David Henderson, MD, is joining the American Medical Association as vice president for equity, diversity and belonging in the Medical Education Department. Previously, Dr. Henderson was chair of the Department of Family Medicine and associate dean for multicultural and community affairs at the University of Connecticut School of Medicine where he was also the principal investigator on that institution’s AMA Accelerating Change in Medical Education grant.
Prior to joining the faculty at the University of Connecticut in 2003, he worked for a year as a physician volunteer in a rural hospital in Sierra Leone, West Africa. He also worked part time as a physician volunteer at Charter Oak Terrace Community Health Center in Hartford for two years.
AMA: What attracted you to working with the AMA’s Medical Education Department on equity, diversity and belonging (EDB) issues?
Dr. Henderson: The fundamental question for me is how can the AMA, through the work that it does, be an agent of change and move us in the direction of improved diversity, equity and belonging? This larger context is invoked because it informs the environment in which the work needs to be done. The AMA is unique among the organizations in the governance structure of medical education.
I tend to think in metaphors, and in my mind the AMA represents a three-legged stool. The three legs represent diversity, education and clinical care. The rails that connect them represent social justice, and the seat is health equity.
AMA: What is your vision for this role?
Dr. Henderson: If recent history is any indication, we live in contentious times. There seems to be constant change driven by the push and pull of oppositional forces that seemingly has no logical near-term resolution. However, if we look at our history, times have always been contentious. This is simply our contemporary experience of historical struggles. Nonetheless, as has always been the case, it is possible for individuals and groups to navigate these struggles and lead the way forward. In its contemporary posture, the AMA is capable of providing such leadership, and the vice president for EDB in the Medical Education Department will be an important voice in both internal and external engagement.
In my opinion, EDB is a process, and it evolves from a debt or asset perspective as opposed to a deficit perspective. I view diversity as the process of promoting the appreciation of the variability of commonality. Equity is the process by which social justice is conceived, made manifest and experienced by individuals and communities. This requires interrogating the historic and cultural roots of power, privilege and disadvantage and creating structures that redistribute power as well as access to resources and opportunities with the goal of fostering full participation and achievement of potential. This is relevant across all aspects of phenotypic, cultural, social and physical variability that define our commonality.
Belonging is actually both process and outcome. From the perspective of a given individual, belonging may be experienced as an outcome. From the perspective of the dominant culture, it is a process. The process is one of collaborative creation of “new space” by acknowledging historic inequities; reforming institutional processes, cultural norms and practices; and inviting genuine co-habitation. This must proceed from a debt or asset perspective, and perspective matters a great deal.
AMA: What sort of projects do you intend to take on?
Dr. Henderson: I need to understand more precisely the vision of Sanjay V. Desai, MD, the AMA’s chief academic officer, before definitively answering this question because I do not want to run counter to his intention. I will simply state that I think that there is much that the AMA can accomplish in improving education. This work has been going on in the Accelerating Change in Medical Education Consortium for some time, and innovations now bridge undergraduate and graduate medical education. We now have an opportunity to look even more deeply into medical education and also venture upstream. To a large extent assessment drives curriculum and environment drives learning. Therefore, I believe interrogating the underlying forces that contribute to inequities in assessment and student outcomes is in urgent need of engagement. Issues related to educational environment, as well as social and academic engagement also demand our attention.
Additionally, there is already evidence that pathway programs alone are not sufficient to achieve the level of health care workforce diversity necessary to meet health equity goals. Finis origine pendet is a Latin phrase that simply means, “the end depends on the beginning.” It adorns the seal of Phillips Exeter Academy which is my secondary school alma mater. In conceiving pathway programs, it was probably never logical to assume that a few summer courses could compensate for the systematic neglect and miseducation that many students in our country experience. Therefore, in my opinion, it is important that the medical education system becomes a strong advocate and activist in promoting reforms in undergraduate, secondary and primary education. The AMA is arguably better suited than any other prominent national organization to pursue this work. This is the only way we are likely to effectively diversify the health care workforce.
AMA: Why are you excited about this role?
Dr. Henderson: I feel that I have been running uphill all my life. The hill has given me everything I have ever needed. It certainly represents challenge but also opportunity and possibility. While it has tested me, it has also nourished me and fostered my growth and development. This new role of vice president for EDB promises to be a very interesting and engaging experience of the hill. To use the main image in Cavafy’s poem Ithaka, the way has been and continues to be long. That is a fact for which I am most grateful.
Each month, the AMA highlights institutions that are part of the AMA Accelerating Change in Medical Education Consortium to showcase their work with the consortium and innovations in medical education. Learn more.