Beyond Implicit Bias to Explicit Action

Abstract

Heightened awareness of societal inequities and injustices has been prevalent in the US in recent years. This awareness has spurred new enthusiasm among many to eliminate racial and ethnic disparities in health and health care, moving toward health equity. A key component of achieving equity in ophthalmology is increasing diversity in our workforce. Underrepresented racial and ethnic minority physicians are more likely to care for patients in medically underserved areas, patients of lower socioeconomic status, and patients from racial and ethnic minority groups, and these patients may all experience better health outcomes. 1 Ophthalmology remains one of the least diverse specialties in medicine.Diversifying residency training programs must come with departmental prioritization and commitment to diversity, equity, and inclusion. In this issue of JAMA Ophthalmology, Pershing et al 2 present data on implicit bias and the association of redaction with review scores on residency application screening. Faculty reviewed randomized sets of redacted and unredacted applications and found no significant differences in review scores of redacted vs unredacted applications based on applicants' sex, underrepresented in medicine (URiM) status, or international medical graduate status. This finding is encouraging, but as the authors suggest, it cannot be the only approach considered by other residency programs. Intentional strategies to facilitate the implementation of a holistic review of ophthalmology residency selection are key.In the current study, applicants from top 20 medical schools received better scores from faculty reviewers. There should be a recognition that, while URiM applicants in this study were more likely to have attended top US News & World Report-ranked medical schools than the general applicant pool, this finding is not consistent with URiM ophthalmology applicants or US medical graduates in general. Comparing the top US News & World Report medical schools and top US News & World Report and Ophthalmology Times ophthalmology departments with the medical schools that have produced the most URiM graduates over the past 10 years, we found that only 2 institutions overlap. The Medical University of South Carolina ranked ninth in number of Black medical graduates between 2010 and 2019, and the Storm Eye Institute ranked 10th on the Ophthalmology Times list. Likewise, the University of Washington ranked fifth in American Indian and Native Alaskan medical graduates and 13th on the US News & World Report medical school list, the small number of American Indian ophthalmology applicants notwithstanding. 3 Topranked institutions are not better at recruiting URiM medical trainees. In fact, medical schools affiliated with historically Black colleges and universities and other racial and ethnic minority-serving institutions train the largest percentage of URiM medical graduates. Access to ophthalmology varies

Diversity, equity and inclusion in ophthalmology

“…Diversity, equity and inclusion (DEI) efforts promote the representation of different races and ethnicities, sexual orientations and sexes, socioeconomic status, age and disability status [1 ▪ ]. DEI initiatives in ophthalmology have received increased support in recent years, as the coronavirus SARS-CoV2 pandemic brought renewed attention to the pervasive health disparities present in the USA [2]. This review highlights the widening disparities in ophthalmology, the lack of diversity in ophthalmology, as well as potential future steps for continued improvement in DEI…”

Success in Increasing Diversity: One Residency Program's Journey

“…However, once URM students are in the pipeline as potential future ophthalmologists, they may encounter barriers in the admissions process based on traditional metrics such as United States Medical Licensing Examination (USMLE) step scores and selection into Alpha Omega Alpha. 4 We believe it is the responsibility of residency program leadership to conduct the admission process with an eye toward matching qualified URM students. In our program at Montefiore Medical Center/Albert Einstein College of Medicine, we have successfully increased representation in our residency program.…”