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    • Diversity and Inclusion Education
  • Diversity and Inclusion Education

  • This page is the result of an effort to create a diversity, equity, and inclusion (DEI) toolkit to assist ophthalmology residents and faculty learn the data and available information to take a critical look at the structures and processes at play that lead to underrepresentation of Black, Latinx, and Native Americans in our ophthalmology community and the impact that lack of diversity has in healthcare outcomes for our patients. The toolkit was curated by Ambar Faridi, MD and Laura Green, MD.

    Journal Articles

    Health and Racial Disparity in Medicine Journal Articles

    • Racism as a Determinant of Health: A Systematic Review and Meta-Analysis (PLoS One, 2015). Review of numerous studies (1983-2013) demonstrating that racism is consistently associated with poorer mental health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580597/
    • COVID-related racial disparities
      • Stolen Breaths (NEJM) : https://www.nejm.org/doi/full/10.1056/NEJMp2021072
      • COVID-19 & Racial/Ethnic Disparities (JAMA) https://jamanetwork.com/journals/jama/fullarticle/2766098
      • COVID-19 and the other pandemic: populations made vulnerable by systemic inequity (Nature Reviews) https://www.nature.com/articles/s41575-020-0330-8
    • How Academia Should Respond to Racism (Nature Reviews, 2020) https://www.nature.com/articles/s41575-020-0349-x
    • Eradicating Racial Injustice in Medicine—If Not Now, When? (JAMA 2020) https://jamanetwork.com/journals/jama/fullarticle/2768353
    • Beyond a Moment – Reckoning with Our History and Embracing Antiracism in Medicine (NEJM 2020) https://www.nejm.org/doi/full/10.1056/NEJMp2021812
    • Hidden in Plain Sight – Reconsidering the Use of Race Correction in Clinical Algorithms (NEJM 2020) https://www.nejm.org/doi/full/10.1056/NEJMms2004740
    • Structural Solutions for the Rarest of the Rare: Underrepresented-Minority Faculty in Medical Subspecialties (NEJM 2020) https://www.nejm.org/doi/full/10.1056/NEJMms2003544
    • Structural Competency: Curriculum for Medical Students, Residents, & Interprofessional Teams on the Structural Factors that Produce Health Disparities (AAMC, 2020) https://www.mededportal.org/doi/10.15766/mep_2374-8265.10888
    • Structural Racism and Health Inequities in the USA: Evidence and Interventions (Lancet 2017) https://www.sciencedirect.com/science/article/pii/S014067361730569X?via%3Dihub#cesec150
    • Structural Racism – A 60 year old Black Woman with Breast Cancer (NEJM 2019) https://www.nejm.org/doi/full/10.1056/NEJMp1811499
    • How Medical Education Is Missing the Bull’s Eye (NEJM, 2020) https://www.nejm.org/doi/full/10.1056/NEJMp1915891?query=recirc_inIssue_bottom_article
    • Racial Microaggressions in Everyday Life: Implications for Clinical Practice (American Psychologist, 2007) https://www.cpedv.org/sites/main/files/file-attachments/how_to_be_an_effective_ally-lessons_learned_microaggressions.pdf
    • Improving Racial Diversity in Ophthalmology Workforce: A Call to Action for Leaders in Ophthalmology (AJO 2020): https://www.ajo.com/article/S0002-9394(20)30575-4/fulltext
    • The Astounding Breadth of Health Disparity: Phenome-Wide Effects of Race on Disease Risk (Journal of the National Medical Association, 2020)  https://reader.elsevier.com/reader/sd/pii/S0027968420301747?token=CCF699E21CED896B5F54D6982ADC18941344CFABCED568283E11F8D973A1565DDB8E6C1029973533D3A3340F00E0578C
    • Ophthalmology Departments Remain Among the Least Diverse Clinical Departments at US Medical Schools (Ophthalmology 2021) https://www.sciencedirect.com/science/article/pii/S0161642021000129?dgcid=rss_sd_all
    • Interviewed While Black (NEJM 2020) https://www.nejm.org/doi/full/10.1056/NEJMp2023999

    • Racial Disparity in the Use of Surgical Procedures in the US (JAMA Surgery 2021) https://jamanetwork.com/journals/jamasurgery/article-abstract/2775061

    Journal Articles on Health Equity and Diversity Provided by the American Academy of Ophthalmology's Leadership Development Program Class XXI, Class of 2019

    Health Equity:

    • Mike, E. V., & Laroche, D. (2020). Preserving Vision in the COVID-19 Pandemic: Focus on Health Equity. Clinical ophthalmology (Auckland, N.Z.), 14, 2073–2077. https://doi.org/10.2147/OPTH.S262586

    • Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician-patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America, 201913405. Advance online publication. https://doi.org/10.1073/pnas.1913405117

    • Rajeshuni, N., Whittemore, A. S., Ludwig, C. A., Mruthyunjaya, P., & Moshfeghi, D. M. (2019). Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014. American journal of ophthalmology, 207, 215–223. https://doi.org/10.1016/j.ajo.2019.04.015

    • Wang, S. Y., Hamid, M. S., Musch, D. C., & Woodward, M. A. (2018). Utilization of Ophthalmologist Consultation for Emergency Care at a University Hospital. JAMA ophthalmology, 136(4), 428–431. https://doi.org/10.1001/jamaophthalmol.2018.0250

    • Elam, A. R., Andrews, C., Musch, D. C., Lee, P. P., & Stein, J. D. (2017). Large Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance. Ophthalmology, 124(10), 1442–1448. https://doi.org/10.1016/j.ophtha.2017.05.003

    • Qiu, M., Wang, S. Y., Singh, K., & Lin, S. C. (2014). Racial disparities in uncorrected and undercorrected refractive error in the United States. Investigative ophthalmology & visual science, 55(10), 6996–7005. https://doi.org/10.1167/iovs.13-12662

    • Zhang, X., Cotch, M. F., Ryskulova, A., Primo, S. A., Nair, P., Chou, C. F., Geiss, L. S., Barker, L. E., Elliott, A. F., Crews, J. E., & Saaddine, J. B. (2012). Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. American journal of ophthalmology, 154(6 Suppl), S53–62.e1. https://doi.org/10.1016/j.ajo.2011.08.045

    • Elam, A. R., & Lee, P. P. (2013). High-risk populations for vision loss and eye care underutilization: a review of the literature and ideas on moving forward. Survey of ophthalmology, 58(4), 348–358. https://doi.org/10.1016/j.survophthal.2012.07.005

    • Zambelli-Weiner, A., Crews, J. E., & Friedman, D. S. (2012). Disparities in adult vision health in the United States. American journal of ophthalmology, 154(6 Suppl), S23–30.e1. https://doi.org/10.1016/j.ajo.2012.03.018

    Diversity:

    • Olivier, M., Forster, S., Carter, K. D., Cruz, O. A., & Lee, P. P. (2020). Lighting a Pathway: The Minority Ophthalmology Mentoring Program. Ophthalmology, 127(7), 848–851. https://doi.org/10.1016/j.ophtha.2020.02.021

    • Doll, KM and Thomas, CR. (2020). Structural Solutions for the Rarest of the Rare — Underrepresented-Minority Faculty in Medical Subspecialties. New England Journal of Medicine, 383(9); 283-285. https://doi.org/10.1056/NEJMms2003544

    • Lett, L. A., Orji, W. U., & Sebro, R. (2018). Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PloS one, 13(11), e0207274.
      https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207274

    • Xierali, I. M., Nivet, M. A., & Wilson, M. R. (2016). Current and Future Status of Diversity in Ophthalmologist Workforce. JAMA ophthalmology, 134(9), 1016–1023. https://doi.org/10.1001/jamaophthalmol.2016.2257

    Books

    • Forty Years of Medical Racism: The Tuskegee Experiments by Michael Uschan

    • How to be Anti-Racist by Ibram X. Kendi

    • Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew 

    • Making Eye Health a Population Health Imperative 

    • Medical Apartheid: The Dark History of Medical Experimentation on African Americans from Colonial Times to the Present by Harriet Washington

    • Medical Bondage by Deirdre Cooper

    • Reproductive Injustice: Racism, Pregnancy, and Premature Birth by Dána Ain Davis

    • Talking with Strangers by Malcolm Gladwell

    • The Health Gap by Michael Marmot 

    • The Immortal Life of Henrietta Lacks by Rebecca Skloot

    • Waking Up Blind by Tom Harbin, MD

    Webinars and TED Talks

    • Racism: The Ultimate Underlying Condition; produced by American Public Health Association.

    • A Path to Reproductive Justice: Research, Practice, and Policies. Provided context of racism in reproductive care across multiple impacted groups. 
    • A Question of Color: Understanding Racial Injustice, Healthcare Disparities, and Glaucoma, Webinar by American Glaucoma Society, Virtual Journal Club, 10/2020.

    • AAMC Webinars – Achieving Inclusion Excellence.

    We are fortunate to have numerous educational resources on diversity, equity, and inclusion, but this can lead to information paralysis and asking ourselves, “Where do we start?” The following TEDTalks shared by AUPO are an excellent starting point for residents and faculty to launch discussions and education in this area. We suggest using the talks as pre-work or homework before a live and interactive flipped classroom session. Subsequent discussions may stem from journal articles and other resources on this site. We hope you find it useful!

      • Implicit Bias, Stereotype Threat and Higher Education

      • The Difference Between Being "Not Racist" and Antiracist

      • We All Have Implicit Biases. So What can We Do About It?

    Other Content

    • Harvard Implicit Bias Test: https://implicit.harvard.edu/implicit/takeatestv3.html 
    • American Public Health Association – Creating the Healthiest Nation: Health and Housing Equity. Racial Inequality in Housing and its Implications for Health Disparities: https://www.apha.org/-/media/files/pdf/topics/equity/health_and_housing_equity.ashx?la=en&hash=FEDA5CD7041C72CBA783AB614E5EC20CAA040DCA 
    • Jane Elliot’s blue eye – brown eye experiment.  https://www.youtube.com/watch?v=oGvoXeXCoUY 
    • How Can We Win by Kimberly Jones https://www.youtube.com/watch?v=3FfFj_to7fU  
    • Just Mercy: A Story of Justice and Redemption: https://www.amazon.com/dp/081298496X/ref=cm_sw_em_r_mt_dp_U_Z384EbRAWW82F?pldnSite=1 and https://www.justmercyfilm.com/ 
    • Oregon Health & Science University Anti-Racist Resources https://docs.google.com/document/u/1/d/1BRlF2_zhNe86SGgHa6-VlBO-QgirITwCTugSfKie5Fs/mobilebasic?fbclid=IwAR2MxhJ3_dyZPsLQol6qKj3z-3ON1hrcX0fpduHjkD4sNYLp7E-_6fXO1oo
    • Harvard Medical School’s Office for Diversity Inclusion and Community Partnership website.  https://dicp.hms.harvard.edu/?fbclid=IwAR0CIxS3yPe55fmTk9TOfyzU4L4lH-uXanH6A7ll1DSoR2Y3Y_wSZqB8oxc.  For anti-racism resources, visit this section of the website:  https://dicp.hms.harvard.edu/resources-anti-racism   
    • Black infants more likely to survice when cared for by Black doctors – US Study https://www.theguardian.com/world/2020/aug/17/black-babies-survival-black-doctors-study 
    • The 10 Commitments Companies Must Make to Advance Racial Justice (Harvard Business Review 2020) https://hbr.org/2020/06/the-10-commitments-companies-must-make-to-advance-racial-justice?utm_medium=email&utm_source=newsletter_monthly&utm_campaign=leadership_not_activesubs&deliveryName=DM86546 
    • A Data-Driven Approach to Addressing Racial Disparities in Health Care Outcomes (Harvard Business Review 2020) https://hbr.org/2020/07/a-data-driven-approach-to-addressing-racial-disparities-in-health-care-outcomes?utm_medium=email&utm_source=newsletter_monthly&utm_campaign=technology_not_activesubs&deliveryName=DM92305 
    • Postmenopausal Black women with heart attacked or coronary artery disease experienced significantly lower treatment rates than Hispanic or white women. https://newsroom.heart.org/news/racial-disparities-continue-for-black-women-seeking-heart-health-care 
    • Medical Students Propose a New Hippocratic Oath – Asking Doctors to Fight Racial Injustice and Misinformation https://www.npr.org/sections/health-shots/2020/11/04/929233492/a-new-hippocratic-oath-asks-doctors-to-fight-racial-injustice-and-misinformation?fbclid=IwAR2LoBdhA83P5XSUlfVVmAaKChwtMm0b1TIGJA-kYDCdhE2mSvcti9bWatY 
    • Medical students seek anti-racist education https://www.washingtonpost.com/health/racism-medical-school-health-disparity/2020/11/06/6608aa7c-1d1f-11eb-90dd-abd0f7086a91_story.html?fbclid=IwAR3cF5BhhY5DD4aPHxHTVCD2jFv9Um6OIfL7AgmWOZnJHUudGrs6EXQwrnM
    • Medical Students edit Hippocratic Oath https://www.npr.org/sections/health-shots/2020/11/04/929233492/a-new-hippocratic-oath-asks-doctors-to-fight-racial-injustice-and-misinformation

    Resources on Implicit Bias and Microaggressions

    Implicit bias:

    • Kirwan Institute 2016 Implicit Bias Review http://kirwaninstitute.osu.edu/my-product/2016-state-of-the-science-implicit-bias-review/

    • Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: Attitudes, self-esteem, and stereotypes. Psychological Review, 102(1), 4–27. https://doi.org/10.1037/0033-295X.102.1.4

    • Greenwald, A., & Krieger, L. (2006). Implicit Bias: Scientific Foundations. California Law Review, 94(4), 945-967. doi:10.2307/20439056

    • Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Strauss, and Giroux

    • Bertrand, Marianne, Dolly Chugh, and Sendhil Mullainathan. 2005. "Implicit Discrimination." American Economic Review, 95 (2): 94-98. DOI: 10.1257/000282805774670365

    • Project Implicit. (2020). Retrieved 25 June 2020, from https://implicit.harvard.edu/implicit/  

    • Mitigating Bias in Virtual Interviews for Applicants Who are Underrepresented in Medicine (J of National Medical Association, 2020) https://reader.elsevier.com/reader/sd/pii/S0027968420301516?token=CAC30EB4DFEE978BF5DDAE62F0B368D88E376AFCCC2729844CB56B7981608A772CFC21DEBC796F751AB544AF09C311C0

    Microaggressions:

    • Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271

    • Gloria Ladson-Billings - National Academy of Education. (2020). Retrieved 25 June 2020, from https://naeducation.org/our-members/gloria-ladson-billings/  

    • Nadal, K.L., Griffin, K.E., Wong, Y., Hamit, S. and Rasmus, M. (2014), The Impact of Racial Microaggressions on Mental Health: Counseling Implications for Clients of Color. Journal of Counseling & Development, 92: 57-66. doi:10.1002/j.1556-6676.2014.00130.x

    • Baker, R., Dee, T., Evans, B., & John, J. (2018). Bias in Online Classes: Evidence from a Field Experiment.

    • Wood, J.L., Urias, M.V. and Harris, F., III (2016), Establishing a Research Center: The Minority Male Community College Collaborative (M2C3). New Directions for Institutional Research, 2015: 65-77. doi:10.1002/ir.20161

    • All of Dr. Wood’s publications https://jlukewood.com/scholarly-publications/

    Activism

    • Black Lives Matter: A global organization founded in 2013 after Trayvon Martin’s murder. https://blacklivesmatter.com/. Sign up for their emails!  

    • National Urban League: Enables African-Americans and the underserved economic self-reliance and provides civil rights support. https://nul.org/

    • NAACP Legal Defense Fund: Protects voting rights and equality for all.  https://www.naacpldf.org/

    • National Coalition on Black Civic Participation: Dedicated to increasing civic engagement and voter participation in Black and underserved communities.  https://www.ncbcp.org/

    • Visit Color of Change at https://colorofchange.org/ and sign up for their emails/newsletters to be able to support them. 

    • Support Black authors:
      • https://www.powells.com/featured/celebrateblackfiction
      • https://www.oprahmag.com/entertainment/books/g26187205/best-books-black-authors/    
      • https://www.publishersweekly.com/pw/by-topic/industry-news/publisher-news/article/83593-amistad-launches-blackoutbestsellerlist-on-social-media.html

    ACGME Requirements

    The ACGME requires that all residency programs educate residents in the following areas that pertain to diversity and inclusion. As of the 2020 ACGME Resident Survey, questions are asked that relate to education in these areas.

     

    ACGME Ophthalmology Program Requirements 7.1.2020

    https://acgme.org/Portals/0/PFAssets/ProgramRequirements/240_Ophthalmology_2020_July.pdf?ver=2020-06-30-144437-230

     

    Introduction. A.

    Residents learn to provide optimal patient care under supervision of faculty members who not only instruct, but serve as role models of excellence, compassion, professionalism, and scholarship.

     

    Graduate medical education transforms medical students into physician scholars who care for the whole patient, family, and a diverse community.

     

    Graduate medical education develops physicians who focus on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve.

     

    Graduate medical education values the strength that a diverse group of physicians brings to medical care.

     

    I.A.

    Background and Intent: Participating sites will reflect the health care needs of the community and the educational needs of residents.

     

    I.C.

    Background and Intent: It is expected that the Sponsoring Institution has, and programs implement, policies and procedures related to recruitment and retention of minorities underrepresented in medicine and medical leadership in accordance with the Sponsoring Institution’s mission and aims. The program’s annual evaluation must include an assessment on the program’s efforts to recruit and retain a diverse workforce, as noted in V.C.1.c).(5).(c).

     

    II.A.4.a).(13)

    The program director must ensure the program’s compliance with the Sponsoring Institution’s policies and procedures on employment and non-discrimination.

     

    IV.B.1.a).(1).(e)

    Residents must demonstrate competence in respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation.

     

    V.C.1.c).(5).(a-c)

    The Program Evaluation Committee should consider the following elements in its assessment of the program: aggregate resident and faculty well-being; recruitment and retention; workforce diversity.

     

    VI..B.6

    Programs, in partnership with their Sponsoring Institutions, must provide a professional, equitable, respectful, and civil environment that is free from discrimination, sexual and other forms of harassment, mistreatment, abuse, or coercion of students, residents, faculty, and staff.

     

    VI.B.7

    Programs, in partnership with their Sponsoring Institutions, should have a process for education of residents and faculty regarding unprofessional behavior and a confidential process for reporting, investigating, and addressing such concerns.

     

    VI.C. Background and Intent

    The ACGME is committed to addressing physician well-being for individuals and as it relates to the learning and working environment. The creation of a learning and working environment with a culture of respect and accountability for physician well-being is crucial to physicians’ ability to deliver the safest, best possible care to patients. The ACGME is leveraging its resources in four key areas to support the ongoing focus on physician well-being: education, influence, research, and collaboration.


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