“Head of the Class”: equity discourses related to department head appointments at one Canadian medical school
DOI:
https://doi.org/10.36834/cmej.76208Abstract
Purpose: Equitable appointments of departmental leaders in medical schools have lagged behind other Equity, Diversity, and Inclusion (EDI) advancements. The purpose of this research was to 1) analyze how policy documents communicate changing ideas of EDI, employment equity, and departmental leadership; and 2) investigate department heads’ (DH) perspectives on EDI policies and practices.
Methods: We conducted a critical discourse analysis to examine underlying assumptions shaping EDI and departmental leadership in one Canadian medical school. We created and analyzed a textual archive of EDI documents (n = 17, 107 pages) and in-depth interviews with past (n = 6) and current (n = 12) DH (830 minutes; 177 pages).
Results: Documents framed EDI as: a legal requirement; an aspiration; and historical reparation. In interviews, participants framed EDI as: affirmative action; relationships; numerical representation; and relinquishing privilege. We noted inconsistent definitions of equity-deserving groups.
Conclusions: Change is slowly happening, with emerging awareness of white privilege, allyship, co-conspiracy, and the minority tax. However, there is more urgent work to be done. This work requires an intersectional lens. Centering the voices, and taking cues from, equity-deserving leaders and scholars, will help ensure that EDI pathways, such as those used to cultivate department leaders, are more inclusive, effective, and aligned with intentions.
References
Tang V, van Buuren A, Martimianakis MAT. Evolving discourses of COVID-19 and implications for medical education: a critical discourse analysis. Can Med Educ J. 2019; 13(6); 6–18. https://doi.org/10.36834/cmej.71675 DOI: https://doi.org/10.36834/cmej.70401
Sonnenberg LK, Do V, LeBlanc C, Busari JO. Six ways to get a grip by calling-out racism and enacting allyship in medical education. Can Med Educ J 2021;12(4):111–5. https://doi.org/10.36834/cmej.71566 DOI: https://doi.org/10.36834/cmej.71566
Naidu T. Modern medicine is a colonial artifact: Introducing decoloniality to medical education research. Acad Med. 2021;96(11S):S9–12. https://doi.org/10.1097/ACM.0000000000004339 DOI: https://doi.org/10.1097/ACM.0000000000004339
Lingras KA, Alexander ME, Vrieze DM. Diversity, equity, and inclusion efforts at a departmental level: building a committee as a vehicle for advancing progress. J Clin Psychol Med Settings. 2021;1–24. https://doi.org/10.1007/s10880-021-09809-w DOI: https://doi.org/10.31234/osf.io/aqv8d
Morse M, Loscalzo J. Creating real change at academic medical centers—how social movements can be timely catalysts. N Engl J Med. 2020;383(3):199–201. https://doi.org/10.1056/NEJMp2002502 DOI: https://doi.org/10.1056/NEJMp2002502
Kruse SD, Hackmann DG, Lindle JC. Academic leadership during a pandemic: department heads leading with a focus on equity. Front Educ. 2020;5. https://doi.org/10.3389/feduc.2020.614641 DOI: https://doi.org/10.3389/feduc.2020.614641
Page SE. Making the difference: Applying a logic of diversity. Acad Manag Perspect. 2007;21(4):6–20. https://doi.org/10.5465/amp.2007.27895335 DOI: https://doi.org/10.5465/amp.2007.27895335
Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383–92. https://doi.org/10.1016/j.jnma.2019.01.006 DOI: https://doi.org/10.1016/j.jnma.2019.01.006
Pritlove C, Juando-Prats C, Ala-Leppilampi K, Parsons JA. The good, the bad, and the ugly of implicit bias. The Lancet. 2019;393(10171):502–4. https://doi.org/10.1016/S0140-6736(18)32267-0 DOI: https://doi.org/10.1016/S0140-6736(18)32267-0
Costello CY. Professional identity crisis: race, class, gender, and success at professional schools. Vanderbilt University Press; 2005. DOI: https://doi.org/10.2307/j.ctv17vf5nn
Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15(1):1–5. https://doi.org/10.1186/s12909-015-0290-9 DOI: https://doi.org/10.1186/s12909-015-0290-9
Cyrus KD. Medical education and the minority tax. JAMA. 2017 May 9;317(18):1833–4. https://doi.org/10.1001/jama.2017.0196 DOI: https://doi.org/10.1001/jama.2017.0196
Campbell KM, Rodríguez JE. Addressing the minority tax: perspectives from two diversity leaders on building minority faculty success in academic medicine. Acad Med. 2019 Dec;94(12):1854–7. https://doi.org/10.1097/ACM.0000000000002839 DOI: https://doi.org/10.1097/ACM.0000000000002839
Balzora S. When the minority tax is doubled: being Black and female in academic medicine. Nat Rev Gastroenterol Hepatol. 2021 Jan;18(1):1–1. https://doi.org/10.1038/s41575-020-00369-2 DOI: https://doi.org/10.1038/s41575-020-00369-2
Faucett EA, Brenner MJ, Thompson DM, Flanary VA. Tackling the minority tax: a roadmap to redistributing engagement in diversity, equity, and inclusion initiatives. Otolaryngol Neck Surg. 2022 Jun 1;166(6):1174–81. https://doi.org/10.1177/01945998221091696 DOI: https://doi.org/10.1177/01945998221091696
Fuentes-Afflick E. Promoting inclusion in academic medicine. JAMA Netw Open. 2018;1(4):e181010–e181010. https://doi.org/10.1001/jamanetworkopen.2018.1010 DOI: https://doi.org/10.1001/jamanetworkopen.2018.1010
Ludmerer KM. Seeking parity for women in academic medicine: a historical perspective. Acad Med. 2020;95(10):1485–7. https://doi.org/10.1097/ACM.0000000000003556 DOI: https://doi.org/10.1097/ACM.0000000000003556
Alwazzan L, Al-Angari SS. Women’s leadership in academic medicine: a systematic review of extent, condition and interventions. BMJ Open. 2020;10(1):e032232. https://doi.org/10.1136/bmjopen-2019-032232 DOI: https://doi.org/10.1136/bmjopen-2019-032232
Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Acad Med J Assoc Am Med Coll. 2018;93(11):1694. https://doi.org/10.1097/ACM.0000000000002146 DOI: https://doi.org/10.1097/ACM.0000000000002146
Chyu J, Peters CE, Nicholson TM, Dai JC, Taylor J, Garg T, et al. Women in leadership in urology: the case for increasing diversity and equity. Urology. 2021;150:16–24. https://doi.org/10.1016/j.urology.2020.07.079 DOI: https://doi.org/10.1016/j.urology.2020.07.079
Feng R, Hoffman SE, Wagner K, Ullman JS, Stippler M, Germano IM. Women neurosurgeons in academic and other leadership positions in the United States. World Neurosurg. 2021;147:80–8. https://doi.org/10.1016/j.wneu.2020.12.069 DOI: https://doi.org/10.1016/j.wneu.2020.12.069
Keane AM, Larson EL, Santosa KB, et al. Women in leadership and their influence on the gender diversity of academic plastic surgery programs. Plast Reconstr Surg. 2021;147(3):516–26. https://doi.org/10.1097/PRS.0000000000007681 DOI: https://doi.org/10.1097/PRS.0000000000007681
Lee LK, Platz E, Klig J, et al. Addressing gender inequities: creation of a multi-institutional consortium of women physicians in academic emergency medicine. Acad Emerg Med. 2021;28(12):1358–67. https://doi.org/10.1111/acem.14361 DOI: https://doi.org/10.1111/acem.14361
Levine RB, Ayyala MS, Skarupski KA, et al. “It’s a little different for men”—sponsorship and gender in academic medicine: a qualitative study. J Gen Intern Med. 2021;36(1):1–8. https://doi.org/10.1007/s11606-020-05956-2 DOI: https://doi.org/10.1007/s11606-020-05956-2
Odei BC, Gawu P, Bae S, et al. Evaluation of progress toward gender equity among departmental chairs in academic medicine. JAMA Intern Med. 2021;181(4):548–50. https://doi.org/0.1001/jamainternmed.2020.6267 DOI: https://doi.org/10.1001/jamainternmed.2020.6267
Tricco AC, Bourgeault I, Moore A, Grunfeld E, Peer N, Straus SE. Advancing gender equity in medicine. Cmaj. 2021;193(7):E244–50. https://doi.org/10.1503/cmaj.200951 DOI: https://doi.org/10.1503/cmaj.200951
Crenshaw KW. On intersectionality: essential writings. The New Press; 2017.
Jordan A, Shim RS, Rodriguez CI, et al. Psychiatry diversity leadership in academic medicine: guidelines for success. Am J Psychiatry. 2021;178(3):224–8. https://doi.org/10.1176/appi.ajp.2020.20091371 DOI: https://doi.org/10.1176/appi.ajp.2020.20091371
Kaslow NJ, Schwartz AC, Ayna DK, et al. Integrating diversity, equity, and inclusion into an academic department of psychiatry and behavioral sciences. Focus. 2021;19(1):61–5. https://doi.org/10.1176/appi.focus.20200024 DOI: https://doi.org/10.1176/appi.focus.20200024
Simonsen KA, Shim RS. Embracing diversity and inclusion in psychiatry leadership. Psychiatr Clin. 2019;42(3):463–71. https://doi.org/10.1016/j.psc.2019.05.006 DOI: https://doi.org/10.1016/j.psc.2019.05.006
Riner AN, Upchurch GR, Trevino JG. Sponsorship to improve diversity and inclusion in surgical leadership. Am J Surg. 2022;223(4):817–8. https://doi.org/10.1016/j.amjsurg.2021.09.022 DOI: https://doi.org/10.1016/j.amjsurg.2021.09.022
Zhu K, Das P, Karimuddin A, Tiwana S, Siddiqi J, Khosa F. Equity, diversity, and inclusion in academic American surgery faculty: an elusive dream. J Surg Res. 2021;258:179–86. https://doi.org/10.1016/j.jss.2020.08.069 DOI: https://doi.org/10.1016/j.jss.2020.08.069
Coe C, Piggott C, Davis A, et al. Leadership pathways in academic family medicine: focus on underrepresented minorities and women. Fam Med. 2020;52(2):104–11. https://doi.org/10.22454/FamMed.2020.545847 DOI: https://doi.org/10.22454/FamMed.2020.545847
Rosseau G, Kim EE, Klein AL, Lartigue JW. Diversity in neurosurgery. In: Agarwal N, Reddy V, editors. Surviving Neurosurgery: Vignettes of Resilience. Cham: Springer International Publishing; 2021;p. 421–31. Available from: https://doi.org/10.1007/978-3-030-86917-5_81 DOI: https://doi.org/10.1007/978-3-030-86917-5_81
Cusson T, Lebel K, Spalluto L, Hillier T, Darras K, Yong-Hing C. Recommendations for Improving Canadian Radiology Equity, Diversity and Inclusion. Can Assoc Radiol J. 2022 May 26;08465371221099956. https://doi.org/10.1177/08465371221099 DOI: https://doi.org/10.1177/08465371221099956
Yong-Hing CJ, Patlas MN, Khosa F. Pioneering EDI in Canadian academic radiology. Can Assoc Radiol J. 2022 Nov;73(4):614-5. https://doi.org/10.1177/08465371221099479 DOI: https://doi.org/10.1177/08465371221099479
Khatchikian AD, Spalluto LB, Patlas MN, Yong-Hing CJ. Canadian association of radiologists commitment to equity, diversity and inclusion in canadian radiology. Can Assoc Radiol J. 2022;0(0). https://doi.org/10.1177/0846537122111 DOI: https://doi.org/10.1177/08465371221112663
Soklaridis S, Lin E, Black G, Paton M, LeBlanc C, Besa R, et al. Moving beyond ‘think leadership, think white male’: the contents and contexts of equity, diversity and inclusion in physician leadership programmes. BMJ Lead. 2022;leader-2021. https://doi.org/10.1136/leader-2021-000542 DOI: https://doi.org/10.1136/leader-2021-000542
Betancourt JR. Eliminating racial and ethnic disparities in health care: what is the role of academic medicine? Acad Med. 2006;81(9):788–92. DOI: https://doi.org/10.1097/00001888-200609000-00004
Dalhousie University. Department chairs. Available from: https://www.dal.ca/about-dal/leadership-and-vision/leadership-team/department-chairs.html [Accessed on Aug 15, 2022].
Stockard J, Greene J, Lewis P, Richmond G. Promoting gender equity in academic departments: a study of department heads in top-ranked chemistry departments. J Women Minor Sci Eng. 2008;14(1). https://doi.org/10.1615/JWomenMinorScienEng.v14.i1.10 DOI: https://doi.org/10.1615/JWomenMinorScienEng.v14.i1.10
Berdrow I. King among kings: understanding the role and responsibilities of the department chair in higher education. Educ Manag Adm Leadersh. 2010 Jul 1;38(4):499–514. https://doi.org/10.1177/1741143210368146 DOI: https://doi.org/10.1177/1741143210368146
Ahmed S. ‘You end up doing the document rather than doing the doing’: Diversity, race equality and the politics of documentation. Ethn Racial Stud. 2007;30(4):590–609. https://doi.org/10.1080/01419870701356015 DOI: https://doi.org/10.1080/01419870701356015
Bhopal K, Pitkin C. ‘Same old story, just a different policy’: race and policy making in higher education in the UK. Race Ethn Educ. 2020 Jul 3;23(4):530–47. https://doi.org/10.1080/13613324.2020.1718082 DOI: https://doi.org/10.1080/13613324.2020.1718082
Chen AY, Kuper A, Whitehead CR. Competent to provide compassionate care? A critical discourse analysis of accreditation standards. Med Educ. 2021;55(4):530–40. https://doi.org/10.1111/medu.14428 DOI: https://doi.org/10.1111/medu.14428
Foucault M. The archaeology of knowledge: Translated from the french by AM Sheridan Smith. Pantheon Books; 1972.
Fairclough N. Critical discourse analysis. In: The Routledge handbook of discourse analysis. Routledge; 2013. p. 9–20.
Whitehead C, Kuper A, Freeman R, Grundland B, Webster F. Compassionate care? A critical discourse analysis of accreditation standards. Med Educ. 2014 Jun;48(6):632–43. https://doi.org/10.1111/medu.12429 DOI: https://doi.org/10.1111/medu.12429
Marshall J, O’Hearn S, McLeod R, et al. Diversity in leadership: report with recommendations [Internet]. Halifax,: Dalhousie University, Faculty of Medicine; 2017. Available from: https://cdn.dal.ca/content/dam/dalhousie/images/faculty/medicine/ForFaculty_Staff/Div_Lead_Report_July_2017.pdf
Diversity in Leadership [Internet]. Dalhousie University. Available from: https://medicine.dal.ca/about/diversity/diversity-in-leadership.html [Accessed on Aug 15, 2022].
Canadian Institutes of Health Research. Tri-Council policy statement: ethical conduct for research involving humans. [Internet]. 2018. Available from: http://publications.gc.ca/collections/collection_2019/irsc-cihr/RR4-2-2019-eng.pdf [Accessed on Aug 17, 2022].
Branch LS. Consolidated federal laws of Canada, employment equity act [Internet]. 2021. Available from: https://laws-lois.justice.gc.ca/eng/acts/e-5.401/ [Accessed on Oct 11, 2022].
Scotia N. Human Rights Act. RSNS C. 1989;214.
Dalhousie University. Employment Equity Policy [Internet]. Available from: https://www.dal.ca/dept/university_secretariat/policies/human-rights---equity/employment-equity-policy.html [Accessed on Oct 11, 2022].
Acosta DA, Lautenberger DM, Castillo-Page L, Skorton DJ. Achieving gender equity is our responsibility: leadership matters. Acad Med. 2020;95(10):1468–71. https://doi.org/10.1097/ACM.0000000000003610 DOI: https://doi.org/10.1097/ACM.0000000000003610
Henry F, Dua E, James CE, et al. The equity myth: racialization and indigeneity at Canadian universities. UBC Press; 2017. DOI: https://doi.org/10.4324/9780429444234-2
Romero R, Miotto K, Casillas A, Sanford J. Understanding the experiences of first-generation medical students: implications for a diverse physician workforce. Acad Psychiatry. 2020 Aug 1;44(4):467–70. https://doi.org/10.1007/s40596-020-01235-8 DOI: https://doi.org/10.1007/s40596-020-01235-8
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