From staff initiatives to recruitment of URMs
American Board of Medical Specialties (ABMS) Member Boards are addressing diversity, equity, and inclusion (DEI) in myriad ways from efforts related to their governance and organizational culture to their certifying examinations and continuing certification programs.
From a governance perspective
Most Member Boards collect demographic data about their governance members and many collect such data for committee members. Using these data, the boards are evaluating bylaws, policies, processes, and other documents aimed at achieving greater diversity in recruiting underrepresented minorities (URMs) as members of leadership and volunteer groups. Additionally, many boards have established task forces/committees to identify DEI-related issues and solutions with respect to creating greater diversity among their governance groups.
At the American Board of Pediatrics (ABP), the senior management team uses the data it has been collecting for years about the race/ethnicity and gender of all governance and committee appointees to inform recruitment and appointment processes to achieve a more diverse and inclusive governance.
This past August, the American Board of Internal Medicine’s (ABIM’s) Board of Directors (BOD) established a DEI Committee to explore opportunities for structural change in the board’s governance, operations, and programs. The following month, ABIM named Pamela Browner White as its first Chief DEI Officer. Browner White, who had served as ABIM’s and the ABIM Foundation’s Senior Vice President of Communications since 2016, will be responsible for setting and implementing an overarching DEI vision for ABIM and the ABIM Foundation. She also will support the work of the governance-led DEI Committee chaired by ABIM Board member Robert Roswell, MD, and supported by ABIM Vice President of Medical Education Research Lorna Lynn, MD, which recently began reviewing ABIM’s policies. Since 2014, ABIM has been collecting race/ethnicity data on nominees to serve on its boards and committees to achieve greater diversity among its leadership and volunteers.
On the organizational front
Several Member Boards are working to identify organizational DEI principles and priorities, assess their organizational culture, and review Human Resources’ processes. Many boards have created or are developing programming and initiatives aimed at educating and informing colleagues about racism in the form of implicit bias training, discussion forums, book clubs, and professional development, among other efforts. More than half of the boards have collected, are collecting, or plan to collect more robust demographic data on their staff.
At ABP, staff have had the opportunity to participate in the Groundwater Approach training by Racial Equity Institute. The board has implemented an internal facing DEI Council and conducted an independent analysis of bias in salary structure. ABP is working with a DEI and racism consultant, conducting implicit bias training, and plans to review all internal policies/procedures. The board has hosted listening sessions where staff have shared their stories, conducted post-meeting racial conversation surveys, held a Juneteenth event, and created DEI resources shared on its internal website.
Similarly, the staff and BOD of the American Board of Anesthesiology (ABA) have participated in DEI-related reading, training, workshops, and forums.
In addition to establishing a core DEI team, in March ABIM selected an external DEI consultant to support and guide the board’s DEI initiatives, including efforts to cultivate a more inclusive workplace. ABIM has hosted all-staff educational opportunities around Juneteenth and Martin Luther King, Jr. Day.
The Member Boards are at various stages in terms of DEI analyses of certification examinations. Some are already gathering fulsome DEI data while others are exploring the expansion of the type of demographic data they collect from candidates or physicians. A few boards have used these data to evaluate the outcomes of their examinations while some are interested in performing these analyses. Most boards currently provide implicit bias training for item writers and examiners and plan to expand such training opportunities in the future.
The American Board of Family Medicine (ABFM) has collected race and ethnicity data for the past eight years and has incorporated them into its ongoing improvement efforts. Using differential item functioning procedures, the board uses a statistical test to flag exam questions that might potentially be biased; the flagged questions are then reviewed by a panel of board certified family physicians who represent the perspectives of different minorities. ABFM hopes to apply these procedures to its longitudinal assessment soon and is exploring the viability of applying them to the Sports Medicine examination. ABFM also will use this data to explore disparities in initial certification. After noticing a substantial difference in initial exam performance among international medical graduates nearly a decade ago, ABFM collaborated with the Accreditation Council for Graduate Medical Education (ACGME) Family Medicine Residency Review Committee to put in place a series of interventions for residencies and their educational environment. The gap between international medical graduate and United States medical graduate performance has narrowed dramatically in recent years.
ABA will begin collecting race/ethnicity data from candidates and certified physicians later this year to enable research on exam performance and outcomes based on demographic data, including a study it plans to conduct in collaboration with ACGME. The board is surveying volunteers to establish a baseline for identifying metrics to set goals and track progress of these efforts. ABA is providing unconscious bias and inclusion training for all examiners.
In 2018, the American Board of Obstetrics and Gynecology (ABOG) began studying unconscious bias in its Certifying Examination process. The board is doing the same for its Qualifying Examination. The following year, all specialty and subspecialty examiners were trained to identify and manage unconscious bias. This training is now a standard requirement for all examiners on a yearly basis.
ABP is in the process of strengthening its bias prevention training materials for volunteers who write, review, and approve test questions and in 2020, began assessing individual test items for the General Pediatrics Certifying Examination for bias with a new Bias and Sensitivity Review Panel.
Continuing certification programs
Additionally, Member Boards are beginning to include DEI content in their continuing certification programs. While the American Board of Ophthalmology (ABO) has added health care equity content to its Quarterly Questions reading list for 2021, ABA recently updated its Maintenance of Certification in Anesthesiology (MOCA®) content outline to include health care disparities and DEI, and will launch related MOCA Minute® questions this year. ABA is considering how lifelong learning and self-assessment in continuing certification could address issues of racism and bias in clinical care.
A few years ago, ABOG began efforts to increase awareness of racial disparities in women’s health through its continuing certification program. The board began offering topical articles to physicians and this year, ABOG will provide additional articles as mandatory reading for all those in the 2021 continuing certification process. The board also grants continuing certification credit for physicians who participate in quality improvement initiatives that aim to reduce health disparities within the specialty.
This past June, ABFM launched a Health Equity Performance Improvement activity that allows family physicians to tailor their improvement activity to their specific practice or community needs. This activity also provides a variety of resources to support physicians in tackling these issues – from reviewing differences in clinical quality among groups that historically have experienced disparities to both practice and community-level assessments and interventions to address social determinants of health. This year, ABFM plans to launch a Knowledge Self-Assessment activity designed for physicians to assess their own knowledge of health disparities and their underlying causes. The board is partnering with the American Academy of Family Physicians to utilize the Academy’s educational materials on health equity, developed by family physicians as part of the Family Medicine for America’s Health Initiative.
The bigger picture
Some Member Boards are working to advance DEI efforts more broadly within their specialty. Overall, these efforts involve collaborating with their respective specialty societies. Activities include convening educational councils, participating in pipeline discussions and activities, and conducting surveys.
This past fall, ABIM and the ABIM Foundation partnered with the Alliance for Academic Internal Medicine, American College of Physicians, and Josiah Macy Jr. Foundation to announce a new grant program for internal medicine residents and faculty members. A total of $300,000 will be available to support projects, between $2,500 and $20,000, designed to promote trust and create a more equitable health system by incorporating DEI into the fabric of internal medicine education. ABIM’s DEI Committee will advise the BOD on developing policies regarding the role of certification in addressing health disparities and structural racism, and ABIM’s specialty boards will discuss opportunities for collaboration in their fields to address discipline-specific issues at their spring 2021 meetings.
Currently, the ABP Foundation funds the New Century Scholars and Frontiers in Science programs, both of which aim to increase URMs in academic medicine by reaching out to residents and fellows. Recently, ABP convened stakeholders and promoted the launch of a learning network for sickle cell disease. Pediatric learning networks are multi-site, practice-based clinical networks that use data for research and improvement.
ABO collaborates with the American Academy of Ophthalmology to provide financial support for the Minority Ophthalmology Mentoring Program to increase diversity in the specialty.
The American Board of Genetics and Genomics is working with its major professional societies on a comprehensive workforce diversity initiative survey and assessment. In addition, the board has convened a group to work directly with historically black colleges’ and universities’ medical schools to recruit URMS into the specialty.
ABOG formed an internal task force in 2020 made up of leadership and staff members plus an ad hoc committee of BOD members charged with, among other tasks, facilitating public acknowledgement and awareness among ABOG stakeholders of the role that racism has played in the specialty’s history. The board also is collaborating with obstetrics/gynecology specialty organizations and societies to address racism and biases across women’s health care and to help facilitate concrete change and equitable patient outcomes.
Additionally, some Member Boards are publishing papers related to diversity in their specialty. ABFM tracks a broad base of demographics of certification candidates (all residents), board eligible physicians, and certified physicians over time. This allows the board to follow the patterns of certified family physicians regarding their practice types, scope of practice locations, and reported compensation, among other measures throughout their careers. ABFM regularly reports its findings in the peer-reviewed literature and reviews them internally to drive programmatic considerations.
© 2021, American Board of Medical Specialties
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