Improving Inclusion in Surgical Residency to Advance Workforce Diversity and Health Equity

PROJECT SUMMARY Physician diversity reduces health disparities. Yet, despite powerful pro-diversity statements from the Institute of Medicine, the American Medical Association, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, the American College of Surgeons, and the American

Surgical Association, diversity remains elusive at all levels in surgery. Lack of inclusion in surgical residency underlies this lack of workforce diversity. To date, efforts to improve inclusion in healthcare have focused on individual beliefs or skills, such as implicit bias training. However, data from organizational

psychology, the scientific field that applies sociocultural psychology to understand human behavior in the workplace, demonstrate that such training does not result in sustained behavioral change. Rather, behavior is understood to reflect organizational culture. Culture, the shared and fundamental beliefs, normative values,

and related social practices of a workplace, profoundly impacts work engagement, relationships with colleagues, and the ability to collaborate to achieve common goals. In order to meaningfully increase inclusion, interventions must address organizational culture. The candidate, a pediatric surgeon, is seeking to develop,

contextually adapt, and implement theoretically driven, evidence-based interventions to improve inclusion in surgical residency programs. To accomplish the aims of the proposed project, the candidate needs to acquire knowledge, skills, and experience in (1) organizational psychology; (2) user-centered design,

and (3) applied implementation science. The project proposes to (1) examine the features of organizational culture (e.g., policies, practices) that support or detract from inclusion in both high- and low-performing US general surgery residency programs; (2) develop targeted, user-informed interventions to address the

organizational culture of low-inclusion programs; and (3) implement and conduct a pilot study of the interventions in low-inclusion programs to dually assess implementation (feasibility, scalability, acceptability) and preliminary effectiveness (perceptions of inclusion, diversity, well-being, explicit and implicit biases;

surgical patient satisfaction). This field of research is important for surgeons and their patients. Inclusive work and learning environments are expected to improve the recruitment and retention of a diverse workforce, as well as work engagement for all; this work has implications for reducing disparities and improving quality. This

proposal is responsive to AHRQ’s Special Emphasis Notice of Interest in Health Services Research to Advance Health Equity (NOT-HS-21-014). The career development plan and research project capitalize on the many strengths of the principal investigator’s research and the research environment at Northwestern

University, including access to world-class mentors and experts in innovative methods at the Kellogg School of Management, the Segal Design Institute, and the Surgical Outcomes and Quality Improvement Center, as well as a large, well-established learning collaborative of 212 US general surgery residency programs.