Diversity and Inclusion

Our department is fortunate to be part of an institution that is committed to addressing disparities in health and healthcare. The costs to our society are high; disparities lower the quality of life and negatively impact life expectancy for many. Our department philosophy is aligned with campus leadership in the areas of recruiting and retaining individuals traditionally under-represented in the health sciences, LGTBQ, and individuals with disabilities, to better reflect the diversity of the population we serve in the San Francisco Bay Area. We further recognize that successfully recruiting people to join our enterprise is not the end of the story. As eloquently stated in the UCSF Principles of Community, it is also critical that we provide an environment in which all individuals in our workforce and trainee programs experience a professional, supportive, collaborative and open environment and have the opportunity to thrive. We are dedicated to the ongoing pursuit of these goals.

Diversity, Equity and Inclusion and Health Equity Training

Not confined to low- and middle-income countries, well-known health and societal inequities exist worldwide, yet many North American anesthesiology training programs do not formally address these issues [1]. Furthermore, anesthesiologists’ essential roles in perioperative, pain and critical care provide them a unique opportunity to help identify systemic differences and drive the change to address them [2].

That’s why, in support of the UCSF mission to advance health worldwide, we’re proud to be working with our Center for Health Equity in Surgery and Anesthesia (CHESA) to develop and implement formal diversity, equity and inclusion (DEI) as well as health equity (HE) curricula within the anesthesia, general surgery, and orthopaedic surgery residency training programs.

Diversity, Equity and Inclusion Curriculum

Tailored for the specific work and training environments of attendees, and created by Odinakachukwu Ehie, MD, FASA, Vice Chair for Diversity, Equity and Inclusion in the Department of Anesthesia and Perioperative Care, our DEI curriculum examines race and culture in what Ehie calls “very curated safe spaces. [3]” Over the course of four two-hour sessions, small groups participate in interactive exercises that uncover unconscious biases and explore power - privilege dynamics. Trainees learn about research that demonstrates first how these biases cause harm – and, second, how heightened awareness can mitigate the harm [3]. Implemented in our training programs, residents participate in the first three workshops in the series during their CA1 year, completing the fourth workshop, developed with the help of Professor Rondall Lane, MD, MPH, as CA2s. The curriculum has also been implemented for faculty and staff in the Department of Anesthesia and Perioperative Care.

Session 1: Unconscious Bias

Session 1 Learning Objectives
Explain two key differences between bias and unconscious bias by providing at least one example of each Assess one’s own unconscious biases in relation to the workshop exercises in a small group discussion Increase internal motivation to reduce bias in a safe and nonthreatening space Identify three ways to apply concepts around unconscious bias to be more intentional in the clinical environment Model three ways to successfully interact with socially dissimilar colleagues and patients

Session 1 Learning Objectives

Explain two key differences between bias and unconscious bias by providing at least one example of each
Assess one’s own unconscious biases in relation to the workshop exercises in a small group discussion
Increase internal motivation to reduce bias in a safe and nonthreatening space
Identify three ways to apply concepts around unconscious bias to be more intentional in the clinical environment
Model three ways to successfully interact with socially dissimilar colleagues and patients

Session 1 Resources
The Harvard Implicit Association Test (IAT) [6] further increases the test-takers’ self-awareness of their implicit biases. The discussion space built into our workshop allows them to process their immediate feelings in a safe manner and explore the relationship of their findings to instances of bias they’ve witnessed in their educational training and workplace. Facilitators also push for further reflection on how implicit biases and structural racism have manifested in their education and training. Having taken the Black-White Implicit Association Test as part of medical school was found to be a statistically significant predictor of decreased implicit racial bias in medical students from their first to last semester. The IAT has also been demonstrated to be a much better predictor of discrimination towards a racial group than self-reported attitudes, and has been a consistent predictor of a wider range of judgments, behaviors, and choices.

Session 1 Resources

The Harvard Implicit Association Test (IAT) [6] further increases the test-takers’ self-awareness of their implicit biases. The discussion space built into our workshop allows them to process their immediate feelings in a safe manner and explore the relationship of their findings to instances of bias they’ve witnessed in their educational training and workplace. Facilitators also push for further reflection on how implicit biases and structural racism have manifested in their education and training. Having taken the Black-White Implicit Association Test as part of medical school was found to be a statistically significant predictor of decreased implicit racial bias in medical students from their first to last semester. The IAT has also been demonstrated to be a much better predictor of discrimination towards a racial group than self-reported attitudes, and has been a consistent predictor of a wider range of judgments, behaviors, and choices.

Session 2: Allyship

Session 2 Learning Objectives
Explain two key examples of allyship that can be demonstrated in your training or specialty. Distinguish two key differences between performative allyship and true allyship Increase the action of self-reflection on one’s own broad spectrum of privilege through a small-group exercise Develop an action plan for sponsoring / mentoring that mirrors the concept of allyship Develop as allies and accomplices in equity by using a role model exercise to increase confidence and comfort in conversations around discrimination

Session 2 Learning Objectives

Explain two key examples of allyship that can be demonstrated in your training or specialty.
Distinguish two key differences between performative allyship and true allyship
Increase the action of self-reflection on one’s own broad spectrum of privilege through a small-group exercise
Develop an action plan for sponsoring / mentoring that mirrors the concept of allyship
Develop as allies and accomplices in equity by using a role model exercise to increase confidence and comfort in conversations around discrimination

Authentic Allyship	Performative Allyship
Empathy/grief/outrage You’re taking risks and holding yourself accountable Brand is of no concern Educating yourself Examining own privilege and using it to help Committed to anti-racist work Not virtue signaling and taking real action It’s not about you Sitting with discomfort	Optics Band wagoning PR/brand/public profile management White fragility You’re resentful Everyone is doing it so I have to Your statement appeared after you were called out Virtue signaling (showing receipts) Centering yourself You’re benefitting

White Fragility	Weaponized White Fragility
Shame Defensiveness Fear Discomfort Policing BIPOC expression Offended Prioritizing own emotions Rationalization Avoidance Taking umbrage Guilt	Shaming Pathologizing black anger Covert aggression Intolerability Policing BIPOC pain expression Insisting on “niceness” Using emotion to harm BIPOC / assuming victimhood Invalidation Refusal to look Using privilege Insidious harm

Session 3: Microaggressions

Session 3 Learning Objectives
Describe three examples of microaggression and micro-inequity in your own words. Distinguish several strategies for addressing microaggressions. Review case scenarios and apply strategies to address microaggressions and equity themes. Enhance comfort level in managing microaggression as a victim through role play in a small group setting. Enhance confidence in managing microaggression as an ally/bystander through role in a small group setting.

Session 3 Learning Objectives

Describe three examples of microaggression and micro-inequity in your own words.
Distinguish several strategies for addressing microaggressions.
Review case scenarios and apply strategies to address microaggressions and equity themes.
Enhance comfort level in managing microaggression as a victim through role play in a small group setting.
Enhance confidence in managing microaggression as an ally/bystander through role in a small group setting.

Indirect Strategies for Addressing Microaggressions	Direct Strategies for Addressing Microaggressions
Ignore/Do Nothing (for the target): Depending on the circumstances removing one’s self from a situation may be an appropriate strategy. Redirect: Change the subject Uplift: Elevate the target “You were partnered with an amazing provider and you are so fortunate to have them taking care of you.” “Besting”: Using data and information to debunk myth/stereotype	Checking In: Schedule/find time to check in, even if the moment has passed. This can be for the target and/or the actor. (“I’ve been reflecting on something that occurred the other day and wanted to know if you have a few minutes to check in?”) Clarify: Ask for clarification on the statement (“What do you mean by ___?” “Can you elaborate on what you meant by ___?”) Raise Awareness: Inform the actor of the potential microaggression you observed (“During the meeting I heard you use the term ___ when referring to ___. I am not sure if you are aware…”) Communicate Impact: Inform the actor of the impact of their statement (“When you said ___ it made me feel ___.”; “I’m feeling uncomfortable by your language.”) Disrupt: Establish a clear boundary “We don’t tolerate derogatory language in our hospital. We ask that everyone speak respectfully.”

Indirect Strategies for Addressing Microaggressions

Direct Strategies for Addressing Microaggressions

Ignore/Do Nothing (for the target): Depending on the circumstances removing one’s self from a situation may be an appropriate strategy.
Redirect: Change the subject
Uplift: Elevate the target “You were partnered with an amazing provider and you are so fortunate to have them taking care of you.”
“Besting”: Using data and information to debunk myth/stereotype

Checking In: Schedule/find time to check in, even if the moment has passed. This can be for the target and/or the actor. (“I’ve been reflecting on something that occurred the other day and wanted to know if you have a few minutes to check in?”)
Clarify: Ask for clarification on the statement (“What do you mean by ___?” “Can you elaborate on what you meant by ___?”)
Raise Awareness: Inform the actor of the potential microaggression you observed (“During the meeting I heard you use the term ___ when referring to ___. I am not sure if you are aware…”)
Communicate Impact: Inform the actor of the impact of their statement (“When you said ___ it made me feel ___.”; “I’m feeling uncomfortable by your language.”)
Disrupt: Establish a clear boundary “We don’t tolerate derogatory language in our hospital. We ask that everyone speak respectfully.”

Session 4: Advanced Unconscious Bias and Tools to Address It

Session 4 Learning Objectives
Distinguish between different types of bias Analyze the impact unconscious bias has in medicine Describe neuroplasticity and its relationship to unconscious bias Describe mindfulness and its relationship to unconscious bias Practice mindfulness tools to use daily in situations where bias may occur

Session 4 Resources
Mindfulness Reduces Bias and Discrimination Tools for Recognizing bias and Acting in an Unbiased Way GIVE Skill from Cognitive Behavioral Therapy THINK Skill from Cognitive Behavioral Therapy STOP Skill from Cognitive Behavioral Therapy FACTS Skill from Cognitive Behavioral Therapy ABC Skill from Cognitive Behavioral Therapy WAVE Skill Cognitive Behavioral Therapy Accumulate positive experience with regard to situation where bias may develop in you Build Mastery: Do at least one thing each day that allows you to feel more control of your emotions and situations where bias may occur. Cope ahead of time with situations where bias can develop Activating egalitarian goals / Counter-stereotypical information Looking for common identities Taking the perspective of the minority or dis-similar group

Session 4 Resources

Mindfulness Reduces Bias and Discrimination
Tools for Recognizing bias and Acting in an Unbiased Way
- GIVE Skill from Cognitive Behavioral Therapy
- THINK Skill from Cognitive Behavioral Therapy
- STOP Skill from Cognitive Behavioral Therapy
- FACTS Skill from Cognitive Behavioral Therapy
- ABC Skill from Cognitive Behavioral Therapy
- WAVE Skill Cognitive Behavioral Therapy
- Accumulate positive experience with regard to situation where bias may develop in you
- Build Mastery: Do at least one thing each day that allows you to feel more control of your emotions and situations where bias may occur.
- Cope ahead of time with situations where bias can develop
- Activating egalitarian goals / Counter-stereotypical information
- Looking for common identities
- Taking the perspective of the minority or dis-similar group

Health Equity Curriculum

"Department of Public Health" sign over iron gate archway at the ZSFG campus Our interactive, longitudinal health equity curriculum trains surgery and anesthesia residents of all levels to recognize and address perioperative disparities in clinical practice. Split into four modules and including a monthly Health Equity / DEI journal club, community engagement, faculty mentorship, and hands-on learning are the hallmarks of the HE curriculum. Learn more on the CHESA website.

Module 1: Health Equity

Module 2: Structural Racism

Module 3: Cultural Humility and Structural Competence

Module 4: Safety Net Health Systems

References

Wollner E, Law T, Sullivan K, Lipnick MS. Why every anesthesia trainee should receive global health equity education. Can J Anaesth. 2020 May 20.
Ehie O, Toledo P, Wright C, Adams J. What Is the Role for Anesthesiologists and Anesthesia Practices in Ensuring Access, Equity, Diversity, and Inclusion? ASA Monitor. 2021 Oct;85: 45-48.
Schwartz, A. In Challenging Times, Ehie Steers Department’s DEI Efforts, Gains. https://anesthesia.ucsf.edu/news/challenging-times-ehie-steers-department’s-dei-efforts-gains
Building a Health Equity Curriculum for Anesthesia and Surgery Residents. https://anesthesia.ucsf.edu/news/building-health-equity-curriculum-anesthesia-and-surgery-residents
Ehie O. Developing a Diversity, Equity, and Inclusion Curriculum for Anesthesia Learners. International Anesthesia Research Society (IARS) Webinar Series Workshop. https://iars.org/iars-webinar-series/?utm_source=header
Implicit Association Test: https://implicit.harvard.edu/implicit/takeatest.html
Diversity Activity Resource Guide. University of Houston. www.uh.edu
Morin, Rich. 2015. “Exploring Racial Bias Among Biracial and Single-Race Adults: The IAT.” Pew Research Center, Washington, D.C.: August 19, 2015.
Green et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine. 2007; Sep;22(9):1231-1238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219763/#
Atcheson S. Allyship – The key to unlocking the power of diversity. Forbes https://www.forbes.com/sites/shereeatcheson/2018/11/30/allyship-the-key-to- unlocking-the-power-of-diversity/#5eed122349c6
Brown KT. Perceiving allies from the perspective of non-dominant group members: Comparisons to Friends and Activists. Current Psychology 2015;34:713-722. https://doi.org/10.1007/s12144-014-9284-8
Ostrove JM, Brown KT. Are allies who we think they are?: A comparative analysis. Journal of Applied Social Psychology 2018;48(4):195-204. https://onlinelibrary.wiley.com/doi/full/10.1111/jasp.12502
Brock University. Human Rights and Equity. Be an Active-Ally to Those Experiencing Racial Injustice. https://brocku.ca/human-rights/active-ally/
Parks S, Birtel MD, Crisp RJ. Evidence That a Brief Meditation Exercise Can Reduce Prejudice Toward Homeless People. Social Psychology. 2014;45(6):4580465. https://econtent.hogrefe.com/doi/10.1027/1864-9335/a000212
Lueke A, Gibson B. Brief Mindfulness Meditation Reduces Discrimination. Psychology of Consciousness: Theory, Research and Practice. 2016;3(1): 34-44. https://psycnet.apa.org/record/2016-06826-001
Burgess D, van Ryn M, Dovidio J, Saha S. Reducing Racial Bias Among Healthcare Providers: Lessons from Social-Cognitive Psychology. J Gen Internal Med. 2007 Jun;22(6):882-7. https://pubmed.ncbi.nlm.nih.gov/17503111/
Lueke A, Gibson B. Mindfulness Meditation Reduces Implicit Age and Race Bias: The Role of Reduced Automaticity of Responding. Social Psychological and Personality Science. 2014 Nov24;6(3): 284-291. https://journals.sagepub.com/doi/10.1177/1948550614559651

Useful Links

UCSF Office of Diversity and Outreach
UCSF School of Medicine: Differences Matter
LGBT Resource Center
UCSF Medical Student Disability Services
UCSF Principles of Community
Diversity in Graduate Medical Education
Under-Represented Faculty & Senior Fellows in Clinical and Translational Research Awards
C-Change

Global Health News

Center for Health Equity in Surgery and Anesthesia Expands Its Influence

August 05, 2022

In the past year, the UCSF Center for Health Equity in Surgery and Anesthesia (CHESA) has grown to more than 100 members from 10 different UCSF departments, while also welcoming new Deputy Director Patti Oroz

Due June 24th: Call for CHESA Annual Seed Award Proposals!

May 09, 2022

The UCSF Center for Health Equity in Surgery and Anesthesia (CHESA), in collaboration with the ZSFG Diversity, Equity, & Inclusion Department and the

Left to right: Michael Lipnick, MD, Sam Percy, MD and colleague at Navajo Nation

Sam Percy, MD, Awarded ASA Humanitarian Service Award

October 08, 2021

Congratulations to Sam Percy, MD, Children's Hospital Colorado Pediatric Anesthesia Fellow and former UCSF Health Equity Action and Leadership (HEAL) Initiative Fellow, on his well-deserved

Michael Lipnick, MD, Sam Percy, MD, and colleague at the Navajo Nation Hospital

One Pandemic, Two Hotspots

April 02, 2021

Department Members Provide Much-Needed Relief In Navajo Nation, NYC

See more Anesthesia News

Diversity and Inclusion News

Billy Nguyen and others at the UCSF Health booth at the ASA exhibit hall

Fellowship Pipeline Program Named as an Educational Exhibit Awardee at the ASA

While diversity in healthcare improves patient outcomes, the number of fellows that identify with an under-represented in medicine group remains low.

Impact of the Women of UCSF Anesthesia and Perioperative Care

The women of Anesthesia and Perioperative Care at UC San Francisco have had a profound impact on our department, the anesthesiology specialty, and medicine. Some of their accomplishments are listed below. Do you have an accomplishment to add to this list?

multicolored strings of lights on a roof with blue sky above

Leah Pimentel, MBA, Appointed Co-Director of the School of Medicine’s Differences Matter: Build Anti-Racism/Anti-Oppression Expertise Program

We are pleased to announce that Leah Pimentel, MBA, the director of Diversity, Equity Inclusion (DEI) and Culture in the Department of Anesthesia and Perioperative Care has been named the co-director for Differences Ma

Leah Pimentel, MBA, Recipient of 2022 Healthcare DEI Champions Award

We are thrilled to announce that Leah Pimentel, MBA, the director of Diversity, Equity Inclusion (DEI) and Culture in the Department of Anesthesia and Perioperative Care, is a 2022 recipient of the