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Striving Toward Excellence:

Faculty Diversity in Medical Education

Striving Toward Excellence:Faculty Diversity in Medical Education

©2009 Association of American Medical Colleges. The data and charts in this report, with attribution, may be distributedand used by and within AAMC member organizations. No other part of this publication may be reproduced or distributedwithout written permission of the Association of American Medical Colleges.

Published by the Association of American Medical Colleges,Diversity Policy and Programs. Summer 2009

Acknowledgements:

This report could not have been accomplished without considerable support from Marc Nivet, Ed.D., who authored theintroductory essay of the report (pages 3-9), Denice Cora-Bramble, M.D., M.B.A. and Gary Butts, M.D., who wrote theforeword to the report, and members of the AAMC’s Diversity Policy and Programs’ Faculty Initiatives Team:Laura Castillo-Page, Ph.D.Lily May Johnson, M.S.Lutheria N. Peters, M.P.H., C.H.E.S.Angela Moses

A special thanks to Ann Steinecke, Ph.D., Hershel Alexander, Ph.D., Valarie Clark, Sarah Bunton, Ph.D., Rae Purcell, EuphiaSmith, Kody Melancon, Norma Iris Poll-Hunter, Ph.D., and LaToya Egwuekwe for contributing to segments of the reportand providing their guidance and expertise. In addition, a special thanks to the Young Physicians Roundtable andEstablished Leaders meeting participants.

To request additional free copies of this publication, please contact:

Mujaji LawAssociation of American Medical CollegesDiversity Policy and Programs2450 N Street, NWWashington, D.C. 20037-1127Phone: 202 862 6203Fax: 202 862 6282E-mail: [email protected]

Free PDF versions of this report are available for download at www.aamc.org/publications

Association of American Medical Colleges, 2009iii

Striving Toward Excellence: Faculty Diversity in Medical Education

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

From Fairness to Excellence: The Future Rationale for Racial and Ethnic Faculty Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Historical Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Dividends of Diversity Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Challenges Faced by Racial and Ethnic Minority Faculty in Academic Medicine: What the Research Tells Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Toward Excellence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Drivers of Excellence: An Overview of Existing and Proposed Approaches to Increase Faculty Diversity . . . . . . . . . . . . . . . . . . . . . . . . . 11

Meeting Overview: AAMC, DPP October 2007 Young Physicians Roundtable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Meeting Overview: AAMC, DPP June 2008 Meeting with EstablishedLeaders in the Field of Diversity and Faculty Professional Development. . . . . . 12

A Combined Summary of Key Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Faculty Pipeline Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Suggested Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Conclusion and Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Appendix I: Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22AAMC Meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22AAMC Publications and Web Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Other AAMC Professional Development Programs . . . . . . . . . . . . . . . . . . . . . . . 26Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Appendix II: Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Table 1: Count of Full-Time Faculty by Sex and Race / Hispanic Origin from 1966 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Table 2: Count of Full-time Faculty by Medical School, Race / Hispanic Origin, and Sex for 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Table 3: Count of Full-Time Faculty by Sex, Race / Hispanic Origin, and Rank from 1997 to 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Table 4: Count of Chairs by Sex and Race / Hispanic Origin from 1997 to 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Table 5: Count of Deans by Sex and Race / Hispanic Origin from 1998, 2003, and 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Table of Contents

Association of American Medical Colleges, 20091


The Association of American MedicalColleges’ (AAMC) report, “StrivingToward Excellence: Faculty Diversity inMedical Education,” presents an evolu-tionary paradigm to increase andsupport faculty diversity that calls onlearning institutions “to developprograms not based solely on the currentlack of diversity but rather to eradicateinhibitors of institutional excellence.”

Through a focus on a social justicecontext and an exploration of thedividends of diversity that relate tocareer advancement and satisfaction inacademic medicine, this proposedparadigm seeks to expand the currentepistemologies and rationales ofincreasing racial and ethnic minorityfaculty diversity. While these messages,grounded in a turbulent history, remainboth relevant and important toacademia, our understanding of therationale for diversity has evolved overthe past years. Why is a diverse facultybody important? Why does it matter?

In spite of myriad well-intentionedscholarly studies and interventionsconcerning the challenge of underrepre-sentation of racial and ethnic minorityfaculty in US medical schools, theproblem persists, with little change in theproportion of African American, Latino /Hispanic and Native American / Alaskanfaculty in medical schools. Even in theface of the sociodemographic changesresulting in more diverse communitiesand a “browning of America,”1 there islittle real racial and ethnic diversity inacademia and even less in leadershippositions. The literature throughout thismonograph highlights the differences infaculty experience, promotion outcomes,career satisfaction and even social capitalbetween racial and ethnic minority andnon-minority faculty and offers ampleevidence of this lack of diversity.

Therefore, addressing these challengesmay benefit from a new paradigm.

In this monograph, Marc Nivet positsthat diversity and excellence have beenhistorically viewed as “two parallel linesof thought” which can have the“unintended consequence of pittingdiversity against excellence.” Building ona report by the Josiah Macy, Jr.Foundation which called for a reformedmedical education experience that wouldbe “collaborative, patient-centered,outcomes-focused and responsive tocommunity needs,” Nivet proposes amuch broader and more importantemphasis: the need for and value ofdiversity to drive excellence and thusprovide added value and ultimatelyimprove patient care for all, whetherthrough research or direct patientcontact.

This monograph puts forth that if we inacademia are to achieve excellence ineducation, patient care and research, weneed to carefully consider the pivotalroles of a diverse student body, facultyand leadership in reaching this goal.Rather than fostering diversity in USmedical schools solely as a matter ofsocial justice or changing demographics,we must re-examine our conceptualframework and intervention strategiesthrough an undisputable and laudablequality-centered lens.

Denice Cora-Bramble, MD, MBA, Senior Vice PresidentChildren's National Medical CenterGoldberg Center for Community Pediatric Health Professor of Pediatrics,George Washington University School ofMedicine

Gary Butts, MDAssociate Professor, Medical Education Associate Professor, Community andPreventive Medicine Associate Professor, Pediatrics Mount Sinai School of Medicine

Foreword



Academic health centers across theUnited States strive perpetually towardexcellence and improved patientoutcomes—whether through research,direct care or educating future practi-tioners. Despite these efforts, somesegments of our society still lack accessto quality health care, and the goal ofexcellence in health care outcomes for allremains elusive.2

Some researchers have surmised that thisis the result of a lack of racially andethnically diverse representation withinthese institutions3–a supposition basedon the idea that the greatest asset of anacademic institution is its humancapital. Thus, one important elementneeded to bring academic medicinecloser to its goal of excellence ineducation and patient care is to makefuller use of all talent available.

In recognition of the urgent need for thefield of medicine to continue to adapt toand better align with societal needs andexpectations, a growing number of

leaders in academic medicine call foracademic health centers to redoubletheir efforts to increase the diversity ofstudents, faculty and staff.4 Although it islaudable to call for increased attentionand efforts to diversify, it is ofparamount importance to review anddistill what we have learned from pastefforts so that future energy can be spentintelligently to ensure greater impactgoing forward. Therefore, thismonograph reviews the past rationalesfor increased student and facultydiversity and discusses the challengesfacing racial and ethnic minoritiespursuing careers in academic medicine;presents a new rationale for diversity andexcellence; where possible, highlightspotentially promising practices that candrive excellence and improve patientcare for all; and offers guidance andresources regarding racial and ethnicminority faculty development.

The challenges and limited success thatmedical education has had in recentdecades in increasing diversity of itsstudent body are widely known.5-6 Thepercentage of first-year AfricanAmerican, Hispanic / Latino or NativeAmerican / Alaskan medical students hasgrown from 7.1 percent in 1970-71 to16.5 percent in 2007-08.7 Despiteoptimism in the early 1990s, mostobservers conclude that while someimprovement has indeed been made,progress has been slow and thepercentage of racial and ethnic minori-ties studying medicine has becomestagnant.3 In the last decade, additionalattention has been directed to the glacialpace of increase in the numbers ofAfrican Americans, Hispanics / Latinos,and Native American / Alaskans in themedical school faculty ranks. As Figure 1shows, Black / African American,Hispanic / Latino, and Native American /Alaskan faculty make up only 7.3percent of all medical school faculty.6

From Fairness toExcellence: TheFuture Rationale forRacial and EthnicFaculty Diversity

Figure 1


A history of rationales for increasedstudent and faculty diversity has evolvedfrom issues of fairness and justice (i.e.,repairing past wrongs) in the 1960s and1970s toward a demographic rationaleover the last 30 years, which suggeststhat the numbers of racial and ethnicminority students and faculty membersmust be increased to meet the changingpopulation of the United States (popula-tion parity) in order to better meet theneeds of increasingly diverse racial andethnic patient populations.3 While thedemographic justification continues tobe prevalent in the diversity literature ofhealth professions, there is growingattention to “dividends of diversity” insuch critical areas as access to care, andquality of care.

The “dividends of diversity” rationaleasserts that diversity is a tool to enhancethe educational climate, and that educa-tional outcomes are directly improved asa result of a diverse student body, whichin turn will lead to the improvedcultural competence of all involved.8-9

When the University of Michigan LawSchool successfully defended its affirma-tive action policies in the SupremeCourt, the “dividends of diversity” was akey component of the argument.10

Moreover, a second dividend—oftencited specifically regarding the racial andethnic makeup of the faculty—is thatgreater diversity will help ensure a morecomprehensive research agenda.11

Specific to medicine, the salience of boththe demographic and dividend ratio-nales is that they are embedded in thecontinued pursuit of improved minoritypatient outcomes and the elimination ofhealth disparities. The research on racialconcordance12 and on cultural compe-tence13 offers invaluable empiricalevidence of the value of faculty and

practitioner diversity to all patients,strongly suggesting that the lack ofdiversity causes disproportionallynegative public health effects on theminority patient population.

While it has been necessary andimportant to continue to develop andamplify rationales for diversity, the“dividend of diversity” rationale issomewhat shortsighted. By positioningthe need for more diversity as primarilya benefit to a subset of the population,the overarching value of a diversemedical profession may be lost:Ultimately, the value of diversity is todrive excellence and improve patientcare for all, whether through research ordirect patient contact. To illustrate, oneneed only ask a hypothetical question:What if the current gap in healthcareoutcomes between minority and non-minority patients were to be drasticallyreduced due to the combination of anefficient universal healthcare system, anaffordable electronic patient recordssystem, and the deeper use of publichealth principles by all physicians?Would the “dividends of diversity”rationale lose some of its impetus?Probably.

Therefore, the time is upon us todevelop a new rationale for diversity, notas a replacement of past rationales but asan extension of thought. Framingdiversity as an institutional driver ofexcellence affords researchers who focuson diversity outcomes a new platformon which to ground their findings. Itoffers the academic health center leaders

the ability to align their calls forincreased faculty and student diversitywith measurable goals of achievingexcellence.

Historically, the need for diversity hasbeen portrayed in the medical educationliterature and by its proponents assomething to contend with, a challengeto be met, and only loosely attached tothe call for excellence in patient care,education and research. Diversity issuesare often layered on top of, or cited inaddition to, stated goals and objectivesof the nation’s academic medical centers.Using the 2010-2011 Medical SchoolAdmission Requirements (MSAR™)guide book, the 147 medical schools’mission statements in the U.S. andCanada were informally scanned for theuse of the words “excellence” (or animplied use of the term, such as distinc-tion, pre-eminent, high quality andoutstanding) and “diversity” (or animplied use of the term, such as under-served and disadvantaged). Excellence asa concept was found to appear 51 times,while diversity is cited only about 37times.14 That is worrisome, since itimplies that “diversity” and “excellence”are regarded as two parallel lines ofthought or two train tracks side by side

that may never meet. In truth, diversityis the engine pushing the “excellence”locomotive along the tracks: Excellencecannot be achieved without diversity.

This reconfiguration is criticallyimportant, since past rationales haveoften had the unintended consequence

4


Diversity is the engine pushing the “excellence” locomotive along thetracks: Excellence cannot be achieved without diversity.

Marc Nivet, Ed.D. Josiah Macy, Jr. Foundation



of pitting diversity against excellence.Such conceptual limitations have enabledcriticism from those who believe affir-mative action and other diversityprograms harm individuals from non-minority groups; indeed they have beenlabeled by some as reverse discrimina-tion. If diversity is framed as a driver toexcellence, it allows researchers andadministrators new avenues for programdevelopment and allows new questionsto be posed. At the same time it supportsan outcome that all Americans desire—excellent patient care for all.

To affect this repositioning of the valueof diversity, it is important to understandhow the concepts around diversity havedeveloped in order to better comprehendthe ground already covered, to identifythe gaps in diversity research andpractice, and ultimately to thoroughlyexamine the nuances so that additionalrationales continue to emerge.

Historical ChallengesThe “fairness” rationale emerged in the1960s as a response to the larger societalimplications of the civil rightsmovement. The historical barriers todiversification of the health professions,and of minorities pursuing medicaleducation, is rooted in the legacy ofsegregation in the United States.

One need not go much further back than1910, when Abraham Flexner, aneducation theorist, was charged by theCarnegie Foundation for theAdvancement of Teaching with the taskof reviewing all 155 medical schools thenin existence in the United States andCanada. The resulting report, known asthe “Flexner Report,” was a criticalexpose of how medical education wasconducted at the time.

Flexner made many suggestions forchange but a primary recommendationwas an insistence that medical schools beaffiliated with and integrated into anestablished university structure.16

Although this and several other reformsrecommended by Flexner are widelycredited with raising the quality ofAmerican medical education and forcingmany for-profit, inadequately financedand/or poorly managed medical schoolsto close, there was a concomitantreduction in the number of physiciansavailable to serve disadvantaged commu-nities.16 The report was particularlycritical of the black medical colleges,which ultimately led to the closure ofseven of the nine historically blackmedical schools. The remainingschools—Howard University College ofMedicine and Meharry MedicalCollege—became the two primaryoptions for African Americans, thuslimiting the opportunity for medicalschool attendance. The law ofunintended consequences coupled withthe brutal realities of segregationremained strikingly evident up until1964 when 97 percent of all medicalstudents in the U.S. were white.17

It was only four short decades ago thatthe conditions of the Civil Rights Act of1964 led medical schools to desegregateif they desired to receive federal fundingfor student financial aid and construc-tion projects for new buildings. Thefollowing year bills creating Medicareand Medicaid were enacted, which hadan immediate impact on the nation’shospitals by requiring an end to histor-ical segregation policies and practices inorder to receive reimbursement forcare.17

This confluence of events demanded adiversification of the physician workforce

and prompted medical education todevelop affirmative action programs (asdid much of higher education) toincrease minority enrollment in medicalschools. In 1970 the AAMC recom-mended that medical schools achieveequality of opportunity by relieving oreliminating barriers and constraints toaccess to the medical profession.9

Through aggressive affirmative actionadmission policies, in 1975, enrollmentof racial and ethnic minorities climbedto 10 percent nationwide, a level thatremained constant until the early 1990s.18

The stagnation in enrollment, combinedwith the continued growth of minoritypopulations, stimulated the AAMC in1991 to create “Project 3000 by 2000”, itssecond major initiative to enhancediversity, which was a call to matriculate3000 racial and ethnic minority studentsby the year 2000.19 As the broadest andmost visible call for population parity todate, “Project 3000 by 2000” representsthe demographic rationale at its apex.

Sadly, the initiative fell well short of itsgoal; however the effort helped increaseminority enrollment to more than 12percent by 1995.19 Since 1995, however,significant legal challenges to affirmativeaction through the courts and a varietyof state ballot initiatives have hamperedor inhibited the ability of educationalinstitutions to diversify their studentbodies. Despite the 2003 Supreme Courtaffirmative action decision in Grutter v.Bollinger et al., in which the compellingstate interest of promoting diversity wasupheld, the climate for employing affir-mative action programs and thedemographic rationale as a tool topromote diversity continues to befraught with obstacles.20


Dividends of DiversityRationaleIn 2003, the Duke University School ofMedicine established the SullivanCommission on Diversity in theHealthcare Workforce, through a grantfrom the W.K. Kellogg Foundation. Thegoal of the commission was to makepolicy recommendations to bring aboutsystemic change to address the lack ofdiversity in the health professions. In itsgroundbreaking report, “MissingPersons: Minorities in the HealthProfessions,” the commission noted thatwhile the current discussion in the liter-ature on diversifying the health profes-sions has focused narrowly on issues ofrecruitment and retention of students,diversity must be considered in abroader context. Because it is themedical school faculty and administra-tive leadership who ensure that an insti-tution’s policies are aligned with itsmission; who set the direction ofmedical education and curricularreform; and who oversee student andfaculty recruitment, retention, andpromotion, the report suggests that oneof the most critical elements in theeffort to diversify the health professionsworkforce is the development of appro-priate faculty and leadership to “push”the agenda.1

Proponents of increased faculty diversityposit that minority faculty membersoffer a different and important qualita-tive perspective on research and teachingand would provide more support toracial and ethnic minority students inthe form of academic guidance, mentor-ship and role modeling.21 In addition, adiverse faculty helps enhance the typesof case studies and structured dialoguesoffered by minorities as teaching toolsand may offer a different perspective.10&22

These principles, however, are notunique to medical education, but aremore broadly applicable to education ingeneral. Paul Umbach, using data from anational study of 13,499 faculty at 134colleges and universities,9 explored theimpact of faculty of color on undergrad-uate education and found evidence tosuggest that a diverse faculty contributessignificantly to the quality of undergrad-uate education. The two primary areasof added value are in the use of abroader range of pedagogical techniquesand more frequent interactions withstudents than their white counterparts.

With the inequalities of health careoutcomes for racial and ethnic minori-ties mounting, even when controlled forincome, insurance status, severity ofillness and age,5&23 proponents ofdiversity began exploring the potentialbenefits of a diverse racial and ethnicpool of faculty members on patientoutcomes. Since the nation's researchagenda is primarily shaped by those whochoose research as a career, andindividual investigators usually conductresearch on problems that are visible toand of interest to them, one can hypoth-esize that increasing the diversity amongresearchers will allow for an expansionof the nation’s research agenda.24 That inturn will enhance patient care andexpand the range of potential solutionsfor eliminating health disparities.9

The cultural competence movement is acombination of both the demographicand dividend rationale, as the followingquote illustrates:

“Given the rapidly changingdemographics of the nation, it is evidentthat future health practitioners will bedelivering care to patients from an evenwider range of cultural and ethnic

backgrounds. In order to provideoptimal care, a health practitioner musthave a firm understanding of howcultural biases, belief systems, ethnicorigins and many other culturally deter-mined factors influence the way peopleexperience illness and respond totreatment.”10

The cultural competence of a healthpractitioner can be defined as having theknowledge, skill, behavior and attitudeto provide the best possible care toindividuals with backgrounds differentfrom one’s own.9 This rationale isimportant because it is evident thatdeveloping diverse culturally competentpractitioners cannot happen in homoge-neous racial and ethnic environments.In an effort to develop cultural compe-tence, health professionals must beeducated in settings reflective of ourdiverse society. Therefore, diversity ofthe faculty, administration and of one’speers in medical school is an importantcomponent of the learning that takesplace both inside and outside theclassroom.9

In exploring the rationales for increaseddiversity in the academic medical schoolenvironment, it is important to reviewthe current challenges that continue toblunt progress.

6




There is a widening body of evidenceregarding the barriers to success forminorities entering careers in academicmedicine. Research since the mid-1980shas primarily focused on the “accumula-tive disadvantaged”25 position in whichminority faculty members findthemselves compared with Whites.Decades of systematic segregation anddiscrimination as well as more subtletraditional factors of cultural and elitismin academic medicine have an isolatingeffect on minority faculty.26 That in turnhas adversely influenced the recruitment,retention and career progress of racialand ethnic minorities.27 Several studieshave illuminated the adverse effects ofthe paucity of minorities pursuingcareers in academic medicine,28&29 such asfeelings of loneliness and isolationleading to a lower level of career satisfaction.

Palepu et al. discovered, through a strati-fied random sample of 3,013 full-timefaculty at 24 U.S. medical schools, theexistence of racial and ethnic disparitiesin faculty promotion, and found thatminority faculty members receivedtenure at lower rates than Whitefaculty.28 African-American faculty werefound to be the least likely of the racialand ethnic minority groups to holdsenior faculty rank when compared withWhite faculty—findings that remainedconsistent even when controlled forfactors that typically influence promo-tions, such as years as a faculty memberor measures of academic productivity.

Palepu and her colleagues notedprevious research suggesting that greaterdebt burdens may partly explain whyminority faculty members spend moretime on clinical activities and less timeon research. Perhaps as a result, more

minorities are on clinical tracks where itgenerally takes longer to achievepromotion. However, even after control-ling for the percentage of time devotedto clinical responsibilities, Palepu andher colleagues found that minorityfaculty members were still less likely tobe promoted. They conclude thatdiscrimination against minorities thatpermeates society may play a role in thelack of promotion. In short, stereotypesof minorities as inferior may exist inacademic medicine.

Moreover, Palepu et al., suggest thatcultural differences may cause minorityfaculty to feel excluded from certainopportunities or not to participate in theinformal information sharing that takesplace in an academic setting. While thephrase “social capital”30 is not used, theauthors question whether cultural andother historic factors may make someminority faculty reluctant to “network”at the divisional or departmental level,thus limiting their opportunity to forgepersonal and professional relationshipswith non-minority colleagues. In orderto gain a better understanding of thefactors that minority faculty perceive asbarriers to advancement, Palepu and hercolleagues suggested that much moreresearch is needed.

In an attempt to build on the Palepustudy, Fang et al.31 compared promotionrates of minority and white medicalschool faculty in the United States, usingdata provided by the AAMC’s FacultyRoster System (the official data trackingsystem for medical school faculty), usinga retrospective cohort design to illumi-nate any disparities between minorityand non-minority peers. Examination of50,145 full-time U.S. medical schoolfaculty members who became assistant

Challenges Faced byRacial and EthnicMinority Faculty inAcademic Medicine:What the ResearchTells Us


or associate professors between 1980 and1989 revealed findings consistent withPalepu: Racial and ethnic minorityfaculty, at both the assistant andassociate professor rank, lagged behindWhite faculty in rates of promotion,even as their representation in academicmedicine had increased.

Additionally, faculty research produc-tivity was measured using receipt ofNational Institutes of Health awards, asthese awards are purported to weighheavily in faculty promotion decisions.The authors hypothesized that a majorcause for lack of promotion could bethat minorities publish less frequentlythan White faculty. The authorsconcluded with a call for further study,stating that they did not believe thedifferences in promotion rates were dueto lack of desire or commitment.29 Takentogether, these studies are instructiveconcerning the difficulties minorityfaculty face in career progression andsatisfaction in academic medicine, andstrongly suggest these difficulties arisefrom an accumulated inheritance ofdisadvantages.

Equally troubling are the findings byPeterson, Ash, Franco & Carr.31 Througha 177-item self-administered survey of1,979 full-time medical school facultymembers working at 24 randomlyselected medical schools in the UnitedStates, Peterson and her colleaguesfound that underrepresented minority(URM) faculty members were substan-tially more likely than majority facultymembers to perceive racial / ethnic biasin their academic careers, and thatfaculty members who reported suchexperiences had lower career satisfactionscores than other faculty. The authorsstated that “the high frequency of

perceived racial / ethnic discriminationamong minority faculty is concerning;however, understanding the reasons forthis and addressing the causes is both amoral and social issue for medicalschools and teaching hospitals.”31

Although this study does not reflect theexperience of minority faculty who hadalready left academic medicine, theauthors admit that, to the extent thatdiscrimination contributes to a facultymember’s departure, their findings maywell have underrepresented thefrequency of racial/ethnic bias andtherefore underestimated its impact. Asthe study suggests, the recruitment andretention of minority faculty membersin academic medicine is important, buttoo little is known about the experienceof minority faculty members, especiallywith regard to racial and ethnic discrim-ination and how such experience affectstheir career satisfaction and academicsuccess.31

Adding to the evidence concerning theinfluence of bias on career satisfaction, a2005 report by Price, Gozu, Kern, Powe,Wand, Golden et al,32 concluded thatvisible dimensions of race / ethnicity,gender, and foreign-born status oftenprovoke bias and result in cumulativeadvantages or disadvantages in theworkplace that have an impact onfaculty recruitment, promotion, andretention. Utilizing qualitative methodssuch as focus-group and semi-structuredone-on-one interviews, Price and hercolleagues interviewed32 faculty membersof different ethnicities who were on thetenure track at Johns Hopkins School ofMedicine. Minority interviewees statedthat they faced additional challenges inresidency training and as current faculty,which they attributed to subtle manifes-tations of bias in the promotion process.

Toward ExcellenceIn considering the past rationales forincreased diversity and the continuedchallenges facing racial and ethnicminorities in academic medicinetogether, it becomes clear that additionalprinciples and new tools must bedeveloped to increase the likelihood ofmore faculty diversity in the near future.

There is much hope these days forgenuine reform of health care, creating asystem in which all patients have accessto affordable health insurance andgreater emphasis is placed on preven-tion. There is a concomitant desire for areformed medical educational experi-ence—one that is collaborative, patient-centered, outcomes-focused and respon-sive to community needs.2 To achievethese reforms, it will be important foradministrators to develop programs notbased solely on the current lack ofdiversity but rather to eradicateinhibitors of institutional excellence.Specific focus on the aforementionedreforms, if correctly undertaken, wouldserve to support the principles thatfoster excellence in medicine, such ashumanism, professionalism, persever-ance and scholarship. The developmentof such models of excellence might serveto attract students from more diversebackgrounds in terms of socio-economicstatus, race, and ethnicity. Moreover,positioning the need for greater diversityamong faculty as a catalyst for excellencemay create a campus atmosphere thatencourages and supports greaternumbers of racial and ethnic minoritymedical students pursuing careers inacademic medicine.

Diversity as a driver of excellence wouldprovide the added benefit of offeringresearchers an additional frame and thus

8




the ability to pose questions about theimpact of diversity on the overall insti-tutional climate and outcomes. The truemeasure of diversity will be assessed notonly by the number of students ordiverse faculty an institution has, butalso by how the institution defines excel-lence and success, and how it isrewarded. The burden of change fallssquarely on academic health centers andthe leadership of their medical schools.Making diversity synonymous withexcellence requires a move from theoryto action. The kind of action required isoutlined throughout the remainder ofthis monograph. However, strongleadership is essential if any meaningfuland lasting change is to occur. If theboard members, presidents, and deans ofour nation’s academic health centers donot hold their institutions accountablefor greater diversity within their facultyranks, genuine excellence will not berealized.

In particular, it is imperative that allfaculty members have the opportunityto attain professional excellence. Theirsuccesses will benefit all students,residents, and the institutions they serve.Mechanisms to ensure this processoccurs are continuously needed. Thenext section of this report will focus onthe strategies recommended byemerging and established racial andethnic minority leaders in academicmedicine on how to increase the recruit-ment, retention, and promotion ofindividuals like themselves who willadvance the field.

For many years, the AAMC hasmaintained a consistent focus onincreasing diversity in academicmedicine by supporting faculty recruit-ment, retention, and promotion efforts.The AAMC has provided numerousprofessional development opportunitiesfor faculty, such as the AAMC MinorityFaculty Career Development Seminar(MinFac) and the Early– and Mid CareerWomen Faculty ProfessionalDevelopment seminars. The AAMC alsoleads ongoing efforts to compile bothqualitative and quantitative data throughthe AAMC Faculty Roster to supportand drive initiatives that support faculty.For example, the AAMC Faculty Rosterassisted the National Institute of Healthin addressing a variety of issues, such asthe aging of faculty, the recruitment ofnew assistant professors, and the propor-tion of faculty pursuing scholarlyactivity in academic medicine. TheAAMC has also established a range ofprofessional development groups such asthe Group on Faculty Affairs (GFA)which aims to build and sustain facultyvitality in medical schools and teachinghospitals. In addition, the Group onDiversity and Inclusion (GDI) serves as anational forum and recognized resourceto support the efforts of AAMC memberinstitutions and academic medicine atthe local, regional, and national levels torealize the benefits of diversity andinclusion in medicine and biomedicalsciences.*

As outlined earlier in this report, despiteongoing efforts to serve and supportdiverse faculty in the field of academicmedicine, there is a persistent dearth ofracial and ethnic diversity among faculty.Much of the related literature attributes

this to various obstacles to advance-ment.29&33-36 The purpose of this section isto summarize and analyze the informa-tion shared during two meetingssponsored by the AAMC, DiversityPolicy and Programs (DPP): the October2007 Young Physicians Roundtable(YPR) and a June 2008 Meeting WithEstablished Leaders (EL) in the Field ofDiversity and Faculty ProfessionalDevelopment.

Each meeting focused on identifyingstrategies for increasing racial and ethnicminority diversity with a focus onfaculty in the field of academicmedicine. Participants were asked toprovide feedback about what theyperceived various stakeholders (e.g.,medical school administration includingdeans and faculty) could do to increasefaculty diversity in academic medicine.Participant feedback from both the YPRand the EL meetings was strikinglysimilar. In the sections that follow, anoverview of each meeting is providedfollowed by the combined summary ofthe key themes raised.

Meeting Overview: AAMC,DPP October 2007 YoungPhysicians Roundtable The YPR participants gathered to collec-tively construct a list of challenges,barriers, goals and objectives theybelieved needed the most attention inaddressing diversity issues among facultyand institutions in academic medicine.Participants of the YPR comprised early-career, emerging, and established leaderswho are underrepresented minorityphysicians involved in issues of diversityand medical education in the U.S.



*See Appendix I for a select list of AAMC professional development oppotunities for faculty and students.

Drivers ofExcellence: AnOverview ofExisting andProposedApproaches toIncrease FacultyDiversity



Through guided discussion, the round-table participants identified variouschallenges affecting the racial and ethnicminority faculty pipeline that beginsduring a student’s high school educationand continues through a facultyappointment. The participants recom-mended several strategies for addressingthese challenges. Among the mostfrequently mentioned was the lack ofmarketing of academic medicine as aprofession to prospective racial andethnic minority individuals betweenhigh school and residency years.

The YPR participants outlined severalsolutions including the identificationand increased awareness of definitionsfor academic medicine as a profession,the roles of a physician in the classroom,and a physician in the clinic. Theyemphasized that once clearly articulated,these definitions can be used in recruit-ment, retention, and promotion inter-ventions directed at diversifying facultypopulations in the field of academicmedicine.

Meeting Overview: AAMC,DPP June 2008 Meeting withEstablished Leaders in theField of Diversity and FacultyProfessional DevelopmentParticipants of the EL meeting camefrom medical schools across the U.S. and

included a medical student, a resident,and several professionals in academicmedicine including two assistant profes-sors, eight associate professors, aprofessor emeritus, a chief of staff, vicedean, and two directors and anexecutive. The participants were asked toprovide their perspectives and additionalcontext around the challenges inincreasing faculty diversity in academicmedicine, as well as strategies andsolutions to address these challenges.

The feedback from the EL meetingprimarily addressed challenges andsolutions in the faculty pipeline, particu-larly for racial and ethnic minorityfaculty over the course of their careers.For example, the participants reiteratedthe previously reported lack of faculty-to-faculty mentors.34 The EL participantsalso underscored the role they perceivedinstitutions and systems should play inachieving faculty diversity goals. One oftheir suggestions echoed a suggestionmade in previous studies that institu-tions focus on assisting early career

faculty in becoming aware of the prepa-rations and planning required forpromotion, as well as the role mentorscan play in helping early career facultyin meeting these requirements.33

Participants provided a number of otherideas and suggestions that are outlined

in further detail throughout the nextsection of this report.

A Combined Summary of KeyThemesThe following is a combined summaryof key themes cited by the participantsin YPR and the EL meetings. Thesethemes highlight faculty pipelinechallenges and suggested solutions thegroups believe will increase racial andethnic diversity across faculty inacademic medicine.

Faculty Pipeline ChallengesThe YPR participants reiterated a pointmade in previous studies that there isinsufficient preparation or late prepara-tion37 of students in medical educationand a lack of racial and ethnic minoritymen early in the pipeline. In addition,the YPR participants cited the lack ofmarketing of academic medicine as aprofession to prospective racial andethnic minority individuals betweenhigh school and residency years. Otherchallenges referenced by the YPR partici-pants included a continued dearth ofopportunities to hone academicmanagement skills37 and inequities inpreparation for prospective medicalstudents taking courses in the biomed-ical sciences. YPR participants alsodiscussed the persistent challengesaround attracting URM students toacademic medicine before medicalschool and the need to address residencyissues (e.g., assisting racial and ethnicminority students with applying andgetting selected).

The EL participants cited challenges theybelieve are having an adverse effect onfaculty diversity, such as the lack ofinstitutional attention to campus climateissues, and in particular, how the experi-ence of being the “one and only,” at aninstitution may impede an individual’s

The YPR participants outlined several solutions including the identi-fication and increased awareness of definitions for academic medicineas a profession, the roles of a physician in the classroom and aphysician in the clinic. They emphasized that once clearly articulated,these definitions can be used in recruitment, retention, andpromotion interventions directed at diversifying faculty populationsin the field of academic medicine.

AAMC Young Physicians Roundtable, 2007



professional or academic progress orsense of enjoyment, and explained thatsuch an environment often leads to asense of isolation,38 especially at institu-tions that have toxic organizational orcultural climates. Participants also citedwhat seemed to be a lack of faculty-to-faculty mentors,34 which in their percep-tion led to a lack of awareness andunderstanding among racial and ethnicminority faculty on how to map outtheir individual career plan in academicmedicine to ensure promotion.

In addition, they remarked, thepromotion process is complicated by thefact that many early career racial andethnic minority faculty are unaware thatthe rules / criteria for promotion mayvary from institution to institution (e.g.,the promotion process at HarvardUniversity is not the same as that at theUniversity of Buffalo). For example, atmost academic institutions taking care ofpatients is not a major criterion in beingconsidered for promotion. The groupstressed a lack of awareness amongfaculty on how to navigate the socialenvironment at their institution.34

Suggested SolutionsThe suggested solutions for increasingfaculty diversity proposed by the partici-pants in the YPR and EL meetings arepresented in the following categories:

• Definitions of academic medicine andfaculty roles

• Marketing programs • Recruitment and retention initiatives• Professional development andmentoring programs

• Leadership development programs • Orientation to the promotion process • Centralized resources, information,and data management

• An infrastructure focused on diversityissues

• Engagement of medical school deansin diversity efforts

• Institutional and systems-level reform • Globalization and medical education

Definitions: Academic Medicine andFaculty RolesOne of the fundamental solutions toarise in discussions with YPR partici-pants was the idea that certain terms thatcharacterize academic medicine as aprofession need to be more clearlydefined. In particular, the group recom-mended identification and increasedawareness of definitions for: academicmedicine, faculty, a physician in theclassroom, and a physician in the clinic.This finding is consistent with the defini-

tion of academic medicine recentlyprovided in the professional journalAcademic Medicine: “[A]academicmedicine is the discovery and develop-ment of basic principles, effectivepolicies, and best practices that advanceresearch and education in the health

sciences, ultimately to improve the healthand well-being of individuals andpopulations.”37 The EL participantsfurther suggested that steps should alsobe taken to understand how institutionsdefine minority faculty to better compre-hend its individual institutional needsaround faculty diversity.

Marketing ProgramsThe YPR participants recognized theneed to conduct proactive marketing ofacademic medicine as a prospectivecareer, particularly to racial and ethnicminority groups. The participantssuggested that marketing activitiesshould be conducted via the Internet(e.g., profiles of faculty members on Websites such as the AspiringDocs.org.® Inaddition, the group recommended theuse of marketing to help students under-stand there are multiple paths intoacademic medicine.

Recruitment and Retention InitiativesParticipants also recommended institu-tions conduct combined recruitment andretention programs in cooperation withinstitutions such as historically blackcolleges and universities and theNational Association of Advisors for theHealth Professions (NAAHP), as thesetargeted recruitment and retentionefforts could potentially bring moreracial and ethnic minorities to theprofession.

Further, recruitment efforts shouldinclude programs similar to the “Project3000 by 2000” initiative, whose chief aimwas to increase diversity among thosewho pursued careers in academicmedicine, as well as proactive recruit-ment of racial and ethnic minority chiefresidents for a career in academicmedicine. Outreach programs designedto encourage qualified non-premed

Participants also cited what seemed to be a lack of faculty-to-facultymentors, which in their perception led to a lack of awareness andunderstanding among racial and ethnic minority faculty on how tomap out their individual career plan in academic medicine to ensurepromotion.

AAMC Established Leaders Meeting, 2008


students to pursue careers in academicmedicine and programs to assistgraduates in establishing the rightplacement for medical school andresidency should also be undertaken.

Professional Development andMentoring ProgramsMentoring was cited as another criticalarea of improvement by YPR partici-pants. They encouraged efforts toprovide mentoring opportunities forstudents throughout their academicjourney and during their careers inacademic medicine and recommendedthe creation of a mentoring programthat is provided jointly by the AAMCand the Student National MedicalAssociation that could be titled the“Minorities in the Academic MedicineAcademy.”

This partnership would be key toproviding ongoing mentoring servicesfor racial and ethnic minorities alongtheir academic and career paths. Theestablishment of a database or trackingsystem of mentors and mentees wouldboth facilitate the creation and ongoingsupport of such programs, as well asenable the effectiveness and reach ofmentoring programs to be accuratelytracked. To help ensure ease of access tomentoring, EL participants called for theestablishment of a Web-basedmentoring program.

In addition, participants stated theimportance of institutions’ ability todefine the “what” and “how” to serveracial and ethnic minorities who are latebloomers and address the issues associ-ated with this group. Collaborativenetworks, such as physicians and acade-micians at historically black medicalschools, may serve as a pool of racialand ethnic minority mentors to those

students, residents, and academicianswho request them.

Leadership Development ProgramsLeadership development was anotherimportant aspect of recruiting, retainingand promoting racial and ethnic minori-ties in academic medicine underscoredby the participants in the YPR and theEL meetings. YPR participants suggestedleadership development activities shouldinclude a focus on investing in womenleaders from racial and ethnic minoritybackgrounds with the intention oftargeting student, resident and facultyprofessional development needs, andrecommended the creation of anAAMC-lead fellowship program thatfocused on individuals at the lateassistant professor and early associateprofessor levels, as well as leadershipdevelopment activities that expand theAAMC Minority Faculty DevelopmentSeminar to include topics on teambuilding and developing coalitions;media advocacy; political strategy(lobbying); promoting public health;and time management.

The EL participants reiterated the needfor leadership development by puttingforward the idea of establishing ways toengage the dean and executive dean toinvest in the development of earlyprofessionals. They also suggested thedevelopment of training modules formedical school deans and departmentchairs on methods to promote a multi-cultural environment, and recom-mended the inclusion of a session at theAAMC Executive Developmentprograms for deans and for departmentchairs, tentatively titled “Creating anenvironment for minorities to thrive.”Finally, EL participants recommendedthat professional development be

tailored to assist practicing physicians intheir transition into academic medicine.

Orientation to the Promotion ProcessThe EL participants agreed that animportant mechanism in addressing thelack of faculty diversity is to assistqualified racial and ethnic minorityfaculty on how to “find individuals whocan actually promote them.” They alsoencouraged institutions to evaluatefaculty on an ongoing basis to determineif they are up for promotion, as is thepolicy at the University of California.Further, institutions should capture“process stories” across all specialtiesabout individual promotion criteria andthe steps all faculty should take to earnpromotion. They also shared their beliefthat, in general, there is a need toencourage a change in institutionalpromotion policy to recognizementoring as a measure of performanceand professional advancement.

Centralized Resources, Information, andData ManagementThe creation of centralized resources,information and data managementabout and for supporting racial andethnic minorities pursuing careers andthose seeking to advance their careers inthe field of academic medicine was citedas another area for improvement by YPRparticipants, particularly the creation ofa database of mentors and mentees, aspreviously cited, which should include,but should not be limited to, thefollowing characteristics: intra- andextra-institutional, stratified by specialty,academic rank, and research interest. Adatabase to identify and centralize grantresources, as well as the establishment ofa scholarship fund for grant writingseminars, junior faculty conferences,epidemiological and statistical analysis

14


workshops, would also further serve topromote diversity.

Participants suggested the creation of ajunior faculty Web site geared towardsupporting and spotlighting racial andethnic minority academic faculty, similarto the Aspiring Docs Web site, whichcould serve as a primary resource forindividuals seeking information aboutcareers in academic medicine. Theparticipants also promoted the creationof a membership roster for corporationsseeking racial and ethnic minorities inhealth careers. The group explained thatroster participation criteria wouldinclude the corporation’s active contri-

butions to diversity efforts in academicmedicine.

In keeping with the suggestions made bythe YPR participants, the EL participantsalso encouraged the AAMC to create adatabase that captures facultypromotion criteria by institution. TheEL participants also suggested that insti-tutions develop a tracking system onfaculty diversity on a Web dashboardthat could be explored and shared, suchas the site developed by the University ofCalifornia, San Francisco.

An Infrastructure Focused on DiversityIssuesEL participants encouraged the develop-ment of an institutional entity (e.g., adiversity cabinet) to address issuesrelated to faculty diversity across theuniversity. EL participants also sawcollaboration as an important tool in

building an infrastructure in this area.For example the EL participantssuggested that academic institutions andacademic societies be brought togetherto share and exchange ideas and strate-gies on their activities with regard todiversity. Consistent with a recommen-dation from the literature, the EL partic-ipants also proposed that institutionsincorporate or embed diversity in themission statement of the school.39

Further, the EL participants suggestedthat academic institutions establishaccountability models (applicable boththe institution at large as well as depart-ment chairs) and provide awards or

incentives around diversity efforts,6

noting that if existing awards could bereframed to reflect progress arounddiversity, more institutions may adoptsuch incentives. The EL participants alsosuggested that institutions shouldexplore developing a diversity matrix toexamine how closely departmental racialand ethnic diversity is reflected in themean number of faculty for the overallinstitution and perhaps even makenational comparisons.

EL participants also recommendedongoing review and monitoring ofexisting standards around diversity, suchas a periodic review and monitoring ofthe Liaison Committee on MedicalEducation (LCME) standards on facultydiversity for ways to address facultydiversity.

Engagement of Medical School Deans inDiversity EffortsThe EL participants also supportedengaging the Council of Deans toendorse or embrace a focus on facultydiversity in academic medicine. Inparticular, the group envisioned effortsto raise awareness across the Council ofDeans that acting on such efforts is theright thing to do. The EL participantsalso encouraged activities to stimulatethe participation of non-minority deansto champion faculty diversity issues andencouraged all institutions to establish afaculty diversity focus across theirexisting faculty even if the currentfaculty lacks diversity.

Institutional and Systems-level Reform The participants also pointed out theneed to address institutional andsystems-level issues, and called for senioradministrative teams across the field toalign their diversity goals with the goalsof their respective institutions. YPRparticipants recommended medicalschools address campus climate issues asthey relate to building a pipeline ofracial and ethnic minorities in academicmedicine, and suggest medical schools



If existing awards could be reframed to reflect progress arounddiversity, more institutions may adopt such incentives.


The EL participants also encouraged activities to stimulate the participation of non-minority deans to champion faculty diversityissues and encouraged all institutions to establish a faculty diversityfocus across their existing faculty even if the current faculty lacksdiversity.



can achieve this goal by encouragingfaculty to be more encouraging of thestudents they already have to pursuecareers in this area. The YPR partici-pants also recommended a focus on thesupport mechanisms available tostudents to demystify the selectionprocess for residency programs. Theparticipants also encouraged institutionsto determine why faculty decide to leavetheir institution in order to help institu-tions make decisive changes in policiesaround institutional cultural climate.

As mentioned earlier by the YPR and theEL participants, there is a need toaddress campus climate issues, particu-larly for those that may cause faculty tofeel isolated. For example, the EL partici-pants proposed efforts to raise awarenessabout the need to understand theexperience and unique needs of differentspecialties such as emergency medicinefaculty members who often work 24

hours per day and may not be able toattend faculty meetings. One recom-mendation was to encourage the AAMCto create a home-study course of theservices and resources it provides.

Participants also raised the need tocreate formalized policies and proce-dures around promotion and tenure, toencourage institutions to develop moreobjective promotion and tenure criteriathat are formalized and encourageminority faculty to undergo “triggerreviews.” Further, at institutions withoutclear promotion criteria, it is importantthat faculty who may need help arepaired with a mentor who can assist indecoding it.

At the national level, the YPR partici-pants also shared their desire to see theAAMC and the National MedicalAssociation combine efforts to increasediversity across faculty in this field.Other suggestions included the review of

training programs of the NationalInstitute of Health (NIH) for minorityfaculty, residents, and others and toenlist additional support from NIH tofurther champion expanded facultydiversity efforts.

Globalization on Medical EducationThe World Bank defines globalization asthe growing integration of economiesand societies around the world.40 TheYPR and the EL participants both citedthe need to address diversity issuesacross faculty in academic medicine as aresult of globalization in general. Forexample, the YPR participants recom-mended the creation of leadershipprograms for training foreign medicalgraduates. The group also highlightedthe need to provide expertise for foreignmedical schools seeking expansionbecause the YPR participants believediversity as defined in this monograph isneeded globally.

16




In summary, the purpose of thismonograph is to encourage academicmedical leaders to shift from thinking ofthe lack of racial and ethnic diversity assolely a recruitment and retentionproblem. It is clear from both the historyof diversity efforts in medicine and fromthe voices of participants in the YPR andEL meetings that a cultural change isnecessary in academic medicine—achange that begins with a conceptualreframing of diversity as merely a toolbenefiting a subset of the population to acore ingredient that propels excellence inresearch, teaching and clinical practice.

This level of change requires that theboard members, presidents, deans anddepartment chairs of our nation’sacademic health centers hold their insti-tutions accountable for diversifyingfaculty in order for academic healthcenters to thrive. As such, the attractionof underrepresented minorities tocareers in academic medicine would beenhanced if academic health centerswere to create an environment thatrespects a balanced personal life,supports community-based participa-tory research, encourages interdiscipli-nary collaboration, and rewards qualityteaching.

The information shared at the YPR andEL meetings reinforce ideas and conceptsoutlined in current literature, particu-larly the need to redouble efforts ofincreasing diversity in academicmedicine, especially across its leadership.The opinions highlighted in thissummary reflect the notion that futureefforts of developing diverse faculty inacademic medicine will require proactivesteps as early as high school andthroughout an individual’s medicaleducation, faculty career and appoint-ment to advanced administrativepositions.

In summary, multiple stakeholders,including faculty, deans, academic insti-tutions and non-profit organizations willplay key roles in planning, imple-menting, and leading the necessarychanges needed to increase, retain, andgrow racial and ethnic faculty diversityto achieved excellence. Continued andfuture efforts to increase racial andethnic minority faculty diversity shouldinclude the following: Define academicmedicine, faculty roles, differentiatebetween the role of a physician in theclinic versus the classroom setting; planand implement marketing, recruitment,retention, professional development,and promotion programs / initiatives;establish centralized resources, informa-tion, and data management; and giveattention and proactive effort to institu-tional, systems and global level issues.The result of this type of cultural trans-formation will be a realization of broaddiversity, one that is not limited to racialand ethnic diversity but rather one thatincorporates diversity of thought,expression, desires, and goals, andultimately enhances the experience of allmedical students, faculty, and patients.

Conclusion andFuture Directions

Overall Key RecommendationsContinued and future efforts to increase racial and ethnic minority facultydiversity should include the following:

• Define academic medicine, faculty roles; and differentiate between the role of aphysician in the clinic versus the classroom setting;

• Plan and implement marketing, recruitment, retention, professional develop-ment, and promotion programs/initiatives across the academic medicine careercontinuum;

• Establish centralized resources, information, and data management; and

• Give attention and proactive effort to institutional, systems- and global-levelissues.



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Appendix I:Resources

AAMC Meetings

• Minority Faculty Career Development Seminar. The Minority Faculty CareerDevelopment Seminar is a three-day professional development seminar designedfor junior faculty (senior fellows, instructors, and assistant professors) who aremembers of racial and ethnic minority groups and who aspire to leadershippositions in academic medicine. The seminar is open to all faculty and fellows fromracial and ethnic minority groups in the field of academic medicine. For informa-tion go to: http://www.aamc.org/meetings.

• The Early Career Women Faculty Professional Development Seminar. The EarlyCareer Women Faculty Professional Development Seminar is a three-day programdesigned for women assistant professors. The program focuses on academicmedicine career building and skills in curriculum vitae development and basicmanagement skills. The accomplished seminar faculty offer inspiration andvaluable career advice. Attendees are encouraged to develop career goals and objec-tives through the career mapping sessions. The seminar is targeted primarily atphysicians, but is also pertinent for Ph.D. scientists. For information go to:http://www.aamc.org/meetings.

• Executive Development Seminar for Associate Deans and Department Chairs. Theobjective of this seminar is to advance medical center leadership and managerialcapacity by exploring management topics and techniques needed day-to-day. Theseminar is open to all associate and vice deans and departmental chairs of medicalschools. Deans of medical centers and research center directors with equivalentresponsibilities may apply to participate. For information go to:http://www.aamc.org/meetings.

• AAMC Annual Meeting. The AAMC annual meeting is the premier event for leadersfrom the nation's medical schools and teaching hospitals. The sessions assist profes-sionals is areas such as ways to advance teamwork in patient care and promotepublic awareness. Sessions also provide information about scientific discovery as apublic good essential to care. For information go to: http://www.aamc.org/meetings.

• Mid-Career Women Faculty Professional Development Seminar. The Mid-CareerWomen Faculty Professional Development Seminar is a three-day programdesigned for women associate or recently promoted full professors. These womenare determined to haveclear potential for advancement to a major administrativeposition such as section or department head. For information go to:http://www.aamc.org/meetings.

• Faculty Affairs Professional Development Conference. The AAMC Faculty AffairsProfessional Development Conference will highlight topics such as promisingpractices in faculty affairs and programs that support faculty vitality. The confer-ence also features a creative mixture of interactive plenary sessions, break outsessions, and opportunities for networking with over 100 faculty affairs leaders andstaff. Conference highlights include: an orientation and luncheon for new facultyaffairs leaders, a special session for senior leaders in faculty affairs and a posterreception. For information go to: http://www.aamc.org/meetings.



• The AAMC Data Book. The AAMC Data Book is a statistical abstract of U.S.medical schools and teaching hospitals with current and historical data on acomprehensive list of topics. The Data Book tables are derived from AAMC reportsand databases, as well as from external sources such as the National Institutes ofHealth, the American Medical Association, the Bureau of Labor Statistics, and theAmerican Hospital Association. The AAMC Data Book is published each year as abound publication that includes the most current information on each subjectavailable at that time. For information go to:http://www.aamc.org/data/databook/start.htm

• The AAMC FACTS Web site. On the AAMC FACTS Web site are a list of tables thatprovide the most comprehensive and objective information regarding U.S. medicalschool applicants and matriculants, enrollment and graduates, MD-PhD studentdata, and Electronic Residency Application Service (ERAS). This data is available tothe public free of charge. In addition, the charts available in PDF format presentlongitudinal data back to 1982. For information go to:http://www.aamc.org/data/facts/

• Directory of American Medical Education 2008-2009. Updated every year, thisdirectory lists administrators, department and division chairs for all the accreditedmedical schools in the United States, Canada and Puerto Rico. In addition to thefaculty listings, each school entry also contains enrollment, type of support, clinicalfacilities and a brief historical statement. The beginning of the directory describesAAMC activities and efforts in research, communications, education and service toits members. Officers and members of the various AAMC organizations are alsolisted, including member academic societies and teaching hospitals. For more infor-mation go to: https://services.aamc.org/publications.

AAMC Publications and Web Resources

• Diversity in Medical Education: Facts and Figures 2008 is the 15th data book in theFacts & Figures Data Series and is published biannually. This publication providesstudents, medical educators and administrators, researchers, policy makers, and thegeneral public with a compendium of detailed statistical information on race,ethnicity, and gender in medical education in the United States for the 2007academic year. This publication also includes data related to the pre-collegecomponent of the education pipeline leading to the M.D. degree and other healthsciences and health professions careers. To download a free Portable DocumentFormat (PDF) go to: http://www.aamc.org/publications. For information e-mail:facts&[email protected].

• The Diversity Research Forum: Successfully Evaluating Diversity Efforts in MedicalEducation is the 3rd annual publication of the proceeding from the AAMCDiversity Research forum. This volume highlights that because diversity has beenshown to improve academic medicine-research and evaluation that focuses ondiversity at academic medical institutions remains a core capacity emphasized bythe Association of American Medical Colleges (AAMC) and the AAMC DiversityPolicy and Programs. This publication highlights the importance of evaluation

Appendix I:(continued)



design, implementation, and data collection and is available online. For informa-tion go to: http://www.aamc.org/publications.

• The Diversity and Faculty Development Digest (DiFac) is produced quarterly by theAssociation of American Medical Colleges (AAMC), Diversity Policy and Programs.The digest highlights research funding opportunities, professional developmentopportunities, and the latest research and reports related to faculty professionaldevelopment. In addition, relevant AAMC resources and opportunities areprovided. To subscribe to DiFac, email: [email protected].

• Women in U.S. Academic Medicine Statistics is an annual survey that is widelyaccessed as an authoritative, historical source of changes in representation ofwomen in medicine. Each year, the survey compiles data on faculty representationby specialty, rank, leadership positions and gender. Contributions to this surveymake it possible for the AAMC to provide medical schools with benchmarking datawith a reliable national comparison. A compendium of these finding is publishedin The Women in U.S. Academic Medicine Statistics and Medical SchoolBenchmarking 2007-2008 report. For additional information or to reference thetables identified in the report, go to the AAMC, Women in Medicine Web site:http://www.aamc.org/members/wim/start.htm.

• Faculty Vitae is a resource that provides information about programs, resources,and data trends related to faculty development. Its features include news andlessons in leadership and management. The spring 2009 Issue of Faculty Vitae onAdvancing Women’s Leadership in Academic Medicine is now available athttp://www.aamc.org/members/facultydev/facultyvitae/start.htm. The articles forthis issue include: Feature: A Continuum of Leadership Development—A Model forSustained Success for Women Leaders in Academic Medicine Leadership, Lesson: TheArt of Successful Nominations, and Spotlight: The Executive Leadership in AcademicMedicine (ELAM) Program for Women Perspectives: Sustaining Success in Leadership.Readers are encouraged to visit the newly updated Archives section to learn aboutthe resources, issues, and articles located at: http://www.aamc.org/members/facul-tydev/facultyvitae/archive.htm.

• Analysis in Brief presents recent findings from the AAMC’s data collection andresearch activities in a concise, easy-to-read report. Published several times a year, itaddresses a wide range of topics and trends that affect medical schools and teachinghospitals. The most recent issues on faculty-related topics and their publicationdates were: Differences in U.S. Medical School Faculty Job Satisfaction by Gender(November 2008), U.S. Medical School Faculty Job Satisfaction (July 2008), andThe Long-term Retention and Attrition of U.S. Medical School Faculty (June2008). The Analysis in Brief archive is located athttp://www.aamc.org/data/aib/start.htm. For more information [email protected].




• Faculty Personnel Policies Database. The Faculty Personnel Policies site houses adatabase that contains information on appointment, promotion, and tenurepolicies of all LCME-accredited U.S. medical schools, including which types offaculty are eligible for tenure at each institution, the length of the probationaryperiod, reasons and eligibility for tenure-clock-stopping policies, as well as otherpolicy data. The source of the data is the Faculty Personnel Policies Survey. Thisresource is available to members of the Group on Faculty Affairs and other selectAAMC constituents. For information go to:http://www.aamc.org/members/facultyaffairs/resources.htm

• Faculty Roster. The AAMC initiated the Faculty Roster in 1966 to support nationalpolicy studies by collecting comprehensive information on the characteristics ofpaid faculty members at accredited allopathic U.S. medical schools. When individ-uals are first appointed to faculty positions, medical schools submit educational,employment, and demographic data to the Faculty Roster, and updates are made asneeded. Institutional participation in the Faculty Roster is voluntary, and each ofthe nation’s 125 medical schools makes a substantial contribution to the quality ofthe Faculty Roster by appointing a Faculty Roster representative to coordinate datareporting. The Faculty Roster has grown to contain records on approximately124,000 active full-time faculty. More than 152,000 inactive faculty are retained forresearch purposes or in case of reactivation. For information go tohttp://review/data/facultyroster/start.htm.

• Faculty Forward. The AAMC Faculty Forward is a new collaborative programamong the AAMC and medical schools and teaching hospitals to make academicmedical centers great places to work. With Faculty Forward, AAMC and medicalschools and teaching hospitals strive to improve faculty satisfaction, retention, andvitality, and enhance institutional culture. For information go to:http://www.aamc.org/opi/facultyforward/start.htm.

• The Group on Faculty Affairs (GFA). In September 2006, the AAMC ExecutiveCouncil approved a proposal to establish the Group on Faculty Affairs (GFA). TheGFA supports institutional leaders in the development and enactment of policiesand programs that advance the academic missions of teaching, research, andclinical care. The GFA’s mission is to build and sustain faculty vitality in medicalschools and teaching hospital. The GFA does this by supporting faculty affairsdeans and administrators in their development and implementation of institutionalpolicies and professional development activities that advance the academicmissions of teaching, research, and clinical care. For information go to:http://www.aamc.org/members/facultyaffairs/about.htm.

• The Group on Diversity and Inclusion (GDI). The GDI serves as a national forumand recognized resource to support the efforts of AAMC member institutions andacademic medicine at the local, regional, and national levels to realize the benefitsof diversity and inclusion in medicine and biomedical sciences. The purpose of theGDI is to unite expertise, experience, and innovation to inform and guide theadvancement of diversity and inclusion throughout academic medicine.



Other AAMC Professional Development Programs

• Medical School Based Career and Leadership Development Programs. This catalogpresents a listing of career and leadership development programs that wereprovided to the AAMC from over thirty different schools to assist other medicalschools in developing effective programs for a variety of faculty. Faculty and staff ofmedical schools that are interested in developing similar programs for theiracademic leaders may wish to consult with these institutions. This catalog is locatedat http://www.aamc.org/members/facultydev/leadershipprograms.pdf.

• http://www.aamc.org/members/facultydev/facultyvitae/leadershipprograms.pdfNational Leadership Development Programs. This catalog is a sampling of leadershipdevelopment programs targeted at leaders in medicine, higher education, andhealth care. This catalog is located athttp://www.aamc.org/members/facultydev/facultyvitae/leadershipprograms.pdf

• Society Based Faculty Development Programs. This document builds upon 2001information collected from presidents of academic societies and association chairs.In 2004, the Council of Academic Societies and Faculty Development andLeadership requested additional information to provide a more comprehensive list.Courses are listed in the following categories: Chairs/Senior AdministrativeOfficers, residency program directors, clerkship directors. This catalog is located athttp://www.aamc.org/members/facultydev/facultyvitae/societybasedprograms.pdf.

• Medical School Based Mentoring Programs.Medical School Based MentoringPrograms are highly useful in developing faculty careers; particularly those ofwomen and minority faculty who are exposed to cultural barriers. Mentoringprograms provide junior faculty the opportunity to share an informal and non-evaluative relationship with a senior faculty member. The mentoring programsdescribed in this catalog are a result of solicitations for information on medicalschool based career and leadership development programs. The descriptions formentoring programs are to assist other medical schools in developing similarprograms for faculty. This catalog is located athttp://www.aamc.org/members/facultydev/mentoringprograms.pdf

• Continuing Medical Education (CME). The purpose of the CME Section is topromote excellence in the education of physicians throughout their careers andthereby contribute to the health of the public. The CME Section fosters amongother things, the development and continued improvement of programs of contin-uing medical education to enhance physician learning and the professional devel-opment of the teachers of continuing medical education. For information go tohttp://www.aamc.org/members/gea/cmesection/

• Careers in Medicine (CiM) is a career planning program designed to help youchoose a medical specialty and select and apply to a residency program. This four-phase process will guide you through the elements of career planning, including

26





self-understanding, exploring a variety of medical careers, and finally choosing aspecialty to meet your career objectives. People whose choice of careers matchestheir values, skills and interests tend to be more satisfied and successful in theirworking lives. This is also true of selecting a specialty. For more information go to:http://www.aamc.org/students/cim/

Other Resources

• The National Initiative on Gender, Culture and Leadership in Medicine, also knownas C—Change for cultural change, addresses the imperative of developing womenand under-represented minority faculty members’ full potential and leadership inacademic medicine in the United States. For information go to:http://www.brandeis.edu/cchange/

• BlackAcademic.com is an online mentoring portal for under-represented faculty,post-docs, graduate students, and those who are committed to their success.BlackAcademic.com provides resources and services for individual scholars,colleges and universities, and professional organizations. Visitors are encouraged toexplore all of the following resources: 1) The Black Academic’s Guide to WinningTenure Without Losing Your Soul is a book full of invaluable tips to help facultysurvive and thrive in academia without losing their voices or their integrity; 2) New Faculty Success Workshops are provided to focus on a variety of profes-sional development topics for under-represented faculty and advanced graduatestudents; 3) Faculty Coaching, is a resource to provide faculty with individualizedsupport and assistance to reach their professional goals; and 4) The MondayMotivator is a free weekly e-mail message that provides an electronic dose ofpositive energy, good vibrations, and productivity tips.

• The Compact for Faculty Diversity is a partnership of regional, federal and founda-tion programs that focus on minority graduate education and faculty diversity. Todate, the Compact partnership consists of: the Southern Regional Education Board(SREB), the Western Interstate Commission for Higher Education (WICHE), theNational Institutes of Health (Bridges to the Professoriate NIGMS-MARC), theNational Science Foundation (Alliance for Graduate Education and theProfessoriate), and the Alfred P. Sloan Foundation and the Office of Federal TRIOPrograms, United States Department of Education (Ronald E. McNair Program).The Compact for Faculty Diversity has a simple goal: to increase the number ofminority students who earn doctoral degrees and become college and universityfaculty. For information:http://www.instituteonteachingandmentoring.org/Compact/index.html




Appendix II:Table 1: Count of Full-time Faculty by Sex andRace / Hispanic Origin from 1966 to 2008

Data Source: AAMC Faculty Roster System as of 3/16/2009.



Table 1: Count of Full-time Faculty by Sex andRace / Hispanic Origin from 1966 to 2008 (con’t)




Table 1: Count of Full-time Faculty by Sex and Race / Hispanic Origin from 1966 to 2008 (con’t)




Appendix II:

Table 2: C

ount of Full-time Faculty by Med

ical

School, Race / Hispan

ic Origin, a

nd Sex for 2008




Table 2: C


ical School,

Race / Hispan

ic Origin, a

nd Sex for 2008 (con’t)




Table 2: C


ical School,

Race / Hispan

ic Origin, a





Appendix II:

Table 3: C

ount of Full-Time Faculty by Sex, Race / Hispan

icOrigin, a

nd Ran

k from 1997 to 2008




Table 3: C


icOrigin, a

nd Ran

k from 1997 to 2008 (con’t)




Table 3: C


icOrigin, a

nd Ran





Appendix II:

Table 4: C

ount of Chairs by Sex an

d Race / Hispan

ic Origin from 1997 to 2008




Table 4: C


d Race / Hispan

icOrigin from 1997 to 2008 (con’t)




Table 4: C


d Race / Hispan

ic Origin

from 1997 to 2008 (con’t)




Appendix II:

Table 5: C

ount of Deans by Sex an

d Race / Hispan

ic Origin for 1998, 2

003, and 2008


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