From Crime to Care — On the Front Lines of Decarceration

  • Morris N
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Abstract

n engl j med 385;6 nejm.org August 5, 2021 diversity, equity, and inclusion (DEI) platforms. DEI officers must be trained in critical race theory, health disparities, and inclusive pedagogy and be able to offer programming on topics ranging from implicit bias to civil discourse. These officers should be people who identify as members of a marginalized group, so that they have shared, authentic lived experiences with discrimination and a personal drive to address these issues. DEI officers who are members of underrepresented groups can serve as role models and mentors. When it comes to conducting diversity training, a trainer's personal experience with discrimination affects perceptions of their effectiveness. 3 Every DEI officer could report and respond to a diversity committee that includes both trainees and faculty. Diversity committee members should be consulted on new clinical and educational endeavors, and institutions should compensate members for this additional work-for instance, by counting diversity-related work as part of their salaried responsibilities , providing them with administrative support, or offering additional training that enhances their career trajectories. To ensure that equity is consistently considered in strategic planning and policy decisions, every major institutional leadership group could include a DEI officer. Every department, section, and residency program could have an identified officer. Although DEI officers bring expertise and focus to equity efforts , true organizational change requires building a culture of equity throughout the institution, from senior leadership to front-line staff. Strong DEI infrastructure is only one part of the necessary commitment to equity at academic hospitals. Institutions could also establish and support affinity groups-groups with shared race, culture , gender, sexual orientation, or other identities. Affinity groups foster personal relationships and build the social capital and sense of belonging that help trainees succeed. They also foster men-toring relationships, facilitate access to institutional resources, and buffer the harm associated with imposter syndrome, social isolation, and stereotype threat that may affect trainees. 4 Separately , trainees from underrepre-sented groups should be able to interact with successful, well-resourced faculty from similar backgrounds. Trainees should have access to a database of such faculty. Second, there is a need for system-level changes promoting health equity. Many trainees from underrepresented groups want to advocate for and serve underre-sourced communities. Doing so should not require extra effort. Key Resources and Practices for Supporting Trainees from Groups That Are Underrepresented in Medicine. Leadership and Infrastructure for Diversity, Equity, and Inclusion (DEI) Skilled and well-resourced DEI officers Officers that are appropriately titled, recognized as essential to strategic planning, and compensated Diversity committee, with members (trainees and faculty) who are compensated for time and recruitment efforts Affinity group support and resources Accessible online list of faculty from underrepresented groups Recruitment initiatives, such as outreach to societies with large numbers of members of underrepresented groups, with DEI officers included in interviews Search committee practices to increase minority faculty, such as maintaining and reporting demographic metrics for applicants, interviewed applicants, and applicants offered positions Review of promotion practices to increase success of minority faculty: Where are minority faculty facing obstacles? How much time are minority faculty spending at each level of promotion, as compared with other faculty? Are promotions committees diverse? Are promotions officers and committees required to be trained in bias reduction? System-Level Changes Promoting Health Equity Well-resourced community outreach and engagement efforts Advocacy training for supporting individual patients and groups with chronic diseases and for promoting distributive justice Well-resourced trainee clinics Clinical performance metrics stratified by social risk factors Quality improvement and health care delivery system redesign with an equity lens Structural Competency and Advocacy Training Lectures on the history of the Flexner Report, the American Medical Association's discriminatory practices, scientific racism, and structural racism Morning-report cases demonstrating the effects of bias, discrimination, inequitable practices (i.e., lack of lessons on dermatologic conditions on darker skin), and racialized medicine (e.g., pulmonary function tests and estimated glomerular filtration rate calculations) Instruction in how structural violence against marginalized populations causes or exacerbates diseases such as diabetes, hypertension, chronic kidney disease, and HIV Bias-Reporting Mechanisms Reporting mechanisms for bias that are free from retribution, protect reporters, and are accountable for changes in the offender's behavior

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Morris, N. P. (2021). From Crime to Care — On the Front Lines of Decarceration. New England Journal of Medicine, 385(5), 385–387. https://doi.org/10.1056/nejmp2107013

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