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Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism

Published:January 12, 2022DOI:https://doi.org/10.1016/j.acap.2022.01.002

      Abstract

      The Academic Pediatrics Association has taken multiple steps over the last 2 years to incorporate the lenses of anti-racism and social justice into our mission and work. In this commentary, we discuss the creation and work of the Anti-Racism and Diversity Task Force, which was charged by the Academic Pediatrics Association's Board of Directors with identifying strategies to promote anti-racism and advance the diversity, equity and inclusion agenda.
      In the last 2 years, the killings of Black, Latinx and Indigenous individuals by law enforcement and the exacerbation of health disparities made even more visible by the COVID-19 pandemic have awakened many individuals and organizations to the systemic racism and social injustice embedded in our society. The effects of hundreds of years of structural racism in the United States have entrenched bias and discrimination into systems that affect the health and well-being of our patients, families, and fellow residents. Countless Black, Latinx, and Indigenous lives have been prematurely lost because of systemic practices entrenched in racism, including within the halls of medicine, where racial/ethnic disparities persist.
      • Flores G
      RESEARCH TCOP
      Racial and ethnic disparities in the health and health care of children.
      The academic community is not exempt from structural racism. Underrepresented in medicine (URiM) physicians (eg, Black, Hispanic, Native American/Alaska Native, Native Hawaiian/Pacific Islander)
      Association of American Medical Colleges
      Underrepresented in Medicine Definition.
      are leaving academic medicine due to discrimination, unsupportive work environments, barriers to promotion and leadership roles, and a lack of mentorship.
      • Blackstock U.
      Why Black Doctors Like me are Leaving Academic Medicine.
      ,
      • Eke O
      • Otugo O
      • Isom J.
      Black women in medicine—rising above invisibility.
      While the nation continues to grapple with racial equity and social justice, health care institutions and professional societies have begun building infrastructures to promote racial equity within organizations and leadership structures.
      • Abman SH
      • Armstrong S
      • Baker S
      • et al.
      The American Pediatric Society and Society for Pediatric Research joint statement against racism and social injustice.
      • Abman SH
      • Bogue CW
      • Baker S
      • et al.
      Racism and social injustice as determinants of child health: the American Pediatric Society Issue of the Year.
      • Blankenburg R
      • Poitevien P
      • Rey JG del
      • et al.
      Dismantling racism: association of pediatric program directors’ commitment to action.
      • Raphael JL
      • Bloom SR
      • Chung PJ
      • et al.
      Racial justice and academic pediatrics: a call for editorial action and our plan to move forward.
      • Trent M
      • Dooley DG
      • Dougé J
      • et al.
      The impact of racism on child and adolescent health.
      • Fisher PG
      • Long SS
      • Cole CR
      • et al.
      Diversity, equity, and inclusion in the journal of pediatrics.
      Achieving equity requires purposeful programming designed to mitigate the systems that contribute to disparities in academic achievement, career advancement, leadership acquisition, and health outcomes.
      • Kapila M
      • Hines E
      • Searby M.
      Why Diversity, Equity, and Inclusion Matter.
      Operationalizing equity through the lens of anti-racism, which focuses on recognizing these systems and uplifting oppressed and historically marginalized communities,
      • Olayiwola JN
      • Joseph JJ
      • Glover AR
      • et al.
      Making Anti-Racism A Core Value In Academic Medicine.
      may induce the power structures within institutions to begin to change. Creating a more equitable system of access and achievement by changing these oppressive structures is a first step on a long road toward a system which supports true justice.
      The Academic Pediatrics Association (APA) has taken multiple steps over the last two years to incorporate this lens into our mission and work. In the paired editorial, Orr et al discuss the changes made by the Leadership Development Nominating Committee Task Force. Here, we will discuss another APA initiative towards creating a more equitable academic pediatrics community.
      During a July 2020 meeting, the APA Board of Directors voted to create a task force charged with identifying strategies to promote anti-racism and advance the diversity, equity and inclusion agenda set forth by the APA Diversity and Inclusion Committee. After an open call for membership, the Anti-Racism and Diversity Task Force was established from APA membership throughout the country and included additional members from the Board of Directors and the APA Diversity and Inclusion Committee. By creating a conceptual framework through the lens of anti-racism, the APA aims to change not only who has a “seat at the table,” but also who has a voice in leadership through workforce development and programming, education, and leadership recruitment strategies. Figure represents this conceptual framework, which informed the creation of Task Force subcommittees and the charge to present the APA Board of Directors and APA Diversity and Inclusion Committee with:
      • 1.
        Recommendations on necessary changes to APA policies, programs, leadership recruitment processes, and abstract/publication selection.
      • 2.
        A collection of tools, resources, and educational materials to serve the broad audience of leadership, members, and trainees that cover the following topics:
        • What is anti-racism and how do I become an anti-racist?
        • How can I recognize and intervene on racism or prejudice in my own professional environment?
        • How do I create an environment of inclusivity and equity in my academic practice?
      • 3.
        Recommendations for how the APA can support, advocate for, and build academic pathways that promote diversity in membership and leadership, and equity in academic pediatrics.
      In addition, each of the subcommittees was charged with making recommendations for how to continuously monitor whether these changes have the desired impact, and when to re-examine the system. Each of these subcommittees worked on separate timelines to complete their task and are therefore at different stages.

      Policies and Procedures Subcommittee

      The Policies and Procedures subcommittee worked directly with the APA's executive director to review every organizational policy. The subcommittee reviewed each policy through an anti-racist lens and recommended changes to increase equity and decrease bias throughout the organization's governance and programs. Of the 21 policies that were reviewed, the subcommittee recommended modifying 16. This included adding language to recognize discrimination and race to mitigate bias; removing subjective language to decrease perceived privilege; mandating diversity, equity and inclusion plans; analyzing data within the organization about diversity, equity, and inclusion; and including this work in leadership recruitment, awards, and stakeholder relationships. As these changes are presented to the APA's Board of Directors, the subcommittee is continuing to develop processes to monitor these changes and ensure they promote measurable outcomes. Table illustrates a series of lessons learned and recommendations for those who are undergoing similar endeavors.
      TableSummary of Recommended Changes to APA Policies and Procedures
      Policy AreaRecommended Changes
      Code of ConductAdd a clause on discrimination and race/ anti-racism
      Designation of Core Programs and ActivitiesInclude a means to promote diversity and inclusion in the criteria for eligibility. Recommend Board to review both policies and ensure programs align with values of organization
      Guidelines for Grants, Contracts and SubcontractsDiversity studies are preferred and considered in the proposal. Add a field in the form that requests a description of ways the study team is diverse. Refer to https://grants.nih.gov/grants/guide/pa-files/pa-20-222.html
      Leadership Handbook for Special Interest Groups/ RegionsShould include DEI vision and efforts including but not limited to leadership recruitment/ elections, content/learning objectives of SIG/ region meetings, etc. Should be thoroughly reviewed to promote, incorporate DEI values into SIG activities and leadership. Leadership recruitment practices should mitigate bias and inequities.
      Liaison GuidelinesLiaison/ Partner organization values will be reviewed prior to establishing an official relationship. Develop a policy on how liaison representatives are chosen and what should be considered for those positions; to mitigate bias and reduce inequities.
      Policy on SurveysShould be reviewed to ensure bias is mitigated
      Procedures for Responding to Allegations of Scientific MisconductWhen allegations are directed to individuals who have received an award from the APA, the Board of Directors must determine, without bias, whether the individual will be permitted to continue as a recipient and representative of the organization, in the introduction, the board may consider allegations that could be bias before proceeding.
      Whistleblower PolicyAdd additional safeguard of discrimination: harassment or Victimization or Discrimination – harassment or victimization for reporting concerns under this policy will not be tolerated.
      Review of the APA policies and procedures revealed that many were not specifically anti-racist. The table summarizes recommendations made to improve this.

      Anti-Racism and Diversity Toolkit Subcommittee

      To equip pediatric leadership, faculty, trainees, and staff with necessary tools and resources to fully engage in anti-racism, the Anti-Racism and Diversity Toolkit Subcommittee compiled resources to assess and facilitate culture change and continuous growth in inclusivity and equity.
      • Argueza BR
      • Saenz SR
      • McBride D.
      From diversity and inclusion to antiracism in medical training institutions.
      This toolkit aims to support pediatric clinicians in various facets of their academic practice, including leadership-practice, peer-peer, provider-patient, and educator-trainee interactions. The toolkit can be accessed at https://www.academicpeds.org/publications-resources/apa-anti-racism-diversity-toolkit/.

      Academic Workforce Development Subcommittee

      There continues to be underrepresentation of minoritized medical students entering pediatrics, which has led to persistently less diverse pediatric residents, fellows and faculty pursuing academic pediatric careers.
      • Montez K
      • Omoruyi EA
      • McNeal-Trice K
      • et al.
      Trends in race/ethnicity of pediatric residents and fellows: 2007–2019.
      Currently, the APA supports several successful initiatives, including the New Century Scholars Resident Mentoring Program
      • Pachter LM
      • Kodjo C.
      New century scholars: a mentorship program to increase workforce diversity in academic pediatrics.
      and the Research in Academic Pediatrics Initiative on Diversity (RAPID)
      • Flores G
      • Mendoza F
      • Brimacombe MB
      • et al.
      Program evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): impact on career development and professional society diversity.
      Program, to help address this disparity. The Academic Workforce Development Subcommittee will examine current pathway programs, identify key gaps in programming (eg, support for URiM fellows, non-MD pediatric scientists), and recommend policies and procedures to create accountability for current and future career development programs to support the building of a diverse academic pediatrics workforce. The work will culminate by the end of 2022.
      By more carefully examining the power structures and related processes in our own professional organization, we aim to assist in dismantling racism not only in our own house, but also in our professional community and pediatric workforce.

      Acknowledgments

      We would like to thank the Academic Pediatrics Association Board of Directors and Immediate Past President Dr. Latha Chandran for establishing the Task Force. We would also like to thank every other member of the Task Force for contributing to our work, listed here in alphabetical order. Michelle S. Barratt, MD; Frank Belmonte, DO; Kecia N. Carroll MD, MPH; Denice Cora-Bramble, MD, MBA; Alissa Darden, MD; Amanda Dumas, MD, MSc; Brandi Freeman, MD; Arvin Garg, MD, MPH; Amalia Guardiola, MD; James Guevara MD, MPH; Terence Joiner, MD; Oriaku Kas-Osoka, MD, MEd; Cynthia Osman, MD; Nicole P. Black, MD, MEd; Janet Serwint, MD; Yael Smiley, MD; Tyler Smith MD, MPH; Rachel Thornton, MD, PhD; Stephanie White, MD, MSHS; and Lahia Yemane, MD.
      Financial statement: This work has not been funded.

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