Obtain as much of the following information about your community & institution as possible:
Demographic breakdown of your clinic’s/institution’s patient population
Demographics of the neighborhood in which your clinic/institution is located
Demographics of the support staff in your clinic/institution (ex. medical assistants, front desk staff, cleaning staff…)
Demographics of the learners at your school/residency/institution
Demographics of the attending physicians/educators/providers at your clinic/institution. If possible, get the demographics of leadership (ex. hospital/institution/clinic leadership, board members, department heads…)
What criteria are used to evaluate applicants? How are applicants scored or compared?
Who is on the recruitment committee?
Pre-work
Quiet room with enough chairs/space for all participants. If you have a group larger than ~6 people, chairs should ideally be mobile so people can break into small groups and then join the large group again.
Supplies
Activity
Read “caucusing guidelines” to the group
If you have a group that includes multiple levels of medical hierarchy (medical students, residents, attendings, nurses, MAs…) consider explicitly pointing out that expertise in medicine does not equate to expertise on issues of race and equity. One example, “For this exercise, experience and expertise may flip from how they are in clinic or on the wards. The attendings in the room may be the learners today and an MA may be the expert. Let’s recognize that we are all here to learn, share, and challenge each other.”
Break into small groups.
Group size may depend on the size of your large group. We have found that groups of 3-4 work well. Breaking into small groups allows people to be more vulnerable than they might be in a large group. It also makes it challenging to not participate.
Consider the make up of your group and how you might do this. Do you want mixed groups that include all levels (ex. student, intern, attending) or would it be helpful to break into groups that might be more comfortable for challenging discussions (ex. group attendings, students, residents separately)? Are the groups assigned in advance or do you have your group “count off” and then group by number (all the “1s” together, “2s” together, etc.)?
Discuss
What patterns do you notice?
How well does the leadership and learner make-up match the community in which you are located?
What is the racial/ethnic make-up of leadership? Does it match the demographics of the larger community? If not, how?
When considering applicants to your institution/the recruitment process:
How could the diversity of your recruitment committee be improved? What voices are missing?
Are there markers of privilege that get disproportionate weight? For example, if you look for grit or resilience in applicants, do you consider factors like being an immigrant, growing up in poverty, loss of a parent, working while in medical school, being a parent, etc…? Does your rubric focus more on factors like having unpaid internships or travel abroad that might preference applicants who have more financial resources?
Do the factors you look at correlate with skill/capability?
Test scores have not been found to correlate well with clinical ability, and several studies have found bias in grading and AOA admission. How heavily are those factors considered in your recruitment process?
Does your institution look for candidates that come from or look like the community that is being served?
In looking at faculty & leadership demographics, what do you notice?
Studies have consistently shown that faculty of color have higher attrition in medicine, and that higher ranks in medical institutions are disproportionately white. Is that true at your institution?
Report back
Ask each group to share some highlights of what they discussed with the large group.
What practical actions could be taken to improve your institutions recruitment & retention?