A Look at the Past, Present, and Future of DEI Medical Education Initiatives

Resistance is frequently rooted in psychological threats to established groups. “Individuals in majority or in-groups may feel that DEI initiatives diminish their achievements, fearing a scenario where they believe less qualified individuals gain influence,” Dr. Johnson said. “Confronting the possibility that one’s success might be intertwined with an unjust system can also be morally unsettling, further fueling the perceived threat.” 

To navigate these challenges, continuous advocacy is essential to cement DEI as a priority, on par with other crucial aspects of healthcare delivery and professional education, he added.

Another significant barrier to wide adoption of DEI initiatives is what has been dubbed the “minority tax,” “cultural tax,” or “diversity tax,” referring to the extra burden or workload that individuals from underrepresented or marginalized groups often experience in professional and academic settings, Dr. Brenner said. Academic medical centers often ask faculty to volunteer for DEI efforts, including committee work, events, recruitment, mentoring, or administrative roles. 

“Oftentimes, these efforts aren’t valued commensurately with traditional metrics of academic success,” Dr. Brenner noted. “Such efforts may go unrecognized, unrewarded, and/or uncompensated.” 

Another obstacle is a lack of funding—initiatives often require specific funding to ensure success and longevity, and sustaining enthusiasm can also be challenging. “Unfortunately, especially in settings where resources are limited and numerous competing demands exist, DEI initiatives may not be prioritized,” said Jennifer A. Villwock, MD, an associate professor of otolaryngology–head and neck surgery at University of Kansas Medical Center in Kansas City, Kan.

Slow but Steady Progress

While DEI initiatives have been broadly adopted, the strength and intentionality of efforts vary. A 2018 diversity survey (Otolaryngol Head Neck Surg. 2018. doi:10.1177/0194599818770614) distributed among otolaryngology programs showed that most programs reported interviewing at least four URM applicants each year; however, over one-third reported having no or only one URM resident matriculate into their program within the previous 15 years, said Sarah N. Bowe, MD, EdM, program director of otolaryngology at San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio–Ft. Sam Houston in Texas. Furthermore, most programs reported having no or only one URM faculty. 

In graduate medical education and AAMC data, trends in representation vary across races and genders. Limited data are available on international medical graduates, first generation, low-income, LGBTQ+, and able-status populations in the otolaryngology workforce, Dr. Watkins said.

Women have had a significant increase in representation within the OHNS workforce (Otolaryngol Clin North Am. 2020. doi:10.1016/j.otc.2020.05.016), but they remain disproportionately underrepresented in otolaryngology residency and fellowship leadership positions, across professorship levels, and among major otolaryngology editorial boards (Laryngoscope. 2021. doi:10.1002/lary.28958).