physicians who identify as Black, Latinx, American Indian, Pacific Islander some Asian subgroups come from racial and ethnic populations that are underrepresented in medicine.
To address this trend, a working group was formed composed of members of the American Academy of Pediatrics, including underrepresented fellows, early-career neonatologists and others, to identify strategies for improving recruitment efforts.
Uchenna E. Anani, M.D., senior author for the task force report, said that while overall, proportions of underrepresented trainees in pediatrics has been stable, the number choosing to become Neonatal-Perinatal Medicine (NPM) fellows has decreased significantly, from 18.8 percent in 2007 to 14.2 percent in 2019.
Their report, published in the Journal of Perinatology, points to the need for a more inclusive fellowship application process, among other recommendations, said Anani, assistant professor of clinical pediatrics in the Division of Neonatology at Vanderbilt University School of Medicine.
Task Force Recommendations
The group recommends 10 steps to creation of a more holistic inclusivity culture:
- Reflect on the current climate for underrepresented trainees.
- Develop infrastructure to support and connect underrepresented trainees.
- Acknowledge and support underrepresented faculty and trainees in diversity efforts.
- Review historical data on recruitment to establish a baseline, set goals and monitor progress.
- Showcase diversity efforts on web, print and social media.
- Build relationships with prospective candidates along the pathway.
- Require microaggression and unconscious-bias training for all members of the recruiting committee.
- Establish a process for holistic application review.
- Design interview day in a way that promotes inclusivity and genuine commitment to diversity.
- Ensure that ranking processes align with strategic aims for diversity.
“Recruitment, retention and promotion of underrepresented physicians is a continuous process requiring a deep commitment to diversity,” Anani said. “These recommendations will allow programs to customize according to their needs and resources. Ultimately, a more diverse workforce will improve the health and lives of our patients, families, trainees, faculty and staff.”
Addressing Culture Within
Patients fare better when providers reflect their cultural and ethnic backgrounds, she said.
“We need to address how to interview and review prospective applicants and how to address the institutional culture,” Anani added. “The culture should support people of all backgrounds to be equitable and serve all patients and families.”
Assessing institutional culture includes identifying any support systems already in place, particularly for those who come from underrepresented backgrounds.
“Everyone has different lived experiences. Programs may need to adapt to support diverse trainees and faculty,” said Anani. And that includes establishing a comfortable work environment, examining data on mentoring, and identifying areas for growth and improvement to support retention.
Recruitment may be improved by focusing on the underrepresented communities being served.
“If there are more Latinx members in your community, you should prioritize bilingual candidates who identify with that culture or who show commitment to serve underserved communities,” she said. “Traditionally, programs have focused on metrics alone. We need a more holistic evaluation to gather insights on who candidates are as individuals. What attributes and experiences makes a great subspecialist?”
Shifting Attitudes
Successful cultural shifts require an all-in attitude across the line.
“The entire department, division and training program need to invest the time and funding to become more diverse,” Anani said.
Recruitment data collected should be followed for several years to chart quality improvement, she added.
Institutions that strive for excellence need to be “holistic, thoughtful and inclusive, recognizing specific barriers faced by people of color,” she said. “Improving the work force ultimately will improve the care you provide.”
“Recruitment, retention and promotion of underrepresented physicians is a continuous process.”
