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A pathway program to increase diversity in surgery: experience from the American Association for the Surgery of Trauma Diversity, Equity, and Inclusion Committee
  1. Lawrence B. Brown1,
  2. Anthony D. Douglas2,
  3. Adam J. Milam3
  1. 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
  3. 3Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
  1. Correspondence to Dr Lawrence B. Brown; lbrow191{at}jhmi.edu

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Pathway programs are effective in increasing numbers of under-represented minorities (URM) in procedural specialties and mitigating healthcare disparities.1 2 Strong et al examined the impact of a pathway program, established by the American Association for the Surgery of Trauma (AAST) Diversity, Equity, and Inclusion (DEI) Committee, on high school (HS) students with healthcare career interests.3 We applaud the authors for implementing and evaluating a pathway program to improve diversity in surgery.

The study identified 10 HS students, primarily from a medical career exposure program at the University of Chicago and assigned them to faculty mentors with similar backgrounds (eg, gender, racial and ethnic concordance). Students were expected to meet four times virtually, or in-person, during an academic year and to attend a workshop held at the AAST annual meeting. Participants were majority female, from areas with high deprivation indices, 50% African-American, and 30% Hispanic. Students initially reported low confidence in becoming a medical doctor, attributing insecurities to standardized exams, racial bias, language barriers, and fear of disappointing others. At the 6-month mark, five out of six respondents reported a reduction in perceived barriers to pursuing a medical career.

While a third had not met with their mentors at 6 months, students reported increased confidence in their ability to pursue careers in medicine and were motivated to further engage in the program. The authors acknowledged that this study was limited by a small cohort, non-response, and potential selection bias. However, a uniform intervention was not described for mentorship meetings, lending variability to student experiences.

The AAST DEI pathway program would benefit from a larger sample size, longer follow-up time, standardized exam preparation, professional development opportunities (eg, resume review, mentee etiquette, research workshops), and targeting students at more proximal points in their education (eg, middle school). Pathway programs should also address known barriers to involvement, such as transportation and food. Additionally, we recommend tiered mentorship by individuals earlier in their medical careers, such as college, medical students, and residents as they may have more relevant and current advice. Formalizing meeting times and correspondence between mentors and mentees could also assist with increased participation and long-term relationship.

Importantly, the article highlights the structural barriers that have led to the dearth of URM physicians in the USA. Pathways to surgical careers often falter before HS due to inequitable early education and broader structural racism.4 5 Consequently, pathway programs alone are insufficient to address the under-representation of minority physicians. However, as our advocacy addresses these societal barriers, these programs remain a critical tool to empower voices of change in our fight against healthcare disparities.

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  • X @lawrenceb_brown

  • Contributors LBB is the guarantor. LBB, ADD, and AJM were responsible for the drafting of this invited commentary.

  • Funding Dr. Brown has research funding support by the Burroughs Wellcome Fund and the National Institute of Diabetes and Digestive and Kidney Diseases (5F32DK132832-03).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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