Small, concrete steps go a long way toward helping to create an antiracist environment within cardiovascular training programs, across divisions, and between institutions. A new review paper lays out how individuals and organizations can take deliberate, ongoing actions to create a diversified and supportive cardiovascular workforce.

“This isn't an all-inclusive blueprint of what should be done,” lead author Nina Williams, MD (Saint Francis Hospital, Tulsa, OK), told TCTMD. “But sometimes people don’t know what to say or where to begin, and these are some ideas to help.”

The paper focuses on five building blocks: recruitment and culture, training and teaching infrastructure, career cultivation and promotion, day-to-day actions, and how to engage on a personal level.

Williams and colleagues say crafting antiracist messaging should start with looking inside organizations and departments to “identify, discuss, and challenge issues of race, color, ethnicity,” as well as the impact those things have on the community. They also recommend drafting a mission statement or objectives that outline expectations for diversity and inclusion.

Williams, who recently completed her fellowship, noted that implicit bias and microaggressions that affect minority trainees often go unnoticed and unreported. There may be reluctance to report them because they don’t not seem overt or dramatic in nature, or because there is no support for that type of reporting. Either way, Williams said by not saying anything, microaggressions build up over time and lead to situations that likely could have been averted by reporting them early and being encouraged to report them.

The paper’s senior author, Lorrel E.B. Toft, MD (Reno School of Medicine, NV), who was Williams’ fellowship director, said the process of writing the paper made her regret that she hadn't done more to develop a formalized system for fellows to report the microaggressions directed at them.

“A key component in my journey is to have the humility to say I was in a position of leadership [and] I wish I would have done more, even though I thought I was doing what I could,” Toft said. “Having that ongoing humility is a really important aspect. Just being able to say, even if I don't intend to, there are things that I'm doing or thoughts that I'm having that are biased.”

Solidarity and Speaking Up Without Fear

In the paper, published in the Journal of the American College of Cardiology, Williams and colleagues offer up many things that colleagues striving to be allies can do to help minority trainees and faculty. “Leaders can specifically nominate under-represented minority members to appropriate positions, thereby opening the door to regional or national networking opportunities and recognition,” they write.

Another issue that should be addressed, they add, is the so-called “minority tax,” in which much of a department or institution’s diversity and inclusion efforts fall to its minority staff members in the form of unofficial and uncompensated mentoring and other supportive activities. Instead, they say diversity and inclusion should be treated as critical work that involves everyone and is shared evenly.

As part of day-to-day efforts to actively create a culture that is antiracist, Williams and colleagues suggest that name usage be consistent and discourage referring to some colleagues by their titles and others by their first names. They also encourage being prepared to immediately address microaggressions from patients or staff directed at minority physicians. Negative comments about names or accents, for example, can be responded to with a positive complement about the talent the physician brings to their work.

On a personal level, the paper encourages engaging in uncomfortable conversations about race and bias and, most importantly, being unafraid to misspeak.

“If anything, it just shows your intentions and humility in understanding what somebody else who's not like you is going through. If you misspeak, it's really not a big deal,” Williams stressed. “If we don't take that initial first step, then everything just stays as it is and you have a stalemate.”

Similarly, Toft said it’s clear that the cardiovascular community understands there is a problem.

“And that's great. It's important that we know this is a problem, but that's kind of where the conversation is right now and the calls to action are very vague,” she said. “None of the steps we outline in our paper cost any money. These are concrete, actionable steps that people who want to be allies can use as a starting point.”


Williams N, Sulistio MS, Winchester DE, et al. How to build an antiracist cardiovascular culture, community, and profession. J Am Coll Cardiol. 2021;77:1257-1261


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