Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology

Cytopathology fellowship and practice: Are our trainees and cytopathologists diverse?

Over the last several years, there has been increased focus on diversity, equity, and inclusion within all areas of pathology and laboratory medicine. Many of the specialty societies within pathology have taken up the mantle of diversity. While there is little research into the diversity of cytopathologists in practice, the Accreditation Council for Graduate Medical Education (ACGME) has been collecting diversity data on pathology and laboratory medicine trainees since 2011. This data are an opportunity to explore how diverse our trainees in cytopathology are, and by extrapolation, allows us to develop some ideas as to how diverse attending level cytopathologists are. The author will also share personal observations from her own training and career regarding diversity in cytopathology.

Perinatal health framework for people with intellectual disability

We propose a framework for guiding research on perinatal health in people with intellectual disability (ID). We developed this framework based on the perinatal health framework for people with physical disabilities, American Association on Intellectual and Developmental Disabilities conceptual framework of human functioning, disability reproductive justice framework, trauma-informed care, and socio-ecological model. The framework reflects health outcomes of birthing people with ID and their infants that result from interactions of factors across the life course at policy (health, social, and disability policies), community (attitudes, social and physical environment), institutional (health care delivery-related factors, access to information/resources), interpersonal (social determinants of health/histories of trauma, social support, interactions with service-providers), and individual levels (demographics, intellectual functioning, adaptive behavior, health conditions, genetic factors, psychosocial factors, health behaviors). This framework will facilitate research to identify factors leading to perinatal health disparities in people with ID and development and evaluation of resources to address them.

Diversity in Orthopaedic Surgery: What Is Next? What is Needed Collectively? How Do You Go About Effecting Positive Change?

Orthopedic surgery as a field is the least diverse medical specialty. Multiple factors contribute to the lack of diversity, including lack of diversity in medical school, lack of role models and mentors, and discrimination and bias. Addressing the lack of diversity includes use of data, implementation of targeted pipeline programs, individual physician advocacy, institutional recruitment and DEI initiatives, and leadership from professional organizations. Targeted pipeline programs and role models and mentors are very effective in increasing diversity. Cultural change is occurring, and the future orthopaedic workforce will be more diverse.

Time and time again: the reincarnations of coerced sterilisation

The recently reported cases of coerced sterilisation of women at a privately operated immigration detention facility in the USA are egregious in their disregard for human dignity and professional ethics, but sadly not surprising. These abuses represent a continuation of efforts to control the reproductive capacity of women, fueled by racist and xenophobic motives. Physicians helped create and legitimise the pseudoscientific framework for the eugenics movement, which would implement forceful sterilisation as its tool of choice to eliminate undesirable traits that were thought to be biologically inherited and predominant among racial and ethnic minorities. Although state-endorsed forcible sterilisation programs have ended, incarcerated women have remained particularly vulnerable to sterilisation abuse. The intersectional vulnerabilities of racism, xenophobia and carcerality must be addressed to prevent such abuses from recurring.

From coercion to respectful care: women's interactions with health care providers when planning a VBAC

BACKGROUND

In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women's perspective.

METHODS

A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents' answers to the open-ended questions.

RESULTS

Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, 'Someone in my corner', included the sub-categories 'belief in women birthing', 'supported my decisions' and 'respectful maternity care'. The negative main category 'Fighting for my birthing rights' included the sub-categories 'the odds were against me', 'lack of belief in women giving birth' and 'coercion'. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care.

CONCLUSIONS

In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.

Implicit bias in healthcare: clinical practice, research and decision making

Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.

Race, Gender, and Residency: a Survey of Trainee Experience

BACKGROUND

Racial minority and female trainees undergo residency attrition at significantly higher rates than their counterparts. We hypothesize that racial minority, and female trainees will report significantly different training experiences from non-minority and male trainees, respectively. Further, we hypothesize that thoughts of withdrawal and summative description of residency experience will be significantly impacted by access to mentorship and feelings of isolation.

METHODS

A link to a Qualtrics survey was sent to program officials from all residency programs registered with the ACGME to be distributed to their trainees. It was live from June through August of 2019 and collected data about respondent's demographics and posed questions addressing some of the key elements of the residency experience.

RESULTS

Minority trainees reported lower scores for ease of execution of orders placed compared to non-minority trainees 2.12 vs. 2.28 (p = 0.030). Females reported more frequently being mistaken for staff at lower training levels and more frequently feeling overwhelmed than male trainees, 3.29 vs. 1.64 (p < 0.001) and 3.57 vs. 3.16 (p < 0.001). Racial minority and female trainees had numerical but nonsignificant differences in scores for access to mentorship and feelings of isolation compared to non-minority, and male trainees, respectively. Trainees who had thoughts of withdrawal reported less access to mentorship (3.12 vs. 3.88 p < 0.001) and more feelings of isolation (2.22 vs. 1.68 p < 0.001). Trainees reporting more positive experiences had greater access to mentorship and lower feelings of isolation than those who reported a neutral or negative experience, 3.89 vs. 3.14 vs. 2.79 (p < 0.001) and 1.60 vs. 2.21 vs. 2.82 (p < 0.001), respectively. Greater access to mentorship and more frequent family contact both significantly decreased feelings of isolation p < 0.001 and p = 0.035.

CONCLUSION

Minority status and female gender impact some of the key elements of the residency experience, manifesting as decreased respect afforded to these trainees. Thoughts of withdrawal and overall residency experience are significantly impacted by access to mentorship and feelings of isolation during residency. Attention should be paid to ensuring that high risk trainees have adequate access to mentorship, making deliberate efforts to cultivate a sense of community and camaraderie among residents, and emphasizing the value of diversity and inclusion.