Higher educational institutions have historically been bastions of knowledge. Controversies have recently engulfed some of these esteemed institutions regarding their history, including exclusivity and marginalization, which are often rooted in race/ethnicity, gender, generational wealth, legacy1, and disability. Today, many institutions are striving to rewrite their narrative by increasing minority staffing, under the guise of broadening perspectives and fostering innovation. Despite these attempts, minority leaders are still vastly underrepresented. There exists enduring hesitation in appointing minorities to leadership positions or allowing them a voice in organizational decision making. Although strides have been made in this area, inequity remains. Bilingual people with English as a second language might be viewed as inept; in reality, they may be skilled, creative, and empathic. There will only be true progress when opinions of individuals who are “different” are sought and valued. These individuals might have an accent, might be unfamiliar with local linguistic phrases or euphemisms, or lack confidence, but they matter. Weighing the suggestions of these individuals less than others will invariably lead to biased policies.

It is often overlooked that diversity and inclusion originate in the pre-hiring process. Academic institutions and healthcare systems must ensure that bias is removed from their job descriptions. A candidate’s religion, ethnicity, and gender can be inferred from his/her name; therefore, this should be redacted during all stages of the pre-hiring process. Candidate evaluation should be based on a standardized and unbiased rubric, rather than a “gut feeling” or selecting a compatible golf buddy. Some studies show that white-sounding names received almost 50% more interview invitations than African American-sounding names,2 with similar results for male versus female. Women are often doubted subconsciously or behind closed doors based on inferred commitment or pregnancy,

Of equal importance is eliminating bias for faculty promotions. The median institution-specific promotion rates for White, Hispanic, and Black faculty, respectively, were 30.2%, 23.5%, and 18.8% (P <.01) from assistant to associate professor and 31.5%, 25.0%, and 16.7% (P <.01) from associate to full professor.3 The promotion process should be open and transparent utilizing fair and standard practices such as a standardized rubric. Failure to do so can lead to feelings of distrust and discouragement, which erode employee morale and participation. This hurts equitable healthcare delivery and leads to worse healthcare outcomes for marginalized patients. Immigrants from low or middle-income countries may have less childhood exposure or formal training in communication styles and emotional and interpersonal skills. This often leads them to seek care from physicians who “look like” them or “talk like” them which further necessitates a diverse healthcare workforce.

Feedback and evaluation of academic healthcare providers and trainees are frequently subjective and therefore bias-prone, especially if the feedback mechanism lacks structure. Individuals typically rate faculty who are in their peer group higher than those that they perceive to be outside, referred to as similarity bias.4 Racial minority faculty, particularly Blacks and Asians, receive more negative evaluations than White faculty in terms of overall quality, helpfulness, and clarity. A two-stage cluster analysis demonstrated that the “very best” instructors were likely to be White, whereas the “very worst” were more likely to be Black or Asian.5 This is consistent with reinforced negative stereotypes of racial minorities and has implications for their tenure as faculty and other promotional opportunities.

Targeting subtle discrimination and materializing “true” diversity, equity, and inclusion in academic institutions requires further legislative reform, greater transparency in the areas of pre-hiring, hiring, evaluation, promotion, and equitable patient care. Organizations need to set goals, value complaints, avoid biased technology, and involve supervisors to evaluate efforts to improve their culture.


  1. Amponsah M, Herszenhorn M. Dept. of education opens investigation into Harvard’s donor, legacy admissions preferences. Harvard Crimson. https://www.thecrimson.com/article/2023/7/26/doe-investigation-donor-legacy-admissions/. Updated July 25, 2023. Accessed September 15, 2023.
  2. Bertrand M, Mullainathan S. Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. Working paper 9873. Natl Bureau Econ Research. http://www.nber.org/papers/w9873. DOI:10.3386/w9873. Published July 2003. Accessed September 15, 2023.
  3. Nunez-Smith M, Ciarleglio M, Sandoval-Schaefer T, et al. Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Public Health. 2012 May;102(5):852-8. doi:10.2105/AJPH.2011.300552. Epub 2012 Mar 15.
  4. Jones B, Smith K, Rock D. 3 biases that hijack performance reviews, and how to address them. Harvard Business Rvw. https://hbr.org/2018/06/3-biases-that-hijack-performance-reviews-and-how-to-address-them. Published June 20, 2018. Accessed September 15, 2023.
  5. Reid LD. The role of perceived race and gender in the evaluation of college teaching on RateMyProfessors.Com. J Diversity Higher Educ. 3(3):137–152.



Health Equity, Medical Education, SGIM

Author Descriptions

Dr. Ali (yousaf_ali@urmc.rochester.edu) is a professor of medicine at the University of Rochester Medical Center in Rochester, NY.