Podium Session III C - DEI
Background: The recent impetus towards diversifying the surgical workforce has resulted in efforts of implementation of diversity, equity, and inclusion (DEI) resources and initiatives by surgical departments. While there is literature discussing the importance of these programs and tools available to further diversity efforts in residency programs, the current state of available DEI resources in United States (US) general surgery (GS) residency programs and their departments is unknown. This survey study sought to evaluate the current state of resident-focused DEI efforts in GS residency programs in the US.
Methods: An electronic 33-item survey, developed by surgical educators experienced in survey-based research and members of the Association for Surgical Education DEI Taskforce, was distributed to 330 program directors of GS residency programs in the US through the Association of Program Directors in Surgery distribution list. The survey collected information on program characteristics and resident demographics, as well as available resident-focused DEI resources and initiatives.
Results: Forty-four (13.33%) program directors responded. Most participating programs in the study were university affiliated (n=20; 45.45%) and community-based university affiliated hospitals (n=17; 38.64%). The median number of trainees per program was 26 (Interquartile Range (IQR): 20.5-33), with a median number of 15 (IQR: 10.5-25) white, 1 (IQR: 0-2) Black, and 3 (IQR: 1-5.5) Asian trainees. The most common type of resident-focused DEI effort was an established system to respond to bias incidents (n=43; 97.73%), followed by displaying diversity in the department (n=40; 90.91%) and infrastructural DEI support (n=38; 86.36%) (Figure 1). The least common types of efforts were promoting trainees under-represented in medicine (URiM) to participate in national surgical societies (n=21; 47.73%) and having specific mentorship of URiM trainees (n=16; 36.36%).
Conclusion: This study is the first to conduct a national characterization of resident-focused DEI resources and initiatives in GS residency programs in the US. There is notable variability of the types of resources hosted and initiatives pursued. Further efforts are required to develop and communicate a set of standard recommendations for DEI resources and initiatives without compromising residency programs’ ability to tailor efforts specific to their trainees.
Introduction & Objectives: The American College of Surgeons Office of Diversity, Equity and Inclusion (DEI) notes that systemic change is needed to eliminate disparities for patients and underrepresented minorities (URM) in the surgery workforce. As such, DEI initiatives at local levels are needed to exact change. Here, we describe the development of a DEI taskforce by the Department of Surgery at an academic medical center in order to provide a roadmap for other institutions and to describe local impact.
Methods: Our Surgery DEI taskforce was assembled in July 2020 in response to the urgent need to prioritize DEI within surgery. Strategic priorities and stakeholders were identified. Led by an attending surgeon, the taskforce initially consisted of surgical faculty and residents interested in advancing DEI efforts in the hospital, medical school, and community. Staff members and medical students were invited to join in September 2020.
Results: The taskforce initially consisted of 16 surgical physicians. Current active membership has grown to include: 15 physicians, 4 residents, 17 students, and 2 nurse practitioners. Early goals included: increasing education on benefits of diversity, promotion equity, and lactation policy creation in 2020. DEI efforts have expanded rapidly since, including: initiating holistic review of Department of Surgery applications, incorporating nine Cultural Complications and DEI Grand Rounds events, and engaging in service activities (e.g., in-person surgical camp and virtual OR tour for URM high schoolers). Inclusion of medical students in the taskforce was pivotal. Since joining, students have facilitated 9 suturing, operating room orientation and robot workshops; 2 suture kit distributions; 9 DEI book/movie club meetings; and 8 mentorship and networking initiatives.
Conclusions: Our departmental DEI taskforce membership and impact has grown since its inception. This collaborative effort has explored and acted on immediate and long-term actions related to education, recruitment, retention, and mentorship in order to support DEI in surgery. Our blueprint can be easily adapted to assist in surgical DEI development or potentially enhance existing DEI programs at institutions and medical schools.
Background: Due to the entirely separate set of obstacles faced by individuals underrepresented in medicine (URiM), the AAMC has promoted holistic review as a best practice in residency recruitment. The goal of this is to create an alternate set of metrics to evaluate applicants, while looking beyond scores at more meaningful attributes that align with program values to diversify the pool of candidates interviewed and selected [1,2]. Currently, there is no standardized set of metrics per the AAMC or ACGME to guide residency programs in this process. Our aim was to evaluate how holistic review affected the diversity of applicants selected for interview and match at our institution.
Methods: We examined the application cycles between 2017-2021 to determine whether changes in the recruitment process influenced the diversity of interviewed and matched applicants after holistic review was implemented. Changes included implementing structured interviews in 2019 and structured interviews plus redacted/blinded screening with a revised scoring rubric in 2020. Outcome variables included pre-interview scores, interview scores, and match status stratified by sex, minority status, URM status, and degree type (MD vs. DO) within application years.
Results: The alterations made at our institution resulted in a higher percentage of URM applicants being invited for interview, an increase in the proportion of matched female applicants, and interview invites extending beyond usual regional limits after holistic review was implemented. There was also a notable challenge in additional time required, such as with redaction and screening times, but an overall decrease in cost of the recruitment process.
Conclusion: Our study demonstrated increased diversity of applicants interviewed and retention of URM applicants with holistic review. Future methods to improve include mitigating bias in the rank list meetings, increasing branding and marketing to demonstrate program strengths, and increased manpower to screen applications. With the SCOTUS decision to curtail affirmative action, programs must maintain a commitment to equitable strategies that go beyond race to diversify the surgical workforce.
[1] “Holistic Review.” AAMC, www.aamc.org/services/member-capacity-building/holistic-review.
[2] Jones AC, Nichols AC, McNicholas CM, Stanford FC. Admissions Is Not Enough: The Racial Achievement Gap in Medical Education. Acad Med. 2021 Feb 1;96(2):176-181. doi: 10.1097/ACM.0000000000003837. PMID: 33149091; PMCID: PMC7855342.
Background:
Evidence shows there is a significant disproportion of underrepresented minorities in medicine (URiM) or female general surgery (GS) residents nationally despite an increase in URiM medical graduates. During the COVID-19 pandemic, virtual interviews became the mainstay. Potential benefits include decreased costs for applicants and increased interview capacity for programs. However, there are few studies on how virtual interviews affected the interview pool in terms of both URiM and female applicants.
Methods:
Applicant data was collected from ERAS for the years 2018-2023 including gender, and self-reported race to a single tertiary care institution’s residency programs. The yearly proportion of applicants and interviewees was calculated for comparison of pre-virtual interviews (applicant cycles for 2018-2020) and virtual interviews (applicant cycles for 2021-2023) for the institution and general surgery. Differences were assessed using Chi-square test with a significance level of 0.05.
Results:
Pre-virtual interviews, applicants to GS were 39.7% female and 30.2% URiM vs interviewees that were 48.6% female and 20.0% URiM. During virtual interviews, applicants to general surgery were 44.3% female and 32.8% URiM; interviewees were 50.4% female and 20.7% URiM. At the institutional level, in pre-virtual interview vs virtual interview years, 21.4% vs 40.5% vs 40.9% were female and 23.2% vs 21.5%. There was a significant increase in applicants during virtual interview year female and identified as URiM for GS (p= <0.0001, and 0.009 respectively). However, there was not a significant increase in these populations interviewed (p= 0.54, and 0.77 respectively). Please see image below./p>
Discussion:
Virtual interviews seem to have enabled applicants to apply more widely, leading to increased diversity at the institutional and GS program level. However, no increase in diversity of interviewees was seen. There is further need for research and measures to improve the diversity of those interviewees.
Background: Women remain underrepresented in many surgical specialties. Factors like gender-based discrimination, recruitment challenges, male-dominated culture, and the gender pay gap have been implicated. Conflict between traditional societal ideals and the demands of a surgical career may also contribute. We sought to explore differences in self-reported home-related responsibilities and burnout between men and women surgeons.
Methods: An anonymous online survey was sent to surgical organizations and department heads across Canada and advertised via social media. The survey assessed demographics, self-reported participation in household-related activities, satisfaction with relationships and leisure activities, and burnout using the Maslach Burnout Inventory for healthcare professionals. Chi-square tests examined differences between men and women on reported household activities and satisfaction, and one-way ANOVA explored gender differences in burnout.
Results: Eighty-five (N=85) surgeons completed the survey, 50.6% of which were women. The most represented specialties were general surgery (45.9%), pediatric surgery (18.8%), and orthopedic surgery (12.9%). The median age was 45 years (IQR 39-52) and the median hours worked per week was 60 hours (IQR 50-65). Most surgeons (94%) reported they were married, common law partners, or in a relationship. The majority (75.9%) reported that their partner was employed and 83.3% had one or more children. We did not find significant gender differences in reported satisfaction in relationships with partners, children, or engagement in leisure or rest. A greater proportion of women reported taking the primary role in housekeeping (p<.001), meal preparation (p<.001), grocery shopping (p=.019), and laundry (p<.001), while a greater proportion of men reported taking a primary role in handywork/repairs (p<.001) and managing finances (p=.025). Burnout did not significantly differ between women and men surgeons, respectively, in emotional exhaustion (3.03 versus 2.56, p=.081), depersonalization (2.06 versus 1.86, p=.55), and personal accomplishment (4.68 versus 4.55, p=.56).
Conclusion: There are discrepancies between men and women surgeons in the responsibilities of certain household-related tasks, which could have an impact on careers. Despite this, women and men surgeons report similar levels of burnout and satisfaction with relationships and leisure activities.