Dr. Vince highlights discussions on diversity, equity, and inclusion in urology

In this interview, Randy Vince Jr, MD, MS, highlights discussions on diversity, equity, and inclusion (DEI), which took place at the American Urological Association (AUA) 2023 Annual Meeting in Chicago, Illinois. Vince is an assistant professor of urologic oncology at Case Western Reserve University and University Hospitals Urology Institute, as well as the director of Minority Men's Health at University Hospitals Cutler Center for Men in Cleveland, Ohio.

Randy Vince, Jr., MD, MS

At the recent AUA meeting, there was a session called, “Race and Medical Research: A Historical Perspective.” Could you provide an overview of those discussions?

First and foremost, I was extremely happy that the AUA elected to even include that in the session. The way that we've defined race in this country historically doesn't have much of a scientific basis. But when we talk about medical research, we've used race in such a way that we try to assign this innate biology to race. But like I said, it doesn't really have much of a scientific basis. So, in that presentation, I tried to highlight how race has been used in medical research, specifically analyzing how this may [be] used toward Black people as a way to uphold systems of oppression, and how—in modern times, when we talk about research—we haven't done much digging to get that out of the way that we do research. We haven't really acknowledged it at all, to be honest with you.

So, in that presentation, I wanted to give historical examples, starting back to slavery, all the way up into modern day, to show how race in medical research was used to uphold the institution of slavery, and how it's been something that's been used to oppress people, even in medicine. We’re supposed to help; we're not supposed to be contributing to oppression. [I wanted to highlight] the fact that we haven't actually done the heavy lifting to remove some of the historical perspective on medical research now.

What can urologists do to combat these historical oppressions and biases?

When I was a fellow, I wrote a piece that was published in JAMA about eradicating racial injustice in medicine. The first thing that I said—I laid out 5 bullet points, from my opinion, on what we could do as the institution of medicine in general, and it's no different for urologists—was to review and understand the history of race and racism in this country. The reason I said that is because many people don't think about how we define race in this country. So, in that presentation [at the AUA], we talked about [how] there has been these blood fractioning laws that [said] if you were 1/8 Black, have a 1/8 African ancestry, now you are considered Black, even though you could be predominantly European ancestry.

It wasn't until I told some of my own personal mentors [to recognize how we] talk about prostate cancer and the [effect] it has on Black men. I have family members of mine who have a White dad and a Black mom. And they are now looped into that category of being increased risk, because they are looked at and labeled as Black, but their father is White, right? Well, your mom doesn't have a prostate. So why does this family member of mine who has a White dad now also fall into the same category as me? It doesn't make sense, if you think about it scientifically. But that's just the way that things have been done in our country. So, that's the first thing, is really taking a deep dive into how we define race in this country and how we've used race in general and how racism has driven the way that we define race. I think when you start with that, then everything else you start to look at you're like, "oh, my gosh, I didn't realize how deep rooted these issues are.” You have to start with that basis, in my opinion.

There was also a discussion at the meeting called, “Pipeline/Pathway Program Lecture: What Works and What doesn’t Work.” Could you provide an overview of that lecture?

One of the things that are called for was nationwide longitudinal pathways. The reason why is because in addition to the race and racism, we know that kids who come from underserved communities are less likely to end up becoming physicians, less likely to go into STEM fields, and there are a number of other things that they're less likely to do. Within that presentation, I wanted to highlight the ways that pipeline programs are implemented, things that cause pipeline programs to fail, and things that cause pipeline programs to succeed.

What we know is that for those programs that succeed, they have the resources to be sustained. They also have a sense of community. Because oftentimes, and I even include myself in this, when you're not from a family of money or means, and you go from living in poverty, not knowing anyone who was a physician, to now becoming a surgeon, it's extremely hard on that journey to put yourself out there, because you're constantly feeling like a fish out of water. So, those pipeline programs that actually foster a sense of community and family, those are the pipeline programs that really do well. That's one of the things that I wanted to highlight in that program, because oftentimes, we have many of our prestigious universities and institutions that say, "we have this pipeline program,” but they don't really commit resources to it, or they're not really interested in fostering a sense of community and family. And in my opinion, those things are pivotal if you want to have a successful pipeline program.

What are some first steps that need to be taken to improve DEI in urology?

There are many steps. Urology, out of all the specialties, if you were to rank them, we would be at the bottom when we talk about diversity, equity, and inclusion. There are many factors. One is going back to that history of race and racism, because I've heard people say, who might not be Black, but a person of color, say, "Oh, well, I'm a person of color, and I could do it, then why can't Black and Latinx people do it?" One of the things that we have to remember is that history, so anything short of that, you're coming into the conversation with half the information. That's one thing.

You have to be very intentional about it. I've been vocal about this in the past, [but] sometimes I feel like when we talk about diversity, equity, and inclusion, people are doing things to, I don't want to say to check a box, but it almost feels like that at times. It almost feels like window dressing, like "Oh, look at us, we're doing this initiative for diversity, equity, and inclusion,” and it's not really pushing the needle much. So, I think that's another thing, just being intentional. I do think we need more pipeline programs, because it's one thing to try to recruit more medical students to come into urology residencies, but if the number of medical students—and I'm just throwing out some numbers here—when we talk about Black men specifically, if the number or the percentage of medical students in medical school now for Black men is the same as it was in 1960, then how do you expect to get more Black men into urology residencies? It doesn't even make sense, if you think about it mathematically. So, those pipeline programs that we were talking about, they are pivotal. I do feel like urology departments can play a bigger role in that, because we have a lot of urology departments that have a lot of money and a lot of resources. They could definitely help when we talk about developing those longitudinal pipelines.

What are the take-home messages from these discussions at the AUA meeting?

We need to be more thoughtful and review how history has an [effect] on our present day. We can't just say, "Oh, that was so long ago, this doesn't [affect] us now,” because it does. A lot of the things that we talk about when we talk about a historical perspective, it's not like that was 10 generations ago. Many people still have grandparents that were descendants of slaves. So, I think that's one of the things that we have to be very cognizant of. We can't make much progress if we don't recognize that history and understand how it's been [affecting] us in present day. That would be one thing that I would encourage everybody to do, regardless of race, because that in itself allows everyone to be a little more conscientious of the issues that we're dealing with, and how deep rooted they are.

Next, I would encourage people to start to think about how seriously they take diversity, equity, and inclusion. Anything short of actually having investments and supplying and putting resources there, we're having window dressing. So, I think that's another thing that people should take away.

When it comes to diversity, equity, and inclusion, fostering [a] community [that] is inclusive to all people, [and] I'm not just talking about Black people, Latinx people, or indigenous [people], I'm talking about all people, where you feel included. You're not dealing with that fish out of water feeling that I talked about or having these massive feelings of impostor syndrome. I think those 3 things would be some major takeaways, in my opinion, if we're really trying to push things forward.