Perceptions of Equity and Inclusion in Acute Care Surgery

Abstract

Objectives and Background: The aim of this study was to characterize equity and inclusion in acute care surgery (ACS) with a survey to examine the demographics of ACS surgeons, the exclusionary or biased behaviors they witnessed and experienced, and where those behaviors happen. A major initiative of the Equity, Quality, and Inclusion in Trauma Surgery Practice Ad Hoc Task Force of the Eastern Association for the Surgery of Trauma was to characterize equity and inclusion in ACS. To do so, a survey was created with the above objectives. Methods: A cross-sectional, mixed-methods anonymous online survey was sent to all EAST members. Closed-ended questions are reported as percentages with a cutoff of α = 0.05 for significance. Quantitative results were analyzed focusing on mistreatment and bias. Results: Most respondents identified as white, non-Hispanic and male. In the past 12 months, 57.5% of females witnessed or experienced sexual harassment, whereas 48.6% of surgeons of color witnessed or experienced racial/ethnic discrimination. Sexual harassment, racial/ethnic prejudice, or discrimination based on sexual orientation/sex identity was more frequent in the workplace than at academic conferences or in ACS. Females were more likely than males to report unfair treatment due to age, appearance or sex in the workplace and ACS (P ≤ 0.002). Surgeons of color were more likely than white, non-Hispanics to report unfair treatment in the workplace and ACS due to race/ethnicity (P < 0.001). Conclusions: This is the first survey of ACS surgeons on equity and inclusion. Perceptions of bias are prevalent. Minorities reported more inequity than their white male counterparts. Behavior in the workplace was worse than at academic conferences or ACS. Ensuring equity and inclusion may help ACS attract and retain the best and brightest without fear of unfair treatment.

An Institutional Approach to Harassment

“… 21 Even higher rates were reported among surgeons of colour (48.6%), in a survey of a society of trauma surgeons. 23 Higher rates of racialized sexual harassment were reported by women from underrepresented minorities (43%) and by Asians (37%), compared with whites (29%), at an academic North American medical centre. 18 …”

“…12 This is consistent with rates of racial discrimination reported by Sharma and colleagues in a global survey of cardiologists (24%), 21 Even higher rates were reported within surgeons of colour (48.6%) by a survey of a society of trauma surgeons. 23 Higher rates of racialized sexual harassment were reported by women from underrepresented minorities (43%) and Asians (37%) compared to whites (29%) at an academic North American medical centre. 18…”

“… 17 Another academic medical institution reported different types of sexual harassment experienced by women, by members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community, and by underrepresented minorities from staff, students, and faculty, with differences in prevalence among department groups. 18 A high prevalence of discrimination, sexual harassment, and bias was reported among acute care surgeons, 23 and 70% of both women and men physicians reported sexual harassment at a German academic medical centre (n = 737). 20 A 2018 study from the National Academies of Science, Engineering, and Medicine revealed that more than 50% of women faculty and staff reported being harassed in academic environments.…”

Enhancing Diversity in Surgery: Association of Out Surgeons and Allies, a New Society to Support and Promote Lesbian, Gay, Bisexual, Transgender, and Queer Surgeons

“…The concept of inclusion focuses on providing opportunities to individuals who would otherwise be excluded or marginalized, while equity focuses on giving all individuals access to the same opportunities. 13,14 AOSA collaborates with national efforts (partnering with various surgical organizations) and institutional initiatives to promote the inclusion and equity of LGBTQ surgeons within the field of surgery. In order to achieve this overarching goal, AOSA has established four main objectives: (1).…”

Importance of diversity, equity, and inclusion in the community practice setting

“…The first step toward attempting to overcome implicit bias and systemic racism is to recognize that these exist. [17][18][19] It does not require membership in the majority demographic. Systemic bias can be so pervasive that minorities have been guilty of committing microaggressions toward other minorities.…”