Bystander or Advocate for Equity and Inclusion—Who Do You Choose to Be?

Diane Magrane, M.D.

Written by Diane Magrane, M.D.

Diane Magrane, M.D., former associate dean for medical education at the University of Vermont Larner College of Medicine, served as keynote speaker for the College’s Celebration of Gender Equity in Medicine and Science on March 4, 2021. Magrane, who is immediate past director of Executive Leadership in Academic Medicine (ELAM) and former Association of American Medical Colleges associate vice president for faculty development and leadership, delivered a keynote address, titled “Bystander or Advocate? Who Do You Choose to Be?” The following blog post is adapted from her talk.

Each year, as we pause to celebrate individuals from diverse backgrounds that are underrepresented in our community and especially in our leadership, I am reminded of a great and persistent problem. What is it about the culture of academic medicine, about the culture of Larner College of Medicine, that makes it necessary to reward equity as exemplary practice? 

Equity builds on the recruitment of diversity and the welcoming of inclusion with actions that give fair opportunity to succeed. It removes the psychological and organizational barriers to success and relieves the daily exhaustion of walking a tightrope of societal expectations. Equity is measured in terms of outcomes—integration of new ideas into practice and recognition of achievement by award, fair salary, and advancement. This is the work the members of the UVM Larner College of Medicine’s Gender Equity Initiative are leading. It is admirable, thoughtful, engaging work that should draw from daily practice. Why then, is it so challenging? 

What is the problem?

The glass ceiling is cracking— the nation just elected an African/ Asian American woman to vice president and the U.S. Congress has confirmed a diverse group of women as secretaries to the president’s cabinet; Vermont’s legislatures are led by women this term. The Larner College of Medicine has four women seated at the department chair table; half the medical students are women and have been so for some time. However, UVM’s data, as reported to the AAMC, looks pretty similar to that of most medical schools, reflecting painfully slow progress in advancing and supporting faculty in particular. 

We owe this sluggish change to our culture— the language that reflects how we think about each other’s work and behavior, our unspoken expectations and ways of interacting with each other, our embedded values, “the way we do it here.”  Culture almost always supports the status quo. The culture of medicine was established by immigrant physicians from Europe in the 19th century; medical schools were largely founded by wealthy property owners, and until the mid 20th century pretty much limited to married, white men in independent practice. So much has changed in the way we learn medicine and the way we practice, but so much of the culture remains to confine the change efforts needed to better serve ourselves and our communities. And culture change is difficult because culture is largely invisible to those within it until someone calls it out. 

What can each of us do to advance a culture of equity? 

Margaret Wheatley, one of the leading scholars on organizational leadership of our time brings together the sciences of physics, biology, organizational systems, and anthropology in her book, Who Do We Choose to Be?  She presents us with choices to flourish with collaboration and interrelationships that use our capacity to be generous, creative and kind to face this reality or to choose to protect and preserve old ways that reliably contribute to fairly predictable disintegration and death of organization and society. How marvelous! That’s how we are trained as physicians and teachers! We need only apply these to ourselves and our colleagues. 

Culture change begins with acts of individual change. You may have heard the phrase “Be the change you aim to see.“ This wisdom often is attributed to Mahatma Ghandi, but the actual author was high school teacher Arleen Lorrance who first used it to advance a program in the poverty- and violence-challenged high schools of Brooklyn. Each of us can choose to be the change through actions that advance everyone’s opportunities while challenging traditional norms. 

We can check the power language that maintains traditional equilibrium and facilitates marginalization, choosing instead to …

  • Acknowledge transgressions in the space and time in which they occur. Politely. Firmly. Failure to do so by waiting until a private conversation after the meeting is called private allyship. It results in silently condoning the transgression.
  • Address issues of bias and discrimination in real time, creating space to hear them out.  Pivoting the conversation away from the alleged sexism or racism towards a more neutral topic is called side stepping. It leaves the challenge unexplained and diminishes the person feeling harmed by it.

When we call it out power language, when we check our own use and readjust, we change the conversation in the room to make it more welcoming and inclusive. 

Allow individuals to express their thoughts and feelings openly, without becoming defensive. Avoid tone policing that shuts down the marginalized person as being angry or emotional. And take care not to put their words into yours. People, even in the midst of their passion, are capable of speaking for themselves.

We can count and report the counts and gaps. We measure –and report–what we value. What do your counts show of gender and race in publications, appointments, conference speakers, awards that are not targeted to specific groups?  What does that say about what we value as a community? The Gender Equity Report Card being developed by Stellar Levy with the Gender Equity Committee is a great example of counting and reporting.

We can acknowledge the good work in front of us. Pay attention to the behaviors described in the gender equity awards. Speak up in favor of these changes and encourage more. Consider how they might be replicated across the institution. 

Twenty years ago, UVM faculty and students designed one of the first medical student curricula in the nation that integrated leadership development as a core theme. That theme, and in particular, the skills related to advocacy for inclusive community, are even more important today as we recognize that equity is key to health, innovation, and productivity. How might UVM continue to lead the nation as ambassadors of this teaching and learning?  Specifically, what would you do differently if you were to commit to creating the most diverse and inclusive medical school in the country?  Where do you have discretion and freedom to act? Will you choose to stand by as a protector of the status quo or will you choose to listen, speak and act to expand diversity, inclusion and equity in this community?

What are your thoughts about this topic?