Diversity, Equity, and Inclusion Efforts at MU SOM and the Department of Dermatology

Introduction

To address health care inequities and improve patient outcomes, especially in populations that are underrepresented in medicine, intentional and simultaneous efforts are needed by the medical community at the individual, local, regional, and national level. Reevaluating and innovating our strategies toward medical education and patient care is essential to produce impactful and sustainable results. Targeted efforts to integrate diversity, equity, and inclusion (DEI) initiatives are important in order to ensure comprehensive medical education and patient access to high quality equitable healthcare. This can be done through addressing cultural bias in medicine, diversifying the healthcare workforce, mentorship, incorporating diverse patient populations in medical education and creating awareness of microaggression, implicit bias and social determinants of health.

A lack of diversity, equity, and inclusion in medicine poses a major hurdle to delivering equitable healthcare services, especially to underrepresented communities. This is underscored by the fact that when compared to whites, racial and ethnic minority groups consistently experience higher rates of morbidity and mortality across most medical specialties, even when accounting for factors that contribute to health disparities.¹ In dermatology, Hispanic and Black patients are less likely to receive outpatient dermatologic care compared to non-Hispanic white patients, as are less-educated, lower-income, publicly insured and uninsured Americans.² Although the U.S. population continues to grow more diverse, Black and Hispanic dermatologists are significantly underrepresented; Black and Hispanic dermatologists make up only 3% and 4.2% of all dermatologists respectively, compared with 12.8% Black and 16.3% Hispanic in the general U.S. population.³ Subsequently, dermatology is recognized as the second least diverse medical specialty which underscores the critical need for DEI efforts in dermatology. Dermatologic organizations have been working nationally to prioritize workforce diversification, DEI education, mentorship, and research efforts to improve access and quality of dermatologic care.⁴

In healthcare education, studies have shown that students educated in diverse learning environments demonstrate broadened perspectives of race, religion, ethnicity, and cultural diversity; they also report improved learning outcomes including active thinking, empathy, intellectual engagement, and motivation.⁵ In addition, prioritizing diversity and inclusion has been shown to result in improved communication, decision-making, adherence to care plans, and problem-solving for complex medical issues.^6,7 More diverse healthcare teams have been associated with reduced racial health disparities, improved patient outcomes and satisfaction, and better team communication, risk assessment, and clinical decision-making.⁸ With a vision to become “the premier and transformational academic health system for Missouri,” the University of Missouri School of Medicine (MU SOM) strives to save and improve lives through exemplary education, research, and patient care. Working toward this goal, the academic health system has incorporated diversity, equity, and inclusion as one of its core values. In this article, we highlight system-wide initiatives to help improve diversity, equity, and inclusion at MU SOM and in the Department of Dermatology.

DEI Efforts Underway at MU SOM

MU SOM is committed to fostering a diverse and inclusive environment. Each department has a Diversity Ambassador to build a culture of collaboration and help ensure the success of each unit’s efforts. The Diversity Ambassadors are encouraged to exchange ideas and share initiatives among departments to reproduce and collaborate on effective strategies.

The Addressing and Reducing Cultural Bias in Medicine curriculum is offered to faculty with the goal to develop a more capable faculty workforce with the ability to manage discussions surrounding race and discrimination, including their role in healthcare. Topics include the historical context of race, cultural self-awareness, privilege, implicit bias, microaggressions, and intersectionality.

Amongst the student body, third- and fourth-year medical students who have demonstrated commitment to advancing diversity, equity, and inclusion are selected to become Student Diversity Ambassadors. They work under the guidance of the Office of Diversity and Inclusion, serving as liaisons between the student body and assisting with centralizing student organization DEI efforts.

The MU SOM Visiting Student Diversity Program provides an opportunity for fourth-year medical students from other institutions to complete an elective rotation with the University of Missouri School of Medicine. The Department of Dermatology and eleven other participating departments highly encourage students in groups underrepresented in medicine to apply for this program, which includes a housing stipend to support the student during their time participating in clinical and educational activities, conferences, and mentorship opportunities. There are several other pipeline programs developed for students underrepresented in medicine, first generation college students, socio-economically disadvantaged students, nontraditional students and those from rural areas, including Med Prep Series, Pathways to Success Pre-Admission Program, Bryant Scholars, Medical Explorations, Excellence in Learning, and the Summer Research Internship.

The Office of Admissions established the Inclusivity Symposium to highlight the school’s commitment to improving inclusion, diversity, and equity. These symposia are held during the interview season for interviewees to directly experience the culture and community of inclusive excellence. Students often enthusiastically volunteer to partake in such activities and are encouraged to give suggestions on how DEI initiatives can be improved.

As a health system, MU SOM was chosen as one of 11 schools to participate in the Anti-Racist Transformation in Medical Education project, a three-year program that develops an institution’s capacity to implement the multi-phased change management strategy of Icahn SOM Mt. Sinai. Goals include building the capacity of institutions to dismantle systemic racism and bias in work and learning environments and promoting shared learning on how to dismantle racism in medical schools.⁹

Among many other initiatives, the Dean for Diversity and Inclusion offers lectures and workshops on microaggression, implicit bias, and social determinants of health. During such lectures, students are encouraged to participate in small group activities to engage in respectful discussions and nurture enthusiasm for improving diversity, equity, and inclusion.

DEI Efforts Underway in the Department of Dermatology

Missouri is an incredibly diverse state, and as the Department of Dermatology of the University of Missouri, our program is committed to training Dermatologists who can care for all Missourians. The department and its training programs have long prioritized improving dermatologic care for underserved Missourians. This necessitates training a diverse group of young physicians from a variety of backgrounds utilizing the broad patient population who accesses our health system. For a number of years we have implemented a holistic review of residency applications, considering all aspects of the applicant including academic evaluations, attributes, and experiences and how they align with the mission of the department and SOM. This approach helps to reduce systemic bias, with the goal of selecting an exceptional and well-rounded group of future dermatologists who will contribute to learning, teaching, and the practice of medicine.^9,10

Representatives from the department usually attend regional and national meetings organized by the Student National Medical Association (SNMA) - an independent, student-run organization focused on the needs and concerns of underrepresented in medicine (URiM) medical students in the United States. These meetings serve as opportunities to create awareness about the dermatology program at MU SOM and recruit top talents from diverse backgrounds to apply to our program.

To ensure comprehensive dermatological education of trainees, dermatology faculty have increased the representation of cutaneous pathology in the skin of color in all lectures to show the diverse presentations of cutaneous manifestations of different diseases. The J. Otto Lottes Health Sciences Library strives to offer books like Taylor and Kelly’s Dermatology for Skin of Color to familiarize students with the presentation of various dermatologic disorders in different skin colors. The Deparment of Dermatology also offers grand rounds and department didactics on a variety of topics related to DEI. Dermatology faculty participate in mentorship and shadowing programs, including the MU SOM Pathways to Success Pre-Admission Program for undergraduate students and the National Medical Association Dermatology Mentorship program for medical students interested in dermatology. Dermatology residents and faculty help organize and staff a monthly specialty night at MedZou Community Health Clinic, which provides free medical services to uninsured residents of central Missouri. This helps reduce disparities and increase access to dermatologic care for diagnosis and treatment of cutaneous conditions in underserved populations. Within the Dermatology Department, a new skin of color clinic has been created as of October 2022 with the goal of offering specialized services for patients of color (defined as skin types IV–VI in the Fitzpatrick Skin Type Classification) to further address medical, surgical, and cosmetic concerns unique to this patient demographic.

DEI Efforts Underway in Dermatology Nationally

At the national level, there are increasing efforts by U.S. dermatologic societies to partake in DEI initiatives with a goal to create a healthcare landscape that is reflective of the population of patients needing dermatologic care. Dermatologic organizations have been working to prioritize DEI education, mentorship, and research efforts such as the Annual Skin of Color Society Scientific Symposium, Diversity Champion Workshop, numerous mentorship programs, and lecture series and curriculum modules with emphasis on skin of color, healthcare disparities, and implicit bias.⁴ The American Academy of Dermatology (AAD) has a well-established AAD Diversity Committee, which created a three-year (2021 – 2023) DEI plan, to help foster diversity in dermatology and increase the availability of dermatological services to under-served populations.¹¹

To affirm its commitment to eliminating health inequities and increasing access to dermatological care, in 2021 the AAD published a formal “Position Statement on Dermatology Workforce Diversity and Health Disparities.”¹² In this position statement, the AAD acknowledges the need to increase awareness of health disparities and social determinants of health among physicians. The statement further affirms the following: 1) supporting policies that allow Fellows of the American Academy of Dermatology (FAAD) to deliver care to all patients with dermatologic conditions that need care; 2) developing and increasing research of dermatologic conditions that occur disproportionately in racially and ethnically diverse groups; 3) supporting the promotion of leadership and faculty development of dermatologists from ethnic and racial groups that are underrepresented among physicians in dermatology; and 4) supporting policies that address systemic and institutional inequities outside of health care that lead to poor health outcomes.¹²

Effective collaboration is a key feature of inclusive leadership.¹³ In recognition for the need of effective collaboration to enhance DEI initiatives, the AAD established an Intersociety Diversity Task Force (IDTF) to “support the goals and facilitate awareness, communication, and implementation of the AAD DEI initiatives.” The IDTF includes the dermatologic societies AAD, Association of Professors of Dermatology, Skin of Color Society, Society of Investigative Dermatology, Women’s Dermatology Society, National Medical Association Dermatology Section, and American Society of Dermatologic Surgeons. The IDTF has also collaborated with the National Hispanic Association, and the program, Nth Dimensions—a pipeline program for women and minorities seeking to match in competitive medical specialties. The program hosts BioSkills workshops at Historically Black Colleges and Universities in an “effort to offer URiM students early exposure opportunities to learn basic dermatologic procedures.”¹⁴

Conclusion

MU SOM and the Department of Dermatology are committed to leading the efforts to improve patient health and quality of care by promoting diversity, equity, and inclusion in the medical school and residency program. The DEI initiatives implemented thus far range from small group discussions in classes, to department-wide efforts, and to recruitment and retention of top talent across the academic health system. With dermatology being the second least diverse medical specialty after orthopedic surgery,¹⁵ we hope that the efforts of the Department of Dermatology at MU SOM will help bridge this gap in order to provide quality, compassionate and comprehensive care to all patients.