Taking Steps to Promote Diversity, Equity, and Inclusion in the Surgical Workforce

Abstract

There is growing emphasis on the importance of recruiting and training surgeons who reflect the patient population, including underrepresented racial minority groups, women, those from rural communities, immigrants, people with disabilities, those within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, and individuals from low-income backgrounds. This is demonstrated by the American College of Surgeons (ACS) statement on diversity, which says "The ACS upholds…its strong commitment to multiculturalism and equal opportunity, respecting and nurturing the diversity of its membership. It recognizes that specific recruitment and development of [individuals] from diverse and underrepresented groups is essential to enhancing the strength of the ACS." 1 We wholeheartedly endorse such a focus within surgery.The publication and ultimate correction of "Predictive Value of Credit Score on Surgery Resident and Fellow Academic and Professional Performance" by Berry et al 2 highlights the danger of not having racial, ethnic, socioeconomic, and other forms of diversity in all of our endeavors as surgeons. The need for such representation clearly extends to research and recruitment. The fundamental problem with their article, as acknowledged in the subsequent correction, 3 is that the authors "interpreted data in isolation of social realities" and failed to recognize the "extensive socioeconomic variables and historical context" impacting credit scores. We appreciate their receptiveness to the scholarly criticism they received and their willingness to reexamine conclusions. Ultimately, we laud the decision to "use [feedback] to better assess [their] own biases and those within the world around us." Still, we wonder whether such a correction would have been necessary if more diverse perspectives were present during research design, manuscript writing, and the peer review process. In light of the robust conversation generated by their original publication and its subsequent correction, it is important to explore the value of diversity, equity, and inclusion in surgical training along with strategies that can be used to cultivate it.Evidence shows that promoting diversity, equity, and inclusion within surgery leads to higher patient satisfaction, better health outcomes, more efficient teams, and increased resident wellness. 4 Diversity allows for differing perspectives, varied experiences, and improved problem solving. As others have commented, it also fosters innovation and inspires trust from the patients that we are charged with caring for. In an academic setting, it allows us to ask more inclusive research questions and VIEWPOINT

Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity with Sustained and Cultivated Careers in Surgery

“…In addition, while the GME Track Resident Survey has a high response rate of 95%, residency information may be missing for the small number of programs who do not respond to the survey. Lastly, while studies of facilitators and barriers to surgical career have been conducted for female and URiM trainees, few studies have explored these factors for low-income and sexual and gender minority students 37 . Our study demonstrates the necessity of performing such studies for socioeconomically disadvantaged students, including in the context of intersectionality with other marginalized identities, including sexual orientation and gender identity.…”

“…17,31 It is as important that we actively address these barriers by creating a more inclusive and diverse surgical workforce. Diversity in the surgical workforce is critical to promote diverse perspectives and innovation, 37 and diverse faculty have a positive effect on the diversity of residents and medical students. 38,39 However, despite this benefit, the growth in female representation in surgery is incremental, whereas there has been little to no change in representation of racial and ethnic minority surgical residents.…”