The Duke University Department of Neurology recognizes that a diverse, inclusive, and equitable community – including clinicians, researchers, trainees, leadership, and staff – is a necessary component of its mission of world-class patient care, education, and research. Our department is committed to building and maintaining a diverse and inclusive community where all members thrive in a welcoming and engaging environment.
Our efforts to improve and maintain equity, diversity, inclusion are built on self-assessment, accountability, and transparency. The foundation of this approach is self-assessment to understand the people of our Department, gauge our successes and areas for improvement, and guide future efforts.
2024 brought about our second census to learn more about the demographic breakdown, beliefs, and preferences of our department. The anonymous survey included questions on job titles, race, gender, countries of origin, languages spoken, time spent in our Department, outside interests, and more. 204 members of the department responded to the census, which was a response rate of approximately 68%.
Review the full 2024 census below, as well as the 2020 census synopsis.
The gender pay equity analysis demonstrated remarkable equity between male and female clinical assistant professors with women making an average salary that is 99% of the average man’s salary. The research assistant professors demonstrated a greater pay gap with women earning an average salary that was 13.5% lower than the average man’s salary. This gap could potentially be explained by duration of service as most of the men who are assistant professors of research have been at Duke for more than 10 years and most of the women who are assistant professors have been here fewer than 10 years.
The Duke Neurology Department maintains an online archive of our grand rounds speakers from 2016 to the present. This archive of our main educational activity for faculty, staff, and trainees contains more than 200 lectures. For our Speaker Analysis, an analyst viewed recordings of these lectures from 2016 to 2019, noting the gender and race of each speaker (this analysis should be interpreted with caution as race and gender are self-identifiable traits that cannot be determined without asking the individual; however, this imperfect method remains a good starting point for a preliminary analysis). We then analyzed this data for both guest speakers and lecturers within our own Department.
The gender analysis of Grand Rounds speakers indicated that men and women from Duke speak in proportion to their numbers in the department (62%-38%). When outside speakers are invited, women and men speak at a rate much closer to 50% each. The racial analysis of Grand Rounds speakers among Duke speakers is again proportionate to the rates in the department (72% White, 23% Asian, 5% Black/Hispanic/Native American). Duke Neurology did not invite a guest speaker from a traditionally underrepresented racial group to speak at Grand rounds between 2016-2019.
As a result of this analysis, the Duke Neurology Department has increased the number of invited speakers from underrepresented in medicine groups for 2020 and will continue to make inviting speakers from these backgrounds in the future. We have also broadened diversity of our grand rounds speakers by inviting advanced practice providers (APPs), physical therapists, pharmacists, and other clinical exeperts to deliver lectures starting in FY 2021.
For decades, residency programs have used mandatory minimum United States Medical Licensing Examination (USMLE) test scores to screen out potential resident applications. Unfortunately, reliance on these scores leaves residency programs vulnerable to recruitment biases. These biases disproportionately reduce the number of under-represented in medicine candidates, even as more holistic measures such as interactions with faculty, feedback from current housestaff, and interpersonal skills show more evidence for accurately evaluating a candidate's potential as a neurologist.
In 2017, Duke Neurology Residency Program redesigned the process by which it selected applicants for interviews based on 2016 data indicating that a heavy reliance on USMLE Step 1 scores was biasing our interview pool in favor of White and Asian applicants. The revision placed more emphasis on grades and letters of recommendation as part of a holistic review of the entire application rather than utilizing a Step 1 minimum cutoff score. The de-emphasis on Step 1 scores was subsequently validated by the USMLE deciding to discontinue numeric scoring of Step 1 in favor of pass/fail results in 2022. The residency continues to track the relative proportion of candidates from underrepresented racial groups that are offered interviews. The absolute percentages vary due to the variability in the number of applications received each year. The residency remains successful in offering interviews to similar proportions of applicants from different racial groups.
The residency offered interviews to approximately the same percentage of applicants from under-represented and non-under-represented backgrounds for the third consecutive year, validating the holistic method of reviewing applications adopted in 2017.
Pre-Redesign
2016-2017 (PGY-4 class)
- 20% URM applicants offered interviews
- 31% non-URM applicants offered interviews
- 1 candidate from underrepresented racial group matched out of 7 slots.
Post-Redesign
2017-2018 (PGY-3 class) - Post Redesign
- 25% URM applicants offered interviews
- 28% non-URM applicants offered interviews
- 0 candidates from underrepresented racial groups matched out of 7 slots.
2018-2019 (PGY-2 class)
- 29% URM applicants offered interviews
- 28% non-URM applicants offered interviews
- 1 candidate from underrepresented racial group matched out of 7 slots.
2019-2020 (PGY-1 class)
- 20% URM applicants offered interviews
- 19% non-URM applicants offered interviews
- 1 candidate from underrepresented racial group matched out of 7 slots.
The current and former directors of our Diversity and Inclusion efforts, Andrew Spector, MD, and Kenyon Railey, MD, summarized these efforts in a 2019 article in the Journal of the National Medical Association, "Reducing Reliance on Test Scores Reduces Racial Bias in Neurology Residency Recruitment." Read that article here.
To assess the success of our efforts relating to diversity and inclusion, and identify future priorities, we assessed employee satisfaction within the Department, perceived respect and ability to thrive, and their thoughts on our diversity and inclusion efforts over the past two years. We analyzed these responses based on gender, race, job title, and other factors. This analysis identified strengths within our efforts, particularly in our Chair’s perceived commitment to diversity and inclusion, a high value for our D&I grand rounds series, and in evaluation of our Diversity Officer.
Review the full 2024 survey results below, as well as a synopsis from 2020.
The Diversity and Inclusion Committee’s 2022-2023 theme will be “Empowerment.” Highlights of our priorities and projects during this year include:
- Updating and publishing a Staff Handbook to maintain departmental transparency and enhance access to information that will help with career trajectory
- Developing APP subspecialty certification and recognition program
- Continuing D&I educational lecture series at Neurology Grand Rounds (3 lectures per year).
- Instituting a guest lecture program for Grand Rounds with speakers from North Carolina Central University (NCCU), a local historically Black university.
- Developing and publishing a health disparities scorecard from collected data
- Creating a partnerships with NCCU, including a neurological careers day for undergrads to learn more about careers in neurology and neuroscience, work on resume writing, and practice interview skills.
- Establishing a community lecture series to improve neurological health literacy
- Developing metrics that demonstrate improvement in key priorities
- Successfully recruiting URM faculty members