July 18, 2020

This issue of Forum is just one example of SGIM’s purposeful approach to diversity and inclusion. As Dr. Kutner stated in her August column, “It is our responsibility to each other, to the field, and to the people and communities that we serve to act.”¹ SGIM has primarily been externally focused in its efforts with regards to diversity, equity and inclusion, working towards its vision of a just system of care in which all people can achieve optimal health.² SGIM is committed to focusing internally as well. Below we answer two key questions regarding SGIM’s commitment to diversity, equity, and inclusion.

What do you see as blind spots in the organization’s commitment to diversity and inclusion?

Recently, our Director of Member Relations, Muna Futur, asked whether SGIM has a diversity council or any workgroup dedicated to diversity and inclusion apart from the Health Equity Commission and the Minorities in Medicine Interest Group, and whether SGIM has a statement focused on diversity and inclusion. Our first reaction was to explain that SGIM has been committed to diversity and inclusion for many years, as reflected in the statement of our core values, which include diversity, equity, and inclusion. The Health Equity Commission (HEC) grew out of the Disparities Task Force that was formed by SGIM’s Council in 2001 to focus on disparities in health and health care. The rationale for converting the task force to a commission was to make it a permanent part of the organization, with the expectation that the HEC would have an important role in collaborating with other entities within the organization. Currently, the purpose of the HEC is “to serve as the chief advocate for SGIM’s health equity related interests for education, research, and provision of clinical care as the Society strives to achieve better health for everyone. In this role, we [the HEC] seek to promote, educate, and collaborate with the membership of SGIM to dismantle structural inequities, optimize the outcomes of each patient-provider encounter, and pursue social justice especially for vulnerable and marginalized populations by engaging with the physician workforce, researchers, policy makers, and educators in efforts to pursue social justice and eliminate inequities in health.”³

SGIM also has the Women and Medicine Commission (WAMC), whose mission is “to facilitate communication among interest groups related to women’s health, promote women’s health as a generalist issue in both clinical practice and health policy, and support the career development of academic women physicians and of all physicians pursuing careers in women’s health.”⁴ The WAMC enables SGIM members to collaborate and network, promotes faculty development, provides educational opportunities, and works to improve women’s health through clinical practice and policy.

After reviewing the missions of these two commissions, we realized that we both had blind spots, and that the Society had blind spots that need attention. First, SGIM does not have a formal overarching statement of our commitment to diversity and inclusion beyond mention in the statement of our core values. Second, we have taken for granted that we share a commitment to being a diverse and inclusive community without establishing a comprehensive set of policies and procedures for ensuring that the commitment is translated into decision-making on a consistent basis.

What specific actions has SGIM taken and/or will take to address the blind spots?

On June 1, 2020, SGIM’s executive leadership and staff released a message on racial injustice, declaring that “SGIM stands against racism and hate in all its forms.”⁵ The statement calls on our community to educate ourselves and others on the historic inequality of black and brown people; publicly speak up against racism and bias at every instance; foster an inclusive and diverse workplace; validate and acknowledge the experiences of those who have suffered the consequences of racial injustice; and support organizations doing the essential work to dismantle structural racism.⁵

On July 3, 2020, the Council decided to form a new workgroup to reassess the Society’s approach to promoting diversity and inclusion. The workgroup will be charged with crafting a formal statement and plan of action. The plan should identify opportunities to be more consistent about promoting diversity and inclusion, and it should make recommendations for specific policies and procedures. The workgroup will include representatives of the HEC, WAMC, Membership Committee, and selected interest groups. The workgroup should consider structure, process, and outcomes as it looks for ways to improve. Special attention will be given to how SGIM nurtures the leadership pipeline and staff within the organization, and how members are nominated and selected for awards and leadership positions. 

As part of the work on strengthening our commitment to diversity and inclusion, it will be important to revisit the report that was given to the Council by our Ad Hoc Workgroup on Sexual Harassment on May 30, 2018. At that time, the Council approved a policy expressing its commitment to ensuring a safe and welcoming environment for all participants at SGIM’s national or regional meetings, including ancillary events and social gatherings. Intended to include all forms of discrimination and harassment, the policy calls for members and other participants to: exercise consideration and respect in your speech and actions; refrain from demeaning, discriminatory, or harassing behavior and speech; be mindful of your surroundings and of your fellow participants; and alert leaders if you notice harassment. The workgroup recommended that SGIM embrace a learning community culture that encourages ongoing dialogue in a collegial manner, recognizing that unconscious bias may occur despite good intent. The workgroup issued other recommendations to ensure zero tolerance for sexual harassment or discrimination in all SGIM activities:

1. Amend the code of conduct to include processes for acting on reports, add a statement that SGIM prohibits retaliation of any kind against individuals who have made good faith reports or complaints of violations of the code, and add verbiage regarding a learning and supportive culture.
2. Broadly disseminate the policies to increase awareness.
3. Ask members to acknowledge and sign the code of conduct at membership renewal and/or registration for meetings.
4. Assign leaders to train and support staff so that they are prepared to handle complaints or concerns that may arise.
5. Develop an electronic confidential incident report form that can be tracked.
6. Include questions on a membership survey to inquire about perceptions of and experiences with harassment or discrimination in SGIM activities.

The workgroup’s last recommendation was to perform an annual review of our commitment to zero tolerance for harassment or discrimination. That review is overdue, and it should be done as part of the new workgroup’s efforts to address blind spots in our commitment to diversity and inclusion. 

Prompted by a recent study highlighting the low number of women in leadership positions in hospital medicine, Karen Freund challenged SGIM to tackle the problem of gender equity in leadership.^{6, 7} We plan to accept that challenge by re-examining how we nurture the development of leaders within the Society (where 11 of 14 elected Council members are women), and how we can more effectively translate career development activities into leadership positions within academic medical centers and other organizations.

While we may think of ourselves as an equitable organization, we also recognize that there are likely opportunities to enhance diversity and inclusion across all of our activities. At this point we don’t know what we don’t know. To quote Vanessa Grubbs’ recent Points of View article published in The New England Journal of Medicine, “It’s time for academic medical institutions to prove their statements aren’t just pretty words by acting to create diversity, equity and inclusion that matter.”⁸ SGIM is taking this to heart. We must identify and acknowledge our blind spots to ensure we have appropriately comprehensive policies on diversity and inclusion accompanied by actions built into the structure and processes of the Society.