Policy Document

Racial Discrimination and Cultural Diversity

BACKGROUND

Racism in Medicine This policy has been developed by the Australian Medical Students’ Association (AMSA) with the intention to take a stand against racism, and promote cultural diversity within the organisation and medicine as a whole. As the peak representative body for a diverse group of 17,000 medical students, across the 22 medical schools in Australia, AMSA acknowledges and commits to addressing the issues of recognising diversity, racism and discrimination within medicine. Racism is a key factor contributing to health inequality in Australia. Numerous studies highlight the specific barriers that Culturally And Linguistically Diverse (CALD) individuals, including migrants and Aboriginal and Torres Strait Islander Australians, face in accessing and receiving quality healthcare [1-3]. Racism also exists within the medical workforce, with many health professionals experiencing racism and citing fears around the accessibility of training positions based on racial discrimination [4, 5]. It is important that racism be dismantled and cultural diversity increased in medical education, leadership and the workforce to ensure high quality of care for all patients in Australia. Racism is a complex, multifactorial issue that has many contextual origins. Racism, as defined by the United Nations, is a “a set of beliefs, often complex, that asserts the natural superiority of one group over another, and which is often used to justify differential treatment and social positions” [6]. Racism can occur at both individual levels and at systemic levels through attitudes, behaviours and structures that either explicitly or covertly perpetuate biases and inequalities within society [6]. Discussions around racism, especially in medicine, particularly need to note the intersectionality of racism with other social determinants of health. The experience of racism varies across a number of social factors including: gender, sexuality, socio-economic status, religion, ableness and ethnicity. Hence, racism can be particularly challenging to address when it intersects these many multifaceted social factors. Particularly within Australia, this represents a key challenge for Aboriginal and Torres Strait Islander Peoples and migrants, who may face additional challenges in access and provision of healthcare within Australia [1-3, 7-11]. Interfaces of Racism in Medicine Within the healthcare workplace there are several key interfaces where racism and discrimination occur. Firstly, there are instances of interpersonal racism between healthcare professionals, of which individual violations are covered under the Racial Discrimination Act [12]. However, workplace bullying is still rampant and can go unreported, with a Royal Australasian College of Surgeons (RACS) report highlighting that this remains largely underreported and more ubiquitous than previously thought in the medical workforce [4]. The findings of a 2013 Beyond Blue study also demonstrated the effect of interpersonal racism on mental health, noting Aboriginal and Torres Strait Islander doctors were 5.5 times more likely to be stressed from bullying and 10 times more likely to be stressed from racism than non-Indigenous doctors [5]. Secondly, there are instances of racism directed towards healthcare professionals from patients. However, this is more complex to address due to the position of power of healthcare

professionals in the doctor-patient relationship. Nonetheless, there is an expanding repertoire of journal publications providing guidelines on managing discriminatory patients [13, 14]. These interpersonal interfaces of racism towards doctors can have large effects on physical and mental health, which has been linked to poorer patient care and general quality of life [15, 16]. Finally, there is racism from the healthcare system towards patients, whether at an individual or institutional level [7-11, 17, 18]. At an individual practitioner level, professional conduct is covered under the Medical Board of Australia “Good Medical Practice” code of conduct, with relevant anti-racism provisions across all healthcare disciplines [19]. While overt attacks of racism may be addressed with this code of conduct, unconscious and institutionalised racism - which is common within healthcare - is likely to go unmonitored and therefore continues to pervade healthcare structures [20, 21]. Doctors who are unaware of their unconscious racial biases will prescribe and deliver care to patients differently, which may impede on the quality of care and further feed into structural artefacts of institutionalised racism [9-11, 22]. Specific barriers to accessing appropriate healthcare include barriers to use of translation services, individual financial barriers, lack of culturally reflective and competent care due to a lack of cultural diversity and sufficient education [7-11, 23-29]. Benefits and Importance of Cultural Diversity Australia is one of the most culturally and linguistically diverse societies in the world. Therefore, a culturally and linguistically diverse workforce that reflects the diversity of the community is better able to serve patients. A workforce composed of doctors from diverse backgrounds enables more flexibility, responsiveness and empathy in the delivery of healthcare in Australia. A broad, collaborative and multi-level effort within the healthcare sector is needed to work towards the eradication of racism, in order to facilitate increased diversity and cultural representation within the health professional workforce [30]. Culture is an integral part of the human identity and acts as a platform from which individuals derive their values, make decisions and find a sense of belonging [31]. The plethora of cultures sourced from individuals’ collective experiences of country, land, people, groups, beliefs and customs means that cultural diversity will always be a part of the community. Within medicine, culture influences both patient and practitioner perceptions of health, illness, healthcare services, treatments and healthcare professionals [30]. The 2016 Census conducted by the Australian Bureau of Statistics found that 33% of Australian residents are born overseas and 27.3% speak a language other than English [32]. Therefore, it is imperative that we acknowledge, celebrate and advance cultural diversity in the community, particularly in leadership and workforce.

Table 1: Trends of top 10 countries of birth for 2012-2016 for Australian medical students [33] The MDANZ Medical School Outcomes Database (MSOD) which collects demographic, education and career intention data on medical students publishes an annual report on their findings of their annual survey of final-year medical students. The National Data Report of

2017 produced Table 1, which highlights a few of the CALD groups that exist amongst medical student cohorts [33]. The heterogeneity of cultures is important because it promotes a unique learning experience [34]. The exchange of different ideas, skills and resources is made possible by the various cultures and experiences that individuals draw upon [35]. Innovation occurs when a team comprised of a variety of people with different viewpoints apply their perspectives to the problem. [36]. Declared by UNESCO to be a “living and renewable treasure” [37], cultural diversity is a necessity for the betterment of society.

Strategies to Redress Racism Leadership Organisational culture, as set by leadership and management, is pivotal to outcomes for CALD healthcare professionals, with significant effects on the mental health and productivity within the healthcare workforce [5, 16, 38]. A recent report by the Australian Human Rights Commission found that a total of 97% of senior positions in the ASX200 were filled by non-Indigenous Australians of Anglo-Celtic or European descent [39]. CALD people were underrepresented in the ASX200 senior leadership by 18.3% and Indigenous Australians were underrepresented by 2.7% in population terms [39]. Additionally, all 40 University Vice-Chancellors were found to be of Anglo-Celtic or European descent [39]. The inherent problem is that eligible and capable individuals from CALD groups may not aspire to take up leadership positions due to perceptions of inadequacy and a lack of their self-identity reflected in organisational culture [37]. Unfortunately, no studies have assessed the level of representation within medical organisations, universities and specialty training colleges within Australia, but it is likely that the aforementioned underrepresentation pervades all industries to differing extents. Studies have suggested that with managerial based increases in diversity, organisational attractiveness increases [38], which may in turn precipitate an increasingly diverse and welcoming workplace. Diverse leadership is also important because these executive teams are better-equipped to understand and manage the challenges that may arise by working with a plethora of cultures in employees and patients [35]. A survey of all AMSA presidents from 2003-2018 inclusive was conducted, calling on their integral knowledge of AMSA’s leadership with respect to cultural diversity. In the survey, presidents were given the opportunity to identify their heritage and whether they identified as CALD individuals. They were also asked to provide figures, to the best of their recollection on the CALD and gender makeup of their teams, and their opinions towards the themes of this policy. Of the 16 presidents, 11 responded to the survey. The results of this survey, shown in Graph 1, indicate a fluctuating trend of CALD involvement in the AMSA National Executive. This data presents limitations, as it is merely a snapshot of a small team of volunteers within this large company. Graph 2 indicates that out of all the respondents, a single past president identified with a CALD background. This provides a ballpark historical indicator of the diversity within the highest echelon of leadership in the organisation. In addition, quotes from their responses to the themes of the policy can be found in Appendix 2.

Graph 1: Percentage of CALD Members in AMSA National Executive Teams according to Respective Presidents

Graph 2: Percentage of Responding Presidents Identifying as CALD Data Collection on Student Cohorts, Training Colleges and Workforces Measuring and evaluating progress to diminish racism and increase cultural diversity is difficult to achieve without any baseline data on the CALD of patients, doctors and students. Data collected on CALD assists organisations in recognising where disparity exists within the organisation, measuring the impact of any existing diversity policies and programs, and guiding the development of future actions to increase diversity [41]. The benefits of data collection have been demonstrated by the positive progress made in workforce gender diversity. For example, since 2012, the Workplace Gender Equality Agency requires all companies with 100 or more staff to collect data on gender equality [42], which has helped achieve systemic change towards gender equality. Such progress has not yet been made for the cultural diversity movement in Australia, as organisations are currently under no equivalent obligation to report on cultural diversity [39]. However, Medical Deans Australia and New Zealand (MDANZ) has set a mandate for medical schools to report on Aboriginal and Torres Strait Islander medical student recruitment, retention and graduation in accordance with their Indigenous Health Priorities policy priorities [43].

Graph 3: Indigenous Australian Medical Students by Year compared to Total Domestic Australian Medical Students in 2017 [44] Total Australian Indigenous student enrolment in 2017 totalled 327 (2.3% of Australian domestic enrolments) with 78 students commencing in the same year (forming 2.4% of

Australian domestic commencements. According to the MDANZ data, 35 Australian Indigenous students graduated in 2016 (1.1% of total domestic graduates) [44].

Table 2: Commencements, graduates and enrolments of Indigenous medical students in Australia and New Zealand [44]

Graph 4: Trends of commencements and graduates of Indigenous medical students in Australia and New Zealand from 2003-2017 [44] Measuring cultural diversity is a complex process. A person’s sense of culture can encompass more than one facet of identity, which poses a problem when attempting to maintain consistent data collection strategies. The Australian Bureau of Statistics released the Standards for Statistics on Cultural and Language diversity, which sets a national standard for measuring diversity through a set of cultural and language indicators [45]. The recommended core indicators comprise of country of birth, main language other than English spoken at home, proficiency in spoken English, and Indigenous status [45]. Furthermore, any data collected must be kept confidential and de-identified before being reported. Diversity Targets and Quotas Targets or quotas for cultural diversity are an effective method of increasing diversity within organisations and institutions. The use of targets and quotas hold organisations accountable and ensures cultural diversity remains a priority [38]. Targets are voluntary goals set by an organisation or institution, whereas quotas are a mandated goal imposed upon an organisation by an external body [38]. The implementation of targets and quotas can be extremely effective and means organisations are more likely to succeed in increasing the diversity of their members. There are benefits to the use of targets and quotas. Targets are voluntarily set by an organisation, making them specific, focused, adjustable and therefore more likely to be achieved [38, 46]. On the other hand, quotas are time-sensitive and enforceable; organisations are obligated to view cultural diversity as a top priority. There are also disadvantages to implementing targets or quotas, most notably the argument that cultural diversity targets can undermine the principle of merit, where fair selection decisions are based solely on merit and the suitability of candidates. However, the principle of merit is already questioned by the under-representation of cultural diversity within leadership positions and the workforce. Thus, targets or quotas may encourage the identification of talent from a wider range of cultural backgrounds [38, 46]. Additionally, these

targets or quotas could be implemented only once minimum standards have been met, ensuring that the quality of candidates remains high. The implementation of a target must be realistic and achievable for the organisation and should also be publicly endorsed in order to hold the organisation accountable. For example, the Australian Broadcasting Corporation set a goal for 15% of senior leaders to be from a non-English speaking background for 2016-18, and the Commonwealth Bank of Australia has set a goal of matching the cultural diversity of the Australian population in their senior executives by 2020 [38]. The diversity of staff and students of a university or hospital should ideally reflect the diversity within the Australian community. Methods to address this include staff and student recruitment strategies focusing on under-represented cultural groups [47]. One option for AMSA and other medical bodies is to set a realistic cultural diversity target in 2018, such as a goal of 20% of AMSA Council and Board members identifying as being of CALD backgrounds. After a period allowing for organisations to implement changes to improve their cultural diversity (e.g. in 4 years), this target and its effectiveness could be assessed, and the implementation of further strategies could be considered. In addition, these targets or quotas must be supported by other policies promoting a more culturally diverse representation in leadership and the workforce. Targets or quotas must also address all phases of procedure where they are implemented. This is particularly relevant for Aboriginal and Torres Strait Islander students in medical school, where intake quotas are insufficient to address the totality of support that is required for these students. In 2011, parity between medical school intake and population proportion was achieved for Aboriginal and Torres Strait Islander students at 2.5% [48]. However, the overall proportion of student cohort and graduation levels still remain reduced as of 2015, at 1.8% and 1.2% respectively [49]. Additionally, in 2016, intake still remained at 2.4% despite population proportion growth to 2.8%, and whilst overall population improved (2.3%), graduation levels were further reduced at 1.1% of domestic students [49, 50]. Two studies conducted by the University of Newcastle Faculty of Medicine and Health Sciences highlighted the need for additional resources to support Indigenous medical students throughout the medical education process to assist with the array of challenges they may face [51, 52]. Together, these clearly demonstrate the crucial need of targets across all points of the medical education process and the appropriate programs to support these students. Cultural Safety Training Discrimination and prejudice based on race or cultural backgrounds is still prevalent in Australia and can influence how specific people or groups are perceived [38]. Addressing this can be achieved through cultural education, training and encouraging positive contact between members of different cultural backgrounds. It requires both a top-down and bottom-up approach, where organisational bodies take responsibility and provide leadership, while staff engage in training and professional development [38, 46]. Strategies to redress racism require leadership and support from organisations and institutions including medical organisations, speciality training colleges and other representative bodies. Through policies that encourage cultural diversity and challenge discrimination, organisations can help promote a safe, inclusive environment with equal opportunities in education and employment, regardless of one’s cultural background. This also demonstrates to the community and relevant stakeholders that cultural diversity is an important issue requiring action [38, 46]. Furthermore, the creation of committees, specialist units or roles to coordinate action on cultural diversity could also be considered [53]. To cater for an increasingly diverse patient population, it is important that health professionals are culturally competent. This can be achieved through the provision of cultural safety training within universities, hospitals, speciality training colleges and other organisations, and ensuring adequate funding for said training and teaching materials [46]. This training requires more than just raising awareness and must present people with strategies to eliminate bias that can be applied in the workplace and within their daily life [46]. In addition, there should be a focus on knowledge and awareness of one’s own cultural worldview, biases and different cultural practices, cultivation of a positive attitude towards cultural differences, and an understanding of how cultural factors can affect health and healthcare [54]. Training on the increased use and promotion of interpreters and their services should also be provided [46]. Importantly, any approach to reduce subconscious bias and increase cultural education and safety must be ongoing and updated as culture and information evolve.

It is important that health professionals practice cultural safety at all times. Cultural safety improves patient-doctor relations and fosters flexibility, openness to change and an ability to shift thinking between contexts [34, 55]. It will enable more responsiveness and empathy in the delivery of healthcare, thus improving the quality of service to patients and ultimately leading to better health outcomes [56, 57]. Additionally, healthcare providers from CALD backgrounds are more likely to thrive in environments where cultural safety is demonstrated [57]. Importantly, the integration of cultural competence is made much easier if there is a variety of cultural backgrounds and experiences within the medical workforce [58, 59]. Mentoring and networking Organisations can also redress racism and increase organisational diversity by actively supporting individuals from culturally diverse backgrounds who exhibit leadership potential. By identifying and recognising emergent leaders, organisations can foster engagement and encourage a more conscious pursuit of future leadership opportunities. A structured way to achieve this is through mentoring programs, with culturally diverse and culturally safe mentors. Existing leaders may unconsciously seek to reproduce the same organisational style with people from the same cultural background [38]. Blinded Applications, Selection Panel Diversity & Positive Action To reduce barriers to entry for vulnerable applicants seeking to further their career in medicine, blinded applications, selection panels and positive action should continue to be used or adopted where possible, independent of Aboriginal and Torres Strait Islander student intake pathways. Where selection panels are not culturally diverse, opportunities remain for unconscious biases to discriminate against vulnerable applicants [60]. In addition, blinded applications & consistent structured interviews should be used to minimise the effects of personal biases, which will exist regardless of panel diversity [61]. For example, multiple mini-interviews, a form of structured interviews, have been shown to be to reduce interviewer bias when compared to traditional interviews, and the use of such interviews could be further encouraged within medical school admissions, specialty colleges and job applications [62]. Furthermore, positive action should be made to actively encourage participation from particularly marginalised communities to attempt to combat perceived barriers to entry.

POSITION STATEMENT

AMSA believes that: 1. Racism in medicine is a pressing and ongoing issue in education and healthcare

settings, with significant consequences for medical students, healthcare practitioners and their patients.

2. Both overt and covert racism within medicine is manifested through personal, institutional and systemic bullying, biases, discrimination, and active persecution.

3. A lack of cultural diversity in education, training, workforce and leadership positions significantly contributes to racism observed in medicine and highlights the benefits associated with increasing cultural diversity within organisations.

4. Developing programs and strategies that create cultural diversity and redress racism within healthcare, education and the broader community is essential.

5. Due to the institutionalised nature of racism, a multidisciplinary and multi-level approach is needed to address the central tenets of racism within healthcare, with active input from governments, organisations and individuals.

6. Any approach to redress racism within healthcare should adopt an intersectional approach, due to the various contextual origins of racism that determine different responses for various groups.

7. Of note, special appreciation of the challenges that Aboriginal and Torres Strait Islander students face within medical education must be considered and catered to.

POLICY

AMSA calls upon: 1. The Federal Government to:

a. Increase federal funding for Commonwealth funded medical interpreters and extend service eligibility to more culturally and linguistically diverse populations.

b. Promote the availability and adoption of translation services appropriately

c. Increase federal funding for higher education support for Aboriginal and

Torres Strait Islander students. d. Provide funding for a report on cultural diversity within healthcare settings.

2. State and Territory Governments to:

a. Provide funding for relevant and ongoing cultural safety programs in hospitals. b. Increase funding for state funded interpreter services. c. Promote the availability and adoption of translation services appropriately.

3. Australian Institute of Health and Welfare (AIHW) to:

a. Collect data on cultural diversity within healthcare, particularly in regards to professional cohorts and attitudes towards workforce inclusivity.

4. Universities to: a. Foster culturally safe environments and enforce policies on racism, bullying,

discrimination and harassment. b. Provide cultural safety training for staff and students.

5. Medical schools to:

a. Encourage cultural diversity in student cohorts and leadership. b. Actively and regularly conduct and fund cultural safety training for all staff and

students, with inclusion of mandatory and regular cultural safety modules as part of a core medical education.

c. Use culturally diverse selection committees. d. Educate selection committees and panelists on the potential for unconscious

biases. e. Utilise blinded applications and structured interviews where possible

independent of Aboriginal and Torres Strait Islander student intake pathways. f. Collect data on the cultural diversity of students and staff. g. Consider implementing targets or quotas where cultural parity is not achieved

for students and staff from a CALD background. h. Implement targets or quotas for Aboriginal and Torres Strait Islander students

and staff across intake, retention and graduation levels to achieve ongoing parity with population levels.

i. Facilitate mentoring and networking programs for culturally diverse students. j. Provide culturally appropriate support for disadvantaged students, particularly:

i. Aboriginal and Torres Strait Islander students ii. Refugee students iii. International students iv. Australian students with a CALD background

k. Provide appropriate mental health services for students who are a victim of racism.

6. The Australian Medical Council to: a. Mandate that universities and specialist colleges be required to provide

adequate cultural safety training as part of the core education process. b. Enforce and prosecute practitioner breaches of the anti-racism provisions

within the Medical Board of Australia’s “Good Medical Practice” code of conduct.

c. Develop guidelines to help protect and support practitioners who are victim of racism from patients or colleagues, including the provision of mental health services.

7. Specialty Training Colleges to: a. Recruit a culturally diverse selection of trainees. b. Actively and regularly conduct cultural safety training for staff

i. Include cultural safety modules as mandatory training and a requirement for fellowship renewal processes.

c. Use culturally diverse selection committees. d. Educate selection committees and panelists on the potential for unconscious

biases. e. Utilise blinded applications and structured interviews where possible

independent of Aboriginal and Torres Strait Islander Peoples intake pathways. f. Collect data regarding cultural diversity of members, including appropriate

data collection for Aboriginal and Torres Strait Islander trainees.

g. Implement targets or quotas where cultural parity is not achieved for students

and staff from a CALD background. h. Implement targets or quotas for Aboriginal and Torres Strait Islander students

and staff across intake, retention and graduation levels to achieve ongoing parity with population levels.

i. Encourage mentoring and networking between junior and senior doctors to promote inclusive and culturally safe organisations.

8. Hospitals and medical workplaces to: a. Acknowledge the existence of racial discrimination in the workplace for

students, practitioners and patients. b. Actively and regularly fund and conduct cultural safety training for staff and

practitioners. c. Increase and promote the adoption of interpreter and language services. d. Create a task force/committee to:

i. Collect data on cultural diversity of staff, ii. Evaluate workforce cultural diversity, iii. Enforce penalties for breaches of the Racial Discrimination Act, iv. Enforce penalties for breaches of the Medical Board of Australia

“Good Medical Practice” code of conduct. e. Implement targets or quotas where cultural parity is not achieved for students

and staff from a CALD background. f. Implement targets or quotas for Aboriginal and Torres Strait Islander students

and staff across intake, retention and graduation levels to achieve ongoing parity with population levels.

g. Provide immediate and appropriate support to practitioners who are victim to overt racism.

h. Develop guidelines to help protect and support practitioners who are victim to racism from patients or colleagues, including the provision of mental health services.

i. Consider appropriate procedures and protocols to minimise the incidence of interpersonal racism.

j. Facilitate the development of culturally diverse staff and organisational culture.

9. Individual health professionals to: a. Recognise and reflect on any potential unconscious biases and acknowledge

power imbalances in practice. b. Actively engage in cultural safety modules. c. Understand and acknowledge the cultural diversity of patients and

accommodate practices accordingly. d. Understand the importance of mentoring programs for the development of

culturally diverse medical students, and actively be involved with program(s) as a mentor.

e. Continue to acknowledge responsibility for the organisation of interpreting services and cultural support wherever appropriate to provide services in languages other than English and increase uptake where appropriate.

f. Seek appropriate support and treatment where their mental health and/or performance is negatively impacted by interpersonal or internalised racism.

10. Medical students to: a. Acknowledge the importance of cultural diversity within the student cohort,

medical workforce and patients. b. Recognise and reflect on potential unconscious biases. c. Educate themselves on the cultural diversity of patients and their experiences,

and how this has affected their ability to access healthcare d. Engage with opportunities to experience other cultures and traditions. e. Recognise and report acts of racism in their personal and professional lives. f. Actively engage in cultural safety modules. g. Seek appropriate support and treatment where their mental health and/or

performance is negatively impacted by interpersonal or internalised racism.

11. AMSA Council, Executive and Board to: a. Conduct annual diversity reviews of the pan-AMSA leadership, including, but

not restricted to, the representation of ethnicities and domestic/international

status and Aboriginal and Torres Strait Islander Peoples. Following this review, the Board and Executive should:

i. Develop a specific plan for representation, including but not limited to: 1. Identify and specifically target areas of leadership with a

cultural bias to promote diversity, including the reasons behind the disparity.

ii. Where positions are selected, consider the use of blinded resumes, standardised interviews and positive action where appropriate;

b. Collect data on cultural diversity of students as part of the national survey. c. Implement an internal target of 20% of AMSA Executive and Board members

to be from a CALD background where cultural parity is not achieved. i. Implement an internal target or quota for Aboriginal and Torres Strait

Islander student representation on AMSA Council, Executive and Board.

d. Organise mentoring programs for culturally diverse students. e. Create a diversity role to assess and support increased cultural diversity

within AMSA. f. Foster further collaboration and integration with Australian Indigenous

Doctors’ Association (AIDA).

12. Medical Societies to: a. Collect data on the diversity of leadership and executive teams. b. Implement targets or quotas where cultural parity is not achieved. c. Promote and create events that celebrate cultural diversity. d. Encourage further integration of individual representatives from the Australian

Indigenous Doctors’ Association and provide them with appropriate support.

APPENDICES

Appendix 1 - Key Definitions Institutional racism ‘Refers to the ways in which racist beliefs or values have been built into the operations of social institutions in such a way as to discriminate against, control and oppress various minority groups’ [20] Internalised racism Is the ‘acceptance of attitudes, beliefs or ideologies about the inferiority of one’s own ethnic/racial group.’[63] Interpersonal racism ‘Interactions between people that maintain and reproduce avoidable and unfair inequalities across ethnic/racial groups.’[63] Casual/Everyday racism A manifestation of interpersonal racism which can include speech and behaviours that treat cultural differences – including forms of dress, cultural practices, physical features or accents – as problematic, manifesting in disapproving glances, exclusionary body language, and marginalising people’s experiences as invalid. [64] Indirect racism ‘Indirect discrimination occurs when there is an unreasonable rule or policy that is the same for everyone but has an unfair effect on people who share a particular attribute.’ [65] Implicit/Unintentional racism 'Implicit racism is an automatic negative reaction to someone of a different race or ethnicity than one’s own. Underlying and unconscious racist attitudes are brought forth when a person is faced with race-related triggers, including preconceived phenotypic differences or assumed cultural or environmental associations.’ [65] Culturally and Linguistically Diverse (CALD) Culturally and linguistically diverse refers to groups and individuals who differ according to religion, race, language and ethnicity, such as migrants, individuals who speak another language at home, and Aboriginal and Torres Strait Islanders. [66]

Cultural Parity Commensurate levels of representation of CALD people with regards to general population proportion. [47] Appendix 2 – AMSA Presidents (2005-2018) Quotes During your involvement did you notice any shifts towards diversity? “I have observed a general shift towards more cultural and gender diversity within the organisation. I haven't been involved for 10 years now, so it is difficult to comment on how much this reflects determined efforts and affirmative action, or simply the make-up the broader medical student community. AMSA has set a positive example for other medical professional organisations by having a large number of female leaders. I'm not sure the extent to which this holds true for ethnic and linguistic diversity.” “I didn’t see any shifts, I didn’t really notice a problem within AMSA.” “I've seen particularly a shift in Gender Equity. I believe this was started through directed discussions at Council on the matter, and subsequent developments such as the GE Project” “More inclusive of students from diverse cultural backgrounds, likely due to enhanced and more accessible activities other than Convention” “The broadening of medical school intakes to be more reflective of the communities their graduates would one day serve.” “We had a discussion for NLDS planning about the importance of having equal gender representation where possible, and I understand this was a factor (but not a quota) in selecting participants. We also highlighted the issue of internships for international students, many of whom are from CALD backgrounds and engaged international student representatives in our policy- and decision-making on this (which I don't think had been done much in the past). We did a lot of work with AIDA and highlighting issues relating to recruitment and retention of Aboriginal and Torres Strait Islander medical students in collaboration with AIDA and other groups (and in a supporting rather than leading way - which again, was a change from previous efforts).” “I was fairly proud of putting together and working with a team who were diverse over a whole range of attributes - we were close to gender balanced, we had people from different cultural, ethnic and religious backgrounds and had a range of sexual orientations. We were a better team for it.” “Yes there were discussions regarding diversity in the context of the work we did on bullying, discrimination and sexual harassment in medicine, with the recognition that having leadership in medicine which doesn't reflect its membership or the population of patients it serves it detrimental to the management and care it provides. When I took over there had only been two female Presidents in the ten years prior; there have been two since and I think this reflects a shift in attitude from aspiring females and more broadly in medicine that we need more diversity in who represents us.” “As part of AMSA's Board we worked on a diversity policy which set targets for diversity over a range of outcomes. We also oversaw a range of new measures to deal with sexual harassment at AMSA's events. As AMSA's Executive and Council we developed policy regarding sexual harassment and bullying in medicine which disproportionately affects females and IMGs in our workforce. AMSA advocated broadly on discrimination, bullying and sexual harassment including submissions to the Royal Australasian College of Surgeons and their Expert Advisory Group on the issue. As President I commented on the lack of diversity in the leadership in AMSA frequently including in my speech to the AMA National Conference, and I personally made it a priority to approach and encourage females to take up leadership positions in the organisation, many of whom went on to become excellent leaders.” Do you believe AMSA needs to take necessary steps to encourage diversity in volunteers and leadership structures? “Yes. Diversity in any organisation is important for inclusion and innovation.” “Yes. We are a representative organisation, our leadership must reflect that. Diverse leadership aids a more inclusive, positive and productive culture.”

“Strong diversity at time of my involvement, policy implementation less significant for change within AMSA but appropriate to build upon strength and lead as a student organisation such that other professional associations are encouraged to improve.” “Yes - CALD students and especially student leaders have been underrepresented. The best way is to engage with affinity groups at a medical school level and foster the development of affinity groups if they do not already exist. Partnering with affinity groups from outside of medical school (broader university groups where there is a critical mass of students from specific groups).” “Yes but quotas is not what I believe works. Targets and good leadership as well as really hard working people who excel and actually want the position should make up these positions. Importantly forcing people to take positions just because of their background or ethnicity when the don’t have the skills or want can backfire.” “I would have thought the main priority should be achieving gender parity and increasing the involvement of Aboriginal and Torres Strait Islander students. Targets would seem to be a much more appropriate tool than quotas, especially in a volunteer-based organisation dependent on goodwill. “ “Yes - I think we would have better diversity in most aspects than most other organisations but there is more we can do, particularly in regards to encouraging a broader diversity of Presidents over time, since looking back past Presidents don't reflect the medical student population in Australia. I have seen a dramatic shift in how we perceive female leadership in the organisation over a few years and this has come about mainly from cultural shifts and encouraging excellent individual females to have the confidence to step up to leadership positions and I think the same principles could be applied to other aspects of diversity.” Is the cultural diversity problem unique to AMSA? “Not unique to AMSA. Positive discrimination can help but needs to be done properly and minimise risk of alienating others.” “This is not unique to AMSA. Common in leadership of workplaces.” “AMSA shares similarities and challenges with many medical organisations, but is more progressive than many others (eg, AMA). We are still a conservative profession and there is a long way to go to ensure cultural and gender diversity in our representative groups. AMSA can lead change in this area.” “This issue is prevalent everywhere. RACS, AMA... I see this in many organizations and boards I’m involved with.” “I would also say that medical workplaces, colleges and the AMA lack an adequate gender balance among their leaders, and that there is an underrepresentation of Aboriginal and Torres Strait Islander persons at all levels. Based on my recollection of past AMA presidents and recent Councils, there would appear to be scope for increased racial diversity there.” Lack of Diversity across leadership teams in Australia… “I think Mukesh as AMA president was a big step, and a lack of POC (person of colour) role models may feel exclusionary. I don’t know if leadership sets precedence for culture - culture is how you treat people every day.” “AMSA benefits from student volunteers at a life stage in which societal gender roles may not yet impact upon gender diversity of leadership teams, hence shielding from significant imbalances that permeate wider society.” “Reporting on cultural diversity is important” “I think this is a well documented phenomenon. I suspect medicine is particularly guilty.” “In AMSA, I would say that we often seem to have Councils which are diverse but we end up with leaders who are similar. I think that reflects a need to encourage potential leaders to step up which is what I tried to do when I was AMSA President - I think as soon as medical students see other females leading AMSA then it becomes closer to the norm, and hopefully

the improvements we have seen over the past few years will continue. I think breaking this "glass ceiling" is what we need to do within AMSA and I would propose we do it in similar ways.” Do you believe there is a lack of CALD individuals in leadership positions within medicine? Does this set precedence for organisational culture and inclusivity? “AMSA should continue to lead change in this area. It should remain a progressive organisation that can set a positive example for other medical groups.” “No. I think there is a lack of Aboriginal and Torres Strait Islanders involved in medical leadership positions but plenty of people of colour in leadership positions in my experience.” “Yes and yes” “Yes. And yes.” “Yes, yes.” “Yes to both.”

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POLICY DETAILS

Name: Racial Discrimination and Cultural Diversity Policy (2018)

Category: C – Supporting Students

History:

Adopted Council 2 2018