It’s not Black and White
The DFTB team believes passionately in equity and equality for all. In our events, we work hard to ensure equal gender representation and mirror ethnic diversity in our speakers in in-person and digital events.
In 2019 we looked at the broader role of gender in paediatrics, describing a leaky pipeline for women across conferences, academia and board membership.
We’ve now looked at the literature surrounding minoritised ethnic and racialised groups* in the paediatric workforce and published our findings in the Journal of Paediatrics and Child Health. Like gender, there are similar barriers to paediatric workforce diversity, mirrored by a growing body of evidence and testimony for the existence of systemic racism within healthcare systems around the world. But it’s not all bad, and we’ve found some initiatives that should be championed. Here’s what we found…
Chantiluke K, Yoshida R, Blow N, Hall, D; Don’t Forget The Bubbles. It is not Black and White: A spotlight on racial diversity in paediatrics. Journal of Paediatrics and Child Health. 2022: 58:8;1293-1296 https://doi.org/10.1111/jpc.16064
*What’s in a name?
As no adequate cohesive term exists, we chose to use the term minoritised ethnic and racialised groups in the acknowledgement that individuals within these groups share being placed into socially constructed minorities.
Why should we be talking about racial diversity?
An empowered, diverse workforce that reflects the population’s diversity benefits both patients and staff. Unfortunately, the current evidence is limited, but it does point to discrimination towards minoritised ethnic and racialised groups within paediatrics. This results in differential attainment (a phrase you’ll repeatedly hear in the literature) in paediatric training and recruitment and a lack of diversity in senior roles.
It might not surprise you to hear that international medical graduates (known as IMGs for short) in the UK have needed to submit significantly more job applications than UK graduates before being appointed to a paediatric consultant post. But you might not expect that this has been occuring as recently as 2019. It doesn’t stop at consultant posts. Paediatricians from minoritised ethnic groups are underrepresented in volunteer positions (such as examiners or committee members) within the RCPCH. Although Black or Black British members make up 5.0% of college members, they only make up 2.8% of volunteer roles.
We know this because national data regarding the ethnicity of medical professionals is relatively well documented in the UK. However, this data isn’t routinely collected in Australia, so the picture is less clear.
What can we do?
Although the recent American Academy of Paediatrics policy statement on The Impact of Racism on Child and Adolescent Health and the Australian Medical Association 2018 Anti-Racism Statement go some way to addressing the issue, the 2021 UK RCPCH Equality, Diversity and Inclusion action plan is commendable for its proposed actions. We suggest eight critical solutions for a more equitable future.
1. Transparency in diversity
Only by improving data collection and knowledge of the paediatric workforce’s diversity can we improve transparency about delivering diversity outcomes within paediatrics.
2. Overcome bias in recruitment
Some great examples of successful strategies by medical schools in the US and New Zealand have shown that reducing faculty bias and increasing engagement and investment in minoritised ethnic and racialised groups can lead to increased recruitment. These strategies can also be applied to postgraduate training.
3. Issues of racial harassment and instigating change
The British Medical Association has established a Racial Harassment Charter for Medical Schools to make a positive, tangible change towards racial equity in medical schools.
4. Monitoring of clinical training placements
We know that effective supervision and mentoring are helpful. Still, more can be done to give paediatric trainees opportunities to speak up about experiences of racial harassment and microaggressions during training. In the UK, the RCPCH has created the new role of equality, diversity and inclusion representative on the Trainee’s Committee.
5. Include Equity, Inclusion and Diversity in paediatric curricula
As future leaders of the paediatric medical workforce, trainees must be knowledgeable about equity, diversity and the social and cultural determinants of health inequities. The RCPCH, the Australian Commissioner for Aboriginal Children and Young People, and the Medical Council of New Zealand have all pledged to review health outcomes for children and young people and address health inequalities in children from minority groups.
6. Development programmes/mentoring schemes
There are some successful mentoring schemes in paediatric programmes: the New Century Scholars Program by the Academic Pediatric Association in the US and the use of peer-support networks for Māori doctors in New Zealand are two great examples. Health Education England has a toolkit for supervisors on differential attainment and online training on supporting internationally educated health professionals.
7. Create diversity in senior staff
Having an ethnically diverse senior workforce can motivate junior staff from minoritised groups. A few solutions include identifying potential volunteers from underrepresented groups, improving accessibility to members from minoritised backgrounds and mentoring from other organisations that have proven to be more effective in addressing this gap.
8. Peer support groups
There are some exciting initiatives borne out of the efforts of individuals. The Australian Indigenous Doctors Association (AIDA) was established to advocate for Indigenous patients and doctors as well as promote cultural diversity in the Australian medical workforce. In the US, the National Medical Association is a long-standing collective of over 50,000 African-American doctors who focus on tackling the public health issues facing Black Americans in addition to supporting the medical and professional education of its members. In the UK, groups such as Melanin Medics and Team Soft Landing have aimed to provide a safe space for ethnically minoritised medics, with Team Soft Landing providing specific support for IMG paediatricians in the UK with workshops and mentoring.
These initiatives, along with action from institutions should be championed. Ultimately, a more empowered, diverse workforce will be better equipped to address child health inequities on an international level.