In March 2021 Odinakachukwu Ehie, MD, assumed the position of Vice Chair of Diversity, Equity, and Inclusion (DEI) in the UCSF Department of Anesthesia and Perioperative Care. Ehie – who also chairs the California Society of Anesthesiologists Committee of Justice, Equity, Diversity, and Inclusion – took on her new role with an understandable sense of urgency.
Police killings of Black Americans and a political environment more racially charged than it has been in a generation have raised awareness of the need for change. Many healthcare providers are painfully aware that the COVID-19 pandemic continues to hit communities of color hardest. Those facts, along with other stubborn health care inequities and the professions’ struggles to fully reflect the populations it serves, made now a time of both challenge and opportunity.
“Before the pandemic, our department had initiatives in place, but post George Floyd, we’ve definitely moved to a much larger scale, with a much greater sense of intentionality,” says Ehie.
Fresh Perspective Helps Identify Areas for Improvement
One thing Ehie brings to the position is her experience as a coach in UCSF School of Medicine’s BRIDGES curriculum and, with it, recognition that UCSF’s residency programs have room to more fully capitalize on a relatively diverse medical school.
“If you’re a medical student applying for residency and you only see one person representing who you are, it’s discouraging,” she says. “You can get very tired of feeling tokenized and you’re looking for a place where you can play a role as part of a family, not just represent one specific community. If you don't see faculty members or residents who represent you within the department, it’s hard to visualize yourself being there.”
She adds that it’s also important that potential residents perceive a commitment to allyship. This goes beyond good intentions to faculty members using their privilege to help residents who do not look like them. “That too takes true intentionality which can lead to greater recruitment and retention of underrepresented in medicine [UIM] faculty of color,” she says.
Similarly, faculty members need to work to make new members from UIM populations feel included. This is particularly challenging in a department as large and spread out as the UCSF Department of Anesthesia and Perioperative Care. The nature of its work in operating rooms and ICUs can make it a challenge for department colleagues to interact during the workday, with COVID-19 only exacerbating the situation. Yet, Ehie says, it’s important to remember that in the absence of any real effort to connect, UIM individuals can be vulnerable to perceiving their isolation as a pointed lack of welcome.
Taking Concrete Steps Forward
Ehie had long believed that one positive step would be the department residency program adopting something like what she’d seen implemented in the medical school where, within the first week, students undergo a Differences Matter orientation. Even before the hard science begins, deans, chairs, medical school leads and students introduce each other and start having conversations around DEI that speak to concepts like identity, privilege and microaggressions. Ehie says, “It’s profound and I felt it needed to be extrapolated to our residencies.”
Thus, even before the events of the past year and her appointment as vice chair, Ehie had taken ownership of an effort to create and implement a diversity curriculum for the anesthesia and surgery residents. Presented in a series of three two-hour workshops, the curriculum is a meaty confrontation with race and culture in what Ehie calls “very curated safe spaces.” Small groups do interactive exercises that uncover unconscious biases. They learn about research that demonstrates first how these biases cause harm when the people carrying them are unaware – and, second, how heightened awareness can mitigate the harm.
“Making people more aware that we all carry these biases within a power-privilege divide that can have devastating effects – in a space where people can be vulnerable enough to express themselves and confront these complex and difficult feelings – is the path to positive change,” says Ehie.
Pre- and post-surveys, as well as interviews with residents, found a very positive response and indicated a genuine thirst for continuing this type of training. Other UCSF departments have heard and some are using it as a model for how they can bring the training to their residents. Ehie is hopeful that by creating these spaces, the department and other departments will be better able to attract and retain more residents, fellows and faculty of color.
The Impact on Resident Matches
Ehie credits the department’s educational leadership with not only effectively using the curriculum in promotional materials, but also diversifying selection committees and broadening the lens for assessing potential candidates. This includes giving more weight to traits like resilience and life experience.
“The things we’ve already done are fantastic,” she says. “By being intentional in including a diverse group of faculty and residents in the matching process, we ended up matching 60 percent UIM residents last year, with six of them Black. Giving people an entry point to prove themselves is the key. We can model similar intentions when considering important decisions, like on faculty search committees and other sponsorship opportunities that can help with academic promotion.”
This is part of why Ehie would like to extend the diversity curriculum for residents to all faculty and staff in the department, with the hope of creating a foundation to increase the likelihood of transformational change. “The harm is in the hidden piece, the unconscious bias that affects decision-making,” she says. She is quick to add that unconscious bias training is not about pointing fingers at anybody, because it is a universal concern. “Like everyone else, my unconscious biases are formed by my life experiences and the ones I held when I was a resident at NYU are very different from today,” says Ehie. “My point is that those who carry power and privilege can become powerful allies if they understand their own biases – and that can only be done if we don’t point fingers. We all need a space to be heard, to make mistakes so we can stretch and change.”
However, creating that space in a busy department spread across multiple facilities is no easy task. To help, Ehie is working with the department’s well-being committee to train co-facilitators from each facility where the department works. She works closely with the Anesthesia Staff Committee for Elevating and Nurturing Diversity (ASCEND) to promote DEI initiatives and professional development for the staff. Together, Ehie and ASCEND provided a staff-tailored version of the residents’ diversity curriculum at the March, April and May 2021 all staff meetings. She is also working with Associate Chair of Finance and Administration Carroll Schreibman to bring in guest speakers and hire a paid DEI and Culture Director. And she is hopeful of continued progress because, she says, department leadership, faculty and staff have expressed genuine interest in building a more diverse, equitable and inclusive community.
“My vision is making sure we reach the entire department, and bringing together all of those who have power and privilege in order to contribute to change,” she says. “That type of intentionality is how we will continue to move the dial.”
Written by Andrew Schwartz.