Promoting Diversity, Equity, and Inclusion in the Health Care Workforce

Yasmine R. Legendre, MPA, Program Associate, Josiah Macy Jr. Foundation

The Josiah Macy Jr. Foundation is the only national foundation solely dedicated to improving the public’s health by advancing change in the education of future health professionals. The Foundation’s current focus is the clinical learning environment where the health care workforce both acquires skills and delivers care. Within this focus, our aim is to make those environments more inclusive and equitable so that all can feel welcome and participate in meeting the evolving needs of the population.

At our March 2020 conference, Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments, the Foundation revealed that one of our new priority areas would be promoting diversity, equity, and belonging among health professional learners (DEB). We could not have imagined how prescient this focus would become. (The full conference report, recommendations, and accompanying papers are available here.)

The Macy Foundation is developing its diversity, equity, and belonging portfolio to address these recommendations. The conference identified four areas where the clinical learning environment can make improvements:

1. Build an institutional culture of fairness and respect by making diversity, equity, and inclusion top priorities.
2. Develop, assess, and improve systems to mitigate harmful biases and eliminate discrimination.
3. Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination, and all forms of oppression.
4. Increase the numbers of health professions students, trainees, faculty, and institutional administrators and leaders from historically marginalized and excluded populations.

Below is a small selection of the nearly 50 grants we have already made in this area, aligned with the key areas we are hoping to influence:

Build an institutional culture of fairness and respect by making diversity, equity, and inclusion top priorities.

• The Icahn School of Medicine at Mount Sinai is leading the Anti-Racist Transformation (ART) in Medical Education initiative at 11 medical schools across the United States and Canada. The program will help these schools develop capacity to dismantle systemic racism and bias in their work and learning environments and promote shared learning on how to dismantle racism within and across medical schools.

Develop, assess, and improve systems to mitigate harmful biases and eliminate discrimination.

• At Yale School of Medicine, the Foundation is supporting the Promoting Diversity, Group Inclusion, and Equity index, which will create a validated tool to assess the climate of equity and inclusion in medical schools and then analyze the data to glean information about characteristics of a medical school’s learning environment associated with greater diversity, inclusion, and equity; and student wellbeing and academic success.
• The American Board of Internal Medicine Foundation is leading a funding collaborative, of which the Macy Foundation is a partner, to support interprofessional teams conducting programs in the clinical learning environment that promote trust and create an equitable health system by incorporating diversity, equity, and inclusion. A grantee learning network will be formed to share ideas and disseminate key lessons learned to national stakeholders.

Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination, and all forms of oppression.

• At Central Michigan University, the Foundation is supporting the implementation of a disability seminar for interprofessional students in their first and second years and faculty on best practices for caring for patients with disabilities.

Increase the numbers of health professions students, trainees, faculty, and institutional administrators and leaders from historically marginalized and excluded populations.

• The Center of American Indian and Minority Health at the University of Minnesota (The Center) is creating training opportunities for medical students and residents with American Indian and Alaska Native (AIAN) patients at tribal and Indian Health Service clinics and hospitals. The Center will provide appropriate training to ensure that learners are well-prepared for caring for an underserved population, thereby enhancing learner participation at these sites without placing additional burdens on physicians and staff. The Center will establish an exportable model for developing community-specific clinical curricula and experiential learning opportunities. Finally, they will provide mentorship and career development opportunities for AIAN students enrolled at the University of Minnesota.
• The American Council of Academic Physical Therapy hosted the National Equity, Diversity, and Inclusion Commission Summit 2022: Building Partnerships, Creating Spaces, and Developing Opportunities to Increase Racial and Ethnic Diversity in Physical Therapy. At the conference, a task force was formed to identify strategies to increase racial and ethnic diversity in physical therapy. The recommendations from the task force will become the guidelines for schools to address diversity in physical therapy.
• Building the Next Generation of Academic Physicians has created a working group to identify pre-faculty competencies and milestones necessary for medical students and residents to develop successful academic careers. Member schools of the National Center Pre-Faculty Development program and others will have the opportunity to adopt these competencies into their strategic plans for diversifying faculty.
• Finally, the Foundation has a long-standing relationship with National Medical Fellowships to support the Josiah Macy Jr. Foundation Scholarship Program, which provides four scholarships on the basis of financial need and commitment to service to second- and third-year underrepresented minority medical students.

The Foundation’s work in driving change also goes beyond making grants. We hosted a three-part webinar series on Exploring the Barriers to Inclusion for Medical Trainees with Disabilities and an eight-part series on Taking Action on Harmful Bias and Discrimination in Clinical Learning Environments. We also initiated the Vital Voices podcast series to address bias and discrimination in the clinical learning environment. The upcoming Macy conference will examine how to ensure fairness in the assessment system for learners. We continue to explore additional opportunities to support this priority in order to realize the goal of supporting inclusivity in health professions education and ensuring that all learners have the opportunity to thrive.

We believe that DEB is an area that requires leadership, and we are happy to see increasing interest from other funders. Health inequities in the United States have reached crisis levels, with some studies indicating that your zip code is a better predictor of life expectancy than your genetic code. Health leaders across the nation are working to reverse disparities like these. Our Foundation is committed to accelerating progress in learning environments by promoting equity, diversity, and belonging for members of the community and for health professionals. We will help clinical learning environments address systemic inequities at the institutional level that reduce career satisfaction and limit advancement opportunities. We will support new efforts to eliminate the implicit and explicit biases that can lead to poor treatment decisions. We know that equitable and inclusive learning environments will support the success of all learners, including those who have historically been excluded from health care professions. Our hope is that our support, coupled with the work of other foundations, helps to transform the health professions learning environment and the health care system into one where everyone feels as though they belong.