Increasing Diversity in Canadian Radiology: From the Hiring Process to Needed Active Retention Efforts

Abstract

The Canadian Association of Radiologists supports equity, diversity, and inclusion (EDI) in employment. It is imperative that institutions implement recruitment and retention practices to ensure a diverse workforce. This requires considerable attention to each step in the process, including the job posting, candidate search, hiring committee composition, interviews, hiring decision, and retention and promotion. Job postings must be widely distributed and visible to underrepresented groups. The candidate search should be completed by a diverse committee with expertise in EDI. All committee members must complete EDI and anti-bias training and conduct a broad search that ensures underrepresented groups are encouraged to apply. Interviews must be offered to all candidates. The hiring decision must avoid the use of subjective criteria. Recruitment of members of underrepresented groups ensures a diverse workforce, and organizations should commit resources to the retention and promotion of these members. Mentorship programs must be implemented and incentives provided to faculty members to serve as mentors. Transparent guidelines for promotion made universally available on department or institution websites. Recruiting a diverse workforce in Medical Imaging will only be achieved if EDI are central to the organization’s goals and strategic plan. All organizational policies, practices, and procedures must be reviewed with an intersectional lens to identify potential gaps, areas for improvement, and areas of strength in the recruitment and retention of members of underrepresented groups.

Introduction

Having a diverse workforce helps healthcare organizations improve both patient care and financial performance, while also fostering innovation.^1,2 The Canadian Association of Radiologists (CAR) stands by its commitment to Equity, Diversity, and Inclusion (EDI), in recent recommendations on why and how to increase EDI within the Canadian Radiology community in order to adequately reflect the population served.^2-6

This document provides recommendations to improve EDI for individuals and institutions when assessing their recruitment practices and work environment. It is adapted from the EDI Requirements and Practices from the Tri-agency Institutional Programs Secretariat (TIPS). ⁷

Some of the complementary, supplementary, and symbiotic processes that result in bias and inequality of opportunities in our workforce ³ are discussed in this document.

The aim of this work is to share recommendations on how to address bias and obstacles in recruitment, hiring, and promotion of a diverse workforce in the radiology population. It is imperative that institutions implement recruitment and retention practices to ensure a diverse workforce. This requires attention to the design and application of (1) job posting; (2) candidate search; (3) hiring committee skills and composition; (4) interviews; (5) hiring decision; and (6) retention and promotion.

Candidate Searching

Qualifications

Regarding qualifications of candidates for the position consider:

• Post only the qualifications and skills necessary for the job.

• Use encompassing, flexible, and clear criteria for assessing excellence that fully document, recognize, and reward the scholarship of teaching, professional service, community service, outreach, mentoring, advocacy, and research.

• Focus on ability over experience. Highly skilled candidates can be overlooked and not short-listed because they lack experience. Candidates from underrepresented groups may lack traditional skills because of systemic barriers and unconscious bias that resulted in their exclusion, particularly at senior levels of leadership.

• Experience and excellence in EDI, defined as the possession of a track record on published papers and editorials, delivery of lectures in the topic of EDI, participation in local, regional, and national EDI committees, communication and advocacy of the topic, among other accountable EDI-related activities should be included in the job description criteria. This is in addition to excellence in education, mentoring, and research that are routinely included in leadership job advertisements. A track record of EDI should be considered in the advertisement and search criteria process as an asset to any job position, and should be mandatory for leadership position applicants.

• Encourage minority group applicants who are not in the leadership pathway (eg, “succession pipeline” for promotion), who have experienced discrimination themselves and therefore developed coping mechanism skills to apply for positions of leadership. Interview panels should be aware that minority groups may possess skills for leadership, but may not have had equal opportunities as candidates from other groups to exert their skills in preparation to the application for a leadership position.

• Promote a competitive search process for any position. Having a single applicant or a preselected candidate may result in disillusionment of the workforce of the organization, particularly of underrepresented minorities.

• Strategic recruitment should be considered when there is documented underrepresentation of a specific group within the institution or section. Clearly communicate in the job posting that the posting is limited to candidates from the specific group and specify the reasons for the recruitment restrictions to candidates. This process should align with provincial/territorial human rights legislation.

• Work-related assessment criteria should apply to comparable experience in non-academic disciplines, such as government or community-based research.

Language Used in the Posting

With regard to the language to be used in the posting make efforts to:

• Use inclusive gender neutral language, such as “all genders” rather than “women and men,” and use the pronoun “them” instead of “him and her.”

• Prefer inclusive, unbiased, ungendered language for limiting unconscious bias in job postings and letters of support. ³ Women are less likely to apply if the job advertisement uses agentic language (words focused on power, achievement, competition) and more likely to apply when there is communal language (words focused on collaboration).

• Ensure the EDI committee reviews and approves the job posting before it is posted to confirm that it aligns with best practices.

Highlights on the Organization’s Commitment to EDI

The job posting should include information about the department and institution that is recruiting the professional, providing web links, EDI policies and action plan, accommodation policies, and family resources for diverse groups. The person responsible for the recruitment should highlight any connections/initiatives that already exist in collaboration with local minority communities, if applicable.

Additional recommendations of information that should be included in the posting are:

• Include commitment-to-equity statements that are meaningful in defining diversity. Avoid using general statements such as those the institution supports applications from individuals from underrepresented groups. Avoid using “qualified” in the equity statement, as all candidates must be qualified.

• If appropriate, engage a search firm with international reach and expertise in finding diverse candidates.

• Ensure that there is sufficient time to identify an optimally diverse pool of candidates. The search process should be competitive.

• Encourage strategic thinking on how to attract international scholars who may not be looking for a new position.

• Consider including international representation on the search and selection committees.

Search for Candidates

Search Committee

The senior management should be committed to an open and transparent search with a focus on EDI.

The CAR recommends compiling a diverse hiring committee with expertise in EDI and experience in conducting interviews. All hiring committees’ members must show evidence of mandatory training or expertise in EDI.

Department Chiefs and Chairs should consider compensating search committee members by providing protected time and relieving them from other assignments during search committee activities.

Search Strategies for Attracting and Recruiting Talent: Job Posting

The person(s) responsible for the job posting and for the overall hiring process should:

• Advertise widely. Job postings and recruitment information should be shared within and outside the organization, both on a provincial and national level, also including other societies discipline-specific and industry-specific associations, depending on the job category of the professional being recruited. Job postings should be visible to underrepresented groups. This can be accomplished by directing the posts to professional associations that represent these groups, that is, Indigenous Physicians Association of Canada, Black Physicians of Canada, and Canadian Women in Medicine. Jobs may also be advertised with the office of diversity and inclusion. ⁸ Efforts in conducting a search that ensures underrepresented groups must be broadened if the initial applicant pool lacks diversity.

• Promote positions by reaching out to colleagues, trainees, community members, and other faculties. Use all networks, including social media, job portals, and electronic mailing lists to promote the position.

• Avoid creating unnecessary barriers to universal visibility of the postings, such as posting inherent values concerning seniority.

• Allow sufficient time to identify an optimally diverse pool of candidates. Advertise job postings publicly for a minimum of 30 days.

• Keep a list of trainees and postdoctoral researchers as they progress through their career. Alert them to employment opportunities.

• Search for candidates through social media, conferences, gatherings, or other events.

• Ask the academic community and stakeholders to approach members of underrepresented groups and encourage them to apply.

• Consider the trade-off between succession planning and diversity promotion. Although it is important for leaders to review and promote talents within their own organizations, consideration should also be given to internal candidates not initially considered for the position as well as external talents. The final goal should be to recruit the best candidates for advancement of the mission of the organization. The process of preparing a diverse workforce for future leadership roles in the organization should start years before the job is posted, as minorities may have had fewer opportunities to develop experience on the roles that they are interested in taking in the future. The Department Chiefs/Chairs must prepare multiple individuals for the leadership pathway well ahead of time they plan to step down. They should equally incentivize all faculty interested in the leadership pathway to apply for leadership roles, thus allowing a larger number of individuals to develop experience in the required leadership tasks. Acting leaders should focus on the education of new leaders that can replace them at any time and provide appropriate protected time for them to learn leadership skills.

• Support individuals from minorities and underrepresented groups should be provided throughout the search process.

Assessment of Applications and Short-Listing Candidates

The person(s) responsible for the overall search and hiring process should:

• Ensure career interruptions due to parental leave, family care, extended illness, or community responsibilities do not negatively impact the assessment of a candidate’s productivity.

• Collect self-identification data from all applicants with a clear statement to indicate that the data is being collected to ensure diversity of the applicant pool.^9,10,11

• Ensure the pool of applicants is diverse. Mandate proactive, strategic outreach to attract members of underrepresented groups. The equity target percentages should be based on the targeted Canada’s population representation of minorities for 2019 (22% racialized minorities, 4.9% Indigenous Peoples, 50.9% women, and 7.5% persons with disabilities). ¹² If the applicant pool is too small or lacks diversity, then the application deadline should be extended and the job posting should be critically reviewed for potential barriers.

• Recognize the value of research outputs that are in different formats or platforms. Applicants from underrepresented groups may not have the most years of experience, greatest number of publications, publications in top-tier platforms, or largest number of academic accomplishments, and may publish articles in non-peer-reviewed journals on issues that are important to specific communities and peoples. ¹³ Some applicants may be focused on producing non-traditional research to meet community needs, community-based work, and developing policies to ensure their research has the largest impact.

• Be aware of limitations that the field of study on a smaller research market may have on attracting research funding, making the candidate’s “funding numbers” not being comparable to those from more traditional research areas.

• Ensure that an applicant with a track record of serving in leadership roles without any record of supporting women and/or minorities during past leadership tenures is asked questions about the reasons for such oversight in an interview.

Assemble of the Hiring Committee

Recommendations for the hiring committee are described below:

• Compile a diverse hiring committee. Include a faculty member with EDI expertise, ideally serving as chair of the hiring committee, who will ensure EDI is considered in all aspects of the committee’s work. Alternatively, the chair can be given explicit instructions to raise EDI concerns during discussions. If there are no available faculty members with EDI expertise, then the committee should hire an EDI advisor to serve as a non-voting member of the committee.

• Ensure that committee members declare any potential conflicts of interest with the candidates prior to commencing the process. Conflicts of interest should be managed throughout the process.

• Ensure that the committee search panel includes gender, race/ethnic, professional activity, and rank/position diversity in its constituent members; for example, including junior and senior trainees and faculty, technologists, and physicists, in addition to clinical and administrative faculty. It is essential to include experts in the committee in the field in which the job is being advertised to enable broad experience within the committee to understand the points of view of the candidate during the interview process.

• Ensure a similar proportion of males and females in the search committee. Previous studies have shown that minorities may have inherent biases within their own communities, themselves, and peers of their communities.^14,15

• Provide mandatory EDI training for all committee members including instructions on how to recognize and combat unconscious bias, ¹⁶ as well as anti-racism, anti-Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit (LGBTQ2S+) discrimination strategies, allyship training, inclusive communications, reconciliation, intersectionality, accessibility and accommodations, and intercultural competence.

• Identify potential biases, stereotypes, and microaggressions revealed during discussions. Support the committee members as they work through them.

• Provide a toolkit for hiring committees that includes:

Interview Process

Shortlisting Candidates for Interviews

While shortlisting candidates for an in-person or online interview the following procedures should be considered by the search committee:

Ensure members of underrepresented groups who meet the qualifications are interviewed. An article on the relationship between finalist pools and actual hiring decisions of 598 finalists for university teaching positions has shown that the likelihood of women being hired is 0% if she is the only finalist among a group of 4 finalists (25% female vs 75% male). This likelihood increases to 50% if the composition of finalist pools is 50% female vs 50% male. ¹⁹ Give all genders equal chance of success of being hired.

• Rank selection criteria prior to screening the applications to ensure an unbiased, consistent, and transparent selection process. Establish clear expectations through the use of an evaluation matrix that reflects the minimum required qualifications and skills identified in the job posting.

• Be explicit that career breaks for family responsibilities, medical needs, or community responsibilities will not negatively impact the selection for an interview or the hiring decision.

Provision of Accessibility and Instructions to Candidates

The search committee should ensure that all parts of the process are accessible to all candidates, and the format and platform for the interview are the same for all candidates. Consider barriers such as cost and geographic restrictions and provide communication accommodations (eg, specialized technology for candidates who are deaf, autistic, or have hearing disabilities). Ensure the candidates can clearly see each of the committee members during the interview and, in particular, the lips of the committee members when they are speaking.

It is highly recommended that one person responsible for the overall search process prepares the candidate for the interview in advance with key information, such as the expected length of the interview, names and job titles of the panel members, and the type and number of interview questions.

Interview Preparation

Prior to the interview date the person responsible for the overall search process should provide interview questions to the search committee members to review in advance. The Committee Chair should consult with the committee members about the questions assigned to committee members at the interview. The Chair should also:

• Ensure all candidates are asked the same questions.

• Include an interview question that allows candidates to elaborate on any personal lived experiences or identities, or any professional or academic experiences that have helped them build knowledge or expertise in EDI.

• Use the same concise matrix and rank for selection criteria for all candidates.

• Account for differences in communication and presentation styles by using a variety of evaluation formats. The committee should consider the interview and CV.

• Provide candidates with an opportunity to have a confidential discussion with staff and/or faculty members not directly involved in the search who can provide information about schools, housing, childcare, places of worship, language training, or any other types of information candidates might need to envision themselves moving to the community.

• Personalize the candidate’s visit as much as possible. Introduce them to faculty with similar areas of expertise or research interests. Consider information and contacts that would be beneficial for them.

• Provide all candidates with the same level of tailored visits.

• Ensure that “impermissible questions” related to personal information (eg, family status) are not asked during the interview process.

• Ensure the method of assessing candidates is equitable. Review the method through the lens of EDI principles by addressing bias; considering diversity of thought, method, and experience.

Virtual Interviews

In case the interviews are online:

• Send an email with instructions of the virtual interview to the candidates at least 1 week ahead of the interview to troubleshoot any potential issues. Ensure the candidate’s internet connection is adequate to reduce the possibility of dropped calls or lagging video/audio. ²⁰

• Provide candidates and committee members with a phone number they can call if they are experiencing technical difficulties or if the connection is lost. Have a back-up plan in the event of technical difficulties.

• Consider time zones and family or work obligations when scheduling interviews.

• Ensure the committee members are familiar with the technology.

• During the interview, mute the microphone of those who are not speaking to minimize background noise and look into the camera (not at the screen). All committee members should introduce themselves and make sure the candidate can see the body language of all members at all times. If there are connectivity issues that require cameras to be turned off, ensure that the camera of at least one of the committee members remains on.

• Minimize interruptions or distractions of committee members during the virtual interview.

Hiring Decisions

At the time of final decisions about the successful candidate for the proposed position the committee should:

• Whenever appropriate, be explicit and transparent about focused strategic hiring (that is limited to individuals from underrepresented groups to address underrepresentation, aligning with provincial/territorial human rights legislation, as applicable).

• Provide a written report to senior management on the process that led to the selection of the successful candidate. In case of a focused strategic hiring process it should also provide the rationale of why a member(s) of the underrepresented group was unsuccessful. The Chair or committee member should approve this rationale.

• Avoid using subjective criteria such as a candidate’s “fit” in the assessment or assumptions on candidates’ future decisions, as these can reflect personal biases of committee members. Concepts about whether a candidate is introverted or extroverted, or has many children of young age should not be considered when assessing their suitability for the position.

• Avoid undervaluing leadership experiences, scholarship, or research that is non-traditional or unconventional, or focused on issues of gender, ethnicity, or ability. Search committees can acquire the help of experts to assess fields with which they are unfamiliar.

• Explicitly remind committees that the need for accommodation cannot be used as a negative point against a candidate in the assessment process.

• Avoid averaging productive periods across non-productive periods, such as those required for parental, family, or medical leave. Some immigrants may have taken longer to attain senior degrees due to the difficulties of relocating and adapting to a new country and language. In addition, many Indigenous scholars and other groups may have completed their senior degrees later in life due to familial, socio-economic, or other reasons.

• Given the persistent gender pay gap in medicine and radiology ²¹ ensure that pay expectations are communicated clearly and negotiated fairly.

Retention and Promotion

In order to retain highly qualified workforce in radiology the leadership of the organization should:

• Ensure EDI guidelines for faculty evaluation and promotion are established and periodically reviewed by groups responsible for EDI oversight at the institution.

• Develop and implement an enhanced mentoring program that includes incentives for faculty members and provides training for both mentors and mentees to optimize the experience, and allows for cross-departmental mentoring. ²

• Ensure that faculty members from underrepresented groups do not shoulder a disproportionate amount of work. Recognize that often members of underrepresented groups will informally mentor a large number of trainees because they are “the only ones” in their faculty or department, and they may feel a responsibility to support and mentor trainees from underrepresented groups.

• Systematically collect, monitor, and analyze disaggregated self-identification data at all levels of faculty using best practices ² to identify any potential systemic barriers to advancement. Measure and report publicly on progress (eg, set firm targets for the representation of the underrepresented groups and develop a strategy to achieve them).

• Conduct environmental scans regularly (annual or biennial) to identify systemic barriers. Anonymously survey faculty, staff, and trainees of every background about the institution’s collegiality and how well it is doing in its EDI work. Use the findings to identify systemic barriers and address them.

• Publicly define what the institution’s definition of a healthy work environment is. The institution should make a long-term and sustainable commitment to assessing, responding to, and addressing policies, programs, and structural realities that affect the climate and potentially prevent inclusion of underrepresented team members.

• Post clear guidelines for promotion and for professional advancement in the institution on the department website. Hold information sessions about promotion requirements and process, including how panels assess promotions, how best to prepare a CV for the process, expected number of hours of teaching, and number of citations and impact factor of publications,.

• Promote the benefits of diversity within the institution. Be explicit that a variety of perspectives and identities at the institution and among faculty leads to a more academically rigorous, culturally sensitive, and innovative research community. The visibility of individuals from underrepresented groups in prominent roles also positively influences trainees, who see a diversity of role models conducting research across all disciplines.

• Consider promotion of EDI principles in an individual’s work as criteria in the deliberations for faculty awards and/or nominations.

• Place a candidate’s teaching evaluations in context. Gender, disability, race, language ability (ie, working in a second or third language) and culture could affect teaching style or the residents’ perceptions of the instructor. This can be the case for female/non-binary or trans instructors in male-dominated fields.

• Identify someone at the institution who can help chairholders resolve any challenges they may face in the early years of their term.

• Ensure that the institution has policies to swiftly and effectively address instances of hate speech, violence, harassment, and other forms of discrimination against all underrepresented groups. These policies must protect members of the community who are subject to aggressions.

• Address pay gaps and ensure fairness in remuneration. This is an institutional leadership responsibility.

• Equally weight reference feedback on candidates regardless of the hierarchy of position of formal and informal referees to avoid conflicts of interest related the opinion of high-rank leaders of the organization in the reference review process. Leaders may consciously or unconsciously lean towards taking steps to keep a productive professional in their organization by omitting positive outcomes of the professional in detriment of their career advancement.

Fostering Continuous Career Advancement

An inherent point for retention of workforce is the possibility that the professional foresees continuous career advancement. The following points should be addressed by leaders of departments of radiology and organizations:

• Reconsider the criteria to be used for formal evaluations considering creative professional activity (CPA) and EDI engagement and leadership as an integral part of the professional evaluation process and of the criteria for academic promotion.

• Clarify the differences in the assessment criteria and point out opportunities and benefits for different professional streams; for example, clinical versus academic.

• Provide transparency on the characteristics of the committee who will be assessing professionals; for example, peers, supervisors, ancillary staff, trainees, etc.

• Provide private feedback to individuals on their professional assessment and offer them access to key assignments, sponsors, assessors, and mentors. ²

• Conduct periodic departmental audits on equitable access to career development opportunities, supporting individuals from minority and underrepresented groups.

In conclusion, recruiting and retaining a diverse workforce in radiology will only be achieved if EDI is central to the organization’s goals and strategic plan. It is the obligation of radiology departments leaders to cultivate a healthy work environment, and to conduct regular environmental scans to identify systemic barriers or discrimination, with clear communication about EDI objectives to all faculty, administrators, employees, and trainees. All organizational policies, practices, and procedures must be reviewed with an intersectional lens to identify potential gaps, areas for improvement, and areas of strength in the recruitment and retention of members of underrepresented groups.