Katherine A. Ortmeyer|Vignesh Raman|Chidinma Tiko-Okoye|Jairo Espinosa|David T. Cooke|Sandra L. Starnes|Cherie P. Erkmen
Goals, organizational change, advocacy, diversity literacy, and sustainability: A checklist for diversity in cardiothoracic surgery training programs
Temple University|Duke University|Lankenau Medical Center|Temple University|University of California, Davis|University of Cincinnati|Temple University
central messagein goals checklist setting goals organizational change advocacy diversity literacy sustainability key promoting di ct surgery programssee commentaries pages 1788 1789 goals checklist setting goals organizational change advocacy diversity literacy sustainability key promoting di ct surgery programs see commentaries pages 1788 1789 diversity physician workforce essential effectively treat rapidly changing patient population optimize modern healthcare environment physicians must culturally competent integrate diversity language communication styles beliefs attitudes patient care1paez ka allen jk beach mc carson ka cooper la physician cultural competence patient ratings patientphysician relationshipj gen intern med 2009 24 495498crossref pubmed scopus 68 google scholar delivery equitable health care depends diverse physician workforce proven result improved patient satisfaction quality care2saha komaromy koepsell td bindman ab patientphysician racial concordance perceived quality use health carearch intern med 1999 159 9971004crossref pubmed scopus 640 google scholar well superior financial performance health systems3gomez le bernet p diversity improves performance outcomesj natl med assoc 2019 111 383392crossref pubmed scopus 124 google scholar outside health care diversity leads improved company culture talent retention increased innovation4the 20192020 hays asia diversity inclusion reporthttpimageemailhayscomlibfe4315707564057c751c71m1f344ca83da484fe59fb9f4c02252159apdfgoogle scholar innovative solutions adaptability essential face major shifts healthcare paradigms unfolding coronavirus disease 2019 pandemic absolutely require diverse physician workforce despite evidence favor diverse workforce diversity among physicians remains low particularly surgical subspecialties among academic cardiothoracic ct surgeons 2018 black hispanic surgeons composed 3 5 workforce respectively despite representing 13 18 general us population5ortmeyer k raman v tikookoye c espinosa j cooke dt erkmen c women minorities underrepresented academic cardiothoracic surgery time next stepsann thorac surg november 5 2020 epub ahead printabstract full text full text pdf scopus 4 google scholar women represented 17 practicing ct surgeons representation groups even lower among senior leadership positions6cooke dt olive j godoy l preventza mathisen dj prager rl importance diverse specialty introducing sts workforce diversity inclusionann thorac surg 2019 108 10001005abstract full text full text pdf pubmed scopus 31 google scholar furthermore trainees surgeons reported high rates racial discrimination gender discrimination harassment adversely affect physician wellness7hu yy ellis rj hewitt db yang ad cheung eo moskowitz jt et aldiscrimination abuse harassment burnout surgical residency trainingn engl j med 2019 381 17411752crossref pubmed scopus 259 google scholar8filut alvarez carnes discrimination toward physicians color systematic reviewj natl med assoc 2020 112 117140crossref pubmed scopus 22 google scholar president emeritus association american medical colleges aamc addressed subject 2019 writing ever must take decisive action end conscious unconscious racial bias overt discrimination gender harassment inequity academic medicine9addressing racism mistreatment academic medicine aamchttpswwwaamcorgnewsinsightsaddressingracismandmistreatmentacademicmedicinegoogle scholar accreditation council graduate medical education acgme also recognized importance developing culture diversity adding common program requirements program must engage practices focus missiondriven ongoing systematic recruitment retention diverse inclusive workforce residents fellows faculty members senior administrative staff members relevant members academic community10common program requirementshttpswwwacgmeorgwhatwedoaccreditationcommonprogramrequirementsgoogle scholar unfortunately guidelines training programs regarding implementation culture diversity inclusion di address propose checklist serve comprehensive framework development programspecific di policy within every ct surgery program figure 1 necessary first step evidence gathered efficacy initiatives directive best practices may developed future medline pubmed search conducted using terms diversity inclusion surgery thoracic surgery guidelines evidence gathered acgme aamc american college surgeons american surgical association various university surgical programs publications psychology sociology business recommendations developed basis review resources search returned hundreds articles di surgery medicine thousands fields outside health care quantities increased every year revealing increased awareness importance diversity focused several key guidelines articles studies developing recommendations five themes emerged critical development successful di program 1 establishment discrete specific goals 2 organizational change support initiatives 3 advocacy support structures attract retain diverse surgeons 4 educational programs diversity literacy culture change 5 sustainability efforts think goals organizational change advocacy literacy sustainability goals figure 21goals first critical component diversity program establishment discrete goals11kaiser cr major b jurcevic dover tl brady lm shapiro jr presumed fair ironic effects organizational diversity structuresj pers soc psychol 2013 104 504519crossref pubmed scopus 179 google scholar initial step creation mission statement defines programs commitment diversity followed vision statement organization sees period sustained effort programs may revise overall mission statement create separate mission statement regarding di program define goals diversity systematic processes deliverables evaluate accomplishments failures11kaiser cr major b jurcevic dover tl brady lm shapiro jr presumed fair ironic effects organizational diversity structuresj pers soc psychol 2013 104 504519crossref pubmed scopus 179 google scholar potential metrics progress include number applicants interviewees trainees women underrepresented minorities medicine uim training programs also establish goals recruitment retention promotion faculty underrepresented populations advancement women uim faculty improves faculty diversity also increases recruitment groups improving applicants trainees perception opportunity field12auseon aj kolibash aj capers q successful efforts increase diversity cardiology fellowship training programj grad med educ 2013 5 481485crossref pubmed google scholar faculty level systems compensation evaluation promotion must scrutinized bias sexism racism members di task force collaborative roundtable forums assistance third party13dibrito sr lopez cm jones c mathur reducing implicit bias association women surgeons heforshe task force best practice recommendationsj coll surg 2019 228 303309abstract full text full text pdf pubmed scopus 44 google scholar diversity mission goals policy disseminated faculty trainees well potential applicants recruitment materials online program descriptions including aamc acgme websites programs aim produce scholarship related performance diversity efforts experiences shared national meetings peerreviewed publications disseminate successful strategies mitigate structural bias ct surgery2organizational change efforts promote diversity ct surgery training program require organizational support depend buyin institutional leadership administrators faculty trainees support staff14kang sk kaplan working toward gender diversity inclusion medicine myths solutionslancet 2019 393 579586abstract full text full text pdf pubmed scopus 77 google scholar program establish task force responsible parties uphold mission15kalev dobbin f kelly e best practices best guesses assessing efficacy corporate affirmative action diversity policiesam sociol rev 2006 71 589617crossref scopus 1043 google scholar task force must seek understand barriers diversity within program prioritize areas effectively targeted change16pedulla diversity inclusion efforts really work harvard business reviewhttpshbrorg202005diversityandinclusioneffortsthatreallyworkgoogle scholar develop actionable goals17daley sp palermo ag nivet sotogreene ml taylor vs butts gc et aldiversity academic medicine 6 successful programs minority faculty development ingredients successmt sinai j med 2008 75 533551crossref pubmed scopus 27 google scholar number tools available assist process including diversity engagement survey18diversity engagement survey aamchttpswwwaamcorgwhatwedomissionareasdiversityinclusionengagementsurveygoogle scholar national institutes health scientific workforce diversity toolkit19nih scientific workforce diversity toolkit swd nihhttpsdiversitynihgovtoolkitgoogle scholar also responsibility task force assess current institutional resources identify additional investments needed achieve diversity goals16pedulla diversity inclusion efforts really work harvard business reviewhttpshbrorg202005diversityandinclusioneffortsthatreallyworkgoogle scholar sponsoring institutions training programs must actively empower diversity task force achieve diversity goals leadership departments health systems medical schools validate task force participation leadership recognition resources administrative personnel ideally compensation invested effort14kang sk kaplan working toward gender diversity inclusion medicine myths solutionslancet 2019 393 579586abstract full text full text pdf pubmed scopus 77 google scholar20taggar ellis r role leaders shaping formal team normsleadersh q 2007 18 105120crossref scopus 83 google scholar faculty contribute diversity efforts meaningful ways mentoring uim trainees developing diversity curricula reorganizing recruitment mitigate bias could receive compensation actions forms compensation may include reduction clinical workload credit educational value unit relative value unitbased performance system acknowledgement valued endeavors promotions21values rvus teaching international association medical science educators iamsehttpwwwiamseorgmsearticlevaluesrvusandteachinggoogle scholar finally programs collaborate existing di officers representatives experts within institutions assist optimizing di processes recruitment retention evaluation promotion trainees faculty diversity specialists within sponsoring institution align training program goals create shared resources example institutions sponsor housing transportation uim students trainees interview attend secondlook visit residency system12auseon aj kolibash aj capers q successful efforts increase diversity cardiology fellowship training programj grad med educ 2013 5 481485crossref pubmed google scholar potential strategies shared among training programs within institution include development websites recruitment materials highlight diversity mission policies institution22kerr hl armstrong la cade je barriers becoming female surgeon influence female surgical role modelspostgrad med j 2016 92 576580crossref pubmed scopus 39 google scholar outreach mentorship programs attract underrepresented populations pipeline programs23mason bs ross w chambers mc grant r parks pipeline program recruits retains women underrepresented minorities procedure based specialties brief reportam j surg 2017 213 662665abstract full text full text pdf pubmed scopus 29 google scholar surgical shadowing schemes24bartlett rd momin sm azam rotimi quick tj development surgical shadowing scheme improve undergraduate experiences surgeryadv med educ pract 2019 10 619626crossref pubmed scopus 4 google scholar funded subinternship opportunities25diversity sub internships center health equity diversity inclusionhttpscediweb01suweduresidentsfellowsdiversityvisitingmedicalstudentsubinternshipprogramgoogle scholar training programs successfully used outside consultants engage faculty trainees sensitive sometimes emotional discussions bias discrimination like diversity efforts approach successful program institutional leadership must dedicate money time effort3advocacy attract retain women uim surgeons ct surgery program important provide formal support system advocate decision pursue specialty often made early undergraduate training medical school therefore ct surgery programs strive improve exposure uim individuals specialty summer research internships students clinical shadowing opportunities collaboration student organizations latino medical student association society black academic surgeons student national medical association association women surgeons training programs actively encourage women uim students apply scholarships offered ct surgery societies attend national ct surgery meetings uim individuals less likely receive mentorship formal mentoring programs developed support individuals throughout training17daley sp palermo ag nivet sotogreene ml taylor vs butts gc et aldiversity academic medicine 6 successful programs minority faculty development ingredients successmt sinai j med 2008 75 533551crossref pubmed scopus 27 google scholar ideally programs develop network mentorship among students residents fellows faculty different stages career relationships fundamental establishing culture inclusion17daley sp palermo ag nivet sotogreene ml taylor vs butts gc et aldiversity academic medicine 6 successful programs minority faculty development ingredients successmt sinai j med 2008 75 533551crossref pubmed scopus 27 google scholar mentors educated prepared recognize discrimination harassment bias grandrounds lectures small group seminars able refer mentees appropriate resources help26pendleton aa coe mtm saillant nn define address gender discrimination sexual harassment surgical training american college surgeonshttpswwwfacsorgeducationdivisionofeducationpublicationsrisearticlesgendergoogle scholar among care team mentors faculty coach trainees promoting inclusion respect responsibility mentorship fall disproportionately women underrepresented minority surgeons program27rodrguez je campbell km pololi lh addressing disparities academic medicine minority taxbmc med educ 2015 15 6crossref pubmed scopus 216 google scholar every surgeon encouraged mentor people differing backgrounds uim individuals women28byerley js mentoring era metoojama 2020 323 17141715crossref pubmed scopus 1 google scholar uim female faculty member recruited continue require advocacy support institution particularly access professional development opportunities opportunities include limited grant writing workshops time management didactics personal finance education administrative assistant support realistic performance expectations tripartite academic mission transparent criteria promotion merit advancement finally must acknowledge profound loneliness burden scarce diverse faculty working field black ct surgeons composing 3 academic ct surgery faculty statistically black surgeon likely black academic room overwhelming effects ones psyche potential loneliness must acknowledged institutional leadership support groups safe spaces whether person technological conferencing provided29gewin v black scientists want colleagues institutionsnature 2020 583 319322crossref pubmed scopus 15 google scholar4literacy critical component diversity policy development educational programs support culture diversity mitigate structural bias30devine pg forscher ps austin aj cox wtl longterm reduction implicit race bias prejudice habitbreaking interventionj exp soc psychol 2012 48 12671278crossref pubmed scopus 546 google scholar programs reference several online resources19nih scientific workforce diversity toolkit swd nihhttpsdiversitynihgovtoolkitgoogle scholar31diversity inclusion toolkit resources aamc available httpswwwaamcorgprofessionaldevelopmentaffinitygroupscfasdiversityinclusiontoolkitresources accessed july 23 2020google scholar consult institutional diversity offices assistance developing diversity curriculum start programs share evidencebased data regarding importance supporting diversity faculty trainees understand discrimination based race gender national origin sexual orientation violates civil rights act 1964 subtle discrimination bias cannot tolerated according program mission policy faculty trainees also receive current evidence prevalence discrimination bias within field ct surgery highlight urgency action faculty receive education mitigating bias especially setting recruitment32erkmen cp kane l cooke dt bias mitigation cardiothoracic recruitment ann thorac surg available httpswwwncbinlmnihgovpmcarticlespmc7368657 accessed july 28 2020google scholar also evaluation promotion trainees well faculty specified acgme common program requirements programs develop curriculum includes trainee faculty member experiencing witnessing discrimination academic institutions usually office equal employment opportunity guide individuals programs challenging events alternatively hospital systems may separate mechanism reporting offices human resources section divisional leadership regardless process reporting clear trainees faculty additionally everyone must understand retaliation ostracism result reporting discrimination bias unlawful education address microaggressions less egregious widespread harmful actions rooted bias ct surgery include belittling comments suggesting women minorities earn position ct surgery assuming women minorities ct fellows excluding women minorities discussions rounds social gatherings ignoring minimizing microaggressions supports structural bias stakeholders may come erroneous conclusion must tolerate microaggression part ct surgery culture therefore microaggressions must definitively acknowledged addressed create safer equitable environment additionally faculty trainees understand assess implicit biases tools like harvard implicit association test33take test available httpsimplicitharvardeduimplicittakeatesthtml accessed july 23 2020google scholar microaggressions implicit bias damaging academic culture overt discrimination ubiquitous likely tolerated34king e jones k subtle bias often worse blatant discrimination harvard business review available httpshbrorg201607whysubtlebiasissooftenworsethanblatantdiscrimination accessed may 22 2020google scholar program develop policy addressing microaggression implicit bias part educational curriculum mission goals policies developed support diversity regularly updated disseminated among faculty trainees staff5sustainability acgme newly highlighted diversity 2019 world events coronavirus disease 2019 national protests regarding racial injustice 2020 compelled introspection regarding structural racism although propose checklist promote di training program task checked forgotten di efforts must sustained integrated everyday practice achievement diversity goals whether relate recruitment mentoring education must assessed least annually revised based experience programs accomplishing diversity goals prompt needs assessmentrather doubling potentially misguided initiatives reevaluation occur ensure areas improvement targeted framing diversity initiatives positive light rather negative punitive language also key sustainability16pedulla diversity inclusion efforts really work harvard business reviewhttpshbrorg202005diversityandinclusioneffortsthatreallyworkgoogle scholar training programs sponsoring institutions must support compensate individuals demonstrating commitment diversity efforts finally faculty trainees look innovative opportunities within program nationally support diverse workforce inclusive environment limitations checklist acknowledge galvanizing commitment di easier said done recommendations cannot realistically applied without significant buyin levels including trainees faculty chiefs chairs important health system leadership second checklist address significant time financial resources necessary effective di program formation diversity task force implementation outreach inreach efforts require significant time even interested ct surgery faculty may able provide constraints candidly acknowledged ct surgery program develops realistic goals diversity finally recommendations listed represent consensus themes literature drawn numerous academic fields tailored needs individual ct surgery programs programs likely different levels adherence acgme requirement diverse inclusive workforce propose checklist starting point studies effective strategies among ct surgery training programs needed hopefully collaboration ct surgery training programs develop best practices implementing culture di dismantling structural racism addressing structural racism improving di positive impact physician wellbeing patient care diversity essential vitality growth ct surgery draw broader population attract best brightest work present goals checklist framework creation di policy within ct surgery program checklist guided themes establishing actionable goals organizational change longitudinal advocacy diversity literacy sustainability principles used template ct surgery programs seeking achieve diverse inclusive training environment