JAMA: Addressing Disparities in Academic Medicine

Joining a much-needed conversation about microaggressions isn’t about embarking on the race for accumulating the most “pity votes” as some of the critics assert. It’s not about self-imposed victimization.

It’s about challenging the exhaustive burden of microaggressions that cumulatively can truly hurt one’s wellbeing. Furthermore, microaggressions serve as reflections of deeper held biases and stereotypes that need to be openly recognized before any semblance of “debiasing” can take place. Such manifestations of bias are particularly pernicious when they emerge in situations of unequal power dynamics. Naturally, then, people would seek the assistance of individuals with some level of authority. You wouldn’t call out your supervisor or professor. Yet, to declare that people who search for such interventions are undignified is ignorant. It is blind to the reality that alongside micro cases of bias, they are also regularly navigating macro modes of discrimination. Many marginalized people in this country are regularly subjected to structural violence and have already been struggling to silently navigate unjust playing fields with respect to areas such as financial resources, social capital, and political clout.

So it wouldn’t be a huge surprise if, at one point, an individual reaches a tipping point and lashes out at someone committing a microaggression. It shouldn’t be appalling when such students seek out systems of support (such as anonymous blogs) after being compelled to silently bear numerous biases for as long as they can remember–for having an entire schema of assumed beliefs and behaviors imprinted on them without their consent. And it certainly would not be especially valuable to focus on a handful of particularly fervent or controversial cases of people openly addressing microaggressions when we still have significant societal inequities in this country going unaddressed.

With recent articles that criticize spaces for discussing microaggressions, seeing today’s JAMA article was so refreshing:

Today, unconscious bias and stereotypes continue to hinder the recruitment of diverse medical students,19 prevent the full participation of qualified individuals in the profession, and impede the nation’s ability to address health care disparities.20

What is needed to move forward? In academic medicine today, the decisions regarding hiring, distribution of resources, and advancement are often in the hands of individuals who are principal investigators, division chiefs, chairs, and deans, usually male and white. These individuals may not recognize their unconscious preferences or that their preferences for individuals who are like them may result in differential treatment that increases the relative advantages of those who are already advantaged (ie, in-group favoritism).21 Among both men and women, unconscious bias can lead to decisions that perpetuate inequalities and reinforce cultural biases, like the association of men with intelligence, leadership, and science.21

For those women and minority physicians who have overcome many obstacles and seek to enter the ranks of junior faculty in academic medicine, several institutional changes may help support their success. The first step is acknowledging that the system is not working effectively. The leadership of academic medical centers must address systematically the sources of imbalance openly and strategically. Within each organization, careful analysis of equity and representation should be performed regularly and should be considered part of the responsibility of all managers and leaders…

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