Representing the voices of underrepresented colleagues and mentoring psychiatric trainees in academic medicine with Dr. Anique Forrester

Anique K. Forrester, MD, joins host Lorenzo Norris, MD, to discuss the importance of continuing to work in academic medicine.

Dr. Forrester is assistant professor at the University of Maryland, Baltimore. She also serves as director of the consultation-liaison psychiatry fellowship at the university.

Dr. Norris and Dr. Forrester have no conflicts of interest.

Take-home points

• Dr. Forrester recently wrote an article in the New England Journal of Medicine discussing minority underrepresentation in academic medicine and the persistent labor of love required to stay in departments that do not explicitly value diversity.
• Underrepresented minority colleagues leave for many reasons, and Dr. Forrester highlights the issues of invisibility, lack of mentorship and support, and burden of microaggressions.
• Dr. Forrester focused her article on why she stays in academic medicine, feeling that it is critical her voice is heard; she knows her presence has changed the tone and outcome of issues. As she says: "One of the things about representation is that someone has to be there to represent."

Summary

• Staying in academic medicine with the presence of systemic racism is a difficult road; however, Dr. Forrester has stayed because of her desire to educate and mold the future of trainees.
• Underrepresented minority (URM) colleagues leave for many reasons, and Dr. Forrester highlights the issues of invisibility, lack of mentorship and support, and burden of microaggressions. The late Chester Pierce, MD, a psychiatrist and the first African American full professor at Massachusetts General Hospital, Boston, coined the term "microaggression" to describe subtle slights or snubs directed at minority and historically stigmatized groups. The cumulative effect of microaggressions is toxic and can lead to self-doubt, damaged self-esteem, and momentum that pushes a URM colleague to leave.
• When a URM colleague leaves a department, there is a short-lived conversation about what could have been done differently to retain them.
• Forrester speaks of the "double hit" that occurs when a URM colleague leaves because it is not just the loss of a colleague, but the additional connection about the shared sense of mission and about progressing conversations about equity and diversity in the department.
• Medical trainees at every level benefit from a diverse core faculty because such diversity provides different perspectives to situations and thus might also provoke an alternative response that is essential to growth. Research has also shown that patient outcomes improve in the presence of diverse medical teams.
• Dr. Forrester talks about using self-reflection to identify one's core mission as the commitment to stay in academic medicine and/or an underrepresented department. When we are stressed, it's instinctive to be reactive to negative situations. Identifying one's intention for being in academic medicine in the first place can reinforce the strength to stay and reach out for support.

References

Forester A. N Engl J Med. 2020 Jul 23;383:e24.

DeAngelis T. Unmasking 'racial microaggressions.' American Psychological Association. Monitor on Psychology. 2009;40(2):42.

Galinsky AD et al. Perspect Psychol Sci. 2015 Nov;10(6):742-8.

Gomez LE, Bernet P. J Nat Med Assoc. 2009 Aug;111(4):383-92.

Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Dr. Posada has no conflicts of interest.

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