key: cord-0074594-4ifdjnr6 authors: Rosario, Javier; Lewiss, Resa E.; Stolz, Lori A.; Del Rios, Marina; Acuña, Josie; Adhikari, Srikar; Amponsah, David; Dessie, Almaz S.; Gottlieb, Michael; Huang, Robert D.; Jones, Jodi; Landry, Adaira; Liu, Rachel B.; Ng, Lorraine; Panebianco, Nova L.; Weekes, Anthony J.; Knight, Starr title: Creating a more racial-ethnic inclusive clinical ultrasound community date: 2022-02-08 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2022.02.015 sha: 2083405235a07a0bac8347bfb011e37655fb7301 doc_id: 74594 cord_uid: 4ifdjnr6 nan Amidst the coronavirus pandemic beginning in 2019 (SARS-CoV-2) and local government shutdowns, the realities of systemic racism have been brought to the forefront. America's history of systemic racism was a pre-existing condition for SARS-CoV-2, exemplified by the disproportionately high morbidity and mortality rates within Black, Indigenous, and Hispanic communities. 1 Understanding that bias, stereotyping, and prejudice play an important role in healthcare disparities, the National Academy of Medicine stated that a key strategy to address these problems is to recruit more medical professionals from underrepresented racial and ethnic backgrounds. 2, 3 These national events have raised the question: What are our responsibilities as emergency physicians, educators, and leaders in the Clinical Ultrasound community to address systemic racism? The emergency medicine (EM) Clinical Ultrasound (CU) community has an opportunity to candidly identify, discuss, and react to examples of structural racism in the delivery of healthcare. We take this opportunity to amplify the voices of the unheard and direct our focus to our blind spots in order to better serve our communities and better support each other as colleagues. Underrepresented minorities, defined as Blacks or African Americans, Hispanics or Latinos, American Indians or Alaskan Natives, Native Hawaiians, and other Pacific Islanders, comprise 33% of the US population. 4 The Association of American Medical Colleges (AAMC) defines being underrepresented in medicine (UiM) as those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. 5 A 2019 AAMC survey reported that 5% of practicing EM physicians identified as Black, 5.8% as Hispanic, and 0.3% as American Indian. 6,7 The AAMC 2019-2020 Report on Residents: Number of Active MD Residents, by Race/Ethnicity data shows similar trends in the distribution for EM doctors in training (Table 1 ). 8 In a study comparing faculty over a 26 year period, the AAMC found that representation worsened for Black and Hispanic faculty across specialties at the assistant, associate, and full professor levels. 9 At the current rate, it would take nearly 1000 years for Black medical school faculty o reach the same percentage of African Americans in the general population. 10 J o u r n a l P r e -p r o o f Journal Pre-proof 8 Moreover, inadequate UiM representation at academic centers, especially in leadership and mentorship roles, has widespread effects upon faculty development, the overall success of the department, and perpetuates racial health disparities that directly impact underserved communities. 11 UiM faculty and residents who work in departments with limited racial and ethnic diversity are more likely to feel unsupported, isolated, and vulnerable to microaggressions. 12, 13 Academic medical centers must recognize and rectify the historical and current impact of racism on communities of color by identifying inequities within the healthcare workforce.s. The EM CU community must do the same. Although no racial-ethnic data has been collected within the CU community, we are no exception to the problem of poor UiM faculty representation. The Emergency Ultrasound Section of the American College of Emergency Physicians (ACEP) was founded in 1996. Of 23 section chairs, none are UiM. 14 The Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine (SAEM) was founded in 2011. Of 11 presidents, none are UiM. 15 The Emergency Ultrasound Section of American Academy of Emergency Medicine (AAEM) was founded in 2017. Of 5 section chairs none are UiM. 16 This drastic underrepresentation in leadership highlights the need for more active and intentional implementation of strategies to increase diversity, and inclusion in the CU community. Disparities in racial-ethnic representation are also present in CU journal editorial boards, authorship in high impact journal publications, and major conference speakers and organizers. The author groups for two of the most cited, high impact policies in Point of Care Ultrasonography and Advanced Clinical Ultrasound: the 2016 ACEP Ultrasound Guidelines and the 2014 ACEP Ultrasound Imaging Criteria Compendium are comprised of a mostly white author group. 17, 18 Change requires a multi-dimensional approach, targeting individual, institutional, and systemic action items. In Table 2 , we recommend actions to mitigate racial and ethnic disparities within the CU community. It is our individual and group responsibility to cultivate an environment founded on equity and inclusivity, which fosters innovative work, improves patient care, and encourages diverse ideas. CU leaders should leverage their privilege to sponsor, mentor, coach, and demand a more inclusive community. 19, 20 Conferences, webinars and podcasts should have policies preventing all white and all male panels. [21] [22] [23] Racial-ethnic diverse educators can be powerful drivers of J o u r n a l P r e -p r o o f change and activism against racism, calling trainees including fellows, residents, medical students, and allied colleagues to action. 22 While we applaud the recent efforts by some journals that have encouraged equity research and have created special issues focusing on racial disparities and potential solutions, we must ensure better racial equity among editorial boards and increase research and publication opportunities for UiM colleagues. 23, 24 We need to expand local and national representation while recommending, promoting, and sponsoring our UiM colleagues for leadership positions. Our community needs to remain open to collaboration and discussion, using every resource to learn how to best address these issues of bias and inequity as we encounter them daily. We must learn how to break the silence and be allies and upstanders for our UiM colleagues. 25 We recommend national CU organizations, such as the Society of Clinical Ultrasound Fellowships, ACEP, SAEM, and AAEM collect, analyze, and share data regarding UiM faculty and fellow representation in academic leadership, salary, promotion, awards, and speaking opportunities. Accessible and public data allows for adequate identification of racial inequalities and helps organize the steps needed to take corrective action. Individual Actions: Implicit Bias and Privilege assessments: 26, 27 • To understand the lens through which one views the world • To recognize how this shapes the way that one interacts with patients, learners, colleagues, friends, and family Diversity, Equity, and Inclusion (DEI) Training: • To learn to identify and respond to microaggressions • To practice allyship and upstander skills • Commit, as an individual to this work -it should mirror the effort invested in other forms of continuing education • Recognize that these skills are of equal value to CU as image acquisition and interpretation • Attend local and national conferences on DEI • Participate in institutional coursework and personal reading Institutional Actions: • Integrate efforts to address disparities into all aspects of recruitment, per LCME and ACGME Guidelines 28, 29 J o u r n a l P r e -p r o o f Worked to death: Latino farmworkers have long been denied basic rights. SARS-CoV-2 showed how deadly racism could be Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It QuickFacts United States Population Association of American Medical Colleges Under-represented minorities in emergency medicine Report on Residents: Number of Active MD Residents, by Race/Ethnicity (Alone or In Combination) and GME Specialty; Data & Reports; AAMC Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties Minorities struggle to advance in academic medicine: A 12-y review of diversity at the highest levels of America's teaching institutions Racism and Health in the United States: A Policy Statement From the American College of Physicians Recognizing and Reacting to Microaggressions in Medicine and Surgery Addressing the Elephant in the Room: Microaggressions in Medicine How we serve: Ultrasound Section Past Leaders American College of Emergency Physicians. Emergency ultrasound guidelines Emergency ultrasound imaging criteria compendium. American College of Emergency Physicians An American crisis: The lack of black men in medicine 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 Why Black doctors like me are leaving faculty positions in academic medical centers' STAT News Podcasting: A Medium for Amplifying Racial Justice Discourse, Reflection, and Representation Within Graduate Medical Education Time to end the Manel tradition The Lancet Group's commitments to gender equity and diversity. The Lancet Microaggressions: Privileged Observers' Duty to Act and What They Can Do Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. ACGME-approved focused revision Racial and Ethnic Diversity in Academic Emergency Medicine: How Far Have We Come? Next Steps for the Future The Path Forward -An Anti Racist Approach to Academic Medicine Vanden Hoek TL. Evaluation of an Enhanced Peer Mentoring Program on Scholarly Productivity and Promotion in Academic Emergency Medicine: A Five-Year Review Unplugging the pipeline -A call for term limits in academic medicine Be Ethical: A Call to Healthcare Leaders: Ending Gender Workforce Disparities is an Ethical Imperative On Racism: A New Standard For Publishing On Racial Health Inequities Responsibility of Medical Journals in Addressing Racism in Health Care Racial Justice and Academic Pediatrics: A Call for Editorial Action and Our Plan to Move Forward