Diversity: From Concepts to Outcomes

ACR CONVERGENCE 2020—In 2020, terms like unconscious bias, diversity and inclusivity are buzzwords in rheumatology, as well as throughout American society. The COVID-19 pandemic revealed stark disparities in healthcare outcomes for rheumatic disease patients of racial and ethnic minorities, including new research that shows Black and Latinx patients have a higher risk of hospitalization and threefold increased odds of requiring mechanical ventilatory support for their illness compared with whites.¹

What do bias, diversity and inclusivity really mean, especially for leaders of academic medical centers who hire staff or recruit students, or healthcare providers treating patients? At ACR Convergence 2020, Marc A. Nivet, EdD, executive vice president for institutional advancement at UT Southwestern Medical Center, Dallas, shared his ideas on how organizations may build on bias training sessions to implement measurable strategies that foster a lasting culture of inclusivity.

Bias & Clinical Decision Making
Bias is a tendency or inclination that results in judgments made without question, said Dr. Nivet.

“We talk about bias, and the connotation, especially within academic medicine, is that bias is inherently negative. Biases are shortcuts that we all take and actually help us more often than not. But there are times when those shortcuts disadvantage certain groups and populations, depending on how we use our biases,” he said. “Just by becoming more conscious of our biases, we can be more thoughtful about the impact they have on our work.”

When hiring medical staff or recruiting students, people may lean on their unconscious biases and exhibit preferences for candidates who resemble them or share their training background, what Dr. Nivet called the Mini-Me syndrome.

Informed decision making may also reflect unconscious biases held by clinicians that affect outcomes for different patient populations, he said, citing two examples. In a 2016 study, half of white medical students and residents believed Black patients have biological differences, such as less sensitive nerve endings or thicker skin, that made them less likely to sense pain and require treatment.² In a 2013 study, 57% of Canadian physicians discussed total knee arthroplasty with male patients with moderate knee osteoarthritis, while only 15% discussed the surgery with female patients with the same diagnosis, although the reason for this disparity was not explained, he said.³

Dr. Nivet

Diversity in Medical Education
How do medical schools, training programs and medical specialties take steps to limit the impact of biases and advance common goals in medicine and medical education? Racial disparity gaps are glaring in U.S. medical schools, which show flat, relatively low matriculation rates for Black males over the past 35 years, Dr. Nivet said.⁴ These gaps appear in professional rheumatology ranks as well: Only 0.8% of practicing adult rheumatologists are Black and 8.5% are non-white Hispanic, while 73.6% are white, according to the 2015 ACR Workforce Study of U.S. rheumatologists and rheumatology professionals.⁵