“The odds were stacked against me”: a qualitative study of underrepresented minorities in surgical training

Abstract

Background The Royal Australasian College of Surgeons (RACS) is expected to provide surgical care to a diverse patient population across Australia and New Zealand (ANZ). To improve the quality‐of‐care individuals receive, the surgical workforce must reflect the population it serves. Achieving diversity within RACS will strengthen therapeutic relationships with patients and promote an inclusive culture. This study investigates the perspectives of underrepresented minority (URM) trainees to highlight barriers for the selection and completion of the RACS Surgical Education and Training (SET) program. Methods This qualitative study used online, semi‐structured, in‐depth interviews of URM trainees. Participants were recruited by self‐identification and were invited to participate based on inclusion criterion. Interviews took place between August and October 2020, were transcribed and de‐identified. Framework analysis was used to identify themes. Findings Eight participants from four surgical specialities were interviewed, six from Australia and two from New Zealand. There were six female and two male participants. The findings identified barriers that were grouped into eight broad areas: discouragement; structural racism, discrimination and unconscious bias; language barriers; policies and procedures; lack of role models; homophobia; sexual harassment and women in surgery. Conclusion The findings offer guidance to RACS and the surgical community to explore new strategies to improve the experience of URM SET trainees. While on a small scale, the study draws directly on the URMs' experiences to inform strategies addressing equity, diversity and inclusion. The aim is to produce a diverse surgical workforce that better delivers healthcare services to a diverse population.

Literature Review on Regulatory Frameworks for Addressing Discrimination in Clinical Supervision

“…Thirteen articles indicted race as the basis for discriminatory practices in supervision. Yuce et al (2020), Constantine and Sue (2007), Davis (2017), Hu et al (2019), Kleintjes and Swartz (1996), Kristoffersson et al (2021), Nguemeni Tiako et al (2021), Nilsson and Duan (2007), Senreich and Dale (2021), Thackwell et al (2016), and McKenzie-Mavinga and George (2020) discussed the racial disparities that exist within the supervisory relationship. Most indicated experiencing everyday racism and different standards on evaluations than their White counterparts (Yuce et al, 2020).…”

“…Yuce et al (2020), Constantine and Sue (2007), Davis (2017), Hu et al (2019), Kleintjes and Swartz (1996), Kristoffersson et al (2021), Nguemeni Tiako et al (2021), Nilsson and Duan (2007), Senreich and Dale (2021), Thackwell et al (2016), and McKenzie-Mavinga and George (2020) discussed the racial disparities that exist within the supervisory relationship. Most indicated experiencing everyday racism and different standards on evaluations than their White counterparts (Yuce et al, 2020). Some studies reported participants experiencing stereotypical assumptions about their status within the organization (Constantine & Sue, 2007) and being mistaken for a “non-physician” (Yuce et al, 2020).…”

“…Most indicated experiencing everyday racism and different standards on evaluations than their White counterparts (Yuce et al, 2020). Some studies reported participants experiencing stereotypical assumptions about their status within the organization (Constantine & Sue, 2007) and being mistaken for a “non-physician” (Yuce et al, 2020). Others found that Black resident trainees felt “voiceless” within their practice institutions (McKenzie-Mavinga & George, 2020).…”

“…McKenzie-Mavinga and George (2020) recommended organizational change that allows White supervisors to hold space for the impact of racism on Black supervisees. Other articles highlighted the complexity of addressing discrimination and emphasized the need for multidimensional strategies (Griffith et al, 2019;Villanueva et al, 2021) to include individual and systemic changes (Harpe et al, 2021;Katz, 2021;Yuce et al, 2020). Articles advocated for adopting zero-tolerance policies for discrimination (Kristoffersson et al, 2021;Szafran et al, 2021).…”

“…study reported higher rates of gender discrimination than any other GRE. Similarly,Villanueva et al (2021),Harbin et al (2008),Hu et al (2019),Brewer et al (2020),Chung et al (2001),Earp (2020),Hammoud et al (2021), andLim et al (2021) found evidence of gender-based discrimination that biased men over women.…”