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Promoting Equity and Inclusion in Adolescent Medicine

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Promoting Equity and Inclusion in Adolescent Medicine

We are a collective of physicians training in adolescent medicine. As Black, Latinx and Asian American physicians in academia, we live on the fence: one foot in our racial/ethnic communities where we desire to deliver comprehensive health care, the other within medical institutions that have historically excluded Black and Brown patients or provided inequitable care. We have witnessed our patients experience crisis on top of crisis. Health, financial stability and academic achievement have all been destabilized due to the COVID-19 pandemic. In the current state of stressful unrest, the Black and Brown communities that we serve have been brutally reminded of the devaluation of our lives. In the last few months, Ahmaud Arbery, Breonna Taylor, Tony McDade, Rayshard Brooks and George Floyd have been killed by police or vigilantes. There are many more whose experiences go undocumented and unpublicized. Repeatedly bearing witness to these distressing events in the media only exacerbates the impact of the existing history of injustice to Black bodies.

As a national conversation about race resurfaces once again, we believe that the work begins at home. We must acknowledge that the U.S. health care system has perpetuated racism for centuries, and it is the responsibility of academic societies and institutions to address it. Medical centers can no longer be based in communities with low resources while quality health care remains unattainable to those living in their surroundings. To best care for Black and Brown adolescents, we must incorporate a health equity lens throughout medical education and recognize how racism is incorporated into diagnoses and physical exams. Our biases are not random; they are developed by teaching and learning racism as doctrine. We must address the hidden curriculum in our training and dissect clinical care from the racist beliefs and practices that reinforce inequity.

This fight is not just our fight, it is all of ours. Our adolescent medicine family should openly discuss racism and address it. Historically, Black and Brown providers have been excluded from leadership positions. We must recruit diverse faculty, trainees and students and continue to push for inclusion and empowerment of all health care workers, especially our frontline staff. The medical clinic and department should function as an anti-racist institution. To be a center of excellence, we must work to acknowledge the intersectional identities of our patients and address their unique experiences and needs. We owe this to our patients who are better served when their providers are not only diverse, but entrenched in this fight against injustice.

As adolescent medicine clinical fellows, we advocate for the creation of an anti-racist medical system that empowers and reflects the diversity of SAHM while promoting racial justice in all spheres. We ask that SAHM members promote an anti-racist agenda both within SAHM and at your respective institutions. All of us exist within this health care ecosystem where our reach impacts not only direct patient care, but also education, community-based services, trainee recruitment, and faculty development. We should use any and all opportunities to serve as agents of change.

In order to accomplish this we advocate that SAHM members take the following actions at their institutions:

Promote quality improvement research that addresses and highlights ways to dismantle systemic racism so all can benefit from an improved and equitable health system.
Dedicate themselves to the creation and support of intentional and transparent pathways for the recruitment, retention and promotion of Black and Brown adolescent medicine faculty members.
Advocate for their departments/divisions to develop mechanisms for anonymous reporting of racism and other acts of bias with transparent follow up and accountability measures that protect those reporting.
Ensure that adolescent medicine departments/divisions identify faculty diversity advocates to serve as liaisons with their institution’s diversity and inclusion office and SAHM's diversity committee. This role does not need to be a faculty of color as the burden of fighting racial injustice should not solely fall on us.
Advocate for their institutions to ensure that clinic-based research and programming reflect the racial and ethnic demographics and needs of adolescents in the communities they serve.
Advocate for legislation and policy that promotes affordable access to high speed broadband internet and technology so that virtual learning and telemedicine is accessible to all patients.

We advocate for and support SAHM in taking the following actions:

Promote the inclusion of anti-racism, diversity and reproductive justice as core areas in adolescent medicine, including education and training for both trainees and faculty.
Promote already existing avenues for funding research and programming about racism, diversity, and equity and exploring initiatives in the upcoming SAHM platforms to better support trainees and faculty who are dedicated to this work.
Provide resources on how to combat racism and promote diversity explicitly displayed on the SAHM website. We commend SAHM for the creation of an anti-racism toolkit and their recent publications supporting anti-racism and the protection of justice involved youth. We hope that these sources continue to be readily highlighted and expanded on well beyond this current critical moment in the United States.
Promote the current mentorship infrastructure that already exists within SAHM and its commitment to supporting advancement of Black and Brown trainees interested in adolescent medicine both in research and clinical care on a national and global scale. Appropriate mentorship for Black and Brown trainees is critical to our retention in academic medicine and development as future leadership.

Authored by the following SAHM members:
Nathalie Duroseau, DO, MS
Rebekah Fenton, MD
Tornia Wyllie, MD
Melissa Dundas, MD
Drisana Henry, MD, MPH
Alexandria Holliday, MD
Camille Manuel, MD
Melissa Menezes, MD
Frinny Polanco Walters, MD
Natasha Ramsey, MD, MPH
Ariel Tassy, MD
Renée Morgan, MBBS, DM
Sarah Ann Anderson, MD, PhD
LaKeshia N. Hyndman, MD
Julen N. Harris, MD, MPH

Endorsed by the SAHM Executive Committee:
Jessica Kahn, MD, MPH, FSAHM
David Bell, MD, MPH
Maria Trent, MD, MPH, FSAHM
Tanya Mullins, MD, MS, FSAHM