The tragic deaths due to racial injustice and the disproportionate impact COVID-19
has had on communities of color have been a wake-up call that despite our efforts
we have still failed to address centuries of racism in our country. Racism has led
to healthcare inequities, poor health outcomes, and increased morbidity and mortality
for racial and ethnic minorities.
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Racism has led to underrepresentation of learners and faculty who are racial and ethnic
minorities
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, unsafe learning environments for our underrepresented in medicine (UIM) learners
(those racial and ethnic populations that are underrepresented in the medical profession
relative to their numbers in the general population)
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, and has contributed to the leakiness of the academic pipeline for UIM individuals
at all levels.
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As an organization of leaders of pediatric education, the Association of Pediatric
Program Directors upholds diversity, equity, and inclusion (DEI) as core values. We
have worked hard to incorporate these values in all that we do. Still we recognize
that we have fallen short and there is far more that we can do as an organization
to fight structural racism. We have failed to address the lack of UIM individuals
in our APPD leadership quickly enough. Only recently did we realize that we do not
have certain necessary demographic information about our members, recognizing we cannot
aggressively seek out diverse representation if we do not know our current demographics.
As Academic Pediatrics is the official journal of the APPD, and in recognition of
the journal's internal commitment to address racism in the field of pediatrics
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, we are using this platform to share the APPD's commitment moving forward to confront
racism in six areas. For each of these areas, we have developed tangible goals, timelines,
and accountability, and we are committed to sharing our progress with our APPD membership
quarterly.
Commitment as APPD and Individual Programs to Becoming Anti-Racist
We are making a strong commitment as APPD and urging our individual residency and
fellowship programs to join us in becoming anti-racist. Anti-racism is not merely
the absence of being racist, but rather actively working to dismantle racism in all
that we do. We are re-examining all of our activities as an organization to ensure
that we are breaking down structural racism in every facet, every project, and every
action team. We have re-written our mission statement to more strongly state our commitment
to DEI. In addition, we are supporting our students, residents, fellows, and program
leadership who advocate against racism.
Building a Roadmap for being an Anti-Racist Organization
We are dedicated to defining what it means to be anti-racist as an organization and
as individual member programs, and then holding ourselves accountable to these metrics.
In this process, we will outline steps to becoming anti-racist. We will also compile
and create job descriptions for a number of positions of leadership in DEI (Vice Chair
of Diversity, Chief Diversity Officer, Associate Program Director dedicated to DEI,
Assistant Dean for DEI) to support the hiring practices of institutions and programs.
Creating Educational Materials for Teaching Ourselves, Our Faculty, Staff, Residents
and Fellows to be Anti-Racist
We are committed to creating educational materials to teach ourselves, our faculty,
staff, residents, and fellows to be anti-racist. We had already built implicit bias,
microaggression, and anti-racism training into our leadership programs (LEAD and LEAPES),
and have highlighted this in annual APPD Conferences for the past four years. In addition
to building curricula, we have started a monthly Confronting Racism session for our
members. We are dedicated to training faculty, staff, residents, and fellows in the
history of racism and structural racism and its impacts on children's health, the
communities in which children live, and our learning environments.
We will work with the ACGME to include anti-racism training in their core requirements
for residents, fellows, and faculty development for all specialties and to require
that all institutions have policies on anti-discrimination. We will also work with
the ABP to include anti-racism content as core content for pediatrics certification
and to develop MOC4 credit for faculty working on anti-racism actions in their home
institutions.
Mentoring and Sponsoring our Underrepresented in Medicine Members
In order to improve the disproportionate attrition in academic medicine for UIM individuals,
we will develop specific mentorship and sponsorship programs for UIM residency and
fellowship program leaders. In addition, we will continue our Advancing Inclusiveness
in Medical Education Scholars (AIMS) Program for UIM residents, to help them develop
skills and further interest in medical education and academic medicine.
Research Confronting Racism
We recognize the importance of researching the impact of structural racism on our
clinical learning environments and on the retention of UIM individuals. We also recognize
that interventions intended to stop the impact of racism in medical education must
be studied and properly researched to ensure realization of an intended effect. APPD
is committed to supporting these studies through our LEARN Research Network and Special
Projects Grants.
Working with Other Organizations to Confront Racism to Improve Children's Health,
Community Health, and Social Justice
We will work with our Pediatric Educational Excellence Across the Continuum partners
(AMSPDC, APA, APPD, COMSEP, and CoPS) and Federation of Pediatric Organizations (AAP,
ABP, AMSPDC, APA, APPD, APS, and SPR) to support the development of UIM individuals.
Recognizing that doing impactful work in DEI takes time and resources, we will work
with these organizations to advocate for financial investment in DEI work, including
pipeline programs, recruitment efforts, mentoring programs, and educational efforts.
We will also encourage economic incentives for individuals doing DEI work to address
the minority tax, which is the extra unpaid, uncompensated responsibility placed on
faculty and mentors who are racial and ethnic minorities in the name of efforts to
achieve diversity.
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In addition, we are working with the Children's Hospital Association (CHA) to explore
looking at quality metrics through a racial and ethnic equity lens. We are committed
to ensuring race and ethnicity information is collected in as accurate a manner as
possible – through specifically asking patients and parents directly. We are looking
at potential inequities in care, including disproportionate involvement of security
and Child Protective Service with families of color and inadequate use of interpreters.
In addition, we are working with CHA to ensure hospital faculty and staff are trained
in racism, implicit bias, and addressing microaggressions.
Steps Moving Forward
We are committed to continuing to listen, learn, and add additional priority actions
to dismantle racism. Sadly, the acts of violence against African Americans and the
disproportionate impact of COVID-19 on people of color underscore how much progress
remains to be made. We must continue to fight for a just and equitable environment
for all and speak out against racism and against structures that create health disparities
and inequities for people of color and other marginalized individuals. As pediatricians
and as educators, we are acutely aware of how our patients and our trainees struggle
with these issues. As we prepare the next generation of pediatricians to provide care
for our most vulnerable citizens, we must empower them to be aware, to empathize,
and especially to act.