Addressing Surgical Disparities at the Root; Working to improve diversity in the surgical workforce

摘要 从根本上解决外科差异：提高外科工作人员的多样性 最近的COVID-19大流行，种族动机的谋杀，以及随后的抗议活动强调了我们 我已经知道，医学上的种族差异远远超过了病人的结果，必须 在所有各级处理。手术结果和满意度的种族和性别差异是有据可查的。 从管道的角度来看，手术努力维持和促进代表性不足的少数民族（UIM）， 女住院医师和女教员。努力提高劳动力的多样性加班没有跟上时代的步伐。 我们患者群体的多样性增加。有证据表明，提高外科工作人员的多样性 可以提高UIM和女性患者的护理质量和结果。这项拟议中的研究涉及一个小组， 跨学科的研究人员具有互补的专业知识和在该主题领域的研究记录 与多个利益攸关方社会合作。我们的目标是减少差距，在外科护理使用 一种新的、跨学科的、多机构的偏差方法来表征外科工作人员中的差异， 制定最佳做法准则，并制定试点干预措施。我们的中心假设是通过使用异常行为 方法，我们可以确定保留和促进妇女和少数民族教师的最佳做法， 实习生在外科手术，可用于帮助增加工作队伍的多样性，并最终病人的质量， 在乎我们将进行二次数据分析，以衡量美国各地外科教师的多样性; 确定具有促进和保留UIM和女教师的最佳和最差记录的课程; 记录这些群体在学术医疗中心的晋升和保留范围，以确定 成功的多样性努力的预测因素使用AAMC数据与ABS数据相结合， 认证考试数据，我们将描述外科实习生的社会人口概况， 美国外科住院医师的流失率，找出那些记录最好和最差的节目， 即将毕业的住院医生我们将利用收集的文化能力和偏见评估调查数据， 我们的目标项目以及与国家医学协会、妇女协会 外科医生和历史上的黑人医学院和大学，并深入，定性访谈， 项目管理人员、UIM和女学员、教师、部门和部门负责人， 我已经成功地-或挣扎在-保留和促进UIM和女教师学习最好的和最差的 实践和组织特点。最后，我们将从我们的定量分析中提取预测因子， 从我们的定性分析的主题，并协调德尔菲小组的学术领袖和病人的宣传 小组创建了一套最佳实践指南，并开发了一个试点研究，以测试表现不佳的程序。 通过定义留住和提升住院医师和教职员工的最佳实践， 并测试这些，以帮助提高学术外科劳动力的多样性，公平性和包容性。

Abstract Addressing Surgical Disparities at the Root: Improving Diversity in the Surgical Workforce The recent COVID-19 pandemic, racially motivated murders, and subsequent protests underscore what we already know--that racial disparities in medicine run far deeper than patient outcomes alone and must be addressed at all levels. Racial and gender disparities in surgical outcomes and satisfaction are well documented. From a pipeline perspective, surgery struggles to maintain and promote underrepresented minority (UIM) and women residents and faculty. Efforts to improve diversity in the workforce overtime have not kept pace with the increased diversity in our patient populations. There is evidence that improving diversity in the surgical workforce can improve the quality and outcomes of care for UIM and women patients. The proposed study involves a team of interdisciplinary investigators with complimentary expertise and a strong record of research in the topic area collaborating with multiple stakeholder societies. Our objective is to reduce disparities in surgical care using a novel, transdisciplinary, multi-institutional deviance approach to characterize disparities in the surgical workforce, set best practice guidelines, and develop a pilot intervention. Our central hypothesis is that by using deviance methodology we can identify best practices in retention and promotion of women and minority faculty and trainees in surgery that can be used to help increase diversity in the work force and ultimately patient quality of care. We will perform a secondary data analysis to measure diversity among surgical faculty across the U.S.; identify programs with the best and worst records of promotion and retention of UIM and women faculty; and document the range of promotion and retention among these groups at academic medical centers to identify predictors of successful diversity efforts Using AAMC data combined with ABS data and qualifying as well as certifying examination data, we will describe the sociodemographic profile of surgical trainees and current attrition rates for surgical residents in the U.S., identifying those programs with the best and worst records of graduating residents. We will utilize data on cultural competency and bias assessment surveys collected from our target programs as well as focus groups with the National Medical Association, the Association of Women Surgeons and the Historically Black Medical Colleges and Universities and in-depth, qualitative interviews with program administrators, UIM and women trainees, faculty, and department and division heads at programs that have been successful - or struggled at - retaining and promoting UIM and women faculty to study best and worst practices and organizational characteristics. Finally, we will take predictors from our quantitative analysis, themes from our qualitative analysis, and coordinate a Delphi panel of academic leaders and patient advocacy groups to create a set of best practice guidelines and develop a pilot study to test at poorly performing programs. By defining best practices for retention and promotion of residents and faculty, we can develop best practices and test these to help improve diversity, equity, and inclusion in the academic surgical workforce.