Diversity, Equity, and Inclusion Among Anesthesiology Trainees

Abstract

Background: Historically in medicine, women and minorities have been underrepresented. This trend is especially significant in the anesthesiology workforce. Objective: The goals of this study were to quantify the current state of diversity by race/ethnicity, gender, and sexual orientation among anesthesiology residents. Methods: An institutionally reviewed and validated survey was delivered through Qualtrics to 130 anesthesiology program directors. Topics addressed included gender identity, sexual orientation, racial and ethnic background, rationale for pursuing anesthesiology, and medical training experiences. The study was administered from February to April 2021; 135 anesthesiology residents responded to the survey. Results: The sample was 44.4% white ( n = 60), 54.1% male ( n = 73), and 83.7% ( n = 113) of respondents self-reported as straight or heterosexual. Respondents indicated that role models/mentors were somewhat or very important in their desire to pursue anesthesiology ( n = 85; 67.2%), 42% reported that having women/diverse faculty was somewhat or very important in their decision to pursue anesthesiology. Discrimination during the anesthesiology residency application process or as a resident ranged from 4.4% due to sexual orientation to 18.7% due to gender/gender identity and race/ethnicity. Conclusions: Experiences of discrimination based on race/ethnicity, gender, and gender identity continues to be a concern among anesthesiology trainees. Creating an environment that is inclusive and supportive of all trainees regardless of race/ethnicity, gender/gender identity, and sexual orientation is needed. Interventions and strategies to create an inclusive environment may improve diversity within anesthesiology.

Pro-Con Debate: Consideration of Race, Ethnicity, and Gender Is Detrimental to Successful Mentorship

“…16–18 Yet, apart from overcoming these structural constraints, anesthesiologists from underrepresented groups must still persevere in the face of bias and discrimination. Nearly 1 in 5 anesthesiology residents endorsed encountering sex-, race-, or ethnicity-related discrimination in their training programs; 19 in another study, more than 4 in 5 practicing anesthesiologists and surgeons in one health system reported experiencing sexist or racist workplace microaggressions. 20 These external obstacles may be compounded by internalized barriers to seeking career advancement, such as stereotype threat, and consequences of persistent marginalization, such as isolation and imposter syndrome.…”

“…36,37 Professional development should equip mentors to recognize the intersectionality of race, ethnicity, and gender in shaping mentees' overall experience and their experience in the specialty, [38][39][40] as well as to understand and address disparities related to sexual and gender minoritized status, or immigrant or international medical graduate status, among others. 3,11,19 By considering these factors, mentors can serve as models on how to intentionally promote equity and inclusivity, which can help foster more diverse environments for mentees. This training should be applied through in-person activities and workshops to generate meaningful discussion or through a reporting system that requires mentees to submit their goals and report on their progress.…”

“…Pro-Con: Mentorship Race, Ethnicity, and Gender discrimination in their training programs; 19 in another study, more than 4 in 5 practicing anesthesiologists and surgeons in one health system reported experiencing sexist or racist workplace microaggressions. 20 These external obstacles may be compounded by internalized barriers to seeking career advancement, such as stereotype threat, and consequences of persistent marginalization, such as isolation and imposter syndrome.…”

Racial Disparities in Compensation Among US Anesthesiologists: Results of a National Survey of Anesthesiologists

“…Recommendations include early outreach programs, bias training for selection committees, fair departmental culture, compensation and promotion transparency, mentorship and sponsorship, and fair and transparent opportunities. 28,29 Encouraging initiatives are emerging that address the current workforce as well as the pipeline of potential anesthesiologists. The Raising Anesthesiology Diversity and Antiracism (RADAR) initiative is a National Institutes of Health (NIH)-funded collaborative with a triple-aim to attract and engage underrepresented and historically marginalized college and medical students into anesthesiology, create a community for residents, fellows, and early-career faculty in anesthesiology, and provide resources and education for senior leaders in anesthesiology on topics, such as racism, bias, and equity.…”

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology

“…Special care should be taken to protect TGD trainees and colleagues from discrimination within anesthesiology departments. Supporting SGM anesthesiologists should be of paramount importance to decrease the burnout and mental health disparities experienced by this population, and because role models and mentors were cited by 67.2% of medical student respondents as the most important factor when deciding to pursue anesthesiology training 48. If TGD anesthesiologists are not currently supported in the workforce, how can it be expected to recruit and retain enough TGD trainees to finally achieve adequate representation in our specialty?…”