SPECIAL ARTICLES

Editors’ Picks: Top 10 Diversity, Equity, Inclusion, and Antiracism Papers in Family Medicine Journals

José E. Rodríguez, MD | Octavia Amaechi, MD | Renee Crichlow, MD | Valerie J. Flattes, PhD | Sumi M. Sexton, MD

Fam Med. 2024;56(10):623-630.

DOI: 10.22454/FamMed.2024.211985

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Abstract

Physicians within the family medicine workforce are the most diverse compared to other medical specialties in both primarily clinical and academic settings. Family physicians also provide care to the most diverse patients and communities across the United States. As such, research and scholarly work from family physicians on diversity, equity, inclusion, and antiracism (DEIA) can be incredibly impactful. Yet many practicing and teaching physicians are unaware of their colleagues’ scholarly DEIA work, which aims to elucidate inequities and barriers to optimal care and, importantly, to educate on ways physicians and learners can recognize and address specific needs of patients and communities marginalized by health care policies and practices. In collaboration with editors from several family medicine journals, the authors move beyond the traditional editorial space to share recent practice-changing and innovative articles, adding voice and momentum to improve DEIA efforts in all spaces where the practice and teaching of family medicine exists.

INTRODUCTION

Family medicine is the undisputed leader in race/ethnicity and gender diversity among practicing physicians, faculty, and academic medicine in the United States. 1-5 Multiple factors have led to this success, yet the profession still lags the general population of the United States in racial and ethnic diversity. Because identity concordance matters in care delivery and is associated with better outcomes and lower costs, 6-8 more work is necessary to ensure that the workforce is sufficiently diverse. While the demographics of the family medicine specialty are well established, less is known about the research and scholarly papers surrounding diversity, equity, inclusion, and antiracism (DEIA) in family medicine.

METHODS

In a 2021 joint editorial, the editors of American Family Physician, Annals of Family Medicine, FPM (formerly Family Practice Management), Family Medicine, Journal of the American Board of Family Medicine (JABFM), Journal of Family Practice, Evidence-Based Practice, Family Practice Essentials, PRiMER (Peer-Reviewed Reports in Medical Education Research), and Canadian Family Physician published the following: “As an intellectual home for our profession, we have a unique responsibility and opportunity to educate and continue the conversation about institutional racism, health inequities, and antiracism in medicine.” 9, 10

Nominating the Articles

To this end, the same group of editors examined their recent publications and nominated representative papers addressing racism, antiracism, health inequities, diversity, equity, and inclusion in medicine. Each editor or editorial team nominated up to five articles from their journal for consideration.

Selecting the Articles

Once nominated, two editors from each journal rated each article on a scale of 1 to 5, with 1 being the least relevant and 5 being the most relevant. Raters determined relevance using the following five criteria:

  • Practice changing
  • Innovative
  • Evidence-based
  • Critical for teaching
  • Impact on family medicine

Where only one paper was nominated, it became the representative piece from its journal. Only the paper with the highest overall ranking was selected in journals with multiple nominations. Where a tie existed, both papers were selected.

RESULTS

Nominated Papers

The papers that were nominated and voted upon are shown in Tables 1A-1I.

Interesting to note is that many of the nominated papers had authors or author teams in common. For example, at least one author (J.R.) was on nominated papers in PRiMER, Family Medicine, JABFM, American Family Physician, and Annals of Family Medicine. Few authors produce high-quality work in DEIA in family medicine. In addition, few of the nominated papers are original research; the majority are special articles, commentary, or editorials. While scholarly works have increased over recent years, this finding may signal that more original research in DEIA is necessary for family medicine.

Selected Papers

When the voting was finished and tallied up, all journals, except for American Family Physician and Annals of Family Medicine, had one representative article, as presented in Table 2 along with a summary.

The summaries presented in Table 2 differ from the abstracts in identifying action points for people practicing family medicine.

DISCUSSION

The articles that received the highest number of votes all centered around race/ethnicity/gender diversity. They address anti-Blackness in medicine and point out solutions for individuals and institutions to overcome these practices. The sole leading paper not focusing on race in the intervention to increase diversity was Stoesser et al’s “Increasing URiM Family Medicine Residents at University of Utah Health,” published in PRiMER. 40 Although the intervention did not consider race, the authors reported the outcomes regarding race and ethnicity.

Limitations

The most important limitation is that the nominators and the selectors all were associate editors, DEIA associate editors, or editors in chief of family medicine journals, which could have biased the sample of papers. While not explicitly defined in the call for nominations, the DEIA papers nominated all dealt with race/ethnicity, gender, or sexual orientation/gender identity. The authors and editors recognize that diversity discussions must move beyond race, ethnicity, gender, sexual orientation, and gender identity. Diversity of socioeconomic status, geography, veteran status, and indigeneity categories can be criteria for the next iteration of this project. An essential pursuit may be a separate article on the history and harms of race-based medicine, providing steps to a race-conscious approach to care and recognizing the impact of bias and racism in the health and well-being of those we serve. Even in today’s complex political environment, these topics interest our specialty.

Next Steps

Recognizing challenges, heeding calls to action, and working to improve the lives of our patients are causes that define family medicine. We hope that by sharing these articles, we can continue researching, identifying, discussing, and implementing the solutions necessary to achieve health equity and eliminate systemic racism in medicine. For example, family medicine can perform more research on patient preferences, that is, What defines a good doctor? Is it different for those who identify as Black? Latinx? Lesbian, gay, bisexual, transgender, queer (or questioning), intersex, asexual, and others? Women? An upcoming special issue of Family Medicine will feature papers on the theme “Recruit, Mentor, and Promote a Diverse Family Medicine Workforce.” Family medicine researchers can draw correlations between health outcomes and teaching diversity. Another idea is to issue concurrent calls for papers addressing DEIA in medical education (PRiMER and Family Medicine), in primary care research (Annals of Family Medicine), and in delivery of care (JABFM and American Family Physician) to encourage our family medicine academic community to continue to produce scholarship that supports DEIA practices.

We continue to collaborate on producing more content to disseminate in various ways so that the family medicine community can witness the evolution of addressing inequities in the scholarly literature and apply lessons learned to teaching and practice. The principal methods used to integrate DEIA in the publishing realm and beyond include biannual cross-journal meetings to discuss each journal’s progress and confirm our commitment, smaller committee meetings throughout the year to work on projects, collaborative presentations at national conferences and joint publications to share progress publicly, and participation in DEIA committees with other scientific journals outside of family medicine (Council of Science Editors) to stay abreast of updates in this evolving field. A recent article by Schrager et al entitled “Family Medicine Editors Collaborate towards Antiracist Publishing” gives an example of how the journals track progress. It includes a table outlining initiatives such as recruiting a diverse editing team, recruiting and mentoring authors from URM groups, and implementing demographic surveys. 46

Within the scope of family medicine publication, we are entering a new era defined by a commitment to DEIA. The journals of family medicine are committed to working together to address this challenge. This initiative is not about adding superficial layers to our existing framework; it is about redefining the core of how we operate and what we represent. Our focus extends beyond the traditional boundaries of academic publishing to ensure that our work genuinely reflects and serves the diverse community of physicians and patients. This deliberate and thoughtful shift acknowledges the complexities of the health care landscape, the health care and scientific workforce, and the multifaceted nature of the human condition. The pursuit of this goal is challenging, but it is a challenge we accept together, with a clear understanding of its importance. We are not under any illusions about the simplicity of this task; it is a continuous, evolving process that demands persistence and a willingness to learn and adapt. Our commitment is to more than just publishing research; it is to create positive change within our specialty. This change impacts the professionals in our field and, most importantly, the patients we serve. In our journey towards a more inclusive and equitable practice, we are listening to you and pushing each other to set new standards for what it means to be at the forefront of family medicine

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Lead Author

José E. Rodríguez, MD

Affiliations: Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT

Co-Authors

Octavia Amaechi, MD - Spartanburg Regional Healthcare System, Spartanburg, SC

Renee Crichlow, MD - Codman Square Health Center, Boston, MA | Department of Family Medicine, School of Medicine, Boston University, Boston, MA

Valerie J. Flattes, PhD - College of Nursing, University of Utah Salt Lake City, Salt Lake City, UT

Sumi M. Sexton, MD - Georgetown University School of Medicine, Washington, DC

Corresponding Author

José E. Rodríguez, MD

Correspondence: Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT

Email: Jose.rodriguez@hsc.utah.edu

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