Increased Diversity Among Residents

Midsection of African American female doctor writing down prognosis. Isolated on white.

Every March we’re excited about Match Day, to see where our students will complete their training. (You can see photos of this year’s event here.) The other side of that process is in seeing who matched with UVAHS and in welcoming new residents in July. We recently have seen a positive difference with regard to the number of underrepresented minorities (URM) in the incoming residents.

The AAMC defines URM as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” In recent years, residents who are URM have made up 7 percent of residencies nationwide. UVA usually follows that trend, matching 7 or 8 percent. Last year, however, UVA matched 10 percent URM to our program; and this year 15 percent! Looking at data from the Department of Medicine, our biggest department, the numbers went from 3 percent historically to 15 percent this year. These are outstanding increases.

This change did not happen by accident.

Great Change … But How Did We Do It??
Undergraduate medical education (UME) tackled this problem more than a decade ago and made astounding advances. Because of efforts made in the School of Medicine, we are now proud to say we have one of the most diverse student populations in the country. We wanted to do the same for our residency trainees, but we also wanted to broaden the AAMC definition of URM to be more inclusive.

As a first step, we conducted meetings to hear how minorities fared at UVA and in Charlottesville. These meetings were with the School, the Diversity Consortium, and the Medical Center, and with leaders in the institution like Dean David Wilkes, Dr. Gregory Townsend, and Dr. Michael Williams. While we had good information about our medical students, we lacked a grasp on how our minority trainees felt. After listening and receiving input from many groups, the Graduate Medical Education Committee task force (co-chaired by Dr. Kristen Atkins and Dr. Gerald Donowitz), working closely with Dr. Susan Kirk, Associate Dean for Graduate Medical Education, realized that there was a real need for us to do better.

Every program director was interested in making a change, however there were no mechanisms in place to make a broad, cohesive, and intentional impact. The GMEC task force assisted in creating these mechanisms by bridging the many groups who were already working on this subject.

The program directors started talking openly with applicants about diversity and what it means (and how it feels) to be an underrepresented minority. We created Diversity Days wherein we announced that several of our interview days would be extended for applicants interested in talking about diversity. While these days were sponsored by the Department of Medicine, they were open to all applicants and departments. Our message to the applicants was that UVA wants every trainee at UVA to thrive. The feedback we received from the applicants was eye-opening. Many had never had interviewers discuss diversity with them before. They appreciated it and recognized we wanted a change and that they could be a part of that change. For some, it was the first time they realized how important it was to belong to a place that was interested in their success.

Additionally, the task force educated program directors at monthly GMEC meetings about what was learned from speaking with GME trainees and applicants. We learned (and taught!) how to talk about diversity to an applicant, how to broach the subject, and how to openly discuss where UVA was with regard to diversity, but also where we wanted it to be. We kept the topic on everyone’s radar.

We also decided we couldn’t wait for the applicants to come to us. Like reaching out to high-school students before applying to college, we are now contacting third- and fourth-year medical students and giving them information about UVA Health System. We are going to regional and national meetings such as the Student National Medical Association (SNMA), the largest student-run organization focused on supporting underrepresented minority medical students.

Great Success and Momentum
All of this work is so that we may best serve our patients. A diverse group of trainees who reflect the community we serve leads to better patient care. And we are working on creating the best, most diverse resident teams. The past year has just been a pilot. We are moving forward with plans to propose new programs, create brochures for all programs for outreach, include more representation at SNMA meetings, and work with faculty across Grounds who conduct research on microaggressions. (There is much training and awareness we need to work on in this area.) We are also going to continue to tap into the underrepresented minority trainees who are already here and continue to solicit their help in recruitment and culture change. We will continue to take the pulse of our current trainees and institute activities and sessions that foster a culture of inclusion among all trainees, regardless of race, ethnicity, religion, gender, or sexual orientation.

Other ideas coming down the road: We are proposing formal training for all faculty in handling microaggressions and providing better access to our UVA Ombuds, Brad Holland, with scheduled on-site office hours. New signage has been implemented at the entrance to the Claude Moore Medical Education Building and the hospital lobby to let trainees (and everyone!) know that UVA is a welcoming place.

What we are doing for graduate medical education is a small component of what the whole community is doing — here at the hospital, in Charlottesville, and in Albemarle County. But we want the community to know that this is an important issue. We have learned much this year, and many of the needed connections are now in place. It was a good year. But it is just the first step in a longer process.

The success of initiatives such as this relies upon the willingness of all to participate. We would like to thank Dean Wilkes, Dr. Susan Kirk, the program directors, the task force, and the GMEC for their efforts in making this happen.

R.J. Canterbury, MD, MS, DLFAPA
Wilford W. Spradlin Professor
Senior Associate Dean for Education

Susan M. Pollart, MD, MS
Ruth E. Murdaugh Professor of Family Medicine
Senior Associate Dean for Faculty Affairs and Faculty Development

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