Improving Inclusion in Surgical Residency to Advance Workforce Diversity and Health Equity

项目总结 医生的多样性减少了健康差距。然而，尽管政府发表了强有力的支持多样性的声明 医学研究所、美国医学会、美国医学院协会、 美国医学研究生教育认证委员会、美国外科医生学会和美国 外科协会表示，在外科手术的各个层面上，多样性仍然难以捉摸。在外科手术中缺乏包容性 常驻是劳动力多样性缺乏的根本原因。到目前为止，改善医疗保健包容性的努力 专注于个人信念或技能，例如内隐偏见训练。然而，来自组织的数据 心理学，应用社会文化心理学来理解人类行为的科学领域 工作场所，表明这种培训不会导致持续的行为改变。相反，行为是 理解为反映组织文化。文化，共同的基本信仰，规范的价值观， 和工作场所的相关社会实践，深刻影响工作敬业度、人际关系 同事，以及合作实现共同目标的能力。为了有意义地增加包容性， 干预措施必须针对组织文化。这位候选人是一名儿科外科医生，正在寻求发展， 根据背景调整并实施理论驱动的循证干预措施，以改善 纳入外科住院医师计划。为了实现拟议项目的目标，候选人 需要获得(1)组织心理学方面的知识、技能和经验；(2)以用户为中心的设计， (3)应用实施学。该项目建议(1)检查组织的特征 文化(例如，政策、实践)支持或贬低美国高绩效和低绩效的包容性 普外科住院医师计划；(2)开发有针对性的、用户知情的干预措施，以解决 低包容性方案的组织文化；以及(3)实施和进行一项试点研究 对低包容性方案进行干预，以双重评估执行情况(可行性、可扩展性、可接受性) 和初步有效性(对包容性、多样性、幸福感、显性和隐性偏见的看法； 外科病人满意度)。这一领域的研究对外科医生和他们的病人都很重要。包容性工作 预计学习环境将改善多样化劳动力的招聘和留住，因为 以及所有人的工作参与度；这项工作对减少差距和提高质量具有影响。这 建议是对AHRQ的特别强调卫生服务研究兴趣通知的回应 促进健康公平(非HS-21-014)。职业发展计划和研究项目充分利用了 西北大学首席研究员的研究和研究环境的许多优势 大学，包括在凯洛格学院获得世界级的创新方法导师和专家 管理，西格尔设计学院，以及手术结果和质量改进中心 作为212个美国普通外科住院医师项目的大型、成熟的学习协作体。

PROJECT SUMMARY Physician diversity reduces health disparities. Yet, despite powerful pro-diversity statements from the Institute of Medicine, the American Medical Association, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, the American College of Surgeons, and the American Surgical Association, diversity remains elusive at all levels in surgery. Lack of inclusion in surgical residency underlies this lack of workforce diversity. To date, efforts to improve inclusion in healthcare have focused on individual beliefs or skills, such as implicit bias training. However, data from organizational psychology, the scientific field that applies sociocultural psychology to understand human behavior in the workplace, demonstrate that such training does not result in sustained behavioral change. Rather, behavior is understood to reflect organizational culture. Culture, the shared and fundamental beliefs, normative values, and related social practices of a workplace, profoundly impacts work engagement, relationships with colleagues, and the ability to collaborate to achieve common goals. In order to meaningfully increase inclusion, interventions must address organizational culture. The candidate, a pediatric surgeon, is seeking to develop, contextually adapt, and implement theoretically driven, evidence-based interventions to improve inclusion in surgical residency programs. To accomplish the aims of the proposed project, the candidate needs to acquire knowledge, skills, and experience in (1) organizational psychology; (2) user-centered design, and (3) applied implementation science. The project proposes to (1) examine the features of organizational culture (e.g., policies, practices) that support or detract from inclusion in both high- and low-performing US general surgery residency programs; (2) develop targeted, user-informed interventions to address the organizational culture of low-inclusion programs; and (3) implement and conduct a pilot study of the interventions in low-inclusion programs to dually assess implementation (feasibility, scalability, acceptability) and preliminary effectiveness (perceptions of inclusion, diversity, well-being, explicit and implicit biases; surgical patient satisfaction). This field of research is important for surgeons and their patients. Inclusive work and learning environments are expected to improve the recruitment and retention of a diverse workforce, as well as work engagement for all; this work has implications for reducing disparities and improving quality. This proposal is responsive to AHRQ’s Special Emphasis Notice of Interest in Health Services Research to Advance Health Equity (NOT-HS-21-014). The career development plan and research project capitalize on the many strengths of the principal investigator’s research and the research environment at Northwestern University, including access to world-class mentors and experts in innovative methods at the Kellogg School of Management, the Segal Design Institute, and the Surgical Outcomes and Quality Improvement Center, as well as a large, well-established learning collaborative of 212 US general surgery residency programs.