Prioritizing Diversity in Otolaryngology–Head and Neck Surgery: Starting a Conversation

Abstract

Academic centers embody the ideals of otolaryngology and are the specialty’s port of entry. Building a diverse otolaryngology workforce—one that mirrors society—is critical. Otolaryngology continues to have an underrepresentation of racial and ethnic minorities. The specialty must therefore redouble efforts, becoming more purposeful in mentoring, recruiting, and retaining underrepresented minorities. Many programs have never had residents who are Black, Indigenous, or people of color. Improving narrow, leaky, or absent pipelines is a moral imperative, both to mitigate health care disparities and to help build a more just health care system. Diversity supports the tripartite mission of patient care, education, and research. This commentary explores diversity in otolaryngology with attention to the salient role of academic medical centers. Leadership matters deeply in such efforts, from culture to finances. Improving outreach, taking a holistic approach to resident selection, and improving mentorship and sponsorship complement advances in racial disparities to foster diversity.

Sex Differences in Faculty Positions Among Top‐Ranked US Otolaryngology Departments

“…Various factors contribute to these lasting effects: discouragement of female and minority participation in STEM, inadequate opportunities for early career exposure, and a lack of holistic medical school and residency application review processes. 11 Though the proportion of female otolaryngology residents increased significantly from 2008 to 2018, racial minorities did not see a similar increase in representation in the field. 8 Whereas Black Americans account for 13% of the US population, they make up only 7.1% of US medical students and 2.3% of otolaryngology residents.…”

“…11 For Latinx populations, those numbers are 18%, 6.4%, and 6.2%, respectively. 11 Programs aimed directly at mentorship of underrepresented minority medical students have been shown to increase these students' interest in applying to an otolaryngology residency. 12 Additionally, program emphases on recruiting diverse residents-specifically via department-level diversity and inclusion initiatives, as well as diversity and inclusion language on departmental websites-are proven examples of successful strategies to increase female representation within residency programs and may, in part, contribute to the narrowing of the gap in female representation that has been observed in recent years.…”

Faculty Recruitment, Retention, and Representation in Leadership: An Evidence-Based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine

“…[27][28][29] Institutional and departmental dashboards should include diversity and equity goals to monitor performance. 1,30,31 Incentive bonuses, academic promotion, and eligibility to leadership positions for all faculty could be tied to participation in diversity and inclusion activities and performance metrics on diversity outcomes. 32 The Medical University of South Carolina developed an assessment tool for each department that included quantitative and qualitative variables (eg, UIM individuals recruited, grand rounds/seminars on diversity, UIM speakers, activities related to healthcare disparities and social determinants of health, and implementation of cultural competency training).…”

“… 27 – 29 Institutional and departmental dashboards should include diversity and equity goals to monitor performance. 1 , 30 , 31 …”

“…Faculty selection should employ a holistic review of candidate applications. 19 , 30 Holistic review emphasizes the need to assess characteristics that the institution values. For example, one group asked questions that were behavior-based on topics related to clinical practice, education, leadership, and diversity and inclusion (eg, “What do you see as the fundamental characteristics of an inclusive environment?”).…”