Analysis of Diversity, Equity, and Inclusion Initiatives Presented Across US Academic Department of Surgery Websites in 2021

Advancing opportunity and representation in the American Venous Forum

OBJECTIVE

Diversity, equity, and inclusion (DEI) within the physician workforce is critical to establishing a diverse provider network that accurately represents the patient population served by vascular surgeons. Vascular surgery remains a largely male-dominated surgical specialty, and the number of women in leadership positions in academic surgical specialties continues to be disproportionate. The representation of women in leadership roles differs across vascular surgery societies. The goal of this study is to provide an update on the representation of women and incorporation of DEI topics at American Venous Forum (AVF) annual meetings and across committees.

METHODS

A retrospective review was conducted of available scientific meeting programs and abstracts presented at the AVF from 2010 to 2023. The time period was divided into before 2019 and after 2019, as this was the year that the Society for Vascular Surgery established the Task Force on DEI. Women's participation and DEI domains were documented for each year. A two-sample unpaired t-test was used to compare mean percentages.

RESULTS

Specifically, within the AVF, women's representation across all roles (presenters, senior authors, moderators, committee chairs, committee members, and officers) has increased when comparing prior years (2010-2019) with a more recent time period (2020-2023). The largest increase was observed for moderators (12.6% vs 30.2%; +17.6%), and the smallest increase was observed for presenters (21.1% vs 28.9%; +7.8%). When comparing the same time periods, the mean percentage of DEI domains (access to care, race and ethnicity, gender, age, health literacy, and socioeconomic status) highlighted in research presentations at AVF annual meetings has increased numerically over time but is not statistically significant except for the DEI domain of age (1.34% vs 3.28%; P = .0008).

CONCLUSIONS

Although there have been positive improvements in the proportion of women in leadership roles at the AVF, the integration of DEI domains at AVF annual meetings continues to show slow progress. This study reflects an opportunity for AVF leaders and councils to prioritize strategies to incorporate important DEI domains into our annual meetings and mission-related efforts. Intentional progress in these areas will ultimately contribute to more successfully carrying out the AVF Core Values (VEINS: Values and integrity, Education, Inclusivity, equity, diversity, Nurturing, Scientific excellence and research).

Mapping the Void: Understanding Diversity, Equity, and Inclusion Training in Medicine

OBJECTIVE

To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.

BACKGROUND

Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.

METHODS

A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.

RESULTS

This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.

CONCLUSIONS

Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.

American Society of Hematology: building a comprehensive minority recruitment and retention professional program

ABSTRACT

In 2003, the Institute of Medicine noted the need to improve workforce diversity. The American Society of Hematology (ASH) responded by developing the Minority Recruitment Initiative (MRI) to recruit diverse physicians/scientists into hematology. We evaluated the outcomes of the program. From 2004 to 2022, there were 405 awardees. Compared with national estimates, MRI awardees were less likely to discontinue their degree programs. MRI graduate student awardees had 0% attrition (97.5% confidence interval [CI], 10.6), whereas the national minority graduate student attrition was 36%. Medical student awardees had 2.2% (95% CI, 0.61-5.6) attrition, compared with the minority medical school attrition of 5.6%. Awardees were more likely than expected to pursue hematology-oncology (5.7% minority national estimate) because 14.4% (95% CI, 8.1-23.0) of medical student awardees and 88.5% (95% CI, 70.0-97.6) of early career awardees remain in the field. ASH has developed a successful program, but continued efforts are needed to advance equity in hematology.

Advancing Cultural Competency and Equity in Surgical Specialties (ACCESS): A Model for a Combined Resident and Faculty DEI Initiative

BACKGROUND

Committees dedicated to diversity, equity, and inclusion (DEI) are not commonplace within departments of surgery. Even rarer are joint initiatives for residents and faculty. We aim to describe the creation of a collaborative committee within a department of surgery to better foster and advance the ideals of DEI.

METHODS

An informal needs-assessment was performed amongst the general surgery residency, advanced practice practitioners, and faculty. Other DEI groups throughout the institution were engaged for feedback and interdisciplinary collaboration.

RESULTS

Gaps were identified in social support for those from diverse backgrounds, advocacy and recruitment, general DEI education, and research. Three pillars were formed: Social Support, Education and Advocacy, and Research. The overall group and each pillar are co-led by residents and faculty. In less than a year, the group has launched a cultural complications morbidity and mortality curriculum, hosted the first city-wide LGTBQ+ in surgery event, created a safe space for discussion and support, and advocated for recruitment DEI initiatives. So far, the group consists of 48 residents, faculty, advanced practice practitioners, and staff.

CONCLUSIONS

An intentional, collaborative effort between residents and faculty in a department of surgery can successfully result in an effective partnership to advance DEI initiatives.

Health Disparities Curricula in General Surgery Residency Programs: A Critical Scoping Review

INTRODUCTION

In 2021, the structural determinants of health (SDOH) were added to the Accreditation Council of Graduate Medical Education common program requirements for all accredited residency programs, including general surgery. In this study, we sought to explore the current scope of, and concepts used in, health disparities curricula for general surgery residents, specifically investigating how general surgery residents learn about health disparities and the SDOH.

METHODS

We searched PubMed, EMBASE, Education Research Complete (EBSCOhost), and Web of Science Core Collection using keywords related to health disparities and the SDOH. Inclusion criteria consisted of all studies published after 2005 that discussed health disparities curricula for Accreditation Council of Graduate Medical Education-accredited general surgery residency programs. Five thousand three hundred seventeen articles were screened using a two-phase process. Data extraction and analysis was performed using critical review methods.

RESULTS

Seventeen articles were identified. Within these articles, seven unique health disparities curricula were found. All seven of the identified curricula employed cultural frameworks as methods to mitigate health disparities. Three curricula, all published after 2011, included education on the SDOH. A wide variety of educational methods were utilized; in-person didactics was the most common.

CONCLUSIONS

In the current literature, culture continues to play a large role in health disparities training for general surgery residents. Though further efforts are needed to understand the methods used in programs that have not published scholarly work, it is imperative to ensure that residents are provided with the sociopolitical perspective needed to understand the SDOH and serve all patients, including those affected by health disparities.

Advancing diversity in spine surgery: the critical role of professional societies and foundations

This manuscript examines the challenges and initiatives within organizations associated with spine surgery to enhance diversity, equity, and inclusion (DEI), focusing on the systemic barriers that hinder the representation of women and underrepresented in medicine (URiM) minorities. Highlighting the contributions of pioneering individuals who overcame racial and gender discrimination to forge paths in these fields, it stresses the importance of professional societies and foundations in promoting DEI. Despite advancements, legal challenges and recent legislation in various states threaten to undermine DEI efforts, presenting a critical moment for organizations to reassess and reinforce their strategies. By detailing the roles of specific professional societies, foundations, and initiatives like the American Society of Black Neurosurgeons and Nth Dimensions, the manuscript underscores the necessity of targeted actions to ensure the progress toward a more inclusive and equitable spine surgery community.

When I Don't see me, Am I seen? Race and student perception of the surgery clerkship

INTRODUCTION

Increasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is imperative to advancing diversity, equity, and inclusion efforts. We examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners at our institution.

METHODS

Evaluations from 235 graduated medical students between the years of 2019 and 2021 were analyzed. T-tests were used to compare numerical data. Free-text comments were qualitatively analyzed using inductive thematic analysis by two independent reviewers with conflicts resolved by a third.

RESULTS

Evaluations were completed by 214 non-URiM students (91.1 ​%) and 21 (8.9 ​%) URiM students. There were no significant differences between URiM and non-URiM students in ratings of faculty and resident teaching. When asked whether residents were positive role models for patient care, non-URiM students were more likely than URiM students to agree (3.284 vs. 2.864, p ​= ​0.040). When asked whether they considered faculty to be positive role models, non- URM students were also more likely to answer affirmatively than URiM students (3.394 vs. 2.909 p ​= ​0.013). Qualitative comments were similar between the two groups. When asked what the strengths of the clerkship were, the most commonly evoked theme was "interactions with team" with subthemes of "team integration" "feeling valued" and positive "faculty" or "resident" interactions. "Operative experience" was the second most commonly evoked strength of the clerkship. The most common criticisms of the clerkship involved "negative interactions with team" with subthemes of "not prioritized above other learners" and "ignored." Negative "academic experience" was the next most commonly evoked weakness, with an affiliated theme of "lack of teaching."

CONCLUSIONS

URiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. Integrating medical students into the team, taking time to teach, and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.