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 summary of best practices to reduce gender based disparities in Internal Medicine ( IM) training, drafted as part of a consensus conference sponsored by the American College of Physicians 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. Internal Medicine recruitment strategies:

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.

Training:

  • Prioritize implicit bias training for all individuals involved in recruitment.
  • Train interviewers- goals of interview, consider blinding scores, appropriate questions, and responses

Accountability and Tracking:

  • Consider delegating a program faculty “champion” to assess gender-based bias during the recruitment process.
  • Keep a record of gender-based metrics such as total number of male/female/ residents in the program, number of male/female applicants interviewed, number of female faculty and female residents highlighted in web-based promotional material, number of female residents/faculty presenting on interview day.
  • 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 gender experiences.
  • Consider sharing data on gender-based disparities across the region to identify barriers experienced by programs towards successful implementation of these strategies.

Information-sharing:

  • 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.

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.

B. Career Development related gender bias:

Mentorship:

  1. 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.
  2. Emphasize the education value of faculty engaging in mentorship/sponsorship/advising and recognize the effort in promotional pathways and productivity metrics.
  3. Offer formalized training in leadership and negotiation to all residents.
  4. Quantify gender break down of full-time faculty, leadership positions, senior faculty within the department and organization.
  5. Assess gender differences amongst trainee’s well-being.

Scholarship:

  1. 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 if the distribution match or reflect the composition of its organization.

Awards:

  1. Track gender based break- down of awards within their institution, regional awards, and national awards. This includes nomination and recipients for these awards.
  2. Measure gender break- down of residents participating in unique or prestigious activities (e.g. sitting on a national organizational council or participating in Doctor’s Dilemma etc.). This would also extend to dynamics at morning report to ensure equal opportunities to participate in academic discussions.
    • 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
  3. Measure gender break- down of residents nominated and accepting Chief resident roles in your program yearly.

C. Family Friendly policies:

  1. Quantify residency experiences of family friendly policies, specifically lactation and FMLA, on their annual surveys to set an internal benchmark.
  2. We recommend national organizations such as American Board of Internal Medicine (ABIM) and the National Residency Matching Program (NRMP) work together to rectify the current mismatch of training completion and fellowship start dates.
  3. Include all leave policies in their application packets and make any leave policies easily accessible to applicants on interview days.
  4. 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.

D. Sexual Harassment:

  1. 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.
  2. Review the reporting policy for sexual harassment and ensure access to all trainees with a clear description of the steps and contact numbers.
  3. Reiterate a no-tolerance policy at all times within the department for any behavior consistent with sexual harassment.
  4. Reiterate a no-tolerance policy for retaliation by superiors such as faculty in leadership positions.
  5. Designate a faculty “ champion” as a mediator in less clear situations that may involve misunderstandings due to differences in cultural background, language barriers etc.