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An Inclusive Residency Program Doesn’t Only Come From Diversity

I scanned the roster of current residents and program leadership. Did I see people of color? Did I see a variety of ethnicities? What about gender diversity? This was my nightly tradition before any residency interview day. As a South Asian Muslim American woman, the answers to these questions greatly influenced how I evaluated prospective residency programs on the interview trail. 

Needless to say, I am not the only one that takes factors such as diversity into consideration. Numerous studies show that prospective residents consider the diversity of the trainees and staff in how highly they rank a residency program. Those who come from underrepresented minorities are more likely to consider ethnic diversity and a training environment that supports minorities in their decision-making than their white colleagues. Similarly, women are more likely to consider the presence of gender diversity. In fact, more residency applicants consider diversity now across all specialities than they did years ago. A study of 2008–2017 residency match data showed that an impressive 33.8% of applicants cited diversity as a factor in program ranking, an increase of more than 10% in the last decade. 

It is unsurprising that minority medical providers feel more propelled to seek out diverse work environments. Minorities frequently face discrimination from not only their patients, but also the very providers they share the workspace with. This unfortunate reality gives greater appeal to diverse workplaces, where minorities are more likely to feel affinity with their co-workers, receive training on topics like cultural humility and health equity, and have resources for support after experiencing micro and macroaggressions. Thus, in a world where I continually swallow the blows of racism, sexism, and Islamophobia, I consciously seek out spaces with people who share some of my core traits for a sense of community and safety. I no doubt applied this philosophy to finding the community where I would complete my residency for a taxing three years of training. 

But I was wrong to think that, to feel the type of community I longed for in a residency program, everyone needed to share my skin color or celebrate the same religious or cultural holidays as me. It is an ACGME requirement that every residency program “must engage in practices that focus on mission-driven, ongoing, systematic recruitment, and retention of a diverse and inclusive workforce of residents.” Part of what this translates to during recruitment season is a variety of ways that programs address the topic of diversity with prospective residents, from “diversity dinners,” to pamphlets and webpages showcasing affinity groups, to personally sent emails offering opportunities to connect with similarly-identifying residents. What surprised me was how I did not necessarily feel an immediate kinship with a program simply because I identified with an affinity group, saw or met residents who shared my religion or ethnicity, or attended a diversity-focused gathering.

This is because diversity and inclusion are two different entities. I realized this distinction when, on one of my interview days, I was asked a question about how I try to be inclusive of my co-workers in the workspace. During no other residency interview was I provided a space to discuss a topic so important as how to be inclusive of others. Another interview conversation that day led me down a path of discussing obstacles I faced as a Muslim medical student. Again, I had never been given a space to speak so frankly about the Islamophobia and racism I experienced as a medical student, experiences that are so integral to who I am. The effect of discussing such topics left me feeling known, celebrated, and supported as a Muslim female of color for the first time that interview season. 

The overwhelming sense of support and belonging I walked away with that interview day marked a profound shift in how I evaluated residency programs. Demographic diversity is only part of what can make minorities like me feel safer in a learning environment. What matters equally is creating a palpable environment of inclusion. This comes with recruiting residents and faculty who themselves possess inclusive mindsets. Another important aspect of creating such a culture is continuing dialogue about diversity and inclusion in the conversations and curricula that residents have day to day. This can range from anti-racism and microaggression training, to connecting part of afternoon didactics to issues of health equity, to providing full-fledged support for residents who face any kind of discrimination. Such efforts have made all the difference at my current training program, where I am often reminded by endeavors like these that I and everyone else around me are valued and belong. 

As someone who carries the identities of multiple minority groups, I will always scan the rosters of institutions where I consider training and be cognizant of how diverse my surroundings appear. And yet, I learned this interview season that a culture of inclusion cannot be assessed from simply scanning the array of faces and names. While creating a more diverse workspace is certainly important, an environment burgeoning with equality and inclusivity is rooted more in the progressive curriculum and kind, accepting natures of the individuals that shape the unique ambient of a training program. I am truly grateful to be part of a program in constant pursuit of this vision.

Sara is a Los Angeles native in her first year of pediatrics training at Seattle Children's Hospital in Seattle, WA. She enjoys reading, hiking, taco trucks, chai, and her cat, Tibby. She is a 2020–2021 Doximity Op-Med Fellow.

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