To our knowledge, this is the first qualitative study to explore in-depth the perceptions and attitudes of faculty regarding the impact of the diversity climate at an academic medical institution. Our focus group and interview discussions elucidate faculty beliefs about the diversity climate that may have been difficult to capture in previous survey studies.4–6
In defining cultural diversity, study participants noted that visible dimensions (race/ethnicity, gender, foreign-born status) often provoke bias and cumulative advantages or disadvantages in the workplace that impact faculty recruitment, promotion, and retention.
We used Hurtado's framework for understanding diversity climate to help us interpret our findings. As illustrated in , the diversity climate is influenced by an institution's historical legacy of inclusion or exclusion of minority students and faculty, and the institution's structural diversity (e.g. number of diverse students, faculty, and staff), psychological climate (e.g. perceptions of racial/ethnic tension), and behavioral dimensions (e.g. the quality and quantity of interactions across diverse groups).18
Using this framework, we were able to better interpret study participants' perceptions and experiences with respect to visible dimensions of diversity to determine the impact on the diversity climate at our institution.
FIGURE 1 Factors influencing racial/ethnic diversity climate within an institution. Source: Hurtado et al.18
Both minority and majority faculty discussed the problem of underrepresentation of ethnic minorities in academic medicine. They agreed that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, qualifications for training programs, and subsequent recruitment to training programs and faculty positions. This finding confirms a recent report that found that parental education and income has a profound effect on academic achievement in the early years of training and success thereafter.19
While inadequate financial resources discourage all qualified students from pursuing a college education and then medical education, lower socioeconomic status is disproportionately present among African Americans and Hispanics.20
Faculty comments in this domain are most relevant to structural diversity
in Hurtado's framework.
Qualified candidates who make it through medical school may face additional race- or ethnicity-based challenges during the rest of their training and future employment. In our study, minority and foreign-born faculty report ethnicity-based disparities in recruitment to residency or fellowship programs and faculty appointments and subtle manifestations of bias in the promotion process. Previous studies that document disparities in faculty promotion substantiate this perception.7,21
In contrast to minority and foreign-born faculty, some majority faculty in our study view promotion as an objective process; others suggest that efforts to increase promotions among minorities may be reverse discrimination. These types of diametrically opposed views may be divisive and negatively impact the psychological climate
of diversity within an institution.
Regarding general experiences in academic medicine, minority faculty further describe structural
barriers (poor retention efforts, lack of mentorship, and cultural homogeneity) that hinder their success and professional satisfaction after recruitment. This finding supports recent studies that reveal that racial or ethnic discordance or gender discordance between mentors and protégés may present unique challenges for individuals in these relationships.22–24
In our study, the paucity of minority role models or mentors is perceived as a major barrier to recruitment and retention of ethnic minorities because it limits the number of visible faculty with whom they can identify with regard to socio-cultural issues.
Our study does have some limitations. First, we had a small sample size, and our sampling frame was based on one institution; therefore, the study results may have limited generalizability to other academic institutions. However, despite our small sample size, we achieved theme saturation. Second, our study may have selection bias. The faculty who responded to our e-mail recruitments may have had recent experiences of bias or disadvantages in the workplace and may have been looking for a venue in which to express their frustrations. Even so, the nature of qualitative studies is such that the perceptions of individuals who voluntarily share such information are represented. Another limitation is the possibility of response bias in that participants may not have felt comfortable expressing their true concerns in a focus group setting. However, this limitation is unlikely since many of the topics discussed in the focus groups were corroborated in the one-on-one interviews. Moreover, focus group and interview participants shared information and experiences that were extremely personal and sometimes emotionally charged.
Despite these limitations, our study has several strengths. Study participants came from a variety of backgrounds, which helped us to explore the institutional context of the diversity climate from different perspectives in an academic medical setting. Second, our findings substantiate and further describe faculty experiences of bias in academic medicine noted in previous survey studies. Third, as a result of their experiences, our study participants identified areas for future interventions that target the psychological climate and the structural diversity of the institution.
Our study identifies subtle disadvantages experienced by URM faculty, such as differences in social and networking connections and unspoken biases, as well as overt factors that could affect recruitment and career advancement, such as overt expressions of bias, differences in prior opportunities, decreased availability of ethnic concordant role models and mentors, and being asked to fulfill socially responsible roles that may take time but not lead to academic advancement. Thomas has suggested that addressing an institution's diversity climate requires that: (1) the institutional culture encourages faculty to openly express their opinions and insights, (2) the institutional culture makes faculty feel valued, and (3) the institution incorporates faculty perspectives into the main mission and culture of the organization.25
Our faculty suggest that our institution's diversity climate would be improved by increasing faculty member's and leadership's awareness of their own attitudes and behaviors, increasing institutional commitment to diversity, and increasing diversity among leadership as well as other faculty and staff. Soliciting faculty input regarding interventions to improve the diversity climate may increase the likelihood that an institution's efforts to increase diversity will be successful. Accordingly, we have developed a survey to quantify differences across race/ethnicity and nativity status in faculty perceptions of the diversity climate at our institution, to explore associations of these perceptions with academic success and professional satisfaction, and to help prioritize future activities of the Diversity Council.