The Daily Dose • Friday, April 14, 2023

Promoting a Diverse Workforce in Academic Anesthesiology

Jane S. Moon, MD

There is a pressing need to recruit, retain, and promote a diverse physician anesthesiologist workforce to encourage equity in healthcare delivery, as well as innovation and inclusivity in the workplace. This topic was the focus of “Diversity in Academic Anesthesiology: Enhancing the Workforce,” a session sponsored by the Raising Anesthesiology Diversity and Antiracism (RADAR) initiative on Friday, April 14, at the IARS 2023 Annual Meeting.

The panel was co-moderated by RADAR founder Matthew Wixson, MD, Associate Chair of Diversity in the Department of Anesthesiology at the University of Michigan, and RADAR leader Scott Markowitz, MD, MSOL, Vice Chair for Diversity, Equity, and Inclusion (DEI) in the Department of Anesthesiology at Washington University in St. Louis. RADAR aims to help anesthesiology departments and training programs increase diversity, equity and inclusion to enhance patient care, the education of students and trainees and the culture of our specialty, institutions and society at large.

Odinakachukwu Ehie, MD, FASA, Vice Chair of Equity, Diversity, and Inclusion in the Department of Anesthesia and Perioperative Care at the University of California, San Francisco (UCSF), spoke on “Promoting Inclusivity in Department Practices and Leadership.” During her talk, she highlighted the importance of DEI curricula in effecting change. As a Bridges Curriculum coach for the UCSF School of Medicine for several years, Dr. Ehie helped establish a strong DEI foundation for medical students. Also, as a UCSF Teachers Scholar in 2020, she started a diversity curriculum for anesthesiology and surgery residents that effectively utilized small group discussions and case scenarios to engage learners during its workshops on unconscious bias, allyship and microaggressions.

Dr. Ehie cited a NEJM study (Hu 2019) that reported mistreatment of general surgery residents due to gender or racial discrimination as being associated with burnout in order to underscore the value of mentorship, sponsorship, and allyship in supporting underrepresented minorities in medicine (URiM). She stated that although racial/ethnic and gender concordance of mentor-mentee dyads may be desirable, dialogue that is open, respectful, and goal-directed can still enable highly effective relationships between nonminority mentors and URiM mentees (Louissant 2021).

Allison Mitchell, MD, Residency Program Director in the Department of Anesthesiology at Washington University in St. Louis, then spoke on “Improving Diversity in Residency Classes and Establishing DEI Curriculums.” As a leader in academic anesthesiology who evaluates a large volume of residency applications each year, Dr. Mitchell emphasized the value of shifting from a traditional to a holistic approach in application review to recruit a more diverse workforce. She cautioned against relying heavily on evaluation measures such as test scores and class rank that have been associated with structural bias.

Dr. Mitchell then focused on the value of DEI curricula in promoting awareness of implicit bias and healthcare disparities and in celebrating the value of a diverse and welcoming workplace. She shared her own department’s success in implementing a four-year DEI curriculum for anesthesiology residents that prioritizes interactive methods of instruction.

Finally, Dr. Mitchell emphasized a commitment to DEI principles as essential to fostering a safe, respectful, and compassionate work culture. Her department has seen success with its Peers in Anesthesiology Supporting a Fair Environment (PIA SAFE) program, which aims to promote a positive and safe culture by addressing concerns about negative behaviors and microaggressions experienced by individual department members.

William McDade, MD, PhD, Chief Diversity, Equity, and Inclusion Officer for the Accreditation Council for Graduate Medical Education (ACGME), gave the final presentation of the session on “Pathways to Science, Medicine, Anesthesiology for a More Diverse Group of Professionals.” He cited the seminal 2003 Institute of Medicine report Unequal Treatment as a primary impetus for the medical community’s commitment to alleviating racial and ethnic disparities in health care.

Dr. McDade showed evidence for increased patient satisfaction among “historically marginalized individuals who receive racially concordant care” and the greater likelihood of historically marginalized physicians choosing to practice in underserved communities after their training. This was a phenomenon that even Abraham Flexner had noted in his 1910 report on American medical education. At the same time, Dr. McDade noted the hazards of expecting underrepresented minority physicians to bear the entire burden of caring for underserved patient populations. He emphasized the need for physicians of all races to “embrace cultural humility to improve the care they give to patients from historically marginalized groups.”

Dr. McDade then described the far-reaching work of the ACGME on the DEI front. First, the ACGME has modified its mission and vision statements to prioritize DEI excellence at the GME level and greater equity in health care delivery. Dr. McDade also drew attention to the ACGME Equity Matters™ Initiative, which aims to increase physician workforce diversity, promote an inclusive learning environment, and encourage healthcare equity by providing rich educational resources on DEI topics in a structured manner. Included on the Equity Matters™ website are options for a continuing medical education (CME) learning paths, video library content and an equity practice toolkit to equip programs and institutions with the tools to achieve equity in meaningful ways.

Dr. McDade also discussed ACGME’s incorporation of a “1.C.” component of its Common Residency Program Requirements. For a residency program to be considered compliant, it must now show evidence of “mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce.”

Warning of political threats like the proposed SB 410 “Do Not Harm Act” in Missouri, which seeks to remove DEI requirements in state-funded universities and healthcare, Dr. McDade emphasized the need to support pathways in medicine for URiM students as early as the pre-college years.

Dr. Wixson then moderated an engaging Q&A discussion that touched upon topics as varied as the value of diverse faculty in promoting a diverse workforce, the power of leaders to create safe and inclusive work environments and the wisdom of utilizing existing organizational mission statements to advocate for DEI principles and culture change.