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 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
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.
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

Health Equity Curriculum

"Department of Public Health" sign over iron gate archway at the ZSFG campusOur 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

  1. Wollner E, Law T, Sullivan K, Lipnick MS. Why every anesthesia trainee should receive global health equity education. Can J Anaesth. 2020 May 20.
  2. 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.
  3. 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
  4. Building a Health Equity Curriculum for Anesthesia and Surgery Residents. https://anesthesia.ucsf.edu/news/building-health-equity-curriculum-anesthesia-and-surgery-residents
  5. 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
  6. Implicit Association Test: https://implicit.harvard.edu/implicit/takeatest.html
  7. Diversity Activity Resource Guide. University of Houston. www.uh.edu
  8. Morin, Rich. 2015. “Exploring Racial Bias Among Biracial and Single-Race Adults: The IAT.” Pew Research Center, Washington, D.C.: August 19, 2015.
  9. 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/#
  10. 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
  11. 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
  12. 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
  13. Brock University. Human Rights and Equity. Be an Active-Ally to Those Experiencing Racial Injustice. https://brocku.ca/human-rights/active-ally/
  14. 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
  15. 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
  16. 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/
  17. 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

Left to right: Michael Lipnick, MD, Sam Percy, MD and colleague at Navajo Nation
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
April 02, 2021

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

Curriculum Format and Goals
October 22, 2020

UCSF medical students and Anesthesia Division of Global Health Equity Interns Rebecca Chen and Janette Tang were awarded an Honorable Mention by the UCSF Short Term Dean’s Prize in Research Committee for their work to develop a Health Equity Curriculum for surgery and anesthesia trainees.

human lung
March 25, 2020

The UCSF COVID-19 Resources Website provides guidance and information for our patients, faculty, staff, trainees, and learners.

Diversity and Inclusion News

Chair

In spite of gains in the overall number of women in the field of anesthesiology, gender disparities remain in leadership positions.

Catherine Chen, MD, MPH, speaking at Anesthesia Research Day

In celebration of Women in Medicine month, and in recognition of the essential contributions of all of the women in the Department of Anesthesia and Perioperative Care at UCSF, we will provide highlights of the many extraordinary women in anesthesia throughout the month of September.

Left: Vanessa Henke, MD, with students and colleagues in the OR during UCSF SCORE 2020

In celebration of Women in Medicine month, and in recognition of the essential contributions of all of the women in the Department of Anesthesia and Perioperative Care at UCSF, we will provide highlights of the many extraordinary women in anesthesia throughout the month of September.