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Department of Pediatrics (CJ Orr, K McNeal-Trice), University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, N.C.Cecil G. Sheps Center for Health Services Research (CJ Orr), University of North Carolina at Chapel Hill, Chapel Hill, N.C.
Department of Health Systems Science (PJ Chung), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CalifDepartments of Pediatrics and Health Policy & Management (PJ Chung), Los Angeles, Calif
The article outlines the process and rationale for the implementation of anti-racist changes to the Academic Pediatric Association Nominating Committee to support the development of leaders from diverse background in academic pediatrics.
The past two years have been extremely challenging, especially for communities of color living in the United States (US). There have been multiple incidents of police violence directed at Black communities, a global pandemic leading to disproportionate morbidity and mortality among Black and Hispanic communities, and a violent insurrection at the Capitol, fueled in part by images of white supremacy, resulting in the tragic losses of life.
These events highlight the systemic racism and inequities that remain prevalent in our society and widen the gap of health disparities.
Leading pediatric journals have responded to current events by acknowledging their role in historic exclusion and racism, and evaluating their contributions to current oppressive systems and commitments to health equity.
In 2018, a subcommittee of the Academic Pediatric Association (APA) Membership Diversity and Inclusion Committee (MDI), developed a policy statement, which has been approved by APA Leadership, highlighting the importance of diversity, equity and inclusion (DEI) within the organization.
Building upon the work pioneered by the APA MDI committee and inspired by a recent publication entitled, “Geting Our House in Order: Re-building Academic Pediatrics by Dismantling the Anti-Black Racist Foundation,”
Critical to the professional development and advancement for individuals in academic pediatrics is progression toward national leadership roles. Individuals continue to be significantly underrepresented in leadership positions within pediatric departments based on their on race and/or ethnicity, gender identity, and/or sexual orientation.
The cause of the disparities in the diversity of leadership is multifactorial and include bias in interpretation of curriculum vitae (CV), imposter syndrome, “characterized persistent doubt concerning one's abilities or accomplishments accompanied by the fear of being exposed as fraud despite evidence of one's on going success,”
Against the background of a national conversation around race, racism, equity, and disparities, the APA sought to re-examine its processes for nominating and recruiting leaders within the organization. The APA's Nominating Committee was joined by representatives from the APA MDI and Anti-Racism Task Force to form the Leadership Development Nominating Committee (LDNC) Task Force. The charge of the LDNC Task Force was to review the current processes for nominating and recruiting leaders within the APA and recommend actionable changes to: 1) Implement anti-racist nomination policies; 2) Decrease unconscious bias in the nomination and selection process; and 3) Increase the diversity of the applicant pool for leadership positions. The work of the LDNC Task Force aligns with multiple other efforts in the APA (Figure) to support the professional development of academic child health professionals, especially from those who identify as pediatricians who are underrepresented in medicine.
After convening, the LDNC Task Force recommendations were approved by the APA Board on May 20, 2021. Below is a summary and rationale for the approved changes to the nominating process.
Scope of Problem
The racial and ethnic diversity of children in the US is increasing. According to 2020 data, approximately half of children identified as White, 26% identified as Hispanic, 14% identified as Black, and 5% identified as Asian.
and the current diversity of APA leadership team also does not reflect the diversity of children in the US. Given this lack of diversity within the APA membership and leadership, the LDNC Task Force proposed changes to the nomination process.
Changes to the APA Nominating Committee Process
Revision #1: Implement a year-round communications strategy highlighting the benefits of APA leadership. To facilitate equitable dissemination of information and opportunities, the year-round communication strategy will use multiple platforms to engage trainees and faculty using modalities such as webinars, social media, and presentations at regional meetings. This strategy will leverage existing programs within the APA designed to support the professional development of fellows and junior faculty who identify as underrepresented in medicine (eg, New Century Scholars, Research in Academic Pediatrics Initiative on Diversity).
Revision #2: Modify the recruitment timeline and increase the time period during which applicants are accepted from 1–2 months to 4 months (September-December). A modified recruitment and application timeline allows more time and opportunities for mentors and sponsors to encourage potential applicants to apply. The modified timeline engages APA members at periods of maximal engagement in academic pediatrics such as the APA Regional and Pediatric Academic Societies meetings, where mentors and sponsors can encourage residents, fellows and junior faculty to apply for leadership positions that enhance their professional development.
Priming of mentors and sponsors regarding their role in promoting diversity within the APA will also be important. Finally, promoting opportunities to meaningfully engage alumni networks of current APA programs, such as the New Century Scholars and Research in Academic Pediatrics Initiative on Diversity, will facilitate identification of potential candidates from a diverse group of early career faculty members.
Revision #3: Create a universal application and remove requirement of a CV. There are limitations to a CV's ability to identify qualified candidates for a leadership position by placing too large an emphasis on metrics such as awards, prior work experiences, universities attended, which have been found to be biased toward individuals from privileged backgrounds, and to not value diverse experiences in an equitable fashion.
The requirement of submitting a CV was removed from the application process to: 1) Avoid deterring applicants due to a perception their CV was not adequate given the known limitations of a CV; 2) Acknowledge the importance of past personal and professional experiences which are not always captured in a CV; and 3) Avoid biasing members of the Nominating Committee based on the length or format of an applicant's CV.
The LDNC Task Force recognized bias often plays a role in promotion and advancement to leadership positions within academic medical centers and therefore candidates for APA leadership positions should be evaluated on criteria beyond past experiences, academic rank and leadership at their own institution. Thus, the Task Force developed an application to assess a candidate's interest in a particular APA position, their past contributions to the APA, their experience in advancing DEI, and their future. In concert with revision #5, candidates will be assessed metrically using a position-specific rubric.
Revision #4: Expand the Nominating Committee from 4 to 6 members and increase the terms of service from 2 to 3 years. Increasing the number of committee members brings more voices and diverse perspectives to the table. Longer terms of service lead to more continuity, sustaining the Nominating Committee's efforts of maintaining a pool of candidates from diverse backgrounds.
Revision #5: Implement position-specific rubrics to objectively review candidates for each position commensurate with experience and to mitigate bias.
Designing systems to address unconscious bias is essential. Position-specific rubric measures help guide the review of applicants in a manner that minimizes subjectivity. Evidence from educational literature demonstrates that rubrics mitigate racial bias in grading.
These rubrics also evaluate how a position would advance an individual's professional development, consistent with the APA's goal of supporting the professional development of academic child health professionals, as well as how the candidate will advance the mission of the APA and DEI. These changes provide applicants an opportunity to share how past personal and professional experiences have shaped, informed, and influenced their career trajectory.
A number of medical professional organizations and health care institutions, both within and outside pediatrics, are modifying structures and processes to promote DEI and anti-racism. These are complex subjects that require sustained, coordinated action at multiple levels, particularly among leadership. This commentary outlining the work of the LDNC Task Force is not intended to be an internal statement of the APA but a public contribution to the on-going efforts to create a more diverse academic pediatric workforce. Dismantling oppressive systems is not a quick or easy endeavor; however, we must “implement what we preach” to be positive agents of change and build a more equitable society.
Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations.