Unintended consequences of measuring equity, diversity, and inclusion in medicine

Inequities, harassment, and discrimination are an ongoing problem in academic medicine. Numerous reports throughout North America and Europe have highlighted worse health outcomes for patients because of systemic and interpersonal discrimination,123 slower career progression and lower compensation for physicians from marginalised groups,45678 and unacceptable prevalence of harassment of medical trainees.910 In response, medical schools and teaching hospitals in high resource settings often convene equity, diversity, and inclusion (EDI) committees, typically composed of doctors with an interest, although not necessarily expertise, in these concerns.

EDI committees often begin their work with a survey of their organisation.1112 Formal measurement can help academic medical organisations evaluate their investment in EDI, target areas for improvement, and generate evidence for effective initiatives.13 Local data may be more helpful than national or international data, as social contexts and barriers for marginalised groups vary between settings. Indeed, recommendations for action often prioritise the collection and transparent reporting of demographic data of all participants in health systems.14

However, EDI committees must not overlook the potential unintended consequences inherent in surveying excluded, oppressed, and marginalised groups (table 1). Some of the risks to physicians working within these institutions may be clear—for example, outing respondents, retraumatisation, or using outdated terms for certain identities. However, many of the consequences arise from insidious institutional factors, such as a lack of leadership support to act on findings, lack of recognition of EDI committee work, or conflicts about data ownership. The unintended consequences are compounded in academic medicine, where there are often fewer protective mechanisms such as human resource departments and employment laws than in other workplaces. …