Practical Approaches to Leadership in Support of Equity, Diversity and Inclusion

By Jean M. Moran, PhD, and William Small Jr., MD, FASTRO

In a continued effort to encourage discussion around gender equity on the ROhub, we would like to share our perspectives on equity, diversity and inclusion (EDI) for women and underrepresented minority professionals. For decades, we as leaders have sought different ways to support the success of women and underrepresented minority professionals in radiation oncology.  At the root of many problems in medicine is a paucity of underrepresented minorities in the pipeline, specifically medical school. For women in medicine, this problem has largely been corrected by women applying, entering and graduating from medical school in similar proportions to men since 2003.1

Although medical student matriculation is an issue in many underrepresented demographics, the problem starts long before medical school. There are significant deficits in education for populations with lower socioeconomic status. To overcome this deficit, more professionals need to advocate for equity in educational opportunities. In addition, mentorship of elementary through high school students, especially for science, is a responsibility that we should all prioritize.

The Loyola University Stritch School of Medicine (SSOM) in Chicago believes in creating an environment that fosters equity, inclusion and excellence. SSOM has been the leader in matriculating DACA (Deferred Action for Childhood Arrivals, also known as DREAMer) students and is the only medical school in the country to have accepted DACA students for seven consecutive years. The university’s administration works closely with the Office of Diversity, Equity and Inclusion and regularly meets with medical student leaders of White Coats for Black Lives to further understand the challenges facing Black students and to establish paths for expansion of underrepresented students and faculty. In addition, the SSOM dean serves as the chief diversity officer, and the president of our university has created a new role of vice president of Institutional Diversity, Equity and Inclusion.

Once in medical or graduate school, recruitment of talented women and underrepresented minorities to radiation oncology and medical physics should be a major goal of all training programs. Many societies and institutions have developed summer fellowships specifically designed to expose underrepresented populations to our profession. Despite these efforts, exposure to our field can be a struggle, as radiation oncology is rarely given much time in the first two years of the curriculum in medical school. The American College of Radiology (ACR) is currently advocating for radiology to be a core medical student rotation, incorporating all the radiological specialties, including radiation oncology. Until such changes to the core curriculum occur, outreach to medical students for inclusion is crucial.

At Loyola, Dr. Small gives an hour-long lecture to second year medical students, which is often the first time they have been exposed to our specialty. Such advocacy efforts before and during medical school can inspire individuals to pursue careers in our field. Similarly, undergraduate students who may be potential recruits for medical physics programs may also be completely unaware of opportunities available through CAMPEP-accredited graduate or certificate programs to pursue our profession.

Within radiation oncology, chairs and other department leaders can model an open, learning mindset for addressing EDI. We are encouraged to see a growth in awareness of the need to address EDI within our field.2,3 One way to demonstrate a commitment is by allotting dedicated time as well as leadership positions in the department. At the University of Michigan’s Department of Radiation Oncology, Kelly Paradis, PhD, serves in a new senior leadership position as associate chair of Equity and Wellness. One active area this department-wide team oversees is ensuring equity in recruitment, by blinding applications, revising the wording of postings and being mindful of the interview structure. Dr. Moran held a clinical physics team meeting focused on lessons learned on implicit bias in the medical physics residency process4 prior to interviews by the team. Educational activities are scheduled with consideration of the availability of all employees to attend.

Leaders are able to support EDI for individual trainees as well. At the beginning of a career, we encourage leaders to explain and reinforce performance expectations while also taking time to understand the career goals of their new employees. Leaders are able to guide women and underrepresented groups in avoiding the well-known phenomenon of heavier committee service load. We both enjoy and are fueled by our relationships with mentees, whether formal or informal. Loyola University in Chicago has a formal program where faculty mentees meet at least twice per year with their primary faculty mentor, an institutional mentor and an outside mentor to report on progress. Leaders are also well positioned to seek and direct their employees to resources that support their goals for professional growth, whether they are departmental, institutional or national.

Another way leaders support employees is at critical intersections between their work and home lives, such as for the birth or adoption of a child. For individual employees, it is beneficial for the leader to direct the individual to institutional policies. At institutions that lack parental leave policies, leaders are uniquely situated to advocate for such policies and ensure support for employees. Leaders also help establish a team-focused culture that supports both women and men using the available benefits. Employees about to take parental leave are encouraged to list their active duties and projects then work together with their leader to identify which items require coverage during leave and which can be paused. Similarly, leaders should check in with the employee after leave to ensure that expectations are reasonable, and the employee should have the same opportunities for advancement as others. Unconscious and conscious biases need extra monitoring at this juncture so that assumptions are not made about an employee stepping back after the birth or adoption of a child.

Our final consideration is to encourage individuals to leverage resources that support their own success. For example, the University of Michigan Medical School has an independent three-year review for each faculty member to reflect upon their achievements and determine if any course corrections are needed to personal career paths. Other resources include the Association of American Medical Colleges (AAMC) workshops for early and mid-career women, the AAPM Medical Physics Leadership Academy and video and workshops from the National Center for Faculty Development & Diversity. Early career individuals are encouraged to apply for the different mentorship programs in ASTRO and AAPM.

We are excited to see more visible efforts in ASTRO, AAPM and other organizations to support EDI. We will continue to look for and act on ways to accelerate progress. Join us in this discussion: What would you like to see your department do to improve equity? What efforts in your department have been successful in improving gender and underrepresented population equity? Join this discussion on the ROhub.

Jean Moran, PhD, is professor and co-director of the Physics Division and associate chair of Clinical Physics in the Department of Radiation Oncology at the University of Michigan.
William Small Jr., MD, FASTRO, is director of the Cardinal Bernardin Cancer Center and chair of radiation oncology at Loyola University Medical Center.
  1. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
  2. Holliday EB, Siker M, Chapman CH, Jagsi R, Bitterman DS, Ahmed AA, Winkfield K, Kelly M, Tarbell NJ, and Deville C.  Achieving gender equity in the radiation oncology physician workforce [published correction appears in Adv Radiat Oncol. 2018 Nov 02;4(1):210]. Adv Radiat Oncol. 2018;3(4):478-483. Published 2018 Oct 21. doi:10.1016/j.adro.2018.09.003
  3. Van Zyl M, Haynes EMK, Batchelar D, and Jakobi J. Examining gender diversity growth as a model for inclusion of all underrepresented persons in medical physics. Med Phys. 2020;47(12):5976-5985. doi:10.1002/mp.14524
  4. Hendrickson K, Juang T, Rodriques A, Burmeister J. Ethical violations and discriminatory behavior in the MedPhys Match. J Appl Clin Med Phys. 2017 Sep;18(5):336-350. doi: 10.1002/acm2.12135

Read previous ASTRO Blog posts from the Gender Equity Community:

Pandemic Health Care Worker and Parent: Considerate Teamwork Vital to Enduring (January 2021)

New Gender Equity Community opens in the ROhub (December 2020)

Posted: February 23, 2021 | with 2 comments

Eric Horwitz
To Drs. Moran and Small, thank you for starting this post on a very important topic. Equity, diversity and inclusion (EDI) for women and underrepresented minority professionals is an extremely important issue in society in general and medicine in particular, and our specialty of radiation oncology is no exception. It is a policy of the Temple University Health System and Fox Chase Cancer Center to encourage and improve EDI. As chair of a department at an NCI designated comprehensive cancer center, I believe our actions can make a difference. Over the past decade, our faculty has grown and we currently have 14 staff. Nine of our faculty are women and five are men. I’m hopeful that in a small way, the makeup of our faculty can influence both med students to select radiation oncology as a specialty and our residents to see that this is a specialty that welcomes EDI and that you can thrive in both your personal life and your career.
3/6/2021 4:45:14 PM

Krisha Howell
The past years have brought a new found awareness to EDI, but many of us are still searching for the best strategies and techniques to translate this awareness into relevant actions in the work and educational environment. Thank you Drs. Moran and Small for demonstrating what changes have been occurring at your institutions.
3/1/2021 12:21:15 PM

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