Diversity and Inclusion Educational AidsThe Society for Education in Anesthesia Diversity and Inclusion Committee is compiling and disseminating educational aids on Diversity and Inclusion on a monthly basis. NOVEMBER 2023: Commit to Kindess at workSubmitted by: Herodotos Ellinas, MD, MHPE (he/him/his) November is the month of giving thanks to ALL no matter what race, religion, ethnicity, gender, sexual orientation or socioeconomic status they belong to. While I was contemplating what educational tip we should publish this month, this Harvard business review tip flew into my inbox. Commit to Kindness at Work When anxiety is high and morale is low, kindness isn’t a luxury—it’s a necessity. Being kind doesn’t only benefit the people around you; research shows it also benefits your own mental health. Here’s how to be kinder at work. First, remember that being kind to others starts with being kind to yourself. Set priorities and boundaries, and take time to recharge when you need it. Once you meet your own needs, you can turn your attention to others. Next, be intentional about establishing and sustaining relationships at work—especially if you’re on a remote or hybrid team. Make plans to meet virtually or in person with your colleagues. Ask about their pets, their recent move, or their family. Most importantly, practice active listening. Showing someone that you genuinely care about what they have to say is an impactful display of kindness. And don’t be shy about giving your colleagues authentic praise. Recognizing and acknowledging people lets them know you appreciate them and their contributions. Finally, be conscientious with your feedback. When you know your teammates more deeply, you can also better understand how to offer them honest, constructive input on their work. Being kind means offering feedback for the betterment of the person receiving it—and the overall success of your company. This tip is adapted from “Why Kindness at Work Pays Off,” by Andrew Swinand Along with this piece, this TED talk by Raegan Hill about the power of kindness encompasses my feelings of thanks to all. In a world full of animosity, distrust, and hopelessness, kindness is the beacon of hope. https://www.ted.com/talks/raegan_hill_the_power_of_kindness?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare Consider kindness as part of your daily routine; positive intent rather than malice. We all need it right now, our world needs it. October 2023: The Bias Behind Undiagnosed Chronic PainSubmitted by: Darryl Brown, MD According to the Centers for Disease control, approximately 20.9% of adults in the United States experience chronic pain and 6.9% of adults have high impact chronic pain, which is defined as not only pain that lasts 3 months or longer but pain that substantially limits the ability to function daily, i.e. unable to work outside the home, go to school or perform household chores.1,2 The prevalence of high impact chronic pain is higher in certain groups including older adults, females, adults who are currently unemployed, veterans, those living in poverty and those with public health insurance.3 It is clear that disparities exist in the prevalence of chronic pain among certain groups and this may be attributed to undiagnosed biases. Dr. Sheetal Dacaria’s TED Talk, “The Bias Behind Your Undiagnosed Chronic Pain,” explores the hidden biases which come to play when treating patients with pain. Pain is defined by the International Association for the Study of Pain as an unpleasant sensory or emotional experience due to actual or perceived tissue damage and is an inherently personal and subjective experience. This experience is shaped by environmental and social cues which are influenced by one’s past experiences. For many physicians, treating pain may be challenging especially when there is no clear source of pain. Dr. Dacaria, an anesthesiologist, asserts that when there is no discernible source of pain, it becomes subject to interpretation. And when pain is open to interpretation, it becomes susceptible to undiagnosed bias. These implicit biases lead to inaccurate diagnoses and inadequate treatment for those who are suffering. Dr. Dacaria shares her own personal experience with pain and the challenges she faced when she sought treatment. She argues that healthcare professionals must be aware of and acknowledge their biases and recognize the impact these biases that they hold have on the care of patients with chronic pain. This anesthesiologist calls upon us to have increased empathy for patients who are suffering with chronic pain to ensure that everyone, regardless of their background, receives appropriate treatment of their pain. https://www.ted.com/talks/sheetal_decaria_the_bias_behind_your_undiagnosed_chronic_pain
Dr. Brown serves as an Assistant Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Mount Sinai Morningside and West Hospitals in NY. SEPTEMBER 2023: AUGUST 26 is "women's equality day"Submitted by: M. Angele Theard, MD After the deaths of Anthony and Stanton in 1906 and 1902 respectively, the work of these two founders of the National American Women’s Suffrage Association was continued by Carrie Chapman Catt, a graduate of Iowa State University who was an outspoken suffragist who fought for peace and Dr. Alice Paul, 26 years Catt’s junior, a graduate of Swarthmore College with a master’s in Sociology and a PhD in Economics from the University of Pennsylvania; and a law degree from the Washington College of Law at American University. Dr. Paul lead rallies and hunger strikes, including picketing the White House to support this key cause in American history. African American ministers like Florence Spearing Randolph necessarily lead separate African American societies, like the New Jersey Woman Suffrage Association to support this movement integral to assuring equity for all women. While these leaders and the many women who worked alongside them were pivotal to the final certification of the 19th Amendment to the Constitution, this achievement would not have been possible without the support of men. In 1920, it was an overwhelmingly male Congress and 36 state legislatures that approved the 19th Amendment. Other male supporters included figures like: Daniel Anthony, Susan’s father who provided both moral and financial support; Frederick Douglass, the only African American to attend the first woman's rights convention in Seneca Falls; Dr. Peter Wilson, a member of the Cayuga Nation and the first Native American to graduate from Geneva Medical College spoke in favor of universal suffrage; and Parker Pillsbury a minister and advocate for abolition and women’s rights. Achieving gender equity in medicine requires that we include our intersectionality. In medicine, ensuring that we, men, women, and non-binary members of different ethnicities, race, religion, sexual orientation, and socioeconomic backgrounds have a voice helps to assure that our increasingly diverse population of learners and patients have the best possible experiences and outcomes. Dr. Michael Kimmel, Professor of Sociology and Gender studies who serves as the director of the Center for the Study of Men and masculinities at Stony Brook University weighs in on the benefits of gender equity in this thoughtful and spirited TED talk. https://www.ted.com/talks/michael_kimmel_why_gender_equality_is_good_for_everyone_men_included References: https://constitutioncenter.org/blog/why-august-26-is-known-as-womans-equality-day https://www.womenshistory.org/education-resources/biographies/susan-b-anthony https://www.womenshistory.org/education-resources/biographies/carrie-chapman-catt https://www.nps.gov/people/alice-paul.htm https://womensuffrage.libraries.rutgers.edu/exhibits/show/womenssuffrage/19century M. Angele Theard, MD, Associate Professor, Anesthesiology, Neuroanesthesia fellowship director, University of Washington, Seattle, WA AUGUST 2023: Continuing Our Quest for a Diverse Healthcare Workforce in the Age of the Supreme Court Decision on Affirmative ActionSubmitted by: M. Angele Theard, MD Amidst the attention medical centers across our nation are placing toward actualizing initiatives for diversifying our healthcare workforce, it is hard to ignore the recent US Supreme Court decision on Affirmative action in university admissions policies. The Supreme Court decision (6-3 in the case of University of north Carolina and 6-2 in the case of Harvard because Justice Ketanji Brown Jackson recused herself from the Harvard case) handed down was that Harvard and University of North Carolina’s (UNC) admissions programs violate the Equal Protection Clause of the 14th amendment.1 Chief Justice Roberts summarized the majority opinion: it is “unlawful for colleges to take race into consideration as a specific factor in admissions”.2 In an informational video from the American Medical Association (AMA), Dr. Sanjay Desai, AMA’s chief academic officer and group vice president of medical education and Dave Henderson, MD, AMA vice president for equity, diversity and belonging in medical education discuss the impact of the Supreme court decision on realizing more diversity in our healthcare workforce.3 Despite concerning suggestions of “color blindness” and the lack of consideration of the impact of affirmative action on increasing diversity, the need for diverse undergraduate students to apply and complete medical school and training continues. While “race cannot be taken into consideration as a specific factor in admissions” Chief Justice Roberts in the majority opinion explains, “applicants must be treated based on his or her experiences as an individual “and continues….. “universities can still consider an applicant's discussion of how race affected his or her life, be it through discrimination, inspiration, or otherwise.” 2 In response to the Supreme Court decision, the Association of American Colleges supported by several other national organizations filed an Amicus brief that asks the Supreme Court to not disrupt the admissions processes that medical schools have designed based on the court’s long-standing precedents.3 Additionally, the AAMC has since updated its website offering insights into holistic admissions processes defined as: mission-aligned admissions or selection processes that take into consideration applicants’ experiences, attributes, and academic metrics as well as the value an applicant would contribute to learning, practice, and teaching.4 Understanding the value or assets that URiM medical students and residents bring to medicine and assuring a space in our selection process for this important consideration helps to facilitate a holistic approach to candidate selection. As program directors make efforts to diversify their selection teams, one opportunity to understand the diverse wealth of experiences candidates may bring to your program is presented in an article by Drs. Uzendu, Boudoulas, and Capers.5 In addition to research experience, clinical skills, leadership ability and academic curiosity, the authors included a category: Diversity Cultural Competency Rating, which at Ohio State University has contributed to the training of at least one URiM interventional Cardiologist for 8 years in a row. They asked candidates questions regarding experiences with community outreach and/or immersion experiences with cultures other than their own with clear scoring rubrics to help in the selection of diverse and broad-minded candidates. Scored interview questions to identify a candidates’ understanding of health disparities integral to caring for our increasingly diverse populace are equally important (questions can easily be reframed based on specialties and level of training): Ask a question related to depth of understanding about racial healthcare disparities. Grade on numeric scale based on completeness and depth of knowledge.
This end to the social construct of race for undergraduate admissions is an important opportunity to ensure that we continue to thoughtfully recruit, evaluate, and select the best and brightest diverse candidates. As members of a society focused on education, patient safety, research, and leadership, we have a wonderful opportunity to share experiences and promote collaboration for understanding to support future generations of Anesthesiologists and all healthcare providers. References:
M. Angele Theard, MD Associate Prof, Anesthesiology, Neuroanesthesia Fellowship Director, APM, University of Washington, Seattle, WA JULY 2023: USING VIRTUAL REALITY TO STEP INTO ANOTHER'S RACIAL EXPERIENCESubmitted by: Josephine Hernandez, MD Dr. Courtney Cogburn is an associate professor at the Columbia University School of Social Work and faculty of the Columbia Population Research Center. She employs a transdisciplinary research strategy to improve the characterization and measurement of racism and in examining the role of racism in the production of racial inequities in health. Dr. Cogburn’s work also explores the potential of media and technology for eradicating racism and eliminating racial inequities in health. She is the lead creator of 1000 Cut Journey, an immersive virtual reality experience of racism that premiered at the 2018 Tribeca Film Festival. She is currently developing projects focused on Black futures, imagination, radical storytelling and healing. She is the Chief Equity Officer and Director of Knowledge Transfer with Learning the Earth with Artificial Intelligence and Physics, an NSF Science and Technology Center. She is also the Associate Director of DEI and co-chair of the Computational Social Science working group at the Columbia Data Science Institute. I had the pleasure of hearing about Dr. Cogburn’s work as our inaugural JEDI speaker for Beth Israel Deaconess Medical Center Anesthesia Week Lecture series. Her virtual reality work focuses on helping us better understand the world through the eyes of marginalized group members. What was amazing was how even a short immersion into another’s skin may have lasting effects. Below I have put links to her Ted Talk and her work on virtual reality: Cogburn, C.D., Bailenson, J.N., Ogle, E., Asher, T. & Nichols, T. (2018). 1000 cut journey. ACM SIGGRAPH (2018). Virtual, Augmented, and Mixed Reality, DOI: https://doi.org/10.1145/3226552.3226575 https://www.youtube.com/watch?v=M7T_u4hpiSE&pp=ygUQY291cnRuZXkgY29nYnVybg%3D%3D Josephine Hernandez, MD
JUNE 2023: PRIDE MONTH: CARING FOR TRANSGENDER AND GENDER DIVERSE PATIENTSSubmitted by: Claire Rhee, MD, Ed Nguyen, MD, Kara G. Segna, MD, Katie J. O’Conor, MD As we enter Pride Month, we recognize its dual purpose as an opportunity to celebrate and advance equal rights, as well as to commemorate historic human rights transgressions against the LGBTQIA+ community.1 As healthcare providers, this month reminds us of the privilege we have to take care of all people no matter what their background is. The transgender population in particular has been experiencing extreme discrimination and exclusion. Numerous states have introduced anti-transgender legislation and other discriminatory laws including restrictions on important gender affirming healthcare. Despite the regressive affront of anti-transgender legislation,2 advancements in gender-affirming care have placed anesthesiologists in an ideal position to deliver groundbreaking care to improve the wellbeing of some of our most vulnerable patients.3,4 Research consistently demonstrates the safety, efficacy, and necessity of gender-affirming care. Gender-affirming care includes not only gender-affirming anatomic procedures and medical/hormonal treatment, but also using a more thorough, informed approach in all aspects of the healthcare experience for transgender patients. Even if you do not work with patients undergoing gender-affirming surgeries, you are likely still caring for transgender patients undergoing other surgeries and perioperative care.5 Transgender patients often avoid seeking medical care due to fear of discrimination and mistreatment.6 Of those that do make it into our clinics and operating rooms, one-third report negative experiences.7 Treating all patients with respect and dignity is important. When connecting with patients on a personal level through validation, we are actively working to improve the healthcare system that provides some of our most marginalized patients with the care they deserve.
For more in-depth engagement on this topic, consider: An op-ed by a transgender medical student: https://stanforddaily.com/2023/03/05/letter-to-the-editor-in-defense-of-the-trans-agenda/ An overview of gender affirming care: A data-based dive into the experiences of transgender adults in the US: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf Disclaimer: This piece represents an actionable snapshot of the authors’ perspectives and recommendations on a dynamic topic at the time of publication. References: 1. Morris BJ. A brief history of lesbian, gay, bisexual, and transgender social movements. American Psychological Association. https://www.apa.org/topics/lgbtq/history. Updated 2023 Mar 16. Accessed 2023 May 31. 2. American Civil Liberties Union. Mapping Attacks on LGBTQ Rights in U.S. State Legislatures.https://www.aclu.org/legislative-attacks-on-lgbtq-rights. Updated 2023 May 26. Accessed 2023 May 31. 3. Turban JL, King D, Kobe J, Reisner SL, Keuroghlian AS. Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLoS One. 2022 Jan 12;17(1):e0261039. doi:10.1371/journal.pone.0261039. 4. Almazan AN, Keuroghlian AS. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surg. 2021 Jul 1;156(7):611-618. doi: 10.1001/jamasurg.2021.0952. 5. Segna KG, Joo SS, Stone AB. Transgender and Nonbinary Patients and Perioperative Scoring Systems: It Is Time for Inclusion. JAMA Surg. 2023 Apr 5. doi:10.1001/jamasurg.2023.0259. Epub ahead of print. 6. Grant JM, Mottet LA, Tanis J. National Transgender Discrimination Survey Report on Health and Health Care. https://cancer-network.org/wp-content/uploads/2017/02/National_Transgender_Discrimination_Survey_Report_on_health_and_health_care.pdf. 2010 October. Accessed 2023 May 31. 7. James SE, Herman, JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016. Dr. Rhee is a Johns Hopkins Anesthesiology-Pediatrics resident physician. Dr. Nguyen is an Assistant Professor in the Johns Hopkins Division of Ambulatory Anesthesia and a member of the anesthesia team of the Johns Hopkins Center for Transgender and Gender Expansive Health. Dr. Segna is the Johns Hopkins Medicine Director of Transgender Anesthesia, Fellowship Director for Regional Anesthesia and Acute Pain, Regional Anesthesia Director for Bayview Medical Center, Dual Faculty in the Johns Hopkins School of Medicine College Advisor Program, and Director of the Johns Hopkins Pain Course. Dr. O’Conor is the Chief Diversity & Equity Officer for Johns Hopkins Medicine, Department of Anesthesiology & Critical Care Medicine and a SEA DEIJ Committee Member.
May 2023: THE TRUE MEANING OF CINCO DE MAYOSubmitted by: Tomás A . Lazo, MD Years ago, someone in school once asked me if I was doing anything to celebrate Cinco de Mayo. As a native Salvadoran, I was confused by this question and asked them to elaborate on the question. "Well, isn't that Mexican independence day?" they asked. After a deep breath I went into an explanation of incorrect assumptions that were made. Unfortunately, these microaggressions happen all the time and we can do a lot to improve the cultural awareness of our environment and our colleagues. For this month, I figured we could dispel some common myths associated with this holiday, dive into the historical relevance of Cinco de Mayo, and celebrate the richness that is Mexican culture. Below are some links that do just that, including a 1-minute and 20-minute podcast about this exact topic.
April 2023: APRIL IS CELEBRATE DIVERSITY MONTHSubmitted by: Isabel Pesola, MD During the month of April, we celebrate the diversity that surrounds us all. This celebration was introduced in 2004 1 as an opportunity to honor and learn about diverse customs, cultures, and experiences. This occasion is a great time to pause to appreciate the unique backgrounds and identities of others and better leverage diverse perspectives for greater innovation, problem-solving, productivity and collaboration.2 References
Isabel Pesola, MD
March 2023: HOW TO DESIGN GENDER BIAS OUT OF YOUR WORKPLACESubmitted by: Darryl P. Brown, MD Gender equality month is celebrated during the month of March, with March 8th being designated as International Women’s Day. It is a time devoted to bringing attention to gender inequities and to promote equality. Sara Sanford’s TED Talk highlights an overlooked point when discussing gender equality in the workplace. While there has been a significant increase in the presence and representation of women in the workplace, simply having women present and “tolerated” is not enough. Stanford stresses that women must be valued and given equal opportunities for advancement. This begins by first acknowledging the unconscious bias which influences the way women are perceived and treated in the workplace. Stanford argues that lasting change can only come from changes in operations which confront bias, rather than solely focusing on changing the way people think and perceive women in the workplace. https://www.ted.com/talks/sara_sanford_how_to_design_gender_bias_out_of_your_workplace?language=e Darryl P. Brown, MD Assistant Professor
February 2023: Black History MonthSubmitted by: Tracey Straker, MD MS MPH CBA FASA Black History Month is an annual celebration of achievements by African Americans and a time for recognizing their central role in U.S. history. Despite significant contributions to the fabric of the United States, African Americans still feel ostracized and displaced from the country that they helped build and fought for. I, Too, a poem by Langston Hughes clearly reflects the feelings of African Americans. Please see below the prose to I, Too and a link to a short pictogram with audio of the poem. I, Too I too sing America. By Langston Hughes References https://www.history.com/topics/black-his tory/black-history-month https://interestingliterature.com/2021/10/best-langston-hughes-poems/ Tracey Straker, MD MS MPH CBA FASA Director General Anesthesia
january 2023: A desire for freedom unites us all: The New Year and Independence Day in Haiti.Submitted by: M. Angele Theard, MD, Anesthesiology and Pain Medicine, University of Washington Medical Center In the 1700’s, Haiti was one of France’s wealthiest colonies due in large part to the production of sugar cane, coffee, indigo and cotton supported by the enslavement of close to 500,000 Africans. Led by general Toussaint L’Ouverture, this determined populace like many other oppressed people around the world before and after rebelled against enslavement and colonial rule. Haitians fought against French slave owners and an army lead by Napoleon Bonaparte in August of 1791. This 13-year revolution ended with the Battle of Vertieres which facilitated the birth of an independent republic.2 On this day, General Jean- Jacque Dessalines declared Jan 1st, 1804, as Haiti’s Independence Day. For the over 1 million Haitians living in the United Sates, this 219th year since the end of the Haitian Revolution will be marked by remembrance of the heroes of this achievement with music, drink, and food with soup Joumou at the center3. Soup Joumou is made from calabaza, a pumpkin-like squash which gives the soup a yellow color to which is added meat, cabbage, potatoes, and other vegetables, and in some versions, pasta. For Haitians, this soup eaten beginning on the eve of Independence Day and into the next day is part of a celebration which commemorates the sacrifice and resilience of Haitian people.
December 2022: November-National Native American Heritage MonthSubmitted by: M. Angele Theard, MD, Dept. of Anesthesiology, University of Washington On Nov 24th, 2022, the United American Indians of New England (UAINE) celebrated the 53rd annual National Day of Mourning in Cole’s Hill Plymouth, MA (above Plymouth Rock).1,2 Many of the people who attended this solemn and spiritual day fasted starting on Nov 23rd until the social at the end of the Day of Mourning. This day which comes towards the end of the National Native American Heritage Month was meant to remember the genocide of Native Americans and the theft of their land. References:
NOVEMBER 2022: HISPANIC HERITAGE MONTHSubmitted by: Tracey Straker, MD MS MPH CBA FASA Established over 50 years ago by President Lyndon B. Johnson, September 15th marks the start of Hispanic Heritage Month. The celebration runs from September 15 through October 15. The celebration started in 1968 as Hispanic Heritage Week under President Lyndon Johnson and was expanded by President Ronald Reagan in 1988 to cover a 30-day period starting on September 15 and ending on October 15. It was enacted into law on August 17, 1988. September 15 coincides with the independence days of seven Latin American countries and kicks off a nation-wide celebration of Hispanic food, music, history, and dance. References: Tracey Straker, MD MS MPH CBA FASA Chair of National Committee on Foreign Medical Education and Accreditation
SEPTEMBER 2022: Retention of the Minority Physician: We Are FailingSubmitted by: Jennifer Lau, MD As educators we have been focused on the pipeline of underrepresented minorities in medicine (URiM) but what we need to talk about is retention. In a 2015 ACGME report black physicians comprised 5% of medical trainees yet were 20% of trainees who are dismissed from training which indicates that there is something about our learning environments that is not inclusive to these trainees1. URiMs reported an increased incidence of microaggressions, differing expectations, and isolation2. In one study URiM trainees who reported discrimination based on race/ethnicity were much more likely to develop depressive symptoms and burnout.3 It is not enough to direct efforts to increasing the admission of URiM physicians, we must look at how well we support them so that they stay and thrive. Dr. Daywalker’s story is a powerful testimonial to how we must examine our system and improve it starting today. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/ Tips to create a more inclusive learning environment:
For additional ideas to help with addressing retention in medical education training programs please see the JGME Diversity, Equity, and Inclusion series.
August 2022: Just Be YourselfSubmitted by: Darryl Brown, MD, Mount Sinai Morningside and West Hospital, New York City, NY You’ve probably heard this advice: Just be yourself at work. Showing up as your authentic self plays an essential part in building meaningful relationships which is critical in any profession however especially so for those in medicine. Social scientist, Bréne Brown states that: “… belonging only happens when we present our authentic, imperfect selves to the world, our sense of belonging can never be greater than our level of self-acceptance.” While the idea of showing up as your authentic self at work largely comes with good intention, it can lead to unintended consequences. Brené Brown (2012). “Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead”, p.122, Penguin
July 2022: Juneteenth: A day to learn, understand, and to celebrate!Submitted by: M. Angele Theard, MD, University of Washington, Seattle, WA In January 1863, the Emancipation Proclamation officially marked the end of the Civil War and the legalization of the enslavement of human beings. However, structural racism ensured the continued official enslavement of African Americans for 2.5 more years until June 19th, 1865 when General Gordon Granger came to Galveston Texas to share Abraham Lincoln’s Proclamation. R44865.pdf (fas.org) In 2009, Harvard Professor and Pulitzer Prize winner for history, Annette Gordon-Reed published On Juneteenth, a memoir in which she shares with us her life growing up in a segregated Texas, and the long onerous history of the road from enslavement to freedom in Texas and the United States. https://sgp.fas.org/crs/misc/R44865.pdf. The link below is one of many interviews of Dr. Gordon-Reed discussing her book. Historian Annette Gordon-Reed on the Meaning of Juneteenth | Amanpour and Company - Bing video June 2022: Celebrating PrideSubmitted by: Tomás A. Lazo, MD, Oregon Health & Science University, Portland, OR June is an exciting month for a variety of reasons. It is the start of summer, the academic year is coming to an end with graduation right around the corner, and it is time to celebrate Pride month. You will likely start seeing many companies temporarily rebranding their logos to show their commitment to the LGBTQ+ community, though be aware that this can be a performative demonstration if you look closely enough. Despite being centered around what most folks think of when they hear about allyship, people within the LGBTQ+ community are still marginalized and face discrimination for being themselves. While gay marriage was legalized in 2015, there is still a lot of work to be done to achieve social justice in this sphere. Healthcare disparities are still ever prevalent in this community. Data points to higher rates of mental health challenges, such as anxiety, depression, and suicidal ideation. LGBTQ youth are much more likely to commit suicide than their peers, which is further amplified for trans youth. LGBTQ+ patients are not as likely to talk to their medical providers about health matters for fear of discrimination and uncertainty. Many states still do not protect against workplace discrimination. The list goes on and on. So, what can we do as healthcare workers? What can we do as friends, colleagues, peers, ALLIES? Education is a fantastic place to start. Inform yourself of the history of gay and queer rights in the United States and what members of this community have faced. Here is a short video with a brief history: https://www.youtube.com/watch?v=wkzwDOCEDCo In addition to arming yourself with historical knowledge, inform yourself of the variety of terms that sit within the umbrella of LGBTQ+ here: https://www.aecf.org/blog/lgbtq-definitions Finally, we can make sure we are being kind and culturally humble when we interact with members of this community and find ways to be an active supporter, either through advocacy, donations, and/or bettering yourself to care for these individuals. As we celebrate the beauty within the rainbow this month, think about how we might strive to make the world a better place for our LGBTQ+ community. I leave you with this short, animated Pixar film which will hopefully bring a smile to your face. https://youtu.be/OkLZN0ziLuI Happy Pride 2022, everyone! May 2022: DR. AUDREY SMEDLEY HELPS US TO UNDERSTAND RACE IN AMERICASubmitted by: M. Angele Theard, MD, Oregon Health & Sciences University Portland, Oregon As we continue to take time to understand one another and our experiences, it is important to understand the role that race has played in our society. Dr. Audrey Smedley who taught at Virginia Commonwealth University was best known for her scholarship on the history of Race in America. She was one of our nation’s first women anthropologists after earning her PhD in Anthropology at Victoria University of Manchester England after completing her BA in History and master’s in Social Anthropology at the University of Michigan. In 2020, Dr. Smedley; mother, researcher, and educators left behind a legacy of work elucidating the social construct – Race. Dr. Smedley explains in an interview in 2003: Below is a link to an article by Dr. Smedley and her son Brian Smedley on this topic: Race as https://www.youtube.com/watch?v=VnfKgffCZ7U&t=56s References: April 2022: CULTURAL COMPETENCY: INSIGHTS FROM DIVERSE MEMBERS OF OUR COMMUNITIESSubmitted by: M. Angele Theard, MD, Oregon Health & Sciences University Portland, Oregon According to the American Psychological Association, cultural competence is defined as: the ability to understand, appreciate, and interact with people from cultures or belief systems different from one’s own. 1 According to a review conducted by authors S. Saha, C Beech, and L. Cooper, the cultural competency movement is discussed in health care beginning in the 1990’s. It was proposed as a way of bridging the divide between the White American cultural perspective of clinicians and the perspectives of mainly immigrant patients with different languages and experiences. Today cultural competency has evolved into a more all-compassing approach that attempts to address sources of racial and ethnic disparities in health care. Cultural competence is an important aspect of positive physician/patient relationships essential for optimizing patient care. The Kentucky Inclusive Health Collaborative has focused their efforts on providing high quality care through attention to health literacy and cultural competency. Click on the link below to view a video created by this collaborative and hear insights on the topics of cultural competence from a diverse group of people who could represent some of our patients. https://www.youtube.com/watch?v=vHePY3J5wJs References
March 2022: Revealing the Bias Within: Addressing Implicit Bias in the Peri-operative WorkplaceSubmitted by: Bryan Mahoney, MD, FASA, Mount Sinai West and Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY The Department of Anesthesiology at the Mount Sinai Morningside and West Department of Anesthesiology utilized a simulation-based model based on anecdotes provided by anesthesiology trainees nationwide to create bystander training in instances of implicit bias observed in the workplace. Download PresentationFEBRUARY 2022: BLACK HISTORY MONTH - ITS BEGINNING AND ITS MEANINGSubmitted by: Tracey Straker, MD, MS, MPH, CBA, FASA, Montefiore Medical Center, Bronx, NY Black History Month is a yearly celebration and acknowledgement of the successes of African Americans. Dr. Carter G Woodson along with Minister Jesse Moorland founded the Association for the Study of Negro Life and History (ASNLH), today’s ASLAH (Association of African American Life and History), an organization focused on promoting the achievements of African Americans and people of African descent. This organization sponsored Negro History Week in 1926, choosing the second week of February to coincide with the birthdays of Abraham Lincoln and Frederick Douglass. By the 1960s, fueled by the Civil Rights Movement, Negro History Week evolved into Black History Month. In 1976, President Gerald Ford officially recognized Black History Month stating to the public “seize the opportunity to honor the too often neglected accomplishments of Black Americans in every area of endeavor throughout our history”. A major part of Black culture is music. Much of America’s music – Jazz, Rock, Country, R&B, and Funk - has as its origin, the blues inspired by the experiences of African Americans. Below is a link to a Black History Month playlist of music that shares aspects of the story of a people and their culture. These artists, through music, speak to protest, resilience, and pride as strengths in our communities. https://www.bestcolleges.com/blog/black-history-month-playlist/ REFERENCES JANUARY 2022: RE-DIRECTING ANGER: LESSONS FROM DR. MARTIN LUTHER KING JRSubmitted by: Tomás A. Lazo, MD, Oregon Health & Science University, Portland, OR I have always been a fan of the NPR Podcast “Code Switch,” as it examines the challenging and ever-evolving relationship between race and society. Since January is host to Martin Luther King Day, I thought this 5-minute listen and portrayal of a specific human aspect of this historical figure may be a great means of providing some much-needed self-reflection regarding anger. While anger is a normal human emotion, we are all too familiar with its destructive impact and potential for harm. However, the Reverend Dr. Martin Luther King Jr was able to harness this raw emotion and put his energy into something more constructive. We may find ourselves becoming angrier and more emotionally charged as of late. The pandemic has been with us for almost two years now. In addition, the reality of systemic racism continues to be ever-present, despite efforts to address it. As a consequence, I myself am overwhelmingly challenged to cope with new and unanticipated stressors. However, if we take the time to provide ourselves some well-warranted grace, perhaps we can use our own anger and frustration as a means of coming to a better understanding of who we are as an individual. In addition, I would argue that the evaluation of that fear, stress, and irritation that we experience can help with clarifying and analyzing the differences that exist between us and provide a better understanding of external perspectives. At the end of the day, we are all human beings, capable of great accomplishments, and also very capable of making mistakes. Instead of focusing on what separates us, let us celebrate our similarities. DECEMBER 2021: KWANZAA, A CELEBRATION OF FAMILY, COMMUNITY, AND CULTURESubmitted by: Tracey Straker, MD, MS, MPH, CBA, FASA, Montefiore Medical Center ,Bronx ,NY Kwanzaa is an African-American holiday that can be celebrated by anyone. Kwanzaa is a time to celebrate family, community, and culture. This annual celebration of African American culture lasts 7 days (from December 26 to January 1) with a communal feast, Karamu usually held on the 6th day followed by reflection on the 7th day. This holiday created by Dr. Maulana Karenga, Professor of Africana Studies at California State University and author of Kwanzaa, a Celebration of Family, Community and Culture is based on African harvest festival traditions. Kwanzaa was first celebrated in 1966. Dr. Karenga borrowed the word kwanza, meaning “first,” from the Swahili phrase matunda ya kwanza, adding the seventh letter, an extra a, to make the word long enough to accommodate one letter for each of the seven children present at an early celebration. Each of the days of the celebration is dedicated to one of the seven principles of Kwanzaa represented by the 7 candles:
There also are seven symbols of the celebration
On each day the family comes together to light one of the colored candles in the kinara, or candleholder (each principle is represented by a candle) starting with umoja; discuss the meaning of each day of Kwanzaa; and plan an activity that illustrates the principle for that day. The remaining candles are lit in alternating manner from left to right starting with the red candle (the struggle) for Kujichagulia followed by the green candle (the future and hope that comes from the struggle) for Ujima and so on. On December 31, families join in a feast called the karamu followed by a day of reflection on January 1. References NOVEMBER 2021: WHAT DOES DEI IN RESEARCH MEAN? ANGEL MENDEZ, UNIVERSITY OF MINNESOTA
Submitted by: Isabel Pesola, MD, Assistant Professor, Albert Einstein College of Medicine/Montefiore Medical Center The NIH recently launched the UNITE Initiative to “end structural racism and racial inequities in the health research enterprise” in March, 2021. So, with new funding, what does Research for DEI mean? Most academic institutions have a lot of work to do in prioritizing and integrating DEI in their research efforts. In the University of Minnesota, 3 faculty members share critical advice to guide us along the path:
https://med.umn.edu/news-events/what-does-dei-research-look You can read more about this plan and keep up with what the NIH is doing to address workforce diversity on the NIH UNITE website OCTOBER 2021: THE INTERNATIONAL DAY OF THE GIRLSubmitted by:Jennifer Lau, MD, Clinical Associate Professor and Director, Pediatric Anesthesiology Fellowship at Keck School of Medicine USC. Coming on the heels of September, which is Women in Medicine Month, comes the International Day of the Girl. Initiated by the United Nations October 11, 2012 to bring attention to the challenges that girls and women face and to promote their human rights and empowerment. Today girls and women still face many challenges of gender discrimination and inequities. A recent documentary “Picture A Scientist” shines a light on the ugly treatment still endured by women in STEM. We are hopeful that bringing awareness to the continued trials of women today that we can make the changes necessary to pave a brighter future for our girls tomorrow. What will you do to be a part of the change? Can you promote her? Mentor her? Sponsor her? Value her? “Picture a Scientist” is currently available on Netflix and for purchase on most streaming platforms.
SEPTEMBER 2021: GENDER-NONCONFORMING CHILDRENSubmitted by: Herodotos Ellinas, MD, MHPE (Professor, Division Pediatric Anesthesiology, Medical College of Wisconsin) August 10, 2021, NYT. Interactive article about a camp and gender-nonconforming children. This extraordinary camp organized by a mom about 14 years ago (ended in 2018) allowed children to be who they are rather than forcing them to pretend. It provided a supportive environment for any child with gender nonconformity to be free from societal "norms." The Kids of Camp I Am, a Decade Later AUGUST 2021: WOMEN’S EQUALITY DAYSubmitted by: Herodotos Ellinas, MD, MHPE (Professor, Division Pediatric Anesthesiology, Medical College of Wisconsin) Did you know that Women’s Equality Day is celebrated on August 26th annually? Although it was ratified on August 18th, 1920, the 19th amendment that gave women the right to vote nationally was officially certified by US Secretary of State Bainbridge Colby on August 26, 1920, hence the observed day. I wish I could honor all the great women who paved the path to a better world, a braver one. I wouldn’t know where to start; there are so many, most of them unmentioned. I will though invite you to browse through the Harvard Business Review article that interviews retired supreme court justice Sandra Day O’Connor. Did you know that Women’s Equality Day is celebrated on August 26th annually? Although it was ratified on August 18th, 1920, the 19th amendment that gave women the right to vote nationally was officially certified by US Secretary of State Bainbridge Colby on August 26, 1920, hence the observed day. I wish I could honor all the great women who paved the path to a better world, a braver one. I wouldn’t know where to start; there are so many, most of them unmentioned. I will though invite you to browse through the Harvard Business Review article that interviews retired supreme court justice Sandra Day O’Connor. https://hbr.org/2013/12/sandra-day-oconnor A few highlights about her life:
After she was appointed to the US Supreme Court in 1981, she famously said: "I think the important thing about my appointment is not that I will decide cases as a woman, but that I am a woman who will get to decide cases." JULY 2021: LGBTQSubmitted by: Tracey Straker, MD, MS, MPH, CBA, FASA (Professor Anesthesiology, Montefiore Medical Center) LGBTQ – a common acronym that most people are now familiar with. Most of us know what each letter stands for, but what does LGBTQ really mean? Do you know the meaning of each word? Are you familiar with the many other words not represented in this acronym? As physicians giving healthcare to many individuals, it is important to understand the differences between these individuals, physically and psychologically. If we are to care for our patients with utmost respect for their choices, then we must educate ourselves on choices available in the LGBTQ diaspora. Click on the link below to gain a fundamental understanding of our patients who have chosen an LGBTQ lifestyle. https://www.aecf.org/blog/lgbtq-definitions JUNE 2021: ASIAN AMERICANS AND PACIFIC ISLANDERS (AAPI) MYTHS DEBUNKEDSubmitted by: Isabel Pesola MD, Assistant Professor Albert Einstein College of Medicine, Montefiore Medical Center There are several myths regarding Asian Americans and Pacific Islanders (AAPI) that need to be debunked. The following article, part of a special National Public Radio (NPR) series, to commemorate the Asian American and Pacific Islander Heritage Month, dismantles the trope of Asian Americans as the” Model Minority”. Asían Americans are not a monolithic group. They trace their origins to different regions of the world, from Southeast Asia to the Pacific Islands. People of Asian American heritage have a huge variety of ethnicities and cultural characteristics. Not all Asian Americans are wealthy and highly educated. The notion of the “Model Minority “ignores the large differences amongst different groups of Asian Americans regarding income and education level. Some Asian Americans arrive in the United States as asylum seekers or refugees. Thirty two percent of Asian Americans fear being attacked. There is underrepresentation in positions of power and leadership. Despite the issues facing Asian Americans, they continue to have the highest voter turnout for presidential elections and are running for state legislatures. MAY 2021: REVEALING THE BIAS FROM WITHINSubmitted by: Bryan Mahoney, M.D., Residency Program Director and Vice Chair of Education and Olga Paniagua, M.D. PGY-3 Resident, Department of Anesthesiology, Perioperative and Pain Medicine; Mount Sinai West and Mount Sinai Morningside Hospitals A review of an ASA mentorship grant-funded project designed to create and educational module on the impact of implicit bias on anesthesiologists and trainees highlighting the first-person experience of these incidents. APRIL 2021: DO YOU SEE ME? CAN YOU SEE PAST MY SKIN COLOR?Submitted by: Herodotos Ellinas, MD, MHPE This fictional letter in the Harvard Business Review from a Black manager to a white boss is a must read for all. "I am an executive, but I feel alienated. " I am in the C-suite, yet I am seen as "the authority on diversity and race issues " and not for my executive experience. I cannot change my skin color. "I choose to stay. " Let's start the COLOR brave conversations. MARCH 2021: RECOGNIZING LUCY, BETSEY, AND ANARCHASubmitted by: Nwadiogo Ejiogu, MD, MA - Icahn School of Medicine - Pronouns: she/her or they/them On February 28 and March 1st 2021, for the first time the American College of Obstetricians and Gynecologists (ACOG) along with several other national obstetric and gynecology (OB/GYN) societies will formally recognize the contributions of three enslaved Black women, Anarcha, Lucy, and Betsey. Anarcha, Lucy, Betsey and many other unnamed enslaved Black women were brutally experimented on without anesthesia by Dr. James Marion Sims in the mid-1800s. The coerced gynecologic surgeries performed on these women, along with their reproductive and intellectual labor, were integral to the development of obstetrics and gynecology. The details of their lives and the abuse they survived at the hands of Dr. Sims is detailed in the book, Medical Bondage: Race, Gender, and the Origins of American Gynecology by Dr. Deidre Cooper Owens. This inaugural day of recognition was primarily a result of the work of Dr. Veronica Pimentel, a maternal-fetal medicine specialist. Her work also provided the impetus for the ACOG joint statement on Collective Action Addressing Racism, a statement which proposes 7 steps to address structural racism. While there were no anesthesiology societies listed in this joint statement or on the statement for the inaugural day of recognition, it is important to understand that our profession is inextricably linked to the troubling origins of the field of OB/GYN. I encourage everyone to honor the lives of Anarcha, Lucy, and Betsey by learning about structural racism and how it impacts health outcomes while working to actively address health care inequities in the perioperative environment and beyond. Resources:
FEBRUARY 2021: MENTORING – DO NOT TAKE IT LIGHTLY!Submitted by: Tomás Lazo, MD The role of mentoring is a common theme that is engrained in education. A mentor can mean the difference between encouragement or giving up. Please take a few minutes to listen to Tomas Lazo MD, SEA DEI Taskforce member, discuss the importance of having a mentor who looked like him as he was challenged in school. JANUARY 2021: HIS DREAM, OUR DREAMSubmitted by: Tomás Lazo, MD As we enter the month of Martin Luther King’s birthday, we acknowledge a man – a man who was not perfect, who had flaws and made mistakes. We also acknowledge a man who was able to transcend his human inadequacies and leave behind a legacy that has lived beyond him. As so many of us strive to see his dream manifest in our lifetime, I ask that you take 2 minutes and 40 seconds to listen and reflect on the words of his dream. What can we do to make his dream our dream? How can we in our own way make an impact? DECEMBER 2020: “SELMA”- EQUAL VOTING RIGHTSSubmitted by: Odinakachukwu Ehie, MD This music video is a moving rendition of a song which pays tribute to the 2014 film named Selma, which chronicles Dr. Martin Luther King, Jr.'s campaign to secure equal voting rights via an epic march from Selma to Montgomery, Alabama in 1965. Dr. King is played by David Oyelowo, and Oprah Winfrey plays Annie Lee Cooper who was an African American civil rights activist in the 1965 Selma Voting Rights Movement. This is a powerful message for everyone to continue the fight for equal voting rights and to strive for equity and justice within our society. As John Lewis says, "Never, ever be afraid to make some noise and get in good trouble, necessary trouble. " NOVEMBER 2020: IS OUR TONE TOO INSECURE OR ARE WE TOO BOSSY? WHY FEMALE VOICES ARE NOT HEARD IN THE ORSubmitted by: Isabel Pesola, MD This month we explore a reflection by Dr. Edward Riley, from the California Society of Anesthesiologists. Thank you, Dr. Riley, for such an honestly written piece. https://csahq.org/news/blog/detail/csa-online-first/2020/10/20/voices-in-the-or-a-self-reflection-and-examination-of-unconscious-bias Dr. Riley’s insights echo those of mine, and perhaps many female colleagues who like me, have been searching for the right tone to speak, or to be heard in the OR- particularly in emergent situations. Are we commanding with enough authority, or are we too bossy? Are we perceived as natural leaders? Do we need to speak louder? Or do we look too young? Dr. Riley’s piece invites the reader to evaluate their own bias. As he states, “we can only change our biases if we first name them, own them, and face the reality of how our prejudices affect our interaction with the world”. OCTOBER 2020: ALLEGORIES ON RACE AND RACISMSubmitted by: Josephine Hernandez, MD In early June there were peaceful demonstrations decrying the murder of George Floyd and many other Black Americans. There were conversations throughout the hospital about institutional racism, health care disparities laid bare by CV-19 and the rise of white supremacy. I noticed that there were residents that simply didn’t understand the depth of problem—residents from other countries. How could I have them begin to understand, so they can take part in the conversation? A colleague, Dr. Sharma Joseph suggested Dr. Camara Jones’ Ted Talk and a brief history of the U.S. My residents and I found Dr. Jones talk non-threatening and really clarified how institutional racism grows and develops roots. My residents had a rich discussion and my residents of color opened up and told them of their experiences. The Ted Talk helped us develop a deeper understanding and created deeper bonds between my residents. SEPTEMBER 2020: REFLECTION: STANDING TOGETHER FOR A BETTER TOMORROWSubmitted by: By Jennifer Lau, MD I recently read Dr. Kali Cyrus’ vulnerable account “Why I gave up my dream of leading diversity efforts in medicine” describing the overwhelming demands and isolation that she experienced while trying to champion diversity and I could not help but think of how common her story is. While reading this article, I reflected on the frustrations of two colleagues who felt unsupported in their effort to advance diversity and inclusion initiatives at the hospital and medical school level. It is heartbreaking that we, as a healthcare community, continue to fail to support so many talented and driven people. To achieve sustainable, transformative change we must go beyond verbal support. Diversity, equity, and inclusion (DEI) has for too long been an institutional check box without deep thought into what that entails. Are we really surprised that studies today still confirm racial bias in patient care or that we still have significant disparities in the make-up of our workforce? The data is clear: there are severe racial and gender incongruities amongst US physicians today affecting patient care. We must strive for better. To fix this problem we need to do more than just kneel on Instagram or put a #BLM sign in our yards. We need to
The lack of diversity in our workforce and the unsupported environments in our institutions are a national crisis and should be treated as such. This is the moment that we must stand together. For the sake of our patients and our colleagues, we cannot fail. References AUGUST 2020: LOVE AND INCLUSIVITYSubmitted by: Herodotos Ellinas, MD, MHPE This 6 min short video by Matthew Richardson set to the music of Leonard Cohen’s Hallelujah is about kindness, love and support for each other. It is about caring regardless of differences in our beliefs. https://www.youtube.com/watch?v=7tftYOSWPL8 July 2020: What is Microaggression and Why Does it Matter - A Short VideoSubmitted by: Tracey Straker, MD, MS, MPH, CBA, FASA For July, this educational aid, a short video, comes from National Public Radio (NPR), and is recommended by the Diversity and Inclusion Task Force because it gives the definition of microaggressions in a simplified manner, explains the feelings of unease that they may cause, and gives possible solutions to the problem. |
