Incorporating Diversity, Equity and Inclusion in Residency Curriculum, Departments and Daily Actions

Allison M. Janda, MD

This impactful and engaging American Society of Anesthesiologists (ASA) panel, “Campfire Session: Incorporating Diversity and Inclusion in Anesthesiology Programs: Residents and Faculty,” held on May 16 at the IARS 2021 Annual Meeting, discussed the importance of Diversity, Equity and Inclusivity (DEI) and how we can incorporate and emphasize the importance of DEI in our residency training programs and throughout our departments.

Tracey Straker, MD, MS, MPH, FASA, Professor of Anesthesiology from Albert Einstein College of Medicine and Montefiore Medical Center, moderated this panel on how DEI can be accentuated in our residency training programs and throughout our departments to improve ourselves, our workplaces and our quality of care for the patients we serve.

The State of Disparities in Anesthesiology

Vilma Joseph, MD, MPH, FASA, Professor of Anesthesiology from Albert Einstein College of Medicine at The University Hospital of Montefiore Medical Center, was the first panelist and discussed the state of disparities in anesthesiology from getting into medical school through becoming a senior faculty member. Dr. Joseph shared the race and ethnicity data from the US Census and compared them to the race and ethnicity of medical school acceptees and medical school graduates, demonstrating the lack of representation of racial and ethnic minorities in these groups. The disparity in representation was most pronounced for the Black and Hispanic populations. This trend was again demonstrated within the field of anesthesiology. To highlight the pipeline issue within our field, the percentage of Black anesthesiology residents that were dismissed from residency programs was 10.3 fold higher than their White counterparts. There are also more men than women within anesthesiology across all races and ethnicities. This disparity reaches all the way up from medical students to anesthesiology chairs, where most anesthesiology chairs and people in ASA leadership roles are White males. This is a stark difference from the US population and demonstrates the immediate need for improvement in representation in medical school acceptees, medical school graduates, anesthesia residents, anesthesia faculty, and leaders within the field of anesthesiology.

Incorporating Diversity and Inclusion in Anesthesiology Programs – Residents and Faculty 

Dr. Straker spoke next on incorporation of a DEI curriculum into the anesthesiology residency and what the curriculum entails. She started by outlining the process underway to create the DEI curriculum. First, she established a DEI taskforce to promote collaboration and gain buy-in from the department, anesthesia subspecialties, residents, fellows, and national subspecialty leaders. She is leading a soft rollout this month at Montefiore and the curriculum includes multiple types of media, workshops, didactics and conversations to create a safe space for residents and faculty to discuss their experiences and issues faced professionally and socially. After incorporating feedback from the Montefiore residents, this valuable and well-developed curriculum will go live in August, 2021 and will be available free of charge to all residency programs.

Recruiting & Retaining a Diverse Anesthesiology Department: Representation Matters

Valerie Armstead, MD, FAAP, DABA, a Professor of Anesthesiology at Temple University Lewis Katz School of Medicine, was the next panelist in this excellent session. Dr. Armstead emphasized that a commitment to diversity improves patient care and demonstrating this commitment helps with recruitment of a care team that is as diverse as the patient base. A diverse care team better establishes trust and effective communication with patients when the patients can identify with individuals on their healthcare team. Additionally, increased diversity can counter the detrimental effects of implicit bias on coworkers and patients. Diversity of care teams is associated with improved team morale and increased retention of residents and faculty and creates a stronger feeling of inclusion, fostering a positive work environment. Dr. Armstead also stressed that diversity without inclusion is ineffective. She emphasized that healthcare teams need to represent a variety of backgrounds and that each individual member must be given a voice to participate in the team and lead for that team to succeed. A commitment to DEI helps cultivate an appealing environment for recruiting new healthcare workers to attract new talent and create more role models from diverse backgrounds which then promotes more diversity and improved patient care. Steps to achieve DEI include improvement of culture from the ground up and demonstration of continued, meaningful support of the DEI mission to show an organization’s dedication to DEI. It is also crucial to understand unconscious bias, expand recruiting initiatives, and focus on employee referrals. Dr. Armstead emphasized that institutions and departments must create a DEI committee with “teeth” who has the support and resources to make meaningful change, consult a DEI recruiting expert, strive for transparency regarding hiring, compensation and promotion and implement diversity-driven recruiting technology.

The Resident Physician (Tomorrow’s Hope)

Alexandra Bastien, MD, Associate Professor of Anesthesiology at the Albert Einstein College of Medicine and Montefiore Medical Center, was the final panelist. Dr. Bastien focused on how to best cultivate a resident physician to achieve the triple aim of delivering excellent quality of care, optimizing costs and improving the health of the population. Aligning with this triple aim, she outlined the FUBU approach for DEI curriculums which emphasizes a Focus on population health, creates Upstanders, not Bystanders and reinforces becoming Upstreamists. Dr. Bastien emphasized that of the four main factors determining population health, clinical care only accounts for 20% of the impact, the other three factors including social and economic factors, health behaviors and environmental factors are significant contributors to population health and are changeable with a DEI curriculum for residents. Millennial residents are primed to help make this change as they are already advocates of resource stewardship and are upstreamists as they are out-of-the box thinkers and innovators. The components lacking in their current curriculum are education on how to handle microaggressions to become upstanders instead of bystanders, tools to communicate their goals and strategies for interventions to promote DEI. The goal of the DEI curriculum is to convey how the culture started in a place of exclusion and after equality was attempted to be applied, there were still marginalized people who were not included. Dr. Bastien emphasized that although equity made somewhat of a difference, in reality, with the impact of privilege and residual bias, there is a long way to go to break down barriers to reach full inclusion.

A question and answer session followed the panelists’ impactful presentations. The panelists tackled a variety of important topics and had an engaging discussion surrounding DEI initiatives and curricula. The full recording is available on-demand on the virtual meeting platform here.