Residency Diversity Data Needed to Understand Reporting of Racism/Discrimination

We applaud the efforts of Dr Potts and colleagues in the presentation of the data from the 2018 CERA study on reports of discrimination and training in family medicine residency programs.1 We were impressed by the high response rate and the high percentage of programs with training or processes to address implicit bias and systemic racism and discrimination. The strong commitment of our majority White program directors to residents from underrepresented backgrounds shows how White privilege can be used to increase the diversity of residency programs.2 At the same time, it is important to recognize that reports of discrimination and racism differ by individual experiences and identities, ie, a Black or Latinx resident is more likely to experience racism than a White resident. We would like to see the race/ethnic diversity of the residents and faculty of these programs with a comparison to reports of discrimination. This would add to the literature, especially if the finding was that overall program diversity was not associated with increased reporting of discrimination.

In the paper, the authors indicated that faculty was the group least likely to report discrimination. Although family medicine is the most diverse of all medical specialties,3 the faculty, when compared to students, residents, and patients, was also the group with the least diversity. This validates the point that White groups experience discrimination less and therefore report it less. However, another finding that we would like to highlight is that where there was not training and/or processes in place, there was decreased reporting of discrimination. This should be a call to action to get reporting structures in place. As the adage goes, “We cannot improve upon that which we do not measure.” Demographic information on the programs would be helpful to unpack this finding as well. Perhaps implementing programs to address racism and discrimination could help in the recruitment of underrepresented in medicine residents and faculty.

We celebrate that reporting of discrimination has been extended to the patients and that patients feel that they could hold their providers accountable for discrimination. This is a step forward. We are also cognizant, however, that residents and providers from marginalized groups, especially racial and ethnic minorities, can sometimes be the targets of racist acts by patients, and we should ensure the safety of our underrepresented employees in those circumstances.4-6 This is a question that should be included for further study, as we continue to become more diverse as a specialty.

We add our voices to those of the authors in calling for the discovery of the most effective tools for reporting of discrimination and holding offenders accountable.7 We are delighted to see what is already happening and hope to see more data collected from family medicine residencies that assist in identifying best practices that truly increase reporting and decrease incidents, making family medicine residencies a safe place for learners from all backgrounds.