Implementation Strategies for Best Practices Towards Reduction in Gender Disparity in Internal Medicine Training: Summary Recommendations from a Consensus Conference from the American College of Physicians
This document is a companion statement to the Memorandum of Understanding for Gender Equity in Medicine, drafted as part of a consensus conference sponsored by the American College of Physicians’ Pennsylvania Chapter involving training programs in the Philadelphia region.
Four physician leaders led pre-summit literature searches, survey-based feedback from participants and key discussion points on 4 sub-topics: recruitment-based gender bias, sexual harassment, career advancement related gender bias and family friendly policies.
In addition to arriving at a consensus on best practices to implement in the Philadelphia region across institutions to reduce gender-based disparities in IM training, the subgroups also outlined strategies to help programs implement these practices which are described below.
A. Setting goals
- Seek buy-in from the program director to make diversity and inclusion a priority
- Goals and priorities of recruitment should be disseminated to all faculty involved in recruitment.
- Prioritize implicit bias training for all individuals involved in recruitment including ways bias is introduced during the virtual interview process.
- Train interviewers regarding the goals of the interview, appropriate questions and responses.
C. Accountability and Tracking
- Consider delegating a program faculty/staff “champion” to assess gender-based bias metrics during the recruitment process.
- Track self-identified gender as well as underrepresented in medicine status of applicants during recruitment, with attention to;
- the number of applicants invited to interview
- the number of applicants ranked to match
- the number of faculty on the recruitment committee
- representation of residents and faculty highlighted in recruitment material
- Seek a diverse faculty recruitment committee and encourage input from all members.
- Account for individual faculty time spent on recruitment activities (particularly UIM faculty). Acknowledge the “minority tax” often placed on UIM faculty and consider ways to compensate.
- Proactively match interviewees and faculty interviewers.
- Survey current residents about perceptions of gender disparities within their program.
- Survey applicants after match day regarding their experience related to gender.
- Share final rank list and seek input from multiple faculty.
- Consider alternative sources of recruitment material (social media, hard copy handouts) to proactively reach applicants (programs often lack control over websites).
- Proactively provide a gender resource sheet for applicants including information about parental leave policies, lactation accommodations, and other institutional support services for parents.
- Consider sharing data on gender-based disparities across the region to identify barriers experienced by programs towards successful implementation of these strategies.
E. Interview day strategies
- Ensure leadership communicates commitment to inclusion/diversity
- Ensure representation of female faculty and female residents.
- De-identify/remove aspects of high-bias metrics from application when shared with the interviewer.
- Review strategies to minimize bias in the virtual space with all residents, faculty, and staff involved in recruitment.
Career Development Related Gender Bias
- We recommend programs provide formalized training to trainees on how to be an effective mentee and formalized training for faculty on how to be effective mentors/sponsors/advisors.
- Emphasize the education value of faculty engaging in mentorship/sponsorship/advising and recognize the effort in promotional pathways and productivity metrics.
- Offer formalized training in leadership and negotiation to all residents.
- Quantify gender break down of full-time faculty, leadership positions, senior faculty within the department and organization.
- Assess gender differences amongst trainee’s well-being.
We recommend programs measure gender distribution of scholarship among trainees this can include regional/national presentations, abstracts, manuscripts, and etc.
- In addition, we recommend each program self-reflect yearly on the scholarship distribution and ask itself does the distribution match or reflect the composition of its organization.
- If gaps are present, consider identifying a program champion to develop an action plan to address the gaps. (eg) A program my have their APD of research devise yearly action plan to address the gender gaps in scholarship.
C. Awards & Prestigious Opportunities
- Track gender break down of awards within your institution, regional awards, and national awards. This includes nomination and recipients for these awards.
- Measure gender break down of residents participating in unique or prestigious activities (eg. Sitting on a national organizational council or participating in Doctor’s Dilemma, & etc). This would extend to dynamics at morning report to ensure equal opportunities to participate in academic discussions.
- Measure gender break down of residents nominated and accepting Chief resident roles in your program yearly.
- Revise Residency Awards qualifications to remove gender bias from the descriptions.
- Require resident award designations be made by committee decision.
- Require gender diversity on all resident committees and councils.
- In addition, we recommend each program self-reflect yearly on the gender distribution of awardees, nominations and prestigious/unique activities and ask itself does the distribution match or reflect the composition of its organization.
Recommend/require implicit bias training for the following:
- Faculty whom regularly complete evaluations
- Clinical competency committee members (CCC)
- Faculty who regularly write letters of recommendation
E. Educational Environment
- Recommend educational sessions to faculty on strategies to remove bias from the educational setting.
Strategies to Develop Family Friendly Policies
- Quantify residency experiences of family friendly policies, specifically lactation and FMLA, on their annual surveys to set an internal benchmark.
- Work with national organizations such as American Board of Internal Medicine ( ABIM) and the National Residency Matching Program (NRMP) to rectify the current mismatch of training completion and fellowship start dates.
- Include all leave policies in their application packets and make any leave policies easily accessible to applicants on interview days.
- Create a toolkit for an at-home elective that would allow residents to continue their training while still being able to care for their child.
Strategies to Minimize Sexual Harassment
- Review current institutional policy on sexual harassment and if inadequate description exists for what constitutes sexual harassment, revise this policy with input of the hospital administration and legal counsel.
- Review the reporting policy for sexual harassment and ensure access to all trainees with a clear description of the steps and contact numbers.
- Reiterate a no-tolerance policy within the department for any behavior consistent with sexual harassment.
- Reiterate a no-tolerance policy for retaliation by superiors such as faculty in leadership positions.
- Designate a faculty “champion” as a mediator in less clear situations that may involve misunderstandings due to differences in cultural background, language barriers etc.