The last few years have witnessed a significant expansion of graduate medical education efforts at UAB School of Medicine in order to increase the recruitment and retention of residents and fellows who belong to groups that are under-represented in medicine. The Dean’s Committee for Graduate Medical Education (DCGME) Subcommittee for Diversity and inclusion has not only sponsored events to increase community among under-represented trainees, but has also initiated crucial research-based strategy initiatives.

Recruitment and retention of a diverse body of residents and fellows is a challenge for most, if not all, academic medical centers in the United States. A myriad of structural and social obstacles means that women, members of the LGBTQ community, religious minorities, and racial and ethnic minorities are often under-represented in medical school classes. This initial under-representation carries forward into training.

In 2018, Latesha Elopre, M.D., and Marquita Hicks, M.D., conducted comprehensive qualitative research in order to understand why some trainees were choosing UAB, and others were matching with other institutions for their residencies. In addition to analyzing themes related to graduate medical education recruitment at UAB, researchers examined data and recommendations from the Association of American Medical Colleges (AAMC). 

The report that summarized this research made a series of 10 recommendations to improve diversity in residency recruitment. These recommendations are:

1. Engage in a holistic review of applicants interviewed (blinding of Step scores).
2. Step score cut-offs for under-represented in medicine (URiM) applicants.
3. Effectively ranking URiM applicants.
4. Tailored interviewers for URiM applicants.
5. Unconscious/Implicit bias training for interviewers.
6. Engagement of highly competitive URiM applicants for Second Look Weekend.
7. Outreach after interviews.
8. Consider a visiting elective program.
9. Attendance at conferences designed to reach URiM applicants.
10. Initiatives to improve cultural competence for all residents and faculty.

In January of this year, Latesha Elopre, M.D., an assistant professor in the Division of Infectious Diseases, was named director of Diversity and Inclusion for Graduate Medical Education. Together with Tera Howard, M.D., who stepped up to leadership at the departure of Marquita Hicks, she co-chairs the DCGME Subcommittee for Diversity and Inclusion. 

The Office for Diversity and Inclusion recently sat down with Dr. Elopre and Alice Goepfert, M.D., who serves as associate dean for Graduate Medical Education as well as holding the position of professor in the Department of Obstetrics and Gynecology’s Division of Maternal-Fetal Medicine. 

Q: What’s been driving the initiatives underway with Graduate Medical Education?

Alice Goepfert: Dr. Vickers announced two years ago that increasing the diversity in recruitment and inclusion in retention of residents was one of his game-changer priorities. Latesha Elopre and Marquita Hicks were, at that time, the co-chairs of the Subcommittee for Diversity and Inclusion on the Dean’s Council for Graduate Medical Education, and they tackled this mandate with enthusiasm. They came up with a very data-driven way to look at where we are currently in terms of diversity and inclusion in GME, and then came up with a research-based approach, grounded in the literature, for how to improve diversity and inclusion. They spoke to the AAMC and other institutions who were effectively increasing diversity, and based their recommendations on this multi-tiered research. 

Latesha Elopre: We had a lot of help from the Office for Diversity and Inclusion, and the strategic plan was reviewed by the Dean’s Council. The programs were asked to list their top priorities to work on for last year, and then we followed up this year, and we’re currently in the process of reporting on this to the Dean’s Council. 

Q: Were there any findings from that report that were surprising?

LE: We had some surprises, and some disappointments. One of the most surprising aspect was that, in speaking to applicants and residents, that nearly all of them talked about the warmth and the friendliness of the people at UAB. This really stood out, and indicates that we have a strong culture of welcoming. On the flip side, something that was a little disappointing was that some people indicated that they felt that some of our diversity efforts felt superficial. 

AG: It signaled to us that we needed to explore this a little further. Why are these efforts coming across as superficial? It’s something that we certainly need to address. Some of this has to do with the comparatively small number of faculty that look like them. We’re hearing that clinically we’re very strong, and we’re warm and welcoming. We also know that our program directors have a clear interest in making improvements, and that we have a very engaged and committed subcommittee. But we obviously have areas that we want to continue to work on. Continuing with implicit bias training is important, and attending conferences like the SNMA, and having visiting student electives will all be critical as we move forward. 

Q: What are the most significant obstacles that you’re facing right now?

AG: One of the key issues we’re trying to promote is holistic review of applicants. There are so many factors that go into making an applicant an excellent fit for our programs, but it’s very easy to place too much emphasis on one part of the application – for example, Step One scores or AOA status. If an applicant has made the Step One cutoff, it’s important to not place as much emphasis on their specific score, and to look instead at the whole person. 

LE: We have enthusiastic program directors, and data-driven recommendations – but it’s going to take dedicated resources to make this happen. 

Q: What are the top priorities moving forward?

AG: Continuing to track our operations – collecting and analyzing data in order to make the best possible decisions – is going to be essential. We want to be able to track our progress, and also to be able to identify additional resources in order to build our programs. 

LE: We also want to be sure we’re continuing to build community, where people who are members of groups who are under-represented in medicine feel that they can find and support each other. This isn’t just about racial or ethnic minorities, but also about people who are part of the LGBTQ community, residents who come from rural backgrounds, or who have had alternative educational trajectories. 

AG: We’ve had some exciting events and mixers, such as the Diversity Celebration Mixer in April 2019, and the Welcome Reception, that have been well received. We’ve also offered professional development seminars. We want to continue to prioritize these events and expand upon them.