Faculty Recruitment
Erika Adams Newman
David J. Brown
BENEFITS OF TEAM DIVERSITY
The faculty makeup at academic institutions does not represent modern society. Women and faculty of color are underrepresented in the higher echelons of academics. According to the Association of American Medical Colleges (AAMC), women represent only 34% of associate professors and 21% of full professors.1 These numbers are much lower for medical school deans (16%) and for department chairs (15%). Given the current rate of advancement, it has been predicted that parity will not be achieved at the current rates. These gaps are thought to account for ongoing health disparities and for achievement gaps for women and faculty of color.
It has been well demonstrated that the highest performing teams reflect the globalization of society and the communities in which they serve. The AAMC has stated that increasing diversity of academic health centers is a significant component of the strategy to reduce health disparities in the United States. Importantly, a representative faculty and leadership team are critical to achieve highest excellence in clinical care, research, and education. The benefits of diversity and representation are strong and reach well beyond demographics and social justice causes. Organizational effectiveness is optimized by diverse talents that span abilities,
background, thought, and identity. This concept has been researched by organizational scholars and is put into perspective by Scott Page in his book, The Diversity Bonus. The foundational element of the model connects cognitive repertoires and identity diversity to produce bonuses for teams with high stakes and complex tasks: one talent plus a different talent equals more than two and leads to higher performance.
background, thought, and identity. This concept has been researched by organizational scholars and is put into perspective by Scott Page in his book, The Diversity Bonus. The foundational element of the model connects cognitive repertoires and identity diversity to produce bonuses for teams with high stakes and complex tasks: one talent plus a different talent equals more than two and leads to higher performance.
In terms of great team building in medicine, this concept creates an exciting opportunity to leverage unique differences for performance strength. For example, consider a strategy on how a team of surgeons is assembled to establish a new specialty division within a department of surgery. The Chair, in drafting successful teammates, will first need to soundly put forth and demonstrate the value of creating the most inclusive culture of individuals with diverse cognitive repertoires. Bonus is added when surgeons with different skill sets from different backgrounds and experiences work together to solve complex problems. Based on what we will call the “academic surgery case” for diversity, a high-performing team would consist of a surgeon that has the experience to drive the busy clinical enterprise and has also spent time studying implementation of novel surgical techniques in urban environments. This surgeon also obtained a master’s degree in public health and is interested in addressing social determinants of health and disparities; a clinician scientist is added to the team, one that is working out the technical details of a translational surgical model in the laboratory. The two doctors are paired with a surgeon with a background in education who has experience teaching complex procedures and has plans to integrate an innovative simulation series for the residents and medical students. The three doctors with their unique identities and talents produce bonuses for the team that are predicted to increase creativity and revenue as well as improve outcomes. These bonuses drive excellence and advance team performance more than if the team had consisted of three doctors with a background in health disparities or if all were translational scientists, for example. Cognitive diversity within healthcare teams leverages the full benefit of teams working together to solve complex problems, more than can be accomplished by any individual and more than teams that lack diversity.
An additional component is that its members are able to serve as mentors, sponsors, and role models for learners with diverse backgrounds and interests. This is critically important to allow students and trainees from underrepresented groups to connect with mentors from similar backgrounds, to share experiences, and to minimize identity isolation. Mentors and sponsors are critical for career success and knowledge transfer of successful norms.
A diverse team is also more culturally competent with the knowledge and skills to serve patients from different cultural and ethnic backgrounds. To effectively care for patients with diverse backgrounds, healthcare teams must have an understanding of how belief systems, cultural biases, and family structure may influence health and medical decision-making.2 A culturally competent team transcends the effects that language barriers, religion, unconventional beliefs, or alternative medicine may have on patients and families (Figure 5.1).
BARRIERS TO INCLUSIVE RECRUITMENT
Broadening representation requires an intentional shift in the traditional recruitment mindset; standard procedures will not work. This is not entirely a pipeline issue. There have been long-standing inequities and exclusion in academia, particularly for women and faculty of color. Only organizations that recognize this can
directly address it. Leaders that cultivate a culture of building high-performing teams with intellectual (and identity) diversity can successfully recruit and retain the best talent. Approaching faculty recruitment utilizing these principles provides an exciting growth opportunity for healthcare systems. Challenges are high because national standards or best practices have not been established.
directly address it. Leaders that cultivate a culture of building high-performing teams with intellectual (and identity) diversity can successfully recruit and retain the best talent. Approaching faculty recruitment utilizing these principles provides an exciting growth opportunity for healthcare systems. Challenges are high because national standards or best practices have not been established.
 Figure 5.1 Healthcare teams must be culturally competent. |
Influence of Implicit Bias
At the forefront is the influence of implicit bias in the recruitment process. Inclusive recruitment procedures are severely limited by individual biases and associations that exist outside of conscious awareness. These biases are not intentional but can be harmful and may hinder recruitment and retention of diverse faculty.
People are treated differently based on the social and identity groups to which they belong. Stereotyping and schemas—the “unconscious hypothesis” about who people are, their motives, and what they are about—are rapid and many times inaccurate. It is important to consider and acknowledge that subtle negative biases contribute to negative evaluations and attitudes toward women and faculty of color. Gender and racial disparities in the science fields can be closely linked to bias and is responsible, at least in part, for large achievement gaps. This stereotyping must be validated and understood by department leaders and search teams in order to decrease, and perhaps account for, the major influence of bias on hiring decisions.
It has been well documented that both male and female faculty judge a female student to be less competent and less worthy of being hired in the biological sciences than an identical male student and offered less direct mentoring and sponsorship. Even more negative schemas around competency and integrity are tied to students and faculty of color. Studies on hiring suggest that men and women tend to have stronger preferences for male candidates even with identical qualifications.3 Men are favored leaders among both men and women faculty.4 Analysis of large numbers of studies comparing male and female leaders shows that when women carry a directive and autocratic leadership style, they receive the lowest ratings. This is thought to reflect a violation of social norms for women. Men, on the other hand, are rated higher with this form of leadership style. These biases are real, pervasive, and difficult to overcome. Academic leaders should be able to recognize and stand against such bias.
Bias in Recommendations
Note should also be made of gender bias in recommendation letters for surgical residency candidates and for faculty hiring. Although letters of recommendation are influential in the match and hiring processes, the subjective descriptions found in letters are gender biased. Qualitative text analysis, quantitative text mining, and topic modeling methods have been used to assess letters of recommendations for applicants in surgery.5 This study found gendered differences in word count—higher for male compared with female applicants; and standout adjectives such as exceptional as well as references to awards, achievements, ability, hardship, leadership, and scholarship were most often applied to men. Positive general terms such as delightful and hard working, as well as physical descriptions and doubt-raisers, were most often applied to women. Topic modeling revealed that words such as care and support were used more commonly with women applicants. These biases held up even when applicants had the same accomplishments and standardized test scores. Given the broad use of letters of recommendation, search teams should look for biased, subjective descriptions and avoid making hiring decisions based on them. Similarly, subjective assessments and “word on the street” about candidates are often negatively biased. Such details are often confusing and difficult to understand how to incorporate into candidate evaluations. This is particularly true for surgical skill assessment and interpersonal skills, which may be difficult to assess objectively.
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